European medical Journal. Urology最新文献

{"title":"The Treatment Algorithm in Diabetic Foot: An Alternative Against Amputation?","authors":"T. Güçer","doi":"10.33590/emj/10100084","DOIUrl":"https://doi.org/10.33590/emj/10100084","url":null,"abstract":"This clinical treatment modality was applied to 62 diabetic ulcers on lower extremities for which surgeons had been advised amputation. Total healing was achieved in 53 of them and was achieved through this treatment in a 3-month period. The remaining nine cases also showed improvement in healing at different levels, but they were not accepted as a ‘satisfactory result’. This treatment modality contains a synthetic prostacyclin analogue, two different phosphodiesterase inhibitors, a peripheral revascularisation agent, another agent increasing peripheral resistance to ischaemia, and a polysaccharide with positive rheologic properties on capillary circulation. Therefore, this treatment was found to be effective on circulation of the extremities, with radiologically-proven insufficient blood supply. The treatment also had a positive effect on recirculation and effects on collateral revascularisation through mechanical vacuum application, modified from standard vacuum treatments. With this combination, this technique was found extremely effective by application, according to the algorithm explained below, and should be an alternative to the current therapy applications in diabetic ulcers.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81513280","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":"Adult-Onset Idiopathic Cervical Dystonia","authors":"S. Rafee, Mahmood Al-Hinai, Michael K. Hutchinson","doi":"10.33590/emj/10005730","DOIUrl":"https://doi.org/10.33590/emj/10005730","url":null,"abstract":"Adult-onset idiopathic focal dystonia is the most common type of primary dystonia, and adult-onset idiopathic cervical dystonia (AOICD) is its most prevalent phenotype. AOICD is an autosomal-dominant disorder with markedly reduced penetrance; clinical expression is dependent on age, sex, and environmental exposure. Motor symptoms at presentation are poorly recognised by non-specialists, leading to long delays in diagnosis. Certain features of history and examination can help diagnose cervical dystonia. There is a relatively high prevalence of anxiety and/or depression, which adversely affects health-related quality of life. Recent studies indicate that patients with AOICD also have disordered social cognition, particularly affecting emotional sensory processing. AOICD can be treated reasonably effectively with botulinum toxin injections, given at 3-month intervals. Oral antidystonic medications are often trialled initially, but are largely ineffective. Comprehensive modern management of patients with AOICD requires recognition of presence of mood disorders, and actively treating the endogenous mood disorder with antidepressant therapy. Botulinum toxin injections alone, no matter how expertly given, will not provide optimal therapy and improved health-related quality of life without an holistic approach to patient management. Increasing evidence indicates that AOICD is a neurophysiological network disorder of GABAergic inhibition, causing a syndrome of dystonia, mood disturbance, and social cognitive dysfunction, with the superior colliculus playing a central role.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85846511","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":"Mexiletine in the Treatment of Non-dystrophic Myotonia: Interviews with Six Medical Experts","authors":"H. Boreham","doi":"10.33590/emj/10197860","DOIUrl":"https://doi.org/10.33590/emj/10197860","url":null,"abstract":"Evidence from randomised controlled clinical trials demonstrates that mexiletine effectively controls myotonic symptoms with a well-described safety profile. Despite this, there are still a limited number of patients on this treatment, and physicians from expert neuromuscular centres may not be fully aware of the potential benefits of mexiletine treatment, including improvements in patients’ quality of life (QoL), the impact on activities of daily living, and the favourable safety profile, even in younger patients.\u0000\u0000During this ‘Meet the Experts’ interview series, five neurologists experienced in the management of non-dystrophic myotonias (NDM), and one specialist cardiologist offered their expert insights on the clinical data and real-world evidence supporting the use of mexiletine in NDM.\u0000\u0000Addressing patient concerns and encouraging treatment acceptance were highlighted as key steps to optimise outcomes from mexiletine therapy. The medical experts emphasised the importance of contextualising the favourable benefit-to-risk profile of mexiletine, particularly regarding cardiac safety concerns and drug monitoring requirements. The expert cardiologist further explained that, in their experience, the cardiac safety profile of mexiletine was no different in patients with NDM when compared to healthy controls used in clinical studies when used as directed.\u0000\u0000When considering anti-myotonia treatment in patients with NDM, medical experts stressed that decision-making should be driven by the overall degree of myotonia. Healthcare professionals (HCP), therefore, need to look beyond basic clinical assessment to understand the true impact of myotonia on patients’ everyday lives.\u0000\u0000Overall, these interviews highlighted the critical role that HCPs can play in leveraging the clinical data and managing patient expectations to ensure maximum treatment success when recommending mexiletine to patients with NDM.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88234874","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":"EGFR-Mutant Non-small Cell Lung Cancer: State-of-the-Art and Future Perspectives","authors":"A. Rossi, E. Mari","doi":"10.33590/emj/10136032","DOIUrl":"https://doi.org/10.33590/emj/10136032","url":null,"abstract":"EGFR mutations are the first identified targetable driver alterations in advanced non-small cell lung cancer (NSCLC), for which specific epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKI) have been developed. These small molecules, administered orally, changed the natural history of patients with EGFR-mutated NSCLC, reporting impressive response and survival data.\u0000\u0000Osimertinib, a third-generation EGFR-TKI, can be considered the standard first-line therapy for the ‘common’ EGFR mutations, which include the exon 19 deletion and Leu858Arg point mutation in exon 21, accounting for 90% of cases. The ‘uncommon’ EGFR mutations, highly heterogeneous and with a low frequency, seem to be more sensitive to afatinib and osimertinib, a second-generation EGFR-TKI, excluding the EGFR exon 20 insertions mutations, for which a platinum-based regimen should be recommended while waiting for specific targeted inhibitors to reach the market.\u0000\u0000However, after an initial activity to first-line EGFR-TKI treatment, a disease progression is reported due to the presence of an intrinsic resistance or the onset of an acquired resistance. The latter can be broadly grouped into EGFR-dependent or EGFR-independent mechanisms of resistance, for which several new drugs and strategic approaches are under investigation.\u0000\u0000This review focuses on the state-of-the-art EGFR-TKIs in the treatment of metastatic NSCLC harbouring EGFR mutations, and also discusses potential future perspectives.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76154093","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":"Aetiology and Outcomes of Thrombocytopenia in Pregnancy: A Cross-Sectional Study in a University Hospital, India","authors":"Sudha V. Hooli, Neelima Shah, P. Shah, Shrradha Suresh, Bali Sukeshani Sunil","doi":"10.33590/emj/10015267","DOIUrl":"https://doi.org/10.33590/emj/10015267","url":null,"abstract":"Background: Thrombocytopenia (TCP) is the second most common haematological finding in pregnancy next to anaemia. It carries a risk for both the mother and the fetus, associated with substantial maternal or neonatal morbidity and mortality. However, a specific therapy, if instituted promptly, improves the outcome for affected patients and their offspring. In patients in India, TCP during pregnancy is an underexplored condition.\u0000\u0000Objectives: To assess the aetiology of TCP in pregnancy and to assess the maternal outcomes of TCP in pregnancy.\u0000\u0000Methodology: The authors included a total of 133 patients in their third trimester (>32 weeks), with a platelet count <149,000 /mm3, admitted to the authors’ institution from 1st January 2021 to 31st December 2021. Patient-related data such as menstrual and obstetric history, presenting complaints, obstetric examination, and basic investigations were collected in a pre-designed, pre-tested proforma. All cases were followed until delivery to record any maternal complications, or any other morbidities. The data were analysed using SPSS (International Business Machines Corporation, Armonk, New York, USA) software. χ2 test was used to compare the proportions between the groups. p<0.05 was considered significant.\u0000\u0000Results: Overall, 64.7% of patients were in the 18–25 years age group and 49.6% of patients were primigravida. Furthermore, 60.9% of patients were diagnosed to have mild TCP, 32.3% had moderate TCP, and only 6.8% patients had severe TCP. The majority (75.2%) of cases were of gestational TCP. In total, 15.8% of cases had pregnancy-induced hypertension (PIH); 3.0% had dengue; 2.3% were COVID-19 positive; 1.5% were diagnosed with haemolysis, elevated liver enzymes, and low platelets syndrome; 1.5% had immune TCP; and only one patient had leptospirosis. Four percent of cases had gestational TCP, 9.5% had PIH, one patient (25.0%) had dengue, and both cases of immune TCP had severe TCP. Twenty-eight percent of gestational TCP cases; 47.6% of PIH cases, both cases of haemolysis, elevated liver enzymes, and low platelets syndrome; 50.0% of dengue cases; and one COVID-19 positive case (33.0%) had moderate TCP. Finally, 6.25% of patients who underwent lower segment caesarean section had severe TCP, 6.00% of patients who underwent vaginal delivery had severe TCP, and out of two patients who had a spontaneous abortion, one (50.00%) had severe TCP at the time of admission. The association was significant (p<0.05).\u0000\u0000Conclusion: TCP is a crucial condition among pregnant patients. Mild TCP is a common type. Correct aetiological diagnosis, and promptly administered adequate and specific therapy are, therefore, essential to significantly improve the outcomes of pregnant patients and their offspring.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73756382","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":"Gastric Pouch Gastrointestinal Stromal Tumour Post-Roux-en-Y Gastric Bypass: A First Reported Case","authors":"W. Dib, Melissa Kyriakos Saad, G. El Hachem, Bassim Sawan, E. Saikaly","doi":"10.33590/emj/10094129","DOIUrl":"https://doi.org/10.33590/emj/10094129","url":null,"abstract":"Gastric gastrointestinal stromal tumour is an extremely rare condition to occur after bariatric surgery. To the authors’ knowledge, only two cases of gastric gastrointestinal stromal tumours after Roux-en-Y gastric bypass have been reported in the medical literature, both occurring in the excluded gastric remnant. Herein, the authors report the third case of gastric gastrointestinal stromal tumour post-Roux-en-Y gastric bypass, and the first case to occur in the gastric pouch, which was managed surgically by laparoscopic resection. From here, combining the observations of clinicians treating and following up patients post-bariatric surgery in an international database will be beneficial to patients, and aid in development of surveillance guidelines.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82605389","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":"Demographic and Clinical Presentation of Hospitalised Patients with SARS-CoV-2 During the First Omicron Wave","authors":"M. Patel, E. Aitken","doi":"10.33590/emj/10174872","DOIUrl":"https://doi.org/10.33590/emj/10174872","url":null,"abstract":"Introduction: The objectives of this retrospective study were to describe clinical presentations and mortality outcomes of hospitalised patients with the COVID-19 Omicron variant within two acute district general hospitals, and to evaluate demographic factors associated with these presentations and mortality.\u0000\u0000Methods: Data was obtained over a month in 2021–2022 from multi-ethnic patients who were hospitalised and detected to have severe acute respiratory syndrome coronavirus 2 Omicron infection. Details included socio-demographic characteristics, vaccination, and mortality. Patients were subdivided into three groups: Group 1 were admitted with true COVID-19 pneumonitis, Group 2 had incidental COVID-19 on admission screening, and Group 3 were negative on admission but developed COVID-19 over 7 days post-admission.\u0000\u0000Results: Of 553 patients, only 24.1% (133/553) were in Group 1, 58.2% (322/553) in Group 2, and 17.7% (98/553) in Group 3. Patients in Group 1 and Group 3 were significantly older than those in Group 2 (p<0.001). Thirty percent of patients from Black, Asian, and minority ethnic backgrounds had COVID-19 pneumonitis compared with 19% of those with White ethnicity (p=0.002). Twenty percent of patients were admitted within nonmedical specialties, i.e., surgical specialties, paediatrics, and obstetrics. Of 36 requiring critical care, 21 were in Group 1. Of those patients, 20/21 (95%) were unvaccinated and seven of the 21 who died were all unvaccinated (100%). Common COVID-19 presentations included delirium, falls, seizures, chronic obstructive pulmonary disease, and antenatal problems. Overall, 13.7% (76/553) patients died and 4.7% (26/553) were directly attributable to COVID-19.\u0000\u0000Conclusions: This large, multi-ethnic study has described clinical presentations and mortality of hospitalised patients with Omicron. It has determined socio-demographic factors associated with these presentations, including ethnicity and vaccination rates. The study provides useful information for future COVID-19 studies examining outcomes and presentations of Omicron and future COVID-19 variants.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88216670","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":"A Study of Correlation of Adiponectin Levels in Metabolic Syndrome","authors":"Apurv Singhal, Vedpal Singh Punia, Akash Bharti, Shaavi Mittal, Praveen Raman Mishra, Prem Kuma","doi":"10.33590/emj/10146572","DOIUrl":"https://doi.org/10.33590/emj/10146572","url":null,"abstract":"Introduction: Metabolic syndrome (MetS), also known as insulin resistance syndrome, is described as a cluster of cardiometabolic symptoms such as high blood pressure, elevated fasting glucose, or insulin resistance. MetS is one of the most serious public health problems being faced globally. The purpose of the current investigation was to determine its prevalence, as well as the relationship between blood adiponectin levels and the development of MetS.\u0000\u0000Materials and Methods: This observational cross-sectional hospital-based study was performed in the Department of General Medicine, School of Medical Sciences and Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India, from January 2019–June 2020. Sixty patients attending the medicine out- or inpatient department, who confirmed consent, and fit into the International Diabetes Federation (IDF) inclusion criteria for MetS, were recruited for this study. The final sample size for this study was found to be 60, with a prevalence of 10%. This is the reason the study’s precision decreased to ±7.6%, implying that the precision of the end result may vary by ±7.6%.\u0000\u0000Results: Subjects without MetS were on average younger, had a lower BMI, and had a smaller waist circumference than those who had MetS, according to the findings. They also had lower blood pressure, pulse rate, and fasting plasma glucose levels than the people with MetS, and there were statistically significant variations in lipid profiles between those with and without MetS. In people who did not have MetS, the mean serum adiponectin concentration was 15.79±2.90 mg/mL, whereas the mean serum adiponectin concentration in people who did have MetS was 11.02±2.63 mg/mL (p<0.001). The levels of adiponectin were compared with the different components of MetS as defined by the IDF. The mean adiponectin concentrations in connection to the clinical characteristics of MetS are shown in Table 1 . The authors discovered that lower adiponectin levels were statistically significantly linked with the majority of the characteristics. In a multivariate analysis, the serum adiponectin content was found to be significantly inversely associated to systolic blood pressure (r=-0.262; p<0.050), BMI (r=-0.288; p<0.050), total cholesterol (r=-0.515; p<0.001), and low-density lipoprotein (r=-0.305; p<0.050) in the study participants.\u0000\u0000Conclusion: In conclusion, the present results suggest that circulating levels of adiponectin are reduced in the presence of MetS.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"170 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76453445","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":"Cutaneous Mucormycosis Co-infection in a Patient with COVID-19","authors":"Raham Rahgoshai, P. Goldberg, Rayhaneh Rahgoshai, Shadi Zain","doi":"10.33590/emj/10098860","DOIUrl":"https://doi.org/10.33590/emj/10098860","url":null,"abstract":"Mucormycosis is a life-threatening fungal infection usually seen in patients who are immunocompromised; however, to date, it has been rarely described in patients with COVID-19, although more recently, reports from India have described an increased incidence of these infections. This report describes a patient with COVID-19 who developed a fatal dermatologic mucormycosis infection. The patient, whose history included therapy for diffuse large B-cell lymphoma, had an incidental positive screening test for COVID-19 in February 2021 after exposure to a family member who had tested positive. They then presented to the emergency room a few weeks later exhibiting progressive dyspnoea and fever. A CT scan of the chest revealed ground glass opacities. They were intubated approximately 2 weeks later and their course was complicated by renal failure, for which continuous renal replacement therapy was started, and by refractory hypoxaemic and hypercapnic respiratory failure in which they were placed on venovenous extracorporeal membrane oxygenation. During their course in the intensive care unit (ICU), they developed a right thigh haematoma, thought to be related to the previous insertion of a femoral arterial pressure monitoring catheter. Several days before the patient’s death, the wound noted to be covered by a brown-black eschar was cultured on April 30 and returned positive for Rhizopus oryzae and Staphylococcus epidermidis on May 5. The patient was immediately started on liposomal amphotericin and posaconazole and taken urgently taken to the operating room for a radical debridement. Unfortunately, their post-operative course was characterised by fulminant haemodynamic collapse and multiple system organ failure, from which the patient died.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80125825","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":"Tackling Extended Hospital Stays in Patients with Acute Bacterial Skin and Skin Structure Infections","authors":"G. Barlow, M. Wilke, G. Béraud","doi":"10.33590/emj/10095006","DOIUrl":"https://doi.org/10.33590/emj/10095006","url":null,"abstract":"Hospitalisation rates for acute bacterial skin and skin structure infection (ABSSSI) are rising and represent a large pharmacoeconomic burden as treatment may involve an extended number of days of antibiotic therapy. This article first aims to provide a review of treatment challenges associated with ABSSSIs in both hospital and outpatient settings, and shows that while more traditionally treatment has been conducted in a hospital setting, for a number of patients, a variety of considerations, including pharmacoeconomics, infection control, and patient preference, has led to the development of recommendations to assess the eligibility of patients for early discharge from hospital to complete their antibiotic regimen in the outpatient setting. However, such patients require monitoring for drug adherence to oral regimens or complications associated with daily intravenous administration, such as injection site reactions and infection. This review also focuses on one of a number of new antibiotics for ABSSSI, dalbavancin, as the long-acting glycopeptide with the most clinical experience to date. This antibiotic has been shown to be as effective as a daily/twice daily regimen with similar safety profiles. Health economic analysis of dalbavancin is also presented. It has shown that in some, though not all, clinical settings a reduction in the overall treatment cost is evident as, despite a higher medication cost, the lower hospitalisation time can lead to greater cost savings. In conclusion, while the burden of ABSSSI is rising, new treatment options provide additional therapeutic choice, although pharmacoeconomic considerations might limit use in some cases.","PeriodicalId":90162,"journal":{"name":"European medical Journal. Urology","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91385480","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}