Romanian Journal of Internal Medicine最新文献

{"title":"Orthostatic hypotension as an unusual presentation of spinal calcium pyrophosphate deposition disease: case report and review of literature.","authors":"Sofia Moura De Azevedo, Rita Carrilho Pichel, Egídio Freitas, Ana Campar, António Marinho, Teresa Mendonça","doi":"10.2478/rjim-2023-0021","DOIUrl":"10.2478/rjim-2023-0021","url":null,"abstract":"<p><p>Calcium pyrophosphate crystal deposition disease (CPPD), also known as pseudogout, with spinal involvement, is associated with clinical manifestations of acute nerve compression or chronic spinal stenosis. Precipitation of crystals of calcium pyrophosphate dihydrate in connective tissues can lead to acute inflammatory arthritis, degenerative chronic arthropathies, and radiographic evidence of cartilage calcification. We present a case of an 87-year-old woman, with unstudied chronic polyarthralgia and symptomatic orthostatic hypotension. It were documented acute calcium pyrophosphate deposition wrist arthritis, and cervical CT and MRI was suggestive of spinal involvement of CPPD. Workup excluded other causes of OH. Surgical approach could be indicated to minimize the symptoms, but it was contra-indicated due to the patient's performance status, so histological diagnosis was not possible. Muscle atrophy played an important part in the rapid progression of this insidious chronic disease. Conservative and symptomatic treatment achieve scarce short-term clinical improvement. Spinal involvement of CPPD was thought to be rare but recent studies show a higher prevalence than expected. We call for attention to the extent of structural changes that may occur when not early diagnosed nor treated. High clinical suspicion is required and this is, to our knowledge, the first report of orthostatic hypotension as a presentation of CPPD.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"212-215"},"PeriodicalIF":1.9,"publicationDate":"2023-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10218392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombotic microangiopathy and disseminated intravascular coagulation in a patient with carcinomatosis of the bone marrow due to gastric adenocarcinoma: Case report.","authors":"Gabriel Suarez-Reyes,&nbsp;Kateir Contreras,&nbsp;Fredy Alexander Avila-Almanza,&nbsp;Ana Janeth Salazar-Vargas,&nbsp;Camilo Molineros-Baron,&nbsp;Julian Serrano-Giraldo","doi":"10.2478/rjim-2023-0015","DOIUrl":"https://doi.org/10.2478/rjim-2023-0015","url":null,"abstract":"<p><p>Carcinomatosis of the bone marrow is a rare clinical condition characterized by diffuse tumor infiltration of the bone marrow accompanied by hematological abnormalities, including thrombotic microangiopathy (TMA) and disseminated intravascular coagulation (DIC). In patients with gastric carcinoma, this association is infrequent. Below we present a case of a 19-year-old female patient with no known pathological history who presented with upper digestive tract bleeding. Upon examination, anemia and thrombocytopenia were documented, with schistocytes in the peripheral blood smear and prolonged coagulation times. Endoscopic studies indicated a lesion in the Borrmann IV gastric body, and the bone marrow biopsy showed the presence of signet ring cells. Because there was no possibility of systemic therapy, the patient died during hospitalization. This case contributes to the medical literature by describing an unusual presentation of a very frequent pathology.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"61 3","pages":"167-174"},"PeriodicalIF":1.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9970686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Reliability and Validity of the RALE and BRIXIA Chest-X Ray Scores in Patients Hospitalized with COVID-19 Pneumonia.","authors":"Themistoklis Paraskevas,&nbsp;Platon M Dimopoulos,&nbsp;Anastasios Kantanis,&nbsp;Anna-Sofia Garatzioti,&nbsp;Iosif Karalis,&nbsp;Christos Michailides,&nbsp;Charikleia Chourpiliadi,&nbsp;Evgenia Matthaiakaki,&nbsp;Christina Kalogeropoulou,&nbsp;Dimitrios Velissaris","doi":"10.2478/rjim-2023-0013","DOIUrl":"https://doi.org/10.2478/rjim-2023-0013","url":null,"abstract":"<p><strong>Introduction: </strong>Chest X-rays are commonly used to assess the severity in patients that present in the emergency department with suspected COVID-19 pneumonia, but in clinical practice quantitative scales are rarely employed.</p><p><strong>Aims: </strong>To evaluate the reliability and validity of two semi-quantitative radiological scales in patients hospitalized for COVID-19 pneumonia (BRIXIA score and RALE score).</p><p><strong>Methods: </strong>Patients hospitalized between October 2021 and March 2022 with confirmed COVID-19 pneumonia diagnosis were eligible for inclusion. All included patients had a chest X-ray taken in the ED before admission. Three raters that participated in the treatment and management of patients with COVID-19 during the pandemic independently assessed chest X-rays.</p><p><strong>Results: </strong>Intraclass coefficients for BRIXΙA and RALES was 0.781 (0.729-0.826) and 0.825 (0.781-0.862) respectively, showing good to excellent reliability overall. Pairwise analysis was performed using quadratic weighted kappa showing significant variability in the inter-rater agreement. The prognostic accuracy of the two scores for in-hospital mortality for all raters was between 0.753 and 0.763 for BRIXIA and 0.737 and 0.790 for RALES, demonstrating good to excellent prognostic value. Both radiological scores were significantly associated with inhospital mortality after adjustment for 4C Mortality score. We found a consistent upwards trend with significant differences between severity groups in both radiological scores.</p><p><strong>Conclusion: </strong>Our findings suggest that BRIXIA and RALES are reliable and can be used to assess the prognosis of patients with COVID-19 requiring hospitalization. However, the inherent subjectivity of radiological scores might make it difficult to set a cut-off value suitable for all assessors.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"61 3","pages":"141-146"},"PeriodicalIF":1.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9967568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardio-Oncology for the Primary Care Provider.","authors":"Nikita Jhawar,&nbsp;Alyssa Mcpherson,&nbsp;Razvan Chirila,&nbsp;Jordan Ray","doi":"10.2478/rjim-2023-0012","DOIUrl":"https://doi.org/10.2478/rjim-2023-0012","url":null,"abstract":"<p><p>Cardiovascular disease is a major cause of mortality among oncologic patients. As cancer therapies continue to evolve and advance, cancer survival rates have been increasing and so has the burden of cardiovascular disease within this population. For this reason, cardio-oncology plays an important role in promoting multidisciplinary care with the primary care provider, oncology, and cardiology. In this review, we discuss the roles of different providers, strategies to monitor patients receiving cardiotoxic therapies, and summarize cancer therapy class-specific toxicities. Continued collaboration among providers and ongoing research related to cardiotoxic cancer therapies will enable patients to receive maximal, evidence-based, comprehensive care.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"61 3","pages":"127-134"},"PeriodicalIF":1.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9967571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of the association of the <i>RAN</i> (rs14035) and <i>XPO5</i> (rs11077) polymorphisms with venous thromboembolism.","authors":"Khloud M Alquraan,&nbsp;Omar F Khabour","doi":"10.2478/rjim-2023-0014","DOIUrl":"https://doi.org/10.2478/rjim-2023-0014","url":null,"abstract":"<p><strong>Introduction: </strong>Venous thromboembolism (VTE) is the third most common hemostatic disease worldwide. Studies have reported a role for microRNA (miRNA) in the homeostasis and development of VTE. The ras-related nuclear protein (<i>RAN</i>) and exportin 5 (<i>XPO5</i>) genes are involved in miRNA biogenesis, as both regulate the transport of pre-miRNA from the nucleus to the cytoplasm. Therefore, the aim of the current study is to examine the association between <i>RAN</i> (rs14035) and <i>XPO5</i> (rs11077) single nucleotide polymorphisms (SNPs) and VTE.</p><p><strong>Methods: </strong>The study sample consisted of 300 subjects (150 patients and 150 age and sex matched controls). The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and tetra-primer amplification refractory mutation system (T-ARMS) techniques were used to genotype rs14035 and rs11077, respectively.</p><p><strong>Results: </strong>The results showed that there was a significant association between the <i>XPO5</i> rs11077 and the risk of VTE (P < 0.05). Subjects with AC (OR: 2.08, CI:1.26-3.44) and CC (OR: 1.77, CI: 0.88-3.55) genotypes were at increased risk of the developing VTE. Regarding <i>RAN</i> gene, no association was found between rs14035 and VTE (P > 0.05). In addition, no associations were found between <i>XPO5</i> rs11077 and <i>RAN</i> rs14035 genotypes with blood cell parameters (P > 0.05). As for the demographic characteristics, the results indicated a strong association between family history and body mass index (BMI) with the risk of VTE (P < 0.01).</p><p><strong>Conclusion: </strong>The <i>XPO5</i> rs11077, BMI and family history might contribute to the development of VTE in Jordan.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"61 3","pages":"154-162"},"PeriodicalIF":1.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9972983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in the diagnosis of leptomeningeal dissemination of glioblastoma in a patient with fever and xanthochromic CSF: a case report.","authors":"Andrei Neagu,&nbsp;Cristian-Mihail Niculae,&nbsp;Irina Lăpădat,&nbsp;Adriana Hristea","doi":"10.2478/rjim-2023-0010","DOIUrl":"https://doi.org/10.2478/rjim-2023-0010","url":null,"abstract":"<p><strong>Background: </strong>Leptomeningeal spread with carcinomatous meningitis is a severe complication of glioblastoma, with a poor prognosis. Diagnosis is challenging, as the sensitivity of classic diagnostic investigations remains low for detecting cerebrospinal fluid (CSF) tumor spread and exclusion of infectious causes is mandatory, especially if unusual clinical findings are present.</p><p><strong>Case presentation: </strong>A 71-year-old woman was admitted to our hospital for recurrent episodes of high fever and xanthochromic meningitis, with subacute onset. Her past medical history was significant for a left temporal glioblastoma, treated with surgical resection and adjuvant chemo- and radiotherapy, with associated systemic immunosuppression secondary to chemotherapy. An extensive workup especially with molecular microbiology testing for exclusion of infectious causes was performed. CSF was analyzed for typical bacterial and viral causes, but also pathogens associated with immunosuppression, such as <i>Listeria monocytogenes</i> and <i>Cryptococcus neoformans.</i> A therapeutic trial of standard antituberculous drugs with repeated lumbar punctures were needed in order to exclude <i>Mycobacterium tuberculosis</i> and to confirm the diagnosis of carcinomatous meningitis by cytopathological examination of the CSF.</p><p><strong>Conclusions: </strong>The case describes an unusual clinical presentation of a patient with glioblastoma associated leptomeningeal dissemination, as high fever and xanthochromic CSF could raise important diagnostic and therapeutic challenges in the clinical practice. The diagnosis of carcinomatous meningitis requires an extensive workup for exclusion of infectious causes which is important for urgent oncologic treatment.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"61 3","pages":"163-166"},"PeriodicalIF":1.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10322885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The correlation between Body Mass Index and histological features of Nonalcoholic Fatty Liver Disease.","authors":"Ana Calin-Necula,&nbsp;Vlad Enciu,&nbsp;Priscila Ologeanu,&nbsp;Alexandru Constantin Moldoveanu,&nbsp;Carmen Fierbinteanu Braticevici","doi":"10.2478/rjim-2023-0011","DOIUrl":"https://doi.org/10.2478/rjim-2023-0011","url":null,"abstract":"<p><p><b>Introduction</b>: NAFLD is strongly associated with metabolic syndrome, and for many years, fatty liver was an exclusive feature of obese patients. The study tries to assess whether the body mass index (BMI) and body circumference is correlated to steatosis, fibrosis, or inflammatory activity of the liver. <b>Methods</b>: 81 patients with recent hepatic biopsy were included in the study and were weighed and measured. The biopsy results were compared to the measurements. <b>Results</b>: The average BMI overall for the whole lot was 30.16. There was a significant difference in BMI across the inflammatory activity categories (p = 0.009): groups with higher necro inflammatory activity tended to have higher BMI values (average values per grade: 0-28, 1-29, 2-33, 3-32, 4-29). There was no significant difference for grades of steatosis (p = 0.871). With regards to waist circumference, the overall average was 90.70cm/35.70in. There was a significant difference across the steatosis categories (p < 0.001): groups with higher steatosis scores had higher waist circumferences (average values per grade: 1-77cm / 30 in, 2-95 cm / 37 in, 3-94 cm / 37 in). There was no significant difference for grades of activity (p = 0.058). <b>Conclusion</b>: BMI and waist circumference are easy to measure, non-invasive parameters, which could be useful in screening patients at higher risk for necro inflammatory activity or severe steatosis.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"61 3","pages":"147-153"},"PeriodicalIF":1.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10322884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycemic control as the main determinant factor of serum VEGF levels in type 2 diabetes mellitus patients.","authors":"Liong Boy Kurniawan,&nbsp;Rika Andriany,&nbsp;Yuyun Widaningsih,&nbsp;Tenri Esa,&nbsp;Uleng Bahrun,&nbsp;Endy Adnan,&nbsp;Mansyur Arif","doi":"10.2478/rjim-2023-0009","DOIUrl":"https://doi.org/10.2478/rjim-2023-0009","url":null,"abstract":"<p><p><b>Introduction.</b> Diabetes mellitus (DM) is a main endocrine disorder that may cause vascular complications as the disease progresses. Vascular endothelial growth factor (VEGF) has been linked to the development of micro and macrovascular diabetic complications. This study aimed to assess several factors including blood pressure, body mass index, lipid profile, kidney function, and glycemic control that may provide the rise of serum VEGF levels in type 2 DM subjects. <b>Methods.</b> This cross-sectional study was carried out among 65 type 2 DM subjects. Systole, diastole, mean arterial pressure (MAP), and body mass index (BMI) were measured. The levels of serum VEGF were measured by Enzyme-linked immunosorbent assay (ELISA), Hemoglobin A1c (HbA1c) levels were measured by latex agglutination inhibition test, while serum glucose, lipid profiles, urea, and creatinine levels were tested by enzymatic photometric method. <b>Results.</b> The levels of serum VEGF had a significant correlation with BMI (p = 0.001, r = 0.397), fasting plasma glucose (FPG) (p = 0.001, r = 0.418), HbA1c (p < 0.001, r = 0.600), systole (p = 0.001), r = 0.397), diastole (p = 0.021, r = 0.286), and MAP (p = 0.001, r = 0.001). Further multivariate linear regression analysis revealed that HbA1c logarithm (log) was the determinant factor of VEGF levels (p < 0.001, β = 0.631, Adjusted R² = 38.9%) <b>Conclusion.</b> HbA1c is the main determinant factor of serum VEGF levels among type 2 DM patients.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":"61 3","pages":"135-140"},"PeriodicalIF":1.9,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10341258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Neurocardiology to Stroke-Heart Syndrome.","authors":"Ileana Raluca Nistor, Leonida Gherasim","doi":"10.2478/rjim-2023-0020","DOIUrl":"10.2478/rjim-2023-0020","url":null,"abstract":"<p><p>The Stroke-Heart syndrome is a major chapter in neurocardiology. Both brain-heart and stroke-heart correlations are based on neurophysiological studies that define and describe the relation between the central autonomic system and cardiac function and it will be presented in this narrative review. The Stroke-Heart syndrome groups the entire spectrum of cardiac changes - clinical, ECG, echocardiographic, biological, morphological - that occur in the first 30 days from the onset of stroke, especially in the first days. Their presence significantly marks the evolution and prognosis of stroke. The damage resulted from hypothalamus-pituitary-adrenal axis activation and high catecholamine release (adrenergic storm) targets mainly the myocyte and the microcirculation.The Takotsubo syndrome and Stunned myocardium are distinct forms of neurogenic myocardial ischemia - with changes in ECG, parietal motility, and biological markers - usually reversible although evolution towards cardiac dysfunction is also possible. The concept of Stroke-Heart syndrome and the brain-heart correlation brought new scientific information regarding stress cardiomyopathy or neurogenic myocardial injury.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"177-185"},"PeriodicalIF":1.9,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9940313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary artery tortuosity and mid-term all-cause mortality of patients with ischemia and non-obstructive coronary arteries.","authors":"Dumitru Emilian Mihai, Caterina Delcea, Cătălin Adrian Buzea, Sabina Balan, Gheorghe Andrei Dan","doi":"10.2478/rjim-2023-0019","DOIUrl":"10.2478/rjim-2023-0019","url":null,"abstract":"<p><p><i><b>Background:</b></i> Coronary artery tortuosity (CAT) is a frequently encountered angiographic feature of patients with ischemia and non-obstructive coronary arteries (INOCA). However, there is limited data regarding the possible correlation between CAT and all-cause mortality in these patients. <i><b>Aim:</b></i> To assess the survival prognostic implications of CAT in INOCA patients and the predictors of all-cause mid-term mortality of these patients. <i><b>Methods:</b></i> All consecutive INOCA patients, with preserved ejection fraction evaluated for clinical ischemia by coronary angiography in our department between January 2014 and December 2020 were considered for inclusion. Patients with epicardial coronary artery stenosis ≥ 50%, severe pulmonary hypertension, or decompensated extra cardiac disease were excluded. Eleid classification was used for CAT severity characterization. We assessed all-cause mortality in January 2023. <i><b>Results:</b></i> Our sample included 328 INOCA patients. 15.54% died during the mean follow-up of 3.75 ± 1.32 years. 79.88% had CAT. CAT patients were older (65.10±9.09 versus 61.24±10.02 years, p=0.002), and more often female (67.18% versus 31.82%, p<0.001). CAT was inversely correlated with all-cause mid-term mortality (OR 0.35, 95%CI 0.16 - 0.77, p=0.01). CAT severity had no impact on survival. In CAT patients the initial multivariable analysis identified NT-proBNP levels (HR 3.96, p=0.01), diabetes mellitus (DM) (HR 4.76, p=0.003), and atrial fibrillation (HR 2.68, p=0.06) as independent predictors of all-cause mortality. In the final analysis, NT-proBNP and DM were the main independent predictors of survival. <i><b>Conclusions</b></i> : In our INOCA cohort, CAT patients were older and more likely female. CAT was inversely correlated with mid-term all-cause mortality. NT-proBNP and DM were the main independent predictors of mortality of CAT patients.</p>","PeriodicalId":21463,"journal":{"name":"Romanian Journal of Internal Medicine","volume":" ","pages":"202-211"},"PeriodicalIF":1.9,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9942447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}