Pub Date : 2023-06-15DOI: 10.35755/jmedassocthai.2023.06.13856
Objective: To evaluate the pregnancy outcomes in COVID-19 vaccination during pregnancy Materials and Methods: The present study was a retrospective cohort study. The data were collected from pregnant women attending antenatal care (ANC) and delivery at Makarak Hospital, Kanchanaburi Province, between September 2021 and April 2022. The studied subjects were categorized into three groups, antepartum factor, intrapartum factor, and postpartum and newborn factor. The relationship of each factor was brought for comparative study in COVID-19 vaccination status as vaccinated or unvaccinated, during pregnancy. Then, multivariable analysis was used to adjust the relationship of the variables in each group. Results: Five hundred sixteen pregnant women attended ANC and delivered. They were aged 27.5 years on the average. Most of them were gravida 2. The proportion of vaccines received was 19.2%. When comparing between the vaccinated and the unvaccinated groups, it was found that the vaccinated group was significantly increased in diabetes disorder (adjusted OR 3.54, 95% CI 1.67 to 7.50) and significantly decreased in neonatal intensive care unit (NICU) admission (adjusted OR 0.43, 95% CI 0.24 to 0.76). Other adverse outcomes between the two groups were not significantly different. In addition, COVID-19 infection rate during intrapartum period was not different (adjusted OR 2.13, 95% CI 0.87 to 5.22, p=0.09). Conclusion: Diabetes disorder during pregnancy was significantly higher and risk of NICU admission was significantly lower in the COVID-19 vaccinated group compared with the unvaccinated group. Adverse obstetric outcomes between the vaccinated and unvaccinated groups were not different. Keywords: Pregnancy outcomes; COVID-19 vaccination; Pregnant women
目的:评价妊娠期接种COVID-19疫苗的妊娠结局。材料与方法:本研究为回顾性队列研究。这些数据是从2021年9月至2022年4月期间在北碧府马卡拉克医院接受产前护理和分娩的孕妇中收集的。研究对象分为三组:产前因素、产时因素、产后和新生儿因素。将各因素与妊娠期接种或未接种COVID-19疫苗状况的关系进行比较研究。然后通过多变量分析调整各组变量之间的关系。结果:516名孕妇参加了ANC并分娩。他们的平均年龄为27.5岁。其中大多数是孕妇。疫苗接种率为19.2%。当比较接种疫苗组和未接种疫苗组时，发现接种疫苗组的糖尿病发病率显著增加(调整OR为3.54,95% CI 1.67至7.50)，新生儿重症监护病房(NICU)入院率显著降低(调整OR为0.43,95% CI为0.24至0.76)。两组间其他不良结局无显著差异。此外，两组分娩期间的COVID-19感染率无差异(校正OR 2.13, 95% CI 0.87 ~ 5.22, p=0.09)。结论:与未接种疫苗组相比，接种疫苗组妊娠期糖尿病患病率明显增高，NICU入院风险明显降低。接种疫苗组和未接种疫苗组之间的不良产科结局没有差异。关键词:妊娠结局;COVID-19疫苗接种;孕妇
{"title":"Pregnancy Outcomes in COVID-19 Vaccination During Pregnancy","authors":"","doi":"10.35755/jmedassocthai.2023.06.13856","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13856","url":null,"abstract":"Objective: To evaluate the pregnancy outcomes in COVID-19 vaccination during pregnancy\u0000\u0000Materials and Methods: The present study was a retrospective cohort study. The data were collected from pregnant women attending antenatal care (ANC) and delivery at Makarak Hospital, Kanchanaburi Province, between September 2021 and April 2022. The studied subjects were categorized into three groups, antepartum factor, intrapartum factor, and postpartum and newborn factor. The relationship of each factor was brought for comparative study in COVID-19 vaccination status as vaccinated or unvaccinated, during pregnancy. Then, multivariable analysis was used to adjust the relationship of the variables in each group.\u0000\u0000Results: Five hundred sixteen pregnant women attended ANC and delivered. They were aged 27.5 years on the average. Most of them were gravida 2. The proportion of vaccines received was 19.2%. When comparing between the vaccinated and the unvaccinated groups, it was found that the vaccinated group was significantly increased in diabetes disorder (adjusted OR 3.54, 95% CI 1.67 to 7.50) and significantly decreased in neonatal intensive care unit (NICU) admission (adjusted OR 0.43, 95% CI 0.24 to 0.76). Other adverse outcomes between the two groups were not significantly different. In addition, COVID-19 infection rate during intrapartum period was not different (adjusted OR 2.13, 95% CI 0.87 to 5.22, p=0.09).\u0000\u0000Conclusion: Diabetes disorder during pregnancy was significantly higher and risk of NICU admission was significantly lower in the COVID-19 vaccinated group compared with the unvaccinated group. Adverse obstetric outcomes between the vaccinated and unvaccinated groups were not different.\u0000\u0000Keywords: Pregnancy outcomes; COVID-19 vaccination; Pregnant women","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78557890","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}
Pub Date : 2023-06-15DOI: 10.35755/jmedassocthai.2023.06.13859
Objective: To investigate the effects and safety of standardized ginger powder (SGP) on healthy volunteers’ unstimulated salivary flow rate (USFR). Materials and Methods: The present study was a single-visit, double-blind, randomized, placebo-control trial conducted in Thailand. Healthy volunteers aged 18 to 60 were eligible if they met all the criteria. They were allocated to four groups using block randomization to ensure an equal number in each group. The control group received a placebo, while the other three experimental groups received 1,000 mg, 1,500 mg, and 2,000 mg SGP, respectively. The primary outcome was the USFR, measured by a modified Schirmer test. The post USFR was measured 45 minutes after the intervention and was compared to the baseline USFR. The research assistants administered placebo and SGP capsules, identical in their appearance. The volunteers and the investigator were unaware of the assigned interventions. Results: Total of 368 volunteers were randomly assigned to four groups, each consisting of 92 participants. All three experimental groups showed a change in USFR. However, only the 2,000 mg group showed a significant increase in the USFR (mean difference 9.47 mm/5 minutes, 95% CI 3.24 to 15.71, p=0.003). Approximately 32.6% of the volunteers reported side effects, mainly gastrointestinal events, such as belching (16.3%) and mild abdominal discomfort (7.9%). Conclusion: Two thousand mg SGP significantly increased USFR, yet the effect size was modest. This may be due to the low concentration of bioactive compounds in the SGP used in the present study. All side effects were minor and temporary. Keywords: Ginger; Unstimulated salivary flow rate; Modified Schirmer test
目的:探讨标准化姜粉(SGP)对健康志愿者非刺激唾液流率(USFR)的影响及安全性。材料和方法:本研究是在泰国进行的单次访问、双盲、随机、安慰剂对照试验。年龄在18岁至60岁之间的健康志愿者如果符合所有标准，就有资格。他们被分成四组，采用分组随机化，以确保每组人数相等。对照组服用安慰剂，而其他三个实验组分别服用1000毫克、1500毫克和2000毫克的SGP。主要结果是USFR，通过改进的Schirmer试验测量。干预后45分钟测量USFR，并与基线USFR进行比较。研究助理给予安慰剂和SGP胶囊，外观相同。志愿者和研究者都不知道指定的干预措施。结果:共有368名志愿者被随机分为四组，每组92人。三个实验组均显示出USFR的变化。然而，只有2000 mg组显示USFR显著增加(平均差异9.47 mm/5分钟，95% CI 3.24至15.71,p=0.003)。大约32.6%的志愿者报告了副作用，主要是胃肠道事件，如打嗝(16.3%)和轻度腹部不适(7.9%)。结论:2000 mg SGP显著增加USFR，但效应不大。这可能是由于本研究中使用的SGP中生物活性化合物的浓度较低。所有的副作用都是轻微和暂时的。关键词:生姜;非刺激唾液流量;修正Schirmer检验
{"title":"The Effects of Ginger on Unstimulated Salivary Flow Rate: A Double-Blind, Randomized, Placebo-Control Trial","authors":"","doi":"10.35755/jmedassocthai.2023.06.13859","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13859","url":null,"abstract":"Objective: To investigate the effects and safety of standardized ginger powder (SGP) on healthy volunteers’ unstimulated salivary flow rate (USFR).\u0000\u0000Materials and Methods: The present study was a single-visit, double-blind, randomized, placebo-control trial conducted in Thailand. Healthy volunteers aged 18 to 60 were eligible if they met all the criteria. They were allocated to four groups using block randomization to ensure an equal number in each group. The control group received a placebo, while the other three experimental groups received 1,000 mg, 1,500 mg, and 2,000 mg SGP, respectively. The primary outcome was the USFR, measured by a modified Schirmer test. The post USFR was measured 45 minutes after the intervention and was compared to the baseline USFR. The research assistants administered placebo and SGP capsules, identical in their appearance. The volunteers and the investigator were unaware of the assigned interventions.\u0000\u0000Results: Total of 368 volunteers were randomly assigned to four groups, each consisting of 92 participants. All three experimental groups showed a change in USFR. However, only the 2,000 mg group showed a significant increase in the USFR (mean difference 9.47 mm/5 minutes, 95% CI 3.24 to 15.71, p=0.003). Approximately 32.6% of the volunteers reported side effects, mainly gastrointestinal events, such as belching (16.3%) and mild abdominal discomfort (7.9%).\u0000\u0000Conclusion: Two thousand mg SGP significantly increased USFR, yet the effect size was modest. This may be due to the low concentration of bioactive compounds in the SGP used in the present study. All side effects were minor and temporary.\u0000\u0000Keywords: Ginger; Unstimulated salivary flow rate; Modified Schirmer test","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85357880","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}
Pub Date : 2023-06-15DOI: 10.35755/jmedassocthai.2023.06.13855
Background: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is a major cause of death in SSc patients. Several studies have reported that serum anti-Scl-70, Krebs von Lungren-6 (KL-6), and surfactant protein D (SP-D) levels are associated with the presence and progression of ILD in SSc patients. Objective: To examine the correlation between levels of these serum biomarkers and disease severity determined by baseline dyspnea index (BDI), high-resolution computed tomography (HRCT) score, and pulmonary function tests. Materials and Methods: The present study was a single-center, cross-sectional study. Serum anti-Scl-70, KL-6, and SP-D from 20 SSc-ILD patients and five non-ILD subjects were measured. The BDI, HRCT score, and pulmonary function tests were used to assess the severity of ILD in SSc-ILD patients. HRCT abnormalities, including ground-glass opacity (GGO), fibrosis, and honeycombing, were scored by using the semi-quantitative scoring system. Results: Serum anti-Scl-70, KL-6, and SP-D in SSc-ILD patients were significantly higher than those in non-ILD subjects. There was a moderate correlation between diffusing capacity for carbon monoxide (DLCO) and serum KL-6 levels (r=–0.551, p=0.022), while the pulmonary fibrosis (PF) score exhibited a strong correlation with serum KL-6 levels (r=0.630, p=0.003). The PF score had a moderate negative correlation with forced vital capacity (FVC) (r=–0.515, p=0.034) and a strong negative correlation with total lung capacity (TLC) and DLCO (r=–0.625, p=0.007, and r=–0.762, p<0.001, respectively). Conclusion: The levels of serum KL-6, and SP-D are elevated in SSc-ILD patients. Serum KL-6 may be a useful non-invasive biomarker for the disease severity, as determined by DLCO and the extent of fibrosis on HRCT, in patients with SSc-ILD. Trial registration: Thai Clinical Trials Registry, TCTR20200314001, registered 13 March 2020, retrospectively registered at http://www.thaiclinicaltrials.org/show/TCTR20200314001 Keywords: Scleroderma; Systemic sclerosis; Interstitial pneumonia; Interstitial lung disease; Fibrosis; Biomarker
{"title":"Circulating Biomarkers and Disease Activity in Systemic Sclerosis-Associated Interstitial Lung Disease","authors":"","doi":"10.35755/jmedassocthai.2023.06.13855","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13855","url":null,"abstract":"Background: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is a major cause of death in SSc patients. Several studies have reported that serum anti-Scl-70, Krebs von Lungren-6 (KL-6), and surfactant protein D (SP-D) levels are associated with the presence and progression of ILD in SSc patients.\u0000\u0000Objective: To examine the correlation between levels of these serum biomarkers and disease severity determined by baseline dyspnea index (BDI), high-resolution computed tomography (HRCT) score, and pulmonary function tests.\u0000\u0000Materials and Methods: The present study was a single-center, cross-sectional study. Serum anti-Scl-70, KL-6, and SP-D from 20 SSc-ILD patients and five non-ILD subjects were measured. The BDI, HRCT score, and pulmonary function tests were used to assess the severity of ILD in SSc-ILD patients. HRCT abnormalities, including ground-glass opacity (GGO), fibrosis, and honeycombing, were scored by using the semi-quantitative scoring system.\u0000\u0000Results: Serum anti-Scl-70, KL-6, and SP-D in SSc-ILD patients were significantly higher than those in non-ILD subjects. There was a moderate correlation between diffusing capacity for carbon monoxide (DLCO) and serum KL-6 levels (r=–0.551, p=0.022), while the pulmonary fibrosis (PF) score exhibited a strong correlation with serum KL-6 levels (r=0.630, p=0.003). The PF score had a moderate negative correlation with forced vital capacity (FVC) (r=–0.515, p=0.034) and a strong negative correlation with total lung capacity (TLC) and DLCO (r=–0.625, p=0.007, and r=–0.762, p<0.001, respectively).\u0000\u0000Conclusion: The levels of serum KL-6, and SP-D are elevated in SSc-ILD patients. Serum KL-6 may be a useful non-invasive biomarker for the disease severity, as determined by DLCO and the extent of fibrosis on HRCT, in patients with SSc-ILD.\u0000\u0000Trial registration: Thai Clinical Trials Registry, TCTR20200314001, registered 13 March 2020, retrospectively registered at http://www.thaiclinicaltrials.org/show/TCTR20200314001\u0000\u0000Keywords: Scleroderma; Systemic sclerosis; Interstitial pneumonia; Interstitial lung disease; Fibrosis; Biomarker","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72414842","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}
Pub Date : 2023-06-15DOI: 10.35755/jmedassocthai.2023.06.13735
Background: Motorcycles accidents were the first cause of death among high school students in Thailand and the world. Therefore, realizing the accident factors for prevention planning were significant. Objective: To investigate the factors affecting motorcycle-related traffic accidents among high school students in Sukhothai, Thailand. Multiple-stage random sampling was used to select 450 respondents, and the data were collected through a questionnaire survey. Materials and Methods: The present study was cross-sectional research. The data were analyzed with descriptive statistics using a frequency distribution table, percentage, and inferential statistics by the Enter method of binary logistic regression for every single variable and multiple variables. Results: From 450 samples, 217 people (48.2%) had traffic accidents. The chance of motorcycle accidents comprised of no driving license (OR 69.596, 95% CI 16.465 to 99.186), male gender (OR 59.898, 95% CI 33.20 to 72.129), risk riding behavior (OR 29.273, 95% CI 6.377 to 39.372), types of motorcycles (OR 17.23, 95% CI 12.02 to 22.2), riding experiences (OR 16.324, 95% CI 3.644 to 26.28), damaged traffic signs (OR 3.32, 95% CI 1.77 to 6.24), riders’ attitude toward the risk riding (OR 0.306, 95% CI 0.106 to 0.886), the knowledge level on traffic rules (OR 0.282, 95% CI 0.109 to 0.728), and social support (OR 0.71, 95% CI 0.44 to 0.94), with statistical significant at 0.05. Conclusion: Based on the present study results, schools and parents should enhance management to cope with accident problems by promoting knowledge of traffic rules, facilitating students to get riding licenses, and reinforcing social support to collaboratively build school models for preventing injuries from riding motorcycles. Keywords: Traffic accident; Motorcycle; High school students
背景:摩托车事故是泰国和世界高中生死亡的第一大原因。因此，了解事故因素对预防规划具有重要意义。目的:调查泰国素可泰地区高中生摩托车相关交通事故的影响因素。采用多阶段随机抽样的方法，抽取450名调查对象，通过问卷调查的方式收集数据。材料与方法:本研究为横断面研究。对数据进行描述性统计，使用频率分布表和百分比，对每个单变量和多变量采用二元逻辑回归的Enter方法进行推理统计。结果:450份样本中有217人发生过交通事故，占48.2%。组成的摩托车事故的机会没有驾驶执照(或69.596,95%可信区间16.465到99.186),男性性别(或59.898,95%可信区间33.20到72.129),风险骑行为(或29.273,95%可信区间6.377到39.372),类型的摩托车(或17.23,95%可信区间12.02到22.2),骑马的经验(或16.324,95%可信区间3.644到26.28),破坏交通标志(或3.32,95%可信区间1.77到6.24),乘客的态度风险骑马(或0.306,95%可信区间0.106到0.886),交通规则的知识水平(或0.282,(95% CI 0.109 ~ 0.728)，社会支持(OR 0.71, 95% CI 0.44 ~ 0.94)，差异有统计学意义(0.05)。结论:基于目前的研究结果，学校和家长应加强管理，应对事故问题，通过宣传交通规则知识，帮助学生获得骑摩托车执照，加强社会支持，共同建立预防骑摩托车伤害的学校模式。关键词:交通事故;摩托车;高中生
{"title":"Factors Affecting Motorcycle Accidents among High School Students in Sukhothai, Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.06.13735","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13735","url":null,"abstract":"Background: Motorcycles accidents were the first cause of death among high school students in Thailand and the world. Therefore, realizing the accident factors for prevention planning were significant.\u0000\u0000Objective: To investigate the factors affecting motorcycle-related traffic accidents among high school students in Sukhothai, Thailand. Multiple-stage random sampling was used to select 450 respondents, and the data were collected through a questionnaire survey.\u0000\u0000Materials and Methods: The present study was cross-sectional research. The data were analyzed with descriptive statistics using a frequency distribution table, percentage, and inferential statistics by the Enter method of binary logistic regression for every single variable and multiple variables.\u0000\u0000Results: From 450 samples, 217 people (48.2%) had traffic accidents. The chance of motorcycle accidents comprised of no driving license (OR 69.596, 95% CI 16.465 to 99.186), male gender (OR 59.898, 95% CI 33.20 to 72.129), risk riding behavior (OR 29.273, 95% CI 6.377 to 39.372), types of motorcycles (OR 17.23, 95% CI 12.02 to 22.2), riding experiences (OR 16.324, 95% CI 3.644 to 26.28), damaged traffic signs (OR 3.32, 95% CI 1.77 to 6.24), riders’ attitude toward the risk riding (OR 0.306, 95% CI 0.106 to 0.886), the knowledge level on traffic rules (OR 0.282, 95% CI 0.109 to 0.728), and social support (OR 0.71, 95% CI 0.44 to 0.94), with statistical significant at 0.05.\u0000\u0000Conclusion: Based on the present study results, schools and parents should enhance management to cope with accident problems by promoting knowledge of traffic rules, facilitating students to get riding licenses, and reinforcing social support to collaboratively build school models for preventing injuries from riding motorcycles.\u0000\u0000Keywords: Traffic accident; Motorcycle; High school students","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74261687","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}
Pub Date : 2023-06-15DOI: 10.35755/jmedassocthai.2023.06.13851
Background: Cystoscopy is a basic procedure for urologists to visualize the urethra, the prostate gland, and the urinary bladder. However, ambulatory cystoscopy may be associated with pain and discomfort. Accordingly, varied types and amounts of lubricating gels were studied to relieve these symptoms. Objective: To compare the efficacy and safety between plain lubricant and lidocaine gel during ambulatory cystoscopy. Materials and Methods: The present study was a double-blind randomized controlled trial conducted to evaluate pain during cystoscopy. One hundred patients were randomized into two groups. Group A, 20 mL of 2% lidocaine hydrochloride gel and Group B, 20 mL of plain lubricant gel were instilled into urethra 15 minutes before the procedure. Pain was assessed by an independent data collector using a numerical rating scale (NRS) and visual analog score (VAS). Blood pressure and pulse rate were compared before and after the procedure. Complications were recorded by telephone within several days. Results: The mean NRS of Group A was lower (3.8±2.38) than that of Group B (4.22±2.65) (p=0.407) and the mean VAS of Group A was 2.7±1.36, Group B was 2.66±1.27 (p=0.880). Additionally, the present study found no difference in the change in mean arterial blood pressure (MAP) (Group A 6.69±11.18 mmHg, Group B 4.84±11.45 mmHg, p=0.416) and pulse rate (Group A 6.4±11.9 BPM, Group B 3.73±13.67 BPM, p=0.302). Gross hematuria was seen in one patient (2%) in Group A and three patients (6%) in Group B. Dysuria was equal in both groups. Conclusion: The plain lubricant gel used for cystoscopy without otherwise manipulation has similar safety and efficacy compared to the lidocaine gel. Keywords: Lubricant gel; Ambulatory cystoscopy; Cystoscopy without otherwise manipulation
{"title":"Randomized Double-Blind Controlled Trial Comparing Safety and Efficacy between Plain Lubricant and Lidocaine Gel during Ambulatory Cystoscopy","authors":"","doi":"10.35755/jmedassocthai.2023.06.13851","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13851","url":null,"abstract":"Background: Cystoscopy is a basic procedure for urologists to visualize the urethra, the prostate gland, and the urinary bladder. However, ambulatory cystoscopy may be associated with pain and discomfort. Accordingly, varied types and amounts of lubricating gels were studied to relieve these symptoms.\u0000\u0000Objective: To compare the efficacy and safety between plain lubricant and lidocaine gel during ambulatory cystoscopy.\u0000\u0000Materials and Methods: The present study was a double-blind randomized controlled trial conducted to evaluate pain during cystoscopy. One hundred patients were randomized into two groups. Group A, 20 mL of 2% lidocaine hydrochloride gel and Group B, 20 mL of plain lubricant gel were instilled into urethra 15 minutes before the procedure. Pain was assessed by an independent data collector using a numerical rating scale (NRS) and visual analog score (VAS). Blood pressure and pulse rate were compared before and after the procedure. Complications were recorded by telephone within several days.\u0000\u0000Results: The mean NRS of Group A was lower (3.8±2.38) than that of Group B (4.22±2.65) (p=0.407) and the mean VAS of Group A was 2.7±1.36, Group B was 2.66±1.27 (p=0.880). Additionally, the present study found no difference in the change in mean arterial blood pressure (MAP) (Group A 6.69±11.18 mmHg, Group B 4.84±11.45 mmHg, p=0.416) and pulse rate (Group A 6.4±11.9 BPM, Group B 3.73±13.67 BPM, p=0.302). Gross hematuria was seen in one patient (2%) in Group A and three patients (6%) in Group B. Dysuria was equal in both groups.\u0000\u0000Conclusion: The plain lubricant gel used for cystoscopy without otherwise manipulation has similar safety and efficacy compared to the lidocaine gel.\u0000\u0000Keywords: Lubricant gel; Ambulatory cystoscopy; Cystoscopy without otherwise manipulation","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73360717","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}
Pub Date : 2023-06-15DOI: 10.35755/jmedassocthai.2023.06.13857
Background: The highly transmissible nature of the Omicron variant raises concerns globally. Objective: To investigated the clinical characteristics and severity of COVID-19 patients infected with the Omicron variant in Thailand, comparing it to the previously dominant Alpha and Delta variants. Materials and Methods: Retrospective data from two secondary hospitals in Thailand during the Omicron variant’s prevalence were analyzed. Demographic and clinical information, including age, comorbidities, symptoms, lab results, and outcomes, were compared with the Alpha and Delta variants. Severity was assessed based on the presence of pneumonia and mortality. Results: Preliminary findings revealed distinct clinical characteristics in COVID-19 patients with the Omicron variant compared to the Alpha and Delta variants. Common symptoms like fever, cough, sore throat, and fatigue varied in frequency and severity across the variants. Breakthrough infections were more prevalent with the Omicron variant. Differences in the development of pneumonia were observed. Conclusion: This comparative study provides initial insights into the clinical characteristics and severity of COVID-19 patients with the Omicron variant in Thailand. Further research is required to validate these findings and improve understanding of Omicron’s impact on disease outcomes. This knowledge will inform effective strategies to mitigate the spread and severity of COVID-19 caused by the Omicron variant. Keywords: Omicron variant; Clinical characteristics; Severity; COVID-19; Delta variant; Alpha variant
{"title":"Clinical Characteristics and Severity of Omicron Variant in Thailand: A Comparative Study from Two Secondary Hospitals","authors":"","doi":"10.35755/jmedassocthai.2023.06.13857","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13857","url":null,"abstract":"Background: The highly transmissible nature of the Omicron variant raises concerns globally.\u0000\u0000Objective: To investigated the clinical characteristics and severity of COVID-19 patients infected with the Omicron variant in Thailand, comparing it to the previously dominant Alpha and Delta variants.\u0000\u0000Materials and Methods: Retrospective data from two secondary hospitals in Thailand during the Omicron variant’s prevalence were analyzed. Demographic and clinical information, including age, comorbidities, symptoms, lab results, and outcomes, were compared with the Alpha and Delta variants. Severity was assessed based on the presence of pneumonia and mortality.\u0000\u0000Results: Preliminary findings revealed distinct clinical characteristics in COVID-19 patients with the Omicron variant compared to the Alpha and Delta variants. Common symptoms like fever, cough, sore throat, and fatigue varied in frequency and severity across the variants. Breakthrough infections were more prevalent with the Omicron variant. Differences in the development of pneumonia were observed.\u0000\u0000Conclusion: This comparative study provides initial insights into the clinical characteristics and severity of COVID-19 patients with the Omicron variant in Thailand. Further research is required to validate these findings and improve understanding of Omicron’s impact on disease outcomes. This knowledge will inform effective strategies to mitigate the spread and severity of COVID-19 caused by the Omicron variant.\u0000\u0000Keywords: Omicron variant; Clinical characteristics; Severity; COVID-19; Delta variant; Alpha variant","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90743378","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}
Pub Date : 2023-06-15DOI: 10.35755/jmedassocthai.2023.06.13789
Background: Thromboembolism can occur at any age, from infancy to adulthood. The genetic risk factors for thromboembolism in the Thai population are protein C and protein S mutations. The diagnosis depends on the activity level of proteins in the plasma. Management of acute thrombotic events in severe protein C deficiency typically requires replacement with protein C in the form of fresh frozen plasma or protein C concentrate. At present, the measurement of protein C and protein S activities level is limited due to the cost and availability of the tests. Therefore, it can take a lengthy time to determine protein C levels, resulting in a delay in treatment, especially in severe cases. Objective: To create an antibody library on filamentous bacteriophage for generating antigen specific monoclonal antibodies and to produce polyclonal antibodies specific to protein C. Results: Recombinant protein C was constructed and produced from human embryonic kidney 293 cells. Protein C was used as an antigen to immunize mice and rabbits. The antibody titers after final boosting immunization reached up to 50,000 in mice and 10,000 in rabbits. The phage antibody library with a capacity of approximately 3×10⁵ CFU was obtained from mice lymphocytes. Polyclonal antibodies were purified from rabbit sera using affinity chromatography and achieved a yield of 2 mg/mL rabbit sera. The purified polyclonal antibodies were able to detect protein C by immunoblotting and ELISA. Conclusion: The present study demonstrated that polyclonal antibodies could be produced from immunized rabbits and the antibody library obtained from immunized mice is beneficial for further isolation of monoclonal antibodies against protein C. Keywords: Protein C; Recombinant protein; Antibody library; Monoclonal antibody; Polyclonal antibody
{"title":"Construction of Antibody Library and Production of Polyclonal Antibodies Specific to Human Protein C","authors":"","doi":"10.35755/jmedassocthai.2023.06.13789","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13789","url":null,"abstract":"Background: Thromboembolism can occur at any age, from infancy to adulthood. The genetic risk factors for thromboembolism in the Thai population are protein C and protein S mutations. The diagnosis depends on the activity level of proteins in the plasma. Management of acute thrombotic events in severe protein C deficiency typically requires replacement with protein C in the form of fresh frozen plasma or protein C concentrate. At present, the measurement of protein C and protein S activities level is limited due to the cost and availability of the tests. Therefore, it can take a lengthy time to determine protein C levels, resulting in a delay in treatment, especially in severe cases.\u0000\u0000Objective: To create an antibody library on filamentous bacteriophage for generating antigen specific monoclonal antibodies and to produce polyclonal antibodies specific to protein C.\u0000\u0000Results: Recombinant protein C was constructed and produced from human embryonic kidney 293 cells. Protein C was used as an antigen to immunize mice and rabbits. The antibody titers after final boosting immunization reached up to 50,000 in mice and 10,000 in rabbits. The phage antibody library with a capacity of approximately 3×10⁵ CFU was obtained from mice lymphocytes. Polyclonal antibodies were purified from rabbit sera using affinity chromatography and achieved a yield of 2 mg/mL rabbit sera. The purified polyclonal antibodies were able to detect protein C by immunoblotting and ELISA.\u0000\u0000Conclusion: The present study demonstrated that polyclonal antibodies could be produced from immunized rabbits and the antibody library obtained from immunized mice is beneficial for further isolation of monoclonal antibodies against protein C.\u0000\u0000Keywords: Protein C; Recombinant protein; Antibody library; Monoclonal antibody; Polyclonal antibody","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78195640","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}
Pub Date : 2023-06-15DOI: 10.35755/jmedassocthai.2023.06.13796
Case Report: An overweight 48-year-old Thai female presented with syncope while she was lying down and watching television. Telemonitoring during she was unconscious demonstrated that there was long pause due to sinus arrest without escape rhythm. She was inserted with temporary transvenous pacemaker because of profound symptomatic bradycardia during nighttime. She was diagnosed as syncope due to nocturnal bradyarrhythmia. The sleep apnea syndrome (SAS) related bradycardia was the most likely diagnosis. Type 1 polysomnography was performed and compatible with moderate obstructive sleep apnea (OSA). The patient received continuous positive airway pressure (CPAP) for treatment of moderate OSA and remained no syncope or long pause during one year follow-up period. Conclusion: This was an unusual case of an overweight woman presenting with profound symptomatic nocturnal bradycardia due to moderate OSA treated with CPAP. Patients presenting with nocturnal bradycardia should always be investigated SAS related bradycardia. Keywords: Nocturnal bradycardia; Overweight; Obstructive sleep apnea; Sleep disordered breathing; Polysomnography
{"title":"An Overweight Woman with Profound Symptomatic Nocturnal Bradycardia: A Case Report","authors":"","doi":"10.35755/jmedassocthai.2023.06.13796","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13796","url":null,"abstract":"Case Report: An overweight 48-year-old Thai female presented with syncope while she was lying down and watching television. Telemonitoring during she was unconscious demonstrated that there was long pause due to sinus arrest without escape rhythm. She was inserted with temporary transvenous pacemaker because of profound symptomatic bradycardia during nighttime. She was diagnosed as syncope due to nocturnal bradyarrhythmia. The sleep apnea syndrome (SAS) related bradycardia was the most likely diagnosis. Type 1 polysomnography was performed and compatible with moderate obstructive sleep apnea (OSA). The patient received continuous positive airway pressure (CPAP) for treatment of moderate OSA and remained no syncope or long pause during one year follow-up period.\u0000\u0000Conclusion: This was an unusual case of an overweight woman presenting with profound symptomatic nocturnal bradycardia due to moderate OSA treated with CPAP. Patients presenting with nocturnal bradycardia should always be investigated SAS related bradycardia.\u0000\u0000Keywords: Nocturnal bradycardia; Overweight; Obstructive sleep apnea; Sleep disordered breathing; Polysomnography","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80941705","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}
Pub Date : 2023-06-15DOI: 10.35755/jmedassocthai.2023.06.13853
Background: Chemotherapy is a backbone treatment in advanced-stage non-small cell lung cancer (NSCLC) for non-targetable mutations and inaccessible to novel therapies. However, the data on the response rate, factors of chemotherapy response, and survival in Thailand are limited. Objective: To find the chemotherapy response rate, factors that predict chemotherapy response and survival in advanced-stage NSCLC. Materials and Methods: A retrospective cohort study was performed by including advanced-stage NSCLC patients older than 18 years old who received chemotherapy at the medical oncology unit, Sawanpracharak Hospital between July 2014 and January 2020. Demographic data, laboratory data, details of treatment, computed tomography (CT) of chest, and survival time were collected. Descriptive statistical analyses followed by univariable and multivariable were performed to determine factors associated with chemotherapy response. Kaplan-Meier survival curve was used to estimate overall survival (OS), and the log-rank test was performed to compare survival differences in each group. The univariable and multivariable Cox regression method was adopted for OS. Results: Tree hundred four chemotherapy-treated advanced-stage NSCLC were included. The chemotherapy response rate was 45.5%, and ECOG 0-1 was a favorable prognosis for chemotherapy response (OR 3.03, 95% CI 1.480 to 7.370, p=0.004). Pericardial metastasis (HR 1.833, 95% CI 1.102 to 3.215, p=0.021), liver metastasis (HR 2.05, 95% CI 1.131 to 3.201, p=0.002), non-objective response rate (ORR) for chemotherapy (HR 1.429, 95% CI 1.099 to 1.859, p=0.008) were worse prognosis factors. Obtaining second-line and third-line systemic treatment were favorable prognoses of survival in advanced-stage NSCLC (HR 0.476, 95% CI 0.348 to 0.651, p<0.001 and HR 0.247, 95% CI 0.123 to 0.494, p<0.001, respectively). Conclusion: The response rate in chemotherapy-treated advanced-stage NSCLC was 45.5%. ECOG 0-1 was an independent factor in chemotherapy response. Liver metastasis, pericardial metastasis, no subsequent treatment, and poor response to chemotherapy were worse prognosis outcomes in advanced-stage NSCLC. Keywords: NSCLC; Advanced-stage; Factor of chemotherapy response; Factor of survival
背景:化疗是晚期非小细胞肺癌(NSCLC)非靶向突变和难以获得新疗法的主要治疗方法。然而，有关泰国的反应率、化疗反应因素和生存率的数据有限。目的:探讨晚期非小细胞肺癌的化疗反应率、影响化疗反应的因素及生存期。材料和方法:回顾性队列研究纳入2014年7月至2020年1月期间在Sawanpracharak医院内科肿瘤科接受化疗的18岁以上晚期非小细胞肺癌患者。收集患者的人口学资料、实验室资料、治疗细节、胸部CT及生存时间。描述性统计分析，然后进行单变量和多变量分析，以确定与化疗反应相关的因素。采用Kaplan-Meier生存曲线估计总生存期(OS)，采用log-rank检验比较各组的生存差异。OS采用单变量和多变量Cox回归方法。结果:共纳入1404例经化疗的晚期非小细胞肺癌。化疗缓解率为45.5%，ECOG 0-1为化疗缓解预后良好(OR 3.03, 95% CI 1.480 ~ 7.370, p=0.004)。心包转移(HR 1.833, 95% CI 1.102 ~ 3.215, p=0.021)、肝转移(HR 2.05, 95% CI 1.131 ~ 3.201, p=0.002)、化疗非客观缓解率(ORR) (HR 1.429, 95% CI 1.099 ~ 1.859, p=0.008)是预后较差的因素。获得二线和三线全身治疗对晚期NSCLC的生存预后有利(HR 0.476, 95% CI 0.348 ~ 0.651, p<0.001); HR 0.247, 95% CI 0.123 ~ 0.494, p<0.001)。结论:化疗治疗晚期非小细胞肺癌有效率为45.5%。ECOG 0-1是化疗反应的独立因素。肝转移、心包转移、无后续治疗和化疗反应差是晚期NSCLC预后较差的结果。关键词:非小细胞肺癌;晚期;化疗反应因素;生存因素
{"title":"Prognostic Factors of Chemotherapy Response and Survival in Non-Small Cell Lung Cancer: Data from Real-World Practice with Limited Access to Novel Therapy","authors":"","doi":"10.35755/jmedassocthai.2023.06.13853","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.06.13853","url":null,"abstract":"Background: Chemotherapy is a backbone treatment in advanced-stage non-small cell lung cancer (NSCLC) for non-targetable mutations and inaccessible to novel therapies. However, the data on the response rate, factors of chemotherapy response, and survival in Thailand are limited.\u0000\u0000Objective: To find the chemotherapy response rate, factors that predict chemotherapy response and survival in advanced-stage NSCLC.\u0000\u0000Materials and Methods: A retrospective cohort study was performed by including advanced-stage NSCLC patients older than 18 years old who received chemotherapy at the medical oncology unit, Sawanpracharak Hospital between July 2014 and January 2020. Demographic data, laboratory data, details of treatment, computed tomography (CT) of chest, and survival time were collected. Descriptive statistical analyses followed by univariable and multivariable were performed to determine factors associated with chemotherapy response. Kaplan-Meier survival curve was used to estimate overall survival (OS), and the log-rank test was performed to compare survival differences in each group. The univariable and multivariable Cox regression method was adopted for OS.\u0000\u0000Results: Tree hundred four chemotherapy-treated advanced-stage NSCLC were included. The chemotherapy response rate was 45.5%, and ECOG 0-1 was a favorable prognosis for chemotherapy response (OR 3.03, 95% CI 1.480 to 7.370, p=0.004). Pericardial metastasis (HR 1.833, 95% CI 1.102 to 3.215, p=0.021), liver metastasis (HR 2.05, 95% CI 1.131 to 3.201, p=0.002), non-objective response rate (ORR) for chemotherapy (HR 1.429, 95% CI 1.099 to 1.859, p=0.008) were worse prognosis factors. Obtaining second-line and third-line systemic treatment were favorable prognoses of survival in advanced-stage NSCLC (HR 0.476, 95% CI 0.348 to 0.651, p<0.001 and HR 0.247, 95% CI 0.123 to 0.494, p<0.001, respectively).\u0000\u0000Conclusion: The response rate in chemotherapy-treated advanced-stage NSCLC was 45.5%. ECOG 0-1 was an independent factor in chemotherapy response. Liver metastasis, pericardial metastasis, no subsequent treatment, and poor response to chemotherapy were worse prognosis outcomes in advanced-stage NSCLC.\u0000\u0000Keywords: NSCLC; Advanced-stage; Factor of chemotherapy response; Factor of survival","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89598361","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}
Pub Date : 2023-05-15DOI: 10.35755/jmedassocthai.2023.05.13847
Background: Because of the high prevalence of chronic kidney disease (CKD) in Thailand, the Ministry of Public Health implemented a policy with the concept of multidisciplinary care team (MDC) approach. Objective: To evaluate the effectiveness of MDC in patients who received health service in CKD clinics. Materials and Methods: The present study was a retrospective cohort study carried out among 1,059 CKD patients from 140 hospitals in 12 regional health districts of Thailand between April and July 2017. McNemar test was used to compare laboratory results and the stage changing of CKD before and after patients received the service by multidisciplinary care teams in CKD clinics. Results: Seventy-four percent of subjects were aged more than 60 years. The average duration between the first and the last visit was 28.74 (range of 1 to 210) months. Mean estimated glomerular filtration rate (eGFR) on diagnosis CKD and last follow-up were 32.08±13.58 and 29.19±16.60 mL/minute, respectively. Mean systolic blood pressure on diagnosis CKD and last follow-up were 136.27±20.19 and 133.10±17.64 mmHg, respectively. Of the 1,059 patients, 15.5% improved the stage of CKD and 52.4% was stable. Stage of CKD, eGFR, blood pressure, creatinine, total cholesterol, triglyceride, and low-density lipoprotein cholesterol had statistically significant differences between before and after receiving health service from MDC in the CKD clinic. Conclusion: MCD in CKD clinic had shown the effectiveness in improving the CKD stage and laboratory examination results among the CKD patients. Keywords: Chronic kidney disease; CKD clinic; Multidisciplinary care team; Effectiveness of care
{"title":"Effectiveness of Multidisciplinary Care Team on Improving the Stages of Chronic Kidney Disease in Thailand","authors":"","doi":"10.35755/jmedassocthai.2023.05.13847","DOIUrl":"https://doi.org/10.35755/jmedassocthai.2023.05.13847","url":null,"abstract":"Background: Because of the high prevalence of chronic kidney disease (CKD) in Thailand, the Ministry of Public Health implemented a policy with the concept of multidisciplinary care team (MDC) approach.\u0000\u0000Objective: To evaluate the effectiveness of MDC in patients who received health service in CKD clinics.\u0000\u0000Materials and Methods: The present study was a retrospective cohort study carried out among 1,059 CKD patients from 140 hospitals in 12 regional health districts of Thailand between April and July 2017. McNemar test was used to compare laboratory results and the stage changing of CKD before and after patients received the service by multidisciplinary care teams in CKD clinics.\u0000\u0000Results: Seventy-four percent of subjects were aged more than 60 years. The average duration between the first and the last visit was 28.74 (range of 1 to 210) months. Mean estimated glomerular filtration rate (eGFR) on diagnosis CKD and last follow-up were 32.08±13.58 and 29.19±16.60 mL/minute, respectively. Mean systolic blood pressure on diagnosis CKD and last follow-up were 136.27±20.19 and 133.10±17.64 mmHg, respectively. Of the 1,059 patients, 15.5% improved the stage of CKD and 52.4% was stable. Stage of CKD, eGFR, blood pressure, creatinine, total cholesterol, triglyceride, and low-density lipoprotein cholesterol had statistically significant differences between before and after receiving health service from MDC in the CKD clinic.\u0000\u0000Conclusion: MCD in CKD clinic had shown the effectiveness in improving the CKD stage and laboratory examination results among the CKD patients.\u0000\u0000Keywords: Chronic kidney disease; CKD clinic; Multidisciplinary care team; Effectiveness of care","PeriodicalId":17486,"journal":{"name":"Journal of the Medical Association of Thailand = Chotmaihet thangphaet","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80545657","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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