Case Reports in Gastroenterology最新文献

{"title":"Primary Peritoneal Clear Cell Carcinoma Presenting with Nonspecific Gastrointestinal Symptoms in a 39-Year-Old Woman: A Case Report.","authors":"Ramya Vasireddy, Thilini Delungahawatta, Greeshma Gaddipati, Jeffrey Iding, Bryan Szeto, Christopher J Haas","doi":"10.1159/000544883","DOIUrl":"10.1159/000544883","url":null,"abstract":"<p><strong>Introduction: </strong>Primary peritoneal clear cell carcinoma (PPCCC) is a rare abdominal tumor, affecting 7 out of every million people. Its vague presenting signs and symptoms often lead to delayed diagnosis and poor prognosis. We present a case involving a young woman with anemia and abdominal discomfort who on further investigation had a 26-cm abdominal tumor identified to be PPCCC. Multimodal therapy with tumor debulking and chemotherapy was pursued. Given the aggressive nature of PPCCC, any clinical suspicion of peritoneal carcinoma should prompt thorough diagnostic evaluation.</p><p><strong>Case presentation: </strong>A 39-year-old woman with menorrhagia and peptic ulcer disease presented with abdominal discomfort of 2 days duration. She initially had headaches managed with ibuprofen. Following this, she had generalized abdominal pain with bloating that worsened with food and had no relief with use of stool softeners. She had associated dizziness with palpitations, chest pressure, and exertional dyspnea. In the emergency department, the patient was mildly tachycardic but otherwise stable. On exam, she had a distended abdomen with generalized tenderness and normoactive bowel sounds. Labs showed normocytic anemia with a hemoglobin of 5.2 mg/dL. Electrocardiogram and abdominal and chest X-rays were normal. A non-contrast computed tomography of the abdomen and pelvis showed a fibroid uterus and posterior displacement of multiple bowel loops by a large septate cystic mass (13.5 × 26.0 × 26.7 cm) occupying the entire abdominal cavity. Elevated CA 125 and CA 19-9 were also noted. She underwent exploratory laparotomy with mass resection, partial omentectomy, left colectomy (given extension into transverse colon), appendectomy, and total abdominal hysterectomy with bilateral salpingectomy. Biopsy and immunohistochemical staining (positive for PAX-8, ER, P53, P16, Napsin A and negative for PR and WT-1) confirmed mass as stage IIIB PPCCC. There was no evidence of malignancy in other tissue samples. The patient was discharged with a plan for outpatient chemotherapy and genetic counseling.</p><p><strong>Conclusion: </strong>Given the rarity of PPCCC, our case highlights how increased clinical vigilance and prompt multidisciplinary efforts are essential for an accurate diagnosis, especially in younger patients to not delay management. Currently, there are no established management guidelines; however, initial treatment with surgical debulking followed by chemotherapy is often practiced.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"198-203"},"PeriodicalIF":0.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11936432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iron Mettle: Unveiling an Unusual Incidental Case Report of Esophageal Ulcer.","authors":"Akshi Raj, Mangesh Londhe, Yogesh Bade, Madhuri Singh, Charusheela Gore, Anuj Sharma","doi":"10.1159/000544108","DOIUrl":"https://doi.org/10.1159/000544108","url":null,"abstract":"<p><strong>Introduction: </strong>Erosive damage to the upper gastrointestinal (GI) tract caused by therapeutic oral iron supplements is relatively uncommon. While such injuries are frequently linked to overdoses of oral iron, they can also occur with doses within the standard therapeutic range. Cases have highlighted GI complications caused by iron, predominantly involving the stomach and sometimes the esophagus. During absorption, iron is initially processed as ferrous iron, which, when bound to proteins, can lead to cellular injury. Additionally, ferric iron exerts a corrosive effect on the GI mucosa and disrupts cellular processes by generating free radicals and triggering lipid peroxidation.</p><p><strong>Case presentation: </strong>A 55-year-old female with dysphagia, pain, and anorexia showed linear to circumferential ulcers covered with white slough extensively around central esophagus with thickened and erythematous mucosa with focal erosions on esophagogastroduodenoscopy.</p><p><strong>Conclusion: </strong>This case highlights a rare case report of iron-induced esophageal ulcer found incidentally and the significance of acknowledging that iron preparations can harm the esophageal mucosa, especially in an Indian population where anemia is fairly predominant.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"184-189"},"PeriodicalIF":0.5,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978364","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":"Chronic Liver Disease Primarily Presenting with Motor Weakness by Intractable Hypokalemia with Combined Respiratory Alkalosis and Chronic Diarrhea: A Case Report.","authors":"Nam-Seon Beck, Yeon-Oh Jeong, Kyung-Hee Lee, Eun-Mi Jun, Joung-Il Im, Sae-Yong Hong","doi":"10.1159/000544099","DOIUrl":"https://doi.org/10.1159/000544099","url":null,"abstract":"<p><strong>Introduction: </strong>Most patients with compensated cirrhosis remain asymptomatic. However, with the onset of decompensation, electrolyte and acid-base disturbances are frequent in patients with chronic liver disease, including hypokalemia. We encountered a case of chronic liver disease with portal hypertension, primarily presenting with motor weakness caused by intractable hypokalemia, hypoxia-associated respiratory alkalosis, and chronic diarrhea.</p><p><strong>Case presentation: </strong>A 54-year-old male presented to the emergency department with motor weakness. He reported experiencing exertional dyspnea and watery diarrhea for the past 3 months, approximately ten times daily. Arterial blood gas analysis indicated hypoxia and hypocapnia compatible with chronic respiratory alkalosis. The transtubular potassium gradient was 1.69, and the aldosterone/renin ratio was 17.6 (ng/dL)/(ng/mL/h). The patient had a 30-year history of consuming 360-720 mL of 20% alcohol almost daily. Abdominal computed tomography revealed multiple regenerative and dysplastic nodules in the liver, splenomegaly, ascites, esophageal varices, and diffuse edematous wall thickening in the bowel, suggesting portal hypertensive enteropathy. Computed tomography of the lungs showed no specific abnormalities in the lungs, pleura, or thoracic wall.</p><p><strong>Conclusion: </strong>We present a case of liver cirrhosis complicated by intractable hypokalemia, respiratory alkalosis, portal hypertension, and chronic diarrhea. A 24-h urine analysis showed renal excretion levels of Na⁺, K⁺, and Cl^- at 6.0, 2.5, and 11.0 mmol, respectively, suggesting renal retention of these electrolytes. Meanwhile, the serum levels of Na⁺, K⁺, and Cl^- were 136, 1.8, and 98 mEq/L, respectively, indicating a preserved balance of sodium and chloride but not potassium. This case underscores the importance of clinicians considering both liver cirrhosis-associated hypoxia and chronic liver disease-induced chronic diarrhea as potential underlying causes, especially when more common causes of hypokalemia have been excluded.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"165-172"},"PeriodicalIF":0.5,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968707","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":"Aseptic Abscess Syndrome: A Case Report of a Rare Extraintestinal Manifestation of Inflammatory Bowel Disease.","authors":"Clive Jude Miranda, Nariman Hossein-Javaheri, Gina Marie Sparacino, Yousef Soofi, Farhan Azad, Nikki Duong","doi":"10.1159/000543761","DOIUrl":"10.1159/000543761","url":null,"abstract":"<p><strong>Introduction: </strong>Aseptic hepatic abscesses are a highly uncommon phenomenon and even more rare in the spectrum of extraintestinal manifestations of inflammatory bowel disease. Part of the spectrum of \"neutrophilic disease,\" both the pathogenesis and the optimal management of these aseptic abscesses remain unclear. In the context of inflammatory bowel disease, sometimes these abscesses appear despite normal endoscopic findings.</p><p><strong>Case presentation: </strong>We describe a highly uncommon case of aseptic hepatic abscess formation in a patient with inflammatory bowel disease.</p><p><strong>Conclusion: </strong>In doing so, we investigated the concept of \"aseptic abscess syndrome\" as it relates to similar autoimmune conditions.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"120-126"},"PeriodicalIF":0.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11867638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522667","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":"Effectiveness of Triamcinolone Injections in Preventing Scar Deformity following Endoscopic Submucosal Dissection for Pharyngeal Cancer.","authors":"Yugo Suzuki, Shinji Ito, Tsuyoshi Ishii, Minoru Oda, Shu Hoteya","doi":"10.1159/000543878","DOIUrl":"https://doi.org/10.1159/000543878","url":null,"abstract":"<p><strong>Introduction: </strong>Endoscopic submucosal dissection (ESD) is an effective treatment for superficial pharyngeal cancer. However, pharyngeal deformity caused by postoperative ulcer contraction is a major concern and can result in a poor quality of life. While local steroid injections have been shown to prevent strictures after ESD for esophageal cancer, their effectiveness in preventing deformities following ESD for pharyngeal cancer remains unclear.</p><p><strong>Case presentation: </strong>A 60-year-old woman with superficial pharyngeal cancer in the left pyriform sinus underwent ESD. After ESD, 80 mg of triamcinolone acetonide was injected into the ulcer bed to prevent scar contracture. The patient experienced mild pharyngeal pain, which resolved within a few days. Histopathological examination confirmed the lesion was well-differentiated SCC, with negative resection margins and no lymphovascular invasion. Follow-up endoscopy at 6 weeks showed granulation tissue in the surgical wound, which completely healed without pharyngeal deformity by 14 weeks post-ESD.</p><p><strong>Conclusion: </strong>This case demonstrated that the injection of triamcinolone in an ulcer that developed after ESD may be an effective method of preventing pharyngeal deformity caused by scar contracture.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"113-119"},"PeriodicalIF":0.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11857159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977333","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 Intra-Abdominal Desmoid Tumor with Edematous Loose Collagen Fibers.","authors":"Mao Iino, Shoji Oura","doi":"10.1159/000543498","DOIUrl":"10.1159/000543498","url":null,"abstract":"<p><strong>Introduction: </strong>Diagnostic physicians tend to judge a low-dense area on computed tomography (CT) as central necrosis when it has no contrast enhancement and locates in the center of large tumors.</p><p><strong>Case presentation: </strong>An 80-year-old woman was referred to our hospital due to the detection of an abdominal mass on ultrasound (US). CT showed a well-demarcated oval mass, 11 cm in size, with a central low-density area. US showed high internal echoes and enhanced posterior echoes. Magnetic resonance imaging (MRI) showed the low-density area on CT to be hypo-intense on T1-weighted images and hyper-intense on T2-weighted images. MRI further showed the central part of the tumor to be hyper-intense both on diffusion-weighted images and apparent diffusion coefficient images. Under the tentative diagnosis of a gastrointestinal stromal tumor with central necrosis, the patient underwent tumor resection, revealing the tumor to be a jejunal submucosal tumor. Pathological study showed collagen fibers with heterogeneous density and sparse proliferation of spindle cells. The center of the tumor had marked edema in addition to sparse collagen fibers. Immunostaining showed that the atypical cells were diffusely positive for β catenin and negative for S100 protein, desmin, and DOG1, leading to the diagnosis of desmoid tumor (DT).</p><p><strong>Conclusions: </strong>Physicians should note that intra-abdominal DT can have edematous loose collagen fibers and may show central necrosis-like findings on CT.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"107-112"},"PeriodicalIF":0.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11857155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143499369","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":"Drug-Induced Liver Injury Associated with Turmeric and Piperine: A Case and Review.","authors":"Atul Shrestha, Sarah Elliott, Joshua Haron Abasszade, Kyle Wu, Thomas Worland, Ian Simpson, Anouk Dev","doi":"10.1159/000543679","DOIUrl":"10.1159/000543679","url":null,"abstract":"<p><strong>Introduction: </strong>Turmeric is a common spice used in traditional Chinese and Ayurvedic medicine for a variety of purported health benefits. Recent concerns have arisen regarding turmeric-induced liver injury linked to formulations with enhanced bioavailability, often including piperine found in black pepper.</p><p><strong>Case presentation: </strong>We explore a case of a 40-year-old female with increasing fatigue, pruritus, and dark urine following consumption of turmeric and black pepper \"wellness shots\" leading to a significant drug-induced liver injury.</p><p><strong>Conclusion: </strong>This case underscores the critical need to recognise herbal remedies, such as turmeric, as potential sources of hepatotoxicity. Despite a reputation of safety, limited regulation and testing of turmeric may mean potential adverse effects are under-recognised. Understanding the mechanisms behind turmeric and black pepper's hepatotoxicity, including the role of potential genetic predispositions, requires further investigation for its safe use.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"96-106"},"PeriodicalIF":0.5,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11850025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490900","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":"Inflammatory Bowel Disease in a Patient Returning from Colombia: Association with Dipeptidyl Peptidase 4 Inhibitor?","authors":"Ahmed B Bayoumy, Gwen M C Masclee, Nanne K H de Boer, Andra Neefjes-Borst, Dirk Jan Stenvers","doi":"10.1159/000543680","DOIUrl":"10.1159/000543680","url":null,"abstract":"<p><strong>Introduction: </strong>Recent-onset colitis poses a diagnostic challenge, necessitating a thorough evaluation to identify potential infectious and non-infectious etiologies. We considered inflammatory bowel disease (IBD) secondary to dipeptidyl peptidase 4 (DPP-4) inhibitor-induced colitis.</p><p><strong>Case presentation: </strong>This case report details the presentation and management of a patient with persistent dysentery, refractory to conventional treatments, ultimately attributed to IBD possibly secondary to long-term DPP-4 inhibitor use. Following an episode of suspected amebiasis, the patient experienced prolonged bloody diarrhea with an endoscopic image compatible with ulcerative colitis. Extensive infectious diagnostics were negative. Ultimately, the cessation of sitagliptin therapy resulted in rapid symptom resolution and normalization of eosinophilia, as well as endoscopic improvement. However, after a few weeks, the patient was readmitted with diarrhea after continued cessation of sitagliptin.</p><p><strong>Conclusion: </strong>This case underscores the importance of considering IBD secondary to DPP-4 inhibitor use in the evaluation of patients with recent-onset IBD. Further research is needed to elucidate the pathophysiological mechanisms underlying the relationship between DPP-4 inhibitors and IBD.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"89-95"},"PeriodicalIF":0.5,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482382","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":"Severe Acute Pancreatitis Complicated by Multiple Intra-Abdominal Hemorrhages.","authors":"Cong-Yu Wang, Yin Gu, Rui-Peng Yan, Xin Li, Fei He, Xiang-Lan Feng, Gen Zhang, Yun-Feng Cui","doi":"10.1159/000543626","DOIUrl":"10.1159/000543626","url":null,"abstract":"<p><strong>Introduction: </strong>Intra-abdominal hemorrhage is a rare yet life-threatening complication of acute pancreatitis (AP), with a higher prevalence in cases of severe acute pancreatitis (SAP). This condition is primarily caused by vessel wall erosion and rupture of pseudoaneurysms (PSAs). However, SAP cases involving multiple sequential arterial hemorrhages are extremely rare. This condition is primarily brought on by the process of vessel wall degeneration and the development of PSAs. Nonetheless, SAP necessitating multiple episodes of arterial bleeding is very uncommon.</p><p><strong>Case presentation: </strong>Here is the case history of a 31-year-old man already being treated for SAP. His condition was then complicated by massive, frequent intra-abdominal bleeding. The patient initially presented to the hospital with SAP. He was transferred to the intensive care unit for proper management. Massive intra-abdominal bleeds occurred on the 31st, 45th, and 60th days during hospitalization. The maximum blood loss was 1,500 mL. In each of the instances, digital subtraction angiography (DSA) embolization was carried out after the bleeding source had been verified. In order to manage SAP, continuous percutaneous drainage and staged pancreatic necrosectomy were undertaken for 6 months. No recurrence of intra-abdominal hemorrhage was detected. Infection of the abdominal cavity was properly controlled. The patient left the hospital in good condition.</p><p><strong>Conclusion: </strong>Spontaneous bleeding in the abdominal cavity is a severe and life-threatening complication of SAP. This is often caused by vessel wall erosion. In such cases, DSA plays a crucial role in diagnosis and management. Besides precisely locating the bleeding source, one can perform a much-needed embolization immediately. Consequently, the disease is under total control, and the patient is much more likely to survive.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"79-88"},"PeriodicalIF":0.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11839214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143457018","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":"Hybrid Endoscopic/Fluoroscopic Gastrostomy Tube Placement: Case Report of a Novel Technique.","authors":"Nicholas Girardi, Benjamin Wharton, Kenneth Cicuto, Alysia Wiley, Lacey LaGrone","doi":"10.1159/000542809","DOIUrl":"10.1159/000542809","url":null,"abstract":"<p><strong>Introduction: </strong>We report the case of a 60-year-old female with a history of perforated gastric ulcer, abdominal abscesses, enterocutaneous fistula, and small bowel obstruction requiring durable gastric decompression prior to delayed fistula takedown. The patient had contraindications to or failed attempts at traditional gastrostomy approaches (surgical, endoscopic, interventional radiology).</p><p><strong>Case report: </strong>Gastrostomy was successfully performed via a novel technique combining interventional radiology and endoscopic placement.</p><p><strong>Discussion: </strong>In certain patients with complex presentations, a hybrid approach to gastrostomy tube placement using fluoroscopy and endoscopy may prove a viable alternative when traditional methods are contraindicated or unsuccessful.</p>","PeriodicalId":9614,"journal":{"name":"Case Reports in Gastroenterology","volume":"19 1","pages":"72-78"},"PeriodicalIF":0.5,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11835415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448243","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}