Surgical technology international最新文献

{"title":"What Does Minimally Invasive Mitral Valve Surgery Really Mean? Defining Totally Endoscopic Mitral Valve Surgery Through Meta Analysis.","authors":"Jessica Katsiroubas, Emily Manin, Jake L Rosen, Yoona Choe, Idy Ding, Keertana Jonnalagadda, T Sloane Guy","doi":"10.52198/23.STI.43.CV1715","DOIUrl":"10.52198/23.STI.43.CV1715","url":null,"abstract":"<p><strong>Introduction: </strong>Minimally invasive approaches to mitral valve surgery are being performed with increasing frequency; however, many of these procedures still involve rib spreading and large incisions. The heterogeneity of self-reported \"minimally invasive\" approaches limits analysis of outcomes. This review aims to formally define totally endoscopic mitral valve surgery (TEMVS) and assess outcomes.</p><p><strong>Materials and methods: </strong>A comprehensive literature search in Pub-Med, Cochrane Library, and EMBASE was used to find studies reporting outcomes on totally endoscopic mitral valve surgery. \"Totally endoscopic\" was defined as incisions less than 3cm and the avoidance of rib spreading. The primary outcome was 30-day mortality and secondary endpoints included postoperative myocardial infarction (MI), stroke, early reoperation, wound infection, renal failure, and prolonged ventilation. Perioperative patient characteristics were also recorded and analyzed.</p><p><strong>Results: </strong>Thirty-three studies (6031 patients) were included in our meta-analysis. The 30-day mortality rate was 0.33%, p=0.88. The most frequent complications were early reoperation (2.12%, p=0.44) and prolonged ventilation (1.46% p=<0.01). Rates of MI, stroke, and renal failure were each less than 1%. Patient characteristics including age, body mass index (BMI), and ejection fractions were also analyzed.</p><p><strong>Conclusions: </strong>We propose a formal definition of TEMVS, which is performed through incisions less than 3cm and without rib spreading. Thirty-day mortality and other adverse sequelae of TEMVS are uncommon.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238641","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":"Surgical Technique for Sphinkeeper® Implantation.","authors":"Christopher Dawoud, Daniel Moritz Felsenreich, Felix Harpain, Stefan Riss","doi":"10.52198/23.STI.43.GS1712","DOIUrl":"10.52198/23.STI.43.GS1712","url":null,"abstract":"<p><p>Fecal incontinence is a distressing condition characterized by the involuntary loss of solid and liquid stool and gas, It affects a significant proportion of the general population, with a reported prevalence ranging from 1% to 20%. Despite its considerable impact on quality of life, therapeutic options for fecal incontinence remain limited. Current treatment modalities for fecal incontinence include conservative approaches such as dietary modifications, pelvic floor exercises, and pharmacotherapy. Surgical interventions, including sphincteroplasty or sacral nerve stimulation, may be considered in more severe cases. Recently, THD Labs (THD S.p.A. Correggio (RE), Italy) introduced the Gatekeeper® as a novel device that supports the implantation of up to four solid prostheses into the intersphincteric groove. Early data were promising, with success rates above 50% and only a few perioperative complications. Subsequently, Gatekeeper® was modified by increasing the length and number (up to 10) of prostheses, and renamed Sphinkeeper® (THD). With this device, nine to 10 small incisions measuring 2 mm are made at a distance of 2-3 cm from the anus. The intersphincteric space is accessed using the delivery system, and positioning is verified through endoanal ultrasound. This procedure is repeated for all 10 prostheses placed around the entire circumference. The Sphinkeeper® offers the potential to improve the management of fecal incontinence, and offers patients a less-invasive alternative to traditional surgical approaches.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238640","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":"Postoperative Opioid Dependence in Patients Undergoing Either Total or Reverse Shoulder Arthroplasty for Proximal Humerus Fracture Fixation.","authors":"Nayeem Baksh, Jeremy Dubin, Scott Douglas, Sandeep S Bains, Daniel Hameed, Mallory C Moore, Qais Naziri, Michael A Mont, John V Ingari","doi":"10.52198/23.STI.43.OS1729","DOIUrl":"10.52198/23.STI.43.OS1729","url":null,"abstract":"<p><strong>Introduction: </strong>In elderly patients who have proximal humerus fractures, treatment commonly involves total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA). Following these procedures, patients often require opioids for postoperative analgesia. This common scenario is of clinical and societal importance, as increased postoperative opioid usage has been shown to worsen outcomes and increase the likelihood for dependence. We aimed to compare postoperative opioid use in patients undergoing either TSA or RSA for fixation of their proximal humerus fracture. Specifically, we assessed: (1) postoperative opioid use at two, four, six, eight, and greater than eight weeks postoperatively; (2) aseptic revision rates at 90-days, one year, and two years postoperatively; and (3) periprosthetic joint infection (PJI) rates at 90-days, one year, and two years postoperatively between patients undergoing TSA or RSA for the surgical management of their proximal humerus fractures.</p><p><strong>Materials and methods: </strong>For this review, we queried a national all-payer database from October 1, 2015 to October 31, 2020 (n=1.5 million) for all patients who had a \"proximal humerus fracture\" diagnosis who underwent either TSA or RSA. There were two cohorts: patients undergoing TSA (n=731) and patients undergoing RSA (n=731). Bivariate Chi-square analyses.</p><p><strong>Results: </strong>We found no differences (p>0.05) in opioid use postoperatively in patients undergoing RSA for proximal humerus management compared to patients undergoing TSA after two weeks. There was not a significant difference in aseptic revision or PJI rates between the two cohorts (all p>0.05).</p><p><strong>Conclusion: </strong>The evidence comparing opioid use in patients undergoing either TSA or RSA for proximal humerus fracture fixation is lacking. Our study specifically showed no differences in opioid use postoperatively in patients undergoing RSA for proximal humerus management compared to patients undergoing TSA.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399356","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":"What is the Efficacy of Intra-Articular Platelet-Rich Plasma Injections for Knee Osteoarthritis in Clinical Practice? A \"Real-Life\" Prospective Cohort.","authors":"Leonardo Oliveira, Dominic King, Jason Genin, Anthony Miniaci, Shujaa Khan, Ignacio Pasqualini, Pedro Rullán, Evan Peck, Farah Tejpar, Gregory Gilot, Melisa Orr, George F Muschler, Nicolas S Piuzzi","doi":"10.52198/23.STI.43.OS1736","DOIUrl":"10.52198/23.STI.43.OS1736","url":null,"abstract":"<p><strong>Introduction: </strong>Platelet-rich plasma (PRP) injections may improve symptoms in patients suffering from knee osteoarthritis. However, there is a lack of data on its effectiveness in a \"real-life\" cohort. This multi-site institutional registry study aimed to assess patients' longitudinal progress after PRP injection for knee osteoarthritis.</p><p><strong>Materials and methods: </strong>All patients receiving PRP injections for knee osteoarthritis at a large, integrated tertiary academic center (December 18, 2017 to March 1, 2021) were eligible. A prospective data collection instrument was used to collect patient demographics, procedural information, and patient-reported outcome measures. Overall, 97 patients met the inclusion criteria, and 53 were included in the analysis.</p><p><strong>Results: </strong>One in four patients (26%) improved on all three Knee Injury and Osteoarthritis Outcome Score subscales: 17% in two subscales and 20% in one subscale, respectively. Overall, 64% of patients improved in at least one patient-reported outcomes measure. At six months post injection, 49% of patients were satisfied.</p><p><strong>Conclusion: </strong>PRP injection provides positive changes in two out of three patients in different magnitudes and characteristics with careful attention to clinically meaningful differences.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399362","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":"Predictors of Readmission and Reoperation Following Shoulder Arthroplasty in Patients Under 45 Years of Age.","authors":"Luke C Zappia, Junho Song, Austen D Katz, Nicholas Sgaglione","doi":"10.52198/23.STI.43.OS1688","DOIUrl":"10.52198/23.STI.43.OS1688","url":null,"abstract":"<p><strong>Background: </strong>The use of shoulder arthroplasty has increased among all age groups, albeit most prominently in older patients. While previous studies have investigated predictors of short-term readmission and reoperation in the general population, there is a paucity of literature available on these in patients under 45 years of age. This study aimed to identify the predictors of 30-day readmission and reoperation following shoulder arthroplasty in patients under 45 years of age.</p><p><strong>Methods: </strong>A retrospective query in the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2019 was used to identify patients who underwent primary reverse and anatomic total shoulder arthroplasty and hemiarthroplasty. Multivariate logistic regression was used to identify predictors of 30-day readmission and reoperation.</p><p><strong>Results: </strong>A total of 530 patients were included. Multivariate regression revealed that Black race and Hispanic ethnicity were independent predictors of readmission. Functional dependence, hypertension requiring medication, and prolonged length of stay predicted reoperation. Finally, low hematocrit and prolonged length of stay predicted morbidity.</p><p><strong>Discussion: </strong>Identifying and accounting for these risk factors for poor outcomes may help improve perioperative risk stratification. As a result, these findings have the potential to reduce healthcare costs associated with readmission and reoperation following shoulder arthroplasty in young patients. Our results also highlight the underlying disparities in healthcare outcomes among racial and ethnic groups that must be considered.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41238639","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 Use of Plant-Based Polysaccharide (PSP) Agents May Improve Early Outcomes Following Total Knee Arthroplasty-A Proof-of-Concept Study.","authors":"Michael Ast, Emile-Victor Kuyl, Dan Devine, Elizabeth Ford, Mohamed Albana, David Mayman, Jason Blevins, Brian Chalmers, Sean McMillan","doi":"10.52198/23.STI.43.OS1733","DOIUrl":"10.52198/23.STI.43.OS1733","url":null,"abstract":"<p><p>Our study sought to investigate the effects of a topical plant-based polysaccharide (PSP) as an adjunctive hemostat to minimize blood loss and improve early clinical outcomes in patients undergoing primary TKA. In this multi-center and randomized proof-of-concept study, 61 patients undergoing TKA were randomly assigned to one of two groups: A) intraoperative utilization of PSP (n=31) or B) no intervention (n=30). The primary outcomes were blood loss and change in hemoglobin, measured preoperatively and 24 hours postoperatively. Other endpoints included postoperative complications, Knee Society Score (KSS), knee range of motion (ROM), and thigh circumference. There was no difference in postoperative change of hemoglobin or calculated blood loss between the PSP and control groups. The PSP group achieved elevated flexion at two weeks (100.1° vs. 86.6°, p<0.05) and better change in KSS from preop to 90 days (29.5 vs. 22.4, p<0.05) than the controls. Some early postoperative outcomes were improved, which suggests a potential benefit of using PSP in primary TKA. However, the clinical significance of these differences warrants further investigation in a larger randomized trial.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399359","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":"Mako® Robotic-Arm Assisted Total Hip Arthroplasty: Avoiding Impingement with Updated THA Software.","authors":"Robert Marchand, Devin Olsen, Craig Shul, Tyler Edmond, Daniel Hameed, Nate Angerett, Michael A Mont","doi":"10.52198/23.STI.43.OS1719","DOIUrl":"10.52198/23.STI.43.OS1719","url":null,"abstract":"<p><p>The use of robotic-assisted total hip arthroplasty and three-dimensional computed tomography scan-based templating has become increasingly popular over the last 10 years. However, proper planning and execution are vital to producing optimal patient outcomes. In order to achieve these outcomes, the robotic-assisted system requires training, familiarity, and experience. The goal of this article is to provide clear and condensed examples of preoperative planning, as well as adjustments that one can make to avoid impingement. The surgical technique for robotic-assisted total hip arthroplasty is also briefly discussed. Examples will be given using the latest computed tomography (CT) scan-based robotic platform for osteoarthritic hips, with specific examples of various cases of impingement that might be encountered by the surgeon and how to ultimately avoid this problem when performing the arthroplasty. This article, through case histories, will discuss the various principles and adjustments that can be made to place components in the ideal location based on individual anatomy.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399342","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":"What Drives the Material Costs of Total Knee Arthroplasty in the Operating Room?","authors":"Hannah L Simmons, Alison K Klika, Ignacio Pasqualini, Pedro J Rullán, Robert M Molloy, Matthew E Deren, Joshua L Tidd, Nicolas S Piuzzi","doi":"10.52198/23.STI.43.OS1703","DOIUrl":"10.52198/23.STI.43.OS1703","url":null,"abstract":"<p><strong>Introduction: </strong>Approximately one-third of US healthcare spending is related to surgical care. Optimizing operating room (OR) spending is crucial, specifically for high-volume procedures like total knee arthroplasty (TKA). Therefore, the primary objective was to identify leading material drivers of cost for TKA procedures within the OR.</p><p><strong>Materials and methods: </strong>Patients who underwent a primary, elective TKA from 2018 to 2019 were included (n=8,672). Intraoperative cost details for each TKA patient were captured from the Vizient Clinical Database Resource Manager (CDB/RM) data. Each cost type was categorized into (1) implant, (2) disposables, (3) wound care, and (4) miscellaneous.</p><p><strong>Results: </strong>7,124 patients undergoing primary TKA were included. Implant-related costs accounted for 87.3% of cost, disposable materials covered 10.7%, and wound care products took 2%. The leading subcategories of implant costs were primary prosthetics (85.1%), revision prosthetics (9.9%), cement (2.8%), and implant instruments (1.7%). Within disposables, surgical products accounted for 81.3% of the cost, patient care products for 8.9%, medical apparel for 7.9%, and electrolytes for 1.8%. For an average individual TKA procedure, 86.4% (±4.4) of total cost went towards the implant, 10.7% (±3.4) towards disposable materials, and 1.6% (±1.4) to wound care products. Within the implant category, 92.5% (± 12.8) of costs were associated with primary implants, 13.3% (± 6.9) with instruments, and 2.5% (± 2.8) with cement.</p><p><strong>Conclusions: </strong>The primary operative material expense category was costs associated with the TKA prosthesis and its fixation followed by disposable materials. A large amount of variation exists in the percent of the total cost for a given TKA procedure that can be attributed to each category.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136399361","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":"Infective Endocarditis After Percutaneous Device Closure of Atrial Septal Defects: Incidence, Diagnosis, and Treatment. Case Report and Literature Review.","authors":"Giuseppe Nasso, Ignazio Condello, Mizar D'Abramo, Angelo De Luca, Claudio Larosa, Giovanni Valenti, Francesco Bartolomucci, Nicola Di Bari, Stefano Sechi, Giuseppe Diaferia, Maria Grazia De Rosis, Vincenzo Amodeo, Giovanni Melina, Giuseppe Speziale, Walter Vignaroli","doi":"10.52198/23.STI.43.CV1740","DOIUrl":"10.52198/23.STI.43.CV1740","url":null,"abstract":"<p><p>Infective endocarditis (IE) on atrial septal defect (ASD) closure devices, while extremely rare, has been reported to be more frequent early after the procedure. We describe a case of late IE after percutaneous closure of patent foramen ovale (PFO). We also performed a literature review on this subject. We reviewed a total of 42,365 patients who were treated with percutaneous devices: 13,916 for ostium secundum (OS) (32%), 24,726 for PFO (58%) and 3,723 for OS+PFO (8%). Among these patients, we identified 50 cases of IE after atrial septal defect device closure (0.001%). In contrast to previous reports, nearly 66% of IE in this setting occurred late, after at least 6 months from the procedure (33/50 patients). A statistical analysis clearly showed that the mean time from the procedure to IE increased in the last five years, probably associated with a change in antiplatelet therapy after ASD closure. Management of IE on an ASD occluder should always be discussed in the setting of a multidisciplinary heart team that includes a cardiologist, cardiac surgeon, and anesthetist. While surgical strategies gave excellent results, conservative management might be considered in cases of small IE vegetations and for patients in good general condition. However, in these cases, the patient must be closely observed with repeated blood and instrumental tests.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446263","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":"An External Acetabular Alignment Guide Decreases Positional Variance.","authors":"Harsh Wadhwa, Shay I Warren, Kingsley Oladeji, Andrea K Finlay, James I Huddleston, Derek F Amanatullah","doi":"10.52198/23.STI.43.OS1735","DOIUrl":"10.52198/23.STI.43.OS1735","url":null,"abstract":"<p><strong>Introduction: </strong>Certain patient and operative factors limit accurate estimation of acetabular component positioning during total hip arthroplasty (THA). This study aimed to determine whether an intraoperative external alignment guide decreases variance in acetabular component positioning.</p><p><strong>Materials and methods: </strong>Adult patients who underwent primary THA from 2014-2018 were reviewed. Exclusion criteria were navigation, robot-assisted surgery, and inflammatory, post-traumatic, or avascular arthritis. One surgeon used an external guide while the second surgeon resected osteophytes and utilized available anatomical landmarks for positioning. Anteversion and inclination, variance, \"safe zone\" positioning, operative time, and hip instability were assessed. Multivariable regression models were used to examine effects on primary and secondary outcomes.</p><p><strong>Results: </strong>409 patients were included, of which 182 underwent component placement with landmarks only. Patients undergoing component placement with landmarks only were younger (p=0.002) and more often smokers (p=0.016). After multivariable risk adjustment, use of the external alignment guide was independently associated with 2.7° higher anteversion (CI: 1.6° to 3.8°) and smaller anteversion variance (-0.3, CI: -0.6 to 0.1) compared to landmarks only. It was independently associated with 3.2° higher inclination (CI: 2.0° to 4.4°), but there was no difference in inclination variance (-0.1, CI: -0.3 to 0.2). The external alignment guide was independently associated with a 14-minute shorter operative time (CI: 9.6 to 18.7) and smaller operative time variance (-0.9, CI: -1.2 to 0.6).</p><p><strong>Discussion: </strong>Use of anatomical landmarks alone was associated with increased likelihood of safe zone positioning but lower precision and longer operative time. While this study was limited by lack of randomization and its retrospective nature, an acetabular positioner may be preferable to palpable or visible anatomy alone for acetabular component placement.</p>","PeriodicalId":22194,"journal":{"name":"Surgical technology international","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462725","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}