American Journal of Tropical Medicine and Hygiene最新文献

{"title":"Travelers Returning to Denmark with Hypereosinophilia and Ancylostoma Infections Detected Using Broad-Specificity Amplicon-Based Next-Generation Sequencing.","authors":"Christen Rune Stensvold, Gabriella Fredman, Anders Porskrog, Marie Helleberg","doi":"10.4269/ajtmh.26-0058","DOIUrl":"https://doi.org/10.4269/ajtmh.26-0058","url":null,"abstract":"<p><p>In nonendemic countries such as Denmark, hookworm infections in travelers may be rare and difficult to detect because of low-grade shedding of parasite eggs and a lack of clinical suspicion and relevant diagnostic capacity. Two cases of hookworm infection observed in 2025 that were detected only through amplicon-based next-generation sequencing (NGS) of fecal DNA are presented in the current study. Both infections were characterized by hypereosinophilia and acquired during 2-week holidays in Asia. Case 1 was infected with Ancylostoma ceylanicum during a holiday in the Philippines, and Case 2 acquired infection with Ancylostoma duodenale/caninum in Thailand. Eggs were found only in Case 2, and only after careful reexamination. These cases reveal that amplicon-based NGS is a simple and useful diagnostic adjunct when routine parasite screening triggered by eosinophilia and abdominal pain after tropical exposure fails to establish the diagnosis. Both cases were treated with ivermectin and albendazole, respectively, with good effect.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Diverse Spectrum of Presumed Ocular Tuberculosis Including Optic Neuropathy in a Tuberculosis-Endemic Region: A Case Series from India.","authors":"Anita Ambasta, Rakhi Kusumesh, Rajnee Sinha, Manish Karn, Rashmi Kumari, Gyan Bhaskar, Abhishek Ranjan, Varuni Pragya","doi":"10.4269/ajtmh.26-0076","DOIUrl":"https://doi.org/10.4269/ajtmh.26-0076","url":null,"abstract":"<p><p>Ocular tuberculosis (TB) presents with diverse clinical manifestations and remains a diagnostic and therapeutic challenge, particularly in TB-endemic regions. In addition, antitubercular therapy (ATT), especially ethambutol and linezolid, may contribute to treatment-related optic neuropathy and visual morbidity. This case series aimed to describe the clinical manifestations of presumed ocular TB and to assess the burden of ATT-induced optic neuropathy during the study duration. Diagnosis was based on clinical features, tuberculin skin test (Mantoux test) or interferon-gamma release assay (e.g., QuantiFERON-TB Gold), systemic evaluation, neuroimaging where indicated, and response to ATT. Anterior and posterior segment findings included: granulomatous uveitis (n = 2), panuveitis (n = 3), phlyctenular conjunctivitis (n = 1), serpiginous-like choroiditis (n = 3), multifocal choroiditis (n = 4), choroidal granuloma (n = 5), choroidal tubercle (n = 3), and Eales disease (n = 4). TB-associated optic neuropathy was observed in 13 patients secondary to intracranial TB. In 26 patients, ATT-induced optic neuropathy was observed. Retrobulbar optic neuritis was more frequently observed than papillitis in these cases. Favorable outcomes were observed in inflammatory ocular TB, whereas visual recovery was limited in patients with optic nerve involvement, particularly in those with intracranial disease. Treatment modification in cases of ATT-induced optic neuropathy was associated with partial visual recovery. To conclude, ocular TB demonstrates varied clinical manifestations, with significant risk of vision loss due to both disease and treatment-related toxicity. Early diagnosis, prompt initiation of ATT, and routine ophthalmic monitoring during therapy are essential to reduce visual morbidity in TB-endemic settings.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Aflatoxin Exposure, Birth Outcomes, and Infant Growth in Uganda.","authors":"Lynne M Ausman, Grace Namirembe, Julieta Mezzano, Jacqueline M Lauer, Robin Shrestha, Edgar Agaba, Bernard Bashaasha, Jeffrey K Griffiths, Elizabeth Marino-Costello, Jia-Sheng Wang, Juergen G Erhardt, Andrew T Gewirtz, Christopher P Duggan, Patrick Webb, Shibani Ghosh","doi":"10.4269/ajtmh.25-0426","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0426","url":null,"abstract":"<p><p>The association between maternal aflatoxin exposure and infant anthropometric birth and growth outcomes was investigated in the present study, controlling for possible confounders. Pregnant women (N = 1,210) from 16 Ugandan subcounties were enrolled in a birth cohort study to track birth outcomes and subsequent growth of infants. Serum concentrations of aflatoxin B1 (AFB1)-lysine adduct, environmental enteric dysfunction markers of anti-lipopolysaccharide and anti-flagellin IgG and IgA, and markers of systemic inflammation, alpha-1 acid glycoprotein, and C-reactive protein were measured in mothers at birth and infants at 6 months of age. A generalized estimating equations model with an exchangeable correlation matrix was used to assess associations between maternal AFB1 blood concentration and weight, length, weight-for-age (WAZ), length-for-age (LAZ), and weight-for-length (WLZ) Z scores. Multivariable linear and logistic regressions were used to assess the association between infant aflatoxin concentrations and growth outcomes at 3 to 6 months of age. Serum aflatoxin concentrations in women at parturition were associated with reduced birth weight (P = 0.037) and WAZ (P = 0.034), but not with other birth outcomes. Aflatoxin concentrations in infants 6 months of age were not associated with changes in weight, height, WAZ, LAZ, or WLZ between 3 and 6 months of age. The present study confirmed an association between maternal aflatoxin and specific birth outcomes, but not between infant serum aflatoxin and infant early growth, which may be due to low exposure to aflatoxin-contaminated foods in early life. This finding highlights the importance of promoting national policy actions that minimize aflatoxin contamination of local food supplies, both on farms and in markets.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asymptomatic Plasmodium falciparum Infection Was Not Associated with Exposure to Soil-Transmitted Helminths in Children in Esse, Cameroon.","authors":"Lauren Lajos, Balotin Fogang, Anne Jensen, Derrick Atchombat, Douglas H Cornwall, Christiane Donkeu, Chris-Marco Nana-Mbianda, Celine Slam, Hugues Clotaire Nana Djeunga, Bin Zhan, Paul Olivier Koki Ndombo, Lawrence S Ayong, Tracey J Lamb","doi":"10.4269/ajtmh.25-0591","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0591","url":null,"abstract":"<p><p>Asymptomatic carriage of Plasmodium falciparum is a major public health threat hindering malaria eradication. Many areas with ongoing malaria transmission are coendemic for soil-transmitted helminths (STHs). Proteins secreted by helminths can regulate host inflammatory immune responses as a survival strategy. Given that malaria is a disease mediated by inflammation, we tested the hypothesis that STH infection and/or exposure might be associated with asymptomatic Plasmodium infection. We performed a 1-month longitudinal study of 134 primary school children across three school-based study sites in Esse, Centre Region, Cameroon. At our initial screening time point, 94.8% of children were microscopy positive for P. falciparum infection, and 85.8% had asymptomatic microscopic P. falciparum infection. A total of 87.4% of children had serologic positivity for at least one STH recombinant antigen. Comparing children with asymptomatic P. falciparum infection and uncomplicated symptomatic malaria at baseline, we found no significant difference in the percentage of children with STH exposure (85.7% versus 90.9%, P >0.05). Daily temperature checks were performed over the course of 1 month to assess whether children with asymptomatic P. falciparum infection developed uncomplicated symptomatic malaria. Of the children who experienced fever, the development of fever was associated with increased reactivity to STH antigens. No correlation was found between anti-STH antibody level and P. falciparum load (P >0.05), and no association was observed between STH exposure and persistent asymptomatic P. falciparum infection. These data suggest that STH exposure is not a major factor that contributes to the asymptomatic carriage of P. falciparum in children.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trachoma Prevalence in Al Rahad Locality, Sudan: Evaluating Chlamydia trachomatis Infection Prevalence as a Complementary Programmatic Indicator.","authors":"Scott D Nash, Emmanuel A Ackah, Balgesa E Elshafie, Zeinab Abdalla, Sara Lavinia Brair, Tania A Gonzalez, Charles A Rivers, Barbara Van Der Pol, E Kelly Callahan, Angelia M Sanders","doi":"10.4269/ajtmh.26-0096","DOIUrl":"https://doi.org/10.4269/ajtmh.26-0096","url":null,"abstract":"<p><p>Trachoma remains endemic in Sudan. A 2009 baseline survey in Al Rahad locality revealed a trachomatous inflammation-follicular (TF) prevalence of 7.1%, prompting azithromycin mass drug administration (MDA). After three MDA rounds (2015-2017), a trachoma impact survey was conducted in 2017. This study's aim was to estimate the prevalence of clinical signs and ocular Chlamydia trachomatis infection identified with DNA testing. A cross-sectional, cluster-random sampling design was used, and certified graders assessed participants for clinical signs and swabbed children for C. trachomatis. The TF prevalence was 6.3% (95% CI: 4.0-10.0), and C. trachomatis prevalence was 0.8% (95% CI: 0.2-3.1). Chlamydia trachomatis infection was clustered centrally in the locality within communities with high TF prevalence. Despite MDA interventions, TF remained above the established 5% elimination threshold, and C. trachomatis infection was observed. Complementary indicators, such as C. trachomatis infection, should be considered in trachoma programs as they aid in better understanding trachoma endemicity.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Cross-Protective Responses against Mayaro Virus among Chikungunya Virus-Infected Patients from Paraguay.","authors":"Gabrielle N Kostecki, Nicolás Aguayo, Fulvia V Campuzano, Julia S Ampuero, Patricia V Aguilar","doi":"10.4269/ajtmh.25-0624","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0624","url":null,"abstract":"<p><p>Mayaro virus (MAYV) is a mosquito-borne alphavirus endemic to Latin America and the Caribbean. It is closely related to chikungunya virus (CHIKV), which has a more global circulation that overlaps with MAYV-endemic areas. Both viruses cause similar symptoms of acute febrile illness and chronic joint pain. Human studies have attempted to determine whether CHIKV can generate cross-protective immunity against MAYV because of their close genetic and antigenic relationship but could not definitively rule out past exposure to MAYV. We investigated cross-reactive MAYV responses using paired blood samples from 15 CHIKV-infected patients from Paraguay, where there have been no reported Mayaro fever cases. These samples were collected during the acute phase of the illness and 2 to 4 weeks after the onset of symptoms. Acute-phase serum samples were confirmed positive for the presence of CHIKV viral RNA with reverse transcription polymerase chain reaction. Plaque reduction neutralization tests were performed on the samples to calculate 80% plaque reduction neutralization titers for CHIKV and MAYV. Previous MAYV exposure was detected in three CHIKV patients, suggesting that past exposure to MAYV might not be sufficient to protect against CHIKV infection. Of the other CHIKV patients without prior MAYV immunity, only one third developed low MAYV cross-neutralizing antibody responses, indicating nonreciprocity in CHIKV and MAYV cross-protection. This study provides evidence of a potential silent circulation of MAYV in Paraguay, which requires further investigation. These findings have critical implications for areas coendemic for MAYV and CHIKV and provide important advances to better understand cross-protection among alphaviruses.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Words and Worms: The Nosology of Strongyloidiasis.","authors":"Christopher V Radcliffe, Joseph M Vinetz","doi":"10.4269/ajtmh.26-0113","DOIUrl":"https://doi.org/10.4269/ajtmh.26-0113","url":null,"abstract":"<p><p>Strongyloidiasis impacts millions of people on several continents. Although chronic infection is often subclinical, select forms of immune dysregulation predispose patients to severe clinical manifestations resulting from acceleration of the nematode's autoinfective cycle. The terms \"hyperinfection syndrome\" and \"disseminated strongyloidiasis\" commonly refer to these disease states; however, contemporary usage is not uniform. We herein review the origins of terms related to the nosology of strongyloidiasis and highlight important mechanisms of disease pathogenesis that make untreated strongyloidiasis highly relevant to contemporary medicine.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Sectional Analysis of Serologic Response to Arthropod-Borne and Hemorrhagic Fever Viruses in Ghanaian Livestock Herders.","authors":"Keersten Ricks, Stephanie Monticelli, Seth Offei Addo, Tamara Clements, Mba-Tihssommah Mosore, Ronald E Bentil, Janice Tagoe, Clara Yeboah, Eric Behene, William Asiedu, Daniel Mingle, Sandra Abankwa Kwarteng, Dorcas Atibilla, Victor Asoala, Christopher Stefan, Andrew Herbert, Terrel Sanders, Anne T Fox, Samuel K Dadzie, Andrew G Letizia, Randal Schoepp, Shirley C Nimo-Paintsil","doi":"10.4269/ajtmh.25-0452","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0452","url":null,"abstract":"<p><p>Zoonotic diseases account for more than 60% of emerging infectious diseases, and they are the leading cause of pandemics. As humans and livestock become increasingly transient and the environment and climate change, disease vectors expand into previously untouched geographical regions, spreading pathogens. In this study, we assessed the seroprevalence of arthropod-borne and hemorrhagic fever viruses of similar clinical presentation and endemicity in high-risk populations in Ghana (animal handlers). Using a microneutralization assay, we compared total IgG prevalence with live virus neutralizing response. In total, 300 blood samples were collected from consenting healthy adults at five military and three civilian sites across Ghana. The observed seroprevalence rates for Rift Valley fever virus (RVFV), Crimean-Congo hemorrhagic fever virus (CCHFV), Ebola virus, Lassa virus, and Marburg virus were 14.7%, 7.0%, 2.3%, 1%, and 0%, respectively. Microneutralization data further verified virus-specific neutralization positives of the total IgG positives. Among animal handlers who had recently skinned livestock, 19 (25.3%) were exposed to RVFV, and 20 (28.6%) of those in the coastal savannah ecological zone were also more likely to be exposed to RVFV compared with those in the other ecological zones (P = 0.002). Animal handlers younger than 25 years old had a higher exposure rate to CCHFV than those older than 25 years old (P <0.001). These data help us better understand the risk of exposure to zoonotic and vector-borne diseases in the region. Moreover, this study establishes methods for assessing seropositivity in a multiplexed format for higher-throughput sample analysis.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147832816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated Temperature Decreases the Insecticidal Efficacy of Yahe LN Insecticide-Treated Nets: Implications for Transport and Storage.","authors":"Holly Reichel, Melanie Koinari, Norelle L Daly, Stephan Karl","doi":"10.4269/ajtmh.25-0622","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0622","url":null,"abstract":"<p><p>A recent durability study has revealed that Yahe LN® insecticide-treated nets (ITNs; Fujian Yamei Industry & Trade Co., LTD, Fuzhou, China) distributed in Papua New Guinea (PNG) in 2021 did not retain their insecticidal efficacy after several months post-distribution. Insecticide-treated nets are frequently shipped and stored in containers where they are exposed to elevated temperatures. When used in the tropics, ITNs may continue to be exposed to high ambient temperatures. The aim for the present study is to better understand the potential impact of elevated temperature during transport and storage on the insecticidal efficacy of Yahe LN ITNs and to investigate why they failed insecticidal efficacy tests after 6 months in PNG. To achieve this aim, Yahe ITNs were stored at elevated temperatures and tested using cone bioassays. The results revealed that ITNs exposed to temperatures between 35°C and 50°C, reflective of those in shipping containers, exhibited a significantly decreased insecticidal efficacy. The present study highlights the importance of developing temperature-stable ITN products and assessing current products for temperature stability.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal Trends and Projections of Leprosy in Brazil: Application of Machine Learning Techniques for Predictive Analysis (2001-2034).","authors":"Simone Oliveira Lucas Bertoldo, Fernanda Aguiar Kucharski, Janaína Sabóia Aguiar de Azevedo, Paula Sacha Frota Nogueira, Manuela de Mendonça Figueirêdo Coelho","doi":"10.4269/ajtmh.25-0588","DOIUrl":"https://doi.org/10.4269/ajtmh.25-0588","url":null,"abstract":"<p><p>Leprosy remains a neglected tropical disease with active transmission. Predictive models improve understanding of epidemiological trends and support control strategies in endemic contexts. This study analyzed leprosy in Brazil between 2001 and 2024, projecting scenarios through 2034. Data were obtained from the National System of Notifiable Diseases, and population estimates were from the Brazilian Institute of Geography and Statistics. Temporal trends were assessed using segmented regression, and projections were generated with statistical methods and machine learning algorithms. Independent variables included sex, age, educational level, clinical form, operational classification, and bacilloscopy index. Consistent decline was observed in the overall detection rate and among individuals younger than 15 years old, suggesting reduced transmission. The proportion of cases diagnosed with grade 2 disability remained high, indicating late detection. Projections showed a gradual decline in endemicity but no elimination of leprosy as a public health problem by 2030. The random forest model identified male sex, age older than 15 years old, lower educational level, and multibacillary clinical form as the main predictors of new cases. The integration of machine learning improved the accuracy of projections and revealed persistent gaps in early diagnosis, providing evidence for targeted interventions and strengthening active surveillance and timely detection. The findings are relevant not only for Brazil but also, for other endemic countries, such as India and Indonesia, reinforcing the global need for intensified elimination strategies. The study demonstrates the potential of predictive modeling to support leprosy control and broader neglected tropical disease programs.</p>","PeriodicalId":7752,"journal":{"name":"American Journal of Tropical Medicine and Hygiene","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}