Best Practice & Research Clinical Obstetrics & Gynaecology最新文献

{"title":"A risk-based classification of late-onset fetal growth disorders according to intrapartum fetal compromise","authors":"José Morales-Roselló,&nbsp;Asma Khalil","doi":"10.1016/j.bpobgyn.2026.102747","DOIUrl":"10.1016/j.bpobgyn.2026.102747","url":null,"abstract":"<div><h3>Objective</h3><div>Fetal growth restriction is associated with increased perinatal mortality and morbidity. We aimed to evaluate whether the combined assessment of birthweight centile (BWc) and cerebroplacental ratio expressed as multiples of the median (CPR MoM) during the late third trimester can identify distinct risk profiles for intrapartum fetal compromise (IFC) in late-onset fetal growth disorders and to propose a risk-based classification to guide birth management.</div></div><div><h3>Methods</h3><div>This retrospective observational study included 1530 singleton pregnancies with births between 34 and 41 weeks’ gestation. All fetuses underwent antenatal ultrasound with fetal biometry and Doppler assessment of the umbilical artery pulsatility index (PI), middle cerebral artery PI, and the CPR was calculated. IFC was defined as either abnormal intrapartum cardiotocography requiring cesarean section, a fetal scalp pH &lt; 7.20, or a neonatal pH &lt; 7.10<strong>.</strong> Fetuses were classified into six groups according to the combination of BWc and CPR MoM.</div></div><div><h3>Results</h3><div>IFC occurred in 7.25% of pregnancies. Lower BWc and abnormal CPR MoM were associated with increased IFC risk, including fetuses with BWc ≥10th centile. Fetuses with BWc &lt;3rd centile and abnormal CPR MoM had the highest IFC risk (24.44%), while those with BWc ≥10th centile and abnormal CPR MoM also showed substantial risk (15.96%). Two groups, BWc &lt;3rd centile with normal CPR MoM and BWc 3rd-9th centile with abnormal CPR MoM, had intermediate IFC risks, while those fetuses with BWc 3rd-9th centile and normal CPR MoM (small-for-gestational-age) presented risks comparable to fetuses with normal BWc and CPR MoM.</div></div><div><h3>Conclusions</h3><div>Late-onset fetal growth disorders represent a spectrum of placental dysfunction rather than a homogeneous pathology. Integration of BWc and CPR MoM identifies distinct risk phenotypes with different probabilities of IFC, supporting a risk-based approach to surveillance and birth management near term.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"107 ","pages":"Article 102747"},"PeriodicalIF":5.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148371406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Cardiac-Fetal-Placental Unit: links between umbilical venous flow and maternal hemodynamics in fetal growth restriction","authors":"Daniele Farsetti,&nbsp;Francesca Pometti,&nbsp;Gian Paolo Novelli,&nbsp;Barbara Vasapollo,&nbsp;Herbert Valensise","doi":"10.1016/j.bpobgyn.2026.102745","DOIUrl":"10.1016/j.bpobgyn.2026.102745","url":null,"abstract":"<div><div>Fetal growth restriction (FGR) is associated with significant perinatal morbidity and mortality, yet its identification remains challenging due to the limited sensitivity of conventional biometric assessment and the lack of a reliable tool for assessing placental function. Placental function depends on uteroplacental perfusion which, in turn reflects maternal cardiovascular adaptation to pregnancy. In this context, umbilical venous flow (UVF) has emerged as a quantitative parameter reflecting fetal blood supply and a potential surrogate marker of placental function.</div><div>This narrative review aims to provide an overview of UVF and maternal hemodynamics, and to explore their interaction within the framework of the cardiac–fetal–placental unit.</div><div>The current literature indicates that UVF is reduced in pregnancies complicated by FGR, and it correlates significantly with maternal cardiac output (CO) and systemic vascular resistance (SVR). A hypodynamic maternal profile (high SVR, low CO) is consistently associated with reduced UVF and impaired placental perfusion, regardless of fetal biometry.</div><div>The integration of maternal cardiovascular assessment and UVF evaluation provides a functional perspective on placental insufficiency and may improve the identification of pregnancies at risk. Furthermore, this approach offers a potential framework for understanding the effects of maternal hemodynamic interventions on fetal growth.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"107 ","pages":"Article 102745"},"PeriodicalIF":5.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148355164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-immune causes of fetal anemia","authors":"Smriti Prasad,&nbsp;Asma Khalil","doi":"10.1016/j.bpobgyn.2026.102744","DOIUrl":"10.1016/j.bpobgyn.2026.102744","url":null,"abstract":"<div><div>Non-immune fetal anemia is a major cause of perinatal morbidity and mortality, affecting 3–5 per 10,000 pregnancies. It results from a range of conditions, including genetic hemoglobinopathies, congenital infections, fetomaternal hemorrhage, and twin-related complications. Advances in ultrasound-based screening, particularly middle cerebral artery peak systolic velocity measurement, have improved early detection, with a sensitivity exceeding 90% for detecting moderate to severe anemia in high-risk population. Intrauterine transfusion remains the primary treatment, with survival rates exceeding 90% in non-hydropic fetuses, though outcomes worsen when hydrops is present. Despite improvements, challenges remain in the early detection of mild anemia, development of curative therapies for genetic disorders, and antiviral treatments for congenital infections. Emerging approaches, including gene therapy, maternal antiviral therapy, and non-invasive prenatal testing, hold promise for improving outcomes. Future research should focus on optimizing fetal interventions, refining prenatal screening, and expanding access to novel therapies.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"107 ","pages":"Article 102744"},"PeriodicalIF":5.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essential tips on sample size calculation and biostatistics","authors":"Daniel Y.T. Fong,&nbsp;Pui Hing Chau,&nbsp;K.F. Lam,&nbsp;C.F. Lee,&nbsp;Naomi Takemura","doi":"10.1016/j.bpobgyn.2026.102749","DOIUrl":"10.1016/j.bpobgyn.2026.102749","url":null,"abstract":"<div><div>Sample size calculation and biostatistical analysis are fundamental to rigorous clinical research, yet many clinician-researchers struggle with appropriate methods. This chapter provides practical, principle-based guidance for non-statisticians on sample size determination and analysis planning. Clearly specified study objectives are the essential foundation. For sample size determination, key considerations include: distinguishing confirmatory from exploratory studies (formal calculation versus sample size rationale); developing a sound analysis plan; selecting appropriate tools; using conservative estimates; defining clinically meaningful effect sizes; accounting for multiplicity; addressing reduced power with co-primary outcomes; and considering approaches for artificial intelligence and machine learning studies. Core principles of biostatistical analysis include: familiarization with statistical software, now facilitated by generative AI; appropriate regression applications; proper handling of missing data; controlling false-positive errors; and distinguishing statistical from clinical significance. These principles apply across common study designs, with clear objectives remaining foundational throughout.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"107 ","pages":"Article 102749"},"PeriodicalIF":5.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Induction of labor in twin pregnancies: systematic review and meta-analysis","authors":"Sara Sorrenti,&nbsp;Can Ozan Ulusoy,&nbsp;Doaa Mohammed,&nbsp;Daniele Di Mascio,&nbsp;Francesco D'Antonio,&nbsp;Asma Khalil","doi":"10.1016/j.bpobgyn.2026.102746","DOIUrl":"10.1016/j.bpobgyn.2026.102746","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the maternal and perinatal outcomes of twin pregnancies undergoing induction of labor (IOL).</div></div><div><h3>Methods</h3><div>MEDLINE, EMBASE, CINAHL, Cochrane database and the Scopus databases were searched electronically up to May 2024 (PROSPERO CRD42024520118). All studies regarding maternal or neonatal outcomes of induction of labor in twins were included. Language was restricted to English. Four different analyses were performed: IOL was compared to spontaneous onset of labor, elective Caesarean delivery, IOL in singletons and at last different methods of IOL in twin pregnancies were compared. Maternal and neonatal outcomes were analysed. Random‐effect head‐to‐head meta‐analyses were used to analyze the data. Quality assessment was performed using ROBINS-I for non-randomised and RoB2 for randomised studies.</div></div><div><h3>Results</h3><div>The comparison of IOL and spontaneous onset of labor (8 studies) showed that the incidence of unplanned Caesarean delivery (CD) was similar between the two groups (pooled OR 0.94, 95% CI 0.36-2.45; p = 0.89). Neonatal deaths were significantly lower in the IOL group compared to the spontaneous onset of labor group (pooled OR 0.22, 95% CI 0.10-0.51, p = 0.0003 for Twin 1 and 0.29, 95% CI 0.14-0.60, p = 0.008 for Twin 2). On the other hand, the comparison of IOL with planned CD (7 studies) demonstrated that the rate of composite adverse maternal outcome was significantly higher in women undergoing IOL compared to women who had planned CD (pooled OR 2.48, 95% CI 1.16-5.31; p = 0.02). However, no significant differences were observed among these two groups regarding neonatal complications (p &gt; 0.05).</div><div>The comparison of IOL outcomes in twin and singleton pregnancies (3 studies) showed no significant difference in the rate of unplanned CD (pooled OR 1.42, 95% CI 0.89-2.28; p = 0.14).</div><div>At last, the comparison of different methods of IOL (5 studies) showed similar rates of Caesarean deliveries were observed in the different groups (pooled OR 1.01, 95% CI 0.56-1.85; p = 0.97).</div><div>The risk of bias assessment showed overall low risk of bias for observational studies (ROBINS-I) and some concerns for the randomized studies (RoB2). According to the GRADE system, the quality of evidence was overall low to moderate.</div></div><div><h3>Conclusions</h3><div>IOL may be considered a safe option in twin pregnancies as it is significantly associated with a lower risk of neonatal mortality and does not seem to increase the risk of unplanned CD when compared to the spontaneous onset of labor. However, IOL is associated with higher maternal morbidity when compared to elective Caesarean delivery. Larger studies are needed to further evaluate predictive factors of unplanned CD after IOL among these pregnancies.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"107 ","pages":"Article 102746"},"PeriodicalIF":5.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148414165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational exposures and maternal mental health across the perinatal period: a systematic review","authors":"Charline Darmaillacq,&nbsp;Sabrina Seryer,&nbsp;Dalia Alleaume,&nbsp;Shukrullah Ahmadi,&nbsp;Eleonore Remy,&nbsp;Susana Barbosa,&nbsp;Laetitia Davidovic,&nbsp;Judith van der Waerden,&nbsp;Jaqueline Wendland","doi":"10.1016/j.bpobgyn.2026.102750","DOIUrl":"10.1016/j.bpobgyn.2026.102750","url":null,"abstract":"<div><div>A growing proportion of women work during pregnancy and return to employment within the first postpartum year. Their working conditions may shape maternal mental health, yet the evidence is uneven. We reviewed how occupational exposures relate to the full range of maternal psychological outcomes, from distress to wellbeing, across pregnancy and the return to work. Ten studies met the criteria. All addressed psychosocial exposures, only two also physical and ergonomic demands, and none chemical or biological hazards. Adverse psychosocial conditions, including job strain, pregnancy discrimination, and poor job quality, predicted higher depression and anxiety in both periods, with perceived stress as a pathway. Protective resources, such as schedule flexibility and social support, helped only under specific conditions. The mental health impact of non-psychosocial exposures is therefore a structural gap, relevant to antenatal care and occupational medicine.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"107 ","pages":"Article 102750"},"PeriodicalIF":5.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148407573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing congenital cytomegalovirus infection in transplant recipients; a focus on uterine transplantation","authors":"A. L'Heveder,&nbsp;K. Jeffery,&nbsp;H. Lyall,&nbsp;E. Nastouli,&nbsp;S. Onanuga,&nbsp;A. Devaney,&nbsp;C. Frise,&nbsp;J.R. Smith,&nbsp;B.P. Jones,&nbsp;B. Jones,&nbsp;I. Quiroga,&nbsp;A. Khalil","doi":"10.1016/j.bpobgyn.2026.102748","DOIUrl":"10.1016/j.bpobgyn.2026.102748","url":null,"abstract":"<div><div>Uterine transplantation (UTx) offers the only treatment for those with uterine factor infertility to carry their own pregnancy. Cytomegalovirus infection is significant in UTx, given its implications for both transplant and pregnancy. There is little evidence and no management guidance on cytomegalovirus in periconception and pregnancy in transplant recipients and no consensus or guidelines on managing cytomegalovirus in UTx. This review highlights the pertinent issues surrounding cytomegalovirus infection following transplantation and congenital cytomegalovirus infection. It summarises the published cases of periconceptional/antenatal cytomegalovirus infection in transplant recipients, outlines the UK UTx team's experience and draws on expert opinion to propose a management strategy for the prevention of congenial cytomegalovirus infection following UTx, which is also applicable to other transplants. The highest risk group for infection are cytomegalovirus IgG negative recipients receiving IgG positive organs (D+/R-). 11 cases of periconceptional/antenatal cytomegalovirus infection have been described, including one UTx case. This team proposes six months of prophylaxis for D+/R-transplant recipients post-transplant. Maternal cytomegalovirus DNA viral load should be checked shortly prior to embryo transfer (ET) in all patients. Prophylaxis (valaciclovir or cytomegalovirus-hyperimmune globulin) around ET and may be considered in D+/R-recipients who have not contracted cytomegalovirus. Frequent monitoring for infection is required in pregnancy. Valaciclovir or cytomegalovirus-hyperimmune globulin should be used to treat infection prior to 20 weeks' gestation due to teratogenicity risk associated with valganciclovir. Valganciclovir may be considered in severe infection and after 20 weeks’. A worldwide registry on cytomegalovirus infection in pregnancy would be useful for future research.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"107 ","pages":"Article 102748"},"PeriodicalIF":5.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148458073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and treatment of PCOS in adolescents: a summary of guidelines and systematic reviews for practitioners","authors":"Tania Dumont ,&nbsp;Magdelena Peeva ,&nbsp;Marwa El Masri","doi":"10.1016/j.bpobgyn.2026.102702","DOIUrl":"10.1016/j.bpobgyn.2026.102702","url":null,"abstract":"<div><div>Polycystic Ovary Syndrome (PCOS) presents unique diagnostic and management challenges in adolescents due to physiologic overlap with normal puberty. This review synthesizes current adolescent-specific guidelines to identify evidence-based diagnostic criteria for adolescent PCOS, to apply first- and second-line management strategies, and to recognize key areas of controversy and unmet need. We emphasize menstrual irregularities and hyperandrogenism as key diagnostic criteria, while noting the limited specificity of polycystic ovarian morphology and anti-Müllerian hormone (AMH) levels in this age group. Management focuses on lifestyle interventions and combined oral contraceptives, with additional pharmacologic options as needed. Individualized monitoring of metabolic risk and psychosocial impact is highlighted. Finally, we propose a research agenda to further explore diagnostic criteria, treatment efficacy, and the long-term metabolic and mental health outcomes in adolescents with PCOS.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"105 ","pages":"Article 102702"},"PeriodicalIF":4.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis and management of primary fetal pleural effusion: A narrative review","authors":"May Abiad ,&nbsp;Ali Javinani ,&nbsp;Maria C. Lopez ,&nbsp;Hiba Mustafa ,&nbsp;Eyal Krispin ,&nbsp;Rodrigo Ruano ,&nbsp;Alireza A. Shamshirsaz","doi":"10.1016/j.bpobgyn.2026.102707","DOIUrl":"10.1016/j.bpobgyn.2026.102707","url":null,"abstract":"<div><div>Primary fetal pleural effusion involves the accumulation of fluid in the fetal pleural space, posing considerable challenges for perinatal diagnosis and management. Primary effusions, emerging from the maldevelopment of lymphatic vessels, differ significantly from secondary effusions, which are associated with a spectrum of anomalies and conditions, affecting clinical approach and prognosis. The diagnosis of primary fetal pleural effusion is one of exclusion. The natural history of the condition ranges from spontaneous resolution in mild cases to progression to life-threatening complications. Fetal interventional strategies, including thoracocentesis, pleurodesis, and thoracoamniotic shunt placement, have evolved with varying degrees of success. The prognosis is largely affected by gestational age at diagnosis, the presence of hydrops, and the implementation of fetal intervention, with improved outcomes observed in non-hydropic fetuses. This narrative review focuses on primary fetal pleural effusion, detailing its diagnosis, natural history, management options, and outcomes, with the aim of clarifying the best approaches to improve outcomes for affected fetuses.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"105 ","pages":"Article 102707"},"PeriodicalIF":4.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometriosis in adolescents: A state-of-the-art review","authors":"Anne K. Smith ,&nbsp;Simran Bhullar ,&nbsp;Alla Vash-Margita","doi":"10.1016/j.bpobgyn.2026.102706","DOIUrl":"10.1016/j.bpobgyn.2026.102706","url":null,"abstract":"<div><div>Endometriosis, once considered rare in adolescents, is now recognized as a common cause of chronic pelvic pain and dysmenorrhea in individuals aged 10–21. This state-of-the-art review explores the evolution of knowledge regarding adolescent endometriosis from early misconceptions to current clinical understanding, highlighting epidemiology, pathophysiology, current diagnostic and management strategies, psychosocial implications, and key knowledge gaps. Adolescents often present with acyclic pain, and associated gastrointestinal (GI) or systemic symptoms, leading to frequent diagnostic delay. Laparoscopy remains the gold standard for diagnosis, though noninvasive strategies are increasingly being developed due to limitations in surgical access and risks of underdiagnosis. Lesions often appear atypical in adolescents, which can cause missed diagnosis. First-line treatment is suppression with hormonal medications and NSAIDs. Surgical intervention is generally reserved for refractory cases, but postoperative recurrence remains high without ongoing hormonal suppression. Psychosocial impacts of endometriosis in adolescents are profound, leading to significant impacts on school participation, emotional health, and social development.</div></div>","PeriodicalId":50732,"journal":{"name":"Best Practice & Research Clinical Obstetrics & Gynaecology","volume":"105 ","pages":"Article 102706"},"PeriodicalIF":4.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146049210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}