Head and Neck-Journal for the Sciences and Specialties of the Head and Neck最新文献

{"title":"Osteocutaneous Submental Flap for Midface Reconstruction: Cohort Study and Description of Technique.","authors":"Richard E Hayden, Justin M Hintze","doi":"10.1002/hed.70033","DOIUrl":"10.1002/hed.70033","url":null,"abstract":"<p><strong>Objective: </strong>Reconstruction of complex midface defects is challenging. Vascularized composite flaps are often needed to replace missing premaxilla and palatal bone, oral and sinonasal lining, as well as external facial skin in these defects. The submental flap has the potential to provide all these various tissues with the added advantage of matching facial skin color and hair-bearing qualities and is available within the surgical field.</p><p><strong>Methods: </strong>A retrospective cohort study was carried out at Mayo Clinic Arizona. Patients who had an osteocutaneous submental flap reconstruction for a midface defect between January 2002 and November 2017 were identified using a prospectively collected database. Patient demographics, surgical characteristics, short-term and long-term complications were collected.</p><p><strong>Results: </strong>The osteocutaneous submental island flap was utilized for reconstruction of midfacial defects in 15 patients. The mean age of the cohort was 60.45 ± 16.57 years, with a male predominance (73.3%). Squamous cell carcinoma was the most common pathology (n = 12, 80%). The mean soft tissue component of the flap utilized for reconstruction was 50cm², with the mean bone length harvested being 4.4 cm. Short-term complications occurred in three (20%) patients requiring re-exploration in the operating room. One patient ultimately experienced flap failure.</p><p><strong>Conclusion: </strong>The pedicled osteocutaneous submental flap is a highly versatile flap that offers excellent bony and soft tissue reconstruction for complex midfacial defects. It provides a rapid, reliable option with minimal donor morbidity and a unique color match to the facial defect.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Bite Forces for Solid Foods: Implications for Patients Postmandibular Reconstruction.","authors":"Jacob J Clark, Emma K Charters, Kai Cheng, Boyang Wan, Masako Dunn, Tim G H Manzie, Dale G Howes, Elizabeth C Ward, Qing Li, Jonathan R Clark","doi":"10.1002/hed.70031","DOIUrl":"https://doi.org/10.1002/hed.70031","url":null,"abstract":"<p><strong>Background: </strong>Bite forces required to masticate different food consistencies remain unknown, complicating dietary guidelines following mandibular reconstruction. This study quantifies the forces required for solid foods and estimates safe bite limits postreconstruction.</p><p><strong>Methods: </strong>Twenty food items were prepared according to IDDSI Levels 5 through 7b. Incisor and molar bite forces were measured using a custom-built force meter. Finite element (FE) analysis simulated safe force thresholds for single-, double-, and triple-segment mandibular reconstructions.</p><p><strong>Results: </strong>Bite force increased with food consistency, ranging from 4.6 N (IDDSI 5, incisors) to 45.4 N (IDDSI 7b, molars). Molars required higher forces than incisors (mean difference 9.0 N, p < 0.001). FE analysis indicated safe bite forces of30-115 N depending on reconstruction complexity and bone union. IDDSI 5 foods were safe in all cases, while higher levels often exceeded thresholds.</p><p><strong>Conclusion: </strong>These findings support evidence-based dietary recommendations after mandibular reconstruction using the IDDSI framework.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining CD103⁺ Tissue-Resident Memory T Cells in Nasopharyngeal Carcinoma.","authors":"Alesha A Thai, Richard J Young, Mathias Bressel, Brigitte B Y Ma, Melvin L K Chua, Pinki Soni, Christopher Angel, Anna Trigos, Danny Rischin, Benjamin J Solomon","doi":"10.1002/hed.70026","DOIUrl":"10.1002/hed.70026","url":null,"abstract":"<p><strong>Background: </strong>Tissue-resident memory T cells (T_RMs), identified by CD103 expression, play key roles in infection and cancer and often correlate with improved survival in the latter. Their characterization in nasopharyngeal carcinoma (NPC) is of interest due to its viral etiology.</p><p><strong>Methods: </strong>NPC tumors from patients treated at Peter MacCallum Cancer Centre (PMCC; 2000-2017) were examined for CD103⁺, CD8⁺ T cells, and PD-L1 abundance, correlated with survival, and underwent NanoString transcriptomic analysis. Additional cohorts from Hong Kong and Singapore were assessed for CD103⁺ intra-tumoral immune cell (ITIC) abundance.</p><p><strong>Results: </strong>Of the 141 PMCC patients, 29% (n = 30/103) of NPC tumors had high CD103⁺ ITIC (defined as ≥ 30%) linked with T_RM gene expression, immune checkpoints, and upregulated pathways in T-cell activation. Abundance of CD103⁺ ITIC was not associated with improved survival (PMCC: HR = 0.9, 95% CI: 0.4-2.1) across all cohorts.</p><p><strong>Conclusions: </strong>Despite similarities to other virally driven tumors, CD103⁺ ITIC abundance was not prognostic in NPC, highlighting the need for better characterization of T_RMs subpopulations.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Adjuvant Capecitabine in Locoregionally Advanced Nasopharyngeal Carcinoma: A Meta-Analysis of Phase III Randomized Trials With Subgroup Analysis by Neoadjuvant Chemotherapy.","authors":"Wala Ben Kridis, Afef Khanfir","doi":"10.1002/hed.70034","DOIUrl":"https://doi.org/10.1002/hed.70034","url":null,"abstract":"<p><strong>Background: </strong>Concurrent chemoradiotherapy (CCRT) is the standard of care for locoregionally advanced nasopharyngeal carcinoma (LA-NPC), yet distant metastasis remains the predominant cause of treatment failure. Two phase III randomized trials have investigated the efficacy of adjuvant capecitabine following CCRT, with or without neoadjuvant chemotherapy (NACT). We conducted a meta-analysis to evaluate the impact of adjuvant capecitabine on survival outcomes and treatment-related toxicity in LA-NPC.</p><p><strong>Methods: </strong>We included two randomized controlled trials involving 586 patients with LA-NPC who received adjuvant capecitabine or observation following definitive CCRT. Hazard ratios (HRs) for failure-free survival (FFS) and overall survival (OS) were pooled using a fixed-effects model. Subgroup analyses were performed based on NACT status. Grade ≥ 3 treatment-related adverse events were compared across treatment arms.</p><p><strong>Results: </strong>Adjuvant capecitabine significantly improved FFS in both trials (HR = 0.51, 95% CI: 0.34-0.75; I² = 0%). A statistically significant OS benefit was also observed (HR = 0.50, 95% CI: 0.31-0.82; p = 0.005). Subgroup analysis of the Chen et al. trial revealed a consistent OS benefit in patients with and without prior NACT (HR = 0.42 and 0.48, respectively), with a pooled HR of 0.43 (95% CI: 0.27-0.71; I² = 0%). Grade ≥ 3 adverse events were more common in the capecitabine arm, particularly in the standard-dose setting (60% vs. 51% in Miao et al.; p = 0.21), but remained manageable.</p><p><strong>Conclusion: </strong>Adjuvant capecitabine significantly improves both failure-free and overall survival in patients with LA-NPC (stage III-IVA), regardless of prior neoadjuvant chemotherapy. Toxicity is acceptable, particularly with low-dose metronomic regimens. These findings support the incorporation of adjuvant capecitabine into standard care for high-risk LA-NPC following CCRT.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Impact of Age and Treatment Strategies in Elderly Patients With Oral Squamous Cell Carcinoma: An 11-Year Retrospective Analysis.","authors":"Yuki Oikawa, Shoken Suzuki, Hidemitsu Igarashi, Yasunori Konno, Masato Yamazaki, Hiroshi Takano, Masayuki Fukuda","doi":"10.1002/hed.70028","DOIUrl":"https://doi.org/10.1002/hed.70028","url":null,"abstract":"<p><strong>Background: </strong>Oral squamous cell carcinoma (OSCC) is becoming increasingly common in elderly populations, particularly in aging societies such as Japan.</p><p><strong>Methods: </strong>This study retrospectively evaluated 312 OSCC patients treated at Akita University Hospital between 2011 and 2021, focusing on prognostic differences between elderly (≥ 75 years) and non-elderly (< 75 years) patients.</p><p><strong>Results: </strong>Among the elderly patients, curative intent was associated with significantly better disease-specific survival (DSS) and overall survival (OS) in comparison to palliative intent. The DSS for the elderly group was 83.2%; notably, it was 90.5% in patients who received curative intent and 4. 2.9% in patients who did not receive curative intent.</p><p><strong>Conclusions: </strong>This study emphasizes the importance of personalized treatment for elderly patients, suggesting that, even in advanced stages, curative intent can yield favorable outcomes in patients with acceptable general health. However, for those with severe comorbidities, palliative intent should be considered, focusing on quality of life.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Retropharyngeal Lymph Node Metastases in Thyroid Cancer.","authors":"Isabelle Fournier, Ashwini Venkata Bandi, Sarah Hamidi, Priyanka Iyer, Naifa L Busaidy, Maria E Cabanillas, Ramona Dadu, Mimi I Hu, Steven G Waguespack, Ugur Nur Basmaci, Michelle D Williams, Mena Mansour, Maria Gule Monroe, Neil D Gross, Ryan P Goepfert, Nancy D Perrier, Victoria Banuchi, Jennifer R Wang, Anastasios Maniakas, Mark E Zafereo","doi":"10.1002/hed.70027","DOIUrl":"https://doi.org/10.1002/hed.70027","url":null,"abstract":"<p><strong>Background: </strong>Retropharyngeal lymph node (RPLN) metastases in thyroid cancer are rare, with optimal management underreported.</p><p><strong>Methods: </strong>Retrospective study of consecutive thyroid cancer patients with RPLN metastases treated at MD Anderson Cancer Center between 2000 and 2024.</p><p><strong>Results: </strong>One hundred and sixty-seven patients (75% differentiated, 21% medullary, 4% poorly differentiated thyroid cancer) were divided into three groups: active surveillance (AS) (13%), surgery (56%), and nonsurgical treatment (31%). In the AS group (median follow-up 2.3 years), RPLN metastases grew a median 3% (range: 0-56) or 0.02 cm (range: 0-0.7) per year. Surgical therapy included transcervical (73%), transoral robotic (14%), transoral (12%), and transmandibular (1%) approaches. Median RPLN metastasis size was 1.7 cm (interquartile range: 1.3-2.2) at surgery. Three months post-operatively, 11% had dysphagia and 1% had velopharyngeal insufficiency. Nonsurgical treatments included radioactive iodine (10%), radiation therapy (11%), and systemic targeted therapy (79%).</p><p><strong>Conclusion: </strong>RPLN metastases grow slowly, and those ≥ 1 cm typically undergo surgical resection without significant long-term morbidity.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Impact and Risk Factors of Cervical Lymph Node Metastasis in Maxillary Gingival Squamous Cell Carcinoma: A Retrospective Study of 81 Patients.","authors":"Takeshi Kuroshima, Naoya Kinoshita, Naoto Nishii, Yu Oikawa, Takuma Kugimoto, Hideaki Hirai, Hirofumi Tomioka, Yasuyuki Michi, Hiroyuki Harada","doi":"10.1002/hed.70021","DOIUrl":"https://doi.org/10.1002/hed.70021","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to investigate the survival impact and predictive factors of cervical lymph node metastasis (CLNM) in patients with maxillary gingival squamous cell carcinoma (MGSCC).</p><p><strong>Methods: </strong>This retrospective study included 81 patients with MGSCC who underwent radical surgery from 2008 to 2018.</p><p><strong>Results: </strong>Pathological CLNM was observed in 24 patients, prevalently in levels IB and II on the ipsilateral side. Cox proportional hazards model analysis revealed histologic grade, CLNM, and local recurrence as independent prognostic factors for 5-year disease-specific survival. Multivariate analysis identified tumoral spread to the gingivobuccal sulcus and the maxillary tuberosity as independent risk factors for CLNM.</p><p><strong>Conclusions: </strong>CLNM is associated with poor survival in patients with MGSCC. Primary tumors extending into the gingivobuccal sulcus or maxillary tuberosity may predict CLNM, particularly at levels IB and II. These findings may provide valuable insights for optimizing neck management strategies.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tongue Surface Electromyography Detects Reduced Motor Unit Recruitment in Oropharyngeal Cancer Survivors With Hypoglossal Neuropathy.","authors":"Nathan J Hansen, Katherine A Hutcheson, Holly McMillan, Shitong Mao, Katelyn Vidad, Carly E Barbon, Karin Woodman, Nicolaas C Anderson, Benjamin Sanchez","doi":"10.1002/hed.70025","DOIUrl":"https://doi.org/10.1002/hed.70025","url":null,"abstract":"<p><strong>Background: </strong>This proof-of-concept case-control study examined the feasibility of tongue high-density surface electromyography (HDS-EMG) to detect hypoglossal neuropathy.</p><p><strong>Methods: </strong>We analyzed tongue HDS-EMG for N = 2 participants. Subjects were graded through clinical tongue functional measures and gold-standard needle EMG. We collected HDS-EMG in three tongue tasks: relaxation, protrusion, and isometric maximum effort. The HDS-EMG was decomposed into motor unit spike train estimates.</p><p><strong>Results: </strong>Muscle relaxation HDS-EMG contained spikes consistent with fasciculation potential morphology. During tongue protrusion, a case of confirmed CN XII neuropathy exhibited an elevated motor unit (MU) discharge rate and fewer MUs (45.71 peaks/s, 3 estimated MUs) compared to the control (11.63 peaks/s, 11 estimated MUs). During isometric contraction, the case exhibited an average discharge rate of 3.96 peaks/s on 3 MU estimates, whereas the control had a discharge rate of 2.58 peaks/s on 5 MU estimates.</p><p><strong>Conclusions: </strong>Non-invasive tongue HDS-EMG appears to show potential sensitivity for detecting reduced MU recruitment in hypoglossal neuropathy.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144978863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lip Reconstruction Following Cancer Resection.","authors":"Abbas M Hassan, Michael M Talanker, Peirong Yu, David M Adelman, Mark T Villa, Matthew M Hanasono","doi":"10.1002/hed.70020","DOIUrl":"https://doi.org/10.1002/hed.70020","url":null,"abstract":"<p><strong>Background: </strong>An analysis of all possible lip defects and a comparison of outcomes following various reconstructive techniques is lacking in the literature.</p><p><strong>Methods: </strong>An analysis of lip reconstructions following cancer resection from 1994 to 2024 was performed.</p><p><strong>Results: </strong>A total of 221 patients underwent lip reconstruction. Tobacco use (p = 0.003), diabetes mellitus (p = 0.042), and concurrent mandible or maxillary reconstruction (p = 0.019) were associated with surgical complications. Recurrent disease (p = 0.011) and oral commissure resection (p = 0.020) were associated with oral incompetence. Tobacco use (p = 0.001) and defects involving both upper and lower lips (p = 0.001) were associated with microstomia. Defects > 50% of the lip had higher rates of oral incompetence (p = 0.001) and microstomia (p = 0.035).</p><p><strong>Conclusions: </strong>Lip reconstruction outcomes are affected by patient-related factors, defect characteristics, and reconstructive techniques. Oral commissure resection, extensive lip defects, and lip defects in combination with mandibulectomy and maxillectomy are most prone to adverse outcomes, and we use our results to propose a comprehensive treatment algorithm.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neck Dissection Reduces Risk of Recurrence in Early-Stage Oral Tongue Cancer.","authors":"Jaclyn Lee, Tan Ding, Mae Wimbiscus, Dandan Liu, Melanie D Hicks, Alexander J Langerman, Robert J Sinard, Kyle Mannion, Sarah L Rohde, Eben L Rosenthal, Michael C Topf","doi":"10.1002/hed.70017","DOIUrl":"https://doi.org/10.1002/hed.70017","url":null,"abstract":"<p><strong>Background: </strong>Patterns of failure in early-stage oral tongue squamous cell carcinoma (OTSCC) managed with surgery alone remain understudied.</p><p><strong>Methods: </strong>Retrospective cohort study from 2000 to 2022 at a single tertiary care center evaluated pT1-T2N0 OTSCC patients who underwent partial glossectomy with or without elective neck dissection (END), without any adjuvant therapy. Predictors of recurrence were analyzed via multivariate Cox proportional hazards model.</p><p><strong>Results: </strong>The study included 201 OTSCC patients (131 pT1 and 70 pT2). Eighty patients (40%) underwent glossectomy alone; 121 (60%) underwent glossectomy with END. At a median follow-up of 56 months (IQR 23-82), 63 patients (31%) developed recurrence (21.4% local; 15.9% regional; 1% distant). Positive margins (HR 5.45 [1.9-15.4]), perineural invasion (HR 4.15 [1.8-9.9]), and increasing depth of invasion (DOI) (HR 1.32 [1.1-1.6]) were independently associated with recurrence. Upfront END reduced the risk of recurrence (HR 0.31 [95% CI: 0.15-0.6]), with benefit starting at tumor DOI 2 mm and greater.</p><p><strong>Conclusions: </strong>Upfront END decreases recurrence for pT1-T2N0 OTSCC treated with surgery alone starting at a DOI of 2 mm.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}