European Journal of Paediatric Neurology最新文献

{"title":"Association of 5-HT, ET-1, PTX-3, and inflammatory markers with clinical parameters in pediatric migraine patients with patent foramen ovale","authors":"Yali Wang,&nbsp;Yingying Wang,&nbsp;Jing Zhang,&nbsp;Chao Jiang","doi":"10.1016/j.ejpn.2025.07.003","DOIUrl":"10.1016/j.ejpn.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric migraine is a debilitating neurological disorder frequently associated with patent foramen ovale (PFO). The roles of vasoactive substances (5-HT, ET-1) and inflammatory markers (PTX-3, TNF-α, CRP) in PFO-related pediatric migraine remain unclear. This study aimed to evaluate their predictive value and associations with clinical parameters.</div></div><div><h3>Methods</h3><div>A prospective cohort study enrolled 149 PFO patients (78 with pediatric migraine, 71 without) and 70 healthy controls. Serum levels of 5-HT, ET-1, PTX-3, TNF-α, PCT, and CRP were measured using ELISA. Clinical data, including pediatric migraine characteristics and PFO features (diameter, right-to-left shunt), were analyzed. Receiver operating characteristic (ROC) curves assessed biomarker performance, and logistic regression identified risk factors.</div></div><div><h3>Results</h3><div>5-HT showed the highest individual predictive accuracy for pediatric migraine (AUC = 0.810), followed by PCT (AUC = 0.786) and PTX-3 (AUC = 0.707). ET-1 exhibited high specificity (99.1 %), while TNF-α and CRP demonstrated high sensitivity (91.1 %). A combined biomarker panel achieved superior performance (AUC = 0.911, specificity = 94.4 %). Elevated 5-HT (adjusted OR = 1.593, p = 0.026) and PTX-3 (adjusted OR = 1.752, p = 0.014) levels were independently associated with pediatric migraine risk after adjusting for covariates.</div></div><div><h3>Conclusion</h3><div>5-HT, PTX-3, and inflammatory markers are promising biomarkers for PFO-related pediatric migraine. A multi-marker approach significantly enhances risk prediction, supporting its potential for clinical stratification and targeted interventions.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"58 ","pages":"Pages 14-19"},"PeriodicalIF":2.3,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric acute-onset neuropsychiatric syndrome: A single-center retrospective study","authors":"Yaping Zheng,&nbsp;Yu Zhang,&nbsp;Yuhang Li,&nbsp;Jiannan Ma","doi":"10.1016/j.ejpn.2025.07.004","DOIUrl":"10.1016/j.ejpn.2025.07.004","url":null,"abstract":"<div><h3>Aim</h3><div>To facilitate the diagnosis of Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) in children, we described the clinical features of a PANS cohort and analyzed whether immunotherapy could shorten the symptom duration.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the medical records of children with PANS at the Children's Hospital of Chongqing Medical University and categorized them into two groups on the basis of whether they received immunotherapy to compare symptom duration.</div></div><div><h3>Results</h3><div>Forty-two patients were included. Thirty-three children (76.2 %) had infection within 4 weeks before onset. Thirty-six (88.1 %) children had obsessive‒compulsive symptoms, 5 children (11.9 %) had eating disorders, and one child had both. Other common clinical manifestations included sleep disturbances (76.2 %, 32/42), academic difficulties (73.8 %, 31/42), irritability (66.7 %, 28/42), developmental regression (54.8 %, 23/42), motor abnormalities (52.4 %, 22/42), hallucinations (52.4 %, 22/42), anxiety (50 %, 21/42), aggression (40.5 %, 17/42), hyperesthesia (31.0 %, 13/42), and emotional lability (23.8 %, 10/42). One child had epileptiform discharges on the electroencephalogram (EEG), while the other 41 children had normal EEGs. Brain magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) analysis were normal in all the children. Immunotherapy was used in 12 patients, and there was not a significant difference in symptom duration between the two groups (immunotherapy group: median 17, IQR 14–21; nonimmunotherapy group: median 15, IQR 11–20; p = 0.275).</div></div><div><h3>Conclusions</h3><div>PANS is usually triggered by infection and is accompanied by a variety of neuropsychiatric symptoms. In our retrospective small-sample study, immunotherapy did not shorten the duration of symptoms in children with PANS. However, further prospective studies are still needed to confirm its effectiveness.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"58 ","pages":"Pages 1-4"},"PeriodicalIF":2.3,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of herpes simplex virus encephalitis in children and young people","authors":"Jay Shetty (Consultant paediatricNeurologist)","doi":"10.1016/j.ejpn.2025.07.006","DOIUrl":"10.1016/j.ejpn.2025.07.006","url":null,"abstract":"","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"57 ","pages":"Page A3"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting a difficult journey: acute symptomatic seizures and post-stroke epilepsy in children","authors":"Gudrun Gröppel","doi":"10.1016/j.ejpn.2025.07.002","DOIUrl":"10.1016/j.ejpn.2025.07.002","url":null,"abstract":"","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"57 ","pages":"Page A1"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tests of dynamic balance, motor function and fear of falling as indicators of fall risk in children with Duchenne muscular dystrophy","authors":"Ruiqing Cui ,&nbsp;Yating Wang ,&nbsp;Yongqiang Chen ,&nbsp;Jinggang Wang ,&nbsp;Meihuan Huang","doi":"10.1016/j.ejpn.2025.07.001","DOIUrl":"10.1016/j.ejpn.2025.07.001","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to examine dynamic balance, motor function, and fear of falling (FOF) as indicators of fall risk in children with Duchenne Muscular dystrophy (DMD).</div></div><div><h3>Methods</h3><div>This cross-sectional study included 92 children with DMD (ages 5–15; mean age 7.44 ± 2.10; mean BMI 17.70 ± 2.96), recruited from Shenzhen Children's Hospital between August 2023 and January 2024. Data collected included demographics, clinical characteristics, and fall history over the past month and year. Dynamic balance was assessed using the four-square step test (FSST), motor function with the motor function measure (MFM-32), 6-min walk test, and timed function tests (TFTs), and FOF using Lim's single-item question.</div></div><div><h3>Results</h3><div>85.9 % reported falls in the past year, with 45.7 % classified as recurrent fallers (≥1 fall/week or day) and 51.1 % reporting recurrent falls (≥3) in the past month. FSST, MFM, and TFTs scores differed significantly between recurrent and non-recurrent fallers across both timeframes (FSST and MFM: p &lt; 0.001; TFTs: p ≤ 0.01). FOF showed no significant group differences (month: p = 0.066; year: p = 0.054). FSST showed high accuracy in identifying recurrent fallers (AUC = 0.856–0.890; cut-off = 10.41s; sensitivity = 80.9 %–81.0 %; specificity = 88.0 %–95.6 %). In contrast, MFM and TFTs had limited discriminative value.</div></div><div><h3>Conclusion</h3><div>Dynamic balance, as assessed by the FSST, is a sensitive and specific indicator for identifying recurrent fallers in children with DMD, supporting its clinical utility in fall risk screening and prevention.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"57 ","pages":"Pages 91-96"},"PeriodicalIF":2.3,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genotype – phenotype correlation of Spinal Muscular Atrophy in the era of disease modifying therapies: A tertiary Indian experience","authors":"Ramya Ramesh Babu ,&nbsp;Madhuri Maganthi ,&nbsp;Dipanjana Datta ,&nbsp;Joanne Ng ,&nbsp;Gauri Krishna ,&nbsp;Ann Agnes Mathew","doi":"10.1016/j.ejpn.2025.06.002","DOIUrl":"10.1016/j.ejpn.2025.06.002","url":null,"abstract":"<div><h3>Aim</h3><div>To correlate <em>SMN2</em> CN with age of disease onset, severity, motor ability and comorbidities across all SMA types from India.</div></div><div><h3>Methods</h3><div>This retrospective study involved the collection and analysis of clinical data, motor assessment scores, and <em>SMN</em> genetics from a cohort of 200 genetically confirmed SMA patients who were referred to our Paediatric Neuromuscular Centre over two years.</div></div><div><h3>Results</h3><div>Among the 200 subjects, 49 had SMA1, 82 had SMA2, 64 had SMA3, and 5 had SMA4. The majority of patients were male (59 %), and most hailed from the five Southern Indian states. Notably, 23 % of patients exhibited parental consanguinity. Our analysis revealed a strong correlation between the number of <em>SMN2</em> copies and disease onset, as well as the achievement of developmental milestones. This trend was consistent with formal motor assessment scores and the presence and severity of co-morbidities, underscoring the pivotal role of <em>SMN2</em> as a disease modifier. Additionally, we observed a small subset of patients with clinically diverse SMA types but identical <em>SMN2</em> CN.</div></div><div><h3>Interpretation</h3><div>This study emphasizes the critical role of <em>SMN2</em> as a disease modifier in SMA, as evidenced by its strong correlation with disease phenotype, motor scores, and the occurrence of co-morbidities. The findings underscore the importance of close monitoring and adherence to standard of care (SOC) protocols, which facilitate the proactive management of complications and co-morbidities. These practices contribute to an improved quality of life and better outcomes for SMA patients in the era of novel therapeutic approaches.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"58 ","pages":"Pages 5-13"},"PeriodicalIF":2.3,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144653219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genotype variability in early-onset Hereditary Spastic Paraplegia: a single-center study","authors":"Vito Luigi Colona ,&nbsp;Lorena Travaglini ,&nbsp;Jacopo Sartorelli ,&nbsp;Gessica Vasco ,&nbsp;Anna Piluso ,&nbsp;Adele D'Amico ,&nbsp;Antonio Novelli ,&nbsp;Enrico Bertini ,&nbsp;Francesco Nicita","doi":"10.1016/j.ejpn.2025.06.001","DOIUrl":"10.1016/j.ejpn.2025.06.001","url":null,"abstract":"<div><div>Hereditary spastic paraplegias (HSPs) are genetically and clinically heterogeneous, slowly progressive neurological disorders characterized by primary involvement of the corticospinal tracts. The early-onset forms of HSP (EO-HSP) are often defined as “cerebral palsy mimics” since symptoms begin in infancy and manifest as spastic di- or tetraplegia and possible neurodevelopmental disorder. The rarity and heterogeneity of these disorders make their diagnosis challenging.</div><div>In this single-center study, we focus on the outcomes and diagnostic detection rate of EO-HSP patients from a cohort of 104 consecutive HSP cases.</div><div>The discussion highlights the genetic variability in cases of EO-HSP that tested positive through a series of molecular analyses, particularly those requiring further investigation via whole exome sequencing (WES). This approach has shed light on the etiopathogenetic role of 19 variants across 10 different genes (<em>COQ4</em>, <em>FOXG1</em>, <em>GRIN2B</em>, <em>HPDL</em>, <em>LRP2</em>, <em>RBMX</em>, <em>SPART</em>, <em>TBCD</em>, <em>ZBTB11</em>, and <em>ZC4H2</em>) in 14 patients with complex EO-HSP. Notably, most of these genes are not conventionally classified as HSP-related or included in the SPG classification on the Online Mendelian Inherited in Men (OMIM) catalog.</div><div>We emphasize the importance of detailed genotype-phenotype correlations and the diagnostic potential of a highly specialized translational approach in clinically selected cases lacking molecular confirmation, thereby expanding our understanding of the genetic variability of EO-HSP.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"57 ","pages":"Pages 82-90"},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144298205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurological involvement in 51 cystinosis patients: A single-center experience","authors":"Ezgi Burgac ,&nbsp;Sonay Duran Yılmaz ,&nbsp;Fatma Derya Bulut ,&nbsp;Deniz Kor ,&nbsp;Esra Kara ,&nbsp;Burcu Köseci ,&nbsp;İrem Kaplan ,&nbsp;Gülşah Seydaoğlu ,&nbsp;Gülen Gül Mert ,&nbsp;Neslihan Önenli Mungan","doi":"10.1016/j.ejpn.2025.05.011","DOIUrl":"10.1016/j.ejpn.2025.05.011","url":null,"abstract":"<div><h3>Background</h3><div>Cystinosis is a lysosomal storage disease resulting from impaired transport of cystine due to variants in <em>CTNS</em> gene. Cystine accumulation leads to renal, corneal, and endocrine involvements. Patients typically present with growth retardation, polyuria/polydipsia, rickets. However, neurological manifestations are rare and become more pronounced with increasing age.</div></div><div><h3>Methods</h3><div>Fifty-one patients with cystinosis were evaluated using cerebral magnetic resonance imaging, electroneuromyography, audiological and psychometric tests.</div></div><div><h3>Results</h3><div>The mean age of the patients was 164.8 ± 112.4 months. The common symptoms were failure to thrive (56.9 %), polyuria/polydipsia (45.1 %), and short stature (37.3 %). Renal, endocrine, ocular, and neurological involvement was present in 100 %, 78.4 %, 76.5 %, and 49 % of patients, respectively. Abnormal magnetic resonance imaging findings were observed in three patients. Psychometric tests were performed in 20 patients. Four patients had borderline intelligence, two had mild, four had moderate, and two had severe intellectual disability. Eight patients had delays in personal-social, fine/gross motor, and language development. Two of 29 patients who underwent audiological evaluation were found to have hearing loss. Three patients had neuropathy, one had myopathy. One patient had epilepsy. There was no significant difference in cystine levels between the patients with and without neurological involvement.</div></div><div><h3>Discussion</h3><div>Compared to literature, our study appears to be a case series in which mental affect was reported the most. This effect may be due to frequent hospitalization, lack of stimulation, sociocultural status of the family and cortical atrophy in patients with chronic renal disease. Hearing loss was first reported in our study, regardless of audiotoxic drug usage.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"57 ","pages":"Pages 50-56"},"PeriodicalIF":2.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key lessons from the first international treatment eligibility committee: the case of metachromatic leukodystrophy","authors":"Daphne H. Schoenmakers ,&nbsp;Marije A.B.C. Asbreuk ,&nbsp;Tamara Martin ,&nbsp;Mareen Datema ,&nbsp;Shanice Beerepoot ,&nbsp;Michal Inbar-Feigenberg ,&nbsp;Samuel Groeschel ,&nbsp;Christiane Kehrer ,&nbsp;Andreas Øberg ,&nbsp;Caroline Sevin ,&nbsp;Francesca Fumagalli ,&nbsp;Caroline G. Bergner ,&nbsp;Päivi Vieira ,&nbsp;Annette Bley ,&nbsp;Johanna Uusimaa ,&nbsp;Morten Andreas Horn ,&nbsp;Klára Brožová ,&nbsp;Eva Stögmann ,&nbsp;Herbert Pichler ,&nbsp;Roswitha Lüftinger ,&nbsp;Nicole I. Wolf","doi":"10.1016/j.ejpn.2025.05.012","DOIUrl":"10.1016/j.ejpn.2025.05.012","url":null,"abstract":"<div><h3>Background</h3><div>Treatment decisions in metachromatic leukodystrophy (MLD), a rare life-threatening neurological disease, are challenging. Hematopoietic stem cell transplantation or autologous stem-cell-based gene therapy can be life-changing but come with uncertainties, risks, and high costs. To address this, the international MLD treatment eligibility panel was established in collaboration with the European Reference Network on Rare Neurological Diseases. The panel reviews and discusses individual MLD cases and provides consensus-based recommendations on whether to treat and which treatment modality. The goal is to streamline international care and treatment counseling by providing uncomplicated access to expert opinion.</div></div><div><h3>Methods</h3><div>The panel operates according to a published standard operating procedure and was evaluated between September 2021–2024. Case data were recorded in a Castor EDC-based system and, with consent, included in the MLD Initiative (MLDi) patient registry. Physicians' experiences were assessed via EUsurvey, and patients’ feedback was collected through an MLDi registry survey.</div></div><div><h3>Findings</h3><div>The panel discussed 43 cases, recommending treatment in 20, abstaining in 19, and reaching no consensus in 4. Open questions regarding cognitive function and lack of outcome data caused challenges in treatment recommendations in late-onset MLD patients. All treatment recommendations were followed. Physicians reported positive experiences with the panel.</div></div><div><h3>Interpretation</h3><div>The MLD treatment eligibility panel demonstrates how international expert advice can be streamlined across Europe for a rare disease like MLD, where disease-specific guidelines are still in development. By balancing complex clinical, social, and ethical parameters, the panel aids in encouraging appropriate use of innovative and costly therapies and guarantees accessibility to expert advice irrespective of country of origin.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"57 ","pages":"Pages 72-81"},"PeriodicalIF":2.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gene therapy in neuronopathic lysosomal storage disorders","authors":"A. Donald ,&nbsp;C. Horgan ,&nbsp;M.J. De Castro Lopez ,&nbsp;S.A. Jones ,&nbsp;R.F. Wynn","doi":"10.1016/j.ejpn.2025.05.010","DOIUrl":"10.1016/j.ejpn.2025.05.010","url":null,"abstract":"<div><div>Lysosomal storage disorders are a group of multisystem monogenic conditions caused mostly by enzyme deficiencies which disrupt lysosomal functioning. Those which result in neuronal dysfunction are considered ‘neuronopathic’. These neurodegenerative conditions, while individually rare, are collectively not uncommon, and are attractive targets for gene and cell-based therapies. In this review we describe the current landscape of such therapies in this group of disorders, where the more severe phenotypes manifest in children. We describe the conditions, the principles of cell therapy and gene therapy, and compare AAV and lentiviral approaches. This is a rapidly evolving area of medicine, and we highlight progress made, and the challenges that are ahead in bringing these therapies to all patients. Throughout, we offer real-world insight into delivering these therapies and suggest a way forward for the future; utilising combined therapies to bridge the obligate delays and increasing collaborative working practices in therapeutic development between clinicians, academics and industry.</div></div>","PeriodicalId":50481,"journal":{"name":"European Journal of Paediatric Neurology","volume":"57 ","pages":"Pages 41-49"},"PeriodicalIF":2.3,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}