Journal of neurosurgical sciences最新文献

{"title":"Predictors of 30-day readmission and prolonged length of hospital stay after spinal chondrosarcoma resection: insights from the National Cancer Database.","authors":"Joseph Rajasekaran, Abdel-Hameed Al-Mistarehi, Avi N Albert, Abdul K Ghaith, Jawad M Khalifeh, A Daniel Davidar, Fnu Ruchika, Feras Fayez, Xinlan Yang, John Gross, Christian Meyer, Sang H Lee, Kristin J Redmond, Nicholas Theodore, Daniel Lubelski","doi":"10.23736/S0390-5616.25.06677-9","DOIUrl":"10.23736/S0390-5616.25.06677-9","url":null,"abstract":"<p><strong>Background: </strong>Spinal chondrosarcoma is a rare malignant tumor requiring complex resection due to its resistance to chemotherapy and radiation. This study aimed to identify predictors of both 30-day readmission and prolonged length of hospital stay (LOS) following surgical resection of spinal chondrosarcoma using data from the National Cancer Database (NCDB).</p><p><strong>Methods: </strong>Using the NCDB, we conducted a retrospective analysis of adult patients diagnosed with spinal or sacral chondrosarcoma between 2004 and 2017 who underwent surgical resection. We collected patient demographics, tumor characteristics, and treatment details. Patients were grouped based on 30-day readmission. A separate analysis was conducted on LOS, defining prolonged LOS as >75^th percentile. Multivariable analyses identified risk factors for each outcome.</p><p><strong>Results: </strong>Of the 1971 patients in the 30-day readmission analysis, 114 (5.8%) experienced readmission. Of the 1392 patients included in the LOS analysis, 341 (24.5%) experienced prolonged LOS. The risk factors of prolonged LOS included age (OR=1.015; 95% CI, 1.006-1.024; P<0.001), male sex (OR=1.440; 95% CI, 1.076-1.926; P=0.014), tumor volume >11 cm³ (OR=1.001; 95% CI, 1.000-1.002; P=0.018), sacral/coccygeal tumors (OR=1.831; 95% CI, 1.162-2.844; P<0.001), and gross total resection (GTR) (OR=1.514; 95% CI, 1.068-2.146; P=0.020). Multivariate regression identified no significant predictors of 30-day readmission.</p><p><strong>Conclusions: </strong>Tumor volume, sex, and other factors influence 30-day readmission and prolonged LOS. Prolonged LOS was further associated with sacral/coccygeal tumors and GTR, reflecting the complexity of surgical management.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"89-97"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145714674","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":"Transcranial Doppler in diagnosing and monitoring reversible cerebral vasoconstriction syndrome: a systematic review.","authors":"Mariana L DE Bastos Maximiano, Ocílio R Gonçalves, João Vitor A Fernandes, Luciano Falcão, Pedro L Magalhães, Victor A Ohannesian, Rebeca Oliveira DA Silva, Rodrigo F Rodrigues, Júlia Tirelli-Rocha, Anderson M DA Silva, Henrique S Cal, Carolina R Albuquerque","doi":"10.23736/S0390-5616.25.06654-8","DOIUrl":"10.23736/S0390-5616.25.06654-8","url":null,"abstract":"<p><strong>Introduction: </strong>Digital subtraction angiography is considered the reference standard for diagnosing reversible cerebral vasoconstriction syndrome (RCVS); however, its invasive nature limits routine application. Transcranial Doppler ultrasonography (TCD) represents a noninvasive and bedside-accessible alternative, but its diagnostic and monitoring value in RCVS remains uncertain.</p><p><strong>Evidence acquisition: </strong>A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed, Embase, Cochrane Library, Scopus, and Web of Science up to January 2024. Eligible studies included case reports, case series, and observational designs involving adults with angiographically confirmed reversible vasoconstriction that reported TCD or color-coded sonography parameters (e.g., mean flow velocity, vasospasm). Risk of bias was assessed with ROBINS-I or Joanna Briggs Institute tools. Due to heterogeneity, results were synthesized descriptively.</p><p><strong>Evidence synthesis: </strong>From 709 records, 8 studies encompassing 128 patients were included. TCD demonstrated increased mean flow velocities in the middle cerebral artery during the acute phase of RCVS, with reported peaks up to 146 cm/s, followed by gradual return to baseline within 6-12 weeks. Vasospasm was observed in up to 93.3% of patients, usually peaking between days 13 and 28. The Lindegaard index, ranging from 2.2 to >7, was valuable in distinguishing hyperemia from vasospasm. Serial bedside examinations, often every 24-48 hours during hospitalization, facilitated timely detection and monitoring of evolving hemodynamic changes. Nonetheless, included studies were small, heterogeneous, and methodologically limited.</p><p><strong>Conclusions: </strong>Transcranial Doppler ultrasonography appears promising as a noninvasive method for detecting cerebral vasospasm and monitoring temporal hemodynamic trajectories in RCVS.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"158-164"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149463","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":"Large language models in artificial intelligence to answer patient questions in spine surgery: an evaluation of current evidence.","authors":"Janam Patel, Zayaan Tirmizi, Ayesha A Waheed, Serhat Aydin, Avi A Gajjar, Najib Muhammad, Andrew Legarreta, Qazi Zeeshan, D Kojo Hamilton, Nitin Agarwal, Hansen Deng","doi":"10.23736/S0390-5616.26.06678-6","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06678-6","url":null,"abstract":"<p><strong>Introduction: </strong>Large language models (LLMs) are increasingly being explored in healthcare, particularly for enhancing patient education. In spine surgery, LLMs have the potential to enhance communication and support patients through perioperative care. However, concerns remain regarding the accuracy, readability, and overall reliability of these tools in delivering patient-facing information. This review aimed to understand the current use of LLMs in answering patient questions in spine surgery.</p><p><strong>Evidence acquisition: </strong>A structured search of PubMed and Google Scholar was conducted using terms focused on LLMs and neurosurgery. Studies were only included if they tested LLMs' ability in answering patient questions related to spine surgery. Exclusion criteria included non-peer-reviewed articles, studies that did not evaluate chatbot performance, or those using LLMs for non-educational purposes.</p><p><strong>Evidence synthesis: </strong>LLMs were tested across a variety of spine-related topics, including scoliosis, lumbar and cervical fusion, endoscopic procedures, and spinal cord stimulation. Studies consistently reported moderate to high accuracy ratings. Readability scores remained a limitation, with most responses written at a college reading level. Empathy and clarity varied by model and condition, with some studies showing improved ratings when assessed by non-medical reviewers. Methodological variability across studies introduced inconsistencies and limited comparability.</p><p><strong>Conclusions: </strong>LLMs show promising utility for patient education in spine surgery for addressing frequently asked questions. However, challenges in readability, accuracy, and standardization limit their current clinical adoption. Moving forward, studies must incorporate standardized evaluation tools, address high rate of content hallucination, and focus on chatbot performance in personalized scenarios. Cross-disciplinary collaboration is essential to ensure safe, accessible integration into neurosurgical care pathways.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147593049","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":"Clinical outcomes of ruptured cerebral arteriovenous malformations in the pediatric population.","authors":"Alis J Dicpinigaitis, Yu Guan, Julia Zhang, Richard Wang, Fawaz Al-Mufti","doi":"10.23736/S0390-5616.25.06643-3","DOIUrl":"10.23736/S0390-5616.25.06643-3","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"176-177"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146201963","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":"Postoperative pain management strategies in brain surgery.","authors":"Huseyin Erdem Ak","doi":"10.23736/S0390-5616.25.06611-1","DOIUrl":"https://doi.org/10.23736/S0390-5616.25.06611-1","url":null,"abstract":"<p><p>The management of postoperative pain after brain surgery is challenging due to the vulnerability of neuroanatomic structures and differences in the perception of pain among different individuals. Pain management is essential for the patient's quick recovery. The main aim of the review is to assess the various pharmacological and non-pharmacological techniques for managing pain in patients after brain surgery, highlighting the potential benefits and safety. This is a focused narrative review of literature published between 2016 and 2024. A targeted search of major databases: PubMed/MEDLINE, EMBASE, Scopus, Web of Science, Cochrane CENTRAL and Google Scholar was performed using terms for postoperative pain, craniotomy, neurosurgery, scalp block, multimodal analgesia, gabapentinoids, dexmedetomidine, cognitive behavioral therapy, Transcutaneous Electrical Nerve Stimulation and related concepts. The present review purposively selected randomized controlled trials, systematic reviews, meta-analyses and high-quality observational studies that evaluated analgesic strategies for major intracranial procedures. Non-English reports, narrative reviews lacking primary data, and studies with inadequate outcome reporting were excluded. Data synthesis is solely narrative and focused on comparative effectiveness and safety. The evidence supports opioid-sparing, multimodal strategies after major intracranial procedures. NSAIDs and acetaminophen show modest reductions in pain up to 12-24 hours. Local anesthetic scalp blocks and wound infiltration such as ropivacaine provide short-term benefit. Gabapentinoids reduce opioid consumption but increase dizziness and somnolence. Dexmedetomidine can delay rescue analgesia intraoperatively but is not consistently superior to alternatives. Non-pharmacologic approaches including, cognitive behavioral therapy, Transcutaneous Electrical Nerve Stimulation, Repetitive transcranial magnetic stimulation or, transcranial magnetic stimulation acupuncture show promise for longer-term or neuropathic symptoms, but evidence is limited and heterogeneous. Multimodal, opioid-sparing regimens, combining systemic non-opioid analgesics, targeted local or regional techniques, and selected adjuvants appear most effective for early postoperative pain after intracranial surgery. Non-pharmacologic therapies and neuromodulation may have adjunctive roles, but higher-quality comparative trials with standardized outcomes are needed to define optimal protocols and long-term effects.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"70 2","pages":"165-174"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633555","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":"Time is money: a systematic review of time directed activity based costing in spine surgery.","authors":"Eric Singh, Long DI, Tyler Cardinal, Lauren Tierney, Andrew Sasser, Solomon Jackson, Seth Tigchelaar, Adham M Khalafallah, Gregory Basil","doi":"10.23736/S0390-5616.26.06646-4","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06646-4","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare costs in the USA have increased without corresponding improvements in patient outcomes, prompting calls for value-based reimbursement models. Accurate cost measurement per episode of care is essential to this approach. Traditional methods, such as cost-to-charge ratio (CCR), lack precision. Time-driven activity-based costing (TDABC), which assigns costs based on time spent per activity, offers a more accurate alternative. This review evaluates TDABC use in spine surgery and its potential to enhance cost transparency and efficiency.</p><p><strong>Evidence acquisition: </strong>This systematic review followed PRISMA guidelines. A literature search was performed for studies published between 1996 and 2025 using terms related to costing strategies and spine surgery. Included studies applied TDABC in cost analysis; non-English and commentary articles were excluded. Extracted data included costing methodologies, cost categories, and study purpose. Bias was assessed using the Newcastle-Ottawa scale.</p><p><strong>Evidence synthesis: </strong>Twelve studies including 6143 patients were analyzed, covering procedures such as ACDF, lumbar laminectomy, and microdiscectomy. Reported costs for single-level ACDF ranged from $ 6776 to $ 27,558. Most studies focused on intraoperative costs, though some included full care episodes. TDABC identified cost differences tied to factors such as surgeon experience and BMI. Personnel time, hospital stay, and postoperative visits were common cost drivers.</p><p><strong>Conclusions: </strong>TDABC offers a more granular and accurate method for analyzing spine surgery costs. However, variation in methodology across studies limits comparability. Standardized protocols and direct comparisons with traditional costing methods are needed to fully leverage TDABC's potential for improving cost management and care efficiency.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":"70 2","pages":"151-157"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633650","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":"Multimodal management of pediatric brain arteriovenous malformations: single-center experience from a retrospective observational study.","authors":"Giuseppe Mirone, Giulia Meccariello, Nicola Onorini, Domenico Cicala, Mario Muto, Eugenio Covelli, Giuseppe Cinalli","doi":"10.23736/S0390-5616.26.06556-2","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06556-2","url":null,"abstract":"<p><strong>Background: </strong>Intracranial arteriovenous malformations (AVMs) are a major cause of intracranial hemorrhage (ICH) in children, often leading to significant neurological deficits or mortality. The primary aim of this study was to analyze the management strategies and long-term outcomes of pediatric AVMs treated at Santobono-Pausilipon Children's Hospital over the past 15 years with a particular focus on hemorrhagic presentation.</p><p><strong>Methods: </strong>A retrospective review was conducted on pediatric patients (0-18 years) diagnosed with intracranial AVMs between July 2008 and December 2024. Data on demographics, clinical presentation, imaging findings, Spetzler-Martin and Supplemented Spetzler-Martin grading, treatment modalities, complications, and outcomes were collected. Treatment approaches included microsurgical resection, endovascular embolization, stereotactic radiosurgery (SRS), and multimodal management were evaluated.</p><p><strong>Results: </strong>A total of 48 pediatric AVM cases were identified (24 males, 24 females; mean age: 8.8 years). The majority (N.=41, 85.4%)) presented with intracranial hemorrhage. Treatment strategies included microsurgical resection (17 cases), embolization (6 cases), SRS (9 cases), and multimodal therapy (14 cases). Mean follow-up was 5 years. Residual AVMs were detected in 13% of cases, with three rebleeding events. The postoperative modified Rankin Scale (mRS) showed favorable outcomes (mRS 0-2) in 37 patients. One patient died due to major hemorrhage.</p><p><strong>Conclusions: </strong>Pediatric AVMs exhibit diverse clinical presentations and require individualized management strategies. While surgical resection remains the most definitive treatment, multimodal approaches may be necessary for high-grade or deep-seated AVMs. Long-term follow-up is crucial due to the risk of AVM recurrence and rebleeding. Advancements in molecular and genetic research may further refine therapeutic strategies for pediatric AVMs in the future.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592686","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":"Sharpening skills: the role of virtual simulation in enhancing spinal neurosurgical proficiency.","authors":"Elio Mazzapicchi, Niccolò Innocenti, Francesco Restelli, Aurora Freguglia, Vittoria M Cojazzi, Davide Rossi, Mariarosa Gammone, Francesco Acerbi, Alessandro Perin, Francesco Dimeco, Francesco Costa","doi":"10.23736/S0390-5616.25.06572-5","DOIUrl":"10.23736/S0390-5616.25.06572-5","url":null,"abstract":"<p><strong>Background: </strong>Traditional neurosurgical training involves a steep learning curve. The introduction of advanced simulation technologies, like virtual reality, provides an alternative method for skill acquisition, allowing for repeated practice and objective assessment. This study focuses on evaluating the learning curve associated with lumbar pedicle Kirschner wire insertion using a virtual fluoroscopic simulator among neurosurgical residents.</p><p><strong>Methods: </strong>Eighteen neurosurgery residents and two interns participated in this study. Participants' initial skill levels were assessed through a questionnaire. Performance metrics, including insertion accuracy, time, and the number of virtual X-ray scans, were recorded across multiple attempts until a \"practical learning plateau\" was reached. Statistical analyses were conducted to model learning curves, assess the correlation between pre-training experience and performance.</p><p><strong>Results: </strong>The average number of attempts required to stabilize performance was 5.61. Learning rates varied, with some residents showing rapid improvement while others progressed more slowly. Higher accuracy in wire placement correlated with reduced usage on X-rays over time. However, experienced residents did not necessarily learn faster, indicating potential challenges in adapting to new simulation-based methods. Post-training feedback highlighted the simulator's utility in increasing confidence and skill levels, although some limitations in anatomical accuracy were noted.</p><p><strong>Conclusions: </strong>This study demonstrates the potential of virtual simulation to enhance neurosurgical training by providing a controlled environment for repeated practice and objective feedback. Simulation-based training can effectively complement traditional methods, though individualized approaches may be necessary to accommodate varying learning rates among residents. Further refinement of simulation tools and their integration into standard training curricula are recommended.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"98-107"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145604280","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":"Artificial intelligence in diagnostic neurosurgery: promising results and need for rigorous validation.","authors":"Palwasha Asghar","doi":"10.23736/S0390-5616.26.06739-1","DOIUrl":"10.23736/S0390-5616.26.06739-1","url":null,"abstract":"","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":"175"},"PeriodicalIF":1.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149422","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":"Targeting EGFR in glioblastoma: lessons from a disappointing journey. A systematic review.","authors":"Ali Berro, Ahmad Assi, Sarah Samhat, Grace Sabra, Rita Haddad, Yara Gebran, Ronald Moussa","doi":"10.23736/S0390-5616.26.06708-1","DOIUrl":"https://doi.org/10.23736/S0390-5616.26.06708-1","url":null,"abstract":"<p><strong>Introduction: </strong>This review aims to review the efficacy and toxicity of anti-epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors in the management of glioblastoma.</p><p><strong>Evidence acquisition: </strong>A systematic review was completed utilizing PubMed, Cochrane, and Embase databases up to February 2025. Boolean operators and the MeSH term \"glioma\" were used, along with relevant keywords related to EGFR.</p><p><strong>Evidence synthesis: </strong>First- and second-generation EGFR-focused TKIs performed poorly in patients with GBM. The use of erlotinib in combination with radiotherapy, alkylating agents, and anti-angiogenic agents yielded the best outcomes in patients with newly diagnosed GBM.</p><p><strong>Conclusions: </strong>EGFR-focused TKIs were largely disappointing as a treatment for GBM. Longstanding issues, including treatment resistance, tumor heterogeneity, and blood-brain barrier penetration persist. Future efforts must focus on tackling these issues, and prioritizing patient selection via biomarkers.</p>","PeriodicalId":16504,"journal":{"name":"Journal of neurosurgical sciences","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147512800","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}