Cureus最新文献

{"title":"Assessing the Clinical Utility of Antinuclear Antibody Titer Dilutions, Antinuclear Antibody Staining Patterns, and Other Common Laboratory Tests in Juvenile Idiopathic Arthritis.","authors":"Willie S Van Heerde, Michael Jutovsky","doi":"10.7759/cureus.76648","DOIUrl":"10.7759/cureus.76648","url":null,"abstract":"<p><p>Chronic musculoskeletal pain in pediatric patients can be challenging to diagnose, particularly in the absence of overt signs of autoimmune disease, as these episodes can manifest episodically. We present a case of a 14-year-old female patient with a two-year history of episodic \"bone pain,\" morning stiffness, and infrequent fever and fatigue. Laboratory testing revealed an antinuclear antibody (ANA) titer of 1:1280 with a nuclear homogeneous pattern and a mildly elevated erythrocyte sedimentation rate (ESR). Although the patient did not meet the criteria for juvenile idiopathic arthritis (JIA), her laboratory findings and irregular musculoskeletal pain prompted the review of literature on the diagnostic value of ANA titers, ANA staining patterns, and other common lab tests in JIA.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76648"},"PeriodicalIF":1.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11685542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916584","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":"Comparative Efficacy of Videolaryngoscopy and Direct Laryngoscopy in Patients Living With Obesity: A Meta-Analysis.","authors":"Hannan Chaudery, Harira Hameed, Zaina Sharif, Sheko Asinger, Andrew McKechnie","doi":"10.7759/cureus.76558","DOIUrl":"10.7759/cureus.76558","url":null,"abstract":"<p><p>Intubation in patients living with obesity poses unique challenges due to altered airway anatomy and reduced physiological reserve, increasing the risk of complications. In synthesizing evidence from multiple trials, our meta-analysis suggests that videolaryngoscopy may provide a higher likelihood of achieving successful intubation on the first attempt compared to direct laryngoscopy while not substantially increasing the procedure time. Videolaryngoscopy was associated with a significant increase in first-pass intubation success compared to direct laryngoscopy, with a pooled risk ratio (RR) of 0.42 (95% CI 0.22 - 0.78, p = 0.0064). There was no significant difference in time to intubation between the two techniques (standardised mean differences (SMD) 0.13, 95% CI -0.26 to 0.52, p = 0.51), a result approached with low certainty due to the high heterogeneity among studies. Although the underlying studies varied in their methods and patient populations, these findings support the consideration of videolaryngoscopy as a potentially more reliable and safer technique for airway management in patients with obesity.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76558"},"PeriodicalIF":1.0,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11682608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904421","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":"Optimizing Urgent Suspected Colon Cancer Referrals and Reducing Colonoscopy Wait Times in Wales.","authors":"Atreya Subramanian, Ashwin Nair, Parinita Swarnkar, Keshav Swarnkar","doi":"10.7759/cureus.76597","DOIUrl":"10.7759/cureus.76597","url":null,"abstract":"<p><strong>Aim: </strong>To assess recent colonoscopies and CT scans in conjunction with the feacal immunochemical test (FIT) for possibly downgrading urgent suspected cancer (USC) referrals.</p><p><strong>Methods: </strong> A retrospective single-centre study was conducted, including all USC referrals for colonoscopy in 2022, excluding anal cancers. The CT and colonoscopy findings for a two-year period prior to the referral, along with the FIT result (if done), were noted. Combinations of tests were used to ascertain if any such combination would predict a negative colonoscopy (no cancer detected).</p><p><strong>Results: </strong> Out of 500 USC referrals made, 160 were positive for colorectal cancer (CRC). Twelve cases had prior negative CT scans and colonoscopies, and none showed cancer (three were FIT and nine FIT not performed). A total of 54 cases had a prior CT with no FIT, four of which showed cancer. Fifteen cases had a prior CT with a negative FIT, and none showed cancer. Sixteen cases had prior negative colonoscopies, and all were negative for cancer (five negative FIT, one positive FIT, and 10 FIT not done ). Combining the categories where no cancer was missed, potentially 40 referrals could have been downgraded safely (8%).</p><p><strong>Conclusions: </strong> The above data indicate that, among the patients being considered for a colorectal USC referral, a combined prior negative colonoscopy and CT scan warrants a downgrading of the referral (irrespective of the FIT result). Referrals with a prior negative CT (abdomen) with a negative FIT or normal colonoscopy within the last two years can be safely downgraded. This will have a positive impact on waiting times and monetary expenditure on the USC pathway, but larger studies would be required to prove the external validity of these findings.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76597"},"PeriodicalIF":1.0,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908087","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":"Reimplantation of Thymus at the First Superior Cavo-Pulmonary Anastomosis and Its Outcome.","authors":"Sachin Talwar, Vuribindi M Reddy, Amitabh Satsangi, Vishal V Bhende, Sherrin Jacob, Aruna Nambirajan, Akshya K Bisoi","doi":"10.7759/cureus.76599","DOIUrl":"10.7759/cureus.76599","url":null,"abstract":"<p><p>During bidirectional cavo-pulmonary anastomosis (bidirectional Glenn; BDG), the thymic tissue is often excised to facilitate the exposure of the superior vena cava and its junction with the innominate vein. Subsequently, it is discarded. Since the last two decades, the lead author (ST) has pursued anchoring the excised thymus in its position by suturing it to the opposite unexcised thymic lobe. At the time of completion Fontan, the authors found the excised thymic tissue to be living on electron microscopy. In this report, the authors describe one such patient. The advantages of this approach have been discussed here. The techniques of performing the BDG and the Fontan are not discussed.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76599"},"PeriodicalIF":1.0,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908091","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":"An Unexpected Evolution: Severe Pneumonia in an Immunocompromised Patient.","authors":"Bernardo Silvério, Ana S Ramoa Oliveira, Ricardo Alves","doi":"10.7759/cureus.76572","DOIUrl":"10.7759/cureus.76572","url":null,"abstract":"<p><p>Community-acquired pneumonia (CAP) varies in clinical presentation, ranging from mild pneumonia characterized by fever and productive cough to severe pneumonia characterized by respiratory distress and sepsis. We present a 40-year-old woman who presents to the emergency room with dyspnea, pleuritic chest pain, productive cough with hemoptysis, and fever. On physical examination, the patient presents with tachypnea and hypotension, which proved refractory to fluid therapy. The analysis reveals pancytopenia and elevated C-reactive protein. The computed tomography (CT) scan shows extensive areas of consolidation and ground-glass opacities, more prominent in the right upper lung lobe. The diagnosis of septic shock with a focus on CAP was established, and the patient was admitted to the Intensive Care Unit (ICU). Later, <i>Streptococcus pyogenes</i> was identified as the causative agent of this severe pneumonia.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76572"},"PeriodicalIF":1.0,"publicationDate":"2024-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908156","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":"Acute Appendicitis Due to Enterobius vermicularis Infestation: A Case Report.","authors":"Ravi Chandra Tata, Mahmoud Abdelreheem, Aina Mercant Osuna, Sudhakar Mangam","doi":"10.7759/cureus.76535","DOIUrl":"10.7759/cureus.76535","url":null,"abstract":"<p><p>Acute appendicitis is the most frequent abdominal surgical emergency worldwide. While luminal obstruction due to fecaliths and lymphoid hyperplasia is a common cause, parasitic infections are a rare but significant contributor. <i>Enterobius vermicularis</i>, the most common helminthic infection in developed countries, can trigger appendiceal inflammation through a mechanical obstruction or immune response. This report presents a case of a 16-year-old male with acute appendicitis secondary to <i>E. vermicularis</i> infestation. The patient presented with typical appendicitis symptoms, and laparoscopic appendectomy revealed the parasitic involvement, confirmed by histopathology. Postoperative recovery was uneventful following surgical intervention and anti-helminthic treatment. <i>E. vermicularis</i> is often an incidental finding in appendectomy specimens but may play a pathogenic role in some cases of appendicitis. This case underscores the importance of considering parasitic infections in patients with atypical presentations of appendicitis and highlights the value of histopathological examination in appendectomy cases.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76535"},"PeriodicalIF":1.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908152","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":"Incidence of Proteinuria Post Radical Nephrectomy in Comparison to Partial Nephrectomy: A Comparative Study.","authors":"Ahmed Alasker, Rakan A Al Muammar, Abdulrahman A Bin Moammar, Hassan Alqahtani, Abdulrahman S Altowaim","doi":"10.7759/cureus.76548","DOIUrl":"10.7759/cureus.76548","url":null,"abstract":"<p><p>Objectives The objective of this study is to enhance understanding of the incidence and impact of proteinuria following nephrectomy, to guide clinical decision-making, and to optimize post-operative monitoring strategies. Specifically, the study seeks to compare the incidence of proteinuria in patients undergoing radical nephrectomy and those receiving partial nephrectomy, thereby contributing valuable insights into post-surgical outcomes that could inform treatment approaches and improve patient care. Methods It is a retrospective cohort design, analyzing clinical data from patients who underwent radical or partial nephrectomy in King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia, between 2014 and 2022. Data was entered in Excel (Microsoft Corporation, Redmond, Washington, United States) and analyzed in IBM SPSS Statistics for Windows, Version 29.0 (Released 2023; IBM Corp., Armonk, New York, United States). Results There was a total of 310 participants, predominantly male (n=167, 53.9%), with radical nephrectomy (n=188, 60.6%) being more common than partial (n=99, 31.9%). Post surgery, a significant decline in estimated glomerular filtration rate (eGFR) was noted in radical nephrectomy at one to three months (73.09 mL/minute) compared to partial nephrectomy (90.99 mL/minute) (p<0.001), with similar trends at 6-12 months. The mortality rate was low at 1.6% (n=5), with significant associations between preoperative eGFR and mortality (p=0.008). Proteinuria post operation was observed in 27.1% (n=84), with significant differences in proteinuria levels between radical (107.10 mg/dL) and partial nephrectomy (62.80 mg/dL) (p=0.031). Conclusion Our study found that radical nephrectomy was more common and associated with a greater decline in postoperative eGFR compared to partial nephrectomy. Proteinuria was significantly higher in radical nephrectomy patients, and preoperative eGFR was linked to mortality risk, highlighting the need for careful monitoring in high-risk individuals.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76548"},"PeriodicalIF":1.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11682697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904528","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":"Knowledge, Attitude, and Perception Toward Evaluation of Acute Heart Failure Among Emergency Medicine Residents in Riyadh, Saudi Arabia.","authors":"Saeed Nassar, Haneen Alkhanbashi, Ahmed M Alkhars, Tawfiq Almezeiny","doi":"10.7759/cureus.76500","DOIUrl":"10.7759/cureus.76500","url":null,"abstract":"<p><strong>Background: </strong>Acute heart failure (AHF) poses significant challenges in clinical practice due to its varied clinical presentations and complex management strategies. Adequate confidence levels among medical residents in diagnosing and managing AHF are crucial for timely and effective patient care.</p><p><strong>Study aim: </strong>This cross-sectional study aimed to assess medical residents' knowledge, attitude, and perception levels in diagnosing and managing AHF and explore factors influencing their confidence levels.</p><p><strong>Methodology: </strong>A total of 52 medical residents from various specialties participated in the study. Based on different clinical parameters, participants completed a questionnaire assessing their confidence levels in diagnosing AHF. Descriptive statistics were used to summarize confidence levels, while chi-square tests explored associations between demographic/clinical factors and confidence levels.</p><p><strong>Results: </strong>The majority of residents exhibited high confidence levels in diagnosing heart failure (HF) based on history and physical examination findings alone (22 (42.3%) and 16 (30.8%), respectively). However, confidence levels were lower when relying solely on laboratory tests and imaging modalities for diagnosis (17 (32.7%) and 18 (34.6%), respectively). Factors such as symptoms (e.g., dizziness) and availability of ultrasound equipment were associated with higher confidence levels (p < 0.05). However, demographic factors such as age, gender, and residency year did not significantly influence confidence levels (p > 0.05).</p><p><strong>Conclusion: </strong>Our study highlights variations in confidence levels among medical residents in diagnosing and managing AHF. While clinical assessment remains paramount, targeted educational interventions focusing on interpreting diagnostic tests and imaging findings are warranted to enhance residents' confidence levels and improve patient care.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76500"},"PeriodicalIF":1.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904461","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":"Quality Assessment of Online Health Information on Thyroid Cancer in the Arabic Language: A Cross-Sectional Study.","authors":"Alaa M Alseheimi, Saleh M Alseheimi, Kholoud A Alhysoni","doi":"10.7759/cureus.76526","DOIUrl":"10.7759/cureus.76526","url":null,"abstract":"<p><p>Introduction The internet is a crucial source of health information, including cancer-related topics, but the quality and reliability of these resources can vary, affecting patient decision-making. Objectives This study aimed to evaluate the quality of thyroid cancer-related websites in the Arabic language, using the DISCERN tool, and explore the content and sources provided by different types of websites. Methods A total of 78 websites were included after excluding 21 based on predefined criteria (e.g., duplicates, non-functional uniform resource locators (URLs)). The websites were categorized into commercial, non-profit, and individual types. Two independent reviewers assessed the websites using the DISCERN tool. Interrater agreement was measured using the k-score. A one-way analysis of variance (ANOVA) was used to compare DISCERN scores across website types, and Spearman's rank correlation was used to analyze the relationship between website ranking and DISCERN scores. Results Almost all websites included a definition of thyroid cancer. Additionally, 15 websites (19.2%) covered the definition, clinical presentation, risk factors, diagnosis, and treatment, while 14 websites (17.9%) offered only clinical presentation, diagnosis, and treatment, and 11 websites (14.1%) offered other combinations of similar content. However, there was a lack of information regarding prognosis and predictors of outcomes following thyroid cancer surgery. The average overall DISCERN score for the 78 websites was 42.65 ± 12.35. Statistically significant differences were found in DISCERN scores across website types, with non-profit websites scoring the highest (38.93 ± 14.12), followed by commercial (37.67 ± 10.34) and individual websites (28.63 ± 10.02). A significant negative correlation was also found between website rank and DISCERN scores (Spearman's r = -0.38, p < 0.0001). Conclusion The study found that non-profit websites provide higher-quality thyroid cancer information compared to commercial and individual sites. Website ranking also affects content quality, emphasizing the importance of patients assessing online resources critically. Health organizations are encouraged to improve the visibility and quality of trustworthy information.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76526"},"PeriodicalIF":1.0,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11682854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904469","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":"Making the Cut: A Six-Year \"Bone-afide\" Membership Trend From Student to Surgeon.","authors":"Minali G Nemani, Emma Barham, Julieanne P Sees","doi":"10.7759/cureus.76484","DOIUrl":"10.7759/cureus.76484","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Mentorship and early exposure vary greatly from school to school for osteopathic medical students. Historically, allopathic medical students have matched at a higher rate for competitive surgical specialties, like orthopedic surgery, compared to osteopathic medical students. The unique position of medical student interest organizations in filling those gaps and their related outcomes, including successful residency acceptance, is unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of our study was to investigate whether membership in the Student Section of the American Osteopathic Academy of Orthopedics (SAOAO) plays a role in osteopathic medical student match success in orthopedic surgery residency programs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This comprehensive observational study was conducted using six years of all public resident data collected from residency program websites and affiliated social media accounts of 200 Accreditation Council for Graduate Medical Education (ACGME)-accredited orthopedic surgery residency training programs and was cross-referenced to the National SAOAO membership directory for the 2019-2024 match cycles, as of August 2024. Data analysis of the 5112 data points was conducted using a two-proportion z-test with significance set at a p-value of less than 0.05. Dataset normality is assumed based on the Central Limit Theorem.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In the 2024 orthopedic surgery match cycle, the data demonstrated 51.8% of matched osteopathic medical students were members of SAOAO, a statistically significant increase compared to previous years of 2019, 28.3%; 2020, 22.3%; 2021, 20.3%; 2022, 41.2%; and 2023, 19.4%. The change over 2019-2024 revealed a positive correlation with SAOAO membership in the orthopedic residency match results. There was a statistically significant increase in female osteopathic residents matching into orthopedic surgery between 2019 and 2024. Among the male osteopathic residents, the percentage of residents with prior SAOAO membership significantly increased from 22.1% in 2019 to 51.2% in 2024. SAOAO membership representation among female residents experienced a statistically significant decrease in 2020 and an increase in 2024. Also in 2024, 25.4% of matched SAOAO members were female. Broken down by gender, the male match rate was 56.3% and the female match rate was 60.0%. From 2018-2019 to 2023-2024, the SAOAO executive board experienced a statistically significant increase in representation of female board members of 12.5% (one of eight) to 62.5% (five of eight), respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Our study trending six years of osteopathic orthopedic surgical match results from 200 ACGME residency programs indicates that over time SAOAO membership has had increased success with osteopathic medical students matching into orthopedic surgery residency programs. Looking at the increased match rates for those on the SAOAO executive board, le","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"16 12","pages":"e76484"},"PeriodicalIF":1.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904465","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}