iGIE最新文献

{"title":"A systematic review of the clinical effectiveness of a novel rigidizing overtube in completing difficult colonoscopies and for challenging colorectal polyp resection","authors":"Eleazar E. Montalvan-Sanchez MD ,&nbsp;Dalton A. Norwood MD ,&nbsp;Diego Izquierdo-Veraza MD ,&nbsp;Renato Beas MD ,&nbsp;Mirian Ramirez-Rojas MILS ,&nbsp;Sergio A. Sánchez-Luna MD ,&nbsp;Shajan Peter MD ,&nbsp;Douglas R. Morgan MD ,&nbsp;Douglas K. Rex MD","doi":"10.1016/j.igie.2025.01.010","DOIUrl":"10.1016/j.igie.2025.01.010","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Completing colonoscopy in redundant colons and resecting complex precancerous lesions are 2 challenging areas in the technical performance of colonoscopy. In this study, we conducted a systematic review to assess the clinical success of a rigidizing overtube (ROT) to facilitate completion of difficult colonoscopy insertions and challenging polyp resections.</div></div><div><h3>Methods</h3><div>We used multiple electronic databases from August 2019 through June 2024 to identify studies evaluating the use of the novel ROT for colonoscopies.</div></div><div><h3>Results</h3><div>Five studies were included with a total of 163 patients. Three studies evaluated the ROT system in challenging colonoscopies, with a combined cecal intubation rate of 100%. There were no adverse events. Four studies evaluated ROT for challenging colorectal polyp resection. The overall clinical success was 94.7%. Procedure facilitation was reported in 3 studies, with an average of 92.5% facilitation. One study compared endoscopic submucosal dissection (ESD) with and without ROT and reported similar en-bloc resection and curative rates with the use of ROT (92% and 88%, respectively) compared with conventional ESD (96% and 92%, respectively). In other studies that evaluated ROT in the removal of challenging polyps (60 patients), technical success was achieved in all cases.</div></div><div><h3>Conclusions</h3><div>ROT is safe, shows potential in enhancing the clinical success of completing difficult colonoscopies, and may be useful for facilitating ESD and endoscopic mucosal resection of some colonic lesions. The mechanism of any benefit is likely in reducing looping in the case of previous incomplete colonoscopies and providing stability in the case of the complex resections. Further controlled studies are warranted and needed to confirm benefit.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 68-74"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143698010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of a multi-degree-of-freedom articulating forceps for endoscopic submucosal dissection and closure of large mucosal defects in a porcine model","authors":"Shunsuke Kamba MD, PhD,&nbsp;Manus Rugivarodom MD,&nbsp;Louis M. Wong Kee Song MD,&nbsp;Nayantara Coelho-Prabhu MBBS,&nbsp;Andrew C. Storm MD,&nbsp;Elizabeth Rajan MD","doi":"10.1016/j.igie.2025.01.006","DOIUrl":"10.1016/j.igie.2025.01.006","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Multi-degree-of-freedom (MDOF) articulating forceps for flexible endoscopy feature a unique device combining rotating and bending articulation to provide active traction. This study aimed to evaluate the efficacy and safety of the MDOF articulating forceps for endoscopic submucosal dissection (ESD) and closure of large post-ESD mucosal defects using a linearized closure technique.</div></div><div><h3>Methods</h3><div>Four rectal sites (20-50 mm) and 3 gastric sites (20-40 mm) were resected in explanted porcine models. ESD was performed by applying active traction of the articulating forceps to the mucosal flap. After ESD, the articulating forceps were used for defect closure by grasping an edge of the mucosal defect and pulling it toward the luminal cavity, allowing submucosal tissue apposition within the defect and configuration of the linear defect for easy through-the-scope clip closure.</div></div><div><h3>Results</h3><div>The mean procedure times of the gastric and rectal ESD were 16.1 ± 8.7 minutes and 20.7 ± 4.3 minutes, respectively. The mean sizes of the post-ESD gastric and rectal mucosal defects were 38.0 ± 12.6 mm and 43.8 ± 10.2 mm. No injury to the muscularis propria or perforations occurred. Complete clip closure was achieved in all mucosal defects. The mean procedure time for defect closure was 29.3 ± 5.4 minutes in the stomach and 15.5 ± 5.2 minutes in the rectum. The mean combined procedure times for ESD and clip closure were 45.4 ± 13.5 minutes in the stomach and 36.3 ± 7.9 minutes in the rectum.</div></div><div><h3>Conclusions</h3><div>The MDOF articulating forceps seem to be an effective and safe adjunct traction tool for ESD and closure of large mucosal defects. Future clinical studies are needed to validate the efficiency, safety, and durability of this approach.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 11-15"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overall survival and margin status in resected gastric stromal tumors","authors":"Fiyinfoluwa O. Abraham MD ,&nbsp;Tarrant McPherson PhD ,&nbsp;Leslie Blackshear MD ,&nbsp;Yuan Liu PhD ,&nbsp;Theresa Gillespie PhD ,&nbsp;Preeyanka Sundar MD ,&nbsp;Vaishali Patel MD ,&nbsp;Jordan Orr MD ,&nbsp;Saurabh Chawla MD ,&nbsp;Steven A. Keilin MD ,&nbsp;Field F. Willingham MD, MPH, FASGE","doi":"10.1016/j.igie.2025.01.013","DOIUrl":"10.1016/j.igie.2025.01.013","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Studies assessing gastrointestinal stromal tumors (GISTs) have found no survival differences based on margin status; however, small sample sizes, merged anatomic locations, and limited follow-up have been limitations. This study examined the impact of margin status on overall survival in a large national cohort of patients with resected gastric GISTs.</div></div><div><h3>Methods</h3><div>Data on patients with gastric GISTs were abstracted from the National Cancer Database, with data collected over a 16-year period (2004-2020). Exclusion criteria included the presence of other primary tumors, unknown patient/tumor characteristics, macroscopic residual margins, metastasis at diagnosis, and prior chemotherapy. The cohort was stratified according to tumor size. R0 is defined as microscopically negative margin, and R1 is microscopically positive margin.</div></div><div><h3>Results</h3><div>After exclusions, there were 8448 patients in the analysis cohort: 8221 (97.3%) had R0 resections, and 227 (2.7%) had R1 resections. On univariate analysis, tumor size ≤5 cm (<em>P</em> &lt; .001), T1 stage (<em>P</em> &lt; .001), low grade (<em>P</em> &lt; .001), and low mitotic index (<em>P</em> &lt; .001) were associated with a decreased risk of death. Margin status (R0 vs R1) did not have an impact on survival in the combined (<em>P</em> = .249), ≤5 cm (<em>P</em> = .961), ≤3 cm (<em>P</em> = .595), or ≤2 cm (<em>P</em> = .614) cohorts. There was also no difference in the risk of death based on the resection margin, in which the hazard ratio (R1 vs R0) with a 95% confidence interval was 1.206 (.862-1.633). In multivariate analysis, the resection margin status did not affect overall survival (<em>P</em> = .666).</div></div><div><h3>Conclusions</h3><div>Congruent with prior studies, there was no difference in survival when comparing R0 with R1 resections in gastric GIST patients without metastasis over an extended follow-up period. These data may be helpful in assessing suitability for endoscopic resection for patients with gastric GISTs.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 48-60"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumen-apposing metal stent placement in severe sepsis secondary to afferent limb syndrome","authors":"Nicholas Noverati MD,&nbsp;Faisal Kamal MD","doi":"10.1016/j.igie.2025.01.003","DOIUrl":"10.1016/j.igie.2025.01.003","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 61-62"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful endoscopic therapy for esophagotracheal fistula using polyglycolic acid sheets","authors":"Zhenkai Wang PhD,&nbsp;Xiang Liu MD,&nbsp;Wanzhen Chen PhD,&nbsp;Quanzhao Di MD,&nbsp;Xiaoqian Yang BSN,&nbsp;Dan Liu BSN","doi":"10.1016/j.igie.2025.01.007","DOIUrl":"10.1016/j.igie.2025.01.007","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 66-67"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations for endoscopy and sedation in the lactating patient","authors":"Lauren D. Feld MD ,&nbsp;Katherine M. Cooper MD ,&nbsp;Shara I. Feld MD, PhD ,&nbsp;Sarah Gray MD ,&nbsp;Amy S. Oxentenko MD","doi":"10.1016/j.igie.2025.01.008","DOIUrl":"10.1016/j.igie.2025.01.008","url":null,"abstract":"<div><div>Lactation is common amongst patients of childbearing age, providing a valuable nutrition source for their infants. There are several concerns to balance with lactating patients in the procedural setting, including interrupted lactation, milk supply, and child safety. However, clinicians have variable comfort with and training in counseling regarding periprocedural lactation. Anecdotally, the authors have noted many endoscopy centers do not use a standardized or guideline-based approach with lactating patients. In this article, we will (1) briefly review the safety and impact of periendoscopy medications on breastmilk and breastmilk supply, and (2) describe our approach for the lactating patient undergoing endoscopy.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 75-77.e2"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143698011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound–guided gastroenterostomy for managing gastroparesis refractory to gastric peroral endoscopic pylorotomy: a promising new therapeutic option","authors":"Jean-Michel Gonzalez MD, PhD,&nbsp;Juliette Phelip MD,&nbsp;Mohamed Gasmi MD,&nbsp;Véronique Vitton MD, PhD,&nbsp;Marc Barthet MD, PhD","doi":"10.1016/j.igie.2025.01.011","DOIUrl":"10.1016/j.igie.2025.01.011","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Gastric peroral endoscopic myotomy (G-POEM) reaches an efficacy rate around 65% for gastroparesis. Endoscopic ultrasound (EUS)–guided gastroenteroanastomosis (EUS-GEA) has demonstrated efficacy in gastric outlet obstruction. We evaluated it for refractory gastroparesis.</div></div><div><h3>Methods</h3><div>We undertook a single-center retrospective study enrolling patients with gastroparesis treated with G-POEM with failure or symptoms recurrence managed with EUS-GEA. The drain-assisted EUS-GEA technique with 20-mm lumen-apposing stent was applied. End points were clinical efficacy at 6 months, adverse events, and recurrence rate.</div></div><div><h3>Results</h3><div>Twelve patients were included, median age 46 years (interquartile range [IQR], 16-78 y). Patients had an abnormal gastric emptying or bezoar, and 50% never improved from baseline. Median follow-up was 11.5 months (IQR, 6-26 mo). Clinical efficacy rate was 75% at 6 months. The median preoperative Gastroparesis Cardinal Symptoms Index was 4.1 (IQR, 1.6-5) versus 1.6 (IQR, 0-2.6; <em>P</em> &lt; .05). No severe periprocedural adverse events occurred.</div></div><div><h3>Conclusions</h3><div>EUS-GEA demonstrated promising results in improving patients with gastroparesis refractory to G-POEM. Prospective evaluation is required to confirm these results.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 16-20"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot randomized trial of efficacy and safety of yogic technique versus polyethylene glycol solution for bowel preparation in colonoscopy","authors":"Manas Kumar Panigrahi MD, DM, FRCP (Edin) ,&nbsp;Mitali Madhumita Rath MD ,&nbsp;Mohd Imran Chouhan MD, DM ,&nbsp;Rajesh Manik PhD ,&nbsp;Ajaya Ghosh R U MSc ,&nbsp;Madhav Sameer Makashir MD, DM ,&nbsp;Hemanta Kumar Nayak MD, DM ,&nbsp;Biswa Mohan Padhy MD, DM ,&nbsp;Subash Chandra Samal MD, DM","doi":"10.1016/j.igie.2024.08.005","DOIUrl":"10.1016/j.igie.2024.08.005","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The traditional yogic technique of shankha prakshalana (SP) has been known to cleanse the bowel, but its efficacy as a bowel preparation agent in colonoscopy has not been studied widely. We compared the efficacy and safety of SP with split-dose polyethylene glycol (PG) in bowel preparation for colonoscopy.</div></div><div><h3>Methods</h3><div>Patients undergoing elective colonoscopy were randomized into 2 groups: PG group (n = 47) and SP group (n = 47). Patients in the PG group were given 2 liters of PG 3350 in a split-dose regimen. Patients in the SP group were administered 400 mL of lukewarm saline water followed by a set of 5 asanas (physical exercises) of SP, with each asana performed 8 times under the supervision of a certified yoga trainer (R.M.). This constituted 1 cycle, which was repeated 6 times (total intake of 2400 mL lukewarm saline water). The Boston Bowel Preparation Scale (BBPS) was used to assess the main outcome of the efficacy of bowel preparation.</div></div><div><h3>Results</h3><div>A total of 94 patients were enrolled, with 47 in each study group. The mean BBPS for the whole colon in the SP group (8.15 ± 1.02) was higher than that in the PG group (7.55 ± 1.08; <em>P</em> = .007). Moreover, the segmental BBPS for the right side of the colon was significantly higher in the SP group (2.64 ± 0.48) than in the PG group (2.36 ± 0.60; <em>P</em> = .010). Adverse effects, such as nausea (31.9% vs 4.3%; <em>P</em> = .001), bloating (27.7% vs none; <em>P</em> &lt; .0001), and disturbed sleep (63.8% vs 12.8%; <em>P</em> &lt; .0001), were significantly more frequent in the PG group than in the SP group.</div></div><div><h3>Conclusions</h3><div>The traditional yogic technique of shankha prakshalana is an effective method for bowel preparation in colonoscopy, with overall better efficacy and safety, compared with the standard split-dose PG regimen. (Clinical trial registration number: CTRI/2020/07/026899.)</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 31-37.e1"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic ultrasound–guided fine-needle biopsy as a novel approach for risk stratification of pancreatic cystic lesions","authors":"Ghazal Hashemipour Moussavi BS ,&nbsp;Maria F. Gomez MPH ,&nbsp;Jennifer Permuth PhD ,&nbsp;Aamir Dam MD ,&nbsp;Anjuli K. Luthra MD ,&nbsp;Luis Pena MD ,&nbsp;Mark Friedman MD ,&nbsp;Saraswathi Cappelle MD ,&nbsp;Barbara Centeno MD ,&nbsp;Shaffer R.S. Mok MD","doi":"10.1016/j.igie.2025.01.009","DOIUrl":"10.1016/j.igie.2025.01.009","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Unlike fine-needle biopsy (FNB), fine-needle aspiration (FNA) is limited by its inability to preserve histopathology. We compared the diagnostic yield of endoscopic ultrasound (EUS)–guided FNA and EUS-FNB for pancreatic cystic lesions (PCLs), hypothesizing that EUS-FNB would frequently provide a tissue diagnosis.</div></div><div><h3>Methods</h3><div>A single-center retrospective cohort study was conducted from 2022 to 2023 on patients with PCLs who underwent either EUS-FNA or EUS-FNB. We compared cyst characteristics and pathology reports to assess diagnostic yield. The relative risk (RR) was calculated to compare FNB’s probability of identifying intraductal papillary mucinous neoplasm (IPMN) grade compared with FNA.</div></div><div><h3>Results</h3><div>A total of 130 PCLs were identified (FNA: n = 34; FNB: n = 96). Patients had a mean age of 68 ± 12 years, and 49% were women. Sex, age, cyst size, location, and presence of pancreatic ductal dilation did not differ significantly between FNA and FNB groups. FNB showed a significantly higher diagnostic yield compared with FNA (81% vs 62%; <em>P</em> = .02), with better performance in identifying an IPMN grade compared with FNA (RR = 1.92; <em>P</em> = .013).</div></div><div><h3>Conclusions</h3><div>Our results reflect one of the first studies, to our knowledge, to consider the diagnostic role of FNB in evaluating PCLs. These preliminary results suggest that FNB may have a potential for high diagnostic performance in PCLs and warrant further exploration using a larger cohort and randomized controlled trials.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 42-47"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reduced migration of esophageal fully covered self-expandable metal stents affixed with clips with anchor prongs","authors":"Jason DuBroff MD, MPH,&nbsp;Daniel Holten MD,&nbsp;Gregory Toy MD,&nbsp;David Jonason MD,&nbsp;Daryl Ramai MD, MPH,&nbsp;John Morris MSc, MD,&nbsp;John Fang MD,&nbsp;Christopher Ko MD","doi":"10.1016/j.igie.2025.01.005","DOIUrl":"10.1016/j.igie.2025.01.005","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Fully covered self-expandable metal stents (FCSEMSs) are a common therapeutic treatment for benign and malignant esophageal disorders. Stent migration is a common adverse event of FSCEMSs. We describe clips with anchor prongs (CAPs) as a novel technique to reduce FCSEMS migration.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 27 patients with FCSEMSs affixed with CAPs and 28 patients without FCSEMS affixation for stent migration as the primary endpoint and used previously published data to determine the relative risk reduction (RRR).</div></div><div><h3>Results</h3><div>Migration was observed in 14.8% of cases (RRR, 43%). CAP affixation was associated with a decreased odds of migration (odds ratio, .19; <em>P</em> = .02). The only adverse event reported in those with (n = 4) or without (n = 14) CAP fixation was postprocedural pain.</div></div><div><h3>Conclusions</h3><div>CAPs may reduce stent migration, providing a novel option for the endoscopist seeking a means of securely attaching esophageal FCSEMSs.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"4 1","pages":"Pages 38-41"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143697907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}