Surgical Innovation最新文献

{"title":"Metaverse and Telementoring: From Surgery to Workshop.","authors":"Michele Ammendola, Francesca Vescio, Mohanad Al Ansari, Jozel Hila, Laura Rizzo, Roberto Romano, Francesco Marchegiani, Nicola de'Angelis, Tullio Piardi, Davide Cavaliere, Adam E Frampton, Tamara M H Gall, Maria Luposella, Riccardo Memeo, Giuseppe Navarra, Silvia Curcio, Giuseppe Currò","doi":"10.1177/15533506241233674","DOIUrl":"10.1177/15533506241233674","url":null,"abstract":"<p><strong>Background: </strong>The Coronavirus 2019 (COVID-19) pandemic has favored the growth of telemedicine systems and in this context the idea of Metaverse was born and developed. A 3D reality in which people can interact with each other through digital reproductions of themselves. Metaverse has already been tested in numerous medical fields due to its ability to combine visual and auditory information with tactile sensations. The purpose of this study is to highlight its potential also in its ability to be used as a telementoring place where the skills and knowledge of surgeons from all over the world can be combined.</p><p><strong>Material and methods: </strong>The first HPB Surgery Workshop was held at the \"Metaverse Surgical Hospital, USA\". During the workshop, surgeons located in various parts of the world reported on hepatic, pancreatic and biliary tract surgery and remotely supported the execution of a robotic liver resection.</p><p><strong>Results: </strong>The Metaverse gave the opportunity for surgeons to meet and discuss HPB pathologies and its surgical strategies and for surgeons in training to interface with experts by participating in a moment of advanced training.</p><p><strong>Conclusion: </strong>In the Metaverse, telementoring can be used at very low cost to improve clinical and surgical practice.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139913557","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":"Prophylactic Intra-abdominal Drainage is Associated With Lower Postoperative Complications in Patients With Crohn's Disease: A Randomized Controlled Trial.","authors":"Ming Duan, Lei Cao, Mengjie Lu, Tenghui Zhang, Qing Ji, Xian Guo, Zhen Guo, Qiong Wu, Yuxiu Liu, Jianfeng Gong, Weiming Zhu, Yi Li","doi":"10.1177/15533506241232598","DOIUrl":"10.1177/15533506241232598","url":null,"abstract":"<p><strong>Background: </strong>Prophylactic intraoperative drains have been shown not superior for patients underwent intestinal surgery. However, for patients with Crohn's disease (CD), this needs further exploration.</p><p><strong>Methods: </strong>In this pilot study, CD patients were randomly assigned to drain (n = 50) and no-drain (n = 50) groups. The primary endpoint was the rate of postoperative prolonged ileus (PPOI). The secondary endpoints were postoperative abdominal ascites, postoperative systemic inflammatory response syndrome (SIRS) and C-reactive protein (CRP) levels.</p><p><strong>Results: </strong>The incidences of PPOI and postoperative abdominal ascites were significantly lower in the drain group (12% vs 44%; 0% vs 24%, both <i>P</i> < .05). Postoperative SIRS incidence and CRP levels were significantly increased in the no-drain group [36% vs 10%; 54.9 vs 34.3 mg/L, both <i>P</i> < .05]. In multivariate analysis, prophylactic drainage was the independent protective factor for PPOI and postoperative LOS.</p><p><strong>Conclusions: </strong>Prophylactic drainage may be associated with improved clinical outcomes in CD patients.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139713102","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":"Is LigaSure Alone Sufficient for the Closure of the Appendix Stump?","authors":"Deniz Tazeoglu, Ahmet Cem Esmer","doi":"10.1177/15533506241234005","DOIUrl":"10.1177/15533506241234005","url":null,"abstract":"<p><strong>Purposes: </strong>Closure of the appendix stump is necessary for laparoscopic appendectomy. Problems that occur during the appendix stump closure can cause severe morbidity. Several methods of stump closure have been described. This study aimed to investigate the adequacy of LigaSure alone in closing the appendix stump.</p><p><strong>Methods: </strong>Patients who were operated on with the diagnosis of acute appendicitis between October 2021 and January 2022 were evaluated retrospectively. The patients were divided into two groups according to the closure technique of the appendix stump hemoclip(group I) and LigaSure only(group II). In addition, demographic data (age, gender), body mass index (BMI), presence of comorbid disease, perioperative appendicitis classification, operation time, postoperative hospital stay, radiological and pathological appendix size of the patients included in the study were recorded. Clavien Dindo was used for postoperative complication assessment.</p><p><strong>Result: </strong>The study included 77 patients. 48(62.3%) of the patients were in group I, and 29(37.7%) were in group II. There was no statistical difference between the groups regarding age, gender distribution, BMI, presence of comorbid disease (<i>P</i> > .05). The operation time of group I was longer than group II (<i>P</i> < .001). There was no difference between the groups in terms of both radiological and pathological appendix size. There was no statistical difference between the groups regarding postoperative complications and severity of complications (<i>P</i> = .76, <i>P</i> = .99, respectively).</p><p><strong>Conclusion: </strong>Appendiceal stump closure can be performed with Ligasure, but it should be noted that this procedure can be performed on selected patients, as in the study group, not on all patients.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736200","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":"A Matched Comparative Analysis of Type-2 Diabetes Mellitus Remission Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.","authors":"Karl Hage, Pearl Ma, Wissam Ghusn, Kayla Ikemiya, Andres Acosta, Robert A Vierkant, Barham K Abu Dayyeh, Kelvin D Higa, Omar M Ghanem","doi":"10.1177/15533506241229040","DOIUrl":"10.1177/15533506241229040","url":null,"abstract":"<p><strong>Objective: </strong>Multiple scores validate long-term type-2 diabetes mellitus (T2DM) remission after metabolic and bariatric surgery (MBS). However, studies comparing Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have not adequately controlled for certain parameters, which may influence procedure selection.</p><p><strong>Methods: </strong>We conducted a multicenter retrospective review of patients with T2DM who underwent RYGB or SG between 2008 and 2017. Data on demographics, clinical, laboratory, and metabolic values were collected annually for up to 14 years. Each eligible RYGB patient was individually matched to an eligible SG patient based on diabetes severity, weight loss, and follow-up duration.</p><p><strong>Results: </strong>Among 1149 T2DM patients, 467 were eligible for matching. We found 97 matched pairs who underwent RYGB or SG. RYGB showed significantly higher T2DM remission rates (46.4%) compared to SG (33.0%) after matching. SG patients had higher insulin usage (35.1%) than RYGB patients (20.6%). RYGB patients also experienced greater decreases in HbA1c levels and diabetes medication usage than SG patients.</p><p><strong>Conclusions: </strong>RYGB demonstrates higher efficacy for T2DM remission compared to SG, regardless of baseline characteristics, T2DM severity, weight loss, and follow-up duration. Further studies are needed to understand the long-term metabolic effects of MBS and the underlying pathophysiology of T2DM remission after MBS.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521784","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":"Single-Port Laparoscopic Extraperitoneal Repair of Pediatric Inguinal Hernias and Hydroceles by Using Hernia Crochet Needle With a Cannula.","authors":"Zhixiong Lin, Lei Yan, Zhihao Fang, Dianming Wu, Mingkun Liu, Yifan Fang","doi":"10.1177/15533506241226497","DOIUrl":"10.1177/15533506241226497","url":null,"abstract":"<p><strong>Purpose: </strong>Numerous modifications laparoscopic techniques have mushroomed in recent years. Here we describe a modified technique of extracorporeal ligation of processus vaginalis in children using a hernia crochet needle with a cannula.</p><p><strong>Methods: </strong>Processus vaginalis repair was carried out on patients diagnosed with inguinal hernia or hydroceles using this novel technique between June 2021 and June 2022. The processus vaginalis was closed extracorporeally using a hernia crochet needle with a cannula. In the presence of patent processus vaginalis, the same procedure would be performed on the contralateral side. The primary outcomes was the safety and efficiency of this modified procedure, and the secondary outcomes was the post operative complications.</p><p><strong>Results: </strong>A total of 212 (165 inguinal hernia and 47 hydroceles) children were corrected by this novel technique. The mean operation time was 27.49 min for unilateral inguinal hernia cases and 36.55 min for bilateral cases. The unilateral hydrocele median operation time was 27.83 min and that for the bilateral cases was 37.30 min. During the mean of 10.92 months of follow-up, there was only a boy subject to a metachronous contralateral occurrence of hernia 10 months after surgery, and no other complications (knot reactions, testicular atrophy, postoperative hydrocele or iatrogenic) have been observed yet.</p><p><strong>Conclusion: </strong>This study shown a unique procedure with using a hernia crochet needle with a cannula to be simple, safe, and effective in managing inguinal hernias and hydroceles in the pediatric population.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139106703","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":"Onyx®, A New Tool for Intraoperative Localization of Liver Lesions.","authors":"J J Rubio-García, A J Mantilla Pinilla, S Gil Sánchez, C Villodre Tudela, C Alcázar López, P Melgar Requena, G Rodríguez Laiz, J Irurzun López, J M Ramia-Ángel","doi":"10.1177/15533506241236732","DOIUrl":"10.1177/15533506241236732","url":null,"abstract":"<p><strong>Background: </strong>Precise preoperative localization of liver tumors facilitates successful surgical procedures, Intraoperative ultrasonography is a sensitive imaging modality. However, the presence of small non-palpable isoechoic intraparenchymal lesions may be challenging intraoperatively.</p><p><strong>Methodology and material description: </strong>Onyx® is a non-adhesive liquid agent comprised of ethylene-vinyl alcohol usually used dissolved in dimethyl-sulfoxide and suspended micronized tantalum powder to provide contrast for visualization under fluoroscopy and ultrasonography and a macroscopic black shape. This embolization material has been increasingly used for the embolization of intracranial arteriovenous malformations. We present the novel application of Onyx® on liver surgery.</p><p><strong>Current status: </strong>We present the case of a female, 55 years-old, whose medical history revealed an elective sigmoidectomy (pT3N1a). After 17 months of follow up, by PET-CT scan, the patient was diagnosed of a small intraparenchymal hypo-attenuated 13 mm tumor located at segment V consistent with metachronous colorectal liver metastasis. Open metastasectomy was performed, ultrasonography-guided Onyx® infusion was delivered the day after, intraoperative ultrasonography showed a palpable hyperechoic material with a posterior acoustic shadowing artifact around the lesion. Onyx® is a promising new tool, without any previous application on liver surgery, feasible with advantages in small not palpable intraparenchymal liver lesions.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139932913","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 Assisted Recognition of Anatomical Landmarks and Laparoscopic Instruments in Transabdominal Preperitoneal Inguinal Hernia Repair.","authors":"Apollon Zygomalas, Dimitrios Kalles, Nikolaos Katsiakis, Andreas Anastasopoulos, Georgios Skroubis","doi":"10.1177/15533506241226502","DOIUrl":"10.1177/15533506241226502","url":null,"abstract":"<p><p>Laparoscopic TAPP (Trans-Abdominal PrePeritoneal) is a minimally invasive surgical procedure used to repair inguinal hernias. Arguably, one important aspect to TAPP hernia repair is the identification of anatomical landmarks and the correct use of various laparoscopic instruments. There are very few studies regarding the use of artificial intelligence in laparoscopic inguinal hernia repair and more specifically in TAPP. The aim of this study is to evaluate the feasibility and usefulness of AI in the recognition of anatomical landmarks and tools in laparoscopic TAPP videos. Imaging data have been exported from 20 Laparoscopic TAPP videos that have been performed by the authors and another 5 high quality TAPP videos from the internet (free access) performed by other surgeons. In total 1095 selected images have been exported for annotation. To accomplish the AI result of computer vision, the YOLOv8 model of deep learning was used. In total 2716 segmented areas of interest have been exported. The AI model was able to detect the various classes with a maximum F1 score of .82 when the confidence threshold was set to .406. The mAP50 was .873 for all classes. The Precision was above 50% when the confidence was over 10%. The Recall rate was above 50% when confidence was less than 70%. These results suggest that the model is effective at balancing precision and recall, capturing both true positives and minimizing false negatives. Artificial Intelligence recognition of anatomical landmarks and laparoscopic instruments in TAPP is feasible with acceptable success rates.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404456","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":"Can Computerized Simulation be Used to Assess Surgical Proficiency in Laparoscopic Colorectal Surgeries? A Systematic Review.","authors":"Si Yuan Chang, Kai Siang Chan, Aung Myint Oo","doi":"10.1177/15533506241232791","DOIUrl":"10.1177/15533506241232791","url":null,"abstract":"<p><strong>Introduction: </strong>Computerized simulation (CS) of surgery in virtual reality (VR), augmented reality (AR) and mixed reality (MR) settings are used to teach foundational skills, but its applicability in advanced training is to be determined. This review aims to summarize the types of CS available for laparoscopic colorectal surgery (CRS) and its utility in assessment of proficiency.</p><p><strong>Methods: </strong>A systematic review of CS in laparoscopic CRS was done on PubMed, Embase, Scopus and Cochrane Library databases.</p><p><strong>Results: </strong>Eleven relevant observational studies were identified. The most common procedure simulated was laparoscopic colectomy. Assessment using performance metrics measured by the simulator such as path length moved by laparoscopic tools, procedure time and number of discrete movements had the most consistent differentiating ability between expert and non-expert cohorts. Surgeons fared similarly in proficiency scores in assessment with CS compared to assessment with traditional cadaveric or porcine models.</p><p><strong>Conclusion: </strong>CS of laparoscopic CRS may be used in assessment of proficiency using performance metrics measuring economy of movement. CS may be a viable assessment tool in advanced surgical training, but further studies should assess utility of incorporating it as a formal assessment tool in training programs.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.2,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139906505","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":"Hybrid (Digital/Water Seal) Chest Drainage System - An Innovative Device for Patients with Anticipated Air Leaks.","authors":"Uyen-Thao Le, Nicolas Hümmler, Frank Greiser, René Tullius-Modlmeier, Marion Benitz, Bernward Passlick","doi":"10.1177/15533506241232618","DOIUrl":"10.1177/15533506241232618","url":null,"abstract":"<p><strong>Background: </strong>To date, several chest drainage systems are available, such as digital drainage systems (DDS) and traditional systems with continuous suction or water seal. However, none of these systems were yet shown to be favorable in the treatment of complex situations such as persistent air leaks or residual spaces. We present in-vitro as well as clinical data of a novel hybrid drainage system consisting of an optimized digital drainage system (ODDS) and an underwater seal drainage system (UWSD).</p><p><strong>Methods: </strong>For in-vitro analysis, a DDS and an ODDS were connected to a pleural cavity simulator. Different air leaks were produced and data on intrapleural pressure and air flow were analyzed. Furthermore, we tested the hybrid drainage system in 10 patients with potential air leaks after pulmonary surgery.</p><p><strong>Results: </strong>In in-vitro analysis, we could show, that with advanced pump technology, pressure fluctuations caused by the drainage system when trying to maintain a set pressure level in patients with airleaks were much smaller when using an ODDS and could even be eliminated when using a fluid collection canister with sufficient buffer capacity. This minimized air leak boosts caused by the drainage system. Optimizing the auto-pressure regulation algorithms also led to a reduced airflow through the fistula and promoted rest. Switching to a passive UWSD also reduced the amount of airflow. Clinical application of the hybrid drainage system yielded promising results.</p><p><strong>Conclusion: </strong>The novel hybrid drainage system shows promising results in the treatment of patients with complex clinical situations such as persistent air leaks.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139973553","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":"Immunotherapeutic Properties of Dexmedetomidine on Pain Management and Cardiovascular Function in Videolaparoscopic Cholecystectomies: A Randomized, Two-Arm, Double-Blinded, Placebo-Controlled Trial.","authors":"Gustavo Nascimento Silva, Virna Guedes Brandão, Marcelo Vaz Perez, Sandoval Lage Sobrinho, João Gabriel de Cerqueira Campos Villardi, Priscilla Mendonça do Sacramento, Luiz Claudio Pereira Ribeiro, Rossano Kepler Alvim Fiorelli","doi":"10.1177/15533506241234591","DOIUrl":"10.1177/15533506241234591","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopy represented one of the most innovative surgical techniques approached in the surgery field. Dexmedetomidine association with general anesthesia promotes the response control to trauma by altering the neuroinflammatory reflex, provides better clinical outcomes in the postoperative period and reduces the excessive use of drugs with risk for addiction. This trial aims to evaluate the potential drug treatment of dexmedetomidine on organic function, with the targets in neuroinflammation, perioperative pain control and blood pressure measurements in a medium-sized surgical model.</p><p><strong>Methods: </strong>Fifty-two patients were randomized in two groups: Sevoflurane and Dexmedetomidine - A (dexmedetomidine infusion [1 μg/kg loading, .2-.5 μg/kg/h thereafter]) vs Sevoflurane and Saline .9% - B. Three blood samples were collected at three times: before surgery, 4 to 6 hours after surgery and 24 hours postoperatively. The primary outcome was inflammatory and endocrine mediators dosage analisys. Finally, we evaluated pain and opioid use as secondary outcomes, also the hemodynamic values.</p><p><strong>Results: </strong>In Dexmedetomidine group A, a reduction of Interleukin 6 was found during 4-6 hours after surgery. A reduction of IL-10 was noted in the measurement of its values 24 hours after the procedure, with statistical significance. Also, systolic and diastolic blood pressure, as well heart rate were attenuated, and there was a lower incidence of pain and opioid consumption in the first postoperative hour (<i>P</i> < .0001) in the anesthetic recovery room.</p><p><strong>Conclusions: </strong>Dexmedetomidine provided anti-inflammatory activity, sympatholytic effect and analgesia with cardiovascular safety. It reinforces the therapeutic nature of highly selective α2-adrenergic agonists when combined within anesthetic interventions.</p>","PeriodicalId":22095,"journal":{"name":"Surgical Innovation","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139932912","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}