Clinical Medicine Insights. Cardiology最新文献

{"title":"Post Myocardial Infarction Ventricular Septal Rupture Revealed By Acute Liver Failure Symptoms: A Case Report.","authors":"Leila Haddar,&nbsp;Amine Bouchlarhem,&nbsp;Salma Bouyaddid,&nbsp;Asmae Kasimi,&nbsp;Noureddine Oulali,&nbsp;Noha El Ouafi,&nbsp;Nabila Ismaili","doi":"10.1177/11795468221075059","DOIUrl":"https://doi.org/10.1177/11795468221075059","url":null,"abstract":"<p><strong>Introduction: </strong>The mechanical complications of acute myocardial infarction (AMI) still kill despite the evolution of medicine. Early diagnosis and adequate management are necessary to improve the prognosis, and this requires first, a good clinical examination that should raise the suspicion of a mechanical complication, then the echocardiography is performed to confirm the diagnosis.</p><p><strong>Case presentation: </strong>We present a case of a 64-year-old patient admitted to the emergency room for jaundice with delayed ST-segment elevation myocardial infarction (STEMI). Physical examination revealed signs of right heart failure, which led us to associate jaundice with signs of acute liver failure secondary to right heart failure. Echocardiography confirmed the diagnosis of a ventricular septal rupture (VSR) with left-right shunt, and a significant dilation of the right ventricle. The patient underwent surgical closure of the VSR with fatal evolution.</p><p><strong>Discussion: </strong>VSR is a rare life-threatening mechanical complication of AMI. The clinical signs depend on the left-right shunt and the onset of heart failure, which are 2 major determinants of the therapeutic strategy and the timing of the surgery. Despite surgical closure of the VSR, the mortality remains high, but the prognosis is better in patients treated with surgery than in patients who are treated medically only.</p><p><strong>Conclusion: </strong>The clinical presentation of VSR may differ from a patient to another. Good clinical sense and echocardiography are essential to set early diagnosis, and thus decide on the adequate management at the right time.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":" ","pages":"11795468221075059"},"PeriodicalIF":3.0,"publicationDate":"2022-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ba/e1/10.1177_11795468221075059.PMC8808021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39770208","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":"Takotsubo Syndrome: A Review of Presentation, Diagnosis and Management.","authors":"Joseph Assad,&nbsp;Giuseppe Femia,&nbsp;Patrick Pender,&nbsp;Tamer Badie,&nbsp;Rohan Rajaratnam","doi":"10.1177/11795468211065782","DOIUrl":"https://doi.org/10.1177/11795468211065782","url":null,"abstract":"<p><p>Takotsubo Syndrome (TTS) is a condition of transient left ventricular dysfunction that is typically triggered by emotional or physical stress. Since first described in Japan in 1990, it has increasingly been recognised in clinical practice, accounting for up to 2% of Acute Coronary Syndrome (ACS) presentations. In fact, the clinical presentation can be indistinguishable from a myocardial infarction. Although current evidence suggests a catecholamine induced myocardial stunning, the pathophysiological mechanisms remain unknown. Interestingly, it is more common in woman, particularly those who are post-menopausal. This review aims to summarise the current research and provide an overview of the diagnostic strategies and treatment options.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":" ","pages":"11795468211065782"},"PeriodicalIF":3.0,"publicationDate":"2022-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/57/a6/10.1177_11795468211065782.PMC8733363.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39888936","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":"A Peek at LVADs Pumping to Recovery.","authors":"Samiullah Arshad,&nbsp;Rachel D Cutting,&nbsp;Daniel J Stephens,&nbsp;Ythan H Goldberg,&nbsp;Claudius Mahr,&nbsp;Mahender Vyasabattu,&nbsp;Ahmed H Abdelfattah,&nbsp;Gaurang N Vaidya","doi":"10.1177/11795468221144352","DOIUrl":"https://doi.org/10.1177/11795468221144352","url":null,"abstract":"<p><p>Left ventricular assist devices (LVADs) have revolutionized the management of patients with advanced heart failure refractory to medical therapy. Current indications of LVADs include Bridge to Transplantation (BTT), Destination Therapy (DT) for long-term use, Bridge to the Decision (BTD) used as a temporary measure, and lastly Bridge to Recovery (BTR). Here, we briefly review the clinical evidence and the molecular mechanisms behind myocardial recovery following LVAD placement. We also share institutional protocols used at 2 major medical centers in the USA.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"16 ","pages":"11795468221144352"},"PeriodicalIF":3.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fe/e4/10.1177_11795468221144352.PMC9806425.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10839644","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":"Myxedema Coma: A Rare Case of Shock Post-Pericardial Window Procedure.","authors":"Blerina Asllanaj,&nbsp;Mark Olson,&nbsp;Yi McWhorter","doi":"10.1177/11795468221141302","DOIUrl":"https://doi.org/10.1177/11795468221141302","url":null,"abstract":"<p><p>The clinical features of severe hypothyroidism vary in presentation, ranging from subclinical symptoms to multiorgan failure referred to as myxedema coma. The cornerstone treatments of myxedema coma include aggressive thyroid hormone replacement combined with excellent supportive care in the intensive care unit. We report a rare case of a 56-year-old female with history of hypothyroidism treated with levothyroxine, who developed myxedema coma post-pericardial window surgery for a large pericardial effusion. She was supported with substantial doses of vasopressors and inotropes for shock. In addition, she was initiated on lung-protection ventilation for acute respiratory distress syndrome. After the diagnosis of myxedema coma was made, she was started on intravenous levothyroxine and hydrocortisone with great sustained clinical response. This case illustrated myxedema coma as an unusual cause of shock in post-operative patients with past medical history of hypothyroidism.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"16 ","pages":"11795468221141302"},"PeriodicalIF":3.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b7/cc/10.1177_11795468221141302.PMC9726846.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10324000","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":"Early Diuretics for De-resuscitation in Septic Patients With Left Ventricular Dysfunction","authors":"Timothy W. Jones, A. Chase, R. Bruning, Naphun Nimmanonda, S. Smith, A. Sikora","doi":"10.1177/11795468221095875","DOIUrl":"https://doi.org/10.1177/11795468221095875","url":null,"abstract":"Introduction: De-resuscitation practices in septic patients with heart failure (HF) are not well characterized. This study aimed to determine if diuretic initiation within 48 hours of intensive care unit (ICU) admission was associated with a positive fluid balance and patient outcomes. Methods: This single-center, retrospective cohort study included adult patients with an established diagnosis of HF admitted to the ICU with sepsis or septic shock. The primary outcome was the incidence of positive fluid balance in patients receiving early (<48 hours) versus late (>48 hours) initiation of diuresis. Secondary outcomes included hospital mortality, ventilator-free days, and hospital and ICU length of stay. Continuous variables were assessed using independent t-test or Mann-Whitney U, while categorical variables were evaluated using the Pearson Chi-squared test. Results: A total of 101 patients were included. Positive fluid balance was significantly reduced at 72 hours (−139 mL vs 4370 mL, P < .001). The duration of mechanical ventilation (4 vs 5 days, P = .129), ventilator-free days (22 vs 18.5 days, P = .129), and in-hospital mortality (28 (38%) vs 12 (43%), P = .821) were similar between groups. In a subgroup analysis excluding patients not receiving renal replacement therap (RRT) (n = 76), early diuretics was associated with lower incidence of mechanical ventilation (41 [73.2%] vs 20 (100%), P = .01) and reduced duration of mechanical ventilation (4 vs 8 days, P = .018). Conclusions: Diuretic use within 48 hours of ICU admission in septic patients with HF resulted in less incidence of positive fluid balance. Early diuresis in this unique patient population warrants further investigation.","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"7 1","pages":""},"PeriodicalIF":3.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73341577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypothyroidism Is Associated With Longer Hospital Stay Following Implantation Of Left Ventricular Assist Device.","authors":"Sakiru O Isa,&nbsp;Olajide Buhari,&nbsp;Muminat Adeniran-Isa,&nbsp;Nischit Baral,&nbsp;Govinda Adhikari,&nbsp;Basel AbdulAzeem,&nbsp;Pramod Savarapu,&nbsp;Oyebimpe Adekolujo,&nbsp;Mustafa Hassan,&nbsp;Adedayo Adeboye","doi":"10.1177/11795468211058761","DOIUrl":"https://doi.org/10.1177/11795468211058761","url":null,"abstract":"<p><strong>Background: </strong>There has been a steady and consistent rise in the use of left ventricular assist devices in the management of patients with advanced heart failure. Hypothyroidism also remains one of the most common endocrine conditions with a significant impact on the development and overall outcomes of heart failure. The authors analyzed the National Inpatient Sample to evaluate the effect of hypothyroidism on the in-hospital outcomes of patients with end-stage heart failure following the placement of left ventricular assist device.</p><p><strong>Methods: </strong>The national inpatient sample was queried to identify all adult patients who had LVAD placement from 2004 to 2014. They were subsequently divided into those with hypothyroidism and those without hypothyroidism. The primary outcome was in-hospital mortality. Other outcomes were acute kidney injury, length, and cost of hospitalization. Logistic regression models were created to determine the outcomes of interest.</p><p><strong>Results: </strong>Of 2643 patients in the study, 5.4% had hypothyroidism, and 94.6% did not. The hypothyroid patients were significantly older compared to the non-hypothyroid patients (mean age 58.6 years vs 49.95 years, <i>P</i>-value <.0001). Both groups had similar gender composition. In-hospital mortality was similar across both groups. However, there was a higher incidence of acute kidney injury (AKI) in the hypothyroid group (adjusted odds ratio [aOR 1.83, <i>P</i>-value <.001]). Hypothyroid patients had longer hospital stays (adjusted mean difference [aMD] 5.19, <i>P</i>-value .0001). Hospital charges were also higher in the hypothyroid group.</p><p><strong>Conclusion: </strong>This study found that LVAD is associated with longer hospital stay in hypothyroid patients with heart failure.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"15 ","pages":"11795468211058761"},"PeriodicalIF":3.0,"publicationDate":"2021-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/63/f7/10.1177_11795468211058761.PMC8646184.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39793528","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":"Perimyocarditis Following COVID-19 Vaccination.","authors":"Mariana Tinoco,&nbsp;Sérgio Leite,&nbsp;Bebiana Faria,&nbsp;Sara Cardoso,&nbsp;Pedro Von Hafe,&nbsp;Geraldo Dias,&nbsp;Filipa Cardoso,&nbsp;Tamara Pereira,&nbsp;Inocência Machado,&nbsp;António Lourenço","doi":"10.1177/11795468211056634","DOIUrl":"10.1177/11795468211056634","url":null,"abstract":"<p><p>A 39-year-old male was admitted in the emergency room with chest pain. He had been given the second dose of Pfizer-BioNTech COVID-19 vaccine 3 days before. The patient denied taking any other medication beyond the usual. He didn't feel sick in the previous days/weeks. Laboratory studies revealed elevated serum levels of troponin and C-reactive protein. An autoantibody screen and a serologic panel to detect common viruses were negative. A cardiac MRI showed myocardial edema/inflammation and confirmed the diagnosis of perimyocarditis which was considered to be a consequence of COVID-19 vaccination. Physicians should be aware of the possibility of cardiovascular complications after COVID-19 vaccination.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"15 ","pages":"11795468211056634"},"PeriodicalIF":3.0,"publicationDate":"2021-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/7d/10.1177_11795468211056634.PMC8637777.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39806375","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":"Predictors of In-hospital Mortality in Cardiogenic Shock Patients on Vasoactive or Inotropic Support.","authors":"Shuktika Nandkeolyar,&nbsp;Tanya Doctorian,&nbsp;Gary Fraser,&nbsp;Rachel Ryu,&nbsp;Colleen Fearon,&nbsp;David Tryon,&nbsp;Whitney Kagabo,&nbsp;Dmitry Abramov,&nbsp;Christopher Hauschild,&nbsp;Liset Stoletniy,&nbsp;Anthony Hilliard,&nbsp;Antoine Sakr","doi":"10.1177/11795468211049449","DOIUrl":"https://doi.org/10.1177/11795468211049449","url":null,"abstract":"<p><strong>Background: </strong>Though controversial, the short-duration in-patient use of inotropes in cardiogenic shock (CS) remain an ACC/AHA Class IIa indication, and are frequently used in the initial treatment of CS. We evaluated in-patient mortality and effect on mortality risk of commonly used vasoactive inotropic medications for the medical management of SCAI stage B and C cardiogenic shock patients in a tertiary care cardiac care unit: dobutamine, dopamine, milrinone, and norepinephrine.</p><p><strong>Methods: </strong>We retrospectively evaluated 342 patients who received dobutamine, milrinone, dopamine, norepinephrine or a combination of these medications for SCAI stage B and C cardiogenic shock. Cox proportional hazards were used to form longitudinal mortality predictions.</p><p><strong>Results: </strong>Overall in-patient mortality was 18%. Each 1 µg/kg/minute increase in dobutamine independently corresponded to a 15% increase in risk of mortality. High dose dobutamine >3 µg/kg/minute is associated with 3-fold increased risk compared to ⩽3 µg/kg/minute (<i>P</i> < .001). Use of milrinone, norepinephrine, and dopamine were not independently associated with mortality.</p><p><strong>Conclusion: </strong>We demonstrate that the overall in-hospital mortality of SCAI stage B and C cardiogenic shock patients medically managed on inotropes was not in excess of prior studies. Dobutamine was independently associated with mortality, while other vasoactive inotropic medications were not. Inotropes remain a feasible method of managing SCAI stage B and C cardiogenic shock.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"15 ","pages":"11795468211049449"},"PeriodicalIF":3.0,"publicationDate":"2021-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7c/35/10.1177_11795468211049449.PMC8554565.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39667045","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":"Right Heart Morphology and Its Association With Excessive and Deficient Cardiac Visceral Adipose Tissue.","authors":"Domagoj Vučić,&nbsp;Nikola Bijelić,&nbsp;Edi Rođak,&nbsp;Jasmina Rajc,&nbsp;Boris Dumenčić,&nbsp;Tatjana Belovari,&nbsp;Damir Mihić,&nbsp;Kristina Selthofer-Relatić","doi":"10.1177/11795468211041330","DOIUrl":"https://doi.org/10.1177/11795468211041330","url":null,"abstract":"<p><p>Visceral adipose tissue is an independent risk factor for the development of atherosclerotic coronary disease, arterial hypertension, diabetes and metabolic syndrome. Right heart morphology often involves the presence of adipose tissue, which can be quantified by non-invasive imaging methods. The last decade brought a wealth of new insights into the function and morphology of adipose tissue, with great emphasis on its role in the pathogenesis of heart disease. Cardiac adipose tissue is involved in thermogenesis, mechanical protection of the heart and energy storage. However, it can also be an endocrine organ that synthesises numerous pro-inflammatory and anti-inflammatory cytokines, the effect of which is accomplished by paracrine and vasocrine mechanisms. Visceral adipose tissue has several compartments that differ in their embryological origin and vascularisation. Deficiency of cardiac adipose tissue, often due to chronic pathological conditions such as oncological diseases or chronic infectious diseases, predicts increased mortality and morbidity. To date, knowledge about the influence of visceral adipose tissue on cardiac morphology is limited, especially the effect on the morphology of the right heart in a state of excess or deficient visceral adipose tissue.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"15 ","pages":"11795468211041330"},"PeriodicalIF":3.0,"publicationDate":"2021-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a4/5a/10.1177_11795468211041330.PMC8485260.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39481392","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":"Epicardial Adipose Tissue: The Genetics Behind an Emerging Cardiovascular Risk Marker.","authors":"João Adriano Sousa,&nbsp;Maria Isabel Mendonça,&nbsp;Marco Serrão,&nbsp;Sofia Borges,&nbsp;Eva Henriques,&nbsp;Sónia Freitas,&nbsp;Margarida Tentem,&nbsp;Marina Santos,&nbsp;Pedro Freitas,&nbsp;António Ferreira,&nbsp;Graça Guerra,&nbsp;António Drumond,&nbsp;Roberto Palma Reis","doi":"10.1177/11795468211029244","DOIUrl":"https://doi.org/10.1177/11795468211029244","url":null,"abstract":"<p><p>Evidence points epicardial adipose tissue (EAT) as an emerging cardiovascular risk marker. Whether genetic polymorphisms linked with atherosclerosis are associated with higher EAT is still unknown. We aim to assess the role of genetic burden of atherosclerosis and its association to EAT in a cohort of asymptomatic individuals without coronary disease. A total of 996 participants were prospectively enrolled in a single Portuguese center. EAT volume was measured by Cardiac Computed Tomography and participants were distributed into 2 groups, above and below median EAT. SNPs were genotyped and linked to their respective pathophysiological axes. A multiplicative genetic risk score (mGRS) was constructed, representing the genetic burden of the studied SNPs. To evaluate the association between genetics and EAT, we compared both groups by global mGRS, mGRS by functional axes, and SNPs individually. Individuals above-median EAT were older, had a higher body mass index (BMI) and higher prevalence of hypertension, metabolic syndrome, diabetes, and dyslipidemia. They presented higher GRS, that remained an independent predictor of higher EAT volumes. The group with more EAT consistently presented higher polymorphic burden across numerous pathways. After adjustment, age, BMI, and mGRS of each functional axis emerged as independently related to higher EAT volumes. Amongst the 33 SNPs, MTHFR677 polymorphism emerged as the only significant and independent predictor of higher EAT volumes. Patients with higher polymorphism burden for atherosclerosis present higher EAT volumes. We present the first study in a Portuguese population, evaluating the genetic profile of EAT through GWAS and GRS, casting further insight into this complicated matter.</p>","PeriodicalId":10419,"journal":{"name":"Clinical Medicine Insights. Cardiology","volume":"15 ","pages":"11795468211029244"},"PeriodicalIF":3.0,"publicationDate":"2021-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/11795468211029244","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39195559","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}