Journal of Craniofacial Surgery最新文献

{"title":"Outcomes of Tongue Reduction Surgery in Beckwith-Wiedemann Syndrome: A Systematic Review.","authors":"Beraki Abraha, Oliva Macintyre, Hannah Brennan, Paul Hong, Michael Bezuhly","doi":"10.1097/SCS.0000000000011045","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011045","url":null,"abstract":"<p><strong>Introduction: </strong>Macroglossia is a frequent clinical feature of Beckwith-Wiedemann syndrome (BWS), a congenital overgrowth disorder. Macroglossia can lead to abnormal breathing, feeding, speech, and dentoskeletal development. Partial glossectomy is a common intervention aimed at reducing these abnormalities. The optimal timing of partial glossectomy remains controversial due to the potential need for secondary surgery and the ongoing growth of the tongue in early childhood.</p><p><strong>Materials and methods: </strong>After PRISMA-ScR and PRISMA-S reporting standards, this systematic review included English language studies of patients with BWS who underwent partial glossectomy. Data were extracted, including patient age, clinical outcomes, and follow-up. Study evidence levels were categorized based on a recognized hierarchy, and bias was assessed using the MINORS criteria.</p><p><strong>Results: </strong>Early tongue reduction surgery (<24 mo) was associated with a lower incidence of class 3 occlusion and anterior open bite compared with later surgery. Improvements in speech intelligibility, tongue mobility, and breathing outcomes, including a reduction in obstructive sleep apnea, were observed, especially in early surgical groups. Feeding and drooling outcomes improved across both early and late surgical interventions, although no direct comparisons were made between the 2. Overall, tongue reduction surgery demonstrated benefits in functional outcomes, whereas dentoskeletal improvements remained variable.</p><p><strong>Conclusion: </strong>Although there is a lack of consensus to the optimal age for the procedure, overall tongue reduction surgery in BWS seems to have functional benefits, including in speech, feeding, and breathing. Dentoskeletal outcomes are more variable. Variability in macroglossia severity, surgical technique, and surgeon experience may account for differences in reported outcomes across studies.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949641","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":"CBCT-Based Analysis of Factors Influencing the Quality of New Bone Formation Following Mandibular Distraction Osteogenesis in Children With Pierre Robin Sequence.","authors":"Jiawei Zhou, Zhe Mao, Kairui Chen, Shuzheng Xu, Yingqiu Cui","doi":"10.1097/SCS.0000000000011054","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011054","url":null,"abstract":"<p><p>The aim of this study was to explore the factors influencing the quality of new bone formation after distraction osteogenesis in children with Pierre Robin sequence (PRS). Using cone-beam computed tomography (CBCT), bone density relative grayscale values of the region of new bone formation before and 3 to 4 months after mandibular distraction osteogenesis (MDO) were measured in 80 children with PRS, and correlation analysis was conducted with the potential clinical influencing factors of the children. CBCT reconstruction of the panoramic film showed that the new bone formation was good at 3 to 4 months after MDO. There was a statistically significant difference in the gray value of cancellous bone before and after the operation (P<0.01). The gray values of bilateral mandibular new bone after MDO were related to cleft palate, preoperative weight, preoperative body mass index (BMI), and distraction length. Finally, the variables included in the multiple linear regression model were cleft palate and preoperative BMI. At 3 to 4 months after MDO, the mineralization degree of cancellous bone in the central region of the bilateral mandibular new bone formation area was lower. The presence of cleft palate and preoperative BMI were identified as the main factors influencing the new bone formation in bilateral mandibles after MDO. This may be attributed to the catch-up nutritional acquisition and growth promotion in children, which facilitates new bone formation, along with greater chewing muscle strength to prevent mineral loss from bones.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949581","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":"Normative Palatal Measurements in Infants: Implications for Nasoalveolar Molding in Cleft Lip and Palate Patients.","authors":"Katherine A Gossett, Serena N Kassam, Tyler M Rist, Jenna Thuman, Seth Stalcup, Milad Yazdani, Mathew J Gregoski, Krishna G Patel","doi":"10.1097/SCS.0000000000011039","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011039","url":null,"abstract":"<p><strong>Background: </strong>Children with cleft lip ± palate (CL/P) may undergo nasoalveolar molding (NAM) before surgery to achieve arch alignment and tension-free closure, yet the endpoint of arch dimensions has not been defined.</p><p><strong>Objective: </strong>To characterize the size and shape of infant palates using anatomic landmarks on magnetic resonance imaging in infants without CL/P.</p><p><strong>Methods: </strong>Magnetic resonance imaging of infants without cleft palate younger than 3 months were reviewed and 13 measurements were taken to define palatal shape: distance between incisive foramen (IF) and incisors (IN), IF and middle of canines (MOC), between MOCs, between first molars (FM), 2 depth and 4 angle measurements.</p><p><strong>Results: </strong>Ninety-two infants between 30 and 44 weeks old were included. Pre-maxillary growth from 30 to 44 weeks demonstrated the slowest growth (0.06 cm) from IF to between IN (B) and the greatest growth (0.7 cm) between the width of FM (K). The measurements between MOC (J) and between FMs (K) had the highest positive correlation to age at 0.55 and 0.61, respectively.</p><p><strong>Conclusion: </strong>There was predictable growth of the palate noted between 30 and 44 weeks, with the most predictive measurements represented by the width of the canines and first molar locations along the alveolus. These values can help guide pre-surgical orthopedics in infants with CL/P.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931856","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":"Aesthetic Reconstruction of Huge Full-Thickness Defection of Lower Eyelid Using Nasolabial Mucosal-Myocutaneous Propeller Flap.","authors":"Yu Zhang, Xi Zhang, Jie Chen","doi":"10.1097/SCS.0000000000011046","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011046","url":null,"abstract":"<p><p>Reconstruction after the excision of a lower eyelid tumor should be focused on the restoration of both functionality and aesthetic appeal. Accurate identification and appropriate intervention are crucial for the favorable resolution of the condition. This technique used a nasolabial mucosal-myocutaneous propeller flap to reconstruct a huge full-thickness defection of right lower eyelid because of basal cell carcinoma. Therefore, the nasolabial mucosal-myocutaneous propeller flap displayed an excellent adaptation to the orbital structure, ensuring high graft survivability, and yielding an aesthetically pleasing outcome with negligible morbidity at the donor site. This case serves as an important reminder to choose the nasolabial mucosal-myocutaneous propeller flap, which was viable and could be applied to reconstruct the skin, tarsus, and palpebral conjunctiva at a time.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931924","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":"Isolated Temporomandibular Arthritis as Presentation of Juvenile Idiopathic Arthritis.","authors":"Luca Bernardo, Alessandro Visioli, Emanuela Del Giudice, Vittoria Carlotta Magenes, Francesca Casini, Giovanni Chiaffoni, Martina Sandini, Valentina Ansuini, Riccardo Lubrano, Angela Mauro","doi":"10.1097/SCS.0000000000011000","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011000","url":null,"abstract":"<p><p>Involvement of the temporomandibular joint (TMJ) in patients with juvenile idiopathic arthritis (JIA) has been increasingly reported, affecting up to 87% of cases. This involvement generally occurs after the diagnosis of JIA has been established; however, in the authors' cases, as in a few others documented in the literature, patients presented with isolated TMJ arthritis as the sole joint involvement. The authors performed a narrative literature review on TMJ involvement in JIA and reported 2 cases that presented with isolated TMJ arthritis as the initial manifestation of JIA. Although isolated TMJ involvement may be rare, it can lead to severe complications, such as complete loss of TMJ function. Thus, clinicians should be aware of this potential presentation to conduct necessary investigations and provide appropriate treatment.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931928","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":"Anatomic Changes of Patients With Obstructive Sleep Apnea Syndrome at Different Stages.","authors":"Semahat Doğru Yuvarlakbaş, Neslihan Boyan, Sedat Kuleci, Hüseyin Tuğsan Balli","doi":"10.1097/SCS.0000000000011053","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011053","url":null,"abstract":"<p><strong>Aim: </strong>In this study, it was aimed to determine the changes in the anatomic structures of individuals with obstructive sleep apnea syndrome (OSAS) classified according to the apnea-hypopnea index (AHI).</p><p><strong>Materials and methods: </strong>Individuals were divided into groups as group 1 (AHI=0, n=20), group 2 (AHI ˂5, n=20), group 3 (AHI=5-15, n=20), group 4 (AHI=16-30, n=20), group 5 (AHI ˃30, n=20). The individuals left lateral cervical vertebra radiographs were taken. Measurements were made from the morphometric points determined using the \"Enlil PACS\" program on the radiologic images (mm). These measurements are categorized into soft tissue, hyoid bone, airway size, and craniofacial variables.</p><p><strong>Results: </strong>As AHI increased, age, body mass index, neck circumference, and Epworth Sleep Scale scores increased in all groups. Soft palate and tongue length, hyoid-mandible, hyoid-posterior pharyngeal wall, and hyoid-spina nasalis posterior distances lengthened. An increase was found between spina nasalis anterior, spina nasalis posterior, distance between condylion and gnathion, and total facial length and lower face length in all groups.</p><p><strong>Conclusions: </strong>It is thought that the results obtained due to the differentiation in anatomic structures may help the methods that will facilitate the diagnosis and treatment of OSAS.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921743","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 Incidence and Aetiology of Maxillofacial Trauma and Concomitant Traumatic Brain Injury in a Johannesburg Tertiary Hospital.","authors":"Faheema Khan, Risimati E Rikhotso","doi":"10.1097/SCS.0000000000011056","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011056","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the incidence and etiology of maxillofacial trauma (MFT) and its association with traumatic brain injury (TBI).</p><p><strong>Background: </strong>Anecdotal evidence suggests that there is an association between MFT and TBI and that higher incidences of TBI are associated with frontal bone and mid-facial fractures. Despite the large volume of maxillofacial facial fractures treated in the authors' unit, no study has been undertaken to establish the relationship between TBI and maxillofacial fractures.</p><p><strong>Methods: </strong>This was a retrospective single-center cross-sectional study that was conducted on patients who presented at Charlotte Maxeke Academic Hospital emergency department with MFT and concomitant TBI over a period of 1 year (January 2019-January 2020). The primary predictor was maxillofacial fractures, which were classified into upper, middle, and lower thirds. The primary outcome variable was TBI indicated by the Glasgow Coma Scale (GCS) and Marshall computed tomography (CT) classification (radiological finding in CT).Variables such as age, etiology, fracture type, and neurological injury indicated by the recorded GCS and Marshall CT classification (I-IV) were collected. Maxillofacial fractures were classified based on the anatomical location. The level of significance was set at P <0.05.</p><p><strong>Results: </strong>A total of 112 patients (102 males, 10 females) presented with MFT and concomitant TBI. The age group 30 to 39, followed by 20 to 29 years, was most affected. Respectively assault (n = 67), gunshots (n = 16), and falls (n = 16) were the main causes of injury. Supra-orbital rim fractures (P = 0.00193), frontal sinus fractures (P < 0.001,), and panfacial fractures (P < 0.001) were significantly associated with TBI. Severe TBI (GCS: 3-8) was associated with higher Marshall CT grading.</p><p><strong>Conclusions: </strong>Facial fractures affecting the upper third and panfacial fractures pose a significant risk for TBI. To identify TBIs, a multidisciplinary evaluation of facial fractures is recommended, especially in high-risk groups.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921899","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":"Risk Factors and Treatment Strategies for Subcutaneous Effusion Secondary to Cerebrospinal Fluid Leakage After Craniotomy.","authors":"Susu Yuan, Yanlin Chen, Yichao Jin, Feng Jia","doi":"10.1097/SCS.0000000000011052","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011052","url":null,"abstract":"<p><strong>Objective: </strong>To confirm the incidence of subcutaneous effusion secondary to cerebrospinal fluid leakage after craniotomy, analyze the risk factors for cerebrospinal fluid leakage leading to subcutaneous effusion, summarize the underlying causes of its occurrence and explore the corresponding treatment strategies.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 757 patients who underwent craniotomy at our hospital from January to December 2023. The authors documented the sex, age, surgical characteristics, and history of chronic diseases for all patients, including those who developed subcutaneous effusion secondary to cerebrospinal fluid leakage. These factors were subjected to univariate regression analysis, and the identified risk factors were evaluated in a multivariate regression analysis.</p><p><strong>Results: </strong>Among 757 patients who underwent craniotomy, 15 developed subcutaneous effusion secondary to cerebrospinal fluid leakage, representing an incidence of 1.98%. This group included 5 patients with acoustic neuroma surgery, 4 with neurovascular decompression, 4 with meningioma surgery, 1 patient undergoing a posterior corpus callosotomy for epilepsy, and 1 patient with cerebellar cavernoma resection. Factors such as acoustic neuroma surgery, neurovascular decompression, infratentorial surgery, longer surgical durations, larger cranial bone removals, higher body mass index, and smoking were associated with an increased risk of developing subcutaneous effusion secondary to cerebrospinal fluid leakage. The average time to onset was 40.8 ± 37.16 days. Three patients with subcutaneous effusion experienced elevated body temperatures, with one testing positive in blood cultures; no other complications were noted. All patients initially received conservative treatment and subsequently underwent surgical repair for the cerebrospinal fluid leak an average of 45.4 ± 57.94 days later, ultimately resulting in recovery and discharge.</p><p><strong>Conclusion: </strong>In 2023, the incidence of subcutaneous effusion secondary to cerebrospinal fluid leakage after craniotomy at our hospital was 1.98%. The fundamental cause of this complication is the pressure difference between the inside and outside of the dura mater, leading to incomplete dural closure and subsequent fluid leakage. Factors such as younger age, acoustic neuroma surgery, neurovascular decompression, infratentorial surgery, longer surgery durations, larger cranial bone removals, higher body mass index, and smoking are associated with an increased risk of subcutaneous effusion. Once subcutaneous effusion occurs, conservative management is the initial step. To optimize outcomes, surgical repair of the cerebrospinal fluid leak should follow conservative treatment. This approach can significantly reduce the likelihood of treatment failure, decrease hospital stays, and cut unnecessary costs.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921882","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":"Effectiveness and Safety of Glue-based Dural Closure in Cranial Surgery: A Retrospective Cohort Study.","authors":"Chunhui Li, Yingjie Wu, Qiulian Mo, Meijun Yang, Hao Liang","doi":"10.1097/SCS.0000000000011069","DOIUrl":"https://doi.org/10.1097/SCS.0000000000011069","url":null,"abstract":"<p><p>Dural closure is a crucial step in cranial surgery, essential for preventing complications like cerebrospinal fluid leakage, wound infections, and meningitis. Traditional suturing techniques, however, pose challenges such as technical difficulty and the potential for tissue damage. This retrospective study aimed to assess the safety and effectiveness of a nonsuture dural closure method using medical glue for direct adhesion of a patch to the dura mater. It was conducted from September 2019 to September 2023, including 169 patients with supratentorial brain injuries who underwent nonsuture dural closure (glue group) and 209 patients who received suture dural closure (suture group). The study compared the operation time and material costs between the two groups, with patients followed for 3 months to monitor complications and adverse events. The results showed that the operation time for dural closure was significantly shorter in the glue group (8.4 ± 3.7 min) compared with the suture group (21.7 ± 4.1 min). Postoperative complications were significantly lower in the glue group. There were no significant differences in adverse events between the groups. These findings suggest that nonsuture dural closure with medical glue is a simple, efficient, and safe alternative to traditional suturing, effectively reducing postoperative complications.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921745","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":"Intraoperative Skull Fracture During Halo Application in Subcranial Le Fort III: Strategies for Managing a Rare Complication.","authors":"Stephen D Moreno, Samuel D Raffaelli, Robert H Liu, Barry Steinberg","doi":"10.1097/SCS.0000000000010959","DOIUrl":"https://doi.org/10.1097/SCS.0000000000010959","url":null,"abstract":"<p><p>External rigid distraction is an established method for achieving subcranial Le Fort III advancement in severe syndromic craniosynostosis. Craniofacial surgeons commonly use halo-type devices for these corrections, as they allow for multiple vectors of pull and facilitate larger midfacial advancements. Although most complications related to their use involve pin displacement or infection, rare complications such as skull fractures have been reported. At 3 months of age, a patient with Apert Syndrome underwent endoscopic-assisted craniectomies for bilateral coronal craniosynostosis. After a year of helmet therapy, he developed pansynostosis and required fronto-orbital advancement. Later at the age of 6, a Le Fort III distraction using a RED II rigid external distractor was performed to address his midfacial hypoplasia, exorbitism, and severe obstructive sleep apnea. While placing the RED II distractor, a shift in the device was noted upon pin fixation, raising suspicion for a unilateral depressed skull fracture. Although computed tomography imaging revealed pin displacement, there was no clinical indication for immediate repair. Given the surgical and psychological burden this could have on the patient, the decision was made to leave the RED II device in place and proceed with the distraction. After distraction and an 8-week latency period for complete consolidation of the facial bony architecture, the RED II device was removed, and the skull fracture was repaired. In patients with multi-operated skulls and residual cranial defects, halo-type devices may present an increased risk of skull fractures. This report discusses alternatives in the literature and presents an example of a rare complication successfully managed with delayed repair.</p>","PeriodicalId":15462,"journal":{"name":"Journal of Craniofacial Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921845","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}