Minerva medica最新文献

{"title":"Insomnia disorder.","authors":"Luigi Ferini-Strambi","doi":"10.23736/S0026-4806.25.09690-9","DOIUrl":"10.23736/S0026-4806.25.09690-9","url":null,"abstract":"<p><p>Insomnia is a prevalent public health issue, characterized by dissatisfaction with the duration, continuity, and quality of sleep. It is closely associated with daytime symptoms, which are essential for diagnosing insomnia disorder. The condition is more common among women, middle-aged and older adults, and individuals with coexisting mental or physical health conditions. Evidence suggests that insomnia increases the risk of various health problems. Addressing insomnia is therefore crucial not only to enhance patients' quality of life but also to mitigate its significant health, social, and economic impacts. However, further studies are needed to evaluate the cost-effectiveness of insomnia treatments. Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the first-line treatment for chronic insomnia in adults. When CBT-I proves ineffective or is unavailable, pharmacological treatments may be considered. Benzodiazepines (BZs) and benzodiazepine receptor agonists (BZRAs) are suitable for short-term treatment (up to 4 weeks). Among BZs, triazolam is notable for its short half-life and demonstrated efficacy in treating sleep-onset and middle-of-the-night (MOTN) insomnia, supported by robust clinical evidence. Additionally, triazolam does not impair psychomotor performance. In certain cases, longer-term use of BZs or BZRAs may be appropriate; however, this approach requires careful individual assessment of the benefits and risks. Non-nightly use of hypnotic medications may also be a viable option for patients who do not require nightly treatment. Low-dose sedating antidepressants may be considered for short-term insomnia management (off-label), while antipsychotics and antihistamines are not recommended for this purpose. Orexin receptor antagonists are an option for treating insomnia for up to three months. It is important to note that although insomnia guidelines are based on daily use as evaluated in randomized controlled trials, clinical practice may vary.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"309-322"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392081","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":"Decoding uterine leiomyosarcoma: is ultrasound diagnosis still a daunting challenge?","authors":"Camilla DI Dio, Stefania Pipitone, Rossella Del Vecchio, Elisa Noce, Marika Denotti, Mauro Ceccanti, Luigi Tarani, Ludovico Muzii, Giampiero Ferraguti, Marco Fiore, Maria G Piccioni","doi":"10.23736/S0026-4806.25.09669-7","DOIUrl":"10.23736/S0026-4806.25.09669-7","url":null,"abstract":"<p><strong>Introduction: </strong>This narrative review, based on the current literature, aims to evaluate whether or not preoperative ultrasound can effectively distinguish between uterine leiomyosarcomas (ULMS) and leiomyomas (ULM).</p><p><strong>Evidence acquisition: </strong>By using PubMed, Scopus and WOS, an extensive literature search was conducted to identify ultrasound characteristics that specifically differentiate uterine ULMS from ULM.</p><p><strong>Evidence synthesis: </strong>This review analyzed several ultrasound features to distinguish ULMS from ULM, including the maximum diameter of myometrial growth, the number of lesions (solitary/multiple), tissue echogenicity (homogeneous/heterogeneous), growth borders (regular/irregular), the presence of cystic regions, shadow presence, subjective color grading, and the vascular pattern of the myometrial lesion (circumferential/intralesional). Our findings suggest that in postmenopausal patients with abnormal uterine bleeding and a new or enlarging mesenchymal mass, ULMS should be suspected. Features such as irregular tumor margins, moderate-to-abundant intralesional blood flow, cystic regions, and lack of calcifications indicate a higher risk of ULMS.</p><p><strong>Conclusions: </strong>Benign and malignant myometrial lesions should be disclosed by algorithms including ultrasound combined with clinical presentations and, if necessary, magnetic resonance imaging. This means that further prospective studies should be conducted to consolidate our findings.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"350-358"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065562","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":"Association between dapagliflozin and risk of dementia and Parkinson's disease: a subgroup analysis of a meta-analysis of randomized controlled trials.","authors":"João V Fernandes, João V Ramos, Maurus M Holanda","doi":"10.23736/S0026-4806.25.09695-8","DOIUrl":"10.23736/S0026-4806.25.09695-8","url":null,"abstract":"<p><strong>Introduction: </strong>Dementia and Parkinson's disease (PD) are prevalent neurodegenerative disorders with substantial global health impacts. Emerging evidence suggests that SGLT2 inhibitors, such as dapagliflozin, may offer neuroprotective benefits. This study aims to evaluate dapagliflozin's association with risks of dementia and PD through a sub-analysis of a meta-analysis of randomized controlled trials (RCTs).</p><p><strong>Evidence acquisition: </strong>This sub-analysis adhered to PRISMA 2020 guidelines and included RCTs from a prior meta-analysis focusing on dapagliflozin. Studies comparing dapagliflozin to placebo with reported dementia or PD outcomes were selected. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic, and bias was evaluated with the Cochrane Risk of Bias 2 tool.</p><p><strong>Evidence synthesis: </strong>Four RCTs met the inclusion criteria. For dementia, the pooled OR was 2.826 (95% CI: 0.264-30.229; I²=0%). For Alzheimer's-type dementia, the OR was 2.308 (95% CI: 0.232-22.928; I²=0%), while for PD, the OR was 0.533 (95% CI: 0.072-3.944; I²=0%). None of the results were statistically significant, and heterogeneity across studies was negligible.</p><p><strong>Conclusions: </strong>This sub-analysis found no significant association between dapagliflozin and reduced risks of dementia or PD. While these results align with previous meta-analyses, further long-term RCTs are necessary to clarify dapagliflozin's neuroprotective potential and broader therapeutic applications.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"323-328"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723050","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":"Steatotic liver disease: what role does alcohol consumption play?","authors":"Gianni Testino, Carmen Fucile, Maurizia Gnocchi, Gian M Rosa, Fabio Caputo","doi":"10.23736/S0026-4806.25.09726-5","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09726-5","url":null,"abstract":"<p><p>Metabolic-dysfunction associated steatotic liver disease (MASLD) includes diagnostic criteria such as overweight/ obesity, metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM). MASLD is a subtype of steatotic liver disease (SLD). MASLD is characterized by SLD plus one or more cardiovascular disease (CVD) risks. Metabolic and alcohol-related liver disease (MetALD) is characterized by an alcohol consumption between 20-40 g/day for females and 30-50 gr/day for males and alcohol related liver disease (ALD) is characterized by an alcohol consumption >40 g/day for females and >50 g/day for males. Synergism or a supra-additive interaction between alcohol consumption (AC) and metabolic factors is well known. The aim of this narrative review is to explore the following points: 1) it is mandatory early identification of AC and it is necessary to also identify low dosage of AC; 2) all SLD subtypes increase cardiovascular and oncologic risk; 3) fibrosis is the most important predictor of long term survival. For this reason early liver fibrosis (LF) detection is crucial to reduce hepatic and extra hepatic pathology and motivate the patient to change lifestyle. This narrative review is based on a detailed analysis of the scientific literature published before December 31, 2024 and examining the most recent guidelines on SLD (PubMed, Web of Science, Scopus, Google Scholar). From the data reported in the present narrative review, the following emerges: 1) due to the significant synergistic effect between SLD and alcohol, the cut-off to distinguish MASLD and MetALD should be reduced to 10 g/day for women and 20 g/day for men; 2) it is useful to identify even low doses of consumption. The most appropriate suggestion is total alcohol abstinence (especially in cases with high oncological risk) and even light AC increases the risk of morbidity and mortality expecially in young people; 3) it is necessary to identify LF early and improve lifestyle; 4) cardiometabolic risk factors are present in >90% of subjects with all subtypes of SLD (mainly ALD) and therefore, cardiologists and hepatologists must cooperate; 5) all subjects who come to our attention for the first time (altered liver function, MS, T2DM, CVDs) must undergo ultrasonography with elastography. Subsequent oncologic surveillance beyond rigid schemes must be decided on a case-by-case basis. In cirrhotic patients and in non-cirrhotic patients at high clinical risk, in our opinion surveillance is semi-annual (especially in the presence of T2DM and/or AC). In light of epidemiological data, in medium-low risk cases, for prudence, surveillance can be annual. It is appropriate to raise awareness among health-care professionals and the broader public that SLD is a major risk factor for liver and non-liver disease. It is necessary to combat SLD with prevention and early detection. Early detection of steatosis and fibrosis is a motivating factor for lifestyle correction. The latter represents both primar","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651668","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":"Unveiling the mechanistic synergy of palmitoylethanolamide and acetyl-L-carnitine in lumbosciatalgia.","authors":"Simone Parisi","doi":"10.23736/S0026-4806.25.09763-0","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09763-0","url":null,"abstract":"","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585945","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":"Pitfalls in contrast enhanced ultrasound: lack of washout in malignant liver lesions. A scoping review.","authors":"Kathleen Möller, Mikael Sawatzki, Christian Jenssen, Carla Serra, Sofia Bakken, Christian Görg, Yi Dong, Christoph F Dietrich","doi":"10.23736/S0026-4806.25.09658-2","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09658-2","url":null,"abstract":"<p><p>Contrast-enhanced ultrasound (CEUS) is a reliable examination procedure to differentiate benign and malignant liver lesions, which is superior to contrast enhanced computed tomography (CECT) and equally to contrast enhanced magnetic resonance imaging (CEMRI) in large comparative studies. In this review, the data on the enhancement of malignant liver lesions in the late phase in CEUS are analyzed in detail. Hypoenhancement in the late phase on CEUS with SonoVue^® is a typical feature of metastases and other malignant tumors. However, this is not guaranteed in every case. It is explicitly analyzed in the present studies which malignant lesions did not demonstrate washout in the late phase with SonoVue^®. Lack of washout is known for some hepatocellular carcinomas. However, there are also a few rare exceptions described for metastases of neuroendocrine tumors. The possible causes are analyzed. While metastases and cholangiocellular carcinoma demonstrate an early marked washout, this can start very late in neuroendocrine metastases. Some predominantly well differentiated hepatocellular carcinomas in the cirrhotic liver may also show no or only very delayed and faintly washout in the late phase. Isoenhancement at the beginning of the late phase does not rule out metastases or HCC (in the cirrhotic liver). This contrast behavior is known for some HCC in the cirrhotic liver, but it is atypical, poorly reported and understood, especially in liver metastases. The present review analyzes the data on isoenhancement in the late phase of malignant liver lesions. The novel aspect is the focus on liver metastases.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556322","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":"Oxidative stress in smokers with and without COPD: what variables are associated?","authors":"Aldo Pezzuto, Alberto Ricci, Antonella Tammaro, Alessia Pacini, Claudia Salvucci, Giuseppe Tonini, Valeria Minoia, Valerio Brigato, Elisa Desideri, Noemi Calabrò, Elisabetta Carico","doi":"10.23736/S0026-4806.25.09723-X","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09723-X","url":null,"abstract":"<p><strong>Background: </strong>Oxidative stress induced by cigarette smoke compounds is one of the factors responsible for bronchial inflammation and airway structural remodeling. On the other side, the individual antioxidant capacity is variable and representative of the body's immune defenses' state. The aim of this study is to detect the level of oxidative stress and anti-oxidant capacity in smokers, comparing COPD with non-COPD patients. To determine the variables associated with oxidative stress.</p><p><strong>Methods: </strong>Fifty-four patients were assessed by spirometry and questionnaires such as CAT, mMRC, Fagestrom's. The exhaled carbon monoxide (eCO) was measured in order to assess smoking exposure. Serum vitamin-D level was also detected. All patients underwent treatment for smoking cessation by Cytisine, an alkaloid partial agonist of the nicotinic acetylcholine receptor. The diagnosis of COPD was determined based on FEV1/FVC ratio <70%. Oxidative stress and anti-oxidant capacity were determined on a saliva sample using commercial assays, after the last cigarette smoked. Data were analyzed using non-parametric statistical tests.</p><p><strong>Results: </strong>In the overall population, the average value of the pack-years index was 40, the Fagestrom's mean value was 5, BMI was 26, exhaled CO (eCO) was 27 ppm. Comparing the two subgroups, COPD and no-CODP, they were comparable in age, Fagestrom's, pack-years. They obviously differed in the functional variables. The d-ROMs value was significantly higher in smokers who had not developed COPD (P<0.01). This group had a lower level of vitamin D than the COPD group (P<0.03), a different value of cigarettes/day (P<0.0001) as well as the value of eCO were detected (P<0.01). In multiregression analysis d-ROMs value is correlated with pack-years and cigarette/day values. d-ROMs, cigarettes/day, vitamin D value were factors affecting COPD.</p><p><strong>Conclusions: </strong>Our results confirm that tobacco smoking causes oxidative stress, and it is associated with pack-years index and cigarettes/day. COPD patients with a high vitamin D level are protected from oxidative stress.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556321","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":"An overview of the role of serum uric acid to high-density lipoprotein cholesterol ratio in type 2 diabetes mellitus and in other inflammatory and metabolic conditions.","authors":"Gulali Aktas","doi":"10.23736/S0026-4806.25.09712-5","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09712-5","url":null,"abstract":"<p><p>The serum uric acid to HDL cholesterol ratio (UHR) has emerged as a novel biomarker linking metabolic dysfunction and inflammation. Elevated UHR reflects a complex interplay between oxidative stress, endothelial dysfunction, and lipid metabolism, contributing to systemic inflammation and disease progression. Recent studies suggest that UHR may serve as a predictive marker for cardiometabolic risk, offering potential advantages over traditional lipid and uric acid measurements alone. However, the underlying mechanisms remain incompletely understood, and standard reference values have yet to be established. Further research is needed to elucidate the causal relationships and assess the clinical utility of UHR in disease risk stratification and management. Understanding the role of UHR in metabolic and inflammatory pathways could enhance early detection and intervention strategies for at-risk individuals. This review elaborates the role of UHR in various metabolic and inflammatory conditions, including type 2 diabetes mellitus, diabetic chronic complications, metabolic syndrome, cardiovascular disease, insulin resistance, and chronic inflammatory states.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546679","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":"Impact of age, sex, and urban environment on allergen-specific IgE profiles to grass pollen components: a cross-sectional study in Northern Italy.","authors":"Mara DE Amici, Claudio Tirelli, Fiorella Barocci, Lucia Sacchi, Amelia Licari, Alessia Marseglia, Angelo G Corsico, Vanessa Ronzoni, Gian L Marseglia","doi":"10.23736/S0026-4806.25.09673-9","DOIUrl":"https://doi.org/10.23736/S0026-4806.25.09673-9","url":null,"abstract":"<p><strong>Background: </strong>Asthma and rhino-conjunctivitis are frequently triggered by sensitization to airborne allergens, particularly grass pollens. This study aimed to assess whether age, sex, and living environment influence allergen-specific IgE responses to grass pollen components, using a molecular diagnostic approach.</p><p><strong>Methods: </strong>A total of 772 patients referred to the Allergology outpatient clinic for suspected grass pollen allergy were enrolled. Allergen-specific IgE levels were measured using the ImmunoCAP ISAC microarray. Patients were stratified into nine groups based on age, sex, and city of residence (Milan, Pavia, and surrounding rural/suburban areas). Sensitization to nine grass pollen components (Cyn d 1, Phl p 1, Phl p 2, Phl p 4, Phl p 5, Phl p 6, Phl p 7, Phl p 11, and Phl p 12) was analyzed.</p><p><strong>Results: </strong>Sensitization patterns varied by sex, age group, and place of residence. Male patients showed higher IgE positivity for Phl p 2 and Phl p 6. Overall, the highest sensitization rates were observed in adolescents and in patients living in Milan. Cyn d 1, Phl p 1, Phl p 4, and Phl p 5 showed widespread sensitization across all groups, though rates were higher in males and in urban areas.</p><p><strong>Conclusions: </strong>This cross-sectional study highlights that demographic and environmental factors - particularly sex, age, and urban living - can influence IgE sensitization to grass pollen components. These findings emphasize the relevance of molecular diagnostics in understanding allergy epidemiology and support the hypothesis that environmental exposure, including air pollution, may affect sensitization profiles.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144532105","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":"Heart failure with preserved ejection fraction and atrial fibrillation.","authors":"Thibault Lenormand, Arnaud Bisson, Laurent Fauchier","doi":"10.23736/S0026-4806.25.09602-8","DOIUrl":"10.23736/S0026-4806.25.09602-8","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are common diseases, inducing increased morbidity and mortality when associated. In this narrative review, we report available evidence in the literature regarding the pathophysiology behind this association, its impact on prognosis, and the therapeutic management of both entities. AF and HFpEF share several pathophysiological mechanisms, most notably inflammation, electrical and structural remodeling of the left atrium with fibrosis and involvement of epicardial adipose tissue, all concurring to left atrial myopathy. AF and HFpEF furthermore favor one another, showing their intricated pathophysiology. The presence of AF in HFpEF worsens patients' prognosis, as does the presence of HFpEF in AF patients. Data on the specific management of this subgroup of patients is scarce. SGLT2 inhibitors appear as the cornerstone of HFpEF treatment, with the same benefit in AF patients. AF management however is less clear, apart for the need for anticoagulation based on the CHA2DS2-VA score. Rate control therapy and rhythm control therapy are in balance for symptom control. Overall, holistic approaches offer the most promises in these comorbid patients. AF and HFpEF partner in comorbid patients and worsen general prognosis. Their management is complex, as is their pathophysiology, and holistic strategies may be the most appropriate way to provide efficient care in these patients.</p>","PeriodicalId":94143,"journal":{"name":"Minerva medica","volume":" ","pages":"234-248"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143723053","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}