Annals of Medicine and Surgery最新文献

{"title":"Monocytes and cervical ripening: a narrative review of prolonged labor pathophysiology.","authors":"Emmanuel Ifeanyi Obeagu, Salma Abdi Mahmoud","doi":"10.1097/MS9.0000000000003004","DOIUrl":"10.1097/MS9.0000000000003004","url":null,"abstract":"<p><p>Prolonged labor, a major obstetric complication, is often linked to inadequate cervical ripening, which hinders labor progression. The process of cervical ripening is governed by complex hormonal and immune-mediated mechanisms, with monocytes playing a central role. These immune cells infiltrate the cervix and differentiate into macrophages, releasing cytokines and proteases that are essential for extracellular matrix (ECM) remodeling, cervical softening, and dilation. However, in prolonged labor, an imbalance in monocyte activity may impede normal cervical ripening, contributing to stalled labor and increased risk of maternal and neonatal complications. Monocytes are critical to the inflammatory response that initiates cervical remodeling during labor. Upon recruitment to the cervix, monocytes release inflammatory cytokines like interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha, which activate matrix metalloproteinases to degrade collagen and ECM proteins, facilitating cervical effacement and dilation. Dysregulated monocyte recruitment and prolonged inflammation, however, may lead to ineffective cervix remodeling, preventing labor from progressing efficiently. Furthermore, these immune responses can influence uterine contractility, either promoting or inhibiting uterine contractions, which further complicates the pathophysiology of prolonged labor.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3289-3299"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia and cerebrovascular disease: pathophysiological insights and clinical implications.","authors":"Emmanuel Ifeanyi Obeagu, Getrude Uzoma Obeagu","doi":"10.1097/MS9.0000000000002907","DOIUrl":"10.1097/MS9.0000000000002907","url":null,"abstract":"<p><p>Anemia and cerebrovascular disease (CVD) are interconnected conditions that significantly impact global health, often coexisting to worsen clinical outcomes. Anemia-induced hypoxia increases the production of reactive oxygen species (ROS) via mitochondrial dysfunction and xanthine oxidase activity, amplifying oxidative stress. ROS directly harm endothelial cells by disrupting tight junctions, increasing vascular permeability, and compromising the integrity of the blood-brain barrier. This review delves into the pathophysiology of anemia in the context of CVD, emphasizing the impact of hypoxia, oxidative stress, and endothelial dysfunction. Clinically, anemia worsens CVD prognosis by elevating the risk of ischemic and hemorrhagic strokes, delaying recovery, and increasing mortality rates. If untreated, anemia exacerbates neuronal damage, promotes vascular remodeling, and perpetuates systemic inflammation, leading to poor functional outcomes. This review underscores the necessity of timely anemia diagnosis and targeted management in patients with cerebrovascular disease to mitigate these adverse outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3254-3267"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case of renal cell carcinoma with tumor thrombus extension into the right atrium.","authors":"Adrian Whiting, Nairuti Shah, Jordan Zucker, Manroop Gill, Eliot Sachsenmeier, Paramvir Singh, Kinza Ahmed, Rutul Upadhyay, Michael Bender","doi":"10.1097/MS9.0000000000002837","DOIUrl":"10.1097/MS9.0000000000002837","url":null,"abstract":"<p><strong>Introduction: </strong>Over the last half-century, mortality from renal cell carcinoma (RCC) has seen a dramatic reduction, while 5-year survival rates have reached an all-time high (34% to 75%).</p><p><strong>Case presentation: </strong>A 77-year-old female with Stage 4 RCC (cT3c, cN1, cM1) presented with acute onset chest and back pain. Imaging revealed interval enlargement of a left renal mass with propagation of tumor thrombus (TT) throughout the left renal vein, intrahepatic and suprahepatic inferior vena cava (IVC) with extension into the right atrium (RA). The patient successfully underwent a high-risk open left nephrectomy with caval thrombectomy, retroperitoneal lymph node dissection, and atrial thrombectomy.</p><p><strong>Discussion: </strong>Approximately, 1% of RCC cases involve the right atrium, and radical nephrectomy with vena caval thrombectomy remains the most effective treatment for cavoatrial TT, with 5-year survival rates between 30% and 72%. While patients with renal vein involvement have better survival rates than those with IVC involvement, advanced TT cases (Types III and IV) often require extracorporeal circulation. Though the patient understood the prognosis of her RCC, discussing the risks of a complex procedure versus not intervening was challenging. Despite a typical median survival of 12 months for level IV tumor thrombus (TT), she remains stable 28 months post-surgery.</p><p><strong>Conclusion: </strong>Although the 5-year survival rate for renal cell carcinoma (RCC) has increased from 34% to 75%, the disease still adversely affects patients' quality of life. A multidisciplinary approach is essential when managing metastatic RCC, particularly involving the heart. Despite the associated risks, surgical intervention is more effective in prolonging life by preventing sudden cardiac death due to embolic events.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3819-3822"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leukocyte dynamics in female reproductive health: roles and mechanisms.","authors":"Emmanuel Ifeanyi Obeagu, Getrude Uzoma Obeagu","doi":"10.1097/MS9.0000000000002926","DOIUrl":"10.1097/MS9.0000000000002926","url":null,"abstract":"<p><p>Leukocytes are critical mediators of immune responses and play multifaceted roles in female reproductive health, influencing processes such as menstruation, ovulation, implantation, pregnancy, and parturition. This review examines the dynamic involvement of key leukocyte populations, including neutrophils, macrophages, T lymphocytes, natural killer (NK) cells, and dendritic cells, across reproductive processes. Leukocytes contribute to tissue remodeling, hormonal regulation, immune tolerance, and pathogen defense. Dysregulation in their functions is implicated in reproductive disorders such as endometriosis, recurrent pregnancy loss (RPL), and complications arising from infections. The review integrates emerging insights into the molecular mechanisms governing leukocyte behavior, emphasizing the roles of cytokines, hormones, and chemokines in guiding their recruitment and activity. Key findings underscore the significance of leukocyte-mediated cytokine networks in maintaining immune homeostasis during pregnancy and their critical roles in spiral artery remodeling for fetal-maternal exchange. Neutrophils and macrophages support menstrual shedding and repair, while NK cells facilitate trophoblast invasion and placental development. Dysregulated leukocyte activity contributes to chronic inflammation in endometriosis and impaired immune tolerance in RPL. Additionally, leukocytes are central to immune defenses against infections, but excessive inflammation can lead to infertility or adverse pregnancy outcomes. Therapeutic strategies targeting these immune cells hold promise for managing reproductive health disorders by modulating inflammation, enhancing immune tolerance, and developing biomarkers for early diagnosis. In conclusion, leukocyte dynamics are integral to reproductive physiology and pathology, with significant potential for translational research to optimize reproductive health outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3268-3278"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total hip arthroplasty with tantalum rod extraction via direct anterior approach based on preoperative DCE-MRI and AI: a case report.","authors":"Chen Zhiyuan, Sun Jiahao, Ma Bowen, Xia Tianwei, Shen Jirong","doi":"10.1097/MS9.0000000000003286","DOIUrl":"10.1097/MS9.0000000000003286","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction and importance: &lt;/strong&gt;Osteonecrosis of the femoral head (ONFH) is a debilitating condition characterized by compromised blood supply to the femoral head, leading to bone marrow or osteocyte death, and ultimately resulting in ischemia, necrosis, and potential collapse of the femoral head. Dynamic contrast-enhanced MRI (DCE-MRI) is a minimally invasive test that has the advantage of providing a microenvironmental picture of the femoral head that cannot be detected by conventional imaging (e.g., X-rays, CT, MR), and accurately assessing the viability and function of the local tissues, thus helping to select the appropriate surgical intervention. In this context, tantalum rod implantation has been employed as a treatment option for ONFH, aiming to provide structural support and potentially improve blood supply to the necrotic area. However, there are few reports in the literature on the evaluation of the efficacy of tantalum rod implantation in combination with DCE-MRI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;A patient with bilateral SONFH, diagnosed according to the ARCO classification, presented with significant pain and limited mobility. Despite undergoing tantalum rod implantation in both hips, the patient reported minimal improvement in symptoms and continued to experience discomfort. Preoperative DCE-MRI was conducted to assess blood supply in the femoral heads, revealing inadequate perfusion in the necrotic areas. Given the poor response to tantalum rod implantation, a decision was made to proceed with DAA-THA to remove the tantalum rods and femoral heads. Intraoperative findings confirmed the presence of necrotic bone and lack of significant revascularization in the affected areas. The retrieved femoral head specimens were subjected to pathological and micro-CT analysis, which further confirmed the extent of necrosis and the inadequacy of blood supply.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical discussion: &lt;/strong&gt;The use of tantalum rods in the treatment of ONFH is based on their osteoconductive properties and potential to promote revascularization. However, the success of this treatment is highly dependent on the preoperative blood supply status of the femoral head. DCE-MRI played a crucial role in this case by providing a clear picture of blood perfusion in the necrotic areas, which helped in identifying patients who may not benefit from tantalum rod implantation. The pathological and micro-CT analysis of the retrieved femoral head specimens provided additional insights into the reasons behind the inefficacy of tantalum rod implantation. Specifically, the lack of significant revascularization and the extent of necrosis highlighted the limitations of this treatment option in certain patient populations. The decision to proceed with DAA-THA was based on the patient's poor response to tantalum rod implantation and the need for a definitive surgical intervention. The use of the AIHIP system for preoperative planning facilitated a pre","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3894-3901"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet activation in breast cancer: mechanisms and therapeutic opportunities - a narrative review.","authors":"Emmanuel Ifeanyi Obeagu","doi":"10.1097/MS9.0000000000003091","DOIUrl":"10.1097/MS9.0000000000003091","url":null,"abstract":"<p><p>Platelet activation is increasingly recognized as a key factor in breast cancer progression, contributing to tumor growth, metastasis, and immune modulation. Platelets interact with tumor cells to promote their survival, facilitate metastasis, and enhance the formation of a pro-inflammatory microenvironment. These interactions are mediated by adhesion molecules such as P-selectin and glycoprotein receptors on both platelets and tumor cells. Additionally, activated platelets release growth factors like vascular endothelial growth factor and platelet-derived growth factor, which promote angiogenesis and tumor vascularization, crucial steps in cancer progression. The coagulation cascade, triggered by platelet activation, further enhances tumor cell dissemination and metastasis. Elevated levels of procoagulant activity in platelets, particularly through the expression of tissue factor, lead to increased thrombin generation, facilitating the formation of fibrin-rich clots that protect circulating tumor cells from immune surveillance. Platelet-derived factors also exert immunomodulatory effects, helping cancer cells evade detection by the immune system, thereby supporting tumor growth and spread.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3356-3361"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive modeling for metastasis in oncology: current methods and future directions.","authors":"Ghulam H Abbas, Edmon R Khouri, Omar Thaher, Safwan Taha, Miljana Vladimirov, Rodolfo J Oviedo, Jeremias Schmidt, Dirk Bausch, Sjaak Pouwels","doi":"10.1097/MS9.0000000000003279","DOIUrl":"10.1097/MS9.0000000000003279","url":null,"abstract":"<p><p>Predictive modeling for metastasis in oncology has gained significant traction due to its potential to improve prognosis, guide treatment strategies and enhance patient outcomes. Current methods leverage advancements in machine learning, genomics and imaging technologies to predict the likelihood of cancer spread. Techniques such as logistic regression, decision trees, support vector machines and neural networks have been employed to analyze clinical, pathological, and molecular data. Genomic profiling, liquid biopsies, and radiomics are increasingly integrated into these models to identify metastatic patterns and risk factors. Despite these advances, challenges persist, including data heterogeneity, model interpretability, and the need for larger, high-quality datasets for validation. Furthermore, the integration of artificial intelligence with precision medicine offers promising avenues for more personalized metastasis predictions. Future directions focus on enhancing model accuracy through deep learning, improving the interpretability of black-box models, and incorporating multi-omics data to capture the complexity of metastatic mechanisms. With the advent of advanced computational tools and growing datasets, predictive modeling in oncology is poised to revolutionize metastasis management, offering clinicians' valuable insights for early detection and tailored treatment strategies.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3489-3508"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revolutionizing breast cancer monitoring: emerging hematocrit-based metrics - a narrative review.","authors":"Emmanuel Ifeanyi Obeagu, Getrude Uzoma Obeagu","doi":"10.1097/MS9.0000000000003020","DOIUrl":"10.1097/MS9.0000000000003020","url":null,"abstract":"<p><p>Breast cancer remains a leading global health concern, with significant strides made in early detection and treatment. However, effective long-term surveillance, particularly for recurrence and metastasis, remains a clinical challenge. Traditional methods like imaging and biopsy are often invasive, costly, and have limited sensitivity in detecting subtle changes during disease progression. Emerging evidence suggests that hematocrit-based metrics - measurements of the proportion of red blood cells (RBCs) in blood - could serve as valuable, minimally invasive biomarkers for monitoring breast cancer. This review highlights recent advancements in hematocrit-focused research and its potential role in revolutionizing breast cancer surveillance. Hematocrit dynamics reflect complex physiological processes influenced by cancer biology, including inflammation, angiogenesis, and treatment-induced bone marrow suppression. Alterations in hematocrit levels have been associated with prognostic outcomes, treatment responses, and early indications of recurrence in breast cancer patients. Coupled with other hematological and molecular markers, hematocrit offers a cost-effective and readily accessible tool to track disease status in real time. Recent technological innovations, such as point-of-care testing, artificial intelligence-driven data analysis, and microfluidic devices, are further advancing the applicability of hematocrit-based metrics in both clinical and remote monitoring settings.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3327-3338"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron homeostasis and health: understanding its role beyond blood health - a narrative review.","authors":"Emmanuel Ifeanyi Obeagu","doi":"10.1097/MS9.0000000000003100","DOIUrl":"10.1097/MS9.0000000000003100","url":null,"abstract":"<p><p>Iron is an essential trace element that plays a critical role in numerous physiological processes, including oxygen transport, cellular metabolism, immune function, and organ health. While its most well-known function is in hemoglobin synthesis for blood health, iron's regulatory mechanisms extend far beyond the bloodstream. This review examines the broader implications of iron homeostasis, focusing on its impact on cellular functions, immune responses, and the health of organs such as the liver, heart, and brain. Disruptions in iron regulation, including both deficiency and overload, can lead to various disorders, including anemia, iron overload diseases, and chronic inflammation. Iron homeostasis is maintained by a complex balance of absorption, storage, and recycling, primarily regulated by hepcidin, a liver-derived hormone. Inadequate iron levels can impair mitochondrial function, DNA synthesis, and immune cell activation, leading to fatigue, anemia, and a weakened immune system. Conversely, excess iron can promote oxidative stress, contributing to tissue damage and conditions like hemochromatosis, cardiomyopathy, and neurodegenerative diseases. The liver, kidneys, heart, and brain are particularly sensitive to changes in iron balance, which can exacerbate or precipitate various health complications.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3362-3371"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liquid biopsies for early detection and monitoring of cancer: advances, challenges, and future directions.","authors":"Zaheer Qureshi, Faryal Altaf, Mikail Khanzada, Adnan Safi, Zoha Asghar, Daniyal Warraich, Shivendra Shah","doi":"10.1097/MS9.0000000000002776","DOIUrl":"10.1097/MS9.0000000000002776","url":null,"abstract":"<p><strong>Objective: </strong>The article offers an extensive survey of the progressions, problems, and future trends of liquid biopsies in the early discovery and surveillance of cancer. Liquid biopsies can detect signals associated with cancer by looking at biological fluids like cerebrospinal fluid, blood, or urine, making them a less invasive alternative to traditional tissue biopsies.</p><p><strong>Methods: </strong>The review explores the molecular biology and techniques behind liquid biopsy, including circulating tumor DNA, circulatory tumor cells, and exosomes. It evaluates clinical applications of liquid biopsy across different cancer types, showing their potential for early diagnosis, monitoring disease progression, and therapy response prediction.</p><p><strong>Results: </strong>The article identifies several critical issues with liquid biopsies, including achieving a balance between high sensitivity and specificity, standardizing protocols, addressing technological heterogeneity, and ensuring cost-effectiveness and accessibility. Also, ethical issues about informed consent, data privacy, incidental findings management, and equal testing access have been examined in this context.</p><p><strong>Conclusion: </strong>Finally, this article sheds light on future developments in liquid biopsies, such as enhanced specificity, sensitivity, and integration with artificial intelligence methods.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3244-3253"},"PeriodicalIF":1.7,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}