Respiratory Medicine and Research最新文献

{"title":"Phenotypes and prognosis of systemic sclerosis: A cluster analysis","authors":"Stefan Nowak ,&nbsp;Dany Jaffuel ,&nbsp;Jacques Morel ,&nbsp;Engi Ahmed ,&nbsp;Anne Sophie Gamez ,&nbsp;Clément Boissin ,&nbsp;Jérémy Charriot ,&nbsp;Nicolas Molinari ,&nbsp;Arnaud Bourdin","doi":"10.1016/j.resmer.2025.101168","DOIUrl":"10.1016/j.resmer.2025.101168","url":null,"abstract":"<div><h3>Introduction</h3><div>Systemic sclerosis is a complex autoimmune disease with significant morbidity and mortality, primarily due to pulmonary complications, including diffuse interstitial lung disease and pulmonary hypertension. The disease course is unpredictable due to its heterogeneous presentation. Our study aimed to form homogeneous cohorts of patients with severe visceral systemic sclerosis and assess their prognoses.</div></div><div><h3>Materials and methods</h3><div>We conducted a single-center retrospective observational study on 198 patients. These patients were clustered based on factors associated with poor disease prognosis using a bottom-up hierarchical clustering technique.</div></div><div><h3>Results</h3><div>We identified four clusters in our population. Cluster 1 (<em>n</em> = 25) included 89 % of patients with pulmonary hypertension, 64 % of whom had associated interstitial lung disease. Cluster 2 (<em>n</em> = 11) included all patients with scleroderma renal crisis, 27 % of whom developed pulmonary hypertension. Cluster 3 (<em>n</em> = 109) exclusively consisted of female patients, 90 % of whom had a limited cutaneous form, with 62 % presenting anticentromere antibodies. These patients did not exhibit severe pulmonary disease. Cluster 4 (<em>n</em> = 53) included patients with significant occupational exposure, 79 % of whom had diffused interstitial lung disease and 83 % had anti-topoisomerase I antibodies. The survival rate was significantly lower in cluster 1 (<em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>This study characterized systemic sclerosis phenotypes, highlighting the heterogeneity in clinical presentation and disease course. The trajectory of patients within each cluster was associated with the onset of pulmonary hypertension onset, which adversely affected the prognosis.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101168"},"PeriodicalIF":2.2,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided pleural biopsy (USGB) outcomes: The impact of respiratory-led one stop shop","authors":"Shyun Ping Tiong,&nbsp;John De Jesus,&nbsp;Tashi Playle,&nbsp;Emily Harvey,&nbsp;Michael Ball,&nbsp;Siyamini Vythilingam,&nbsp;Rachelle Asciak","doi":"10.1016/j.resmer.2025.101167","DOIUrl":"10.1016/j.resmer.2025.101167","url":null,"abstract":"","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101167"},"PeriodicalIF":2.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bronchoscopic detection of aspiration in patients with bronchiectasis and Mycobacterium avium complex pulmonary infection","authors":"Leah Lande ,&nbsp;Spencer Whealon ,&nbsp;Eden Singer ,&nbsp;Lee W. Greenspon ,&nbsp;Erin Rains ,&nbsp;Rebecca Kwait ,&nbsp;Meghan Buckley ,&nbsp;Weidan Peng ,&nbsp;Janet Sawicki ,&nbsp;Joseph O. Falkinham III ,&nbsp;Myra D. Williams ,&nbsp;Donald D. Peterson","doi":"10.1016/j.resmer.2025.101166","DOIUrl":"10.1016/j.resmer.2025.101166","url":null,"abstract":"<div><h3>Rationale</h3><div>To investigate whether gastroesophageal reflux with laryngopharyngeal reflux and aspiration play a role in the pathogenesis of bronchiectasis and <em>Mycobacterium avium</em> complex (MAC) pulmonary infection.</div></div><div><h3>Methods</h3><div>In this prospective case-control study, subjects included 31 patients with bronchiectasis undergoing bronchoscopy to investigate suspected MAC infection and 9 control subjects undergoing bronchoscopy for alternative reasons. Patients drank 45 mL of FD&amp;C Blue #1 mixed with 200 mL of tap water the night prior to bronchoscopy. During bronchoscopy, the bronchial mucosa was inspected for the presence of blue dye staining. Bronchoalveolar lavage (BAL) samples were obtained from the most affected segments on CT scan and were cultured for mycobacteria and assayed for pepsin and bile acids. Gastric aspirate samples were obtained for mycobacterial culture.</div></div><div><h3>Results</h3><div>93.8% of patients with confirmed pulmonary MAC infection and 91.7% of patients with evidence of bronchiectasis by CT scan, but negative mycobacterial cultures, had blue dye staining of the bronchial mucosa vs. 11.3% of control patients (<em>p</em> &lt; 0.001). Areas of abnormality on CT correlated with airways demonstrating blue staining by bronchoscopy in 100% of MAC patients and 90.9% of patients with bronchiectasis and negative mycobacterial cultures. MAC patients had higher median BAL pepsin levels compared to combined MAC negative patients (subjects with bronchiectasis and negative mycobacterial cultures and true controls), 5.4 ng/mL vs. 3.4 ng/mL (<em>p</em> = 0.019). 78.6% of MAC patients vs. 26.3% of combined MAC negative patients had BAL bile acid concentrations of &gt;/= 0.493 uM (<em>p</em> = 0.005). There was no significant difference in age, supraglottic index, reflux symptoms, gastric pH, or proton pump inhibitor use between the MAC positive vs. MAC negative patients. 42.8% of patients with growth of MAC on BAL also had growth of MAC in the gastric aspirate.</div></div><div><h3>Conclusions</h3><div>Reflux and aspiration of gastric contents into the airways show a strong association with bronchiectasis and may be associated with MAC pulmonary disease. The novel method introduced in this study of drinking blue dye the evening prior to bronchoscopy should be utilized in the evaluation of infectious and inflammatory lung diseases in which aspiration may play a role.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101166"},"PeriodicalIF":2.2,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143681862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microbiological characteristics of pleural infection in adults: A 10-year retrospective study from a tertiary respiratory care hospital","authors":"Khouloud Ben Dhaou ,&nbsp;Imen Bouzouita ,&nbsp;Asma Ghariani ,&nbsp;Emna Mehiri-Zeghal ,&nbsp;Leila Slim-Saidi","doi":"10.1016/j.resmer.2025.101164","DOIUrl":"10.1016/j.resmer.2025.101164","url":null,"abstract":"<div><h3>Introduction</h3><div>Pleural infection is a high-mortality disease with a rising incidence in the past two decades. The knowledge of the main causative organisms is an important step for appropriate treatment. This study aims to describe etiologic and antibiotic resistance features of non-tuberculous pleural infections in adults in a tertiary care center specializing in the treatment of respiratory diseases.</div></div><div><h3>Methods</h3><div>This retrospective study was conducted at the microbiology laboratory of Abderrahmen Mami pneumology and phthisiology hospital, Ariana, Tunisia from January 2014 to December 2023. Pleural fluid samples were collected from adult patients with pleural effusion, from any cause, admitted to the different clinical services. Bacterial isolation and identification were performed by conventional techniques. The disk diffusion and the Vitek 2 methods were used for the susceptibility testing.</div></div><div><h3>Results</h3><div>During the study period, 5235 pleural fluid specimens were included. The sex ratio M/F was 2:1, and the median age was 57 years (interquartile range: 43–68 years). Culture was positive in 9.6 % of all cases, and in 31.4 % of purulent pleural fluids. The Gram stain had 41.5 % (95 % CI 35.6–47.6) sensitivity and 99.8 % (95 % CI 99.6–99.9) specificity in detecting microorganisms. A pleural fluid leukocyte count &gt;10,000/mL showed a sensitivity of 51.4 % (95 % CI 47.7–55.8) and a specificity of 91.7 % (95 % CI 90.8–92.4). A total of 544 microorganisms were isolated. The main causative microorganisms were viridans streptococci group (32.1 %), <em>Enterobacteriaceae</em> (25.3 %), <em>Staphylococcus aureus</em> (10.2 %), and anaerobes (9.3 %). Among Enterobacteriaceae, 19 % were resistant to third-generation cephalosporins and 6.4 % to carbapenems. The resistance to penicillin G was detected in 19 % of the <em>viridans streptococci</em> group. Methicilline Resistant <em>Staphylococcus aureus</em> percentage was 14.2 %.</div></div><div><h3>Conclusion</h3><div>Conventional culture yielded 31.4 % positivity in purulent pleural fluids, and Gram-positive organisms were the leading cause of non-tuberculous pleural infections in adults over the past ten years. These results highlight the need for new molecular methods to improve culture-negative empyema diagnosis.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101164"},"PeriodicalIF":2.2,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Lung tensioning device” for emphysema: The comeback of the coil","authors":"Nicolas Guibert,&nbsp;Thomas Villeneuve,&nbsp;Juliette Edme,&nbsp;Julien Mazières,&nbsp;Gavin Plat,&nbsp;Valentin Héluain","doi":"10.1016/j.resmer.2025.101163","DOIUrl":"10.1016/j.resmer.2025.101163","url":null,"abstract":"","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101163"},"PeriodicalIF":2.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143520995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The positional change in vital capacity as a tool to identify diaphragm dysfunction: A qualitative systematic review","authors":"Hendrik Kever ,&nbsp;Giuseppe Liistro ,&nbsp;Dominique Butenda Babapu ,&nbsp;Gregory Reychler","doi":"10.1016/j.resmer.2025.101162","DOIUrl":"10.1016/j.resmer.2025.101162","url":null,"abstract":"<div><h3>Background</h3><div>Sitting to supine fall in vital capacity (∆VC) is commonly used to screen for diaphragmatic dysfunction (DD), but the predictive threshold value varies.</div><div>This systematic review aimed to compare the position-dependent change in vital capacity (VC) in patients with objectively confirmed DD.</div></div><div><h3>Research question</h3><div>What is the optimal predictive value of ∆VC to diagnose DD.</div></div><div><h3>Study design and methods</h3><div>We searched Medline/PubMed, Embase and Scopus, including backward citations, for studies from database inception to December 5, 2023. Included trials measured position change in VC in adult patients with DD, confirmed independently by a parameter other than ∆VC. Risk of bias was assessed using the Downs and Black checklist.</div></div><div><h3>Results</h3><div>Of 497 records identified, 10 studies were included, totalling 393 adults, of which 284 had DD. In patients with confirmed unilateral diaphragmatic paralysis, mean change in VC ranged from 7 to 23%, and in those with bilateral diaphragmatic paralysis, from 19 to 37%. In studies providing only values for DD without specifying unilateral or bilateral involvement, it ranged from 31 to 42%. In control groups, it ranged from 3 to 9%.</div></div><div><h3>Interpretation</h3><div>The change in VC appears to be a valid test for confirming DD when using a cut-off value of 20%, though this approach results in very low sensitivity.</div><div>A cut-off value of 15% should be used in a screening setting as an initial approach of a multimodal strategy, without being sensible enough to exclude milder forms of DD.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101162"},"PeriodicalIF":2.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143464108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-acting muscarinic antagonists (LAMA) in asthma: What is the best strategy?","authors":"Guillaume Mahay ,&nbsp;Maeva Zysman ,&nbsp;Nicolas Guibert ,&nbsp;Cindy Barnig ,&nbsp;Laurent Guilleminault ,&nbsp;Clairelyne Dupin","doi":"10.1016/j.resmer.2025.101157","DOIUrl":"10.1016/j.resmer.2025.101157","url":null,"abstract":"<div><div>The use of long-acting muscarinic antagonists (LAMA) in asthma is supported by their mechanism of action and evidence of drug synergy with inhaled corticosteroids ± long-acting β-agonists. This review discusses the scientific rationale, clinical data, and recommendations for the use of LAMA in the asthma therapeutic strategy. Adding a LAMA to a dual therapy with an inhaled corticosteroid and long-acting β-agonist has been shown to reduce exacerbations, increase asthma control, and improve quality of life, with a good safety profile. In addition, using a single inhaler device containing multiple drugs enhances patients’ adherence to therapy. Some predictive factors of the efficacy of this triple therapy have been suggested in the literature: patients with a history of at least one exacerbation within the past 12 months, male patients, those younger than 65 years, and non-smokers have been reported to have a greater improvement from baseline forced expiratory volume in 1 second (FEV1) compared with patients without these characteristics, while patients with high bronchial hyperresponsiveness and persistent airway limitations (PAL) seem to show better gains in the exacerbation rate. However, eosinophil levels do not seem to predict the efficacy of LAMA. The role and long-term benefits of LAMA combined with biologic therapy in severe asthma remain uncertain, with more clinical data needed.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101157"},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of severe exacerbations of COPD by French intensivists and adherence to guidelines","authors":"Luc Haudebourg ,&nbsp;Morgane Faure ,&nbsp;Martin Dres ,&nbsp;Nicolas Roche ,&nbsp;Nicolas Terzi ,&nbsp;Elise Morawiec ,&nbsp;Julie Delemazure ,&nbsp;Armand Mekontso-Dessap ,&nbsp;Thomas Similowski ,&nbsp;Maxens Decavèle ,&nbsp;Alexandre Demoule","doi":"10.1016/j.resmer.2025.101159","DOIUrl":"10.1016/j.resmer.2025.101159","url":null,"abstract":"<div><h3>Background</h3><div>Severe exacerbations of chronic obstructive pulmonary disease (ECOPD) require hospitalization in intensive care unit (ICU) in 10 % of cases. This study aims to describe current practices for the management of severe ECOPD in the ICU and to evaluate adherence to the 2017 French guidelines.</div></div><div><h3>Methods</h3><div>From March to May 2019, we conducted a cross-sectional multicenter survey across 80 ICUs in France. A 9-item questionnaire exploring physicians practices in terms of diagnostic workup and management of severe ECOPD was sent to participating centers.</div></div><div><h3>Results</h3><div>Four hundred and thirty-eight physicians responded to the survey, 75 % were senior physicians, 39 % were certified medical intensivists and 67 % worked in a medical or respiratory ICU. Nebulized short-acting beta agonists prescription was mostly driven by the presence of wheezing, silent chest or respiratory failure, even though guidelines recommend them systematically for ECOPD (moderate adhesion to guidelines). Antibiotic prescription was mostly driven by increased sputum purulence and volume, fever, signs of respiratory distress or the severity of the underlying COPD, but was not deemed systematic in case of severity signs (poor adhesion to guidelines). Regarding the use of biomarkers for antibiotics prescription, adhesion to guidelines was moderate. The prescription of systemic corticosteroids was not deemed systematic but was rather considered if no improvement was observed 72 h after admission (good adhesion to guidelines).</div></div><div><h3>Conclusion</h3><div>Reported management of severe ECOPD does not follow all guidelines. Future works should focus on understanding barriers to clinical practice guidelines implementation.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101159"},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tele-medicine experiences and expectations from patients with neuromuscular diseases treated with non-invasive ventilation","authors":"Sandrine Segovia-Kueny ,&nbsp;Mathieu Delorme ,&nbsp;Caroline Stalens ,&nbsp;Julie Lejeune ,&nbsp;Frédéric Lofaso ,&nbsp;Hélène Prigent ,&nbsp;Antoine Leotard","doi":"10.1016/j.resmer.2025.101160","DOIUrl":"10.1016/j.resmer.2025.101160","url":null,"abstract":"","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101160"},"PeriodicalIF":2.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143206498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forced vital capacity reduction severity in pulmonary fibrosis and post-lung transplantation outcomes","authors":"Manon Levêque ,&nbsp;Julien Bermudez ,&nbsp;Ana Nieves ,&nbsp;Florence Daviet ,&nbsp;Antoine Roux ,&nbsp;Xavier Demant ,&nbsp;Benjamin Renaud-Picard ,&nbsp;Jérôme Le Pavec ,&nbsp;Hervé Mal ,&nbsp;Thomas Villeneuve ,&nbsp;Jean-François Mornex ,&nbsp;Loïc Falque ,&nbsp;Véronique Boussaud ,&nbsp;Christiane Knoop ,&nbsp;Adrien Tissot ,&nbsp;Martine Reynaud-Gaubert ,&nbsp;Benjamin Coiffard ,&nbsp;the COLT consortium","doi":"10.1016/j.resmer.2025.101158","DOIUrl":"10.1016/j.resmer.2025.101158","url":null,"abstract":"<div><h3>Background</h3><div>The ISHLT guidelines recommend early referral to a lung transplantation (LTx) center for patients with interstitial lung disease (ILD) due to the unpredictable course. To our knowledge, no study has assessed the impact of forced vital capacity (FVC) reduction severity on LTx outcomes in ILD. This study aims to determine whether the severity of FVC reduction is associated with post-transplant outcomes in ILD.</div></div><div><h3>Methods and Results</h3><div>Recipients from the French multicentric COLT cohort who underwent lung transplantation for ILD were included in this study. FVC was assessed to determine if the severity of its reduction is associated with post-transplant outcomes. 311 recipients were included in the study. FVC was identified as a significant risk factor for mortality at one year in multivariate analysis (<em>p</em> = 0.003). The ROC curve for FVC estimated the probability of death at one year with an area under the curve of 64 % (95 % confidence interval 57–71 %) and defined an optimal FVC threshold of 46 %. Recipients with an FVC ≤46 % were more likely to be listed as emergency cases, had lower FVC at one year, and exhibited reduced short- and long-term survival.</div></div><div><h3>Conclusions</h3><div>The severity of pre-transplant FVC reduction is a risk factor for poorer post-transplant outcomes. The findings should stimulate discussion about benefits of LTx for patients with lower FVC. An FVC threshold of ≤46 % should be considered in discussions about lung transplantation indications, decisions regarding single lung transplantation, and the selection of smaller donor lungs. Respirologists managing patients with ILD should consider early referral to a LTx center.</div></div>","PeriodicalId":48479,"journal":{"name":"Respiratory Medicine and Research","volume":"87 ","pages":"Article 101158"},"PeriodicalIF":2.2,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}