American Journal of Otolaryngology最新文献

{"title":"A non-local dual-stream fusion network for laryngoscope recognition","authors":"Ran Wei ,&nbsp;Yan Liang ,&nbsp;Lei Geng ,&nbsp;Wei Wang ,&nbsp;Mei Wei","doi":"10.1016/j.amjoto.2024.104565","DOIUrl":"10.1016/j.amjoto.2024.104565","url":null,"abstract":"<div><h3>Purpose</h3><div>To use deep learning technology to design and implement a model that can automatically classify laryngoscope images and assist doctors in diagnosing laryngeal diseases.</div></div><div><h3>Materials and methods</h3><div>The experiment was based on 3057 images (normal, glottic cancer, granuloma, Reinke's Edema, vocal cord cyst, leukoplakia, nodules and polyps) from the dataset Laryngoscope8. A classification model based on deep neural networks was developed and tested. Model performance was verified by a variety of evaluation measures, including accuracy, recall, specificity, F1-Score and area under the receiver operating characteristic curve. In addition, the Grad-Cam technology was used to visualize the feature map of the model to improve the interpretation of the network.</div></div><div><h3>Results</h3><div>The model has high classification accuracy and robustness, and can accurately classify various types of laryngoscope images. In the test set of independent individuals, the overall accuracy reaches 86.51 %, and the average area under curve value is 0.954. The performance of the model is significantly better than other existing algorithms.</div></div><div><h3>Conclusion</h3><div>This paper proposes a deep learning based automatic classification model for laryngoscope images. By integrating the output features of deep neural network ResNet and Transformer, eight laryngeal diseases can be accurately classified. This indicates that the proposed method can be effectively applied to the study of laryngeal diseases.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104565"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translational research for elucidating the relationship between chronic cough and laryngopharyngeal reflux disease","authors":"Mejdeddine Al Barajraji ,&nbsp;Jennifer Aoun ,&nbsp;Manon Louvrier ,&nbsp;Noémie Nemry ,&nbsp;Jerome R. Lechien","doi":"10.1016/j.amjoto.2024.104558","DOIUrl":"10.1016/j.amjoto.2024.104558","url":null,"abstract":"","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104558"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of TISA “Transcutaneous Implant Skin Anomalies” scale for cutaneous complications related to bone conduction hearing implants","authors":"Santiago Hernández ,&nbsp;Juan Camilo Ospina ,&nbsp;Paula Andrea Téllez ,&nbsp;María Teresa Rodríguez-Ruíz ,&nbsp;Elisa Gutiérrez-Gómez ,&nbsp;Laura Arango","doi":"10.1016/j.amjoto.2024.104554","DOIUrl":"10.1016/j.amjoto.2024.104554","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the use of the TISA (Transcutaneous Implant Skin Anomalies) scale by members of the Colombian Association of Otology (ACON) in the evaluation of patients using bone conduction implants.</div></div><div><h3>Methods</h3><div>A cross-sectional descriptive observational study was conducted among the members of the Colombian Association of Otology. A voluntary survey was performed, where participants evaluated images of patients with transcutaneous bone conduction implants exhibiting different skin conditions. Additionally, they provided their expert opinions on the scale's face validity.</div></div><div><h3>Results</h3><div>90 % (36/40) of the Colombian Association of Otology members participated in the survey, with 79.4 % (286/380) of correct answers when compared to the initial assessment made by the otologist who captured the pictures. Otologists unanimously agreed that it is easy to apply in follow-up consultations and 77.7 % believed that the scale covered all possible complications.</div></div><div><h3>Conclusion</h3><div>The TISA scale is useful to classify skin complications in patients with transcutaneous bone conduction implants. Its application is both easy and quick, facilitating efficient comparisons in follow-ups or between different otologists.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104554"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral internal superior laryngeal nerve injections for unexplained chronic cough","authors":"Andrew Jay Bowen ,&nbsp;Ariel Roitman ,&nbsp;Sydney Ring ,&nbsp;David O. Francis ,&nbsp;Ruth J. Davis ,&nbsp;Timothy McCulloch ,&nbsp;Seth H. Dailey","doi":"10.1016/j.amjoto.2024.104568","DOIUrl":"10.1016/j.amjoto.2024.104568","url":null,"abstract":"<div><h3>Objective</h3><div>Internal Superior laryngeal nerve (iSLN) injections with steroids and anesthetic for Unexplained Chronic Cough (UCC) was initially described as a unilateral injection. This study reports the safety profile and patient-reported outcomes of concurrent bilateral iSLN injections for UCC.</div></div><div><h3>Study design</h3><div>Retrospective chart review.</div></div><div><h3>Setting</h3><div>Tertiary center.</div></div><div><h3>Methods</h3><div>A chart review from 2018 to 2023 was performed for patients with UCC who underwent bilateral iSLN injections. Demographics, clinical history, and physical exam findings were recorded, along with any post-injection complications. The primary outcome was patient-reported percent improvement in cough symptoms. Nonparametric statistical analyses were performed to examine whether treatment effectiveness differed based on (a) duration of cough, (b) whether an upper respiratory illness (URI) preceded the start of the cough, (c) had undergone prior speech therapy or (d) neuromodulator treatment for cough, (e) laterality of symptoms, and (f) demonstrated abnormal flexible laryngoscopy/stroboscopy findings.</div></div><div><h3>Results</h3><div>12 UCC patients underwent a median of 2 injections (Interquartile Range (IQR): 1–5.5 injections) for a total of 42 injections). There were no aspiration events and only 3 self-limited minor complications. 75 % of patients reported improvement with at least one of their injections with a median percentage response of 73 % (IQR: 26–89 %) and a reported median duration of response of 2.2 months (IQR: 1.2–3.2 months). Nonparametric testing revealed greater responses to injection in patients with abnormal flexible laryngoscopy/stroboscopic findings with their initial injection (<em>p</em> ≤0.02).</div></div><div><h3>Conclusion</h3><div>Bilateral concurrent iSLN injections are a safe and effective way of treating UCC that may require fewer visits to effectively treat UCC.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104568"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of open airway reconstruction in high-risk post-COVID patients: A case-matched control study","authors":"Benjamin van der Woerd ,&nbsp;Ryan S. Ziltzer ,&nbsp;Anna Mathew ,&nbsp;Karla O'Dell","doi":"10.1016/j.amjoto.2024.104540","DOIUrl":"10.1016/j.amjoto.2024.104540","url":null,"abstract":"<div><h3>Objectives</h3><div>COVID-19 pneumonia patients may have high rates of intubation and reduced pulmonary function once recovered. Poor pulmonary function is a relative contraindication to open airway reconstruction, post-COVID patients may extrapolate as high-risk for open airway reconstruction. This presents challenges in airway stenosis management of post-COVID pneumonia patients. This study reports the safety and outcomes of open airway reconstruction in carefully selected post-COVID patients.</div></div><div><h3>Methods</h3><div>A retrospective case-matched control study of six post-COVID tracheal stenosis cases treated with tracheal resection and six matched controls. Controls were matched based on age, length of stenosis, and comorbidities. Primary outcomes are peri-operative safety events and need for future airway interventions.</div></div><div><h3>Results</h3><div>Post-COVID cases and non-COVID controls were closely matched on age, length of stenosis, and comorbidities (<em>p</em> &gt; 0.05). Duration of follow-up was not significantly different (<em>p</em> = 0.1894). No patients required reintubation, tracheostomy, ICU admission, or ventilator placement in the peri-operative period. There was one allergic reaction to antibiotics in a case and one aspiration pneumonia in a control. One case required in-office steroid injection and injection augmentation post-operatively, but no patients from either group required future operative airway intervention during the follow-up period.</div></div><div><h3>Conclusion</h3><div>Post-COVID tracheal stenosis cases had comparably excellent outcomes with matched controls after open tracheal construction, with few peri-operative safety events and minimal need for future interventions. These data indicate open airway reconstruction is a safe and effective option for the treatment of tracheal stenosis in carefully selected post-COVID patients.</div></div><div><h3>Level of evidence</h3><div>4</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104540"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The added value of narrow band imaging in Sinonasal tumour resection and surveillance: Our experience","authors":"Yazan Kanaan ,&nbsp;Ra'ed Al-Ashqar ,&nbsp;Hisham Khalil ,&nbsp;Konstantinos Geronatsios ,&nbsp;Marios Stavrakas","doi":"10.1016/j.amjoto.2024.104534","DOIUrl":"10.1016/j.amjoto.2024.104534","url":null,"abstract":"<div><h3>Background &amp; purpose</h3><div>Narrow Band Imaging (NBI), developed by Olympus Medical Systems, has played a role in diagnosing digestive tract lesions and cancers, diagnosing and characterizing bladder cancers during cystoscopy and in the diagnosis and management of Head and Neck cancers. We aim to explore the potential use of NBI in the diagnosis, management, and follow-up of sinonasal tumours.</div></div><div><h3>Methods</h3><div>We present a series of cases treated at our institution, where NBI played a crucial role in the diagnosis, surgical management, intraoperative decision-making, and follow-up. The cases include a patient with sinonasal lymphoma, 2 patients with sinonosal malignant melanoma and a patient with olfactory neuroblastoma.</div></div><div><h3>Results</h3><div>In our experience, NBI proved beneficial not only in detecting otherwise unseen nasal lesions but also in targeted biopsies and intraoperative planning, on some occasions altering the course of treatment. NBI may also be a simple, inexpensive surveillance method for detecting sinonasal tumours recurrence after excision.</div></div><div><h3>Conclusion</h3><div>While there are limitations to its use, there is potential for NBI to be of significant use in rhinology practice, reducing morbidity and tumour recurrence rates and streamlining the diagnostic and surveillance process.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104534"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construction and validation of a prognostic nomogram for idiopathic sudden sensorineural hearing loss based on a multicenter retrospective study","authors":"Chao-qun Hong ,&nbsp;Qiao-fei Jia ,&nbsp;Jing-jing Zhu ,&nbsp;Hua-jun Lu","doi":"10.1016/j.amjoto.2024.104556","DOIUrl":"10.1016/j.amjoto.2024.104556","url":null,"abstract":"<div><h3>Background</h3><div>Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden hearing loss of unknown etiology, with complex and diverse prognostic factors.</div><div>Aim</div><div>This study aims to identify independent prognostic factors for ISSNHL and to construct and validate a nomogram based on these factors.</div></div><div><h3>Methods</h3><div>This study collected multicenter retrospective data and compared the differences between effective treatment and ineffective treatment groups in terms of age, vertigo, and several serum markers. Significant prognostic factors were identified using univariate Logistic regression analysis, followed by multivariate Logistic regression to identify independent prognostic factors. Based on the results of the multivariate Logistic regression, a nomogram was constructed in the training set and its applicability was validated in both internal and external validation sets.</div></div><div><h3>Results</h3><div>A total of 400 ISSNHL patients were included in the study. Multivariate Logistic regression analysis identified age, vertigo, FIB, MLR, and CRP/Alb as independent prognostic factors. The nomogram demonstrated good predictive performance in the training set, internal validation set, and external validation set, with C-indices of 0.78, 0.79, and 0.78, respectively.</div></div><div><h3>Conclusion</h3><div>This study identified independent prognostic factors for the treatment efficacy of ISSNHL and developed a nomogram with good predictive performance. This nomogram can provide clinicians with individualized prognostic assessments and treatment decision support, thereby improving the treatment outcomes and prognosis for ISSNHL patients.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104556"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Newborn screening for deafness genes with cord blood-based multicolour melting curve analysis","authors":"Xianning Dai ,&nbsp;Kai Xu ,&nbsp;Liya Dai ,&nbsp;Xi Chen ,&nbsp;Haibin Xie ,&nbsp;Yu Zhang ,&nbsp;Huizhen Zheng ,&nbsp;Qian Wang ,&nbsp;Binjiao Zheng ,&nbsp;Yu Tong","doi":"10.1016/j.amjoto.2024.104530","DOIUrl":"10.1016/j.amjoto.2024.104530","url":null,"abstract":"<div><h3>Background</h3><div>The purpose of the research was to examine the prevalence rates of screening for genetics and hearing simultaneously in neonates and provide scientific evidence for the beneficial application of newborn screening in the Southeast China population.</div></div><div><h3>Methods</h3><div>Between June 2015 and March 2023, 27,843 newborns were enrolled in the study. All participants were screened by otoacoustic emissions at 2 days of age. Fifteen variant hotspots in the four deafness genes (<em>GJB2</em>, <em>GJB3</em>, <em>SLC26A4</em> and <em>MTRNR1</em>) were detected using multicolour melting curve analysis. Newborn screening data were also analysed.</div></div><div><h3>Results</h3><div>In otoacoustic emissions testing, 244 newborns (0.88 %) failed the secondary screening. According to genetic testing, 1307 (4.69 %) newborns had at least one variant. <em>GJB2</em> c.235delC (2.34 %) and <em>SLC26A4</em> c.919-2 A &gt; G (0.91 %) were the major deafness-related variants in the Wenzhou area of Southeast China. In addition, a difference in the number of newborns with variants was observed between the passed and failed groups. The difference in the positive rate between the two groups was statistically significant (<em>χ</em>^<em>2</em> = 274.969, <em>P</em> &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>Newborn screening for deafness genes by cord blood-based melting curve analysis can be applied to genetic counselling, prenatal diagnosis, and genetic screening of newborns with sensorineural hearing impairment with an unknown cause. The new PCR melting curve analysis approach is more effective and more convenient than SNaPshot and MS-based assay testing. Furthermore, it has a lower cost and is more suitable for clinical testing.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104530"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142862997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Racial and ethnic disparities in Meniere's disease clinical trials: A systematic review","authors":"Alexa N. Pearce,&nbsp;Soroush Farsi,&nbsp;Carissa Saadi,&nbsp;Olivia Speed,&nbsp;John Dornhoffer,&nbsp;Robert A. Saadi","doi":"10.1016/j.amjoto.2024.104579","DOIUrl":"10.1016/j.amjoto.2024.104579","url":null,"abstract":"<div><h3>Objective</h3><div>Our study aims to shed light on racial, ethnic, and geographic disparities in phase 2/3 Meniere's disease (MD) clinical trials, with the ultimate goal of enhancing the inclusivity and effectiveness of future MD research.</div></div><div><h3>Methods</h3><div>We conducted a systematic review of phase 2/3 MD Randomized Controlled Trials (RCTs). Using the search terms “Meniere's Disease” and “Endolymphatic hydrops”, we searched <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> and PubMed for RCTs taking place from January 2004 to October 2024. Race (self-identification with one or more groups, such as White, Black, Asian, etc.) and ethnicity (Hispanic or non-Hispanic) data were extracted for each RCT.</div></div><div><h3>Results</h3><div>Twenty-eight RCTs were included in the analysis (2455 total participants). Thirteen of the clinical trials took place in Europe. One took place across Europe and in the United States. Nine RCTs took place in North America. Three RCTs took place in Asia, and two took place in Central or South America. Eight of the studies published comprehensive race data. Across these RCTs, 93.9 % of participants were Caucasian. 2.8 % identified as African American/Black, and 0.8 % identified as Asian. 0.3 % of participants were American Indian/Alaskan Native. 2.2 % identified as other or unspecified. None identified as Native Hawaiian/Pacific Islander.</div></div><div><h3>Discussion</h3><div>The assessed RCTs demonstrated a demographic spread in line with the presumed increased susceptibility of White individuals to MD. However, less than a third of included studies reported race and ethnicity data. These findings underscore the necessity for future MD RCTs to focus on reporting racial and ethnic diversity to better understand generalizability of results.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104579"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using fresh frozen cadaveric rib cartilage graft for nasal septal perforation repair","authors":"Parker Tumlin,&nbsp;Amani Kais,&nbsp;Chadi A. Makary","doi":"10.1016/j.amjoto.2024.104590","DOIUrl":"10.1016/j.amjoto.2024.104590","url":null,"abstract":"<div><h3>Introduction</h3><div>The anterior ethmoidal artery (AEA) flap has been demonstrated to be a reliable option for endoscopic repair of symptomatic nasal septal perforations. The use of fresh frozen cadaveric rib cartilage has been described as a safe alternative graft for rhinoplasty procedures.</div></div><div><h3>Goal</h3><div>The aim of this study was to discuss our initial outcomes of use of cadaveric rib cartilage graft in combination with the AEA flap in endoscopic nasal septal perforation repair.</div></div><div><h3>Methods</h3><div>A single institution retrospective case series of all consecutive patients who underwent repair of nasal septal perforation utilizing the AEA flap combined with a cadaveric rib cartilage between December of 2022 to August of 2024 was conducted. Demographics and comorbidities were collected preoperatively. The main outcome of this study was surgical success rate defined as closure of the septal perforation.</div></div><div><h3>Results</h3><div>Six patients were included. Four out of six patients had previously failed septal perforation repair, and two patients had a concomitant open septorhinoplasty after raising the AEA flap endoscopically. Overall success rate for complete closure was 100 % with mean follow up of 9.5 months (range of 2–22 months). No major or minor direct postoperative adverse events were encountered.</div></div><div><h3>Conclusion</h3><div>Initial outcomes of use of the endoscopic AEA flap in combination with a cadaveric rib cartilage graft for closure of a nasal septal perforation are promising. Future studies with larger sample sizes and longer follow up time would be useful to verify these outcomes.</div></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"46 1","pages":"Article 104590"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}