ASM case reports最新文献

{"title":"Disseminated <i>Mycobacterium intracellulare</i> subsp. <i>chimaera</i> infection, undiagnosed for years, highlights the enduring clinical utility of \"old school\" microbiological testing and a robust differential.","authors":"Ayesha Khan","doi":"10.1128/asmcr.00091-25","DOIUrl":"10.1128/asmcr.00091-25","url":null,"abstract":"<p><p>Disseminated <i>Mycobacterium intracellulare</i> subsp. <i>chimaera</i> (MC) infections are rare, slow-progressing, and easily overlooked, particularly when a patient's history of prior cardiac surgery is not incorporated into the diagnostic evaluation. In a recent <i>ASM Case Reports</i> article (1:e00003-25, 2025, https://doi.org/10.1128/asmcr.00003-25), Ladines-Lim et al. describe a disseminated MC infection in a patient with prior aortic and mitral valve replacement that remained undiagnosed for over 4 years. Conventional microbiological testing was not pursued early in the course of illness because the history of cardiopulmonary bypass was not linked with the constellation of unexplained symptoms. This case urges clinicians to remain vigilant and suspect MC in patients with prior open-chest cardiac surgery who present with gradually worsening, systemic symptoms. Since 2013, global outbreaks of delayed-onset MC infections have been traced to contaminated heater cooler devices, yet many centers continue to face barriers to replacing or monitoring such equipment. A delayed diagnosis in this case was eventually established by cell-free metagenomic next-generation sequencing (cfmNGS). However, the result was not acted upon until weeks later, after central nervous system involvement. A more timely, cost-effective diagnosis might have been achieved using traditional, widely available, culture-based testing guided by a robust exposure-driven differential. Clinicians should suspect MC in patients with prior cardiac surgery-even years earlier-who develop unexplained, progressive systemic symptoms. Early suspicion and appropriate testing are critical to improved outcomes. This case shows that next-generation sequencing assays are only as useful as the clinical reasoning guiding their use. Traditional microbiological testing-when leveraged early and thoughtfully-remains an accessible cornerstone of diagnosing complex MC infections.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12955461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One confirmed and one potential human case of influenza A(H5N1) detected through an expanded subtyping protocol.","authors":"Grant P Higerd-Rusli, Abraar Karan, Seth A Hoffman, Ingrid E A Morante, ChunHong Huang, Malaya K Sahoo, Matthew M Hernandez, Benjamin A Pinsky","doi":"10.1128/asmcr.00165-25","DOIUrl":"10.1128/asmcr.00165-25","url":null,"abstract":"<p><p>Current U.S. surveillance for highly pathogenic avian influenza A(H5N1) in humans prioritizes individuals with known animal exposures, potentially missing community-acquired infections. To address this gap, we implemented universal H5 subtyping of all influenza A-positive respiratory samples collected within our hospital system, regardless of patient exposure history. Between August 2024 and April 2025, we subtyped 4,488 influenza A-positive samples and identified two cases positive for H5 RNA in Alameda County, California, USA. The first case was a 14-month-old girl with mild respiratory symptoms and no H5N1 exposure risks; sequencing of the sample revealed an H5 gene closely related to clade 2.3.4.4b, genotype B3.13 viruses circulating in U.S. dairies. The second case was a 79-year-old male, also with no known exposures, whose sample reproducibly tested positive with a high cycle threshold value but could not be confirmed by public health laboratories. Both patients had evidence of co-infection with other common respiratory viruses. These findings, while requiring cautious interpretation due to low virus levels and the presence of potential confounding factors, highlight limitations in exposure-based testing and demonstrate the potential for cryptic H5N1 circulation. This report underscores that broader, geographically targeted surveillance may be a critical tool for early detection of potential community transmission of pandemic-capable pathogens.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12772291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"The promise and pitfalls: interpreting dual β-lactam success in <i>Mycobacterium abscessus</i> with caution\".","authors":"Khalid M Dousa, Robert A Bonomo","doi":"10.1128/asmcr.00170-25","DOIUrl":"10.1128/asmcr.00170-25","url":null,"abstract":"<p><p>We read with interest the recent commentary (C. Mejia-Chew, ASM Case Rep 1:e00084-25, 2025, https://doi.org/10.1128/asmcr.00084-25) on our case report (M. Shimamura, B. Becken, J. Tansmore, M. Cristinziano, et al., ASM Case Rep 1:e00087-24, 2025, https://doi.org/10.1128/asmcr.00087-24). β-lactam therapy represents a mechanistically rational and clinically promising strategy for <i>Mycobacterium abscessus</i>, a pathogen with limited therapeutic options. Reported cases of β-lactam combinations illustrate how <i>in vitro</i> data, translational insights, and multidisciplinary clinical decision-making can inform salvage therapy in the absence of robust animal preclinical or clinical trial data. While challenges remain-including lack of standardized synergy testing, limited animal models, and complex polytherapy-these experiences underscore the importance of transparent reporting and provide the platform for rigorously evaluating β-lactam regimens.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12772358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report of <i>Enterococcus thailandicus</i> bacteremia, with genomic characterization of its clinical isolate.","authors":"Yusuke Tsuda, Taro Noguchi, Shuji Yamamoto, Koh Shinohara, Yasuhiro Tsuchido, Masaki Yamamoto, Yasufumi Matsumura, Miki Nagao","doi":"10.1128/asmcr.00104-25","DOIUrl":"10.1128/asmcr.00104-25","url":null,"abstract":"<p><strong>Background: </strong><i>Enterococcus thailandicus</i> was initially isolated from food in Thailand, and a single clinical case involving an intra-abdominal abscess was reported. No reports on the bacteremia or whole-genome sequencing of clinically isolated <i>E. thailandicus</i> have been published.</p><p><strong>Case summary: </strong>A 50-year-old woman with intestinal Crohn's disease was admitted because of bloody stools. She had been treated twice previously for a perianal abscess. She developed a fever on day 15 of hospitalization. Both blood and urine cultures were polymicrobial and included <i>E. thailandicus</i>, which was susceptible to penicillins. She was treated for the perianal abscess and pyelonephritis with intravenous penicillins combined with beta-lactamase inhibitors for 2 weeks, followed by oral amoxicillin-clavulanic acid for 4 weeks. The identities of the isolates in the blood and urine cultures were confirmed using whole-genome analysis. No antimicrobial resistance genes, virulence genes, or plasmid replicons were identified in these isolates. Phylogenetic analysis of the clinical isolates and 21 <i>E. thailandicus</i> isolates in public databases indicated a relatively close lineage to that obtained from pig stool samples in Japan. No antimicrobial resistance genes conferring resistance to penicillins were identified in any of the <i>E. thailandicus</i> genomes.</p><p><strong>Conclusion: </strong>Phylogenetic analysis suggested that infection with <i>E. thailandicus</i> in this patient may have originated in Japan. The prognosis after treatment with penicillins was favorable.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12955394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A raw deal: the intersection of the immunocompromised cat, influenza, and a lapse of infection prevention and control measures.","authors":"Kelli J Maddock","doi":"10.1128/asmcr.00180-25","DOIUrl":"10.1128/asmcr.00180-25","url":null,"abstract":"<p><p>The case report by Chen et al. (ASM Case Rep 1:e00134-25, 2025, https://doi.org/10.1128/asmcr.00134-25) importantly describes nosocomial transmission of highly pathogenic avian influenza (HPAI) in an immunocompromised resident clinic cat. This case highlights several significant public health threats, starting with HPAI spillover from birds to cats, foxes, and cattle; probable HPAI infection due to contaminated commercially prepared raw pet foods; nosocomial infection of an immunocompromised animal; and lapses in infection prevention and control (IPC) measures. This case underscores the need for formal IPC guidelines or a risk assessment-based protocol for resident clinic or personal pets in veterinary settings. As the availability of and interest in using commercial raw pet foods increase, there is a need for education surrounding infectious disease risk, safe handling, and handwashing procedures for use of these products, as well as the potential risk for fecal shedding of important enteric pathogens. Further emphasizing the importance of IPC, nosocomial outbreaks caused by <i>Salmonella</i> and antimicrobial-resistant bacteria have been identified in large animal and companion animal practices, with a recent case describing probable zoonotic and nosocomial spread of carbapenem-resistant organisms. To mitigate these risks, veterinary practices (clinics or hospitals) require resources and education for IPC to minimize and investigate nosocomial transmission of infectious diseases. Finally, the availability of high-quality point-of-care test options for veterinary infectious diseases would support human, animal, and population health by providing rapid and actionable results for disease response.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12772288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bruton tyrosine kinase inhibitors and invasive aspergillosis and mucormycosis: a case report and multi-center exploratory retrospective study.","authors":"Eric Bhaimia, Daniel Russell, Carlos A Q Santos","doi":"10.1128/asmcr.00087-25","DOIUrl":"10.1128/asmcr.00087-25","url":null,"abstract":"<p><strong>Background: </strong>Bruton tyrosine kinase inhibitors (BTKIs) are increasingly utilized for patients with certain malignant hematologic conditions. While cases of invasive fungal infections have been reported in patients on BTKIs, no multi-center epidemiological studies have been performed. The Epic Cosmos platform, a nationwide electronic health record data set, provides an opportunity to assess real-world epidemiologic data.</p><p><strong>Case summary: </strong>A 69-year-old female with recently diagnosed Waldenström macroglobulinemia with associated autoimmune hemolytic anemia undergoing treatment with zanubrutinib and prednisone presented with fatigue and acute kidney injury. Imaging demonstrated a bladder mass with bilateral hydronephrosis leading to transurethral resection of the bladder mass with histopathology revealing both broad ribbon-like hyphae resembling Mucorales spp. and acute-angle branching resembling <i>Aspergillus</i> spp. with angioinvasion. Additional imaging revealed bilateral pulmonary cavitary lesions and renal and brain involvement. Bronchoalveolar lavage returned a positive galactomannan and culture growth of <i>Aspergillus fumigatus</i>. The patient was treated with liposomal amphotericin B with eventual transition to oral isavuconazole. Zanubrutinib and steroids were discontinued. To assess real-world occurrence of IFIs in patients on BTKIs, we performed an exploratory analysis using Epic Cosmos.</p><p><strong>Conclusion: </strong>IFIs continue to be described in patients undergoing treatment with BTKIs. Through exploratory analysis using Epic Cosmos, aspergillosis occurred not infrequently (0.5%-1.9%) in patients on various BTKIs. Of patients on ibrutinib with a diagnosis of chronic graft-versus-host disease, aspergillosis was identified in 32 (8.3%) patients. Patients on BTKIs who developed aspergillosis were frequently on corticosteroids. Mucormycosis in patients on BTKIs was rare (<0.1%).</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12772241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First case of a human <i>Candida berthetii</i> systemic infection in a preterm infant: a case report.","authors":"Elaine Cristina Francisco, Fatima M V Porfirio, Larissa M Favarello, Elisa J U Kusano, Debora D Krenke, Regina Matielo, Denise Vilarino Louzada, Lúcio Flávio Peixoto de Lima, Lígia C Pierrotti, Arnaldo L Colombo","doi":"10.1128/asmcr.00120-25","DOIUrl":"10.1128/asmcr.00120-25","url":null,"abstract":"<p><strong>Background: </strong>We report the first case of invasive human infection caused by <i>Candida berthetii</i> in a preterm infant.</p><p><strong>Case summary: </strong>A premature neonate who required prolonged hospitalization, intensive care support, multiple surgical interventions, and broad-spectrum antibiotics developed persistent candidemia due to <i>C. berthetii</i>. Species identification was confirmed through sequencing of the internal transcribed spacer region of ribosomal DNA. Antifungal susceptibility testing, performed using the the European Committee on Antimicrobial Susceptibility Testing (EUCAST) microbroth dilution method, revealed high minimal inhibitory concentrations (MICs) to fluconazole and anidulafungin but low MICs for amphotericin B. Despite switching to liposomal amphotericin B, the infant progressed to multiple organ dysfunction and died. The poor clinical outcome was attributed to both the severity of underlying conditions associated with candidemia and the delay in starting adequate antifungal therapy.</p><p><strong>Conclusion: </strong>This case broadens the current understanding of rare yeast pathogens and highlights the critical need for improved diagnostic tools to accurately detect and identify uncommon <i>Candida</i> species. Clinicians should remain vigilant to the emergence of rare yeast pathogens causing fungemia, especially among immunosuppressed hosts undergoing invasive medical procedures and prolonged exposure to broad-spectrum antimicrobials.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12772378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first reported case of <i>Mycobacterium shinjukuense</i> pulmonary disease from China.","authors":"Reeti Khare, Minh-Vu H Nguyen, Harleen Sahni","doi":"10.1128/asmcr.00167-25","DOIUrl":"10.1128/asmcr.00167-25","url":null,"abstract":"<p><strong>Background: </strong>This report describes the first clinical case of <i>Mycobacterium shinjukuense</i> pulmonary disease (PD) originating in China, thereby extending the known geographic distribution of this nontuberculous mycobacterial (NTM) species beyond Japan and Korea.</p><p><strong>Case summary: </strong><i>M. shinjukuense</i> caused chronic nodular-bronchiectatic PD in a 55-year-old woman. Computed tomography scans demonstrated persistent nodules and bronchiectasis over an 8-year period (2018-2025). A definitive diagnosis was achieved via a positive bronchoalveolar lavage culture followed by subsequent repeated detection in sputa 3 years after the initial presentation. Her symptoms were productive cough, hemoptysis, and dyspnea, and they fluctuated throughout this time, as did culture positivity on serial sputum testing. She improved clinically on airway clearance therapy alone and did not need antimicrobial therapy.</p><p><strong>Conclusion: </strong>This case highlights the indolent progression and diagnostic delay often associated with NTM-PD, as well as the presence of <i>M. shinjukuense</i> in new geographic regions.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12955460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the surface: a case report of penile tuberculosis as the first sign of miliary disease in a solid organ transplant recipient.","authors":"M Tan, S Green, C Kenny, Y O'Meara, S Pisharoty, R Hanson, G J Nason, G Woods, F Kelly, C Mejia-Chew","doi":"10.1128/asmcr.00141-25","DOIUrl":"10.1128/asmcr.00141-25","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) remains a major opportunistic infection in solid organ transplant recipients, with an incidence significantly higher than in the general population. Immunosuppression often leads to atypical and disseminated forms of TB, complicating timely diagnosis. Extrapulmonary TB can manifest in various genitourinary sites, but penile involvement is exceedingly rare, comprising less than 1% of urogenital TB cases.</p><p><strong>Case summary: </strong>We report a confirmed case of penile TB in a 56-year-old abattoir worker with a history of renal transplant, who presented with a penile ulcer with cellulitis and systemic symptoms. Imaging revealed miliary pulmonary TB, confirmed on molecular testing from both respiratory and skin tissue samples. The patient was commenced on a four-drug anti-tuberculous regimen with dose modifications due to drug interactions with immunosuppressive medications. Clinical improvement with resolution of the penile lesion and systemic symptoms was noted.</p><p><strong>Conclusion: </strong>This case highlights the need for increased clinical suspicion for TB in immunosuppressed patients presenting with atypical genitourinary symptoms. Early recognition and prompt initiation of treatment, alongside careful adjustment of immunosuppression, are critical to achieving favorable outcomes. Given the rarity of penile TB and the complexity of its management in transplant recipients, this case contributes to the limited literature and underscores the importance of a multidisciplinary approach.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12772334/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invasive <i>Conidiobolus</i> infection in an immunocompromised pediatric patient in Southern California.","authors":"Jacky Lu, Samuel M Goodfellow, Esther Vaugon, Andrew Karnaze, Cristina Costales, Michael A Smit, Jennifer Dien Bard","doi":"10.1128/asmcr.00155-25","DOIUrl":"10.1128/asmcr.00155-25","url":null,"abstract":"<p><strong>Background: </strong><i>Conidiobolus</i> species are largely known to cause rhinofacial cellulitis in healthy individuals but can manifest as an invasive infection in immunocompromised patients. Few cases have been described in the literature as they are difficult to diagnose and rarely observed in North America, particularly in the pediatric population.</p><p><strong>Case summary: </strong>A 15-year-old boy with a history of multiple bone marrow transplants for mixed phenotype acute leukemia presented to the emergency department with febrile neutropenia and chills. His clinical course was complicated by potential <i>Rothia mucilaginosa</i> bacteremia, but imaging revealed a potential invasive pulmonary fungal infection. Following rapid decompensation and admission in the intensive care unit, plasma cell-free DNA sequencing was ordered, identifying <i>Conidiobolus</i> species. The same organism was then isolated in the patient's sputum culture shortly thereafter. This organism was found to demonstrate high minimum inhibitory concentration to antifungals tested <i>in vitro</i>. Ultimately, the patient was discharged on posaconazole and trimethoprim-sulfamethoxazole.</p><p><strong>Conclusion: </strong><i>Conidiobolus</i> can be an agent of invasive fungal infection and may be considered a potential infectious agent in the immunocompromised patient. Treatment and outcomes of invasive <i>Conidiobolus</i> remain elusive.</p>","PeriodicalId":521101,"journal":{"name":"ASM case reports","volume":"2 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12955414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}