European Spine Journal最新文献

{"title":"Bone density as a risk of early loss of correction after percutaneous posterior spinal fixation for traumatic thoracolumbar fracture: a study on the usefulness of Hounsfield unit values on computed tomography scan.","authors":"Takeru Akabane, Tomoto Suzuki, Yuki Konno, Hiromori Sagae, Makoto Sugita, Hiroshi Hasegawa, Shikou Takada, Tamon Asano, Michiaki Takagi","doi":"10.1007/s00586-024-08508-y","DOIUrl":"10.1007/s00586-024-08508-y","url":null,"abstract":"<p><strong>Purpose: </strong>Vertebral Hounsfield unit values on computed tomography scan (CT values) have been found to be correlated with bone density measured using dual-energy X-ray absorptiometry. We hypothesized that low preoperative CT values are risk factors for early loss of correction after percutaneous posterior spinal fixation (PPSF). This study aimed to evaluate the usefulness of measuring preoperative CT values.</p><p><strong>Methods: </strong>In total, 104 patients underwent PPSF due to traumatic thoracolumbar fracture. Among them, 53 with a range of fixation that was within two vertebrae above and below the fractured vertebra were selected. CT values were measured preoperatively from the most cephalad vertebrae on the fixed vertebrae. Vertebral wedge angle (VWA) and local kyphosis angle (LKA) were measured before and after surgery. participants were classified into progression (P) and nonprogression (NP) groups. The P group comprised patients with LKA progressing > 10° from the immediate postoperative period to 3 months postoperatively. Meanwhile, the NP group included patients without progression.</p><p><strong>Results: </strong>Eight (15.1%) patients were included in the P group. The vertebral CT values were 102.2 ± 36.7 in the P group and 162.4 ± 59.7 in the NP group (p < 0.01). The pedicle CT values were 114.4 ± 45.9 in the P group and 170.8 ± 72.3 in the NP group (p < 0.05). At 2 weeks postoperatively, VWA and LKA of the P group progressed to 9.8° ± 7.0° and 10.9° ± 7.6°, respectively.</p><p><strong>Conclusion: </strong>CT values can predict progressive loss of correction after PPSF.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"498-505"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377837","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":"Effect of percutaneous kyphoplasty combined with percutaneous microwave ablation on pain and clinical outcome in patients with spinal metastases.","authors":"Mei Bai, Hailin Wang, Aoran Li, Tingting Zhang","doi":"10.1007/s00586-024-08558-2","DOIUrl":"10.1007/s00586-024-08558-2","url":null,"abstract":"<p><strong>Objective: </strong>To study the effect of percutaneous kyphoplasty (PKP) combined with microwave ablation (MWA) on pain and clinical outcomes in patients with spinal metastases.</p><p><strong>Methods: </strong>Eighty-seven patients with spinal metastases were retrospectively collected and divided into the PKP group (40 cases), and PKP + MWA group (47 cases). The postoperative efficacy (Frankel grade classification) was assessed, and the height of the diseased vertebrae, pain indices [visual analogue scale (VAS) and analgesic use score (AUS)], dysfunction in daily activities [Oswestry disability index (ODI)], quality of life (quality of life scores for tumor patients), and physical status score [Eastern Cooperative Oncology Group performance status] were compared. The incidence rate of adverse events and the survival of both groups were also counted.</p><p><strong>Results: </strong>Postoperatively, the PKP + MWA group had a higher total effective rate than the PKP group (P < 0.05). Versus the PKP group, the PKP + MWA group showed improved recovery of vertebral height, lower VAS, AUS, and ODI scores, higher QLS, and better physical status (all P < 0.05). Postoperative adverse events were not significantly different between the two groups (P > 0.05). The disease-free survival rate and overall survival rate within 1 year were higher in the PKP + MWA group than in the PKP group (P < 0.05).</p><p><strong>Conclusion: </strong>PKP combined with MWA elevates the height of the diseased vertebrae, alleviates the symptoms of pain and dysfunction, and promotes the quality of life and physical status in patients with spinal metastases.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"657-664"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686327","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":"Serum IL-6 and TGF-β1 concentrations as diagnostic biomarkers in elderly male patients with osteoporosis.","authors":"Zhijun Chen, Guotao Yang, Weiping Su, Shuangjun He, Yaowei Wang","doi":"10.1007/s00586-024-08553-7","DOIUrl":"10.1007/s00586-024-08553-7","url":null,"abstract":"<p><strong>Purpose: </strong>This research is intended to evaluate the correlations of serum IL-6 and TGF-β1 concentrations with bone density and turnover markers as well as their diagnostic value in elderly male patients with osteoporosis (OP).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 335 elderly men (≥ 60 years; 90 with normal bone mass, 120 osteopenia cases, and 125 OP cases). Lumbar spine/femoral neck BMD values were measured using dual-energy X-ray absorptiometry. Correlations of serum IL-6 and TGF-β1 concentrations with bone density and bone turnover markers in OP patients were analyzed utilizing Pearson or Spearman correlation coefficients. Independent influencing factors for OP were identified by logistic multivariate regression analysis. The diagnostic value of serum IL-6 and TGF-β1 was assessed with ROC curves and MedCalc software.</p><p><strong>Results: </strong>Smoking history, drinking history, lumbar spine BMD, femoral neck BMD, PINP, and β-CTX markedly differed among the normal bone mass, osteopenia, and OP groups. Elevated IL-6 and reduced TGF-β1 concentrations were observed in serum samples of OP. Serum IL-6 concentrations was inversely associated with bone density markers but positively lined to bone turnover markers. Conversely, serum TGF-β1 was positively related to bone density markers but negatively associated with bone turnover markers. Smoking history, PINP, and IL-6, were identified as independent risk factors while lumbar spine BMD, femoral neck BMD, and TGF-β1 were independent protective markers for OP. The combined assessment of serum IL-6 and TGF-β1 showed superior diagnostic performance for OP.</p><p><strong>Conclusion: </strong>Serum IL-6 in combination with TGF-β1 exhibits good diagnostic performance for OP.</p><p><strong>Level of evidence: </strong>Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"513-521"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681143","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":"Letter to the editor concerning \"influence of socioeconomic deprivation and geographic disparities in the management of surgical adolescent idiopathic scoliosis: a multicentric retrospective cohort in Northern France\" by B. Kipper, et al. (Eur Spine J [2024]: doi: 10.1007/s00586-024-08556-4).","authors":"Shangxian Pan, Kuangyang Yang, Kexin Wang","doi":"10.1007/s00586-024-08638-3","DOIUrl":"10.1007/s00586-024-08638-3","url":null,"abstract":"","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"804-805"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909377","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":"Clinical applications of 3D printing in spine surgery: a systematic review.","authors":"Benjamin Hajnal, Agoston Jakab Pokorni, Mate Turbucz, Ferenc Bereczki, Marton Bartos, Aron Lazary, Peter Endre Eltes","doi":"10.1007/s00586-024-08594-y","DOIUrl":"10.1007/s00586-024-08594-y","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this systematic review is to present a comprehensive summary of existing research on the use of 3D printing in spinal surgery.</p><p><strong>Methods: </strong>The researchers conducted a thorough search of four digital databases (PubMed, Web of Science, Scopus, and Embase) to identify relevant studies published between January 1999 and December 2022. The review focused on various aspects, including the types of objects printed, clinical applications, clinical outcomes, time and cost considerations, 3D printing materials, location of 3D printing, and technologies utilized. Out of the 1620 studies initially identified and the 17 added by manual search, 105 met the inclusion criteria for this review, collectively involving 2088 patients whose surgeries involved 3D printed objects.</p><p><strong>Results: </strong>The studies presented a variety of 3D printed devices, such as anatomical models, intraoperative navigational templates, and customized implants. The most widely used type of objects are drill guides (53%) and anatomical models (25%) which can also be used for simulating the surgery. Custom made implants are much less frequently used (16% of papers). These devices significantly improved clinical outcomes, particularly enhancing the accuracy of pedicle screw placement. Most studies (88%) reported reduced operation times, although two noted longer times due to procedural complexities. A variety of 3DP technologies and materials were used, with STL, FDM, and SLS common for models and guides, and titanium for implants via EBM, SLM, and DMLS. Materialise software (Mimics, 3-Matic, Magics) was frequently utilized. While most studies mentioned outsourced production, in-house printing was implied in several cases, indicating a trend towards localized 3D printing in spine surgery.</p><p><strong>Conclusions: </strong>3D printing in spine surgery, a rapidly growing area of research, is predominantly used for creating drill guides for screw insertion, anatomical models, and innovative implants, enhancing clinical outcomes and reducing operative time. While cost-efficiency remains uncertain due to insufficient data, some 3D printing applications, like pedicle screw drill guides, are already widely accepted and routinely used in hospitals.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"454-471"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142946753","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":"Assessing bone quality in hounsfield units using computed tomography: what value should be used to classify bone as normal or osteoporotic?","authors":"Emily C Courtois, Donna D Ohnmeiss","doi":"10.1007/s00586-024-08565-3","DOIUrl":"10.1007/s00586-024-08565-3","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate threshold values for classifying bone as normal or osteoporotic based on Computed Tomography (CT) Hounsfield Units (HU) and to determine if clinically applicable values could be derived to aid spine surgeons evaluating bone quality using CT.</p><p><strong>Methods: </strong>This literature review was completed using PubMed and Ovid (MedLine), using syntax specific to bone quality and CT. The included articles were original clinical studies assessing bone quality and utilized composite L1-L4 HU values compared against dual-energy X-ray absorptiometry (DEXA) values. Extracted data study descriptors, CT measurement technique, and CT threshold values. CTs were measured from L1-L4 using either axial or sagittal images, and must classify their bone quality findings for any of the following 3 categories: normal, osteopenia, or osteoporosis.</p><p><strong>Results: </strong>This review located 34 studies measuring bone density using CT with threshold values, of which, 10 were included in the final review. Number of patients ranged from 74 to 283 and cohort ages from 20s to 70.6 years. CT threshold values for assessing normal and osteoporotic bone quality ranged from 150 to 179 and 87 to 155, respectively. From combining values across studies, a HU value of ≥ 170 HU was associated with normal bone and ≤ 115 HU with osteoporosis.</p><p><strong>Conclusion: </strong>There is variation in HU values used to differentiate normal from compromised bone quality, even after limiting studies. For patients with HU values between or near 170 or 115 HU, a DEXA scan may be warranted for further evaluation. With ongoing investigation in this area, threshold values for classifying bone quality using CT will be continually refined.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"493-497"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686354","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":"Utility of narrow band imaging in a patient with a spinal cord cavernous malformation.","authors":"Kazuya Otsuki, Hideki Hayashi, Kazuhiro Kasashima, Hiroki Toda","doi":"10.1007/s00586-024-08615-w","DOIUrl":"10.1007/s00586-024-08615-w","url":null,"abstract":"<p><strong>Background: </strong>Complete removal of the lesion from the spinal cord cavernous malformation is crucial in patients with spinal cord cavernous malformation. Herein, we report that narrow-band imaging (NBI) is useful to confirm the complete removal of spinal cord cavernous malformations.</p><p><strong>Clinical presentation: </strong>A 45-year-old woman was followed up for the past seven years due to multiple intracranial cavernous malformations. She reported abnormal pressure sensation in the right hip. Thoracic MRI revealed an intramedullary lesion at the 6th thoracic vertebra, suggesting hemorrhage from a spinal cord cavernous malformation. Subsequently, the patient experienced worsening numbness and gait disturbances. The patient underwent surgery using monitoring of motor- and sensory-evoked potentials in the lower extremities. An intramedullary lesion with hematoma was removed using an exoscope and indocyanine green imaging. However, NBI revealed a residual lesion in the removal cavity, which was additionally removed. Postoperatively, the abnormal sensation was alleviated with no loss of motor function.</p><p><strong>Conclusion: </strong>NBI is helpful in detecting hidden spinal cord cavernous malformations.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"719-723"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834442","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 utilizing real-time contrast medium to detect the fistulas in spinal epidural arachnoid cysts and treat with minimally invasive surgery.","authors":"Wei Gao, Qixuan Jiang, Tianjian Liu, Aiqin Chen, Xiaohang Jiang, Xinben Hu, Chi Gu, Yajuan Tang, Fang Shen, Jingyin Chen, Guangyu Ying, Yongjian Zhu","doi":"10.1007/s00586-024-08635-6","DOIUrl":"10.1007/s00586-024-08635-6","url":null,"abstract":"<p><strong>Background: </strong>Spinal epidural arachnoid cysts (SEACs) are rare, non-neoplastic pathologies that can cause compressive myelopathy. Preoperative identification of the exact fistula location is crucial for minimally invasive management.</p><p><strong>Methods: </strong>This single-center retrospective study included 27 patients with SEACs who underwent \"double-needle puncture myelography\" to precisely localize the fistula before minimally invasive surgery. Clinical presentations, radiological findings, and surgical outcomes were analyzed.</p><p><strong>Results: </strong>Among the 27 patients, the most common clinical complaint was sensory dysfunction (14 patients, 51.9%). Motor dysfunction, manifested as lower limb weakness, was observed in 11 patients (40.7%), while 2 patients were asymptomatic at admission. Consistency analysis between radiographic localization and intraoperative findings demonstrated that the \"double-needle puncture myelography\" technique accurately identified the surgical segments and laterality of all fistulas except for one patient, who required repeat radiographic localization. Minimally invasive approaches, including hemilaminectomy or mini-hemilaminectomy, were successfully performed in 26 patients (96.3%) for fistula exposure.</p><p><strong>Conclusions: </strong>The \"double-needle puncture myelography\" technique allows for the swift acquisition of precise anteroposterior and lateral projection dynamic X-ray images during the procedure. As a valuable preoperative diagnostic tool, it accurately pinpoints the location of the fistula, thereby minimizing surgical trauma and preserving spinal stability.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":"34 2","pages":"472-478"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370579","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":"Patterns of sitting spinal alignment in non-ambulatory scoliosis patients with paraplegia: an observational study.","authors":"Jun Ouchida, Hiroaki Nakashima, Tetsuya Ohara, Masaaki Machino, Sadayuki Ito, Naoki Segi, Ippei Yamauchi, Shiro Imagama","doi":"10.1007/s00586-024-08584-0","DOIUrl":"10.1007/s00586-024-08584-0","url":null,"abstract":"<p><strong>Purpose: </strong>To classify sagittal spinopelvic alignment patterns of non-ambulatory scoliosis patients with paraplegia based on lateral sitting radiographs and explore their relation to clinical background and physical function.</p><p><strong>Methods: </strong>We reviewed non-ambulatory scoliosis patients with paraplegia, excluding those with prior spinal surgery from a single-center database. Alignment patterns in sitting postures were classified into slump sitting (SS) and erect sitting (ES) based on the most posterior edge of the spine's location on lateral sitting radiographs. Radiographical spinopelvic sagittal alignment, demographics, and physical functions were analyzed. Clinical scoring for physical functions included Hoffer's ambulator classification, Hoffer's modified sitting classification, and the Modified Ashworth Score (MAS) for the severity of spasticity in the lower extremities. Percentages of patients without spasticity, with MAS of 0 indicating \"no spasticity.\" were also compared between the two alignment patterns.</p><p><strong>Results: </strong>Of 172 patients screened, 86 met inclusion criteria, revealing two distinct alignment patterns: SS showed greater thoracic kyphosis, smaller lumbar lordosis, pelvic retroversion, and hip hyperflexion compared to ES. No significant differences in demographic data or curve patterns were observed between groups. The SS group had a significantly higher percentage of patients without spasticity compared to the ES group (39.2% vs. 14.3%, P = 0.016).</p><p><strong>Conclusion: </strong>Identified were two distinct sagittal alignment patterns in seated scoliosis patients with paraplegia, with potential influences from spasticity in the lower extremities. Recognizing these patterns can aid in assessing the function of sitting balance that includes the hip joint and in optimizing strategies for the treatment of scoliosis patients with paraplegia.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"556-564"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750017","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":"Minimal-invasive, image guided, 360-degree resection of ilio-lumbo-sacral ostechondroma, planned on the 3D model in a child with hereditary multiple ostechondroma (HMO).","authors":"Lukas Bobinski, Evangelos Tachtaras, Erik Hedström","doi":"10.1007/s00586-024-08625-8","DOIUrl":"10.1007/s00586-024-08625-8","url":null,"abstract":"<p><strong>Background: </strong>Hereditary Multiple Osteochondromas (HMO), previously known as Multiple Hereditary Exostoses (MHE), is a genetic disorder characterized by the formation of multiple, benign, exostoses (osteochondromas) growing from the metaphyseal region of long bones as well as from the axial skeleton. Lesions originating from the lumbar spine region are rare, and are most common growing from the posterior element of the vertebrae. HMO associated osteochondromas are difficult to treat due to continuous and incontrollable growth of these lesions and a lifetime risk for malignant transformation.</p><p><strong>Case report: </strong>We describe a case of a 16-year old patient with known HMO who developed a giant ilio-lumbo-sacral osteochondroma. The tumor protruded into the L4-S1 intraspinal foramina with exophytic expansion to the right psoas muscle and lumbar plexus with compression of the right common iliac vein. To plan and execute the resection and minimize the risk of complications, we used a 3D printed model of the lesion with intraabdominal vessels. The patient was operated during a two-stage procedure - first by mini-open, transabdominal, navigated resection of the lesion, followed by delayed posterior, mini-invasive, navigated resection. The outcome was uneventful and there were no signs of regrowth or malignant transformation during 4 years of follow-up.</p><p><strong>Conclusion: </strong>We describe a 360-degree surgical resection with application of a 3D printed model, navigation, and mini-invasive techniques. Our report may be useful and inspire spine surgeons to apply similar techniques to treat complex spine lesions.</p>","PeriodicalId":12323,"journal":{"name":"European Spine Journal","volume":" ","pages":"643-649"},"PeriodicalIF":2.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909393","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}