Continuous glucose monitoring (CGM) system is largely used in clinical practice in patients with type 1 diabetes and insulin-treated patients with type 2 diabetes. It is a needful tool for a more comprehensive assessment of glucose control. Patients can benefit from real-time information on current glucose, glucose trend, and hypo or hyperglycemia alarms. Healthcare can rapidly understand how much time patients spend in a good glucose range, hypoglycemia or hyperglycemia. Several clinical trials have demonstrated the benefits of CGM in reducing glycated hemoglobin, as well as the time spent in hypoglycemia, and increasing the time in range. CGM reduces the rate of severe acute complications and hospital admission improving the quality of life. Patients on insulin treatment and pregnant women are the perfect candidates for CGM. However, even patients on non-intensive insulin treatment or other therapies might benefit from CGM to gain and maintain reasonable glycemic control, and again improve the quality of life.
{"title":"Il monitoraggio in continuo della glicemia: stato dell’arte","authors":"C. Irace, Sergio Di Molfetta","doi":"10.30682/ildia2204g","DOIUrl":"https://doi.org/10.30682/ildia2204g","url":null,"abstract":"Continuous glucose monitoring (CGM) system is largely used in clinical practice in patients with type 1 diabetes and insulin-treated patients with type 2 diabetes. It is a needful tool for a more comprehensive assessment of glucose control. Patients can benefit from real-time information on current glucose, glucose trend, and hypo or hyperglycemia alarms. Healthcare can rapidly understand how much time patients spend in a good glucose range, hypoglycemia or hyperglycemia. \u0000Several clinical trials have demonstrated the benefits of CGM in reducing glycated hemoglobin, as well as the time spent in hypoglycemia, and increasing the time in range. CGM reduces the rate of severe acute complications and hospital admission improving the quality of life. Patients on insulin treatment and pregnant women are the perfect candidates for CGM. However, even patients on non-intensive insulin treatment or other therapies might benefit from CGM to gain and maintain reasonable glycemic control, and again improve the quality of life.","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130527377","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}
Today, 463 million people worldwide suffer from diabetes, while 374 million have prediabetes. Unfortunately, this number is expected to double by 2030. However, data about the prevalence of diabetes are influenced by the age group to which it refers. For example, in 2000, 12% of people between 65 and 70 years old as well as 15% of the over 80s were affected by diabetes. Nowadays, the percentage of over 65s with diabetes is about 20-25%, with some geographical differences. Dementia is another critical health problem which is greatly increasing especially among the elderly. While it is well known that diabetes is a significant risk factor for worsening vision, renal function, and increased risk of cardiovascular disease, a number of recent epidemiological evidence reported that diabetes can also be considered a risk factor for cognitive dysfunction. Therefore, while basic research and trials on human models are focused on understanding the pathophysiological mechanisms underlying the development of cognitive decline in individuals with diabetes, in clinical practice the prevention of cognitive decline in the individual with diabetes is critically important. In this paper, we will discuss the pathogenetic mechanisms, clinical approach, and diagnostic strategies that can be used in a clinical-ambulatory setting for early diagnosis of cognitive decline in patients with diabetes.
{"title":"Diabete e declino cognitivo: dall’epidemiologia ai test diagnostici","authors":"Gianluigi Ferrazza, Alessandro Nucera, Stefano Rizza","doi":"10.30682/ildia2204b","DOIUrl":"https://doi.org/10.30682/ildia2204b","url":null,"abstract":"Today, 463 million people worldwide suffer from diabetes, while 374 million have prediabetes. Unfortunately, this number is expected to double by 2030. However, data about the prevalence of diabetes are influenced by the age group to which it refers. For example, in 2000, 12% of people between 65 and 70 years old as well as 15% of the over 80s were affected by diabetes. Nowadays, the percentage of over 65s with diabetes is about 20-25%, with some geographical differences. Dementia is another critical health problem which is greatly increasing especially among the elderly. While it is well known that diabetes is a significant risk factor for worsening vision, renal function, and increased risk of cardiovascular disease, a number of recent epidemiological evidence reported that diabetes can also be considered a risk factor for cognitive dysfunction. Therefore, while basic research and trials on human models are focused on understanding the pathophysiological mechanisms underlying the development of cognitive decline in individuals with diabetes, in clinical practice the prevention of cognitive decline in the individual with diabetes is critically important. In this paper, we will discuss the pathogenetic mechanisms, clinical approach, and diagnostic strategies that can be used in a clinical-ambulatory setting for early diagnosis of cognitive decline in patients with diabetes.","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114350268","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}
Alessia Greco, Pia Montanucci, Teresa Pescara, Giuseppe Basta e Riccardo Calafiore
Advances in cell and molecular technology have fostered development of innovative approaches to manage type 1 diabetes mellitus. The main focus is to replace destroyed β cells by induced pluripotent-(hiPSC) and/or mesenchymal stem cells (hMSC) thanks to multi-step differentiation protocols. The aim is to obtain β-like cells invisible to the host's immune system by their physical envelopment within recombinant, last generation biopolymers that prevent contact between embodied cells and host’s immune system, thereby avoiding recipient’s general immunosuppression with its global side effects.
{"title":"Terapia cellulare e molecolare sperimentale del diabete mellito di tipo 1 con cellule staminali: stato attuale","authors":"Alessia Greco, Pia Montanucci, Teresa Pescara, Giuseppe Basta e Riccardo Calafiore","doi":"10.30682/ildia2203f","DOIUrl":"https://doi.org/10.30682/ildia2203f","url":null,"abstract":"Advances in cell and molecular technology have fostered development of innovative approaches to manage type 1 diabetes mellitus. The main focus is to replace destroyed β cells by induced pluripotent-(hiPSC) and/or mesenchymal stem cells (hMSC) thanks to multi-step differentiation protocols. The aim is to obtain β-like cells invisible to the host's immune system by their physical envelopment within recombinant, last generation biopolymers that prevent contact between embodied cells and host’s immune system, thereby avoiding recipient’s general immunosuppression with its global side effects.","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124578242","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}
Background/aim: different guidelines provide similar, but not identical, therapeutic targets for HbA1c in type 2 diabetes. These targets can also depend on the different pharmacological strategies adopted for intensifying glycemic control. This editorial is aimed at providing a reference for the choice of glycemic targets in patients with type 2 diabetes, as recommended by the new Italian guidelines for the treatment of type 2 diabetes. Methods and results: the present paper revised the recently published Italian guidelines for the treatment of type 2 diabetes (outpatients), either in primary care or specialist referral. The guideline has been developed following the methods described in the Manual of the National Guideline System (http://www.snlg-iss.it) by a panel nominated by the Società Italiana di Diabetologia (SID) and Associazione Medici Diabetologi (AMD).
{"title":"I target glicemici alla luce delle nuove linee guida italiane per il trattamento del diabete di tipo 2","authors":"M. Monami","doi":"10.30682/ildia2203d","DOIUrl":"https://doi.org/10.30682/ildia2203d","url":null,"abstract":"Background/aim: different guidelines provide similar, but not identical, therapeutic targets for HbA1c in type 2 diabetes. These targets can also depend on the different pharmacological strategies adopted for intensifying glycemic control. This editorial is aimed at providing a reference for the choice of glycemic targets in patients with type 2 diabetes, as recommended by the new Italian guidelines for the treatment of type 2 diabetes. Methods and results: the present paper revised the recently published Italian guidelines for the treatment of type 2 diabetes (outpatients), either in primary care or specialist referral. The guideline has been developed following the methods described in the Manual of the National Guideline System (http://www.snlg-iss.it) by a panel nominated by the Società Italiana di Diabetologia (SID) and Associazione Medici Diabetologi (AMD).","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129532058","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}
For glucose-lowering drugs inducing hypoglycemia, a marginally protective effect on the risk of MACE was observed for HbA1c 48-58 mmol/mol, whereas a significant reduction of microvascular complications was observed for HbA1c<49 mmol/mol, but with higher risk of severe hypoglycaemia. Drugs not inducing hypoglycaemia were associated with a reduction of MACE, renal adverse events, and all-cause mortality, for HbA1c<7% (no data for lower targets). Conclusions: the present paper illustrates the recommendations of the Italian guidelines for the treatment of type 2 diabetes on therapeutic targets for HbA1c. In synthesis, the improvement of glycemic control with drugs not inducing hypoglycemia is associated with a reduction in the risk of long-term chronic vascular and renal complications, and all-cause mortality suggesting an HbA1c target of 53 mmol/mol. When the reduction of HbA1c is achieved with drugs inducing hypoglycemia, a progressive reduction of complications and an increase in the risk of severe hypoglycemia is observed suggesting higher HbA1c thresholds (49-58 mmol/mol).
{"title":"Quali target glicemici nelle donne con diabete gestazionale?","authors":"A. cura di Marta Letizia Hribal","doi":"10.30682/ildia2203e","DOIUrl":"https://doi.org/10.30682/ildia2203e","url":null,"abstract":"For glucose-lowering drugs inducing hypoglycemia, a marginally protective effect on the risk of MACE was observed for HbA1c 48-58 mmol/mol, whereas a significant reduction of microvascular complications was observed for HbA1c<49 mmol/mol, but with higher risk of severe hypoglycaemia. Drugs not inducing hypoglycaemia were associated with a reduction of MACE, renal adverse events, and all-cause mortality, for HbA1c<7% (no data for lower targets). Conclusions: the present paper illustrates the recommendations of the Italian guidelines for the treatment of type 2 diabetes on therapeutic targets for HbA1c. In synthesis, the improvement of glycemic control with drugs not inducing hypoglycemia is associated with a reduction in the risk of long-term chronic vascular and renal complications, and all-cause mortality suggesting an HbA1c target of 53 mmol/mol. When the reduction of HbA1c is achieved with drugs inducing hypoglycemia, a progressive reduction of complications and an increase in the risk of severe hypoglycemia is observed suggesting higher HbA1c thresholds (49-58 mmol/mol).","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"312 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122241157","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}
Umberto Capece, Chiara M.A. Cefalo, F. Cinti, A. Giaccari
Background: Painful diabetic neuropathy has been identified as the major determinant of depressive symptoms in people with diabetes. It is also known that the manifestations of diabetic neuropathy can be heterogeneous and sometimes insidious to recognize and treat. Clinical case: We present the diagnostic-therapeutic course of a case in which diabetic neuropathy was strongly influenced by a significant psychopathological component. Discussion/Conclusions: The boundary between depression and neuropathy can be blurred, and determining which pathology came first is controversial.
{"title":"Neuropatia diabetica e depressione: uovo o gallina?","authors":"Umberto Capece, Chiara M.A. Cefalo, F. Cinti, A. Giaccari","doi":"10.30682/ildia2203g","DOIUrl":"https://doi.org/10.30682/ildia2203g","url":null,"abstract":"Background: Painful diabetic neuropathy has been identified as the major determinant of depressive symptoms in people with diabetes. It is also known that the manifestations of diabetic neuropathy can be heterogeneous and sometimes insidious to recognize and treat. \u0000Clinical case: We present the diagnostic-therapeutic course of a case in which diabetic neuropathy was strongly influenced by a significant psychopathological component. \u0000Discussion/Conclusions: The boundary between depression and neuropathy can be blurred, and determining which pathology came first is controversial.","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128194370","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}
Giovanni Petralli, Edoardo Biancalana, Giulia Piazza, A. Solini
SGLT2 inhibitors are molecules able to reduce blood glucose levels and body weight, and to lower systolic blood pressure. They also exert important diuretic and modulatory effects of renal hemodynamics, as well as a series of anti-inflammatory actions, thus contributing to reduce the cardiovascular burden in subjects with and without type 2 diabetes. Such benefit mainly translates into reduced risk for hospitalization due to heart failure, and reduced decline of glomerular filtration, associated with a powerful anti-albuminuric effect. For this reason, they constitute an indispensable treatment in a modern approach to cardiorenal prevention. This review recapitulates the clinical evidence supporting the use of SGLT2 inhibitors in these patients, and the main mechanisms of cardiorenal protection.
{"title":"Gliflozine e sindrome cardio-renale","authors":"Giovanni Petralli, Edoardo Biancalana, Giulia Piazza, A. Solini","doi":"10.30682/ildia2203c","DOIUrl":"https://doi.org/10.30682/ildia2203c","url":null,"abstract":"SGLT2 inhibitors are molecules able to reduce blood glucose levels and body weight, and to lower systolic blood pressure. They also exert important diuretic and modulatory effects of renal hemodynamics, as well as a series of anti-inflammatory actions, thus contributing to reduce the cardiovascular burden in subjects with and without type 2 diabetes. Such benefit mainly translates into reduced risk for hospitalization due to heart failure, and reduced decline of glomerular filtration, associated with a powerful anti-albuminuric effect. For this reason, they constitute an indispensable treatment in a modern approach to cardiorenal prevention. This review recapitulates the clinical evidence supporting the use of SGLT2 inhibitors in these patients, and the main mechanisms of cardiorenal protection.","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129050039","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}
Most of the glucose is reabsorbed in the kidney by the sodium-glucose cotransporters 2 (SGLT2): SGLT2i inhibitors significantly reduce the renal glucose threshold in the patient with and in the patient without diabetes. This effect explains the consistent drop in blood sugar in the patient with diabetes and a decrease (5-10 mg/dl) in the non-diabetic person. Notably, SGLT2i inhibit sodium reabsorption leading to a reduction in the expansion of plasma volume and blood pressure. At the cardiovascular level, SGLT2i reduce preload and post-load, improves cardiac metabolism and bioenergetics, inhibits the sodium hydrogen antiport, and reduce the adrenergic system’s activation. Glucagon-like peptide 1 receptor agonists (GLP-1RA) enhance endothelial function, stabilize atherosclerotic plaque and increase angiogenesis. Similar to SGLT2i, GLP-1RAs reduce arterial stiffness and low-grade inflammation. A peculiar action of GLP-1 is the inhibition of platelet aggregation, most likely linked to the ability of these drugs to stimulate nitric oxide synthesis in platelets. They also increase sodium excretion with a consequent drop in blood pressure and significantly reduce fatty liver disease, an important cardiovascular risk factor. The clinical characteristics of these two classes of drugs are described, and their benefits on the cardiovascular system in patients without diabetes are discussed.
{"title":"Terapie innovative per il diabete: effetti sul rischio di scompenso cardiovascolare nel paziente non diabetico","authors":"A. Avogaro","doi":"10.30682/ildia2203a","DOIUrl":"https://doi.org/10.30682/ildia2203a","url":null,"abstract":"Most of the glucose is reabsorbed in the kidney by the sodium-glucose cotransporters 2 (SGLT2): SGLT2i inhibitors significantly reduce the renal glucose threshold in the patient with and in the patient without diabetes. This effect explains the consistent drop in blood sugar in the patient with diabetes and a decrease (5-10 mg/dl) in the non-diabetic person. Notably, SGLT2i inhibit sodium reabsorption leading to a reduction in the expansion of plasma volume and blood pressure. At the cardiovascular level, SGLT2i reduce preload and post-load, improves cardiac metabolism and bioenergetics, inhibits the sodium hydrogen antiport, and reduce the adrenergic system’s activation. Glucagon-like peptide 1 receptor agonists (GLP-1RA) enhance endothelial function, stabilize atherosclerotic plaque and increase angiogenesis. Similar to SGLT2i, GLP-1RAs reduce arterial stiffness and low-grade inflammation. A peculiar action of GLP-1 is the inhibition of platelet aggregation, most likely linked to the ability of these drugs to stimulate nitric oxide synthesis in platelets. They also increase sodium excretion with a consequent drop in blood pressure and significantly reduce fatty liver disease, an important cardiovascular risk factor. The clinical characteristics of these two classes of drugs are described, and their benefits on the cardiovascular system in patients without diabetes are discussed.","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127616829","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}
The importance of differentiating between primary cardiovascular prevention and secondary prevention in diabetes will be discussed in light of the results obtained by the cardiovascular outcome trials (CVOTs). In patients with diabetes, the distinction between primary and secondary cardiovascular prevention could be artificial. The main criteria for enrollment in cardiovascular outcome trials that define the so-called patient in secondary prevention are, typically: i) the history of heart attack or unstable angina; ii) the history of ischemic or hemorrhagic stroke, iii) subclinical conditions, i.e., multivessel coronary ar¬tery disease, occlusive peripheral vascular disease with stenosis greater than 50%, or with a Winsor index less than 0.9. However, in patients with diabetes, a significant coronary atherosclerotic disease can be asymptomatic: this has important clinical implications, i.e., i. patients with diabetes are frequently undertreated, ii: it is unclear whether all asymptomatic patients should be screened for coronary artery disease for implementing optimal medical therapy. The conclusion is that placing the outpatient in the so-called primary or secondary prevention without a clinical event is impossible.
{"title":"Uno scompenso per due, col terzo incomodo","authors":"Gian Paolo Fadini","doi":"10.30682/ildia2203b","DOIUrl":"https://doi.org/10.30682/ildia2203b","url":null,"abstract":"The importance of differentiating between primary cardiovascular prevention and secondary prevention in diabetes will be discussed in light of the results obtained by the cardiovascular outcome trials (CVOTs). In patients with diabetes, the distinction between primary and secondary cardiovascular prevention could be artificial. The main criteria for enrollment in cardiovascular outcome trials that define the so-called patient in secondary prevention are, typically: i) the history of heart attack or unstable angina; ii) the history of ischemic or hemorrhagic stroke, iii) subclinical conditions, i.e., multivessel coronary ar¬tery disease, occlusive peripheral vascular disease with stenosis greater than 50%, or with a Winsor index less than 0.9. However, in patients with diabetes, a significant coronary atherosclerotic disease can be asymptomatic: this has important clinical implications, i.e., i. patients with diabetes are frequently undertreated, ii: it is unclear whether all asymptomatic patients should be screened for coronary artery disease for implementing optimal medical therapy. The conclusion is that placing the outpatient in the so-called primary or secondary prevention without a clinical event is impossible.","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134521554","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":"Il trapianto di cellule staminali nel trattamento della disfunzione erettile","authors":"A. cura di Marta Letizia Hribal","doi":"10.30682/ildia2202f","DOIUrl":"https://doi.org/10.30682/ildia2202f","url":null,"abstract":"","PeriodicalId":119243,"journal":{"name":"Il Diabete","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122126787","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}
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