Revista clinica espanola最新文献

{"title":"Trends in the structure, activity, and outcomes of Internal Medicine Services in the National Health System (2007-2024): The RECALMIN Study VI.","authors":"M M Chimeno Viñas, J M Porcel, P Pérez-Martínez, J L Bianchi Llave, J Moreno Díaz, N Del Prado, F J Elola Somoza","doi":"10.1016/j.rceng.2026.502621","DOIUrl":"10.1016/j.rceng.2026.502621","url":null,"abstract":"<p><strong>Objectives: </strong>To analyse the evolution of the structure, activity and outcomes of Internal Medicine Departments (IMDs) within the Spanish National Health System (SNHS) between 2007 and 2024, and to assess their alignment with the strategic priorities of the specialty.</p><p><strong>Methods: </strong>Observational study based on two data sources: (1) the RECALMIN survey on IMD structure and activity, and (2) the Minimum Basic Data Set (CMBD), including more than 9.9 million hospital discharges. Temporal trends were analysed using Poisson regression models and risk-adjusted models for hospital mortality.</p><p><strong>Results: </strong>Over the study period, a significant increase was observed in the number of internists per population (IRR = 1.04-1.06), as well as in hospital activity and patient complexity. IMDs account for approximately 20% of all hospital discharges within the SNHS. Crude hospital mortality increased, whereas risk-adjusted mortality showed a declining trend until 2015 followed by subsequent stabilisation. The implementation of key organisational models (hospital-at-home programmes, co-management models, and care pathways for complex chronic patients) remains limited.</p><p><strong>Conclusions: </strong>IMDs have experienced a sustained increase in activity and case complexity over the past two decades, while maintaining overall stable risk-adjusted outcomes. However, a gap persists between the growing care burden and the implementation of organisational models aligned with the strategic direction of the specialty.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502621"},"PeriodicalIF":0.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027528","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":"Joint position paper on anterior ischemic optic neuropathy (AION). Vascular Risk Group and Systemic Autoimmune Diseases Group (GEAS) of the Spanish Society of Internal Medicine (SEMI) together with the Spanish Retina and Vitreous Society (SERV).","authors":"F Jaén Águila, A J Gómez Escobar, N Navarrete Navarrete, A Bustos Merlo, P García Robles, E Gutiérrez Sánchez, R García Alonso, M E Salguero Cámara, N Muñoz Rivas, A González García, L Arias Barquet, L Castilla Guerra","doi":"10.1016/j.rceng.2026.502615","DOIUrl":"10.1016/j.rceng.2026.502615","url":null,"abstract":"<p><p>Anterior ischemic optic neuropathy (AION) is one of the leading causes of sudden, painless, monocular vision loss in individuals over 50 years of age. Two forms can be distinguished, with clearly different clinical, diagnostic, and therapeutic implications: the arteritic form, most commonly associated with giant cell arteritis (GCA), which constitutes a medical and ophthalmological emergency; and the non-arteritic form, which is far more frequent and for which no specific effective treatment is currently available. Despite its clinical relevance and the frequent coexistence of vascular risk factors, the management of AION remains heterogeneous, with considerable variability in care pathways, etiological assessment, and follow-up and secondary prevention strategies. This situation highlights the need for a comprehensive and coordinated approach, in which close collaboration between Ophthalmology and Internal Medicine is essential. This position statement is part of a series of joint working groups documents promoted by the Vascular Risk Group of the Spanish Society of Internal Medicine (SEMI) and the Spanish Retina and Vitreous Society (SERV), which began with the consensuses on retinal arterial and venous occlusion. Internists with extensive experience in vasculitis and systemic diseases, who are members of the Systemic Autoimmune Diseases Group (GEAS), have participated in the preparation of this text. The aim is to establish a consensus-based proposal for the clinical management of AION. The epidemiological, pathophysiological, diagnostic and therapeutic aspects of the disease are critically reviewed, and practical recommendations are provided to improve early detection, etiological management and the prevention of visual and systemic complications, with particular emphasis on the role of the internist in the care of these patients. The recommendations included in this document should be interpreted as expert consensus-based recommendations, particularly in those sections where high‑quality evidence is lacking.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502615"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914723","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":"Joint pain: a practical guide to the diagnosis of arthritis.","authors":"C Romero Gómez, R Rodríguez Rodríguez, D Lozano Fernández, H Hernández Negrín","doi":"10.1016/j.rceng.2026.502617","DOIUrl":"10.1016/j.rceng.2026.502617","url":null,"abstract":"<p><p>Joint pain is one of the most common reasons for consultation in clinical practice, and its correct interpretation presents a diagnostic challenge due to the wide variety of causes and clinical presentations. The assessment of joint pain requires a structured clinical approach that allows differentiation between joint and extra-articular causes and distinguishes between inflammatory and non-inflammatory processes. A detailed medical history and targeted physical examination form the cornerstone of the diagnostic process, facilitating the identification of clinical patterns based on the number of joints affected, their distribution and the course of the condition over time. Supporting investigations, including laboratory tests, synovial fluid analysis and imaging techniques, should be used judiciously and always within the clinical context, avoiding indiscriminate testing. This approach allows for the early recognition of potentially serious conditions, the identification of warning signs and the optimisation of decision-making in clinical practice.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502617"},"PeriodicalIF":0.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890044","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":"Executive summary of the consensus document for recommendations on the treatment of venous thromboembolism in pregnancy: consensus document from the Spanish Society of Internal Medicine, the Spanish Society of Medical Radiology, the Spanish Society of Vascular Interventional Radiology and the Spanish Society of Gynecology and Obstetrics 2026.","authors":"M Á Fidalgo-Fernández, M Ortiz, S Moragón-Ledesma, S Lojo-Lendoiro, P Demelo-Rodriguez, M Grau-García, M Martín-Asenjo, B Serrano-Sánchez, N Martínez-Sánchez, O Madridano-Cobo, E Gálvez-González, F Galeano-Valle","doi":"10.1016/j.rceng.2026.502613","DOIUrl":"10.1016/j.rceng.2026.502613","url":null,"abstract":"<p><strong>Introduction: </strong>Low-molecular-weight heparin is the anticoagulant treatment of choice for managing venous thromboembolism (VTE) during pregnancy and lactation. Vitamin K antagonists are contraindicated between weeks 6-12 of gestation due to their association with a specific embryopathy, and during the third trimester due to the risk of bleeding. Direct oral anticoagulants are contraindicated during pregnancy and breastfeeding because of the risk of prenatal malformations. Reperfusion techniques, such as systemic thrombolysis or mechanical thrombectomy, are reserved for cases of pulmonary embolism with hemodynamic instability.</p><p><strong>Methods and results: </strong>This consensus document, developed by the Spanish Societies of Internal Medicine, Medical Radiology, Vascular and Interventional Radiology, and Gynecology and Obstetrics, provides a comprehensive review of the most recent evidence on the treatment of VTE in pregnant patients and updates current recommendations.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502613"},"PeriodicalIF":0.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148725146","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":"Treatment of osteoporosis in clinical practice: when, whom, how, and for how long.","authors":"R Arboiro Pinel","doi":"10.1016/j.rceng.2026.502614","DOIUrl":"10.1016/j.rceng.2026.502614","url":null,"abstract":"<p><p>Osteoporosis is a highly prevalent chronic disease associated with an increased risk of fragility fractures and a substantial clinical and socioeconomic burden. Its management is based on fracture risk stratification, integrating clinical risk factors, bone mineral density, and tools such as FRAX®. Previous fragility fracture is the strongest predictor of future fractures and, in most cases, indicates the need for pharmacological treatment. In patients at high risk, antiresorptive agents remain the cornerstone of therapy, whereas in those at very high risk, an initial anabolic strategy followed by antiresorptive treatment should be considered. Treatment duration and sequencing require periodic reassessment, particularly with bisphosphonates and denosumab, whose discontinuation must be carefully planned to avoid rebound effects. This practical approach allows individualized clinical decision-making and aims to optimize fracture prevention, treatment adherence, and long-term outcomes in patients with osteoporosis in routine clinical practice settings.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502614"},"PeriodicalIF":0.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724262","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":"Stickler syndrome type 1: case series and new genetic variants.","authors":"L Landeras, L Riancho-Zarrabeitia, A de la Mora, C Morales, J A Riancho","doi":"10.1016/j.rceng.2026.502612","DOIUrl":"10.1016/j.rceng.2026.502612","url":null,"abstract":"<p><strong>Introduction: </strong>Stickler syndrome is a hereditary connective tissue disease with variable eye, auditory and musculoskeletal involvement. Its multi-organ signs require various specialists to be aware of it. We present a case series illustrating clinical variability and the presence of undescribed genetic variants.</p><p><strong>Methods: </strong>Descriptive observational study of patients with clinical and genetic diagnosis of Stickler syndrome evaluated in a specialized hospital setting. Clinical signs and identified genetic variants were analyzed, as well as intra- and inter-familial variability in cases with shared mutations.</p><p><strong>Results: </strong>The cohort comprised 18 patients carrying pathogenic or likely pathogenic heterozygous variants in the COL2A1 gene. Six distinct variants were identified, five of which have not been reported in other patients. Ophthalmological signs were the most prevalent clinical features, with myopia and retinal detachment observed in 67% of patients, followed by hearing loss (44%) and early-onset osteoarthritis (44%). Ocular signs exhibited the earliest age at onset. Intrafamilial analyses revealed relative phenotypic homogeneity among individuals harboring the same mutation, whereas marked differences were observed between families, suggesting distinct clinical profiles associated with specific genetic variants.</p><p><strong>Conclusions: </strong>This case series confirms the marked clinical heterogeneity of Stickler syndrome and identifies novel disease-causing variants in COL2A1. The findings support the presence of a partial genotype-phenotype correlation, which may inform clinical surveillance and risk stratification, particularly with regard to ophthalmological complications.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502612"},"PeriodicalIF":0.0,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148727550","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":"Metabolic alkalosis and clinical outcomes in acute heart failure: a systematic review and meta-analysis.","authors":"Oriol Aguiló, Òscar Miró, Xavi Castells, Doron Aronson, Akihiro Shirakabe, Harriette Gc Van Spall, Joan Carles Trullàs","doi":"10.1016/j.rceng.2026.502616","DOIUrl":"10.1016/j.rceng.2026.502616","url":null,"abstract":"<p><strong>Background and objective: </strong>To assess the relationship between alkalosis or metabolic alkalosis (MA) and mortality or rehospitalisation in patients with acute heart failure (AHF) through a systematic review and meta-analysis.</p><p><strong>Materials and methods: </strong>PubMed, Scopus and Web of Science were searched from inception to February 2025. Eligible studies included at least 50 patients and evaluated the association between alkalosis or MA and mortality or rehospitalisation in AHF. The review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42024525906).</p><p><strong>Results: </strong>Of 1,395 potentially relevant publications, five studies were included in the systematic review. The prevalence of alkalosis ranged from 12% to 44%, whereas the prevalence of MA ranged from 3% to 9%. Two retrospective studies found an association between MA and in-hospital mortality, although this finding was not confirmed in other studies. Only one prospective study reported an association between MA and rehospitalisation for AHF at 30 and 90 days of follow-up. Four studies including 19,296 patients were included in the meta-analysis. No significant association was observed between alkalosis or MA and in-hospital mortality (OR 1.43, 95% CI 0.91-2.25 and OR 1.47, 95% CI 0.95-2.27, respectively).</p><p><strong>Conclusions: </strong>Very few studies have evaluated the relationship between alkalosis or MA and mortality or rehospitalisation in patients with AHF. The prognostic impact of MA in AHF remains uncertain. Meta-analysis showed no significant association between MA and in-hospital mortality. However, the limited available data do not allow robust conclusions to be drawn.</p>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":" ","pages":"502616"},"PeriodicalIF":0.0,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148715089","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":"Venous thromboembolic disease associated with hormonal contraceptives. Venous Thromboembolism Group of the Spanish Society of Internal Medicine and the Catalan Society of Contraception","authors":"A. Franco Moreno,&nbsp;J. Perelló Capó,&nbsp;O. Madridano Cobo,&nbsp;N. Muñoz Rivas,&nbsp;M. Martín Asenjo,&nbsp;Á. Blanco Molina","doi":"10.1016/j.rceng.2026.502579","DOIUrl":"10.1016/j.rceng.2026.502579","url":null,"abstract":"<div><div>Combined hormonal contraceptives (CHCs) constitute one of the most widely used contraceptive methods in women of reproductive age and play a relevant role not only in contraception but also in the treatment of various gynecological conditions. However, their use is associated with an increased risk of venous thromboembolic disease (VTE; deep vein thrombosis and pulmonary embolism) due to the induction of a hypercoagulable state. This effect is primarily related to the estrogenic component and is modulated by the type of associated progestogen. The formulations containing low-dose estrogen and levonorgestrel, as well as progestin-only contraceptives (except medroxyprogesterone), have the most favorable prothrombotic profile and should be prioritized when hormonal contraception is indicated, particularly in women with additional risk factors. In women with VTE risk factors, the use of progestogen-only is recommended, as these are not associated with an increased thrombotic risk. The use of CHC after an episode of VTE requires individualized assessment; in selected cases, it may be temporarily continued during anticoagulant therapy. Before discontinuation of anticoagulation, CHCs should be replaced by a progestogen-only. CHCs are contraindicated in women with a history of VTE who are not receiving anticoagulant treatment. Appropriate selection of the contraceptive method and patient education regarding the symptoms of VTE are essential to minimize thrombotic risk, optimize safety, and promote early detection of thrombosis. This document provides an updated review of the thrombotic risk associated with different CHCs and offers practical recommendations for their management in women at high risk or with a history of VTE, emphasizing the need for individualized evaluation and a multidisciplinary approach.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502579"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059305","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":"The impact of inclusion in a palliative care program for patients with advanced dementia","authors":"C. Vicente Martín,&nbsp;V. de la Cuesta Esteban,&nbsp;N. Trapero Iglesias,&nbsp;A.C. Gil Abizanda,&nbsp;A. Sáenz de Urturi Rodríguez,&nbsp;J.M. Galván Román,&nbsp;R. Barba Martín,&nbsp;J.A. Rueda Camino","doi":"10.1016/j.rceng.2026.502576","DOIUrl":"10.1016/j.rceng.2026.502576","url":null,"abstract":"<div><h3>Background</h3><div>Despite evidence, it remains unclear whether the inclusion of patients with advanced dementia (AD) in palliative care (PC) is beneficial. The aim of this study is to examine the impact of enrolment in a PC program on the subsequent clinical management of these patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study including patients with AD admitted between June 2022 and June 2025. Patients were classified into two groups: included in palliative care (PCU group) or not included (NO-PCU group). We compared the mean number of hospital care transitions, the proportion of invasive and/or life-sustaining treatments, and the total length of hospital stay. Outcomes were adjusted using negative binomial regression.</div></div><div><h3>Results</h3><div>298 patients were included, 149 assigned to each group, with 67% being female and a mean age of 88 years (SD 6.6). The mean number of hospital care transitions was 2.7 in the non-PCU group vs. 1.7 in the PCU group (<em>p</em> &lt; 0.001). After adjustment for confounding, the effect remained significant: IRR 0.52 (95% CI: 0.49-0.54). Inclusion in the PCU group was associated with a significant reduction in interventional procedures -6%; 95% CI: −9.9% to -2.2%) and in the use of broad-spectrum antibiotics (mean difference: −0.7; <em>p</em> &lt; 0.001). The total hospital length of stay was 30 days (95% CI: 22.7-37.3) in the PCU group vs 111 days (95% CI: 25.6-196.4) in the non-PCU group (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>Inclusion in a PC program for patients with AD is associated with lower rates of hospital care transitions and reduced use of invasive procedures.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502576"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059331","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":"Protective effect of pneumococcal vaccination on pneumococcal pneumonia outcomes: analysis adjusted for severity and comorbidity","authors":"J.M. Moreno Salcedo,&nbsp;P. Malo Rico,&nbsp;G. Alcalá Rivera,&nbsp;M.F. Rueda Narváez","doi":"10.1016/j.rceng.2026.502575","DOIUrl":"10.1016/j.rceng.2026.502575","url":null,"abstract":"<div><h3>Background and objective</h3><div>Pneumococcal vaccination may attenuate the severity of pneumococcal pneumonia even in breakthrough infections. However, evidence on this effect stratified by clinical severity is scarce. The objective was to evaluate whether vaccination reduces poor outcomes in patients hospitalized for pneumococcal pneumonia, specifically according to CURB-65 severity.</div></div><div><h3>Methods</h3><div>Retrospective observational study of 90 adults with microbiologically confirmed pneumococcal pneumonia (January 2020–December 2024). Poor outcome was defined as death or ICU admission. Propensity score matching (PSM) 1:1 was performed to control for indication bias, adjusting for age, sex, comorbidity, CURB-65, and dependency. In the matched sample (43 pairs), the effect of vaccination on poor outcome was analysed with logistic regression further adjusted for comorbidity and CURB-65. Sensitivity analysis was conducted with inverse probability of treatment weighting (IPTW).</div></div><div><h3>Results</h3><div>Vaccinated patients had higher age, comorbidity, and CURB-65 at admission. PSM achieved adequate balance between groups. In the matched sample, poor outcome occurred in 34.9% of vaccinated and 51.2% of unvaccinated (absolute reduction 16.3%). Adjusted OR for vaccination was 0.42 (95% CI: 0.16–1.07; <em>p</em> = 0.070), suggesting a possible protective effect, although statistical significance was not reached. CURB-65 was an independent predictor of poor outcome (OR per point: 1.93; <em>p</em> = 0.006). IPTW yielded an OR of 1.28 (95% CI: 0.67–2.47; <em>p</em> = 0.46).</div></div><div><h3>Conclusions</h3><div>Pneumococcal vaccination shows a possible protective effect, with a trend toward clinically relevant benefit, especially in patients with more severe disease (CURB-65 ≥ 3), reducing poor outcomes by 16.3%. This finding supports vaccination in adults with risk factors.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"226 7","pages":"Article 502575"},"PeriodicalIF":0.0,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148059309","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}