International Angiology最新文献

{"title":"Narrative review on the management of post-thrombotic syndrome: approaching the emerging technologies.","authors":"Andres V Figueroa, Sebastian Cifuentes, Armin Tabiei, Alejandro Pizano, Todd E Rasmussen, Nicos Labropoulos, Jorge H Ulloa","doi":"10.23736/S0392-9590.25.05410-0","DOIUrl":"10.23736/S0392-9590.25.05410-0","url":null,"abstract":"<p><p>Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) and the most challenging form of chronic venous disease. Up to 50% of patients who suffer DVT will develop PTS. Clinical manifestations such as limb pain, edema, skin damage, and ulceration result from venous hypertension due to reflux, obstruction, or a combination of both. The current treatment option is conservative management with limited efficiency. PTS severely affects the quality of life, and definitive surgical treatment is urgently needed. This article aims to review the current management paradigm and introduce new in-development surgical alternatives. A narrative review of the literature published between 2010 and 2025 was conducted in PubMed, Embase and the Cochrane Library. Reviewed articles included management guidelines, trial reports, reviews, and cohort studies regarding the management of post-thrombotic syndrome and deep valvular insufficiency. The SANRA Guidelines for narrative reviews were followed. Sixty-seven articles addressing current and future treatment options for PTS were included. Over the last five decades, previous unsuccessful attempts to restore deep valvular function provided the knowledge ground for promising candidates. Technological improvements within the last decade have taken a novel implantable bioprosthetic valve, an endovascular neovalve creation device, and a transcatheter-based venous valve replacement system remarkably close to being the next-generation armamentarium for treating PTS. The efficacy of current management alternatives for PTS remains limited. The experience gained over the last 50 years has propelled the development of novel prosthetic devices and endovascular systems in response to the unmet need for an effective PTS treatment. Early-phase results are promising and have granted the buildout of larger ongoing trials.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 5","pages":"353-365"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of shear wave elastography in the assessment of carotid plaque vulnerability: a systematic review and meta-analysis.","authors":"Christos F Pitros, Vasiliki Manaki, John D Kakisis, Stavros K Kakkos","doi":"10.23736/S0392-9590.25.05427-6","DOIUrl":"10.23736/S0392-9590.25.05427-6","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is the second most common cause of death and disability worldwide. The correlation between plaque vulnerability and stroke risk needs to be further determined. Shear wave elastography is a promising, non-invasive, low-cost tool for carotid plaques vulnerability assessment. We examined the role of quantification of the carotid plaque's composition using shear wave elastography (SWE) and the subsequent classification of the plaque as symptomatic (in patients who have had stroke/TIA attributed to the plaque) or asymptomatic, and likewise as vulnerable (having features that predispose to stroke, such as lipid-rich necrotic core or hemorrhage) or stable.</p><p><strong>Evidence acquisition: </strong>A systematic review and meta-analysis were conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Databases Medline (PubMed), Scopus, Cochrane Library and ClinicalTrials.gov were searched from inception to July 2024. The primary goal was to evaluate SWE as a diagnostic tool for vulnerable carotid plaques.</p><p><strong>Evidence synthesis: </strong>The search resulted in the identification of 606 studies, of which 24 specifically examined our primary objective. Five comparative studies were included in the symptomatic vs. asymptomatic group of the meta-analysis, while three were included in the vulnerable vs. stable group. For symptomatic vs. asymptomatic plaques analysis the pooled Standardized Mean Difference (SMD) is -0.89 with a 95% confidence interval (CI) of [-1.28, -0.50], while for vulnerable vs. stable plaques analysis the pooled SMD -2.38 with a 95% CI of [-3.68, -1.07]. Symptomatic and vulnerable carotid plaques showcased significantly lower Young's modulus (kPa) values (both, P<0.001).</p><p><strong>Conclusions: </strong>SWE has shown promising results for carotid plaque assessment and stroke risk stratification. Further prospective multicenter clinical studies are needed to determine optimal techniques and parameters for Young's modulus and shear wave velocity indexes, enhancing stroke prevention and treatment.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 5","pages":"415-425"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking and lower extremity artery disease.","authors":"Pier L Antignani, Pavel Poredoš, Aleš Blinc, Matija Cevc, Agata Stanek, Arkadiusz Jawien, Armando Mansilha","doi":"10.23736/S0392-9590.25.05302-7","DOIUrl":"10.23736/S0392-9590.25.05302-7","url":null,"abstract":"<p><p>Cigarette smoking is a major preventable risk factor for lower extremity arterial disease (LEAD) and is strongly associated with a higher risk of disease progression, worse post-procedural outcomes, and increased healthcare utilization. Smoking provokes the development of atherosclerotic through different mechanisms. Endothelial cell dysfunction, oxidative stress, inflammation, and arterial stiffness are among the key factors related to the development of atherogenesis due to smoking. Smoking cessation among patients with LEAD and the use of smoking cessation methods, including pharmacological treatment, are mandatory. Given that smoking cessation interventions remain underutilized. Therefore, in this narrative review we highlight the importance of incorporating smoking cessation treatments as part of the medical management of LEAD. Regulatory approaches to reduce tobacco use and support smoking cessation have the potential to reduce the burden of LEAD.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"383-390"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caseload or endovascular aortic repair is not associated with a change in 90-day mortality after surgery for ruptured abdominal aortic aneurysms in Sweden.","authors":"Fredrik B Lundgren, Thomas J Troëng","doi":"10.23736/S0392-9590.25.05456-2","DOIUrl":"10.23736/S0392-9590.25.05456-2","url":null,"abstract":"<p><strong>Background: </strong>Reports on mortality rates after ruptured abdominal aortic aneurysm (RAAA) vary. We investigated whether institutional caseload volume of abdominal aortic aneurysm (AAA) or institutional proportion of endovascular aortic repair (EVAR) for RAAA are associated with decreased 90-day mortality of RAAA in Sweden.</p><p><strong>Methods: </strong>Retrospective, observational, nationwide, five-year, cohort study of 1040 RAAAs from Swedvasc, a prospective vascular registry including all vascular units in Sweden. Patient age, sex, heart disease, previous cardiac insufficiency, pulmonary disease, kidney disease, patient frailty, preoperative hemodynamic instability, and loss of consciousness were retrieved from different data sources and modelled versus 90-day mortality with logistic regression. Supplementary variables helped for imputation of missing values. Each patient was assigned a Hospital Caseload Value (HCV) the annual caseload volume of (intact and ruptured) AAAs at the hospital performing the operation and a Hospital EVAR proportion Value (HEV) the proportion of EVAR at the hospital performing the operation when treating RAAA. Further, institutional 90-day mortality was regressed on institutional caseload volume and proportion of EVAR for RAAA with logistic regression.</p><p><strong>Results: </strong>Ninety-day mortality was 30.4 percent. Neither HCV nor HEV were associated with postoperative mortality for individual patients (HCV odds ratio (OR) 1.10, P value=0.28; HEV OR 1.04, P value=0.46) or at the institutional level (caseload volume OR=1.06, P=0.19, and proportion of EVAR use OR=1.01, P=0.46).</p><p><strong>Conclusions: </strong>Caseload of AAA or EVAR for RAAA were not associated with a change in postoperative 90-day mortality in Sweden.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 5","pages":"391-400"},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conversion to carotid artery stenting after neurological intolerance at cross-clamping during carotid endarterectomy: is it a safe option?","authors":"Arkadiusz Migdalski, Arkadiusz Jawień","doi":"10.23736/S0392-9590.25.05453-7","DOIUrl":"10.23736/S0392-9590.25.05453-7","url":null,"abstract":"<p><strong>Introduction: </strong>In the case of intolerance to cross-clamping (CC) during carotid endarterectomy (CEA), the method-of-choice is to place a shunt and continue the procedure. However, some centers abandon open carotid revascularization in case of CC intolerance and perform conversion to carotid artery stenting (CAS). This approach remains controversial and is not accepted by many clinicians.</p><p><strong>Evidence acquisition: </strong>PubMed, Embase, Web of Science and Cochrane databases were searched for reports published over the last 15 years (2010-2025) regarding conversion to CAS after neurological intolerance to CC during CEA.</p><p><strong>Evidence synthesis: </strong>Carotid CC intolerance may develop in around 10% of patients undergoing CEA under locoregional anesthesia. There is some evidence that patients who develop CC intolerance may have higher degrees of contralateral carotid stenosis and a higher incidence of perioperative cerebrovascular events compared with individuals who do not develop neurological symptoms after CC. Conversion to CAS may be an alternative to usage of a shunt.</p><p><strong>Conclusions: </strong>The occurrence of carotid CC intolerance during CEA may be a reason to abandon the procedure and convert to CAS. Nonetheless, the evidence on this topic is not robust, as it is based on small, single-center studies. A multicenter study may provide better-quality evidence in the future.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"311-315"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Technical considerations for reconstruction of extracranial carotid artery redundancy concurrent with endarterectomy.","authors":"Rachel M Breault, Mark K Eskandari, Gabriel A Wallace","doi":"10.23736/S0392-9590.25.05429-X","DOIUrl":"10.23736/S0392-9590.25.05429-X","url":null,"abstract":"<p><p>Anatomic variations of the cervical internal carotid artery (ICA) are present in a significant incidence of the general population. These variations can include redundancy of the ICA, loops, kinks, and coils. When present, these anatomical variances must be addressed at the time of carotid endarterectomy (CEA) and may contribute to technical complexity associated with the operation. Pre-operative anticipation and familiarity with techniques to address these variant anatomies intraoperatively are of benefit to surgeons who perform carotid endarterectomy. Multiple technical approaches have been described to address these ICA configurations with complex CEA including eversion endarterectomy with proximal transposition of the ICA, standard endarterectomy with rotational proximal transposition or shortening to facilitate re-implantation of the ICA, segmental resection of the redundant endarterectomized ICA with backwall reconstruction and anterior wall patch angioplasty, segmental resection of the common carotid artery with primary re-anastomosis, plication of the ICA, anteposition of the ICA using adjacent muscle bellies, and extraluminal methods such as suturing the arterial adventitia to adjacent muscle and the use of fibrin glue and gelatin. We summarize an optimized approach to carotid endarterectomy considering the breadth of anatomical variations and approaches to correction of them, with an emphasis on the importance of individualized surgical planning and the necessity of the contemporary carotid surgeon's familiarity with technical options and intraoperative adaptability.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"263-270"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of the Prevalence of Asymptomatic Carotid Artery Stenosis Risk Score in the cohort of the Cyprus Epidemiological Study on Atherosclerosis.","authors":"Andrew N Nicolaides, Andrie G Panayiotou, Maura B Griffin, Theodosis Tyllis, Efthyvoulos Kyriacou, Costantinos Avraamides, Stavros Kakkos, Constantinos Koshiaris, Richard M Martin","doi":"10.23736/S0392-9590.25.05457-4","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05457-4","url":null,"abstract":"<p><strong>Background: </strong>There has been a continuous debate on the value of screening for asymptomatic carotid artery stenosis (CAS) because of the low prevalence in the general population as well as the risk of complications associated with surgical intervention. The aim of the study was to determine the association between the Prevalence of Asymptomatic Carotid Artery Stenosis (PACAS) risk score and (a) the prevalence of asymptomatic CAS ≥50%, ≥70%, <50%, and the prevalence of two or more bifurcations with plaque (carotid or common femoral), (b) the risk of stroke/transient ischemic attack (TIA) and atherosclerotic cardiovascular disease (ASCVD), and (c) the effect of two or more bifurcations (carotid or common femoral) with plaque (BWP) in up classifying subjects into higher risk in the cohort of the Cyprus Epidemiological Study on Atherosclerosis (CESA).</p><p><strong>Methods: </strong>CESA is a prospective study in the Republic of Cyprus with 1102 subjects aged 40-89 at baseline of which 1000 were free of ASCVD at recruitment. Follow-up was for a mean of 15.5±4.6 years (range 1-20). Both carotid bifurcations and both common femoral bifurcations were scanned with ultrasound to determine presence of plaques and degree of CAS.</p><p><strong>Results: </strong>The prevalence of CAS ≥50% and ≥70% in the cohort was 3.3% and 0.7% respectively. A PACAS score of ≥11 (11-20) was able to identify a subgroup of 230 (23%) with a prevalence of 26 (2.6%) CAS ≥50%. This subgroup contained 26 (72%) of the 36 plaques that produced a CAS ≥50%. A PACAS score ≥15 was able to identify a subgroup of 37 (3.7%) with a prevalence of 5 (13.5%) CAS ≥70%. PACAS scores of 0-4, 5-10, 11-14 and 15-20 identified four groups of 10-year observed ASCVD risk of 2% (low-risk), 13% (moderate-risk), 22% (high-risk) and 63% (very high- risk) respectively. The presence of two or more BWP could up classify 31 (14.5%) out of 225 in the low risk to the moderate risk group and 298 (48.2%) out of 619 subjects in the moderate risk group into a high-risk group.</p><p><strong>Conclusions: </strong>PACAS risk score performed well in the CESA cohort. It identified subgroups with a high prevalence of moderate and severe carotid artery stenosis. In addition, it identified four groups of 10-year risk of ASCVD: Low, moderate, high and very high risk. Modulation of this risk could be achieved by the number of bifurcations with plaque.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"301-310"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Urgent management of symptomatic carotid artery stenosis: a critical review of the literature.","authors":"Francesca Santoro, Marco Sferruzzi, Nunzio Montelione, Vincenzo Catanese, Rosalinda Calandrelli, Francesco Spinelli, Francesco Stilo, Vincenzo DI Lazzaro, Fabio Pilato","doi":"10.23736/S0392-9590.25.05446-X","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05446-X","url":null,"abstract":"<p><p>Although there is a consensus on the role of carotid endarterectomy in symptomatic carotid stenosis, the optimal timing of surgery and its role in the context of acute stroke remain controversial. This study aims to review the key factors influencing treatment decisions, including patient characteristics, anatomical considerations, imaging findings and procedural risks associated with acute carotid endarterectomy (CEA) and carotid artery stenting (CAS). We performed a narrative review of the existing literature to summarize current evidence on the indications, timing, and outcomes of CEA and CAS in patients with recent ischemic stroke related to carotid stenosis. 86 articles were identified. After reviewing 10 studies were included in the review. The primary outcome evaluated in all studies was the perioperative day stroke/death rate. Although some discrepancies were found among the studies, CEA showed a stroke/death rate ranging from approximately 1.3% within the first 7 days to 3.6% after 7 days. In contrast, CAS had a higher rate in the early period (8.3%) compared to later (7.1%), highlighting an increased risk of CAS within the first 7 days. Managing symptomatic carotid stenosis requires a careful, individualized approach considering patient characteristics, comorbidities, and the timing of surgery. Early intervention is beneficial, but patient-specific risk factors must be weighed carefully.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"330-340"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term outcomes of endovascular treatment for internal carotid artery dissection.","authors":"Salvatore Bruno, Domenico Mirabella, Ettore Dinoto, Felice Pecoraro","doi":"10.23736/S0392-9590.25.05426-4","DOIUrl":"https://doi.org/10.23736/S0392-9590.25.05426-4","url":null,"abstract":"<p><strong>Background: </strong>This study aims to assess the feasibility and safety of endovascular treatment of spontaneous internal carotid artery dissections (ICAD) using a proximal embolic protection device (EPD).</p><p><strong>Methods: </strong>From January 2012 to December 2023 all consecutive patients admitted for ICAD who underwent carotid artery stenting using MoMa Ultra (Medtronic, Minneapolis, MN, USA) proximal EPD were included in this single-center study and were retrospectively analyzed. The presence of neurological symptoms was the only indication for treatment. Early outcomes included technical success, perioperative mortality, and major cardiovascular and cerebral complications. Late outcomes were recurrent neurological symptoms, patency, and reinterventions.</p><p><strong>Results: </strong>A total of 9 patients were included in the study, all presenting with neurological symptoms. Among them, 8 were diagnosed with a transitory ischemic attack (TIA), while 1 had amaurosis fugax and transitory aphasia. Significant haemodinamic ICAD were 7. Complete anatomic resolution was achieved in all patients with no further lesions of the carotid axis. At a median follow-up of 63.9 months (IQR 27.1- 63.3), a single patient died due to worsening of pre-existent chronic heart failure; no intrastent restenosis were registered and all stents were patent.</p><p><strong>Conclusions: </strong>The use of a proximal EPD for endovascular treatment of ICAD under flow arrest seems to be feasible and safe, minimizing the risk of intraoperative stroke. Larger series are required to confirm these results and validate the treatment strategy.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":"44 4","pages":"323-329"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of carotid plaque analysis in therapeutic decision-making for carotid disease.","authors":"Ivan B Casella, Helio B Neto, Eduardo C Teixeira, José A Tavares Monteiro, Bruno D Constantin, Peter C Françolin, Thiago N Villari, Calógero Presti","doi":"10.23736/S0392-9590.25.05443-4","DOIUrl":"10.23736/S0392-9590.25.05443-4","url":null,"abstract":"<p><p>Carotid atherosclerosis is an important yet declining etiology of embolic stroke and cerebrovascular or retinal ischemic events with an embolic source. The severity of stenosis is the most important anatomic factor for deciding whether to use optimized medical therapy alone or interventional therapy. Recently, specific features of the atherosclerotic plaque have attracted increasing attention; for example, total plaque area, juxtaluminal black area, intraplaque hemorrhage, and mainly echolucent plaques are associated with high risk of late stroke, and these features now influence the therapeutic choices. This review describes the current state of carotid plaque analysis using different image modalities and its effect on current guidelines and clinical practice.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"283-290"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}