Journal of Clinical Monitoring and Computing最新文献

{"title":"Impact of cardiopulmonary bypass flow on the lower limit of cerebral autoregulation during cardiac surgery: a randomized cross-over pilot study.","authors":"Olivier Desebbe, Antoine Berna, Alexandre Joosten, Darren Raphael, Ghislain Malapert, Dimitri Rolo, Fabio Silvio Taccone, Laurent Gergele","doi":"10.1007/s10877-025-01290-2","DOIUrl":"10.1007/s10877-025-01290-2","url":null,"abstract":"<p><p>Assessment of cerebral autoregulation is challenging under different hemodynamic conditions during cardiac surgery and must be rapidly calculated in order to optimize mean arterial pressure (MAP). Whether systemic flow during cardiopulmonary bypass impacts the lower limit of cerebral autoregulation (LLA) remains unclear. Forty patients requiring cardiac surgery were included in this randomized crossover study. Patients assigned to the conventional/high blood flow arm received 20 min of conventional cardiopulmonary bypass (CPB) blood flow (2.2 L/min.m^-²) followed by 20 min of high blood flow (2.8 L/min.m^-²), both during aortic cross clamping. Patients assigned to the high/conventional arm received the same flows but in reverse order. During each 20-minute period, MAP was gradually increased from 40 to 90 mmHg, while PaCO₂, hematocrit, depth of anesthesia, central temperature and arterial oxygen tension were kept constant. Continuous cerebral blood flow velocities of the middle cerebral artery (Fv) were monitored using transcranial doppler. Cerebral autoregulation was calculated using a Pearson's correlation coefficient (Mean flow index, Mxa) between the MAP and Fv. Mxa values were then plotted across MAP ranges. The LLA was defined as the corresponding MAP value when Mxa initially decreased and crossed the threshold value of 0.4. A mixed model, including the LLA as the dependent variable, the CPB flow and period as fixed effects and patients as a random effect was used to compare conventional and high CPB flows. Thirty-seven patients were analyzed. The LLA mean difference between groups, adjusted on the period, was - 2.8 (SE 2.4) mmHg with 95% CI [-7.8, + 2.1 mmHg], p = 0.2538). 24% of patients presented an LLA < 65 mmHg during the conventional CPB flow phase versus 35% during the high CPB flow phase. Increasing the cardiopulmonary pump flow did not decrease the LLA during cardiac surgery.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":"571-580"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968405","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":"Precision of electromyography according to the calibration approach of neuromuscular monitoring: a randomised prospective agreement study.","authors":"Flora T Scheffenbichler, Bernhard Ulm, Laura Borgstedt, Anna Scholze, Nadine Kretsch, Nadine Zia, Viola Friedrich, Magdalena Marb, Stefan J Schaller, Bettina Jungwirth, Manfred Blobner","doi":"10.1007/s10877-025-01304-z","DOIUrl":"https://doi.org/10.1007/s10877-025-01304-z","url":null,"abstract":"<p><strong>Purpose: </strong>Anaesthesia providers often complain that quantitative neuromuscular monitoring does not accurately assess neuromuscular function, a problem that can be mitigated by appropriate calibration. However, there are only very limited recommendations for the calibration of quantitative neuromuscular monitoring in clinical routine. Therefore, this multicentre prospective agreement study compared the precision of electromyography using three different calibration approaches.</p><p><strong>Methods: </strong>Sixty patients were assigned to one of three investigational calibration approaches: calibration before anaesthesia induction, calibration during anaesthesia induction, i.e., at loss of consciousness and state entropy < 85, or uncalibrated. All patients received electromyography calibration under deep anaesthesia on the second arm (control as recommended for research). The primary endpoint was the repeatability coefficient, which describes the fluctuation of the following train-of-four (TOF) reading. It therefore provides an estimate of the precision of a measurement method. Secondary endpoints included agreement with control calibration and pain at induction.</p><p><strong>Results: </strong>The repeatability coefficient at TOF ratios ≥ 0.8 indicated that electromyography monitoring was less precise when TOF readings were uncalibrated (0.124 ± 0.130) or with calibration during induction (0.087 ± 0.104) but was acceptable after calibration before induction (0.075 ± 0.036) compared to those measured after calibration on the contralateral arm (control: 0.072 ± 0.027, 0.061 ± 0.021, and 0.083 ± 0.063, respectively). Recall of pain at anaesthesia induction did not differ between investigational groups.</p><p><strong>Conclusion: </strong>The findings underline the importance of thoroughly performed calibration for precise TOF readings to reliably exclude residual neuromuscular blockade. Electromyography was most precise when calibration was performed under deep anaesthesia (control). If that approach is not possible in the clinical setting, our data suggest that calibration before anaesthesia induction can be considered if previously discussed with the patient.</p><p><strong>Clinical trial registration: </strong>Clinical Trials NCT04911088, registered January 6, 2021.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144174074","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":"Standardizing light conditions during ICU pupillometry: a caution from clinical practice.","authors":"Charikleia S Vrettou, Ioanna M Dimopoulou","doi":"10.1007/s10877-025-01305-y","DOIUrl":"https://doi.org/10.1007/s10877-025-01305-y","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150550","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":"Does capnography improve safety in moderate-deep sedation for gastrointestinal endoscopic procedures provided by anaesthesiologists? A prospective cohort study.","authors":"Isabel Valbuena, Azahara Sancho, Estíbaliz Alsina, Nicolás Brogly, Fernando Gilsanz","doi":"10.1007/s10877-025-01299-7","DOIUrl":"https://doi.org/10.1007/s10877-025-01299-7","url":null,"abstract":"<p><p>This study aimed to determine whether the use of capnography reduces the incidence of respiratory and cardiovascular adverse events during procedural sedation and analgesia (PSA) for gastrointestinal endoscopic procedures (GEP) provided by experienced anaesthesiologists. A prospective cohort study was conducted, including patients undergoing GEP under PSA. Patients were divided in two groups: Group A (pulse oximetry) and Group B (capnography with Capnostream^™ monitor plus pulse oximetry). Interventions undertaken to resolve hypoxaemia, airway obstruction, or apnoea were recorded. Age, comorbidities, ASA Classification, sedative drugs, respiratory and cardiovascular adverse events, recovery Aldrete Scale value, and patient satisfaction were also recorded. Both parametric and non-parametric tests were applied. A total of 1,146 patients were included: Group A, n = 538, and Group B, n = 608. Diagnostic colonoscopy was the most frecuent procedure (49.7%), followed by diagnostic gastroscopy (22.5%) and therapeutic colonoscopy (22.2%). Apnoea < 60 s was detected only in patients monitored with capnography (35.4% vs. 0%, p < 0.000). The use of capnography significantly reduced the incidence of moderate hypoxaemia (3% vs. 6.5%, p = 0.004). Severe hypoxaemia was significantly reduced with capnography only in patients with cardio-respiratory comorbidities (2.2% vs. 4.4%, p = 0.032). The capnography group showed a lower incidence of cardiovascular events. Respiratory adverse events, such as desaturation and airway obstruction, increased with age and ASA classification, as did the need for airway maneuvers. Prolonged apnoea and intubation were rare in both groups. Mandibular traction manoeuvres were significantly more frequent in Group B (9.9% vs. 3%, p < 0.000), reducing the need for other interventions. Patient satisfaction at discharge was higher when capnography was used (p < 0,000). Moderate-deep sedation for GEP performed by experienced anaesthesiologists, combined with capnography, enhances safety, with extremely rare major complications. Capnography monitoring allowed the timely identification and resolution of apnoea and airway obstruction, avoiding severe desaturation and cardiovascular adverse events.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142661","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":"Effectiveness of hypotension prediction index software in reducing intraoperative hypotension in prolonged prone-position spine surgery: a single-center clinical trial.","authors":"Myrto A Pilakouta Depaskouale, Stela A Archonta, Sofia Κ Moutafidou, Nikolaos A Paidakakos, Antonia N Dimakopoulou, Paraskevi K Matsota","doi":"10.1007/s10877-025-01303-0","DOIUrl":"https://doi.org/10.1007/s10877-025-01303-0","url":null,"abstract":"<p><p>Intraoperative hypotension (IOH) is associated with morbidity and mortality. The Hypotension Prediction Index (HPI), a machine learning-based tool, offers the opportunity for a proactive approach by predicting hypotensive events. This single center, single blind randomized clinical trial aimed to evaluate the hypothesis that an HPI software-guided approach to IOH management during prone position spine surgery could reduce its incidence compared to our standard care practices. 85 adult patients undergoing spine fusion surgery in the prone position were enrolled. Patients were randomized with a 1:1 allocation ratio. Participants were blinded to their group allocation. In the intervention group, the HPI software was actively used to guide IOH management. In the control group, HPI software readings were blinded, and standard care was administered. The primary outcome was the comparison of time-weighted average (TWA) of IOH between the two groups. Secondary outcomes included a comparison of the incidence of postoperative in-hospital events related to IOH between groups. 77 patients were included in the final analysis (39 in the intervention group), as 8 patients were excluded due to technical issues. No statistically significant difference was found between the intervention and control groups in the TWA of IOH (0.10 mmHg [0.05, 0.23] vs. 0.15 mmHg [0.09, 0.37], p-value 0.088). However, the total duration of hypotensive events per patient was significantly lower in the intervention group (4 min [0.5, 12.2] vs. 11.2 min [2.6, 20.1]; p-value 0.019). Postoperative complication rates did not differ significantly between the two groups. HPI-guided management did not significantly reduce the TWA of IOH compared to standard care in patients undergoing prone-position spine surgery. Complication rates were similar between the two groups.Clinical Trial Registration: This trial was registered with ClinicalTrials.gov (registration number: NCT05341167).</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132454","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":"Quantitative electroencephalogram and machine learning to predict expired sevoflurane concentration in infants.","authors":"Rachit Kumar, Justin Skowno, Britta S von Ungern-Sternberg, Andrew Davidson, Ting Xu, Jianmin Zhang, XingRong Song, Mazhong Zhang, Ping Zhao, Huacheng Liu, Yifei Jiang, Yunxia Zuo, Jurgen C de Graaff, Laszlo Vutskits, Vanessa A Olbrecht, Peter Szmuk, Allan F Simpao, Fuchiang Rich Tsui, Jayant Nick Pratap, Asif Padiyath, Olivia Nelson, Charles D Kurth, Ian Yuan","doi":"10.1007/s10877-025-01301-2","DOIUrl":"https://doi.org/10.1007/s10877-025-01301-2","url":null,"abstract":"<p><p>Processed electroencephalography (EEG) indices used to guide anesthetic dosing in adults are not validated in young infants. Raw EEG can be processed mathematically, yielding quantitative EEG parameters (qEEG). We hypothesized that machine learning combined with qEEG can accurately classify expired sevoflurane concentrations in young infants. Knowledge from this may contribute to development of future infant-specific EEG algorithms. Frontal EEG collected from infants ≤ 3 months were time-matched as one-minute epochs to expired sevoflurane (eSevo). Fifteen qEEG parameters were extracted from each epoch and eight machine learning models combined the qEEG to classify each epoch into one of four eSevo levels (%): 0.1-1.0, 1.0-2.1, 2.1-2.9, and > 2.9. 64 epochs formed the post hoc SHAP dataset to determine the qEEG that contributed most to the model. The remaining epochs were randomly split 50 times into 80/20 training/testing sets. Accuracy and F1-score determined model performance. 42 infants provided 4574 epochs. The top classifiers K-nearest neighbors, default multi-layer perceptron, and support vector machine achieved 67.5-68.7% accuracy. Burst suppression ratio and entropy β were the top contributors to the models. Post hoc analysis performed without burst suppression ratio yielded similar prediction performance. In young infants, machine learning applied to qEEG predicted eSevo levels with moderate success. Burst suppression ratio, the most important contributor, represented an efficient EEG feature that encapsulated underlying EEG changes seen on other qEEG features. These results provided insight into EEG parameter selection and optimal machine learning models used for future development of infant-specific EEG algorithms.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208681","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":"Editor letter for Sanna Holmskär \"Is quantitative pupillometry affected by ambient light? A prospective crossover study. J Clin Monit Comput, 2025\".","authors":"David Couret, Willelm Doucet, Romain Asmolov, Pierre Simeone, Lionel Velly","doi":"10.1007/s10877-025-01302-1","DOIUrl":"https://doi.org/10.1007/s10877-025-01302-1","url":null,"abstract":"","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144086214","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":"Developing a machine learning-based prediction model for postinduction hypotension.","authors":"Maksim Katsin, Maxim Glebov, Haim Berkenstadt, Dina Orkin, Yotam Portnoy, Adi Shuchami, Amit Yaniv-Rosenfeld, Teddy Lazebnik","doi":"10.1007/s10877-025-01295-x","DOIUrl":"https://doi.org/10.1007/s10877-025-01295-x","url":null,"abstract":"<p><p>Arterial hypotension is a common and often unintended event during surgery under general anesthesia, associated with increased postoperative complications, such as kidney injury, myocardial injury, and stroke. Postinduction hypotension (PIH) is influenced by patient-specific factors, chronic medication use, and anesthetic induction regimens. Traditional predictive models struggle with this complexity, making machine learning (ML) a promising alternative due to its ability to handle complex datasets and identify hidden patterns. This study aimed to develop and validate an ML-based model for predicting PIH and identifying key clinical predictors. A retrospective cohort study of 20,309 adult patients undergoing non-obstetric surgery under general anesthesia with intravenous induction was conducted. The primary outcome was the occurrence of PIH, defined as mean arterial pressure (MAP) < 55 mmHg within 10 min post-induction. Data were split into training and validation sets using k-fold cross-validation. The model's predictive performance was evaluated using the area under the receiver operating characteristic curve (AUC), and feature importance was assessed using SHapley Additive exPlanations (SHAP) values. PIH occurred in 4,948 patients (24.4%). Key predictors included preinduction systolic and mean arterial pressures, propofol dose, and beta-blocker use. The ML model achieved an AUC of 0.732 in predicting PIH. The ML-based model demonstrated significant predictive capability for PIH, identifying key clinical predictors. This model holds the potential for improving preoperative planning and patient risk stratification. However, further validation through prospective studies is necessary to confirm these findings.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995222","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":"The haemodynamic effects of pneumoperitoneum on pulse pressure variation - a prospective, observational study.","authors":"Henrik Lynge Hovgaard, Simon Tilma Vistisen, Johannes Enevoldsen, Frank Vincenzo de Paoli, Peter Juhl-Olsen","doi":"10.1007/s10877-025-01300-3","DOIUrl":"https://doi.org/10.1007/s10877-025-01300-3","url":null,"abstract":"<p><p>The effects of pneumoperitoneum on dynamic predictors of fluid responsiveness such as pulse pressure variation (PPV) remain uncertain. This uncertainty arises from potentially opposing physiological mechanisms that affect cardiovascular dynamics during conditions with increased intra-abdominal pressure (IAP). Deriving PPV with high precision during induction of pneumoperitoneum may provide new insights into the complex relationship between intra-abdominal pressure changes and PPV. The hypothesis was that PPV derived from a generalised additive model (PPV_GAM) would increase with the induction of pneumoperitoneum and the associacted increase in IAP. This was a prospective, observational study in patients undergoing oesophagectomy. Before and after induction of pneumoperitoneum, haemodynamic variables including PPV and stroke volume variation (SVV) were recorded with the Hemosphere monitor. PPV_GAM was estimated offline from the arterial blood pressure curve. A total of 34 patients were included in the final analysis. PPV_GAM increased by a factor of 1.49 (95% CI: 1.25-1.77) as intra-abdominal pressure increased from baseline to 12 mmHg. SVV and PPV from the HemoSphere monitor increased with a factor of 1.25 (95% CI: 1.13-1.39, p < 0.001) and 1.14 (95% CI: 1.00-1.29, p = 0.048), respectively. PPV derived from a generalised additive model increased approximately 50% from the induction of pneumoperitoneum to an IAP of 12 mmHg. PPV and SVV derived from the Hemosphere monitor also increased signicantly.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970660","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":"Variations of SPI during outpatient laparoscopic cholecystectomy without muscle relaxants using ANI-guided remifentanil.","authors":"E Boselli, B Allaouchiche","doi":"10.1007/s10877-025-01297-9","DOIUrl":"https://doi.org/10.1007/s10877-025-01297-9","url":null,"abstract":"<p><p>This study compared ANI and SPI during outpatient laparoscopic cholecystectomy without muscle relaxants. Forty adult patients were included in this prospective observational study. Induction was performed using propofol, ketamine and remifentanil. All patients received bilateral TAP block. Maintenance of anesthesia was performed using remifentanil targeted to ANI 50-80 and desflurane targeted to MAC 0.8-1.2 without muscle relaxants. The ANI and SPI values were collected at different time-points and analyzed using repeated-measures ANOVA. The relationship between ANI and SPI were analyzed by linear regression. All procedures were performed without muscle relaxants. The mean ± SD ANI values significantly decreased from 70 ± 12 at induction to 57 ± 15 at intubation and 56 ± 17 at extubation and were maintained in the 50-80 target range throughout incision to exsufflation. The mean ± SD SPI values significantly decreased from 60 ± 15 at induction to 38 ± 16 at intubation, increased at 73 ± 14 at extubation and were in the 20-50 target range throughout incision to exsufflation. There was a poor but significant negative linear relationship (r² = 0.053, p < 0.001) between SPI and ANI values. During laparoscopic cholecystectomy without muscle relaxants, remifentanil titrated to achieve a target ANI range of 50-80 provides SPI values with poor correlation ranging from 20 to 50, corresponding to adequate nociception-antinociception balance. Other studies comparing ANI and SPI guided remifentanil administration are required to determine the effect of each strategy on patient outcomes during laparoscopic cholecystectomy or other types of surgery.</p>","PeriodicalId":15513,"journal":{"name":"Journal of Clinical Monitoring and Computing","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010172","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}