Communications medicine最新文献

{"title":"Associations of mental disorders with maternal health outcomes.","authors":"Pallavi Dubey, Alok Kumar Dwivedi, Kunal Sharma, Sarah L Martin, Peter M Thompson, Sireesha Y Reddy","doi":"10.1038/s43856-025-01062-8","DOIUrl":"10.1038/s43856-025-01062-8","url":null,"abstract":"<p><strong>Background: </strong>Mental disorders are highly prevalent during pregnancy and are associated with unfavorable obstetrical outcomes, including maternal mortality. This study examined specific and combined associations of mental disorders with maternal morbidities.</p><p><strong>Methods: </strong>A cross-sectional study of all delivery hospitalizations between the ages of 12-55 years was conducted using the National Inpatient Sample data from 2017. The International Classification of Diseases-10 codes were used to define exposures including depressive, anxiety, post-traumatic stress (PTSD), sleep, and bipolar disorders, and outcomes including premature rupture of membranes (PROM), hydramnios, placental disorder, cesarean delivery, fetal death, preterm birth, and postpartum hemorrhage (PPH). Survey-weighted logistic regression analysis was conducted to evaluate the associations between mental disorders and obstetric outcomes after adjusting for age, race/ethnicity, household income, primary payer, smoking, alcohol use, substance use, and obesity.</p><p><strong>Results: </strong>The analysis of 715,810 delivery hospitalizations, representing 3,579,046 deliveries in the US demonstrates that sleep disorder is associated with PROM (OR = 1.41; 95% CI: 1.13, 1.75), placental disorder (OR = 1.56; 95% CI: 1.24, 1.95), cesarean delivery (OR = 1.50; 95% CI: 1.36, 1.65), and PPH (OR = 1.36; 95% CI: 1.10, 1.68) to a greater extent than other mental disorders. However, depressive disorder is greatly associated with hydramnios (OR = 1.16; 95% CI: 1.08, 1.25) and fetal death (OR = 1.38; 95% CI: 1.18, 1.61), while PTSD (OR = 1.40; 95% CI: 1.19, 1.64) is associated with preterm birth than other mental disorders.</p><p><strong>Conclusions: </strong>Most mental disorders are independently associated with critical obstetric outcomes, with the extent of associations depending on specific obstetric outcomes. The study findings indicate the need for mandatory screening and management of mental health conditions in routine obstetrical care to improve maternal and child health outcomes.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"350"},"PeriodicalIF":5.4,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12350604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144849958","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 modular approach to forecasting COVID-19 hospital bed occupancy.","authors":"Ruarai J Tobin, Camelia R Walker, Robert Moss, James M McCaw, David J Price, Freya M Shearer","doi":"10.1038/s43856-025-01086-0","DOIUrl":"10.1038/s43856-025-01086-0","url":null,"abstract":"<p><strong>Background: </strong>Monitoring the number of COVID-19 patients in hospital beds was a critical component of Australia's real-time surveillance strategy for the disease. From 2021 to 2023, we produced short-term forecasts of bed occupancy to support public health decision-making.</p><p><strong>Methods: </strong>We present a model for forecasting the number of ward and intensive care unit (ICU) beds occupied by COVID-19 cases. The model simulates the stochastic progression of COVID-19 patients through the hospital system and is fit to reported occupancy counts using an approximate Bayesian method. We do not directly model infection dynamics-instead, taking independently produced forecasts of case incidence as an input-enabling the independent development of our model from that of the underlying case forecast(s).</p><p><strong>Results: </strong>Here, we evaluate the performance of 21-day forecasts of ward and ICU occupancy across Australia's eight states and territories produced across the period March and September 2022. We find forecasts are on average biased downwards immediately prior to epidemic peaks and biased upwards post-peak. Forecast performance is best in jurisdictions with the largest population sizes.</p><p><strong>Conclusions: </strong>Our forecasts of COVID-19 hospital burden were reported weekly to national decision-making committees to support Australia's public health response. Our modular approach for forecasting clinical burden is found to enable both the independent development of our model from that of the underlying case forecast(s) and the performance benefits of an ensemble case forecast to be leveraged by our occupancy forecasts.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"349"},"PeriodicalIF":5.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12343809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838726","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":"Diagnostic test accuracy of simplified algorithms for diagnosing acute rheumatic fever: a systematic review.","authors":"Rui Providencia, Ghazaleh Aali, Fang Zhu, Thomas Katairo, Mahmood Ahmad, Jonathan Jh Bray, Ferruccio Pelone, Eloi Marijon, Miryan Cassandra, David S Celermajer, Farhad Shokraneh","doi":"10.1038/s43856-025-01023-1","DOIUrl":"10.1038/s43856-025-01023-1","url":null,"abstract":"<p><strong>Background: </strong>Rheumatic heart disease, the long-term sequel to acute rheumatic fever, remains a prevalent public health problem in Africa and other low to middle-income regions of the world. Diagnosing acute rheumatic fever and using the modified Jones criteria in high-prevalence areas remains challenging.</p><p><strong>Methods: </strong>We assessed the (i) diagnostic accuracy of simplified diagnostic algorithms among children, adolescents, and adults with suspected acute rheumatic fever, and (ii) the impact of different diagnostic criteria on the development of rheumatic heart disease (PROSPERO CRD42022344077). The MEDLINE, Embase, and Conference Proceedings Citation Index-Science were searched for relevant reports (date: 15th March 2025).</p><p><strong>Results: </strong>Here we identify 12,075 records, and three studies (four reports) meeting our eligibility criteria. Simplified diagnostic algorithms using only clinical data at community health centre-level (AUC 0.69, sensitivity 66% and specificity 68%), or adding 12-lead electrocardiogram and simple laboratory investigations at district-level facilities (AUC 0.76, sensitivity 77% and specificity 67%) perform worse than models including the full-set of laboratory investigations and echocardiography at National referral hospitals (AUC 0.91, sensitivity 84% & specificity 87%). Using modified Jones criteria without echocardiography results in an important loss of sensitivity (sensitivity 79%, specificity 100% & AUC 0.90). Progression to rheumatic heart disease is reported in 2.5-5% of children and young adults in high-prevalence areas who do not meet the full modified Jones criteria.</p><p><strong>Conclusions: </strong>Simplification of the modified Jones criteria in areas without access to echocardiography and laboratory investigations may lead to underdiagnosis of acute rheumatic fever. Some patients who do not meet the modified Jones criteria for definite acute rheumatic fever diagnosis may still progress to develop rheumatic heart disease.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"348"},"PeriodicalIF":5.4,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12344290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838727","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":"Prenatal exposure to genocide accelerates epigenetic aging in third- and fourth-generation clocks among young adults in Rwanda.","authors":"Glorieuse Uwizeye, Luisa M Rivera, Hannah G Stolrow, Brock C Christensen, Julienne N Rutherford, Zaneta M Thayer","doi":"10.1038/s43856-025-01065-5","DOIUrl":"10.1038/s43856-025-01065-5","url":null,"abstract":"<p><strong>Background: </strong>Prenatal exposure genocide-related to trauma has been previously associated with increased morbidity. Whether the prenatal exposure to genocide and rape also impacts various aspects of biological regulation, including patterns of DNA methylation, remains unknown. The purpose of this study was to evaluate whether prenatal exposure to genocide-related trauma, including conception through rape, is associated with accelerated epigenetic aging, a molecular indicator of biological aging.</p><p><strong>Methods: </strong>We used a cross-sectional dataset to evaluate whether prenatal exposure to genocide or genocidal rape, among individuals conceived during the 1994 genocide against Tutsi in Rwanda were associated with differences in age acceleration in a range of clocks (first generation: Horvath and Hannum; second generation: PhenoAge; third generation: GrimAge and DunedinPace; and fourth generation: YingDamAge and YingAdaptAge), while taking into account exposure to adverse childhood experiences (ACEs). Participants were 24 years old during the time of data collection, and we enrolled 46 female and 45 male participants. Control participants were those of Rwandan descent who did not live in Rwanda during the genocide.</p><p><strong>Results: </strong>We show that there are no differences in age acceleration observed with first- or second-generation age clocks. However, age acceleration was associated with prenatal exposure to extreme stress for all other clocks, with the greatest acceleration observed in the genocidal rape conception group. For the YingDamAge clock, acceleration effects were strengthened after the inclusion of ACEs.</p><p><strong>Conclusions: </strong>Our findings suggest that prenatal trauma exposure is associated with epigenetic age acceleration. Third and fourth-generation clocks may more accurately capture these relationships.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"346"},"PeriodicalIF":5.4,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812747","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":"AI and digital health for childhood cancer care in Ghana.","authors":"Eric Ny Nyarko, Sheila Santa, Patrick Diaba-Nuhoho","doi":"10.1038/s43856-025-01047-7","DOIUrl":"10.1038/s43856-025-01047-7","url":null,"abstract":"","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"344"},"PeriodicalIF":5.4,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805409","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":"Neurobehavioral mechanisms of fear and anxiety in multiple sclerosis.","authors":"Lil Meyer-Arndt, Rebekka Rust, Judith Bellmann-Strobl, Tanja Schmitz-Hübsch, Lajos Marko, Sofia Forslund, Michael Scheel, Stefan M Gold, Stefan Hetzer, Friedemann Paul, Martin Weygandt","doi":"10.1038/s43856-025-01085-1","DOIUrl":"10.1038/s43856-025-01085-1","url":null,"abstract":"<p><strong>Background: </strong>Anxiety is a common yet often underdiagnosed and undertreated comorbidity in multiple sclerosis (MS). While altered fear processing is a hallmark of anxiety in other populations, its neurobehavioral mechanisms in MS remain poorly understood. This study investigates the extent to which neurobehavioral mechanisms of fear generalization contribute to anxiety in MS.</p><p><strong>Methods: </strong>We recruited 18 persons with MS (PwMS) and anxiety, 36 PwMS without anxiety, and 23 healthy persons (HPs). Participants completed a functional MRI (fMRI) fear generalization task to assess fear processing and diffusion-weighted MRI for graph-based structural connectome analyses.</p><p><strong>Results: </strong>Consistent with findings in non-MS anxiety populations, PwMS with anxiety exhibit fear overgeneralization, perceiving non-threating stimuli as threatening. A machine learning model trained on HPs in a multivariate pattern analysis (MVPA) cross-decoding approach accurately predicts behavioral fear generalization in both MS groups using whole-brain fMRI fear response patterns. Regional fMRI prediction and graph-based structural connectivity analyses reveal that fear response activity and structural network integrity of partially overlapping areas, such as hippocampus (for fear stimulus comparison) and anterior insula (for fear excitation), are crucial for MS fear generalization. Reduced network integrity in such regions is a direct indicator of MS anxiety.</p><p><strong>Conclusions: </strong>Our findings demonstrate that MS anxiety is substantially characterized by fear overgeneralization. The fact that a machine learning model trained to associate fMRI fear response patterns with fear ratings in HPs predicts fear ratings from fMRI data across MS groups using an MVPA cross-decoding approach suggests that generic fear processing mechanisms substantially contribute to anxiety in MS.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"345"},"PeriodicalIF":5.4,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812746","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":"Association of SARS-CoV-2 vaccination status with risk of influenza-like illness and loss of workdays in healthcare workers.","authors":"Tamara Dörr, Joanne Lacy, Tala Ballouz, Alexia Cusini, Fabian Grässli, Sarah Haile, Emina Kocan, J Carsten Möller, Milo A Puhan, Matthias Schlegel, Matthias von Kietzell, Markus Rütti, Reto Stocker, Danielle Vuichard Gysin, Christian R Kahlert, Stefan P Kuster, Philipp Kohler","doi":"10.1038/s43856-025-01046-8","DOIUrl":"10.1038/s43856-025-01046-8","url":null,"abstract":"<p><strong>Background: </strong>In the post-pandemic phase, the value of annual SARS-CoV-2 booster vaccination in healthcare-workers is unclear. In this multicentre cohort study, we sought to determine the association of SARS-CoV-2 vaccination status and other risk factors with the occurrence of influenza-like respiratory illness and workdays lost due to influenza-like respiratory illness.</p><p><strong>Methods: </strong>During a period of high SARS-CoV-2 community transmission (November 2023 to May 2024), we collected weekly data on symptoms and sick day leave and used negative binomial regression to identify risk factors for these outcomes among 1745 healthcare workers. To single out the effect of the vaccine and account for potential confounding, additional inverse probability weighted analysis was performed.</p><p><strong>Results: </strong>In both analyses, we show that more SARS-CoV-2 vaccinations are associated with a higher risk of influenza-like respiratory illness and workdays lost. For influenza-like respiratory illness, the association is stronger with a more recent timing of the vaccination rather than the number of vaccinations, which suggests that the effect wanes over time. In contrast, seasonal influenza vaccination is associated with a decreased risk for both outcomes.</p><p><strong>Conclusions: </strong>Based on our data, we conclude that SARS-CoV-2 booster vaccination does not contribute to the protection of the healthcare workforce in a post-pandemic setting. SARS-CoV-2 vaccination may even temporarily increase the likelihood of symptomatic infection and workday loss.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"347"},"PeriodicalIF":5.4,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144812745","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 schema for sporadic and heritable disease pathogenesis integrating spatiotemporal distribution with the character of genetic variants.","authors":"Hussam Alkaissi, Yasemin Cole, Tara T Doucet-O'Hare, Jared S Rosenblum, Zhengping Zhuang, Karel Pacak","doi":"10.1038/s43856-025-01039-7","DOIUrl":"10.1038/s43856-025-01039-7","url":null,"abstract":"","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"340"},"PeriodicalIF":5.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805404","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":"Assessment of clinician well-being and the factors that influence it using validated questionnaires: a systematic review.","authors":"Claudie Audet, Andréanne Bernier, Marimée Godbout-Parent, Hermine Lore Nguena Nguefack, Liz Ferland, Paula L Bush, Marie-Dominique Poirier, Sonia Lussier, Tracie A Barnett, Sylvie D Lambert, Anaïs Lacasse","doi":"10.1038/s43856-025-01069-1","DOIUrl":"10.1038/s43856-025-01069-1","url":null,"abstract":"<p><strong>Background: </strong>Measuring clinician experiences of care and well-being (e.g. job satisfaction, fulfillment) offers insights into the practice environment's impact, aiding workforce retention, patient safety, and care quality. However, valid measurement instruments are essential. This systematic review identified validated self-reported questionnaires designed to assess clinician well-being and its influencing factors.</p><p><strong>Methods: </strong>Psychometric studies in English or French on measurement instruments addressing factors that influence clinician well-being, as proposed by the National Academy of Medicine, were included. Studies published between 2013 and 2023 were retrieved in December 2023 by searching these databases: CINAHL, Embase, HaPI, MEDLINE, PsycINFO, Mental Measurements Yearbook, and APA PsycTests. Study selection was completed by two independent reviewers. Results were summarized narratively, in tables, and figures. Quality of psychometric studies was assessed by the number of measurement properties addressed. The review protocol was registered with INPLASY® (202410047).</p><p><strong>Results: </strong>Out of 10,441 records identified, 136 studies are included. The majority come from the USA (27.2%), Spain (11.0%), Canada (5.9%), or Australia (5.9%). Most focus on instruments for clinicians, regardless of their specialty (55.9%). Among profession-specific instruments (44.1%), nurses and physicians are mainly targeted. The most common domains are: (1) 'Learning/practice environment' (38.2%), (2) 'Healthcare responsibilities' (21.3%), and (3) 'Organizational factors' (19.1%). The most frequently addressed measurement properties are: (1) Internal consistency (88.2%), (2) Structural validity (75.7%), and (3) Content validity (68.4%).</p><p><strong>Conclusions: </strong>Many tools for measuring clinician well-being exist, but few are fully validated. The results of this review provide a foundation to support ongoing psychometric evaluation and cross-cultural adaptation.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"343"},"PeriodicalIF":5.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805410","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":"Adding salt to foods increases the risk of metabolic dysfunction-associated steatotic liver disease.","authors":"Han Chen, Xujun Zhang, Shujuan Lin, Qiong Wu","doi":"10.1038/s43856-025-01074-4","DOIUrl":"10.1038/s43856-025-01074-4","url":null,"abstract":"<p><strong>Background: </strong>Although salt intake has been linked to multiple cardiometabolic diseases, whether the frequency of adding salt to foods, a reasonable proxy for long-term salt intake, is related to metabolic dysfunction-associated steatotic liver disease (MASLD) incidence remains unknown.</p><p><strong>Methods: </strong>This prospective study included 494,110 UK Biobank participants (mean age 56.5 years) who were free of MASLD at baseline. Participants were followed for a median of 13.6 years. Cox proportional hazards models were used to examine the relationship between the frequency of adding salt to foods and incident MASLD. Mediation analyses explored the role of blood biomarkers, and interaction analyses assessed whether genetic factors modify this association.</p><p><strong>Results: </strong>Here, we show that among the cohort, 7171 participants develop MASLD during follow-up. Compared to people who never or rarely adding salt, those who sometimes, usually, and always add salt to foods have 7%, 20%, and 35% higher risk, respectively. This association is stronger in people with normal body mass index and those who frequently drink alcohol. Blood markers of inflammation and metabolism, such as C-reactive protein, insulin-like growth factor-1, triglycerides, and urate, partially mediate this relationship. A significant interaction is observed, with PNPLA3 genetic susceptibility amplifying the MASLD risk associated with frequently adding salt to foods.</p><p><strong>Conclusions: </strong>A higher frequency of adding salt to foods is associated with increased MASLD risk. Reducing table salt use represents a simple, actionable strategy for disease prevention, particularly for genetically susceptible individuals.</p>","PeriodicalId":72646,"journal":{"name":"Communications medicine","volume":"5 1","pages":"342"},"PeriodicalIF":5.4,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12334587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805408","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}