Erik Hansen, Eric Irungu, J. K. Nyagetuba, J. Mbogo
Background: The approach to management of patients with disorders of sex development (DSD) has been refined over the past two decades. We sought to review DSD cases at our hospital and hypothesized that age at presentation would decline over time. Methods: A retrospective review of patients presenting to our hospital between January 1, 2005 and July 31, 2018, with findings of ambiguous genitalia was performed. Results: A total of 44 patients were identified, 3 with cloacal exstrophy. Of the 41 remaining patients, the majority (n = 24) had ovotesticular DSD. Three time periods in the evolution to a multidisciplinary team (MDT) approach were identified: Period 1 (2003–2009), Period 2 (2010– 2013), and Period 3 (2014–present). Median presenting age in Periods 1, 2, and 3 were 7 years (95% CI: 0.5–15), 6.5 years (95% CI: 1–19), and 11 years (95% CI: 2–17), respectively, and were not statistically different. Conclusion: Management of patients with DSD poses a challenge to healthcare providers across the globe. The gradual evolution of patient management with incorporation of MDTs and progression toward delayed surgery is seen in this study. There is indeed a need to set up regional centers of excellence, public awareness programs, and healthcare personnel training programs for optimal management of these patients in low- and middle-income countries (LMICs).
{"title":"Management of differences in sexual development: evolution of an approach for a resource-limited setting","authors":"Erik Hansen, Eric Irungu, J. K. Nyagetuba, J. Mbogo","doi":"10.4314/aas.v19i4.5","DOIUrl":"https://doi.org/10.4314/aas.v19i4.5","url":null,"abstract":"Background: The approach to management of patients with disorders of sex development (DSD) has been refined over the past two decades. We sought to review DSD cases at our hospital and hypothesized that age at presentation would decline over time. Methods: A retrospective review of patients presenting to our hospital between January 1, 2005 and July 31, 2018, with findings of ambiguous genitalia was performed. Results: A total of 44 patients were identified, 3 with cloacal exstrophy. Of the 41 remaining patients, the majority (n = 24) had ovotesticular DSD. Three time periods in the evolution to a multidisciplinary team (MDT) approach were identified: Period 1 (2003–2009), Period 2 (2010– 2013), and Period 3 (2014–present). Median presenting age in Periods 1, 2, and 3 were 7 years (95% CI: 0.5–15), 6.5 years (95% CI: 1–19), and 11 years (95% CI: 2–17), respectively, and were not statistically different. Conclusion: Management of patients with DSD poses a challenge to healthcare providers across the globe. The gradual evolution of patient management with incorporation of MDTs and progression toward delayed surgery is seen in this study. There is indeed a need to set up regional centers of excellence, public awareness programs, and healthcare personnel training programs for optimal management of these patients in low- and middle-income countries (LMICs).","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87698903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Informed consent for surgical case reports","authors":"Mohamed Onyango, Brian Kariuki","doi":"10.4314/aas.v19i3.1","DOIUrl":"https://doi.org/10.4314/aas.v19i3.1","url":null,"abstract":"No Abstract.","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76118635","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}
E. Ogunleye, O. Adekola, O. Olusoji, A. Olugbemi, S. Sanni
Bronchogenic cyst is a common primary cyst of the mediastinum, and it is usually located in the middle mediastinum and intrapulmonary regions. Bronchogenic cysts are lesions of congenital origin that occur due to abnormal budding from the primitive ventral foregut. They are common in the pediatric age group and have symptoms of respiratory distress, recurrent cough, wheezing, and stridor. Definitive management involves surgical excision. We herein report our experience of a bronchogenic cyst complicated by Mycobacterium tuberculosis infection in an 8-month-old infant. The patient underwent a right posterolateral thoracotomy, and an intrapulmonary bronchogenic cyst filled with purulent fluid was excised. The patient was given antituberculous medication, and the post-operative outcome was good.
{"title":"Infected Bronchogenic Cyst with Mycobacterium tuberculosis as a Cause of Respiratory Distress: A Case Report","authors":"E. Ogunleye, O. Adekola, O. Olusoji, A. Olugbemi, S. Sanni","doi":"10.4314/aas.v19i3.6","DOIUrl":"https://doi.org/10.4314/aas.v19i3.6","url":null,"abstract":"Bronchogenic cyst is a common primary cyst of the mediastinum, and it is usually located in the middle mediastinum and intrapulmonary regions. Bronchogenic cysts are lesions of congenital origin that occur due to abnormal budding from the primitive ventral foregut. They are common in the pediatric age group and have symptoms of respiratory distress, recurrent cough, wheezing, and stridor. Definitive management involves surgical excision. We herein report our experience of a bronchogenic cyst complicated by Mycobacterium tuberculosis infection in an 8-month-old infant. The patient underwent a right posterolateral thoracotomy, and an intrapulmonary bronchogenic cyst filled with purulent fluid was excised. The patient was given antituberculous medication, and the post-operative outcome was good.","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89945289","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}
Andrew Tabu Kaggwa, Protus Kituyi, Elijah Muteti, R. Ayumba
Background: Management of cancer-related bone pain (CRBP) with analgesics poses a substantial challenge. This study aimed to determine the correlation between pain control satisfaction and prescribed analgesics. Methods: This 12-month descriptive prospective study included 96 adults who were consecutively sampled and followed up daily for 5 days. Eligible patients had histopathologically confirmed tumor, osseous lesion(s) on radiographs, and cognitive capacity to rank pain on the Numerical Rating Scale. Data were collected using questionnaires drafted from the Brief Pain Inventory. Self-assessed pain scores within the past 24 hours were reported on a scale of 0 (no pain) to 10 (worst pain). Pain control satisfaction was assessed as a single response question (satisfied, not sure, or dissatisfied). Associations were examined in multiple logistic regression models. Ethical approval and informed consent were obtained. Results: The median age was 57 (range, 19–90) years, and more males (52.1%) than females were recruited. The proportion of CRBP ranged from 83.3% to 86.5%, whereas that of moderate to severe pain ranged from 57.3% to 69.8%. Overall, 70.8% were satisfied with their pain control. Patients prescribed opioids (adjusted odds ratio, 0.027; p=0.041) had an increased likelihood of pain control satisfaction. Conclusion: Although a high percentage of patients experienced moderate to severe CRBP, a majority were satisfied with their analgesic pain control. Prescription opioids were associated with higher satisfaction. Policies that sustain ready accessibility of analgesics, particularly opioids, should be implemented.
{"title":"Cancer-Related Bone Pain: Patients’ Satisfaction with Analgesic Pain Control","authors":"Andrew Tabu Kaggwa, Protus Kituyi, Elijah Muteti, R. Ayumba","doi":"10.4314/aas.v19i3.3","DOIUrl":"https://doi.org/10.4314/aas.v19i3.3","url":null,"abstract":"Background: Management of cancer-related bone pain (CRBP) with analgesics poses a substantial challenge. This study aimed to determine the correlation between pain control satisfaction and prescribed analgesics. Methods: This 12-month descriptive prospective study included 96 adults who were consecutively sampled and followed up daily for 5 days. Eligible patients had histopathologically confirmed tumor, osseous lesion(s) on radiographs, and cognitive capacity to rank pain on the Numerical Rating Scale. Data were collected using questionnaires drafted from the Brief Pain Inventory. Self-assessed pain scores within the past 24 hours were reported on a scale of 0 (no pain) to 10 (worst pain). Pain control satisfaction was assessed as a single response question (satisfied, not sure, or dissatisfied). Associations were examined in multiple logistic regression models. Ethical approval and informed consent were obtained. Results: The median age was 57 (range, 19–90) years, and more males (52.1%) than females were recruited. The proportion of CRBP ranged from 83.3% to 86.5%, whereas that of moderate to severe pain ranged from 57.3% to 69.8%. Overall, 70.8% were satisfied with their pain control. Patients prescribed opioids (adjusted odds ratio, 0.027; p=0.041) had an increased likelihood of pain control satisfaction. Conclusion: Although a high percentage of patients experienced moderate to severe CRBP, a majority were satisfied with their analgesic pain control. Prescription opioids were associated with higher satisfaction. Policies that sustain ready accessibility of analgesics, particularly opioids, should be implemented.","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"28 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89573133","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}
Vein of Galen aneurysmal malformations (VGAM) are arteriovenous fistulas between the choroidal or quadrigeminal arteries and the embryonic precursor of the vein of Galen – the median prosencephalic vein. VGAM represents 30% of arteriovenous malformations in the paediatric age group. They are associated with a high morbidity and 90% mortality if untreated but respond well to intervention with mortality reduced to below 40%. There are few documented cases of VGAM worldwide and scarce data about these lesions in sub-Saharan Africa with challenges in diagnosis and management. We present two cases of infants diagnosed with VGAM and treated with endovascular embolisation. We examine the clinical and radiological data at presentation, intervention and follow-up at one year. We report on some of the technical neurointerventional details. Both patients had satisfactory radiological results and the interventions resulted notable clinical improvements from baseline. Physicians should maintain a high index of suspicion treating infants and toddlers presenting with macrocephaly, neurocognitive decline and cardiopulmonary symptoms. Upon diagnosis endovascular interventions are feasible and available.
{"title":"Endovascular Treatment of Vein of Galen Malformation in Kenya, East Africa","authors":"E. Mogere, C. Munguti","doi":"10.4314/aas.v19i3.4","DOIUrl":"https://doi.org/10.4314/aas.v19i3.4","url":null,"abstract":"Vein of Galen aneurysmal malformations (VGAM) are arteriovenous fistulas between the choroidal or quadrigeminal arteries and the embryonic precursor of the vein of Galen – the median prosencephalic vein. VGAM represents 30% of arteriovenous malformations in the paediatric age group. They are associated with a high morbidity and 90% mortality if untreated but respond well to intervention with mortality reduced to below 40%. There are few documented cases of VGAM worldwide and scarce data about these lesions in sub-Saharan Africa with challenges in diagnosis and management. We present two cases of infants diagnosed with VGAM and treated with endovascular embolisation. We examine the clinical and radiological data at presentation, intervention and follow-up at one year. We report on some of the technical neurointerventional details. Both patients had satisfactory radiological results and the interventions resulted notable clinical improvements from baseline. Physicians should maintain a high index of suspicion treating infants and toddlers presenting with macrocephaly, neurocognitive decline and cardiopulmonary symptoms. Upon diagnosis endovascular interventions are feasible and available.","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74838138","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}
Theeran Gill, Jaikumar Nallamuthu, Shabbar Husain, Wazir Azzam, F. Hayati, I. Sagap
Inflammatory bowel disease is an emerging gastrointestinal disease in Malaysia. One of its rare complications includes giant inflammatory polyposis (GIP). A 39-year-old woman presented with worsening per rectal mucous discharge, associated with blood, colicky abdominal pain, and weight loss. A series of endoscopies at another hospital did not provide an inconclusive diagnosis. Another repeat colonoscopy showed a left-sided colitis with marked erythema and friability with islands of polyps; this was concluded to be an ulcerative colitis based on histopathology; thus, medical treatment was commenced. However, 2 months later, the patient presented with constipation, which required laxatives, as well as a worsened lower abdominal pain. Subsequent colonoscopy revealed obstruction-caused GIP at the mid rectum extending to the lower rectum, which was confirmed by imaging modalities. She was diagnosed with obstructing GIP coupled with ulcerative colitis, and panproctocolectomy and ileal pouch anal anastomosis were planned.
{"title":"Giant Inflammatory Polyposis of the Rectum as a Complication of Ulcerative Colitis","authors":"Theeran Gill, Jaikumar Nallamuthu, Shabbar Husain, Wazir Azzam, F. Hayati, I. Sagap","doi":"10.4314/aas.v19i3.7","DOIUrl":"https://doi.org/10.4314/aas.v19i3.7","url":null,"abstract":"Inflammatory bowel disease is an emerging gastrointestinal disease in Malaysia. One of its rare complications includes giant inflammatory polyposis (GIP). A 39-year-old woman presented with worsening per rectal mucous discharge, associated with blood, colicky abdominal pain, and weight loss. A series of endoscopies at another hospital did not provide an inconclusive diagnosis. Another repeat colonoscopy showed a left-sided colitis with marked erythema and friability with islands of polyps; this was concluded to be an ulcerative colitis based on histopathology; thus, medical treatment was commenced. However, 2 months later, the patient presented with constipation, which required laxatives, as well as a worsened lower abdominal pain. Subsequent colonoscopy revealed obstruction-caused GIP at the mid rectum extending to the lower rectum, which was confirmed by imaging modalities. She was diagnosed with obstructing GIP coupled with ulcerative colitis, and panproctocolectomy and ileal pouch anal anastomosis were planned.","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73741204","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}
Intermittent calf pain is also called claudication. It is common in patients with spinal canal stenosis or those with peripheral vascular occlusion disorders. It is rarely found in local muscle pathology. We herein report a case of a 50-year-old man who presented with left-sided calf pain on mild exertion. On evaluation, the systemic review was normal, with no spondylosis or vascular pathology, but with local fatty degeneration in the gastrocnemius, which was causing the calf pain. He was given analgesics and underwent physiotherapy and counseling, and his condition improved over 6 months.
{"title":"A Rare Case of Intermittent Calf Pain: Gastrocnemius Fatty Degeneration","authors":"Kalande Fredrick","doi":"10.4314/aas.v19i3.5","DOIUrl":"https://doi.org/10.4314/aas.v19i3.5","url":null,"abstract":"Intermittent calf pain is also called claudication. It is common in patients with spinal canal stenosis or those with peripheral vascular occlusion disorders. It is rarely found in local muscle pathology. We herein report a case of a 50-year-old man who presented with left-sided calf pain on mild exertion. On evaluation, the systemic review was normal, with no spondylosis or vascular pathology, but with local fatty degeneration in the gastrocnemius, which was causing the calf pain. He was given analgesics and underwent physiotherapy and counseling, and his condition improved over 6 months. ","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89616833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Appendectomy is a common emergency procedure in general surgery. The objective of this study was to identify factors that impact on outcomes following appendectomy for acute appendicitis. Methodology: A chart review of all patients with a diagnosis of acute appendicitis who underwent appendectomy at Aga Khan University Hospital between January 2018 and December 2019 was performed. Results: Most of the patients (male-tofemale ratio, 2:1; mean age, 35±15.6 years) presented with acute uncomplicated appendicitis within an average of 2.98 days from symptom onset. The most common clinical sign was right lower quadrant tenderness. Abdominal ultrasound had a low sensitivity (33%), but computed tomography of the abdomen, which is the preferred imaging modality, had a high sensitivity (93%). The overall complication rate was 10.9%, with no statistically significant difference between open and laparoscopic appendectomy in terms of duration of surgery, length of hospital stay, and complication rates. The negative appendectomy rate was 6%. Conclusion: The complication rates of acute appendicitis in this setting are within international rates, but the negative appendectomy rate remains high. A more accurate interpretation of available imaging modalities is needed to improve this rate.
{"title":"Optimizing Clinical Outcomes of Acute Appendicitis","authors":"C. Munguti, Stanley Mugambi, A. Abdallah","doi":"10.4314/aas.v19i3.2","DOIUrl":"https://doi.org/10.4314/aas.v19i3.2","url":null,"abstract":"Background: Appendectomy is a common emergency procedure in general surgery. The objective of this study was to identify factors that impact on outcomes following appendectomy for acute appendicitis. Methodology: A chart review of all patients with a diagnosis of acute appendicitis who underwent appendectomy at Aga Khan University Hospital between January 2018 and December 2019 was performed. Results: Most of the patients (male-tofemale ratio, 2:1; mean age, 35±15.6 years) presented with acute uncomplicated appendicitis within an average of 2.98 days from symptom onset. The most common clinical sign was right lower quadrant tenderness. Abdominal ultrasound had a low sensitivity (33%), but computed tomography of the abdomen, which is the preferred imaging modality, had a high sensitivity (93%). The overall complication rate was 10.9%, with no statistically significant difference between open and laparoscopic appendectomy in terms of duration of surgery, length of hospital stay, and complication rates. The negative appendectomy rate was 6%. Conclusion: The complication rates of acute appendicitis in this setting are within international rates, but the negative appendectomy rate remains high. A more accurate interpretation of available imaging modalities is needed to improve this rate.","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88725684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter to the editor regarding “Perception and challenges of health science students toward E-learning in a sub-Saharan African country: a multi-institutional study”","authors":"K. Kilova, Тanya Kitova, B. Kitov","doi":"10.4314/aas.v19i4.2","DOIUrl":"https://doi.org/10.4314/aas.v19i4.2","url":null,"abstract":"No abstract.","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"258 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73483649","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}
Ikechukwu Ezeah, M. Nweke, O. Adejumo, O. Junaid, O. Ige
Peripheral venous cannulation is a common invasive procedure. Fracture of an intravenous cannula is rare and an under-reported complication of peripheral venous cannulation. Embolization of the intravenous fragment into the central venous system is potentially fatal. Urgent surgical retrieval, which is performed through a transverse or longitudinal incision, is the treatment of choice. We herein present the use of Z-plasty incision for the retrieval of a retained fractured peripheral intravenous cannula in a 61-year-old Nigerian man on hemodialysis for chronic kidney disease. The major benefits of this innovation are facilitation of access for exploration and prevention of joint contracture.
{"title":"Seek and you shall find—retrieval of a retained fractured intravenous cannula by Z-plasty incision: a case report","authors":"Ikechukwu Ezeah, M. Nweke, O. Adejumo, O. Junaid, O. Ige","doi":"10.4314/aas.v20i1.7","DOIUrl":"https://doi.org/10.4314/aas.v20i1.7","url":null,"abstract":"Peripheral venous cannulation is a common invasive procedure. Fracture of an intravenous cannula is rare and an under-reported complication of peripheral venous cannulation. Embolization of the intravenous fragment into the central venous system is potentially fatal. Urgent surgical retrieval, which is performed through a transverse or longitudinal incision, is the treatment of choice. We herein present the use of Z-plasty incision for the retrieval of a retained fractured peripheral intravenous cannula in a 61-year-old Nigerian man on hemodialysis for chronic kidney disease. The major benefits of this innovation are facilitation of access for exploration and prevention of joint contracture.","PeriodicalId":37442,"journal":{"name":"Annals of African Surgery","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88866251","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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