Journal of Clinical Anesthesia最新文献

{"title":"Response to Letter to the Editor: “Frailty as an independent risk factor for prolonged postoperative length of stay: A retrospective analysis of 2015–2019 ACS NSQIP data”","authors":"Jane Y. Xu MPH , Hannah E. Madden BS , Pablo Martínez-Camblor PhD , Stacie G. Deiner MD","doi":"10.1016/j.jclinane.2025.111817","DOIUrl":"10.1016/j.jclinane.2025.111817","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111817"},"PeriodicalIF":5.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143682736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Virtual reality improves pain threshold and recall in healthy adults: A randomized, crossover study","authors":"Samuel T. Rodriguez MD ,&nbsp;Ricardo T. Jimenez BA ,&nbsp;Ellen Y. Wang MD ,&nbsp;Michelle Zuniga-Hernandez BS ,&nbsp;Janet Titzler BS ,&nbsp;Christian Jackson BS ,&nbsp;Man Yee Suen MMedSci ,&nbsp;Craig Yamaguchi BS ,&nbsp;Brian Ko ,&nbsp;Jiang-Ti Kong MD ,&nbsp;Thomas J. Caruso MD, PhD","doi":"10.1016/j.jclinane.2025.111816","DOIUrl":"10.1016/j.jclinane.2025.111816","url":null,"abstract":"<div><h3>Study objective</h3><div>Virtual reality (VR) is an emerging technology increasingly used to ameliorate acute and chronic pain although controlled, quantifiable data are limited. The purpose of this study is to evaluate VR's effect on heat pain threshold (HPT), pressure pain threshold (PPT), immediate pain and anxiety, and recalled pain and anxiety.</div></div><div><h3>Design</h3><div>Prospective, randomized, crossover clinical trial.</div></div><div><h3>Setting</h3><div>The Stanford Chariot Program conducted this study at the Stanford School of Medicine Health System.</div></div><div><h3>Patients</h3><div>Healthy participants meeting inclusion criteria were recruited by solicitation from the Stanford School of Medicine Health System.</div></div><div><h3>Interventions</h3><div>Participants were randomized by hand dominance and condition sequence and underwent standardized pain threshold tests with a thermode or an algometer during VR and control conditions.</div></div><div><h3>Measurements</h3><div>Pain threshold, numeric pain scores, and anxiety scores were immediately recorded. Recalled pain and anxiety scores were recorded 24 h later.</div></div><div><h3>Main results</h3><div>A total of 80 participants were included, 40 who underwent HPT testing and 40 who underwent PPT testing. VR increased pain thresholds for both HPT (<em>P</em> <em>=</em> 0.002) and PPT (<em>P</em> <em>=</em> 0.044). The use of VR resulted in no difference in initial pain scores for HPT (<em>P</em> <em>=</em> 0.432) or PPT (<em>P</em> <em>=</em> 0.24). There was no difference in recalled pain when using VR for HPT (<em>P</em> <em>=</em> 0.851) although there was for PPT (<em>P</em> <em>=</em> 0.003). Initial and recalled anxiety scores for HPT (<em>P</em> <em>=</em> 0.006, <em>P</em> <em>=</em> 0.018, respectively) and PPT (<em>P</em> <em>=</em> 0.014, <em>P</em> <em>=</em> 0.002, respectively) were all reduced when using VR.</div></div><div><h3>Conclusions</h3><div>This study demonstrates that VR increased pain thresholds while modulating initial and recalled experiences with anxiety, which has implications for enhancing patient experiences during medical interventions and long-term health outcomes by optimizing memories during stressful events.</div><div>Clinical trial registration: <span><span>NCT05836649</span><svg><path></path></svg></span>, 4/19/23.</div><div>IRB registration: Stanford IRB #69330.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111816"},"PeriodicalIF":5.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between the Duke Activity Status Index and complications after noncardiac surgery: A systematic review","authors":"Earlene Silvapulle ,&nbsp;Jai Darvall ,&nbsp;Anurika De Silva","doi":"10.1016/j.jclinane.2025.111808","DOIUrl":"10.1016/j.jclinane.2025.111808","url":null,"abstract":"<div><h3>Background</h3><div>Individuals with poor functional capacity are at increased risk of perioperative complications. The Duke Activity Status Index (DASI) can ascertain the maximum physical activity achievable. However, the accuracy of the DASI score in identifying high-risk individuals is unclear. The objective of this systematic review was to determine the association between the DASI score and postoperative complications.</div></div><div><h3>Methods</h3><div>Studies conducted in adults undergoing elective or emergency noncardiac surgery were eligible. The search strategy used MEDLINE, EMBASE, EMCARE and Cochrane CENTRAL, from January 1st, 1988 to August 8th, 2024. Study quality and risk of bias were evaluated independently by two assessors.</div></div><div><h3>Results</h3><div>Of 5989 citations, nine studies (3100 participants) were included. The DASI score was associated with postoperative mortality (two studies, 732 participants) and postoperative cardiovascular complications (two studies, 2055 participants). The DASI score provided fair prediction of postoperative complications (three studies, area under the receiver operating characteristic curve range 0.71 to 0.75). Marked study heterogeneity precluded meta-analysis.</div></div><div><h3>Discussion</h3><div>This systematic review found an association between low DASI scores and cardiovascular complications, postoperative complications and mortality, and variable association between DASI scores and hospital length of stay. The major limitation to the evidence was the significant heterogeneity of study population, outcome definitions, DASI thresholds and cardiovascular endpoints.</div></div><div><h3>Conclusion</h3><div>Amongst adults undergoing noncardiac surgery, the DASI score is associated with postoperative complications, cardiovascular complications and mortality. Further research is required to identify a DASI threshold (or confirm the DASI threshold of 34) that accurately predicts postoperative complications, including major cardiac events.</div></div><div><h3>Other</h3><div>This systematic review was registered with PROSPERO on March 4th, 2024 (CRD42024331864). No funding was obtained for this review.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111808"},"PeriodicalIF":5.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143636858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of differential glycemic management goals in pre-anhepatic and anhepatic phase on early grafted liver function after liver transplantation: An open-label, randomized, controlled study","authors":"Yi Duan MD ,&nbsp;Lei Cui MD ,&nbsp;Zuozhi Li MD, PhD ,&nbsp;Zhifeng Gao MD ,&nbsp;Fulei Gu MD ,&nbsp;Huan Zhang MD","doi":"10.1016/j.jclinane.2025.111807","DOIUrl":"10.1016/j.jclinane.2025.111807","url":null,"abstract":"<div><h3>Background</h3><div>Liver graft function is related to the quality of liver transplantation (LT). High-quality perioperative glycemic management is considered hepatoprotective. However, no studies have explored the effects of specialized and staged blood glucose management target ranges on reducing glycemic variability (GV) and early allograft dysfunction (EAD) after LT.</div></div><div><h3>Methods</h3><div>In this prospective randomized controlled trial, a total of 188 LT recipients were randomly assigned 1:1 to the less intensive glucose management (LIGM) group and the more intensive glucose management (MIGM) group. They followed goals of 7.8–10.0 mmol/L and 4.5–6.7 mmol/L in the pre-anhepatic and anhepatic phases, respectively, and the goals of 4.1–10.0 mmol/L in the neohepatic phase and postoperatively. The primary outcome was EAD, and the secondary outcomes were GV, incidence of hyperglycemia/hypoglycemia, postoperative liver enzyme levels, 30-day postoperative infection rate, one-year survival rate, and TNF-α, IL-6 and C-reactive protein levels.</div></div><div><h3>Results</h3><div>A total of 182 adult patients (89 in the LIGM group and 93 in the MIGM group) completed the study. The mean age of the recipients was 51.46 ± 10.79 years, and the median MELD score before surgery was 16. The incidence of EAD was significantly lower in the LIGM group than in the MIGM group (10.11 % vs 31.18 %, P &lt; 0.001), with a relative risk (RR) of 0.32 (2-sided 95 % CI 0.110–0.562). There was no statistical difference in the 30-day postoperative infection rate between the two groups (<em>P</em> &gt; 0.05). The one-year survival rate of the LIGM group was higher than that of the MIGM group (92.13 % vs 82.02 %, <em>P</em> = 0.044).</div></div><div><h3>Conclusions</h3><div>Adopting LIGM (7.8–10.0 mmol/L) during the pre-anhepatic and anhepatic phases helps to reduce the incidence of EAD after LT and promotes the recovery of liver function, but does not increase the incidence of postoperative infections.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111807"},"PeriodicalIF":5.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143628469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of intraoperative intraocular pressure using different head fixation devices in prone spinal surgery","authors":"Kosuke Sugimura MD ,&nbsp;Tamie Takenami MD, PhD ,&nbsp;Tomoko Suzuki PhD ,&nbsp;Tetsuya Ikeda MD, PhD ,&nbsp;Mayuko Sakai MD, PhD ,&nbsp;Wataru Saitou MD, PhD","doi":"10.1016/j.jclinane.2025.111812","DOIUrl":"10.1016/j.jclinane.2025.111812","url":null,"abstract":"<div><h3>Study objective</h3><div>We aimed to compare intraoperative intraocular pressure (IOP) during prone spinal surgery using a horseshoe headrest versus pinned head-holder to identify the safer device, which causes a lower increase in IOP.</div></div><div><h3>Design</h3><div>A prospective cohort study.</div></div><div><h3>Setting</h3><div>Operating room.</div></div><div><h3>Patients</h3><div>Healthy adults (aged 49–78 years) with an American Society of Anesthesiologists classification of I/II.</div></div><div><h3>Interventions</h3><div>Prone spinal surgery using a horseshoe headrest (Hs group) or pinned head-holder (Pin group) during 2016–2018.</div></div><div><h3>Measurements</h3><div>Both groups were examined for IOP, anterior chamber angle, and fundus findings the day before surgery. The IOP was measured immediately after intubation until the end of surgery. Risk factors for increased IOP in prone positioning were examined. A linear mixed model was used to investigate the rate of IOP increase with operative time.</div></div><div><h3>Main results</h3><div>The IOP in both groups was similar after 1 h and 2 h in the prone position and was highest at suture closure. The range of significantly elevated IOP varied in each group. The Pin group took longer to elevate IOP after prone positioning and recover IOP after supine positioning than the Hs group. The operative time and prone duration were significantly greater in the Pin group, with no significant IOP difference between the groups at all time points. The linear mixed model showed a high rate of IOP elevation up to 1 h in the prone position, after which the rate of IOP elevation decreased, with no significant IOP difference between the two groups at any time point. No risk factors for increasing IOP in the prone position were identified.</div></div><div><h3>Conclusions</h3><div>No differences in intraoperative IOP according to the head fixation device were observed. Therefore, the incidence of postoperative visual impairment could be comparable between the devices if direct eye compression is avoided during surgery.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111812"},"PeriodicalIF":5.0,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143619306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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 regarding “Intraoperative high and low blood pressures are not associated with delirium after cardiac surgery: A retrospective cohort study”","authors":"Shuang-Bo Dai MD,&nbsp;Jun-Jie Lin MD","doi":"10.1016/j.jclinane.2025.111809","DOIUrl":"10.1016/j.jclinane.2025.111809","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111809"},"PeriodicalIF":5.0,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficiency of interpectoral and pectoserratus plane blocks for breast surgery: A randomized controlled trial","authors":"Aline Albi-Feldzer ,&nbsp;Guillaume Gayraud ,&nbsp;Sylvain Dureau ,&nbsp;Marion Augé ,&nbsp;Adrien Lemoine ,&nbsp;Julien Raft","doi":"10.1016/j.jclinane.2025.111805","DOIUrl":"10.1016/j.jclinane.2025.111805","url":null,"abstract":"<div><h3>Background</h3><div>Interpectoral and pectoserratus plane blocks are fascial plane blocks that are used during anterolateral superficial chest wall surgery. However, the true analgesic efficacy of these blocks in oncological breast surgery is unclear because of the diversity of breast-surgery procedures. The primary hypothesis of this study was that these blocks reduce the incidence of acute pain.</div></div><div><h3>Methods</h3><div>This double-blinded, multicenter, randomized controlled study included 185 patients. Patients were randomized equally into two groups at a 1:1 ratio according to the type of interfascial injection received (ropivacaine vs. saline). The incidence of analgesic rescue during the first 3 postoperative hours was the primary outcome measure.</div></div><div><h3>Results</h3><div>The authors enrolled 182 women. The analgesic rescue incidence was lower in the ropivacaine group. Interpectoral and pectoserratus plane blocks with ropivacaine had an incidence of analgesic rescue of 43 % (<em>n</em> = 37) versus 61 % (<em>n</em> = 50) in patients given the placebo (relative risk = 0.70; 95 % CI = 0.52 to 0.94; <em>p</em> = 0.02). Interpectoral and pectoserratus plane blocks with ropivacaine are associated with a 30 % reduction in the use of rescue analgesics.</div></div><div><h3>Conclusions</h3><div>Interpectoral and pectoserratus plane blocks reduced the incidence of analgesic rescue and reduced the postoperative pain score to the mild range after oncological breast-conserving surgery and sentinel lymph-node biopsy.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111805"},"PeriodicalIF":5.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting admission to and length of stay in intensive care units after general anesthesia: Time-dependent role of pre- and intraoperative data for clinical decision-making","authors":"Andrea Stieger ,&nbsp;Patrick Schober ,&nbsp;Philipp Venetz ,&nbsp;Lukas Andereggen ,&nbsp;Corina Bello ,&nbsp;Mark G. Filipovic ,&nbsp;Markus M. Luedi ,&nbsp;Markus Huber","doi":"10.1016/j.jclinane.2025.111810","DOIUrl":"10.1016/j.jclinane.2025.111810","url":null,"abstract":"<div><h3>Background</h3><div>Accurate prediction of intensive care unit (ICU) admission and length of stay (LOS) after major surgery is essential for optimizing patient outcomes and healthcare resources. Factors such as age, BMI, comorbidities, and perioperative complications significantly influence ICU admissions and LOS. Machine learning methods have been increasingly utilized to predict these outcomes, but their clinical utility beyond traditional metrics remains underexplored.</div></div><div><h3>Methods</h3><div>This study examined a sub-cohort of 6043 patients who underwent general anesthesia at Seoul National University Hospital from August 2016 to June 2017. Various prediction models, including logistic regression and random forest, were developed for ICU admission and different LOS thresholds, e.g., a LOS of more than a week. Clinical utility was evaluated using decision curve analysis (DCA) across predefined risk preferences.</div></div><div><h3>Results</h3><div>Among patients studied, 19.8 % were admitted to the ICU, with 1.4 % staying longer than a week. Prediction models demonstrated high discrimination (AUROC 0.93 to 0.96) and good calibration for ICU admission and short LOS. DCA revealed that intraoperative data provided the greatest decision-related benefit for predicting ICU admission, while preoperative data became more important for predicting longer LOS.</div></div><div><h3>Conclusion</h3><div>Intraoperative data are crucial for immediate postoperative decisions, while preoperative data are essential for extended LOS predictions. These findings highlight the need for a comprehensive risk assessment approach in perioperative care, utilizing both preoperative and intraoperative information to enhance clinical decision-making and resource allocation.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111810"},"PeriodicalIF":5.0,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143580049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of anesthesia program that graduating medical students find important: A cross-sectional survey","authors":"Geoffrey Hayward ,&nbsp;Mark C. Kendall ,&nbsp;Danny Bui ,&nbsp;Zachary Gandee ,&nbsp;Tyler Jacobsen ,&nbsp;Joshua Tanzer ,&nbsp;Gildasio De Oliveira","doi":"10.1016/j.jclinane.2025.111791","DOIUrl":"10.1016/j.jclinane.2025.111791","url":null,"abstract":"<div><h3>Background</h3><div>Applying to residency programs and constructing a rank order list is a challenging process and is a vital task that fourth year medical students must undergo each year. The aim of our study was to identify common themes in what residency applicants are considering when applying to an anesthesiology program and compare them between male and female applicants.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was distributed to all 1447 medical students who applied to the Brown University Anesthesiology residency program for the 2022 National Residency Matching Program (NRMP). The survey consisted of 53 questions designed to assess the factors that candidates deem important when ranking a residency program highly. Exploratory factor analysis was performed to determine the item-factor assignment. Confirmatory analysis was done to test the associations between the average scores for each of the identified factors. Associations and average scores among male and female responders were explored.</div></div><div><h3>Results</h3><div>922 medical students completed the survey with a response rate of 63.7 %. An exploratory factor analysis (<em>n</em> = 457) performed on a random split sample (RSS) revealed a 45-item, seven-factor structure consisting of the following themes: exposure, teaching quality, gender and racial diversity, financial considerations, work life balance, prestige, and living in the same area. A confirmatory factor analysis was performed for the seven-factor model on the second RSS (<em>n</em> = 465). The model demonstrated adequate fit (Comparative Fit Index, CFI = 0.90, root mean square error of approximation [RIMSEA] = 0.085). Post hoc modification significantly improved the model fit (CFI = 0.98, RMSEA = 0.057).</div></div><div><h3>Conclusion</h3><div>Anesthesia applicants prioritize clinical exposure, teaching quality, diversity, and practical training factors like simulation and POCUS training. In addition, applicants also weigh financial considerations and work-life balance heavily in their ranking of anesthesia programs. Understanding these preferences can help anesthesia programs effectively market their programs to improve recruitment outcomes and to attract top applicants.</div></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111791"},"PeriodicalIF":5.0,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143562130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns in comparing supraglottic and subglottic jet ventilation: Duration, monitoring, and patient selection matter","authors":"Xiaoyan Huang,&nbsp;Rong Qian","doi":"10.1016/j.jclinane.2025.111789","DOIUrl":"10.1016/j.jclinane.2025.111789","url":null,"abstract":"","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"103 ","pages":"Article 111789"},"PeriodicalIF":5.0,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}