The Egyptian Journal of Cardiothoracic Anesthesia最新文献

{"title":"Anesthetic management of a multiple and mixed cardiac valvular disease for noncardiac surgery: a case report","authors":"R. Kadni, R. Nayak, M. Sarkar, Laji Samuel","doi":"10.4103/ejca.ejca_16_21","DOIUrl":"https://doi.org/10.4103/ejca.ejca_16_21","url":null,"abstract":"A thorough knowledge of pathophysiology of multiple and mixed valvular heart disease is a requirement for a stable perioperative care. We present anesthetic management of a 62-year male patient with bivalvular mixed lesions with gastric adenocarcinoma for gastrectomy. Fixed-output cardiac state, anemia, maintenance of hemodynamic goals for longer duration, and postoperative analgesia were the anesthetic concerns. Hemodynamic aberrations can be inevitable in such scenario. Proper understanding of the lesions, optimization, preparation, and planning for anticipation of adverse hemodynamic events plays a crucial role for expecting a better clinical outcome.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128763921","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":"Hemodynamic and analgesic aspects in conscoius sedation for chronic subdural hematoma evacuation: a rendomized controlled comparison between magnesium sulphate versus fentanyl","authors":"Rania S. Fahmy, Amal Elsawy, M. Mostafa, A. Hasanin, T. Radwan, N. Abdallah","doi":"10.4103/ejca.ejca_5_22","DOIUrl":"https://doi.org/10.4103/ejca.ejca_5_22","url":null,"abstract":"Objectives Subdural hematoma evacuation has been performed under general anesthesia, local anesthesia, and conscious sedation, though the adequacy of any of those techniques on its own is questionable. We aimed to compare the hemodynamic and analgesic effects of magnesium sulfate versus fentanyl as adjuncts to propofol-induced conscious sedation in patients subjected to chronic subdural hematoma (CSDH) evacuation with local infiltration. Patients and methods In this randomized controlled trial, we included adult patients with CSDH undergoing evacuation through burr-hole surgery. All patients received continuous infusion of propofol. Patients in the magnesium group (n=16) received magnesium sulfate (loading dose of 50 mg/kg and then continuous infusion at 15 mg/kg/h). Patients in the fentanyl group (n=16) received fentanyl (loading dose: 1 μg/kg and then continuous infusion at 0.5 μg/kg/h). The primary outcome was intraoperative systolic blood pressure. The secondary outcomes included incidence of hypotension and bradycardia, the total dose of propofol, time to awake, and the incidence of postoperative nausea and vomiting. Results A total of 32 patients were analyzed. The average intraoperative systolic blood pressure was better maintained in the magnesium group. Furthermore, the incidence of hypotension, nausea, and vomiting was lower in the magnesium group. The time to awake was shorter in the magnesium group. The incidence of bradycardia, total propofol requirements, time to first rescue analgesia, and surgeon satisfaction were comparable between groups. Conclusion Magnesium sulfate was associated with a better hemodynamic profile and less incidence of nausea and vomiting in comparison with fentanyl when combined with propofol for conscious sedation during CSDH evacuation. It produced an anesthetic-sparing effect comparable to fentanyl.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"60 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129342312","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":"Perioperative anesthetic management of transposition of great arteries: a review","authors":"V. Datt, Suman Kashav, R. Wadhwa, Shardha Malik, S. Agarwal, H. Minhas, P. Rai","doi":"10.4103/ejca.ejca_17_21","DOIUrl":"https://doi.org/10.4103/ejca.ejca_17_21","url":null,"abstract":"Transposition of great arteries (TGA) comprises 5–7% of all CHDs. It is characterized by atrioventricular concordance and ventriculoarterial discordance, resulting in the systemic and pulmonary circulations as parallel instead of the normal in-series circulation. Survival of the baby depends on mixing of blood between these two circulations either with an atrial septal defect, ventricular septal defect, or at the great arterial level via patent ductus arteriosus. Therefore, the clinical manifestation is highly variable and influenced by the presence or absence of these associated anomalies. Patients with TGA without mixing of blood present with cyanosis and acidosis and are hemodynamically compromised soon after birth and require resuscitation to re-establish connection between parallel circuits by reopening the ductus with intravenous prostaglandin (0.05–0.1 μg/kg/min) or establishing interatrial flow with balloon atrial septostomy. In addition, patients may require inotropic support, ventilator support, or extracorporeal membrane oxygenation in extreme cases with refractory cardiorespiratory decompensation for survival or as a bridge to definitive therapy. TGA is uniformly fatal in the infant period, with 30% mortality in the first week of life, and 50% within the first month, and 90% in the first year of life if untreated. Fortunately, modern medical and surgical management techniques have resulted in 90% of patients living into adulthood, typically with a vigorous quality of life. Currently, the definitive corrective surgery is the arterial switch operation (ASO), as a single-stage procedure with excellent short-term and long-term outcomes. The overall perioperative survival following ASO is more than 90%. Long-term and arrhythmia-free survival is ∼97% at 25 years. All standard general anesthetics can be used safely for perioperative management, and mortality owing to anesthetic management has not been witnessed. This systematic review describes the definition and etiology of TGA, clinical presentation, pathophysiology, brief current surgical approaches, anesthetic and cardiopulmonary bypass management, and postoperative course of a patient with TGA undergoing ASO.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133528686","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":"Effect of coronavirus disease 2019 pandemic on cardiothoracic hospitalization rates and emergency services: the collateral damage","authors":"Mohammed Abd Jawad, Hoda Shokri, Ihab Ali","doi":"10.4103/ejca.ejca_15_21","DOIUrl":"https://doi.org/10.4103/ejca.ejca_15_21","url":null,"abstract":"Background The recent coronavirus disease 2019 (COVID-19) pandemic has taken a great toll on the already strained healthcare services. In this study, we aim to evaluate the effect of the COVID-19 pandemic on hospitalization rates for cardiac emergencies in our high-flow tertiary center. Patients and methods A retrospective nonrandomized descriptive study was conducted on urgent and emergency cardiovascular hospitalization rates from October 2019 to September 2020, which were compared with the data from the same time of the previous year. Results The total number of patients with acute mechanical valve thrombosis significantly decreased from 11 patients in the year before the pandemic to only one in April 2020 (P<0.001). Acute type A aortic dissection patient numbers decreased significantly from 16 to eight patients (P<0.05). Lastly, both urgent and emergency thoracic procedures decreased significantly during the COVID-19 year, which was evident from April to July 2020 (P<0.001). Conclusions Critical healthcare conditions should not be overshadowed by newly emerging pandemics. Future developed healthcare strategies should accommodate the increasing numbers of patients and ensure a reliable ‘safe zone’ for patients to avoid nosocomial infections.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123358851","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":"A randomized, double-blind interventional study comparing the effect of levobupivacaine versus ropivacaine with fentanyl as an adjuvant in thoracic epidural analgesia for post-thoracotomy pain relief","authors":"Anjum Saiyed, Ayesha Arif, S. Morwal, R. Meena, P. Bansal, A. Hussain","doi":"10.4103/ejca.ejca_9_21","DOIUrl":"https://doi.org/10.4103/ejca.ejca_9_21","url":null,"abstract":"Context Majority of studies have compared the clinical efficacy of levobupivacaine or ropivacaine with bupivacaine. Therefore, new and safer anesthetic agents ropivacaine and levobupivacaine have been introduced and are commonly used nowadays. Aims To assess and compare the effect of levobupivacaine versus ropivacaine with fentanyl as an adjuvant in thoracic epidural analgesia for post-thoracotomy pain relief. Settings and design The study was conducted in the Department of Anesthesia, Cardiothoracic and Vascular OT. Study design Hospital-based randomized, double-blind interventional study. Patients and methods After obtaining the Institutional Ethics Committee approval and written informed consent, 60 patients aged between 18 and 60 years of either sex, with American Society of Anesthesiologist status II/III, with weight more than 45 and less than 65 kg and height between 152 and 182 cm, scheduled to undergo surgeries with thoracotomy were enrolled for the study. The patients were randomized to receive injection levobupivacaine (0.2%) or ropivacaine (0.2%) 6 ml in 20 ml normal saline with injection fentanyl 20 μg bolus in the epidural space followed by injection levobupivacaine 0.1% or ropivacaine 0.1% with fentanyl 2 μg /ml at a rate of 0.1 ml/kg/h thoracic epidural infusion till 24 h postoperatively. Statistical analysis used Independent t test and analysis of variance test were used to compare the continuous variable and χ2 test was used for categorical variables. Results The demographic and preoperative hemodynamic and respiratory parameters were comparable in both the groups. The postoperative hemodynamic variables, respiratory parameters, and pain scores were also comparable in both the groups. In visual analog scale score, statistically significant difference was observed at 20, 24, and 28 h. Patients receiving levobupivacaine required rescue analgesia later (31.78±15.22 h) than patients receiving ropivacaine (23.16±13.67 h) and were extubated earlier with lesser duration of ICU and hospital stay. Conclusions We concluded that the duration of analgesia was longer with levobupivacaine with fentanyl as compared with ropivacaine with fentanyl as need for first rescue analgesia was later in the levobupivacaine group. In the levobupivacaine group patients were extubated earlier and had a lesser stay in ICU and hospital.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133309468","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":"Effectiveness of magnesium sulfate on the smoothness of extubation in patients undergoing general anesthesia with endotracheal intubation: a randomized controlled trial","authors":"A. Salem, S. Ragab, Atef Mahmoud","doi":"10.4103/ejca.ejca_10_21","DOIUrl":"https://doi.org/10.4103/ejca.ejca_10_21","url":null,"abstract":"Purpose Tracheal extubation remains a critical step in anesthetic management and is supposedly associated with coughing, bucking, laryngospasm, and agitation. Physicians should make all possible efforts to allow optimal smooth extubation and attenuate the airway and circulatory responses. Several drugs have been discovered to attenuate the aforementioned reflexes. The popularity of magnesium sulfate (MgSO4) can be attributed to its sedative, analgesic, and antihypertensive properties. We aimed to study the effect of MgSO4 on the smooth accomplishment of tracheal extubation. Patients and methods We selected 60 patients, aged 18–65 years. All patients had undergone a standardized anesthetic technique. They were randomized to either the MgSO4 group (group M, 30 patients) or placebo group (control group C, 30 patients). We recorded and analyzed the smoothness of tracheal extubation, sedation score, hemodynamics, visual analog scale pain score, the time of extubation, the duration of surgery, the amount of fentanyl consumption, and postoperative morphine consumption. Results The aforementioned two groups were homogenized to obtain their demographic information. There were no clinically significant differences between the groups, based on the average arterial pressure, heart rate, or oxygen saturation. However, the smoothness of extubation score was lower in the MgSO4 group (median=1, interquartile range: 1, 2) than in the control group (median=3, interquartile range: 2, 3) (P<0.001). However, the Ramsey sedation score was higher and the visual analog scale was lower in the MgSO4 group compared with the control group. The MgSO4 group revealed lower intraoperative fentanyl consumption than the control group. Moreover, the MgSO4 group displayed lower postoperative morphine use. Conclusion The MgSO4 group was associated with smooth extubation conditions, concomitant with less coughing, bucking, and laryngospasm than the control group.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"140 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122851104","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":"A comparative study to assess the efficacy of dexmedetomidine as an adjuvant to bupivacaine in the ultrasound-guided pectoral and serratus plane nerve block for patients undergoing modified radical mastectomy","authors":"E. Mahdy, A. Elrahman, Elsayed Abdelzaam","doi":"10.4103/ejca.ejca_13_21","DOIUrl":"https://doi.org/10.4103/ejca.ejca_13_21","url":null,"abstract":"Background and aims Dexmedetomidine has been noticed to be safe and efficient in prolonging the duration of peripheral nerve blocks. This study was designed to compare the length, quality of postoperative analgesia, hemodynamic stability, and patient’s satisfaction and number of patients requiring analgesia with the addition of dexmedetomidine to bupivacaine versus plain bupivacaine in pectoral nerve block (pecs) for modified radical mastectomy (MRM). Patients and methods These patients were randomly allocated using a computerized random number generator into two groups: group I (control group) (30 patients) received 25 ml of 0.25% of plain bupivacaine that was used for modified pecs block. Group II (study group) (30 patients) received 25 ml of 0.25% of plain bupivacaine plus dexmedetomidine (Precedex) 1 μg/kg that were used for pecs block. Results The results showed a longer duration of analgesia in group II (21±3 h) in comparison with group I (16±4 h). Statistical analysis showed a statistically highly significant (P=0.006). Also, consumption of morphine was lower in group II (5±3 mg/24 h) in comparison with group I (9±4 mg/24 h). Statistical analysis showed a statistically significant (P=0.01). Conclusion Dexmedetomidine as an adjunct to bupivacaine helps increase the duration and improves the quality of postoperative analgesia in pecs block without serious side effects.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130501310","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":"Intravascular volume assessment using internal jugular vein ultrasonography in pediatric renal transplant surgery: a prospective observational study","authors":"Heba M. Nassar, I. Abdel-Aal, Fatma El-Zahraa Ibrahim, Reham Saleh, Sara Habib, S. Soaida","doi":"10.4103/ejca.ejca_28_20","DOIUrl":"https://doi.org/10.4103/ejca.ejca_28_20","url":null,"abstract":"Purpose Assessment of the intravascular volume status during surgery is challenging, especially in pediatric patients. Ultrasound has become a versatile noninvasive modality for assessing volume status. This study aimed to evaluate the reliability of ultrasonographic internal jugular vein (IJV) dimensions as a new tool to assess the intravascular volume status in pediatric patients undergoing living donor renal transplant surgery. Patients and methods This prospective observational study included pediatric renal transplant recipients, aged 3–12 years, weighing more than 10 kg, and having an end-stage renal disease. Hemodynamic data (heart rate, systolic, diastolic, and mean blood pressures), central venous pressure (CVP), sonographic measurement of IJV (diameter and cross-sectional area), and left ventricular end-diastolic area (LVEDA) were measured 1 min after induction, before clamping of renal vessels, and after declamping of renal vessels. The correlations between the ultrasonographic IJV dimensions and both LVEDA (primary outcome) and CVP were evaluated. Results Overall, 18 pediatric patients (12 females, six males) with end-stage renal disease were eligible for this study. The mean age was 9.33±2.57 years, and the mean weight was 21.67±5.99 kg. There was a poor correlation between IJV dimensions (diameter and cross-sectional area) and both LVEDA and CVP at the three-time points of assessments. Conclusion Ultrasonographic IJV dimensions (diameter and cross-sectional area) were not reliable for assessing intravascular volume status in living donor renal transplant surgery in pediatric patients.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121980667","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":"Pericardial cyst: revisited","authors":"A. Sharma, Surendra Patel, Danishwar Meena, Mritunjay Kumar, M. Kamal, A. Kaushik","doi":"10.4103/ejca.ejca_8_21","DOIUrl":"https://doi.org/10.4103/ejca.ejca_8_21","url":null,"abstract":"Pericardial cysts are rare mediastinal abnormalities, which are usually congenital but may also be acquired after cardiothoracic surgery. Pericardial cysts are most commonly located at the cardiophrenic angle or, rarely, in the posterior or anterior superior mediastinum. The majority of pericardial cysts are asymptomatic and are found incidentally on imaging studies. Our case was an 18-year-old female with a diagnosis of ostium secundum atrial septal defect (ASD). She was planned for surgical closure of ASD. On the opening of the pericardium, a pericardial cyst of around 3.0×2.0-cm size, filled with clear fluid, was found in the aorta–pulmonary artery groove. Marsupialization of the cyst was done followed by routine direct suture closure of ASD. Postoperative recovery was uneventful, and the patient was discharged on the third postoperative day. Histopathology of tissue confirmed our diagnosis. Our aim to present this case report is to show an incidental finding of the pericardial cyst at a rare location and to discuss its perioperative implications.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129319268","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":"Measurement of coronary sinus blood flow using transesophageal echocardiography to estimate the adequacy of revascularization in patients undergoing off-pump coronary artery bypass grafting","authors":"Mrugesh Prajapati, Nikhil Yadav, H. Gandhi, V. Arora, Srikanth Gujja, Prahya Sachan, Sanjay Patel","doi":"10.4103/ejca.ejca_3_21","DOIUrl":"https://doi.org/10.4103/ejca.ejca_3_21","url":null,"abstract":"Introduction Revascularization of coronary artery increases the blood flow in the coronary sinus (CS) too. The study aimed to measure the CS blood flow using transesophageal echocardiography (TEE) to estimate the adequacy of revascularization in patients undergoing off-pump coronary artery bypass grafting. Patients and methods After ethical committee approval, 100 patients scheduled for elective coronary artery bypass grafting were included in this study. After induction of balanced anesthesia according to institutional protocol, a 5-Hz multiplane phased-array TEE probe was inserted into patients’ esophagus, and the following parameters were calculated at pre-revascularization and post-revascularization periods: velocity time integral of CS, coronary sinus diameter, coronary sinus cross-section area, and coronary sinus blood flow (CSBF) per beat and per minute. Results Our study showed a statistically significant increase in velocity time integral in the post-revascularization period as compared with the pre-revascularization period (P<0.001). There was significant increment in mean CS diameter in the post-revascularization period as compared with the pre-revascularization period (0.79 vs.0.68 cm) (P<0.001). There was a significant increase in CSBF per minute in the post-revascularization period (363.8±80.55 ml) as compared with the pre-revascularization period (218.9±46.61 ml) (P<0.001). Conclusion TEE is a superior modality to evaluate CSBF before and after coronary artery bypass revascularization to determine the adequacy of surgical revascularization in real time during off-pump coronary artery bypass revascularization.","PeriodicalId":289218,"journal":{"name":"The Egyptian Journal of Cardiothoracic Anesthesia","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122521418","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}