Pancreatology最新文献

{"title":"The efficacy and safety profile of third-line treatment in patients with metastatic pancreatic adenocarcinoma.","authors":"Chi-Chen Lan, Tai-Jan Chiu, Chia-Yen Hung, Kun-Yun Yeh, Chang-Hsien Lu, Yen-Yang Chen, Jen-Shi Chen, Yu-Shin Hung, Wen-Chi Chou","doi":"10.1016/j.pan.2025.01.012","DOIUrl":"https://doi.org/10.1016/j.pan.2025.01.012","url":null,"abstract":"<p><strong>Background: </strong>For metastatic pancreatic ductal adenocarcinoma (mPDAC), there are no established third-line chemotherapy options. We examined the efficacy and safety of third-line chemotherapy in patients with mPDAC in real-world practice.</p><p><strong>Methods: </strong>We retrospectively analyzed 257 patients with mPDAC and progressive disease after first-line treatment with gemcitabine-based regimens and second-line treatment with liposomal irinotecan plus 5-fluorouracil and leucovorin at five Taiwanese medical centers from 2018 to 2022. Treatment efficacy and toxicity were analyzed in 77 of 257 patients receiving third-line treatment subsequently. We performed univariate and multivariate analyses to identify prognostic factors for overall survival (OS) in patients receiving third-line treatment.</p><p><strong>Results: </strong>Patients receiving third-line treatment had a median OS of 4.5 months (95 % confidence interval [CI], 3.6-5.4), compared to 1.6 months (95 % CI, 1.3-1.9) for those who did not. Independent poor prognostic factors for OS included the absence of previous pancreatectomy (adjusted hazard ratio [aHR] 3.03, 95 % CI, 1.30-7.14, P = 0.001), an ECOG score of ≥2 ((aHR 9.81, 95 % CI 4.34-22.1, P < 0.001), and progressive disease response during second-line treatment (aHR 1.90, 95 % CI 1.21-8.91, P = 0.020, P = 0.020). Median OS for patients with none, one, two, and three poor prognostic factors were 15.9 (95 % CI, 12.3-19.6), 7.0 (2.6-13.3), 4.4 (3.5-5.2), and 2.0 (1.7-2.2) months, respectively. 43 of 77 patients (56 %) experienced at least one grade 3 or 4 toxicity.</p><p><strong>Conclusion: </strong>In real-world settings, patients with mPDAC receiving third-line chemotherapy may have a moderate survival advantage, although clinicians should carefully select patients owing to high incidence of grade 3/4 toxicities.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364829","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":"Contrast agent dispersion visualized by CE-EUS may be a prediction tool for FOLFIRINOX chemotherapy effectiveness in patients with pancreatic adenocarcinoma.","authors":"Mike J P de Jong, Foke van Delft, Fer D W Radstake, Tom H Perik, Geke Litjens, Tanya M Bisseling, Fons van der Sommen, Erwin-Jan M van Geenen, John J Hermans, Peter D Siersema","doi":"10.1016/j.pan.2025.01.011","DOIUrl":"https://doi.org/10.1016/j.pan.2025.01.011","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic ductal adenocarcinoma (PDAC) still has a dismal 5-year overall survival of 13 %. Chemotherapy is increasingly used as treatment in both (neo-) adjuvant and palliative conditions. However, the overall survival benefits of chemotherapy must be weighed against significant side effects leading to a reduction in quality of life. CE-EUS and elastography could provide additional information about the vascularization and elasticity of the pancreatic tumor. The aim of this study was to investigate if contrast-enhanced endoscopic ultrasound and/or elastography could be suitable to predict the effectiveness of FOLFIRINOX.</p><p><strong>Methods: </strong>Single center, prospective proof-of-concept study in which intravenous contrast agent was administered and strain ratio was calculated in patients undergoing EUS in their regular diagnostic work-up. Directly after contrast administration, a video of 120 s was recorded and afterwards tracked and fitted by a Modified Local Density Random Walk (mLDRW) model.</p><p><strong>Results: </strong>We included 17 patients. Based on cross-sectional imaging based RECIST criteria, chemotherapy treatment was effective in 11 patients and not effective in 6 patients. The contrast dispersion parameter (κ1) differed significantly between both groups in favor of the responders: 2.994 (IQR 1.670-5.170) vs 1.203 (IQR 0.953-1.756), p = 0.005. The elastography strain ratio was higher in the effectively treated group (20.9 vs 13.6, p = 0.138).</p><p><strong>Conclusion: </strong>This proof-of-concept study showed that the dispersion parameter of the first wave of contrast was 2.5 times higher in patients in whom FOLFIRINOX was effective, suggesting that this parameter could possibly be a reliable prediction tool.</p>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256141","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":"Repeated pancreatic juice cytology via endoscopic nasopancreatic drainage catheter combined with clinical findings improves diagnostic ability for malignant cases of suspected pancreatic cancer with non-identifiable tumors","authors":"Tatsunori Satoh ,&nbsp;Junichi Kaneko ,&nbsp;Eiji Nakatani ,&nbsp;Hirotoshi Ishiwatari ,&nbsp;Junya Sato ,&nbsp;Akihiko Ohata ,&nbsp;Reiko Yamada ,&nbsp;Tetsuro Miwata ,&nbsp;Kazuma Ishikawa ,&nbsp;Fumitaka Niiya ,&nbsp;Yosuke Kobayashi ,&nbsp;Yasushi Hamaya ,&nbsp;Jun Ito ,&nbsp;Kazuhito Kawata ,&nbsp;Azumi Suzuki ,&nbsp;Yasunari Sakamoto ,&nbsp;Yuya Ishiguro ,&nbsp;Haruna Takahashi ,&nbsp;Shinya Kawaguchi","doi":"10.1016/j.pan.2024.11.022","DOIUrl":"10.1016/j.pan.2024.11.022","url":null,"abstract":"<div><h3>Background/objectives</h3><div>The detection of pancreatic cancer (PC) often depends on indirect indicators such as parenchyma atrophy (PPA), main pancreatic duct stenosis, and low echoic areas, particularly when no mass is evident on imaging. While pathological evaluation is the gold standard for differentiating malignant from benign conditions, endoscopic ultrasound-guided fine-needle aspiration/biopsy is not always feasible in such cases. Serial pancreatic juice aspiration cytologic examination (SPACE) via endoscopic nasopancreatic drainage (NPD) has emerged as an alternative diagnostic method, though its accuracy remains underevaluated. This study aimed to evaluate the diagnostic performance of SPACE and explore strategies to enhance its accuracy in diagnosing PC.</div></div><div><h3>Methods</h3><div>This multicenter, retrospective study analyzed patients who underwent SPACE between January 2015 and September 2023. The inclusion criteria focused on cases lacking a clear pancreatic mass but exhibiting indirect signs suggestive of PC. Diagnostic accuracy was determined using surgical pathology or a minimum follow-up period of 12 months as the reference standard.</div></div><div><h3>Results</h3><div>Among 164 patients, 85 (51.8 %) were diagnosed with malignancy. The sensitivity and specificity of SPACE were 74.1 % and 87.3 %, respectively, with a area under the receiver operating characteristic curve (ROC-AUC) of 0.807 (95%CI: 0.748–0.867). Incorporating patient age, CEA and PPA with SPACE results further improved diagnostic performance, yielding a ROC-AUC of 0.828 (95%CI: 0.76–0.897, p = 0.013).</div></div><div><h3>Conclusions</h3><div>Combining SPACE with clinical and imaging findings significantly enhances diagnostic accuracy in suspected PC cases where conventional imaging fails to detect tumors. This integrated approach has the potential to enhance clinical outcomes by facilitating more accurate patient management.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 125-133"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792165","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 islet autotransplantation on 30-day post-operative outcomes in patients undergoing total pancreatectomy: A NSQIP retrospective cohort analysis of 584 patients","authors":"Armin Rouhi,&nbsp;Kevin Verhoeff,&nbsp;Blaire Anderson,&nbsp;Khaled Dajani,&nbsp;David L. Bigam,&nbsp;A.M James Shapiro","doi":"10.1016/j.pan.2024.12.002","DOIUrl":"10.1016/j.pan.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Total pancreatectomy (TP) offers a surgical option for refractory pancreatitis, yet confers substantial long-term morbidity associated with resultant diabetes. While total pancreatectomy with islet autotransplantation (TPIAT) offers an intuitive solution, data evaluating its safety have been limited to single-center studies. The aim of this study is to evaluate whether the addition of islet autotransplantation to TP confers additional post-operative morbidity within the 30-day post-operative period.</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of prospectively collected cases from the National Surgical Quality Improvement Program (NSQIP) database. Cases of TP with or without islet autotransplantation from 2016 to 2021 were included. Baseline demographics, and a comprehensive list of 30-day postoperative outcomes were evaluated. Multivariable logistic regression models were constructed to evaluate the impact of each factor on 30-day complications.</div></div><div><h3>Results</h3><div>A total of 584 cases were included with 171 (29.2 %) patients undergoing TPIAT. TPIAT patients were younger (58.8 vs. 39.5; p &lt; 0.0001), and had lower incidences of pre-existing diabetes (41.4 % vs. 19.9 %; p &lt; 0.0001) and hypertension (48.2 % vs. 24.6 %; p &lt; 0.0001). TPIAT cohort had longer length of stay (10.3 days vs.12.2 days; p = 0.0006). There was no difference in overall rates of serious complications between the two cohorts (50.1 % vs. 45.0 %; p = 0.263). After adjusting for demographic differences between cohorts using multivariable logistic regression models, TPIAT was not associated with serious complications (OR 0.71; p = 0.168) compared to TP alone.</div></div><div><h3>Conclusion</h3><div>The results from this study suggest that TPIAT does not appear to be associated with increased 30-day morbidity, and should be considered in patients to mitigate the long-term morbidity associated with diabetes mellitus post TP.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 147-152"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854756","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":"Onset of pancreatic cancer before and after acute pancreatitis: A multicenter longitudinal cohort study","authors":"Tamás Hussein ,&nbsp;Péter Mátrai ,&nbsp;Vivien Vass ,&nbsp;Andrea Szentesi ,&nbsp;Péter Hegyi","doi":"10.1016/j.pan.2024.12.007","DOIUrl":"10.1016/j.pan.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic cancer (PC) is a leading cause of cancer mortality, often diagnosed at advanced stages. Acute pancreatitis (AP), particularly idiopathic cases, may serve as an early indicator of PC.</div></div><div><h3>Objective</h3><div>This multicenter cohort study investigated the incidence of PC before and after an AP episode, focusing on idiopathic AP and the role of pseudocysts as potential early markers for PC development.</div></div><div><h3>Methods</h3><div>We analyzed data from 2356 AP patients across 25 centers, with a median follow-up of 4.1 years (IQR: 1.6–6.8 years). Patients were categorized into 'PC before AP' and 'PC after AP' groups, and relative risk (RR) and adjusted odds ratios (OR) were calculated for idiopathic AP cases to quantify PC risk.</div></div><div><h3>Results</h3><div>Among all cases, 69 patients (2.9 %) developed PC: 1.4 % (n = 34) before and 1.5 % (n = 35) after AP. Idiopathic AP cases had a fourfold higher risk of PC (OR = 4.46, [2.25–8.85]). Notably, pseudocysts were five times more prevalent in the PC group (14 %) compared to controls (3 %) (RR = 5.66; p &lt; 0.01), often located at the tumor site. PC developed in 3 % of idiopathic AP cases versus 1.0 % in non-idiopathic cases. The median time to PC diagnosis post-AP was 373 days.</div></div><div><h3>Conclusion</h3><div>Idiopathic AP and pseudocyst formation significantly elevate the risk of PC, particularly within two years. These findings underscore the need for structured follow-up and early screening in idiopathic AP cases to improve PC detection and survival outcomes.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 29-34"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903362","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":"Author’s reply to the Letter to Editor regarding “Exploring the Role of Neoadjuvant Therapy for Resectable Pancreatic Cancer”","authors":"S. Yamada,&nbsp;D. Hashimoto,&nbsp;S. Satoi","doi":"10.1016/j.pan.2024.11.017","DOIUrl":"10.1016/j.pan.2024.11.017","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Page 189"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771006","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 Editor regarding “Autoimmune pancreatitis associated with severe postoperative pneumonia”","authors":"Gyula Farkas Jr.,&nbsp;Gábor Demeter,&nbsp;György Lázár","doi":"10.1016/j.pan.2024.12.004","DOIUrl":"10.1016/j.pan.2024.12.004","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Page 190"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818883","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":"Three-tiered critical care management of acute pancreatitis","authors":"Piroska Pázmány ,&nbsp;Anna Kanjo ,&nbsp;Zsanett Macht-Szalai ,&nbsp;Noémi Gede ,&nbsp;Nelli Farkas ,&nbsp;Bálint Erőss ,&nbsp;Andrea Szentesi ,&nbsp;Áron Vincze ,&nbsp;Roland Hagendorn ,&nbsp;Zsolt Márton ,&nbsp;Andrea Párniczky ,&nbsp;Péter Hegyi ,&nbsp;Zsolt Molnár","doi":"10.1016/j.pan.2024.11.021","DOIUrl":"10.1016/j.pan.2024.11.021","url":null,"abstract":"<div><h3>Introduction and aims</h3><div>Acute pancreatitis (AP) can rapidly progress from a stable condition to multiple organ failure with high mortality. We aimed to describe the characteristics of AP patients requiring admission to a critical care facility and to identify predictors of disease progression.</div></div><div><h3>Methods</h3><div>We conducted a post-hoc analysis using prospectively collected data from AP patients admitted to the high dependency unit (HDU) and intensive care unit (ICU) at the University of Pécs, Hungary, from 2016 to 2019. Patients were categorized according to critical care needs and severity. Daily records of organ function, organ support and laboratory parameters were kept. Descriptive analysis and predictive models were developed to forecast the need for escalated critical care and mortality.</div></div><div><h3>Results</h3><div>Analysis of 92 cases (65 % male, mean age 63 (range 19–92) years) revealed a median critical care stay of 8 days (range 1–69) and a mortality rate of 47 %. Naive Bayes prediction models using admission C-reactive protein (CRP) and amylase levels achieved 75 % accuracy in predicting mortality and a 65 % probability of requiring HDU and/or ICU admission. CRP levels increased significantly (47 vs 62 mg/l, p: 0.015) from 48 to 24 h before critical care admission, contrasting with controls, resulting in significantly higher CRP levels in critical care patients (62 vs 32 mg/l, p: 0.007) 24 h before admission.</div></div><div><h3>Conclusion</h3><div>Our findings suggest that on-admission CRP and amylase cannot reliably predict progression of AP. However, elevated and increasing levels of CRP and amylase may indicate the need for early HDU admission to enable closer monitoring.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 39-47"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854965","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":"No definite associations between opioid doses and severity of acute pancreatitis – Results from a multicentre international prospective study","authors":"Cecilie Siggaard Knoph ,&nbsp;Nejo Joseph ,&nbsp;James Lucocq ,&nbsp;Søren Schou Olesen ,&nbsp;Wei Huang ,&nbsp;Jahnvi Dhar ,&nbsp;Jayanta Samanta ,&nbsp;Rupjyoti Talukdar ,&nbsp;Gabriele Capurso ,&nbsp;Paoletta Preatoni ,&nbsp;Enrique de-Madaria ,&nbsp;Dhiraj Yadav ,&nbsp;John Windsor ,&nbsp;Asbjørn Mohr Drewes ,&nbsp;Manu Nayar ,&nbsp;PAINAP Collaborative ,&nbsp;Sanjay Pandanaboyana","doi":"10.1016/j.pan.2024.12.014","DOIUrl":"10.1016/j.pan.2024.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal pain is the cardinal symptom of acute pancreatitis (AP), often requiring opioid therapy. This study aimed to investigate the dose-dependent relationship between opioid therapy and moderately severe or severe AP.</div></div><div><h3>Methods</h3><div>This was a post-hoc analysis of the prospective PAINAP database, which recruited patients with first-time AP from 118 centres across 27 countries between April–June 30, 2022. Baseline demographic details, opioid treatment dose, and AP outcome characteristics were extracted. The intravenous morphine-equivalent doses (MEDs) of each opioid administered were calculated based on daily doses and duration. They were subsequently summarised into cumulative MEDs. Furthermore, mean daily intravenous MEDs were registered. Using multivariable regression analysis, associations between opioid doses and the severity of AP were explored.</div></div><div><h3>Results</h3><div>The final cohort consisted of 1,043 patients receiving various doses of opioids (51 % male; median age 54 years). Most (79 %) patients had mild, 14 % moderately severe, and 7 % severe AP. Median cumulative MED was 20 mg (IQR, 8–48), whereas median daily MED was 6 (IQR, 3–11), and median duration was 3 days (IQR, 2–5). There was a significant association between moderately severe or severe AP and cumulative intravenous MEDs per 10 mg (OR 1.02 (IQR 1.00–1.03), P = 0.01). When considering daily intravenous MEDs, this association was non-significant (P = 0.15).</div></div><div><h3>Conclusions</h3><div>The association between opioid doses and AP severity was dose-dependent with cumulative opioid doses but not with daily doses. In the absence of adequate evidence and potential reverse causation bias, future studies are warranted to assess the safety of opioids in AP.</div></div>","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 12-19"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915441","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":"Obituary Martin Sarner, London 1935–2024","authors":"Markus M. Lerch","doi":"10.1016/j.pan.2024.12.019","DOIUrl":"10.1016/j.pan.2024.12.019","url":null,"abstract":"","PeriodicalId":19976,"journal":{"name":"Pancreatology","volume":"25 1","pages":"Pages 1-2"},"PeriodicalIF":2.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143145753","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}