Journal of Liver Transplantation最新文献

{"title":"Biodegradable internal biliary stenting in orthotopic liver transplantation – A feasibility study","authors":"Nicholas Dalkie ,&nbsp;Jonathan Ng ,&nbsp;Peter Lim ,&nbsp;Eunice Lee ,&nbsp;Ruelan Furtado ,&nbsp;Robert Jones ,&nbsp;Rhys Vaughan ,&nbsp;Marios Efthymiou ,&nbsp;Sujievvan Chandran ,&nbsp;Marcos V. Perini","doi":"10.1016/j.liver.2024.100242","DOIUrl":"10.1016/j.liver.2024.100242","url":null,"abstract":"<div><h3>Introduction</h3><div>Biliary complications remain a common cause of morbidity after liver transplantation and often require invasive interventions to manage. We aimed to assess the technical feasibility and safety of placement of a biodegradable stent across the biliary anastomosis at the time of liver transplantation in patients having a duct to duct biliary reconstruction.</div></div><div><h3>Methods</h3><div>For this prospective, single-arm, descriptive study, 10 consecutive patients undergoing whole graft, deceased donor, liver transplantation and duct-to-duct biliary tract reconstruction were enrolled and a biodegradable biliary stent was sutured into the bile duct across the anastomosis.</div></div><div><h3>Results</h3><div>In all 10 patients it was technically feasible to place and secure the stent safely during the operation. After &gt;6 months (median of 212 days) follow up, no patients had developed biliary anastomotic stricture. One patient had transient bile leak immediately post-operative that was managed conservatively. One patient required endoscopic intervention for non-anastomotic stricture development and biliary cast material that had resulted in stent dysfunction.</div></div><div><h3>Discussion</h3><div>The results of this study suggest surgical feasibility of placement of an absorbable biliary stent across the biliary anastomosis at the time of liver transplantation, as well as an acceptable safety profile. Further studies are required to confirm these safety and feasibility findings and to assess efficacy in reducing rates of biliary complications and the need for endoscopic intervention in the early post-transplant period.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100242"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427316","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":"Antibody-mediated rejection in post-liver transplant clinical care: Are we there yet for timely diagnosis and treatment?","authors":"Kevin H. Toomer ,&nbsp;Ahmet Gurakar ,&nbsp;Kiyoko Oshima","doi":"10.1016/j.liver.2024.100236","DOIUrl":"10.1016/j.liver.2024.100236","url":null,"abstract":"<div><p>With improvements in medical management and surgical technique in the field of solid organ transplantation, many historically prominent causes of liver allograft injury have been ameliorated or, in the case of Hepatitis C virus, eliminated altogether. In this transformed clinical landscape, antibody-mediated rejection (AMR) has emerged as a defining barrier to maintenance of long-term liver allograft function. The liver's unique anatomy, high regenerative capacity, and tolerogenic immunological environment tend to mitigate the severest AMR manifestations. Consequently, the clinical importance of AMR in the liver has been recognized more slowly than for other solid organ allografts. Significant strides have been made in elucidating clinical and histopathologic features of acute and chronic liver AMR, with the Banff 2016 criteria among the most notable. However, current histopathologic definitions of AMR are lacking in sensitivity and specificity. C4d staining is an imperfect biological surrogate for antibody-mediated injury, and suffers from significant technical limitations. The frequent co-occurrence of T cell mediated rejection and non-immunologic allograft damage (including recurrence of primary disease) also hinders definitive identification of AMR and results in misattribution of its effects. The goal of this review is to summarize the current understanding of AMR in the context of liver transplantation, including risk factors, pathogenesis, and current diagnostic and treatment strategies. Potential directions of future research are also addressed.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100236"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666967624000370/pdfft?md5=244fd1c1f91ffee3f2d7d5bc8f819ed6&pid=1-s2.0-S2666967624000370-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952809","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":"Technical refinements to reduce the early biliary complication in living donor liver transplantation","authors":"Tsan-Shiun Lin ,&nbsp;Yeong-Sing Lee ,&nbsp;Khee-Ghee Tan ,&nbsp;Stephen Matthew B. Santos ,&nbsp;Chih-Che Lin ,&nbsp;Shih-Ho Wang ,&nbsp;Chee-Chien Yong ,&nbsp;Wei-Feng Li ,&nbsp;Yu-Fan Cheng ,&nbsp;Chih-Chi Wang ,&nbsp;Chao-Long Chen","doi":"10.1016/j.liver.2024.100241","DOIUrl":"10.1016/j.liver.2024.100241","url":null,"abstract":"<div><h3>Background</h3><div>Biliary reconstruction is a key factor that affects biliary complication rates. Surgical experience plays a pivotal role, but continuous technical refinement is essential for enhancing biliary outcomes. This study aimed to evaluate the biliary outcomes of LDLTs in patients undergoing microsurgical biliary reconstruction with continual technical refinements.</div></div><div><h3>Materials and Methods</h3><div>This observational cohort study analyzed data was conducted from 2006 to 2022. Microsurgical biliary reconstruction was performed using various refinements, including selective biliary stent insertion, ipsilateral (anatomical) bile duct anastomosis, use of a figure-of-8 suture over the junction of the graft and recipient bile ducts, and centralization techniques for size discrepancies greater than 2 to 1. Comparison and evaluation of early BC within one year post transplant was performed.</div></div><div><h3>Results</h3><div>1780 patients (including 1563 adults and 217 paediatric patients) underwent microsurgical biliary reconstruction in LDLTs at KCGMH between 2006 and 2022. The donor grafts comprised 1109 right liver grafts and 671 left liver grafts. Of the grafts, 23.1 % had multiple bile ducts and 16.1 % had bile duct sizes &lt;3 mm. Duct-to-duct anastomosis was performed in most cases 1417 (79.6 %), while 363 (20.4 %) Roux-en-Y hepaticojejunostomies (RY HJ) was performed. The overall early BCs rate was 10 % and notable improvements were observed, decreasing from 10.35 % between 2006 and 2021 to 6.5 % by 2022. Early BS comprised the most part of 6.1 % as compared to 2.7 % one year after transplantation. Stent insertion in selected cases, ipsilateral anastomosis, and the figure-of-8 suture technique significantly reduced early BCs. Although centralization technique showed promising results, its effect was not statistically significant.</div></div><div><h3>Conclusions</h3><div>Continual technical refinements in MBR can contribute to a substantial reduction in early BCs following LDLT, ultimately leading to improved patient outcomes.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100241"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142552085","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":"Masked kidney allograft failure after simultaneous liver and kidney transplantation: A case report","authors":"Kasra Shirini ,&nbsp;Ujwal Gautam ,&nbsp;Hiba Ahmed ,&nbsp;Raphael P.H. Meier ,&nbsp;Cinthia Drachenberg ,&nbsp;Abdolreza Haririan","doi":"10.1016/j.liver.2024.100237","DOIUrl":"10.1016/j.liver.2024.100237","url":null,"abstract":"<div><p>Kidney utilization for simultaneous liver-kidney transplantation (SLK) has seen a significant increase in recent years, driven by the rising prevalence of renal dysfunction among liver transplant candidates. However, a substantial proportion of SLK recipients experience native kidney function recovery post-transplant, rendering the kidney transplant unnecessary. This case report presents a remarkable instance of native renal function recovery in a SLK recipient, discovered eleven years after transplantation, when the transplanted kidney was found to have undergone extensive fibrosis and atrophy, masked by native kidney recovery. This case highlights the challenges posed by evaluation of SLK candidates and the need for improved tools to predict native kidney recovery. Safety net mechanism for those who do not recover kidney function should be utilized more to avoid the unnecessary utilization of scarce kidney allografts, which are critically needed for waitlisted patients with kidney failure.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100237"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666967624000382/pdfft?md5=9d9e835379b1ff1d8263f3cf175d087d&pid=1-s2.0-S2666967624000382-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142039991","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":"Short-term alcohol abstinence prior to liver transplantation and impact on rejection","authors":"Kaitlyn Legg ,&nbsp;Tracy Sparkes ,&nbsp;Ian Booth ,&nbsp;Daniel Maluf ,&nbsp;Chandra Bhati ,&nbsp;Neha Jakhete ,&nbsp;Sari Freedman","doi":"10.1016/j.liver.2024.100240","DOIUrl":"10.1016/j.liver.2024.100240","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Alcohol-associated liver disease (ALD) is a leading indication for liver transplant (LT). Historically, centers implemented 6-month abstinence periods prior to LT listing; however, the impact of this abstinence time on post-transplant rejection outcomes is unclear. This study evaluated if short-term abstinence is associated with increased rejection post-LT.</div></div><div><h3>Methods</h3><div>This single-center, retrospective, cohort included adult LT recipients from 11/1/2015 to 7/21/2021 with a primary indication of ALD. Patients were grouped by pre-transplant abstinence time of &lt;6 or ≥6-months. The primary endpoint was biopsy proven acute rejection (BPAR) at 12-months post-LT. Secondary endpoints were infection, alcohol relapse, patient and graft survival at 12-months.</div></div><div><h3>Results</h3><div>Overall, 228 LT recipients met inclusion criteria (&lt;6-months: <em>n</em> = 130; ≥6-months: <em>n</em> = 98). Patients with &lt;6-months of abstinence were younger, had higher MELD scores, and more renal replacement therapy needs. Incidence of BPAR within 12 months of LT was 28 % in the &lt;6-month group vs. 18 % in the ≥6-month group (<em>p</em> = 0.078). Tacrolimus initiation was lower at 7 days post-LT in the &lt;6-month group (77% vs. 89 %; <em>p</em> = 0.029). Delay in tacrolimus initiation past 7 days post-LT was associated with greater BPAR (35% vs. 12 %; <em>p</em> = 0.0001). Increased bloodstream infections (21% vs. 7 %; <em>p</em> = 0.04) and CMV DNAemia (31% vs. 7 %; <em>p</em> = 0.0008) were seen in the &lt;6-month group. Patient and graft survival was similar between groups.</div></div><div><h3>Conclusions</h3><div>Abstinence time of &lt;6-months was not associated with more BPAR within 12-months post-LT. The &lt;6-month group was sicker at time of LT, which correlates to lower tacrolimus exposure early post-LT and heightened incidence of bacteremia and CMV viremia. Given the high acuity of the &lt;6-month abstinence group, the risk of BPAR must be closely balanced with infection risk.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100240"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427317","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":"Daratumumab as a rescue therapy for antibody-mediated rejection in super-urgent ABO-incompatible pediatric liver transplantation","authors":"Zeynep Demir ,&nbsp;Jean Paul Duong Van Huyen ,&nbsp;Carmen Capito ,&nbsp;Julien Zuber ,&nbsp;Aline Floch ,&nbsp;Muriel Girard ,&nbsp;Dominique Debray","doi":"10.1016/j.liver.2024.100245","DOIUrl":"10.1016/j.liver.2024.100245","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100245"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530856","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":"The effects of underlying inflammatory bowel disease on the outcomes of primary sclerosing cholangitis liver transplant recipients","authors":"Mausam J. Patel ,&nbsp;Bill Y. Zhang ,&nbsp;Thomas G. Cotter ,&nbsp;Ahmad Anouti","doi":"10.1016/j.liver.2024.100244","DOIUrl":"10.1016/j.liver.2024.100244","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammatory bowel disease (IBD) influences primary sclerosing cholangitis (PSC) severity, however, the impact of IBD on PSC liver transplantation (LT) outcomes is poorly understood. We aimed to elucidate the impact of IBD in modulating PSC LT outcomes.</div></div><div><h3>Methods</h3><div>Using UNOS data from 2010 through 2021, we identified PSC LT candidates with and without (±) IBD. We used adjusted competing-risk regression analysis to evaluate waitlist outcomes, Kaplan-Meier analysis to assess graft survival, and Cox proportional hazards modeling to identify factors associated with graft survival.</div></div><div><h3>Results</h3><div>Out of 5,586 PSC candidates added to the waitlist, 3,652 patients had IBD. Older age (SHR 1.01; 95 %CI 1.01–1.02) and initial MELD/PELD (SHR 1.03; 95 %CI 1.02–1.04) were associated with increased risk of waitlist mortality, while private insurance (SHR 0.00; 95 %CI 0.00–0.01) with reduced risk. PSC-IBD LT recipients had increased prevalence of cholangiocarcinoma (4.8 % vs 3.4 %, p=0.005). Longer donor cold ischemia times (HR 1.06; 95 %CI 1.03–1.09), presence of recipient diabetes (HR 1.52; 95 %CI 1.13–2.05), and employment (HR 0.75, 95 %CI 0.60–0.94) had an increased risk of graft failure among PSC patients with IBD, not seen in those without IBD.</div></div><div><h3>Conclusion</h3><div>Regardless of IBD, LT for PSC results in excellent outcomes. Certain clinicodemographic factors impacted waitlist and recipient mortality highlighting potential targets to enhance outcomes.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100244"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427318","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":"Going with the flow: High-flow nasal cannula for management of post-transplant hypoxemia in hepatopulmonary syndrome","authors":"Hilary M. DuBrock","doi":"10.1016/j.liver.2024.100235","DOIUrl":"10.1016/j.liver.2024.100235","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"16 ","pages":"Article 100235"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666967624000369/pdfft?md5=87a8b02371db15973643f1532cae4e4a&pid=1-s2.0-S2666967624000369-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141953209","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":"Outcomes of hypothermic hyperoxygenated perfusion compared to static cold storage for liver transplant. A systematic review and meta-analysis of randomized clinical trials","authors":"Mario A. O'Connor Cordova ,&nbsp;Alan G. Ortega-Macias ,&nbsp;Francisco Altamirano ,&nbsp;Maria E. Hoyos ,&nbsp;Fernando Gonzalez-Zorrilla","doi":"10.1016/j.liver.2024.100226","DOIUrl":"10.1016/j.liver.2024.100226","url":null,"abstract":"<div><h3>Background</h3><p>While liver transplant effectiveness in treating life-limiting liver disease is uncontested, challenges remain in organ preservation.</p></div><div><h3>Methods</h3><p>Following PRISMA guidelines, a systematic review was performed to determine the impact of Hypothermic Oxygenated Perfusion (HOPE) on liver transplant outcomes compared to static cold storage (SCS).</p></div><div><h3>Results</h3><p>A total of five studies were included, totaling 586 patients, out of which 267 patients had HOPE-preserved grafts and 319 SCS-preserved grafts. Analysis showed a significant decrease in early graft dysfunction and biliary complications in the HOPE group when compared to SCS (RR = 0.52; 95 % CI = 0.33–0.81]; <em>p</em> = 0.01) (RR = 0.75; 95 % CI = [0.60–0.94]; <em>p</em> = 0.02), respectively. Similarly, non-anastomotic biliary strictures were significantly reduced in the HOPE group (RR = 0.41; 95 % CI = [0.20–0.86]; <em>p</em> = 0.03). Of note, no statistical significance was found on the one-year graft loss and recipient death (RR = 0.40; 95 % CI = [0.09–1.83]; <em>p</em> = 0.12 and RR = 0.62; 95 % CI = [0.29–1.32]; <em>p</em> = 0.14, respectively). Likewise, no statistical difference was evident in acute rejection (RR = 0.54; 95 % CI = [0.04–7.14]; <em>p</em> = 0.20) and postreperfusion syndrome rate (RR = 0.92; 95 % CI = [0.35–2.41]; <em>p</em> = 0.73). After statistical analysis, no significant differences in major complications, primary nonfunction, re-transplantation, hepatic artery thrombosis, need for renal replacement therapy, intensive care unit, and hospital length of stay were evident.</p></div><div><h3>Conclusions</h3><p>Liver preservation techniques are gaining popularity by enabling rescue and transplantation of marginal livers. In this study, HOPE showed statistically significant differences in reducing rates of biliary complications, biliary stricture, and early graft dysfunction. Further studies are needed to evaluate financial burden and long-term outcomes to completely elucidate the impact of this organ preservation technique.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"15 ","pages":"Article 100226"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666967624000278/pdfft?md5=8aafd4345bab5f3a7cc81bb71e11e7b4&pid=1-s2.0-S2666967624000278-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141036320","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":"Automated segmentation of liver tumors from computed tomographic scans","authors":"R.V. Manjunath ,&nbsp;Yashaswini Gowda N","doi":"10.1016/j.liver.2024.100232","DOIUrl":"https://doi.org/10.1016/j.liver.2024.100232","url":null,"abstract":"<div><p>The precision of liver tumor segmentation heavily depends on the doctor's expertise, hence it is required to produce an algorithm for automatic liver tumor segmentation to reduce the manual intervention in assessing liver disease identification. We propose a CNN-based UNet architecture designed to segment liver tumors from CT images of size 128×128. In this model, modifications were made to the encoder, decoder, and bridge paths to enhance feature extraction efficiency. The performance of the modified UNet was evaluated against an existing segmentation method using the same CT image size. The comparison focused on the Dice similarity coefficient and accuracy. Our proposed method demonstrated a high Dice similarity coefficient of 75.37 % and an accuracy of 99.75 % on the 3Dircadb dataset. These results indicate that our modified UNet achieved superior segmentation metrics compared to state-of-the-art methods, showcasing its effectiveness in liver tumor segmentation.</p></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"15 ","pages":"Article 100232"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666967624000333/pdfft?md5=f4c5eea1b8e1306ce82e2e5d4e0ff7cd&pid=1-s2.0-S2666967624000333-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141434522","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}