David Hettle, Mustafa Elsayed, Samuel Mensah, Francesca Neuberger, Debbie Nolder, Hristina Vasileva, Kevin Tetteh, Tim Cutfield, Imogen Jones, Spencer Polley, Louise Turner, Thomas Lavstsen, Colin Sutherland, Peter Chiodini, Izak Heys
{"title":"A case of <i>Plasmodium falciparum</i> malaria presenting 13 years after leaving an endemic area.","authors":"David Hettle, Mustafa Elsayed, Samuel Mensah, Francesca Neuberger, Debbie Nolder, Hristina Vasileva, Kevin Tetteh, Tim Cutfield, Imogen Jones, Spencer Polley, Louise Turner, Thomas Lavstsen, Colin Sutherland, Peter Chiodini, Izak Heys","doi":"10.1080/23744235.2025.2505078","DOIUrl":"10.1080/23744235.2025.2505078","url":null,"abstract":"<p><p><i>Plasmodium falciparum</i> usually causes an acute malaria infection, with symptoms presenting from 8 to 11 days onwards following inoculation by an infected mosquito. However, evidence suggesting chronic carriage of blood-stage infection, which can lead to recrudescence of parasitaemia as immunity wanes, has been documented in migrants from malaria-endemic to non-endemic regions. We report the case of a pregnant patient who presented in late 2020 with symptomatic <i>P. falciparum</i> malaria, having lived continuously in areas non-endemic for malaria (Spain and the UK) for 13 years. The patient was originally from Equatorial Guinea but had not visited a malaria-endemic region since leaving Africa in 2007. Serological characterisation of peripheral antibodies circulating 4 months prior to, during and 2 months after the acute malaria episode suggests induction of IgG recognising placental malaria-specific antigens during the pregnancy. These antibodies waned in titre following successful treatment of the acute malaria episode. Immunological recognition of other blood-stage parasite antigens prior to the acute episode was seen, consistent with an ongoing chronic infection, presumably contracted during childhood before the individual left Equatorial Guinea 13 years earlier. This represents one of the longest-documented periods between exposure and eventual clinical presentation with <i>P. falciparum</i> malaria, and the longest described in a pregnant patient. Our findings have implications for eradication programmes and patient care, with the need to consider <i>P. falciparum</i> infection in patients who have migrated to malaria non-endemic settings, particularly those with altered physiological states such as pregnancy, despite absence of a recent travel history to an endemic region.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"687-694"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Heterogeneity in the seroprevalence of hepatitis E virus among hospital attendees: a retrospective study in Shanghai, China.","authors":"Jie Lu, Qing Li, Chenxi Zhang, Ziqiang Li, Qing Guo, Zhujun Cao, Yu-Feng Yao, Qing Xie","doi":"10.1080/23744235.2025.2471819","DOIUrl":"10.1080/23744235.2025.2471819","url":null,"abstract":"<p><strong>Background: </strong>Hepatitis E virus (HEV) infection is endemic in China. However, there are scarce data of HEV infection among hospital attendees seeking medical treatment or examination for various reasons.</p><p><strong>Objective: </strong>We aim to investigate the prevalence and incidence of HEV infection by time, age, sex, and across departments in a tertiary hospital.</p><p><strong>Methods: </strong>Paired results of anti-HEV immunoglobulin G (IgG) and IgM of 31,181 unique subjects during 2021-2022 were analysed.</p><p><strong>Results: </strong>Overall seropositivity (95% confidence interval) of anti-HEV IgG and IgM was 41.25% (40.71%-41.80%) and 2.35% (2.19%-2.53%), respectively. Acute hepatitis E was more prevalent during winter-early spring and among adults aged 31-70. Anti-HEV IgG seroprevalence increased with age, levelling off at > 60 years of age. Not only the seropositivity, but also the levels of anti-HEV IgG were significantly lower in women than men of middle and old age. Young patients from the Department of Neurology had a significantly higher ratio of past HEV infection, while patients with manifestations of hepatitis, gastrointestinal symptoms or hematological diseases had higher seropositivity of anti-HEVIgM and should have high priority to HEV screening.</p><p><strong>Conclusion: </strong>Heterogeneity of HEV seroprevalence was noted at different times of the year, between sexes, among age groups and across departments in general hospital. The concentration of HEV-infected patients in a few departments supports a more focused screening strategy in health-care settings.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"647-657"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Risk factors and clinical outcomes in patients with HCV eradication by direct-acting antivirals: a systematic review and meta-analysis.","authors":"Hualing Li, Jiahuan Jiao, Yuyi Gu, Yu Zeng, Yunjian Sheng","doi":"10.1080/23744235.2025.2493370","DOIUrl":"10.1080/23744235.2025.2493370","url":null,"abstract":"<p><strong>Background: </strong>In hepatitis C patients with sustained virologic response (SVR) achieved after direct-acting antivirals (DAAs), the incidence of adverse clinical outcomes can be reduced but not completely eliminated. This meta-analysis aims at estimating the incidence of clinical outcomes in hepatitis C patients after achieving SVR with DAAs.</p><p><strong>Methods: </strong>Literature search was carried out in PubMed, Cochrane Library database, Web of Science, and Embase. The primary endpoint was the incidence of hepatocellular carcinoma (HCC) occurrence, HCC recurrence, decompensated cirrhosis, and liver-related mortality, following DAA-induced elimination of hepatitis C virus (HCV). Subgroup analyses were performed according to age, gender, comorbidities, region, fibrosis stage, presence of decompensation, duration of follow-up, start point of follow-up, and HCC treatment modality. Furthermore, meta-regression was performed to explore sources of high heterogeneity.</p><p><strong>Results: </strong>Finally, 132 articles were included in our study. The pooled HCC occurrence rate was 1.50/100 person-years (95% CI, 1.35-1.65), HCC recurrence rate was 17.00/100 person-years (95% CI, 13.83-20.42), decompensation rate was 0.30/100 person-years (95% CI, 0.16-0.48), and liver-related mortality was 0.32/100 person-years (95% CI, 0.14-0.56). Meta-regression showed that duration of follow-up and fibrosis grade were important contributors to HCC occurrence. Age, start point of follow-up, and duration of follow-up were important contributors to HCC recurrence rate.</p><p><strong>Conclusion: </strong>Patients with DAA-induced HCV elimination remain at risk for adverse outcomes, particularly those with cirrhosis and HCC history. The exposure to adverse outcomes tended to decrease over time, and the frequency and intensity of follow-up might be reduced in the future, which will require new scoring models to identify these individuals.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"597-627"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin B Laupland, Adam G Stewart, Felicity Edwards, Patrick N A Harris, Sonali Coulter
{"title":"Community-onset bloodstream infection among people with opioid use disorders: a twenty-year population-based cohort study in Queensland, Australia.","authors":"Kevin B Laupland, Adam G Stewart, Felicity Edwards, Patrick N A Harris, Sonali Coulter","doi":"10.1080/23744235.2025.2471823","DOIUrl":"10.1080/23744235.2025.2471823","url":null,"abstract":"<p><strong>Background: </strong>Few studies have examined infection risk related to opioid misuse in non-selected populations.</p><p><strong>Objectives: </strong>We sought to identify clinical factors and outcomes among adults with opioid use disorder-associated bloodstream infections (BSI)in Queensland, Australia.</p><p><strong>Methods: </strong>All Queensland residents aged ≥20 years with incident community-onset BSI hospitalised within the public healthcare system during 2000-2019 were included. Patients with opioid use disorders were identified and clinical and outcome information obtained using state-wide databases.</p><p><strong>Results: </strong>77,392 community-onset BSIs occurred among 66,424 individuals of which 828 (1.3%) patients were diagnosed with an opioid use disorder. Subjects with opioid use disorders were younger and less likely to have healthcare-associated infections. While the prevalence of nearly all co-morbidities evaluated was higher among subjects without opioid use disorders, patients with opioid use disorders were six times more likely to have liver disease. Endocarditis was eight times more likely among subjects with opioid use disorders, and these patients were more likely to be infected with <i>Staphylococcus aureus</i> and/or yeasts, and less likely <i>Escherichia coli</i> as compared to those without opioid use disorders. The median hospital stays were 18 and 8 days and crude all cause 30-day case-fatality was 5.1% versus 11.4% for those with and without opioid use disorders, respectively (<i>p</i> < 0.001 for each). After adjusting for confounding variables, an opioid use disorder was not associated with increased risk for death (adjusted odds ratio; 1.0; 95% confidence interval, 0.7-1.4; <i>p</i> = 0.9).</p><p><strong>Conclusion: </strong>Opioid use disorders are potentially modifiable conditions that are associated with a major burden of BSI-related disease.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"669-675"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristina Nyström, Edward Trybala, Joanna Said, Anette Roth, Marianela Patzi Churqui, Ambjörn Kärmander, Tomas Cihlar, John P Bilello, Tomas Bergström, Martin Lagging
{"title":"Remdesivir is active <i>in vitro</i> against tick-borne encephalitis virus and selects for resistance mutations in the viral RNA-dependent RNA polymerase.","authors":"Kristina Nyström, Edward Trybala, Joanna Said, Anette Roth, Marianela Patzi Churqui, Ambjörn Kärmander, Tomas Cihlar, John P Bilello, Tomas Bergström, Martin Lagging","doi":"10.1080/23744235.2025.2468510","DOIUrl":"10.1080/23744235.2025.2468510","url":null,"abstract":"<p><strong>Background: </strong>Tick-borne encephalitis (TBE) is a neurological disease caused by the tick-borne encephalitis virus (TBEV). Despite available vaccines, breakthrough infections occur, some fatal.</p><p><strong>Objectives: </strong>As no antiviral therapy for TBE is currently approved, this study evaluated the <i>in vitro</i> activity of already licenced remdesivir (RDV) and sofosbuvir (SOF) for possible drug repurposing against TBEV.</p><p><strong>Methods: </strong>TBEV was cultured in A549 cells, and the inhibitory effects of RDV (GS-5734), its parent nucleotide GS-441524, and SOF (GS-7977) were assessed.</p><p><strong>Results: </strong>After 78 h, RDV demonstrated significantly lower EC<sub>50</sub> values than SOF (0.14 vs. 11 µM) based on TBEV RNA levels measured by RT-qPCR. RDV also had a lower mean EC<sub>50</sub> (0.55 µM) compared to GS-441524 and SOF (>8.9 and 13.1 µM, respectively) using crystal violet staining after 5 days. After 11 passages of TBEV in the presence of RDV, emergence of virus with a higher EC<sub>50</sub> (1.32 vs. 0.55 µM) was detected with two mutations (L3122F and Y3278F) in NS5, the viral RNA-dependent RNA polymerase (RdRp), and one substitution in envelope (E) protein (E402G). Similarly, SOF resistance appeared after 20 passages, increasing EC<sub>50</sub> values (35.5 vs. 10 µM).</p><p><strong>Conclusion: </strong>RDV exhibits potent <i>in vitro</i> antiviral activity against TBEV via specific targeting of the viral RdRp as confirmed by the emergence of resistance-associated double NS5 substitutions <i>in vitro</i> in the presence of RDV. While the potential <i>in vivo</i> implications of the observed RDV resistance remain to be determined, these <i>in vitro</i> data support further assessment of RDV for the treatment of TBEV infection.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"628-635"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Siri Westborg, Karin Elfving, Ylva Lindroth, Lisa Stark, Karolina Gullsby, Åsa Gylfe, Björn Herrmann
{"title":"Assessment of <i>Chlamydia trachomatis</i> testing in Sweden 2016-2023 and the incidence of associated complications.","authors":"Siri Westborg, Karin Elfving, Ylva Lindroth, Lisa Stark, Karolina Gullsby, Åsa Gylfe, Björn Herrmann","doi":"10.1080/23744235.2025.2523593","DOIUrl":"https://doi.org/10.1080/23744235.2025.2523593","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess chlamydia diagnostics in different clinic types, including internet-based self-sampling (IBSS). Furthermore, we investigated the incidence of chlamydia-associated complications.</p><p><strong>Methods: </strong>Data on <i>Chlamydia trachomatis</i> (CT) testing were retrieved from six healthcare regions in the years 2016-2023 across different categories of testing facilities. National data on CT diagnostics and number of PID, ectopic pregnancy and infertility cases were obtained from Swedish health authorities.</p><p><strong>Results: </strong>The number of CT cases detected through IBSS increased by 85% from 2016 (<i>n</i> = 1967) to 2023 (<i>n</i> = 3644) when it accounted for 43% of all cases. The proportion of CT-positive individuals of all tested persons was similar for IBSS (7.0-8.5% per year); STI clinics (8.5-9.9%) and youth clinics (9.7-10.9%). In contrast, gynaecology clinics had a low proportion of CT-positive individuals (1.8-2.3%), and primary healthcare clinics a decreasing proportion (2016: 4.8%; 2023: 3.0%). For women in Sweden aged 15-39 years, there was a 33% decrease in detected CT cases from 2008 to 2022 (1577-1048 cases/100,000 women) while PID rates decreased by 63% from 2008 to 2022 (224-83 cases/100,000 women).</p><p><strong>Conclusions: </strong>IBSS has become the most important CT case detector in Sweden. Primary care and gynaecology clinics have low positivity rates. The decrease in PID rates may be due to generous CT testing, although other explanations are possible. Considering the low positivity rates in some clinic types and that asymptomatic CT cases have a low PID rate a reduced testing may be justified.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"1-11"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marianela Patzi-Churqui, Hao Wang, Timur Tunovic, Fredy Saguti, Karolina Rembeck, Kristina Nyström, Magnus Lindh, Heléne Norder
{"title":"Measures against SARS-CoV-2 in Sweden were more efficient against rhinovirus infections in older adults than in children: a molecular epidemiology perspective.","authors":"Marianela Patzi-Churqui, Hao Wang, Timur Tunovic, Fredy Saguti, Karolina Rembeck, Kristina Nyström, Magnus Lindh, Heléne Norder","doi":"10.1080/23744235.2025.2516656","DOIUrl":"https://doi.org/10.1080/23744235.2025.2516656","url":null,"abstract":"<p><strong>Background: </strong>Acute respiratory infections (ARIs) are a major global health concern, particularly for children and the elderly. Although rhinoviruses are the primary pathogens causing ARIs, their epidemiology during reduced population mobility and behavioral changes is not well understood. This study aimed to assess whether the Swedish COVID-19 measures changed the epidemiology of Rhinovirus and ARI-causing viruses other than SARS-CoV-2 in the western part of Sweden in 2020.</p><p><strong>Methods: </strong>A total of 13,791 nasopharyngeal samples from ARI-patients were analyzed for 19 different viruses and bacteria by qPCR. Of the 3,607 samples positive for any virus, 2,018 were positive for rhinovirus (RV) and enterovirus (EV), and 106 contained adenoviruses. Among the EV/RV reactive samples, 249 strains were typed using partial sequencing of 5'UTR and 204 by VP1 or VP4-VP2.</p><p><strong>Results: </strong>After week 12 when the interventions were implemented, most of the ARI-causing viruses were EV/RV and adenoviruses, besides SARS-CoV-2. In September-October 2020, an outbreak caused by RV-A strains predominantly infected children younger than 13 years and individuals within the age range of their parents. RV-A strains were identified in 118 of 242 (49%) RV-positive samples, followed by RV-C (36%) and RV-B (10%). Before the first wave of SARS-CoV-2, a RV-C outbreak affected all age groups.</p><p><strong>Conclusions: </strong>This study shows that the moderate Swedish interventions against SARS-CoV-2 were more effective against the spread of ARI-causing virus among adults over 56 years than among young children. These results suggest the need for new strategies for preventing the spread of ARI pathogens like RV and EV, which cause disease in all age groups and can lead to large outbreaks.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"1-12"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144289768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Josefina Robertson, Arvid Edén, Aylin Yilmaz, Lars-Magnus Andersson, Lars Hagberg, Kristina Nyström, Staffan Nilsson, Carl-Johan Treutiger, Petra Tunbäck, Johanna M Gostner, Henrik Zetterberg, Magnus Gisslén
{"title":"Increased immune activation in people living with HIV on antiretroviral therapy but not when compared with persons on HIV preexposure prophylaxis.","authors":"Josefina Robertson, Arvid Edén, Aylin Yilmaz, Lars-Magnus Andersson, Lars Hagberg, Kristina Nyström, Staffan Nilsson, Carl-Johan Treutiger, Petra Tunbäck, Johanna M Gostner, Henrik Zetterberg, Magnus Gisslén","doi":"10.1080/23744235.2025.2515157","DOIUrl":"https://doi.org/10.1080/23744235.2025.2515157","url":null,"abstract":"<p><strong>Background: </strong>Residual immune activation is common in people living with HIV (PWH) despite antiretroviral therapy (ART) and may be associated with HIV-specific, as well as lifestyle-related factors.</p><p><strong>Objective: </strong>We aimed to investigate markers of immune activation and neuronal injury in PWH on ART compared with controls with similar lifestyle.</p><p><strong>Methods: </strong>Cerebrospinal fluid (CSF) and blood were collected from 50 men who have sex with men (MSM) with HIV on ART, 50 HIV-negative MSM on preexposure prophylaxis (PrEP), and 25 HIV-negative controls without PrEP. β2-microglobulin, neopterin, and neurofilament light protein (NfL) were analyzed. Cytomegalovirus and herpes simplex virus-2 serostatus, as well as sexually transmitted bacterial infections were registered.</p><p><strong>Results: </strong>Serum and CSF β2-microglobulin and neopterin did not differ significantly between MSM with HIV and MSM on PrEP. However, both groups had significantly higher serum levels of β2-microglobulin and neopterin compared with HIV-negative controls without PrEP. Age-adjusted CSF NfL levels were also similar in MSM with HIV and MSM on PrEP, but higher than in controls without PrEP. A recent syphilis infection was associated with increased immune activation in CSF and blood.</p><p><strong>Conclusion: </strong>Increased levels of immune activation and neuronal injury markers were found in virologically suppressed MSM with HIV and MSM on PrEP compared with controls. These findings imply that other factors than HIV contribute to the residual immune activation and impact on neurons observed in MSM with HIV on ART, and emphasize the importance of appropriate controls with similar lifestyle in studies of biomarkers in PWH.</p>","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Krishna Prasad Acharya, Sarita Phuyal, AbdulRahman A Saied, Seohyun Hong, Dong Keon Yon
{"title":"Don't let war and conflict impede rabies control in Iraq.","authors":"Krishna Prasad Acharya, Sarita Phuyal, AbdulRahman A Saied, Seohyun Hong, Dong Keon Yon","doi":"10.1080/23744235.2025.2514243","DOIUrl":"https://doi.org/10.1080/23744235.2025.2514243","url":null,"abstract":"","PeriodicalId":73372,"journal":{"name":"Infectious diseases (London, England)","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}