Pub Date : 2022-12-20DOI: 10.14739/2310-1210.2022.6.266619
V. I. Tsumbaliuk, I. Lurin, V. Makarov, V. Nehoduiko, O. Buchnieva, S. Tertyshnyi, Y. Bunin
Damage to the major vessels in a retroperitoneal trauma belongs to the category of the most difficult, including damage to the inferior vena cava. The aim of the work is to demonstrate the features of clinical manifestations and tactical solutions of a gunshot fragment blind wound of the inferior vena cava with the migration of a foreign body along the blood stream. Materials and methods. A case of a gunshot fragment wound of the inferior vena cava with migration of the foreign body along the blood stream was studied. An injured person underwent sCT with and without contrast, FAST protocol, general blood test, biochemical blood test, CBV was determined using the formula of Moore, hourly diuresis was measured. Results. The patient was operated on for vital signs, the condition of the injured person was stabilized. During the revision of the abdominal cavity and paranephric tissue, no foreign body was identified. In the immediate postoperative period, the injured person underwent chest and abdominal CT, according to the data of that, a metal fragment was identified, which migrated along the inferior vena cava to the point of connection with the right atrium. The injured man was operated on at another specialized facility, where the foreign body was removed using a surgical magnetic tool. Conclusions. Fire damage to the inferior vena cava is classically accompanied by a severe general condition, massive blood loss, which requires urgent surgical interventions. Multi-component preoperative preparation, a clearly established diagnostic plan, a multidisciplinary approach based on the example of our clinical case allow saving life even in the most complex cases.
{"title":"A clinical case of gunshot shrapnel penetrating wound of the chest with injury to the inferior vena cava with migration of a foreign body along the blood stream","authors":"V. I. Tsumbaliuk, I. Lurin, V. Makarov, V. Nehoduiko, O. Buchnieva, S. Tertyshnyi, Y. Bunin","doi":"10.14739/2310-1210.2022.6.266619","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.6.266619","url":null,"abstract":"Damage to the major vessels in a retroperitoneal trauma belongs to the category of the most difficult, including damage to the inferior vena cava.\u0000The aim of the work is to demonstrate the features of clinical manifestations and tactical solutions of a gunshot fragment blind wound of the inferior vena cava with the migration of a foreign body along the blood stream.\u0000Materials and methods. A case of a gunshot fragment wound of the inferior vena cava with migration of the foreign body along the blood stream was studied. An injured person underwent sCT with and without contrast, FAST protocol, general blood test, biochemical blood test, CBV was determined using the formula of Moore, hourly diuresis was measured.\u0000Results. The patient was operated on for vital signs, the condition of the injured person was stabilized. During the revision of the abdominal cavity and paranephric tissue, no foreign body was identified. In the immediate postoperative period, the injured person underwent chest and abdominal CT, according to the data of that, a metal fragment was identified, which migrated along the inferior vena cava to the point of connection with the right atrium.\u0000The injured man was operated on at another specialized facility, where the foreign body was removed using a surgical magnetic tool.\u0000Conclusions. Fire damage to the inferior vena cava is classically accompanied by a severe general condition, massive blood loss, which requires urgent surgical interventions. Multi-component preoperative preparation, a clearly established diagnostic plan, a multidisciplinary approach based on the example of our clinical case allow saving life even in the most complex cases.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91119392","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 : 2022-12-20DOI: 10.14739/2310-1210.2022.6.258359
BС С. І К. В. Скрябіна A, Ільченко, F. E
The aim of the study was to investigate the heterogeneity of phenotypic manifestations of cystic fibrosis (CF) in children depending on the CFTR gene mutation and to determine predictors of the disease severity for the personalization of treatment and prevention of complications. Materials and methods. Fifty-nine children with CF, aged 1 to 18 years (mean age was 12.0 (8.5; 15.0) years), were examined. All patients underwent general clinical, genetic, laboratory and microbiological examination. Instrumental methods of examination included spirometry, chest X-ray and computed tomography, ultrasound densitometry. According to the functional effects of CFTR mutations, the patients were divided into two groups. The group with “severe” genotypes (n = 40) included patients with two class I and/or II mutations, and the group with “mild” genotypes (n = 10) included patients with at least one class IV or V mutation. Mutations were not identified in 9 patients. Results. Analysis of the spectrum of genetic variants in the CFTR gene showed that 10 patients (20.0 %) were identified with the “mild” genotype, and 40 patients (80.0 %) with the “severe” genotype. The most common mutation was F508del predominantly in the compound heterozygous state (42.4 %). It was found that patients with the “mild” genotype were characterized by a more favorable course of the disease than patients with the “severe” genotype. No statistically significant phenotypic features of the CF course in children depending on the F508del mutation status (F508del/F508del or F508del/nonF508del) were found, except for earlier formation of pulmonary hypertension in patients with the homozygous condition (47.1% vs 16.0 %, P < 0.05). Conclusions. Examination of the relationship between CFTR genotype and phenotype has revealed associations between CFTR mutations and lesion severity of both the digestive and bronchopulmonary systems. Identification of disease severity predictors can provide a more accurate prediction of the disease course, that will determine the patient management and prevent the development of complications.
该研究的目的是调查儿童囊性纤维化(CF)表型表现的异质性，这取决于CFTR基因突变，并确定疾病严重程度的预测因素，以便个性化治疗和预防并发症。材料和方法。59例CF患儿，年龄1 ~ 18岁(平均年龄12.0岁;15.0岁)，接受了检查。所有患者均接受一般临床、遗传学、实验室和微生物学检查。仪器检查方法包括肺活量测定、胸部x线和计算机断层扫描、超声密度测定。根据CFTR突变对功能的影响，将患者分为两组。“严重”基因型组(n = 40)包括两个I类和/或II类突变的患者，“轻度”基因型组(n = 10)包括至少一个IV类或V类突变的患者。9例患者未发现突变。CFTR基因变异谱分析显示，10例(20.0%)患者为“轻度”基因型，40例(80.0%)患者为“重度”基因型。最常见的突变是F508del，主要发生在复合杂合状态(42.4%)。结果发现，“轻度”基因型患者的病程比“重度”基因型患者的病程更有利。F508del突变状态(F508del/F508del或F508del/非F508del)在儿童CF病程中未发现统计学上显著的表型特征，但纯合子状态患者更早形成肺动脉高压(47.1% vs 16.0%， P < 0.05)。对CFTR基因型和表型之间关系的研究揭示了CFTR突变与消化系统和支气管肺系统病变严重程度之间的关联。识别疾病严重程度预测因子可以更准确地预测病程，从而确定患者的治疗方法并预防并发症的发生。
{"title":"Heterogeneity of phenotypic manifestations of cystic fibrosis in children and predictors of the disease severity","authors":"BС С. І К. В. Скрябіна A, Ільченко, F. E","doi":"10.14739/2310-1210.2022.6.258359","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.6.258359","url":null,"abstract":"The aim of the study was to investigate the heterogeneity of phenotypic manifestations of cystic fibrosis (CF) in children depending on the CFTR gene mutation and to determine predictors of the disease severity for the personalization of treatment and prevention of complications.\u0000Materials and methods. Fifty-nine children with CF, aged 1 to 18 years (mean age was 12.0 (8.5; 15.0) years), were examined. All patients underwent general clinical, genetic, laboratory and microbiological examination. Instrumental methods of examination included spirometry, chest X-ray and computed tomography, ultrasound densitometry. According to the functional effects of CFTR mutations, the patients were divided into two groups. The group with “severe” genotypes (n = 40) included patients with two class I and/or II mutations, and the group with “mild” genotypes (n = 10) included patients with at least one class IV or V mutation. Mutations were not identified in 9 patients.\u0000Results. Analysis of the spectrum of genetic variants in the CFTR gene showed that 10 patients (20.0 %) were identified with the “mild” genotype, and 40 patients (80.0 %) with the “severe” genotype. The most common mutation was F508del predominantly in the compound heterozygous state (42.4 %). It was found that patients with the “mild” genotype were characterized by a more favorable course of the disease than patients with the “severe” genotype. No statistically significant phenotypic features of the CF course in children depending on the F508del mutation status (F508del/F508del or F508del/nonF508del) were found, except for earlier formation of pulmonary hypertension in patients with the homozygous condition (47.1% vs 16.0 %, P < 0.05).\u0000Conclusions. Examination of the relationship between CFTR genotype and phenotype has revealed associations between CFTR mutations and lesion severity of both the digestive and bronchopulmonary systems. Identification of disease severity predictors can provide a more accurate prediction of the disease course, that will determine the patient management and prevent the development of complications.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"72 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91079320","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 : 2022-12-20DOI: 10.14739/2310-1210.2022.6.261148
M. S. Lisunov, M. L. Holovakha, M. O. Kozhеmiaka
Rupture of the distal biceps tendon is an injury that most often affects men of working age, so the time and quality of rehabilitation is of great socio-economic importance. Conservative treatment in most cases is impractical, as it leads to a significant increase in treatment time and period of incapacity and does not provide a satisfactory recovery of functions. The main problems of surgical treatment of the distal biceps tendon rupture of the shoulder are considered in the article. Today, there are many methods of surgical treatment, including anchor fixation to the hump of the radial bone; fixation of the distal biceps tendon by using an oval-shaped cortical button fixator, etc. The article presents the main methods of treatment, their advantages and disadvantages. The aim of the study. To improve the results of surgical treatment of distal biceps brachii tendon rupture by reducing the recovery time and reducing the proportion of complications using a modified technique of button fixation. Materials and methods. The study was performed by retrospective analysis of the surgical treatment results of 35 patients with fresh rupture of the distal biceps tendon, who were divided into two groups – operated with anchor fixator (n = 15) and cortical button fixator (n = 20). Functional outcomes were assessed by the DASH scale in 3 days, 2 weeks, 6 weeks and 3 months after the intervention; pain intensity was measured by the Visual Analogue Scale (VAS) after 3 days and 2 weeks at rest, after 6 weeks and 3 months – during exercise; the time of surgery was evaluated. Results. There was a statistically significant improvement in the DASH score at 6 weeks and 3 months after intervention in the cortical fixator group (P = 0.008 and P = 0.003, respectively). Cortical fixation surgery required less surgical time (P = 0.0016) and was accompanied by less pain in the early postoperative period (P = 0.0015). Conclusions. Surgical intervention with the proposed method takes less operating time, requires a shorter period of immobilization, is accompanied by lower risks for loss of the retainer stability. Features of the proposed intervention technique avoid heterotopic ossification. Early onset of active movements can accelerate the functional restoration of the injured limb. Surgical intervention with the proposed method requires less surgical access, accompanied by lower pain intensity in the early postoperative period.
{"title":"Results of surgical treatment of distal biceps tendon ruptures","authors":"M. S. Lisunov, M. L. Holovakha, M. O. Kozhеmiaka","doi":"10.14739/2310-1210.2022.6.261148","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.6.261148","url":null,"abstract":"Rupture of the distal biceps tendon is an injury that most often affects men of working age, so the time and quality of rehabilitation is of great socio-economic importance. Conservative treatment in most cases is impractical, as it leads to a significant increase in treatment time and period of incapacity and does not provide a satisfactory recovery of functions. The main problems of surgical treatment of the distal biceps tendon rupture of the shoulder are considered in the article. Today, there are many methods of surgical treatment, including anchor fixation to the hump of the radial bone; fixation of the distal biceps tendon by using an oval-shaped cortical button fixator, etc. The article presents the main methods of treatment, their advantages and disadvantages.\u0000The aim of the study. To improve the results of surgical treatment of distal biceps brachii tendon rupture by reducing the recovery time and reducing the proportion of complications using a modified technique of button fixation.\u0000Materials and methods. The study was performed by retrospective analysis of the surgical treatment results of 35 patients with fresh rupture of the distal biceps tendon, who were divided into two groups – operated with anchor fixator (n = 15) and cortical button fixator (n = 20). Functional outcomes were assessed by the DASH scale in 3 days, 2 weeks, 6 weeks and 3 months after the intervention; pain intensity was measured by the Visual Analogue Scale (VAS) after 3 days and 2 weeks at rest, after 6 weeks and 3 months – during exercise; the time of surgery was evaluated.\u0000Results. There was a statistically significant improvement in the DASH score at 6 weeks and 3 months after intervention in the cortical fixator group (P = 0.008 and P = 0.003, respectively). Cortical fixation surgery required less surgical time (P = 0.0016) and was accompanied by less pain in the early postoperative period (P = 0.0015).\u0000Conclusions. Surgical intervention with the proposed method takes less operating time, requires a shorter period of immobilization, is accompanied by lower risks for loss of the retainer stability. Features of the proposed intervention technique avoid heterotopic ossification. Early onset of active movements can accelerate the functional restoration of the injured limb. Surgical intervention with the proposed method requires less surgical access, accompanied by lower pain intensity in the early postoperative period.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"2338 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86569919","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 : 2022-12-20DOI: 10.14739/2310-1210.2022.6.261741
O. Dubenko, A. O. Chernenko
Comorbid and co-occurring diseases are risk factors for the progression of episodic migraine to chronic migraine. Biomarkers for migraine could help with diagnosis and treatment selection and monitoring. Aim. To examine the role of the plasma level of calcitonin-gene-related peptide (CGRP) in the diagnosis of episodic migraine in combination with comorbid conditions in the form of cervicalgia and psychoemotional disorders. Materials and methods. The study included 112 patients (84 women, 28 men; mean age 18-58 years), episodic migraine with typical aura – 17, without aura – 60. Patients were divided into 3 groups: I – episodic migraine with cervicalgia (n = 42), II – episodic migraine only (n = 35), III – cervicalgia only (n = 35). The Visual Analogue Scale, Migraine Disability Assessment (MIDAS) score, Headache Impact Test (HIT-6), Neck Disability Index, State-Trait Anxiety Inventory, Beck’s Depression Inventory and the number of days with headache were assessed. The control group consisted of 30 healthy persons to compare the level of CGRP. The serum level of CGRP was determine by enzyme-linked immunosorbent assay using the sandwich ELISA principle. Results. Plasma level of CGRP was higher in groups I and II compared with group III (P = 0.012543), where it did not differ from the control (51.48 ± 5.08 pg/ml). The highest level of CGRP was observed in group I (242.98 ± 5.08 pg/ml) in comparison with group II (145.82 ± 15.38 pg/ml, P = 0.000341). Co-occurring neck-pain in patients with episodic migraine was associated with mood and anxiety disorders. Migraine severity, according to the MIDAS score, was most significantly influenced by plasma level of CGRP, severity of subjective and objective symptoms of headache by the HIT-6, level of State-anxiety and Trait-anxiety, number of days with headache during the last 3 months. Conclusions. The serum level of CGRP is a reliable diagnostic and differential diagnostic laboratory biomarker for episodic migraine. Additional painful syndrome such as cervicalgia influences CGRP level and daily activity, mood and anxiety disorders in episodic migraine patients.
合并症和并发疾病是发作性偏头痛发展为慢性偏头痛的危险因素。偏头痛的生物标志物有助于诊断、治疗选择和监测。探讨血浆降钙素基因相关肽(CGRP)水平在诊断伴有颈痛和精神情绪障碍的发作性偏头痛中的作用。材料和方法。该研究包括112例患者(84例女性，28例男性;平均年龄18-58岁)，有典型先兆的发作性偏头痛- 17岁，无先兆- 60岁。患者分为3组:1 -发作性偏头痛伴颈痛(n = 42)， II -仅发作性偏头痛(n = 35)， III -仅颈痛(n = 35)。评定视觉模拟量表、偏头痛失能评定(MIDAS)评分、头痛影响测验(HIT-6)、颈部失能指数、状态-特质焦虑量表、贝克抑郁量表和头痛天数。对照组为30名健康人，比较CGRP水平。采用夹心ELISA法，采用酶联免疫吸附法测定血清CGRP水平。ⅰ组和ⅱ组血浆CGRP水平高于ⅲ组(P = 0.012543)，与对照组(51.48±5.08 pg/ml)无显著差异。CGRP水平I组(242.98±5.08 pg/ml)高于II组(145.82±15.38 pg/ml, P = 0.000341)。发作性偏头痛患者同时发生的颈部疼痛与情绪和焦虑障碍有关。根据MIDAS评分，血浆CGRP水平、HIT-6主观和客观头痛症状的严重程度、状态焦虑和特质焦虑水平、最近3个月内头痛天数对偏头痛严重程度的影响最为显著。血清CGRP水平是发作性偏头痛可靠的诊断和鉴别诊断实验室生物标志物。额外的疼痛综合征，如颈痛会影响发作性偏头痛患者的CGRP水平和日常活动、情绪和焦虑障碍。
{"title":"Plasma level of calcitonin gene-related peptide in the diagnosis of episodic migraine with comorbid conditions","authors":"O. Dubenko, A. O. Chernenko","doi":"10.14739/2310-1210.2022.6.261741","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.6.261741","url":null,"abstract":"Comorbid and co-occurring diseases are risk factors for the progression of episodic migraine to chronic migraine. Biomarkers for migraine could help with diagnosis and treatment selection and monitoring.\u0000Aim. To examine the role of the plasma level of calcitonin-gene-related peptide (CGRP) in the diagnosis of episodic migraine in combination with comorbid conditions in the form of cervicalgia and psychoemotional disorders.\u0000Materials and methods. The study included 112 patients (84 women, 28 men; mean age 18-58 years), episodic migraine with typical aura – 17, without aura – 60. Patients were divided into 3 groups: I – episodic migraine with cervicalgia (n = 42), II – episodic migraine only (n = 35), III – cervicalgia only (n = 35).\u0000The Visual Analogue Scale, Migraine Disability Assessment (MIDAS) score, Headache Impact Test (HIT-6), Neck Disability Index, State-Trait Anxiety Inventory, Beck’s Depression Inventory and the number of days with headache were assessed. The control group consisted of 30 healthy persons to compare the level of CGRP. The serum level of CGRP was determine by enzyme-linked immunosorbent assay using the sandwich ELISA principle.\u0000Results. Plasma level of CGRP was higher in groups I and II compared with group III (P = 0.012543), where it did not differ from the control (51.48 ± 5.08 pg/ml). The highest level of CGRP was observed in group I (242.98 ± 5.08 pg/ml) in comparison with group II (145.82 ± 15.38 pg/ml, P = 0.000341). Co-occurring neck-pain in patients with episodic migraine was associated with mood and anxiety disorders.\u0000Migraine severity, according to the MIDAS score, was most significantly influenced by plasma level of CGRP, severity of subjective and objective symptoms of headache by the HIT-6, level of State-anxiety and Trait-anxiety, number of days with headache during the last 3 months.\u0000Conclusions. The serum level of CGRP is a reliable diagnostic and differential diagnostic laboratory biomarker for episodic migraine. Additional painful syndrome such as cervicalgia influences CGRP level and daily activity, mood and anxiety disorders in episodic migraine patients.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"227 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76295274","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 : 2022-12-20DOI: 10.14739/2310-1210.2022.6.264473
D. Syvolap
Endoscopic biliary sphincterotomy (EST) is the cornerstone of endoscopic retrograde cholangiopancreatography (ERCP), and bleeding is one of the most common complications after performing EST. The frequency of bleeding after EST varies greatly from 1.0 % to 48.0 %. Clinically, bleeding can range from minor to life-threatening. The aim of the work was to find out the frequency and risk factors for immediate, delayed and recurrent bleeding after EST, ways of prevention and the most effective methods of treatment for this complication based on the meta-analysis results of recent years. Conclusions. Bleeding after endoscopic papillosphincterotomy is a common complication with a mortality rate of 1.2–9.0 %. Independent risk factors are liver cirrhosis, duodenal ulcer, end-stage renal failure, hemodialysis, duration of the procedure, prior use of antiplatelet drugs, especially in patients with a low level of platelets (<100,000/μL), and elderly individuals (>80 years). The risk of bleeding after EST does not depend on the size of papillectomy, and the preventive use of proton pump inhibitors does not reduce the risk of bleeding after EST. The advantages of endoscopic papillary balloon dilatation in reducing the risk of bleeding in patients with liver cirrhosis and in individuals on hemodialysis have been proven. The use of stents (FC-SEMS) is recognized as an effective hemostatic approach to refractory bleeding after EST but is limited in using due to the high cost and additional stent removal procedure. Endoscopic application of peptide hemostatic gel is considered as a third-line hemostatic strategy for bleeding after performing EST.
{"title":"Bleeding after endoscopic intervention for the major duodenal papilla (a literature review)","authors":"D. Syvolap","doi":"10.14739/2310-1210.2022.6.264473","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.6.264473","url":null,"abstract":"Endoscopic biliary sphincterotomy (EST) is the cornerstone of endoscopic retrograde cholangiopancreatography (ERCP), and bleeding is one of the most common complications after performing EST. The frequency of bleeding after EST varies greatly from 1.0 % to 48.0 %. Clinically, bleeding can range from minor to life-threatening.\u0000The aim of the work was to find out the frequency and risk factors for immediate, delayed and recurrent bleeding after EST, ways of prevention and the most effective methods of treatment for this complication based on the meta-analysis results of recent years.\u0000Conclusions. Bleeding after endoscopic papillosphincterotomy is a common complication with a mortality rate of 1.2–9.0 %. Independent risk factors are liver cirrhosis, duodenal ulcer, end-stage renal failure, hemodialysis, duration of the procedure, prior use of antiplatelet drugs, especially in patients with a low level of platelets (<100,000/μL), and elderly individuals (>80 years). The risk of bleeding after EST does not depend on the size of papillectomy, and the preventive use of proton pump inhibitors does not reduce the risk of bleeding after EST.\u0000The advantages of endoscopic papillary balloon dilatation in reducing the risk of bleeding in patients with liver cirrhosis and in individuals on hemodialysis have been proven. The use of stents (FC-SEMS) is recognized as an effective hemostatic approach to refractory bleeding after EST but is limited in using due to the high cost and additional stent removal procedure. Endoscopic application of peptide hemostatic gel is considered as a third-line hemostatic strategy for bleeding after performing EST.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"103 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85619782","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 : 2022-12-20DOI: 10.14739/2310-1210.2022.6.259924
V. Chuhunov, V. I. Darii, D. Safonov, A. Horodokin
Aim. To systematize neuroleptic-induced and neurologic components of residual condition in schizophrenia. Materials and methods. 100 patients of Communal Non-Profit Enterprise “Regional Clinical Institution for the Provision of Psychiatric Care” of Zaporizhzhia Regional Council with diagnosis of recurrent schizophrenia (ICD-10: F20.5) were examined. Results. The study has found correlations between pharmacotherapy and cerebrovascular pathology with positive and negative symptoms of residual schizophrenia. Noticeable positive correlations were established between specific antipsychotic prescriptions and positive negative schizophrenia symptoms, while only minor correlations with negative symptoms were found. Analysis of cerebrovascular pathology with positive and negative symptoms showed that most noticeable positive correlations were anterior area stroke with hallucinations. Overall dominance of negative correlations over positive ones showed possible trend of “forced normalization” caused by cerebrovascular pathology of schizophrenia manifestations in recurrent condition, which was, however, also minor. Conclusions. The study has found correlations between pharmacotherapy and cerebrovascular pathology with positive and negative symptoms of residual schizophrenia. The concept of “antipsychotic course experience” was introduced.
{"title":"Pharmacogenic and neurologic components of residual condition in schizophrenia","authors":"V. Chuhunov, V. I. Darii, D. Safonov, A. Horodokin","doi":"10.14739/2310-1210.2022.6.259924","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.6.259924","url":null,"abstract":"Aim. To systematize neuroleptic-induced and neurologic components of residual condition in schizophrenia.\u0000Materials and methods. 100 patients of Communal Non-Profit Enterprise “Regional Clinical Institution for the Provision of Psychiatric Care” of Zaporizhzhia Regional Council with diagnosis of recurrent schizophrenia (ICD-10: F20.5) were examined.\u0000Results. The study has found correlations between pharmacotherapy and cerebrovascular pathology with positive and negative symptoms of residual schizophrenia. Noticeable positive correlations were established between specific antipsychotic prescriptions and positive negative schizophrenia symptoms, while only minor correlations with negative symptoms were found.\u0000Analysis of cerebrovascular pathology with positive and negative symptoms showed that most noticeable positive correlations were anterior area stroke with hallucinations.\u0000Overall dominance of negative correlations over positive ones showed possible trend of “forced normalization” caused by cerebrovascular pathology of schizophrenia manifestations in recurrent condition, which was, however, also minor.\u0000Conclusions. The study has found correlations between pharmacotherapy and cerebrovascular pathology with positive and negative symptoms of residual schizophrenia. The concept of “antipsychotic course experience” was introduced.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"37 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91176543","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 : 2022-12-20DOI: 10.14739/2310-1210.2022.6.261182
H. O. Lezhenko, O. Pashkova, N. Chudova
The aim of the study. To establish a possible association between the skeletal muscles state, changes in lipid metabolism and the development of insulin resistance in children with type I diabetes mellitus. Materials and methods. 98 children with type 1 diabetes, aged from 11 to 17 years, were examined. Children were divided into 3 groups depending on the state of skeletal muscles: the first group – 22 children without disorders of the muscular system; the second group – 42 children with dynapenia; the third group – 34 patients with diabetic myopathy. The control group – 30 conditionally healthy children. The groups were representative by age, sex, and body mass index. Children were subjected to examinations of skeletal muscle mass and fat mass, followed by calculation of the skeletal muscle index and body fat percentage, sonomyography of the anterior group of thigh muscles with their thickness determination, measurements of the degree and coefficient of muscle hypotrophy, fasting blood glucose level, serum cholesterol, triglycerides and triglyceride-glucose (TyG) index. Insulin resistance was diagnosed when the TyG index was higher than 4.33 c. u. Results. It was found that the development of diabetic myopathy, in addition to a decrease in muscle mass, was characterized by a redistribution of the body component composition due an increase in the fat mass proportion. These changes were accompanied by a disturbance of lipid metabolism in the form of increase in serum cholesterol level, triglycerides and TyG index, which was 4.33 c. u. higher in 32.4 % of children with diabetic myopathy, and in 9.5 % of children with dynapenia, while among patients with normal state of the muscular system, the TyG index exceeded the threshold value in no case. Comparison of clinical and laboratory indicators depending on the TyG index level found an increase in the fat mass proportion, a violation of glycemic control, an increase in the daily dose of insulin, appearance of combined hyperlipidemia and the dawn phenomenon in children with an indicator that was higher than 4.33 c. u. All these were indicative of the insulin resistance development. Conclusions. Skeletal muscle dysfunction in children with type 1 diabetes is a causal risk factor for the development of insulin resistance, a sensitive marker of which is the TyG index. The simplicity of calculating this indicator allows it to be used in daily clinical practice.
{"title":"The association between the skeletal muscle state, lipid metabolism disorders and the development of insulin resistance in children with type 1 diabetes mellitus","authors":"H. O. Lezhenko, O. Pashkova, N. Chudova","doi":"10.14739/2310-1210.2022.6.261182","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.6.261182","url":null,"abstract":"The aim of the study. To establish a possible association between the skeletal muscles state, changes in lipid metabolism and the development of insulin resistance in children with type I diabetes mellitus.\u0000Materials and methods. 98 children with type 1 diabetes, aged from 11 to 17 years, were examined. Children were divided into 3 groups depending on the state of skeletal muscles: the first group – 22 children without disorders of the muscular system; the second group – 42 children with dynapenia; the third group – 34 patients with diabetic myopathy. The control group – 30 conditionally healthy children. The groups were representative by age, sex, and body mass index.\u0000Children were subjected to examinations of skeletal muscle mass and fat mass, followed by calculation of the skeletal muscle index and body fat percentage, sonomyography of the anterior group of thigh muscles with their thickness determination, measurements of the degree and coefficient of muscle hypotrophy, fasting blood glucose level, serum cholesterol, triglycerides and triglyceride-glucose (TyG) index. Insulin resistance was diagnosed when the TyG index was higher than 4.33 c. u.\u0000Results. It was found that the development of diabetic myopathy, in addition to a decrease in muscle mass, was characterized by a redistribution of the body component composition due an increase in the fat mass proportion. These changes were accompanied by a disturbance of lipid metabolism in the form of increase in serum cholesterol level, triglycerides and TyG index, which was 4.33 c. u. higher in 32.4 % of children with diabetic myopathy, and in 9.5 % of children with dynapenia, while among patients with normal state of the muscular system, the TyG index exceeded the threshold value in no case. Comparison of clinical and laboratory indicators depending on the TyG index level found an increase in the fat mass proportion, a violation of glycemic control, an increase in the daily dose of insulin, appearance of combined hyperlipidemia and the dawn phenomenon in children with an indicator that was higher than 4.33 c. u. All these were indicative of the insulin resistance development.\u0000Conclusions. Skeletal muscle dysfunction in children with type 1 diabetes is a causal risk factor for the development of insulin resistance, a sensitive marker of which is the TyG index. The simplicity of calculating this indicator allows it to be used in daily clinical practice.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"9 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83406048","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 : 2022-12-20DOI: 10.14739/2310-1210.2022.6.259771
Yа. M. Postol, A. Sahalevych, R. V. Serhiichuk, A. Korytskyi, V. Ozhohin, Yaroslav Dubovyi, A. Khrapchuk
Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment. Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods. Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety. Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy. Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive.
尿石症是最常见的泌尿系统疾病之一(30 - 45%)，在40 - 60岁达到高峰。大约50%的患者一生中有一次肾结石复发，在手术患者中，超过10 - 15%的患者报告复发，需要反复手术治疗。世界范围内肾结石的发病率不断增加，需要发展新的和改进现有的手术治疗方法，其特点是效率高、侵入性低、并发症少、术后康复。经皮肾镜碎石术与输尿管柔性肾镜碎石术联合应用，结合两种方法的优点，可提高肾结石的安全性，改善肾结石的治疗效果，特别是在复杂的尿路结石病例中。目的:在评价经皮肾穿刺碎石术与逆行或顺行柔性肾内手术联合治疗肾结石的有效性和安全性的基础上，总结国内外有关经皮肾穿刺碎石术治疗肾结石的科学文献。材料和方法。文献综述是在2015-2022年期间使用PubMed、Google Scholar、Web of Science和Scopus数据库进行的。检索关键词:肾结石的外科治疗、内镜联合肾内手术(ECIRS)、经皮肾镜取石术、逆行肾内手术、同时应用输尿管软镜取石术和经皮肾镜取石术、同时应用输尿管软镜取石术和经皮肾镜取石术。ECIRS的使用增加了一期治疗肾结石的有效性，并发症最少，并减少了所需的再次手术次数。治疗复杂形式的肾结石可能是ECIRS的优先事项。ECIRS的主要缺点是需要两名外科医生同时进行手术，并且需要两套内窥镜设备，这使得该手术非常昂贵。
{"title":"The use of endoscopic combined intrarenal surgery in the treatment of nephrolithiasis","authors":"Yа. M. Postol, A. Sahalevych, R. V. Serhiichuk, A. Korytskyi, V. Ozhohin, Yaroslav Dubovyi, A. Khrapchuk","doi":"10.14739/2310-1210.2022.6.259771","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.6.259771","url":null,"abstract":"Urolithiasis is one of the most common urological conditions (30–45 %), peaking in the 4th–6th decades of life. About 50 % of patients have one recurrent episode of nephrolithiasis during their lifetime, and among the operated patients, more than 10–15 % of individuals report recurrences with the need for repeated surgical treatment.\u0000Increasing the incidence of nephrolithiasis in the world requires the development of new and improvement of existing methods of surgical treatment, which would be characterized by a high level of efficiency and low invasiveness with minimal complications and postoperative rehabilitation. The use of a combination of percutaneous nephrolithotripsy and flexible ureteronephrolithotripsy, especially in complex cases of urolithiasis, can increase the safety and improve the treatment of nephrolithiasis by combining the positive qualities of both methods.\u0000Aim. To summarize the data of the world scientific literature on the treatment of nephrolithiasis by studying a combination of percutaneous nephrolithotripsy and retrograde or antegrade flexible intrarenal surgery based on the evaluation of their effectiveness and safety.\u0000Materials and methods. The literature review was conducted using the databases PubMed, Google Scholar, Web of Science and Scopus for the period 2015–2022. The following keywords were used for the search: surgical treatment of nephrolithiasis, endoscopic combined intrarenal surgery (ECIRS), percutaneous nephrolithotomy, retrograde intrarenal surgery, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotomy, simultaneous use of flexible ureterorenoscopy and percutaneous nephrolithotripsy.\u0000Conclusions. The use of ECIRS increases the effectiveness of one-stage treatment of nephrolithiasis with minimal complications and reduces the number of re-operations required. Treatment of complex forms of nephrolithiasis may be a priority for ECIRS. The main disadvantages of ECIRS are the need for simultaneous operation of two operating surgeons and the availability of two sets of endoscopic equipment, which make this procedure expensive.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77227812","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 : 2022-12-20DOI: 10.14739/2310-1210.2022.6.260492
O. Rekovets, Y. Sirenko, O. Torbas
In recent years, the method of determining the Cardio-Ankle Vascular Index (CAVI) has been introduced into clinical practice, which can be used to determine changes in the stiffness of the large arteries regardless of changes in blood pressure (BP). Aim. To compare the effect of 12-month angiotensin II receptor blocker (ARB) therapy with olmesartan, azilsartan and telmisartan on the large arteries stiffness based on the CAVI determination. Material and methods. The study included 126 patients (57 men, 69 women) with hypertension, who were selected to compare the effect of ARB drug therapy on the arterial stiffness by CAVI: olmesartan, azilsartan and telmisartan for 12 months. All patients had mild and moderate hypertension. The patients underwent the following examinations: office BP measurement, ambulatory BP monitoring (ABPM), biochemical blood test, echocardiogram, CAVI, registration of side effects. Results. The average office systolic BP (SBP) throughout the group was 152.56 ± 1.00 mm Hg, office diastolic BP (DBP) – 94.83 ± 0.58 mm Hg, heart rate (HR) – 72.46 ± 0.80 bpm, 24-hour SBP – 135.60 ± 0.96 mm Hg, 24-hour DBP – 82.41 ± 0.84 mm Hg, 24-hour HR – 71.88 ± 0.89 beats/min., CAVI on the right – 7.89 ± 0.27, CAVI on the left – 8.00 ± 0.31. Office and ambulatory BP indicators were decreased equally in all groups. In the olmesartan group, CAVI was significantly decreased by 7 % on the right (P < 0.05) and 5 % on the left (P < 0.05). In the telmisartan group, CAVI was decreased by 6 % on the right (P < 0.05) and 5 % on the left (P < 0.05). In the azilsartan group, CAVI was significantly decreased by 5 % both on the right (P < 0.05) and left (P < 0.05). Conclusions. Long-term antihypertensive therapy with three different AT II receptor blockers, olmesartan, azilsartan, and telmisartan has helped to reduce stiffness of the large arteries according to CAVI by 5–7 % from the initial level.
{"title":"The impact of different angiotensin II receptor blockers on the stiffness of the large arteries and effectiveness of therapy","authors":"O. Rekovets, Y. Sirenko, O. Torbas","doi":"10.14739/2310-1210.2022.6.260492","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.6.260492","url":null,"abstract":"In recent years, the method of determining the Cardio-Ankle Vascular Index (CAVI) has been introduced into clinical practice, which can be used to determine changes in the stiffness of the large arteries regardless of changes in blood pressure (BP).\u0000Aim. To compare the effect of 12-month angiotensin II receptor blocker (ARB) therapy with olmesartan, azilsartan and telmisartan on the large arteries stiffness based on the CAVI determination.\u0000Material and methods. The study included 126 patients (57 men, 69 women) with hypertension, who were selected to compare the effect of ARB drug therapy on the arterial stiffness by CAVI: olmesartan, azilsartan and telmisartan for 12 months. All patients had mild and moderate hypertension. The patients underwent the following examinations: office BP measurement, ambulatory BP monitoring (ABPM), biochemical blood test, echocardiogram, CAVI, registration of side effects.\u0000Results. The average office systolic BP (SBP) throughout the group was 152.56 ± 1.00 mm Hg, office diastolic BP (DBP) – 94.83 ± 0.58 mm Hg, heart rate (HR) – 72.46 ± 0.80 bpm, 24-hour SBP – 135.60 ± 0.96 mm Hg, 24-hour DBP – 82.41 ± 0.84 mm Hg, 24-hour HR – 71.88 ± 0.89 beats/min., CAVI on the right – 7.89 ± 0.27, CAVI on the left – 8.00 ± 0.31. Office and ambulatory BP indicators were decreased equally in all groups. In the olmesartan group, CAVI was significantly decreased by 7 % on the right (P < 0.05) and 5 % on the left (P < 0.05). In the telmisartan group, CAVI was decreased by 6 % on the right (P < 0.05) and 5 % on the left (P < 0.05). In the azilsartan group, CAVI was significantly decreased by 5 % both on the right (P < 0.05) and left (P < 0.05).\u0000Conclusions. Long-term antihypertensive therapy with three different AT II receptor blockers, olmesartan, azilsartan, and telmisartan has helped to reduce stiffness of the large arteries according to CAVI by 5–7 % from the initial level.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"12 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85992896","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 : 2022-11-09DOI: 10.14739/2310-1210.2022.5.266062
B. Samura, M. Panasenko
Heart dysfunction that occurred after using of anticancer drugs and monoclonal antibodies may be a limit factor in treatment of chronic lymphoproliferative diseases (CLPD). Cancer therapy-related cardiovascular toxicity include hypotension, hypertension, arrhythmias, conduction disturbances, pericarditis, thromboembolic events, heart failure, death. The risk of cardiotoxicity may be increased by some factors that include drug exposure, age, history of heart diseases, arterial hypertension, drug combination, previous radiotherapy or chemotherapy. The aim of the work is to assess the impact of anticancer treatment on the occurrence of cardiovascular events in patients with CLPD according to the world scientific literature data. It is important to detect the cardiovascular toxicity before the development of clinical manifestations of damage to the myocardium and blood vessels. The role of markers in identifying the risk group of adverse cardiovascular events remains unclear. Early diagnostics and determination of prognostic factors of cardiovascular toxicity, which develop after anticancer therapy of CLPD, are important and not solved problems. Conclusions. The prognosis for the development of cardiovascular events after antitumor treatment of CLPD remains unfavorable. Clinical monitoring, imaging methods, determination of the biomarker levels (natriuretic peptides, troponins) for cardiotoxicity risk stratification are recommended during antitumor treatment to identify early signs and risk of cardiotoxicity. The use of the latest biomarkers and their combinations may be a way to improve the assessment of the cardiotoxicity risk in CLPD. To date, there is no sufficient evidence on the feasibility of routine determining these biomarkers, which indicates the need to plan new studies.
{"title":"Chronic lymphoproliferative diseases and cardiovascular risk (a literature review)","authors":"B. Samura, M. Panasenko","doi":"10.14739/2310-1210.2022.5.266062","DOIUrl":"https://doi.org/10.14739/2310-1210.2022.5.266062","url":null,"abstract":"Heart dysfunction that occurred after using of anticancer drugs and monoclonal antibodies may be a limit factor in treatment of chronic lymphoproliferative diseases (CLPD). Cancer therapy-related cardiovascular toxicity include hypotension, hypertension, arrhythmias, conduction disturbances, pericarditis, thromboembolic events, heart failure, death. The risk of cardiotoxicity may be increased by some factors that include drug exposure, age, history of heart diseases, arterial hypertension, drug combination, previous radiotherapy or chemotherapy.\u0000The aim of the work is to assess the impact of anticancer treatment on the occurrence of cardiovascular events in patients with CLPD according to the world scientific literature data.\u0000It is important to detect the cardiovascular toxicity before the development of clinical manifestations of damage to the myocardium and blood vessels. The role of markers in identifying the risk group of adverse cardiovascular events remains unclear. Early diagnostics and determination of prognostic factors of cardiovascular toxicity, which develop after anticancer therapy of CLPD, are important and not solved problems.\u0000Conclusions. The prognosis for the development of cardiovascular events after antitumor treatment of CLPD remains unfavorable. Clinical monitoring, imaging methods, determination of the biomarker levels (natriuretic peptides, troponins) for cardiotoxicity risk stratification are recommended during antitumor treatment to identify early signs and risk of cardiotoxicity. The use of the latest biomarkers and their combinations may be a way to improve the assessment of the cardiotoxicity risk in CLPD. To date, there is no sufficient evidence on the feasibility of routine determining these biomarkers, which indicates the need to plan new studies.","PeriodicalId":23832,"journal":{"name":"Zaporozhye Medical Journal","volume":"26 1","pages":""},"PeriodicalIF":0.1,"publicationDate":"2022-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75264603","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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