World Journal of Surgery最新文献

{"title":"On the Shoulders of Giants: The Specialist Surgeon Workforce in East, Central and Southern Africa.","authors":"Dominique Vervoort","doi":"10.1002/wjs.12544","DOIUrl":"https://doi.org/10.1002/wjs.12544","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adoption of the Enhanced Recovery After Surgery Practices for Colorectal Procedures: A Nationwide Assessment in Ukraine.","authors":"Marta Antoniv, Inesa Huivaniuk, Andrei Nikiforchin, Taras Ivanykovych, Valeriia Chorna, Hansel Mundaca Hurtado, Adrian Pavel, Ali Dzhemiliev, Oleg Turkot, Viacheslav Kopetskyi, Andriy Beznosenko, Ronald Bleday, Julie Hallet, Nelya Melnitchouk","doi":"10.1002/wjs.12536","DOIUrl":"https://doi.org/10.1002/wjs.12536","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Observational Study of Curative Effects Between Complete Video-Assisted Thoracoscopic Surgery and Conservative Treatment for Multiple Rib Fractures in Non-Frail Chests.","authors":"Minghui Han, Qingying Zhang, Gang Xue, Jing Yang, Tianyuan Liu, Yuanqing Gao, Hong Zhao, Ronghua Yang","doi":"10.1002/wjs.12538","DOIUrl":"https://doi.org/10.1002/wjs.12538","url":null,"abstract":"<p><strong>Background: </strong>Multiple rib fractures (MRFs) are common injuries and result in serious morbidity and mortality after trauma. Complete video-assisted thoracoscopic surgery (c-VATS) has been increasingly used in the treatment of MRFs. This study was to compare the clinical effects of c-VATS and conservative treatment for MRFs.</p><p><strong>Methods: </strong>60 patients with MRFs without flail chest were selected. Patients were divided into a c-VATS group (30 cases) and a conservative treatment group (30 cases). In the c-VATS group, patients were operated on with the internal fixation of rib fracture with complete video-assisted thoracoscopic surgery. Patients in the conservative treatment group were given symptomatic treatment measures such as oxygen therapy, fluid replacement, pain relief, rib band fixation, closed chest drainage, and drug anti-infection therapy. These treatment-related indexes were retrospectively analyzed, including abbreviated injury scale (AIS) score, visual analog scale (VAS) of pain score, blood gas analysis, lung function, hospitalization cost, and fracture healing after discharge.</p><p><strong>Results: </strong>There were no significant differences in age, sex, number of fractures, or AIS score between the two groups. Blood gas analysis and pulmonary function indices showed better improvement in the c-VATS group (p < 0.05). The VAS pain score was 3.42 ± 0.54 in the c-VATS group and 4.98 ± 1.01 in the conservative group, indicating better pain control in the c-VATS group (p < 0.05). Hospitalization time was shorter in the c-VATS group (9.54 ± 2.61 days) compared to the conservative group (12.64 ± 3.54 days) (p < 0.05). Three months after discharge, follow-up evaluations revealed that the c-VATS group exhibited significantly better fracture healing (96.67%) compared to the conservative treatment group (80%) (p < 0.05). The average hospitalization cost in the c-VATS group (35,689 ± 7361) was significantly higher than that in the conservative treatment group (12,624 ± 3638) (p < 0.05).</p><p><strong>Conclusion: </strong>In treating MRFs, c-VATS with internal fixation resulted in significant improvements in lung function, shorter pain duration, and a lower rate of fracture malunion. c-VATS with internal fixation represents a feasible, safe, and minimally invasive surgical approach for the treatment of MRFs, which is worthy of clinical promotion.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simulation to Scalpel: A Systematic Review of True Evidence of Skills Transfer as Seen Through the Lens of Patient Outcomes.","authors":"Sanjay Kumar Yadav, Animesh Jose, Dhananjaya Sharma, Chandra Shekhar Biyani","doi":"10.1002/wjs.12525","DOIUrl":"https://doi.org/10.1002/wjs.12525","url":null,"abstract":"<p><strong>Introduction: </strong>Simulation-based training (SBT) has become an essential component of surgical education. However, the definitive evidence for dissrect patient outcomes remains inconsistent. This prompted us to conduct this systematic review and meta-analysis to evaluate Kirkpatrick Level 4 evidence on whether SBT translates into clinical benefits and improves patient outcomes.</p><p><strong>Methods: </strong>We designed a search protocol a priori and followed PRISMA guidelines for systematic reviews. Medline (via PubMed), Cochrane Library, online clinical trial registers, and websites were reviewed from their inception until 31^st October 2024. Included studies were randomized controlled trials with patients undergoing any invasive intervention involving manual skills after SBT compared to the same intervention involving manual skills without SBT and comparing Clavien-Dindo complication grades. The methodological quality of included studies was assessed using the Cochrane's revised tool to assess the risk of bias in randomized trials. The Cochrane Collaboration's Review Manager software version 5.3 was utilized for data analysis. The grading of recommendation, assessment, development, and evaluation (GRADE) instrument was used for recommendation strength in the included studies in the meta-analysis.</p><p><strong>Results: </strong>Ten studies were included in the final meta-analysis; all were rated as low risk of bias. The results favored simulation, but no statistically significant difference was observed between simulation and conventional training. The GRADE assessment reflected moderate certainty.</p><p><strong>Discussion: </strong>We evaluated the effectiveness of simulation-based training (SBT) in improving patient-centric outcomes, classified by Clavien-Dindo complication grades using Kirkpatrick Level 4 evidence from randomized controlled trials, and discovered that results were comparable to traditional training. Future studies are needed to address this limitation in the current evidence base for simulation-based training to confirm and maximize its patient-centered benefits.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of the Hand-Assisted Laparoscopic Approach for Repeat Hepatectomy: A Propensity Score Matching Analysis.","authors":"Chun-Han Lin, Ivy Yenwen Chau, Hao-Jan Lei, Shu-Cheng Chou, Yi-Chu Kao, Ching-Chu Chiang, Chan-Wei Tseng, Cheng-Yuan Hsia, Gar-Yang Chau","doi":"10.1002/wjs.12527","DOIUrl":"https://doi.org/10.1002/wjs.12527","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic liver surgery following previous resections poses significant challenges due to adhesions and altered anatomy. Hand-assisted laparoscopic liver resection (HALR) combines the tactile advantages of open surgery with minimally invasive techniques, potentially benefitting patients undergoing repeat hepatectomy. This study aims to assess the safety and efficacy of HALR for repeat hepatectomy and compare these outcomes with those of an open liver resection (OR).</p><p><strong>Methods: </strong>A retrospective study included patients who underwent repeat hepatectomy via HALR or OR from January 2013 to December 2022. Patient characteristics and outcomes were compared before and after propensity score matching. The primary outcome was 90-day morbidity. Surgical difficulty was stratified using the Institut Mutualiste Montsouris (IMM) classification into grade I (low), grade II (intermediate), and grade III (high).</p><p><strong>Results: </strong>The study included 248 patients: 112 in the HALR group and 136 in the OR group. Conversion to open occurred in 2 cases (1.8%). After matching, 76 HALR patients were compared with 76 OR patients. HALR patients had a longer operative time (median: 402 vs. 277 min and p < 0.001), shorter postoperative hospital stay (median: 8.0 vs. 9.0 days and p < 0.001), and higher hospital cost (median: $10,607 vs. $6260 and p < 0.001). No significant differences in 90-day morbidity or readmission rates. Risk factors for 90-day morbidity included the ASA score ≥ 2, diabetes, IMM grade 3, and portal hypertension.</p><p><strong>Conclusion: </strong>HALR for repeat hepatectomy is feasible and safe, with perioperative outcomes comparable to OR. HALR may be a viable alternative for selected patients.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of Parathyroid Autofluorescence in Differentiating Parathyroid Pathology.","authors":"Shawn Y Hsu, Eric J Kuo, Catherine McManus, Rachel Liou, James A Lee, Jennifer H Kuo","doi":"10.1002/wjs.12524","DOIUrl":"https://doi.org/10.1002/wjs.12524","url":null,"abstract":"<p><strong>Background: </strong>Near-infrared autofluorescence (NIRAF) spectroscopy is an emerging adjunct for intraoperative parathyroid identification. However, its ability to differentiate between normocellular, hyperplastic, or adenomatous parathyroids remains unexplored. We hypothesize that parathyroid adenomas have lower NIRAF ratios than normocellular parathyroids since the likely fluorophore is the calcium-sensing receptor (CaSR), which is downregulated in adenomas.</p><p><strong>Methods: </strong>In vivo NIRAF ratios for each identified parathyroid gland were recorded for patients undergoing thyroidectomy or parathyroidectomy from 08/2023 to 12/2023 at a single institution. Parathyroids were categorized as normocellular by visual inspection and hyperplastic or adenomatous by final histology.</p><p><strong>Results: </strong>Of the 44 patients included (66% underwent parathyroidectomy and 34% underwent thyroidectomy), 137 parathyroids were identified intraoperatively with 66 resected and analyzed histologically. A total of 71 (52%) parathyroids were normocellular, 45 (33%) were hyperplastic, and 21 (15%) were adenomatous. Among the resected parathyroids, there was moderate agreement (81%) between visual categorization and final histology for hyperplasia versus adenoma (κ = 0.6). Parathyroid adenomas had lower median NIRAF ratios than normocellular parathyroids (p = 0.0005). Median NIRAF ratios were not significantly different between normocellular and hyperplastic parathyroids (p = 0.35) nor between hyperplastic parathyroids and adenomas (p = 0.04). The performance of NIRAF spectroscopy in differentiating parathyroid pathology is poor based on receiver operator characteristics analysis.</p><p><strong>Conclusion: </strong>Parathyroid adenomas have lower NIRAF ratios than normocellular parathyroids. However, the performance of using NIRAF ratios to differentiate between parathyroid pathology is poor. Therefore, the differences in NIRAF ratios are unlikely to be sufficient at point-of-care use to distinguish between various parathyroid pathologies. As NIRAF ratios are highest in normocellular parathyroid glands, NIRAF appears to be most useful in detecting normal parathyroid glands.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Cancer Recurrence Exerts the Strongest Influence on Choice Between Active Surveillance and Thyroid Surgery as Initial Treatment for Low-Risk Thyroid Cancer: Results of a Discrete Choice Experiment.","authors":"Jacob Hampton, Gavin Cooper, Laura Wall, Christopher Rowe, Nicholas Zdenkowski, Elizabeth Fradgley, Julie Miller, Jenny Gough, Scott Brown, Christine O'Neill","doi":"10.1002/wjs.12520","DOIUrl":"https://doi.org/10.1002/wjs.12520","url":null,"abstract":"<p><strong>Background: </strong>Treatment options for low-risk differentiated thyroid cancer (DTC) include active surveillance (AS), hemithyroidectomy (HT), or total thyroidectomy (TT). Improved understanding of patient values and preferences is required to inform shared decision-making. This study examined factors influencing patient treatment preferences and trade-offs for low-risk DTC.</p><p><strong>Methods: </strong>Adult participants with benign thyroid nodules or low-risk DTC completed an online discrete choice experiment (DCE). Utilizing the scenario of a 50-year-old person with a small solitary DTC, participants chose between three unlabeled treatment options (representing AS, HT, and TT). Risk profiles varied across 5 domains: voice change, thyroid hormone supplementation, hypocalcaemia, chance of future thyroid surgery, and 10-year risk of cancer recurrence. Participants self-reported demographics, disease factors, and answered a decisional regret scale. A conditional logit model was utilized.</p><p><strong>Results: </strong>The DCE was completed by 143 patients across three sites. The conditional logit model demonstrated that participants preferred AS (49%) over TT (29%) or HT (22%). All five domains influenced choices (all p < 0.001), but perceived risk of cancer recurrence exerted most influence. Cancer survivors chose AS less often than those with benign disease (46% vs. 57%), driven by perceived risks of further surgery and cancer recurrence. As the perceived risk of cancer recurrence increased, more participants preferred HT over AS.</p><p><strong>Conclusion: </strong>This study demonstrates that when blinded to the actual treatment, patients prefer the trade-offs associated with AS rather than TT or HT. Perceived risk of cancer recurrence exerted the greatest influence. Accurate risk stratification for cancer recurrence is critical to shared decision-making.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Risk Factors for New-Onset Perioperative Atrial Fibrillation Following Minimally Invasive Esophagectomy: A Single-Center Retrospective Study.","authors":"Xiaoxi Li, Ling Yu, Jiaonan Yang, Miao Fu, Hongyu Tan","doi":"10.1002/wjs.12537","DOIUrl":"https://doi.org/10.1002/wjs.12537","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is the most common cardiovascular complication following esophagectomy. The aim of this study was to identify the risk factors for new-onset perioperative (intraoperative and/or postoperative) AF in patients undergoing minimally invasive esophagectomy (MIE).</p><p><strong>Methods: </strong>This study used a single-center retrospective design and included 814 patients who were diagnosed with esophageal cancer and underwent McKeown MIE. The patients' characteristics and perioperative data were collected from the electronic medical records and analyzed.</p><p><strong>Results: </strong>New-onset perioperative AF occurred in 5.3% of the patients (43/814), with 4 patients developing intraoperative AF and 39 patients developing postoperative AF. Multivariate logistic regression analysis identified age (odds ratio [OR] 1.081 and p < 0.001), history of coronary heart disease (OR 4.269 and p < 0.001), and intraoperative blood loss (OR 1.004 and p = 0.008) as independent risk factors for perioperative AF following MIE. The area under the receiver operating characteristic curve for the multivariate logistic regression model was 0.735 (95% confidence interval 0.660-0.810). The incidences of postoperative pulmonary complications and anastomotic leakage were significantly higher in patients with perioperative AF than in those without perioperative AF (both p = 0.011). Patients with perioperative AF also had a longer hospital stay (15.0 vs. 13.0 days and p = 0.034).</p><p><strong>Conclusions: </strong>Increasing age, history of coronary heart disease, and intraoperative blood loss were associated with new-onset perioperative AF following MIE. However, the impact of intraoperative blood loss on AF is likely to be of marginal clinical relevance. The observed AF fell below projected estimates, resulting in inadequate statistical power for the study outcomes.</p><p><strong>Trial registration: </strong>Chinese Clinical Trial Registry (No. ChiCTR2300074003; date of registration, 27/07/2023).</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting Oncological Safety: Extreme Oncoplasty as an Alternative to Mastectomy-Insights From a Single-Center Experience in Low and Middle-Income Country.","authors":"Kulsoom Shaikh, Aiman Arif, Mehwish Mooghal, Lubna Mushtaque Vohra","doi":"10.1002/wjs.12521","DOIUrl":"https://doi.org/10.1002/wjs.12521","url":null,"abstract":"<p><strong>Background: </strong>Extreme oncoplastic breast-conserving surgery (eOBCS), euphemism for radical conservation, expands the indications of breast conservation for tumor that typically requires a mastectomy. Existing data show no discernible survival differences between mastectomy and breast-conserving surgery; however, limited evidence exists regarding local recurrences between these groups. We report the oncological outcomes of eOBCS in terms of margin safety and disease recurrence at our institute. Median surgical margin was 0.68 (0.2-2) cm away. Two patients (4.3%) required re-excision of positive margins. One locoregional and four distant disease recurrences were encountered with 5-year local recurrence free, distant recurrence free, and overall survivals estimated to be 91%, 73%, and 78%, respectively. Satisfactory cosmesis was attained in all patients without significant perioperative complications.</p><p><strong>Methodology: </strong>47 patients underwent eOBCS between July'17 and June'22. Mean follow-up was 54 (24-84) months. Primary endpoints were the resection margin status and need for reoperation. Secondary endpoints were 5-year local and distant recurrence free and overall survivals. Median surgical margin was 0.68 (0.2-2) cm away. Two patients (4.3%) required re-excision of positive margins. One locoregional and four distant disease recurrences were encountered with 5-year local recurrence free, distant recurrence free, and overall survivals estimated to be 91%, 73%, and 78%, respectively. Satisfactory cosmesis was attained in all patients without significant perioperative complications.</p><p><strong>Results: </strong>Mean age at diagnosis was 46.8 (±13.2) years. IDC (70.2%) was the commonest histological type. 32% of cancers were >5 cm in size, 30% were multifocal, and 40.4% were node positive. 25% were triple negative whereas, 7% were Her2Neu positive. Therapeutic mammoplasty (44.4%) was the frequently performed surgical procedure followed by local rotational flaps (27.6%). Mean pretreatment mammographic tumor size was 50 mm (±7.5) mm. 40.4% of the patients qualified for neoadjuvant therapies and 91.5% received radiation. Median surgical margin was 0.68 (0.2-2) cm away. Two patients (4.3%) required re-excision of positive margins. One locoregional and four distant disease recurrences were encountered with 5-year local recurrence free, distant recurrence free, and overall survivals estimated to be 91%, 73%, and 78%, respectively. Satisfactory cosmesis was attained in all patients without significant perioperative complications.</p><p><strong>Conclusion: </strong>eOBCS is an innovative and aesthetically promising surgical technique enabling successful breast conservation in patients necessitating mastectomy. Our data substantiate the oncological safety of eOBCS; however, it requires appropriate patient selection and multidisciplinary planning.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143558221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: Financial Impact and Healthcare Expenditures Among Surgical Patients in Burundi.","authors":"Vladimir Resanovic, Aleksandar Resanovic, Dusan Micic, Zlatibor Loncar","doi":"10.1002/wjs.12529","DOIUrl":"https://doi.org/10.1002/wjs.12529","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143537563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}