Annals of African Medicine最新文献

{"title":"Uterine Artery Doppler Resistance before and during Pregnancy: Insights from an African Population.","authors":"Yaw Amo Wiafe, Prince Nyansah Adotey, Keren Kwegyan, Benedict Apaw Agyei, Ijeoma C Anyitey-Kokor, Charles Mawunyo Senaya, Andrew Donkor","doi":"10.4103/aam.aam_875_25","DOIUrl":"https://doi.org/10.4103/aam.aam_875_25","url":null,"abstract":"<p><strong>Objective: </strong>This study assessed the extent of uterine artery resistivity during pregnancy compared to the nonpregnant state and established reference ranges for an African population.</p><p><strong>Methods: </strong>A multicenter observational study was conducted, involving 745 females (pregnant and nonpregnant) in Ghana. Transabdominal Doppler ultrasound assessments were performed to measure resistive index (RI) and pulsatility index (PI) in the nongravid and pregnant women presenting for prenatal ultrasound at different gestational stages. Statistical analyses, including Kruskal-Wallis tests and multiple linear regression, were used to evaluate differences in Doppler indices.</p><p><strong>Results: </strong>The mean PI and RI for the nongravid uterus are 2.07 and 0.77, respectively. In the first trimester (<12 weeks), PI declines by 31.93%, while RI decreases modestly by 9.28%. By 12-16 weeks, PI and RI decline further by 44.25% and 12.81%, respectively, suggesting ongoing arterial remodeling. The most significant drop occurs between 17-24 weeks, where PI falls by 64.54% and RI by 22.22%, reflecting substantial vascular dilation. After 24 weeks, the PI declines beyond 70% decline and the RI beyond 24%.</p><p><strong>Conclusion: </strong>These findings establish critical reference benchmarks, where deviations from expected declines may indicate a pregnancy complication warranting closer clinical monitoring.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697292","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":"Comparative Efficacy of Ulinastatin and Vitamin C in Burn-associated Sepsis: A Randomized Controlled Trial.","authors":"Naveen Kumar, Anshu Singh, Ravi Kumar, Manish Kumar, Ajay Kumar Chaudhary","doi":"10.4103/aam.aam_15_26","DOIUrl":"https://doi.org/10.4103/aam.aam_15_26","url":null,"abstract":"<p><strong>Introduction: </strong>Sepsis remains a leading cause of morbidity and mortality in burn patients due to inflammatory dysregulation and immune impairment. Adjunctive therapies such as ulinastatin and Vitamin C may attenuate inflammation and improve organ function, but comparative evidence in burn-associated sepsis is limited. This study compared ulinastatin and Vitamin C in burn patients with sepsis, focusing on survival, organ dysfunction, and inflammatory biomarkers.</p><p><strong>Materials and methods: </strong>This prospective, randomized, triple-blind controlled trial was conducted over 1 year in the burn intensive care unit (ICU) of a tertiary care center. Seventy adult patients (≥18 years) with 10%-40% total body surface area thermal burns and sepsis as per Sepsis-3 criteria were randomized to receive either ulinastatin (200,000 IU intravenous [IV]) or Vitamin C (1.5 g IV) for 3 days. Biomarkers (interleukin [IL-6], C-reactive protein [CRP], procalcitonin [PCT], and lactate) and clinical parameters (PaO2/FiO2 [P/F] ratio and ICU stay) were assessed at baseline and at 24, 48, and 72 h.</p><p><strong>Results: </strong>Both the groups showed clinical and biomarker improvement over time. Ulinastatin resulted in significantly greater reductions in IL-6 and CRP by 72 h and was associated with shorter ICU stays, reduced vasopressor requirement, and improved P/F ratio compared to the Vitamin C group. PCT decreased more significantly in the Vitamin C group over time. Mortality was lower in the ulinastatin group (22.8%) compared to the Vitamin C group (34.3%), although not statistically significant (P = 0.289). No adverse drug-related effects were reported.</p><p><strong>Conclusion: </strong>Both ulinastatin and Vitamin C provided benefit in burn-associated sepsis; however, ulinastatin demonstrated more consistent anti-inflammatory effects and reduced need for intensive supportive measures, supporting its role as an adjunctive therapy.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697114","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":"Role of Hyperbaric Oxygen Therapy in Rehabilitation of Stroke Patients: A Randomized Controlled Pilot Study.","authors":"Ramakant Yadav, Usha Shukla, Urvashi Yadav, Shipra Verma, Sushil Kumar Shukla","doi":"10.4103/aam.aam_804_25","DOIUrl":"https://doi.org/10.4103/aam.aam_804_25","url":null,"abstract":"<p><strong>Background: </strong>Improvement in neurological function has been reported in stroke patients after hyperbaric oxygen therapy (HBOT) administration. Although the majority of spontaneous neurological recovery occurs within the first 90 days poststroke, HBOT may further augment this recovery process. This study aimed to evaluate the role of HBOT in improving neurological function and quality of life (QoL) in stroke patients.</p><p><strong>Materials and methods: </strong>This randomized controlled pilot study involved 30 patients who experienced an ischemic stroke 3-6 months before enrollment, randomly assigned to two groups: Group H (n = 15), which received 24 sessions of HBOT along with conventional physiotherapy and Group C (n = 15), which received only conventional physiotherapy. The primary outcome was the change in motor function, assessed using the National Institutes of Health Stroke Scale (NIHSS). The secondary outcomes included the changes in cognitive function, evaluated with the Mini-Mental State Examination (MMSE), and QoL, measured using the Short Form-36 questionnaire.</p><p><strong>Results: </strong>Following HBOT, there was a significant improvement in the NIHSS score from a baseline of (7.27 ± 2.71) to (5.46 ± 2.47) and in the MMSE from a baseline of (24.8 ± 2.98) to (26.73 ± 1.90). Similar improvements were also observed in Group C after the intervention compared to baseline. Group H showed significant improvement in the SF-36 questionnaire except for bodily pain and vitality, while Group C showed no significant change.</p><p><strong>Conclusion: </strong>Although clinical improvement in motor and cognitive function was better after giving HBOT in the 3-6 months poststroke period, the between-group comparisons postintervention were not statistically significant.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697271","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":"Mondor's Disease of the Penis: Clinical Presentation, Diagnosis, and Conservative Management.","authors":"V S Athavale, George Paul, Nithin Nayani","doi":"10.4103/aam.aam_684_25","DOIUrl":"https://doi.org/10.4103/aam.aam_684_25","url":null,"abstract":"<p><strong>Abstract: </strong>Mondor's disease of the penis is a rare, benign thrombophlebitis of the superficial dorsal vein, often presenting as a painful, cord-like induration along the penile shaft. Though alarming to patients, it is a self-limiting condition that responds well to conservative management. A 54-year-old male presented with pain and swelling over the dorsal shaft of the penis for 15 days. Examination revealed a tender, cord-like induration without ulceration or discharge. Laboratory parameters were normal. Doppler ultrasonography demonstrated a dilated, thrombosed superficial dorsal vein with loss of venous flow, confirming the diagnosis of penile Mondor's disease. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs, fractionated flavonoids, warm compresses, vitamin supplements, and temporary sexual abstinence. Marked symptomatic relief was observed within 2 weeks, with complete resolution of induration by 6 weeks. Penile Mondor's disease is an uncommon but self-limiting condition that can be effectively managed with conservative therapy. Early recognition, reassurance, and avoidance of unnecessary interventions are essential. Fractionated flavonoids may provide additional benefit in symptom resolution and recovery.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697246","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":"Adaptive Therapeutic Plasma Exchange Technologies in Low-resource Settings: Utilization, Safety, and Clinical Insights from 2507 Neurological Cases.","authors":"Vijay Kumawat, Parmatma Prasad Tripathi, Vidyashree Anchan Vittal","doi":"10.4103/aam.aam_6_26","DOIUrl":"https://doi.org/10.4103/aam.aam_6_26","url":null,"abstract":"<p><strong>Background: </strong>Therapeutic plasma exchange (TPE) is an established immunomodulatory therapy with proven efficacy in a wide range of neurological disorders. In recent years, expanding indications, combined with cost-effectiveness and a favorable safety profile, have increased their relevance, particularly in low-resource settings where access to intravenous immunoglobulin may be limited. This study analyzes our institutional experience with TPE in the management of diverse neurological conditions.</p><p><strong>Materials and methods: </strong>We conducted a retrospective observational study over a 5-year period (January 2015-December 2019) at the transfusion medicine department of a tertiary care neurological center. TPE was performed with a target plasma removal of 150-200 mL/kg body weight per session, using appropriate replacement fluids. Data regarding patient demographics, neurological indications, American Society for Apheresis indication categories, number of procedures, and procedure-related complications were analyzed.</p><p><strong>Results: </strong>A total of 13,387 TPE procedures were performed in 2507 patients, with ages ranging from 9 to 86 years (mean age: 38.18 years). Guillain-Barré syndrome was the most common indication, accounting for 56.20% of cases, followed by other immune-mediated neurological disorders. Hypotension was the most frequently observed adverse event. Importantly, no procedure-related mortality was recorded during the study period.</p><p><strong>Conclusion: </strong>Therapeutic plasmapheresis is a safe, effective, and adaptable treatment modality for a broad spectrum of neurological disorders. Its favorable safety profile and clinical utility support its role as a valuable and sustainable therapeutic option, particularly in low-resource healthcare settings.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697068","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":"Bilateral Displaced Midshaft Clavicle Fractures Following High-energy Road Traffic Trauma: A Case Report and Review of the Literature.","authors":"Swaroop Solunke, Shourya Chaudhary","doi":"10.4103/aam.aam_798_25","DOIUrl":"https://doi.org/10.4103/aam.aam_798_25","url":null,"abstract":"<p><strong>Abstract: </strong>Bilateral clavicle fractures represent one of the rarest patterns of shoulder girdle trauma, occurring predominantly after high-energy mechanisms and posing unique challenges in diagnosis and management. Their simultaneous disruption compromises both clavicular struts, resulting in impaired shoulder biomechanics and necessitating timely stabilization for optimal functional recovery. A 25-year-old male sustained high-velocity trauma following a motorcycle accident and presented with severe bilateral shoulder pain, deformity, swelling, and markedly restricted arm elevation. Neurological and distal vascular examinations were normal. Radiographs demonstrated displaced bilateral midshaft clavicle fractures (Allman Group I), with no associated thoracic or systemic injuries. Due to significant displacement and bilateral involvement, open reduction and internal fixation was performed using 8-hole titanium anatomical locking plates on both sides through an anterior approach. Stable fixation was confirmed intraoperatively. Early pendulum exercises were initiated, followed by progressive passive and active range-of-motion rehabilitation. Postoperative recovery was uneventful. At 1 month, the patient achieved shoulder abduction of 110° on the right and 100° on the left, with full muscle strength bilaterally. Serial imaging demonstrated progressive fracture consolidation with maintained anatomical alignment. Bilateral displaced midshaft clavicle fractures, though rare, can be effectively managed with anatomical locking plate fixation, providing stable reconstruction and permitting early mobilization. This case reinforces the value of operative intervention in high-energy bilateral clavicular injuries, contributing to the limited but growing evidence guiding treatment of this uncommon trauma pattern.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697074","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":"Rare Common Peroneal Nerve Neuropraxia after Removal of Upper Tibial Pin Traction.","authors":"Dattatray Bhakare, Rahul Salunkhe, Urva Dholu, Aditya Sethi, Swati Bhakare","doi":"10.4103/aam.aam_843_25","DOIUrl":"https://doi.org/10.4103/aam.aam_843_25","url":null,"abstract":"<p><strong>Abstract: </strong>Common peroneal nerve (CPN) injury is an uncommon complication associated with skeletal traction. Neurological deficits occurring after removal of upper tibial pin traction (UTPT) are exceedingly rare and sparsely reported in the literature. A 27-year-old male sustained a closed left subtrochanteric femur fracture following a road traffic accident. Preoperative UTPT was applied with no immediate neurological deficit. UTPT was removed intraoperatively before definitive fixation. Postoperatively, the patient developed left-sided foot drop. Electromyography and nerve conduction velocity studies at 6 weeks demonstrated neuropraxia of the CPN. Although UTPT is considered a safe and effective method for temporary fracture stabilization, clinicians should be aware of the potential for rare traction-related nerve injuries. Early recognition, appropriate splintage, and rehabilitation can result in favorable outcomes.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697208","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":"Effect of Throat Pack Use on Postoperative Sore Throat in Nasal Surgeries: A Prospective Observational Study.","authors":"Siri Kandavar, N Dinesh Kumar","doi":"10.4103/aam.aam_838_25","DOIUrl":"https://doi.org/10.4103/aam.aam_838_25","url":null,"abstract":"<p><strong>Background: </strong>Postoperative sore throat (POST) is a common complication following general anesthesia in ENT and nasal surgeries, where surgical bleeding into the pharynx is a well-documented concern. Throat packs are used to absorb blood, secretions, and debris to reduce aspiration risk, but mechanical irritation of the delicate pharyngeal mucosa may result in mucosal trauma and postoperative airway discomfort.</p><p><strong>Objectives: </strong>The objective of the study is to compare the occurrence and severity of POST in nasal surgeries performed with and without throat pack insertion.</p><p><strong>Methodology: </strong>This prospective observational study was conducted at a tertiary care hospital between April 2024 and May 2025. Seventy-two adult patients (20-60 years), American Society of Anesthesiologists (ASA) physical status I-II, undergoing elective nasal surgeries under general anesthesia with endotracheal intubation, were enrolled. Patients were divided into two groups: Group I (with a throat pack, n = 36) and Group II (without a throat pack, n = 36). POST was assessed at 2, 24, and 48 h postoperatively using the Harding and McVey scoring system. Statistical analysis was performed using SPSS v29.0, with P < 0.05 considered statistically significant.</p><p><strong>Results: </strong>POST was observed in both groups; however, its occurrence and severity were significantly higher in the throat pack group. All patients in Group I experienced POST, compared to 94.4% in Group II. Moderate-to-severe sore throat was more common in Group I during the early postoperative period. The duration of surgery showed a significant association with POST (P = 0.047), whereas ASA grade and type of surgery did not demonstrate significant associations.</p><p><strong>Conclusion: </strong>POST was observed in both the throat pack and the no throat pack groups. Considering the potential risk of blood and saline aspiration during nasal surgeries, the use of a throat pack may be advocated as a protective measure in all nasal procedures. Careful insertion, appropriate sizing, and timely removal of the throat pack are essential to minimize pharyngeal mucosal trauma while ensuring patient safety.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697109","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":"Rare Presentation of Calcaneal Tuberculosis Treated with Debridement and Antibiotic-impregnated Cement.","authors":"Swaroop Solunke, Shourya Chaudhary","doi":"10.4103/aam.aam_865_25","DOIUrl":"https://doi.org/10.4103/aam.aam_865_25","url":null,"abstract":"<p><strong>Abstract: </strong>Calcaneal tuberculosis (TB) is an uncommon manifestation of osteoarticular TB, accounting for <0.1% of skeletal cases. Its nonspecific features such as heel pain and swelling without systemic signs frequently mimic chronic osteomyelitis or bone tumors, often resulting in delayed diagnosis and risk of long-term disability. We report a case of a 20-year-old male presenting with progressive heel pain and swelling. Diagnostic evaluation included plain radiographs, which demonstrated a lytic lesion in the posterior-inferior calcaneus, and magnetic resonance imaging, which revealed marrow involvement. Histopathology of curetted material showed granulomatous inflammation with caseous necrosis. Cartridge-based nucleic acid amplification testing confirmed Mycobacterium tuberculosis. Surgical debridement was performed, and the residual cavity was filled with antibiotic-impregnated polymethylmethacrylate (PMMA) cement. Postoperatively, the patient was commenced on a bedaquiline-based antitubercular regimen as per drug susceptibility testing. The patient's postoperative course was uneventful. Serial follow-up radiographs showed stable cement position and progressive healing changes. By 5 months, the patient achieved pain-free ambulation with no evidence of recurrence or implant-related complications. This case highlights the need for high clinical suspicion of TB when evaluating lytic calcaneal lesions in endemic regions. In addition to systemic antitubercular therapy, the use of antibiotic-loaded PMMA cement after debridement can serve as an effective surgical adjunct by providing local infection control and immediate mechanical stability in the load-bearing hindfoot.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697191","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":"Descending Guillain-Barré Syndrome Presenting as Bilateral Phrenic Nerve Palsy.","authors":"Tushar Ramesh Sahasrabudhe, Rishi Govind Orakkan, K Mithun Nilgiri, Satish Nirahle","doi":"10.4103/aam.aam_790_25","DOIUrl":"https://doi.org/10.4103/aam.aam_790_25","url":null,"abstract":"<p><strong>Abstract: </strong>Bilateral phrenic nerve palsy is a rare and potentially life-threatening cause of respiratory failure, particularly when occurring in young, otherwise healthy individuals without identifiable risk factors. We report a case of a 32-year-old male presenting with acute-onset orthopnoea following a brief history of bilateral shoulder pain. Clinical examination revealed paradoxical abdominal breathing, and imaging demonstrated elevated hemidiaphragms with markedly reduced diaphragmatic excursion, suggestive of diaphragmatic dysfunction. Extensive evaluation excluded common causes including pulmonary, structural cervical, neuromuscular junction, and toxic aetiologies. Nerve conduction studies, cerebrospinal fluid analysis, and autoimmune markers were non-contributory. Despite inconclusive investigations, the progressive respiratory compromise and clinical pattern raised suspicion for an atypical immune-mediated neuropathy, likely a descending variant of Guillain-Barré Syndrome presenting as isolated bilateral phrenic nerve palsy. The patient showed no improvement with corticosteroids and required intermittent non-invasive ventilation. Due to financial constraints, plasmapheresis was initiated, resulting in significant clinical recovery and complete resolution of symptoms. This case underscores the importance of early recognition of diaphragmatic weakness and reliance on clinical judgment in atypical presentations. Prompt empirical treatment can be life-saving, even in the absence of definitive diagnostic confirmation.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147697106","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}