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

{"title":"Trans Oral Robotic Surgery for HPV-Negative Oropharyngeal Squamous Cell Carcinoma: Follow-Up on Oncological and Functional Outcomes.","authors":"Khalid Azalmad, Karma Lambercy, Avinash Beharry, Nathalie Piazzon, Marie Barbesier, Margaux Dalla-Vale, Manuela Moraru, Sabina Berezowska, Christian Simon","doi":"10.1002/hed.27958","DOIUrl":"https://doi.org/10.1002/hed.27958","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of transoral robotic surgery (TORS) for HPV-negative oropharyngeal cancers (OPSCC) is less explored, especially regarding long-term outcomes and prognostic factors.</p><p><strong>Methods: </strong>We conducted a retrospective monocentric study on 37 patients with HPV-negative OPSCC treated with TORS with a median follow-up of 3 years, assessing survival outcomes using Kaplan-Meyer statistics and swallowing function via the functional outcome swallowing scale (FOSS). Histopathological parameters were collected either from medical records or histology slides were re-evaluated.</p><p><strong>Results: </strong>Patients demonstrated high disease-specific survival (DSS) but lower overall survival (OS), with a cohort characterized by high comorbidity rates. Vascular invasion was a significant adverse factor for relapse-free survival (RFS) and OS, while lymphatic invasion was not. Most patients demonstrated significant preservation of swallowing function.</p><p><strong>Conclusions: </strong>TORS for HPV-negative OPSCC demonstrates high DSS and preserved swallowing function. Vascular invasion is a key prognostic factor for survival outcomes.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481363","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":"The Prevalence and Prognostic Implications of BRAF K601E Mutations in Thyroid Neoplasms: A Systematic Review and Meta-Analysis","authors":"Alyssa Webster,&nbsp;Rami M. Elshazli,&nbsp;Dylan Pinion,&nbsp;Robert D. E. Clark,&nbsp;Grace Kelly,&nbsp;Peter P. Issa,&nbsp;Mohammad H. Hussein,&nbsp;Manal S. Fawzy,&nbsp;Eman A. Toraih,&nbsp;Emad Kandil","doi":"10.1002/hed.27950","DOIUrl":"10.1002/hed.27950","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Activating mutations in the <i>BRAF</i> oncogene occur in 45% of papillary thyroid carcinomas (PTCs). Though less studied, K601E may identify a clinically distinct subset of thyroid neoplasms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A bioinformatics assessment was conducted using the COSMIC database and in silico data analysis. A systematic search was conducted through August 2024 to identify studies reporting <i>BRAF</i> mutation in thyroid neoplasms. Pooled prevalence, histopathological subtype distribution, extrathyroidal extension, lymph node metastasis, recurrence, and survival were extracted/analyzed from 32 studies (13 191 patients).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In the COSMIC database, <i>BRAF</i> K601E was found in various tissue types but mainly in the thyroid. In silico data analysis revealed a structural and functional basis for differences between K601E and V600E. Upon systematic review, the <i>BRAF</i> K601E mutation was identified in 2.8% of PTCs compared to 22% with V600E. The stratified analysis revealed geographical differences, with higher rates in Italy (5.23%) and the United States of America (3.31%). The K601E mutant was enriched for follicular-patterned variants like NIFTP (11.2% of cases). Meta-analysis demonstrated significantly reduced extrathyroidal extension for K601E versus V600E mutants (RR = 0.22, 95% CI = 0.10–0.50, <i>p</i> = 0.0003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>K601E-mutated neoplasms could be a unique clinicopathological entity associated with low-risk histology and reduced extrathyroidal extension, consistent with a more indolent course than V600E mutants. Although detecting K601E may potentially guide conservative management, further prospective studies are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":"46 12","pages":"3133-3145"},"PeriodicalIF":2.3,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hed.27950","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provider Perspectives and Access to Palliative Care: An American Head and Neck Society (AHNS) Survey.","authors":"Shreya Sriram, Akua Owusu-Boahene, Rebecca A Gersten, Christine G Gourin","doi":"10.1002/hed.27957","DOIUrl":"https://doi.org/10.1002/hed.27957","url":null,"abstract":"<p><strong>Background: </strong>To explore provider perspectives about palliative care (PC) in head and neck cancer (HNC) care.</p><p><strong>Methods: </strong>A 25-question electronic survey was disseminated to the membership of the American Head and Neck Society (AHNS) from April 10, 2023, through June 13, 2023.</p><p><strong>Results: </strong>Respondents were most likely to refer to PC at symptomatic disease progression (52%) or terminal diagnosis (29%) rather than at initial diagnosis (17%). Participants less likely to refer to PC were less likely to refer to symptomatic progression (8% vs. 39%, p = 0.0006) or address advance directives (62% vs. 87%, p = 0.0406). Symptom burden questionnaires were used by only 29% of respondents. Discordance was identified between self-reported and actual access to local inpatient and outpatient PC services.</p><p><strong>Conclusions: </strong>Barriers to PC identified include a lack of established optimal timing of PC referral, a perceived lack of local access to PC, and a lack of uniform standardized assessment of symptom burden.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382524","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":"Managing Thyroid Nodules in Brain-Dead Donors: Our Experience and a Review of the Literature.","authors":"Luca Giovanni Locatello, Nicole Caiazza, Federico Cavallo Ronchi, Anna Maria Bergamin-Bracale, Cesare Miani","doi":"10.1002/hed.27946","DOIUrl":"https://doi.org/10.1002/hed.27946","url":null,"abstract":"<p><strong>Background: </strong>Thyroid nodules are common findings during the diagnostic work-up in potential organ donors. A fast yet thorough assessment to rule out cancer is mandatory but their management remains heterogeneous among hospitals and the evidence in this field is scarce. We present our institutional experience and review the most recent literature on this topic.</p><p><strong>Methods: </strong>Retrospective case series and systematic review of the literature.</p><p><strong>Results: </strong>In the years 2000-2023, 47 total thyroidectomies were performed on potential brain-dead donors. Intraoperative frozen section (FS) revealed 6 cases (13.9%) of papillary carcinoma that led to organ discarding in 3 cases (6.9%). The mean operative time of the procedures was 42.75 min and no procurement-delaying complications were registered.</p><p><strong>Conclusion: </strong>Total thyroidectomy with an intraoperative FS is a sound method for assessing suspicious nodules before organ harvesting. Future randomized studies comparing its performance against fine needle aspiration biopsy are needed to define the most cost-effective and time-saving strategy.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382523","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":"Intraoperative Real-Time Image-Guided Fibular Harvest and Mandibular Reconstruction: A Feasibility Study on Cadaveric Specimens.","authors":"Georgia Grzybowski, Molly Murray Stewart, Thomas D Milner, Anat Bahat Dinur, Orla M McGee, Amir Pakdel, Khanh Linh Tran, Sidney S Fels, Antony J Hodgson, Eitan Prisman","doi":"10.1002/hed.27954","DOIUrl":"https://doi.org/10.1002/hed.27954","url":null,"abstract":"<p><strong>Background: </strong>This study assesses the feasibility of real-time surgical navigation to plan and guide sequential steps during mandible reconstruction on a series of cadaveric specimens.</p><p><strong>Methods: </strong>An image-guided surgical (IGS) system was designed including customized mandible and fibula fixation devices with navigation reference frames and an accompanied image-guided software. The mandibular and fibular segmental osteotomies were performed using the IGS in all five cadaveric patients. Procedural time and cephalometric measurements were recorded.</p><p><strong>Results: </strong>Five real-time IGS mandibulectomy and fibular reconstruction were successfully performed. The mean Dice score and Hausdorff-95 distance between the planned and actual mandible reconstructions was 0.8 ± 0.08 and 7.29 ± 4.81 mm, respectively. Intercoronoid width, interangle width, and mandible projection differences were 1.15 ± 1.17 mm, 0.9 ± 0.56 mm, and 1.47 ± 1.62 mm, respectively.</p><p><strong>Conclusion: </strong>This study presents the first demonstration of a comprehensive image-guided workflow for mandibulectomy and fibular flap reconstruction on cadaveric specimens and resulted in adequate cephalometric accuracy.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376341","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":"Benefits of Bedside Open Tracheostomy: A Safe and Cost-Effective Alternative to the Operating Room.","authors":"Arianna Winchester, David Strum, Arman Saeedi, Nupur Bhatt, Michael Chow, Ghayoour Mir, Adam Jacobson","doi":"10.1002/hed.27948","DOIUrl":"10.1002/hed.27948","url":null,"abstract":"<p><strong>Introduction: </strong>Tracheostomy is a commonly performed procedure in Otolaryngology and can be performed in different settings. We evaluate patient characteristics and cost efficacy of tracheostomy at the bedside versus operating room (OR).</p><p><strong>Materials and methods: </strong>Retrospective chart review was performed for adult intensive care unit (ICU) patients who underwent tracheostomy from 2020 to 2023. Data and cost of procedures were analyzed using descriptive statistics.</p><p><strong>Results: </strong>One hundred and sixty-five patients were included. One hundred and thirty-four (81.2%) patients underwent bedside tracheostomy. Age, sex, and BMI were not significantly different. Average time from consult to procedure and operative time was significantly shorter (p = 0.03; 0.008). There were no differences in postoperative complications, 30-day mortality, ICU length of stay (LOS), or overall LOS. Tracheostomy at the bedside offered a 73.1% cost reduction compared with performed in the OR.</p><p><strong>Conclusion: </strong>Advantages of bedside tracheostomy include decreased operative time, time from consult to procedure, and cost reduction for the hospital system. We advocate for consideration of bedside tracheostomy when appropriate.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367546","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":"Glucose Transporter 1 Inhibitors Induce Autophagy and Synergize With Lenvatinib in Thyroid Cancer Cells.","authors":"Chi-Yu Kuo, Yi-Chiung Hsu, Ming-Jen Chen, Chi-Hsin Lin, Ying-Syuan Li, Shih-Ping Cheng","doi":"10.1002/hed.27953","DOIUrl":"https://doi.org/10.1002/hed.27953","url":null,"abstract":"<p><strong>Background: </strong>Less differentiated thyroid cancer may upregulate the expression of glucose transporter 1 (GLUT1) and increase glycolytic activity. However, it is uncertain whether GLUT1 can be used as a target for therapy.</p><p><strong>Methods: </strong>Thyroid cancer cell lines were treated with two different GLUT1 inhibitors, STF-31 and BAY-876. Functional assays were conducted to evaluate the effects of these inhibitors on cell biology.</p><p><strong>Results: </strong>GLUT1 inhibitors dose-dependently decreased cell growth and clonogenicity of thyroid cancer cells. Cell cycle analysis showed that these inhibitors caused G2/M arrest instead of apoptosis. Additionally, treatment with GLUT1 inhibitors led to the activation of autophagy. In both the Transwell and spheroid models, GLUT1 inhibitors significantly suppressed cell invasiveness. Moreover, GLUT1 inhibitors demonstrated synergistic interactions when combined with lenvatinib.</p><p><strong>Conclusions: </strong>Treatment with GLUT1 inhibitors activates autophagy and provokes cell cycle arrest, accompanied by a decrease in colony formation and invasive capacity in thyroid cancer cells.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367547","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":"Development of a Preclinical Double Model of Mandibular Irradiated Bone and Osteoradionecrosis in New Zealand Rabbits.","authors":"Alessandra Ruaro, Stefano Taboni, Harley H L Chan, Tiziana Mondello, Patricia Lindsay, Teesha Komal, Lara Alessandrini, Marta Sbaraglia, Elena Bellan, Roberto Maroldi, Jason Townson, Michael J Daly, Federica Re, Chiara Pasini, Marco Krengli, Luciana Sartore, Domenico Russo, Piero Nicolai, Marco Ferrari, Ralph W Gilbert, Jonathan C Irish","doi":"10.1002/hed.27955","DOIUrl":"https://doi.org/10.1002/hed.27955","url":null,"abstract":"<p><strong>Purpose: </strong>Radiotherapy (RT) plays a crucial role in head and neck (HN) cancer treatment. Nevertheless, it can lead to serious and challenging adverse events such as osteoradionecrosis (ORN). A preclinical rabbit model of irradiated bone and ORN is herein proposed, with the aim to develop a viable model to be exploited for investigating new therapeutic approaches.</p><p><strong>Methods: </strong>Nine New Zealand white rabbits were irradiated using a single beam positioned to the left of the mandible and directed perpendicular to the left mandible. A 10 × 10 mm² region of interest (ROI) located below the first molar tooth on the left side was identified and irradiated with 7 Gy each fraction, once every 2 days, for five fractions. Dose distributions demonstrated that the corresponding ROI on the contralateral (right) mandibular side received approximately 5 Gy each fraction, thus bilateral irradiation of the mandible was achieved. ROIs were categorized as ROI_H on the left side receiving the high dose and ROI_L on the right side receiving the low dose. Rabbits were followed up clinically and imaged monthly. After 4 months, the irradiated bone was excised, and histological examination of ROIs was performed.</p><p><strong>Results: </strong>Radiological signs suggestive for ORN were detected in the entire population (100%) 16 weeks after irradiation on ROI_H, which consisted of cortical erosion and loss of trabeculae. ROI_L did not show any radiological evidence of bone damage. Histologically, both sides showed comparable signs of injury, with marked reduction in osteocyte count and increase in empty lacunae count.</p><p><strong>Conclusions: </strong>A preclinical double model was successfully developed. The side receiving the higher dose showed radiological and histological signs of bone damage, resulting in an ORN model. Whereas the contralateral side, receiving the lower dose, presented with histological damage only and a normal radiological appearance. This work describes the creation of a double model, an ORN and irradiated bone model, for further study using this animal species.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373608","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":"CYLD Alterations Are Associated With Metastasis and Poor Prognosis in Human Papilloma Virus-Positive Head and Neck Cancer.","authors":"Zhibin Cui, Hyunseok Kang, Hua Li, Eliot D Lee, Yoon Se Lee, Christopher N Peterson, Steven R Long, Jennifer R Grandis, Daniel E Johnson","doi":"10.1002/hed.27944","DOIUrl":"https://doi.org/10.1002/hed.27944","url":null,"abstract":"<p><strong>Background: </strong>Human papilloma virus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) is an emerging epidemic and a subset of HPV-positive patients experience aggressive disease with metastases. The CYLD gene is frequently altered in HPV-positive HNSCC, but the role of these alterations in disease progression is poorly understood.</p><p><strong>Methods: </strong>We identified 11 HPV-positive HNSCC patients with CYLD alterations and assessed their clinical course. We also characterized a unique, HPV-positive, metastatic, HNSCC patient-derived xenograft (PDX).</p><p><strong>Results: </strong>All 11 patients developed metastasis with reduced overall survival when compared with metastatic HPV-positive patients with wild-type CYLD. The metastatic PDX harbored a CYLD mutation (S371*) and exhibited reduced expression of connexin 43, a potentially antimetastatic protein. We also investigated the functional impact of the S371* mutation, as well as 2 CYLD mutations from our 11-patient cohort.</p><p><strong>Conclusion: </strong>Our findings indicate that alterations in CYLD in HPV-positive HNSCC are associated with metastasis and poor prognosis.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332758","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":"Tumor Microenvironment-Based Risk Stratification of Oropharyngeal Squamous Cell Carcinoma.","authors":"Alhadi Almangush, Lauri Jouhi, Caj Haglund, Jaana Hagström, Antti A Mäkitie, Ilmo Leivo","doi":"10.1002/hed.27945","DOIUrl":"https://doi.org/10.1002/hed.27945","url":null,"abstract":"<p><strong>Background: </strong>Evaluation of the prognostic impact of tumor microenvironment (TME) has received attention in recent years. We introduce a TME-based risk stratification for oropharyngeal squamous cell carcinoma (OPSCC).</p><p><strong>Material and methods: </strong>A total of 182 patients treated for OPSCC at the Helsinki University Hospital were included. TME-based risk stratification was designed combining tumor-stroma ratio and stromal tumor-infiltrating lymphocytes assessed in hematoxylin and eosin-stained sections.</p><p><strong>Results: </strong>In multivariable analysis, TME-based risk stratification associated with poor disease-free survival with a hazard ratio (HR) of 2.68 (95% CI 1.11-6.48, p = 0.029). In addition, the proposed risk stratification was associated with poor disease-specific survival (HR 2.687, 95% CI 1.28-5.66, p = 0.009) and poor overall survival (HR 2.21, 95% CI 1.23-3.99, p = 0.008).</p><p><strong>Conclusion: </strong>Our TME-based risk stratification provides a powerful prognostic tool that can be used in daily treatment planning of OPSCC together with tumor-related prognostic markers.</p>","PeriodicalId":55072,"journal":{"name":"Head and Neck-Journal for the Sciences and Specialties of the Head and Neck","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332762","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}