Acta Gastroenterologica Latinoamericana最新文献

{"title":"[Simultaneous Measurement of Hydrogen and Methane Improves Diagnostic Yield in the Diagnosis of Intestinal Microbial Overgrowth].","authors":"Luis Soifer, Fernando Man, Melina Man","doi":"10.52787/agl.v53i4.320","DOIUrl":"10.52787/agl.v53i4.320","url":null,"abstract":"<p><p><b>Introduction</b>. Breath tests have been widely used for the diagnosis of small intestinal microbial overgrowth. Some of the equipment currently used for gas measurement tends to have limitations; the simplest portable equipment measures only hydrogen, while the most complete ones allow the simultaneous measurement of hydrogen, methane, CO2, and recently hydrogen sulfide. The presence of elevated methane values usually coincides with decreased hydrogen excretion and, therefore, by measuring only exhaled hydrogen levels, the study is reported erroneously as normal.</p><p><strong>Aim: </strong>. To analyze the comparative diagnostic yield between the isolated measurement of hydrogen and the simultaneous measurement of hydrogen and methane.</p><p><strong>Material and methods: </strong>. An observational study was carried out by analyzing hydrogen and methane concentrations in exhaled air, using lactulose as substrate. The study included 353 patients (78% women), with an age range of 18/75, who presented one or more of the following symptoms: abdominal pain, bloating, flatulence and chronic defecatory problems. Values ≥ 20 ppm for hydrogen within 90 minutes lactulose of ingestion were considered positive, and for methane, values ≥ 10 ppm at any time during the study. The diagnostic yield was calculated using the formula: number of positive studies divided by the total number of studies performed. Based on the normal reference values, the number and percentage of diagnoses of small intestinal bacterial overgrowth, intestinal methanogenic overgrowth and mixed microbial overgrowth were calculated.</p><p><strong>Results: </strong>. Out of a total of 353 patients, 111 (31.44%) were LBT positive; 78 (22.09%) had mixed flora (SIBO + IMO); 54 (15.29%) had methanogenic overgrowth; 55 (15.62%) had small intestine bacterial overgrowth, (accepted as a positive hydrogenic response exclusively) and 55 (15.62%) were negative. Fifty-four (15.29%) had a flat curve. The diagnostic yield varies if we consider only positive SIBO by exclusive hydrogen measurement, in such cases it was 0.16 (95% CI 0.12-0.19). However, when considering mixed cases (partial diagnosis) the diagnostic yield was 0.47 (95% CI 0.41-0.52). On the other hand, the simultaneous measurement of hydrogen and methane added was positive for those with methanogenic overgrowth (111+55+78/353) and the diagnostic yield is 0.69 (CI 0.64-0.73). Conclusion. The simultaneous measurement of H2 and CH4 would improve the diagnostic yield compared to the isolated measurement of hydrogen.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"378-384"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[[Introduction to the Analysis of Recurrent Events in Clinical Trials]].","authors":"Emiliano Rossi","doi":"10.52787/agl.v53i4.365","DOIUrl":"10.52787/agl.v53i4.365","url":null,"abstract":"","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"331-333"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500180/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Allergy to Cow's Milk Protein Simulating Hirschsprung's Disease Based on Barium Enema Findings. A Case Report].","authors":"Juanita Higuera Carrillo, Michelle Higuera","doi":"10.52787/agl.v53i4.318","DOIUrl":"10.52787/agl.v53i4.318","url":null,"abstract":"<p><strong>Introduction: </strong>. Cow's milk protein allergy can have multiple clinical manifestations. Some cases present with inflammation of the rectosigmoid colon with secondary colonic dysmotility similar to Hirschsprung's disease. Previous studies have shown that the proportion of cow's milk protein allergy in newborns presenting with Hirschsprung's disease-like symptoms is high.</p><p><strong>Aim: </strong>. To describe the clinical case of a patient with cow's milk protein allergy, with symptoms and barium enema imaging suggestive of Hirschsprung's disease.</p><p><strong>Clinical case: </strong>. A term infant, previously healthy, with episodes of regurgitation since two weeks of life and worsening of symptoms with vomiting and irritability at three months of age. Physical examination revealed findings compatible with cow's milk protein allergy. She was exclusively breastfed and instructed to continue on a cow's milk exclusion diet. Three days after the onset of symptoms, her condition worsened with vomiting and the imaging studies were expanded with findings that could have been related to Hirschsprung's Disease. An endorectal biopsy was performed and Hirschsprung's disease was ruled out. It was indicated to discontinue breastfeeding and continue with the amino acid-based formula, with adequate tolerance, weight and height progression, resolution of xeroderma and abdominal distension.</p><p><strong>Conclusion: </strong>. In patients with severe abdominal distension or findings simulating Hirschsprung's disease, cow's milk protein allergy should be considered as an increasingly common entity in the differential diagnosis, and appropriate diagnostic tests should be performed to establish the diagnosis. Endorectal biopsy is indicated to confirm the definitive diagnosis of Hirschsprung's disease.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"385-389"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Treatment of Fecal Incontinence: A Surgical Approach].","authors":"Alejandro Moreira Grecco, Tomás Flores","doi":"10.52787/agl.v53i4.375","DOIUrl":"10.52787/agl.v53i4.375","url":null,"abstract":"<p><p>A review of the different treatments for fecal incontinence is presented, with special emphasis on the results of surgical procedures for this condition. It addresses a comprehensive and personalized approach to the management of patients with fecal incontinence, which is of capital importance, where the results of the different therapeutic options must be weighed in their relationship to the quality of life of the patients. Finally, a treatment algorithm for said condition is suggested.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"337-345"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Screening for Biliary Atresia through QR Code Implementation].","authors":"Cinthia Bastianelli, Adriana Spiess, Analía Gallardo, Estefanía Bracamonte, Emanuel Campos, Margarita Ramonet","doi":"10.52787/agl.v53i4.338","DOIUrl":"10.52787/agl.v53i4.338","url":null,"abstract":"<p><strong>Introduction: </strong>. Biliary atresia is an inflammatory, obstructive, and idiopathic process affecting the bile ducts that leads to biliary cirrhosis. Early diagnosis and Kasai surgery offer patients the possibility of survival without requiring a liver transplant.</p><p><strong>Main: </strong>. To describe the implementation of a novel method of screening for biliary atresia using a quick response (QR) code at a fourth-level care hospital.</p><p><strong>Materials and methods: </strong>. An observational, descriptive and prospective study was carried out at the Hospital Público Materno Infantil, Salta, Argentina, between September 2022 and September 2023. During this period, the screening for biliary atresia was carried out through a survey accessible via a QR code. This survey had to be completed between 15-30 days of life of the newborn´s, comparing the color of stools with a numbered colorimetric chart. The responses were categorized as \"normal\" and \"abnormal\". Patients with abnormally colored stools were contacted by phone and scheduled for a medical consultation.</p><p><strong>Results: </strong>. A total of 6,113 live newborns were registered. 1,294 surveys were analyzed. The response rate was 21%. 57.3% of respondents completed the survey between 15 and 30 days after birth. Among the 1,294 patients surveyed, 17 recorded abnormal responses, of which one had biliary atresia and two had secondary cholestasis. The screening presented a false-positive rate of 1.1% (14/1,294). The estimated percentage of true positives from the screening was 0.2% (3/1,294). The prevalence of biliary atresia was 0.1% (1/1,294).</p><p><strong>Conclusion: </strong>. The response rate to screening for biliary atresia using the QR code during the evaluated period was lower than that reported using colorimetric cards. Adherence increased in the last months of the program´s implementation, which requires more time for execution and dissemination. We believe that this technological innovation applied to screening could represent a progress in the early detection of biliary atresia.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 4","pages":"355-360"},"PeriodicalIF":0.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Precision Medicine in the Primary and Secondary Prevention of Gastric Cancer].","authors":"Irina Luzko, Patricio Medel-Jara, Joan Llach, Diego Reyes, Leticia Moreira, Arnoldo Riquelme","doi":"10.52787/agl.v53i3.349","DOIUrl":"10.52787/agl.v53i3.349","url":null,"abstract":"<p><p>Gastric cancer is one of the most frequent cancers worldwide. It has a poor prognosis associated with late-stage diagnosis, that significantly decreases overall survival. This highlights the importance of prevention and early detection to improve the clinical course of patients. Prevention and early diagnosis of gastric cancer perfectly exemplify the model of precision medicine, a healthcare approach that seeks to place the burden more on the individual than on the general population. This requires not only a comprehensive knowledge of the disease but also the identification of individual factors and the understanding of genetic, molecular and environmental differences, which are key to the development of much more personalized treatment strategies. With this approach, in gastric cancer prevention the subject is always at the center, the measures focus directly on the individual and, secondarily, lead to the optimization of the use of resources. This review briefly discusses primary prevention strategies for gastric cancer based on detection and eradication of Helicobacter pylori and, on the other hand, describes some of the most promising biomarkers for the detection and diagnosis of early gastric cancer identified in blood, saliva, urine, feces, and gastric juice, all of which are components of potential secondary prevention measures.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 3","pages":"241-254"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hepatocellular Carcinoma: Epidemiological Reality in Tucumán, Argentine Northwest].","authors":"Fernando Buabse, Felipe Palazzo, Ana Palazzo, Dolores Murga, Daniela Perez, Moira Zunino, Claudia Gadea, Carlos Garrocho, Juan José Rodríguez, Rodrigo Segovia, Analía Soria, Pablo Berarducchi, Iris Aybar, Marcela Ortiz Mayor, Carmen Seoane, Nancy Soria, Daniela Lionetti, Marcelo López Avellaneda, Germán Alanís, Marcelo Ferraro, Santiago Villavicencio, Roxana González","doi":"10.52787/agl.v53i3.337","DOIUrl":"10.52787/agl.v53i3.337","url":null,"abstract":"<p><strong>Introduction: </strong>Hepatocellular carcinoma is the most common primary liver tumor (80 to 90%). It is the sixth most frequent tumor and the third that causes the most cancer-related deaths. 85% occurs in Asia and Africa. In Latin America and Argentina, it is not fully represented in the literature due to the socio-economic reality. Most hepatocellular carcinomas present on the basis of cirrhosis.</p><p><strong>Objective: </strong>To characterize the pidemiology of hepatocellular carcinoma in Tucumán, Argentina.</p><p><strong>Material and method: </strong>A descriptive, multicentric, study of both public and private activity in the province was carried out. Based on international guidelines, diagnosis and treatment of patients with hepatocellular carcinoma were carried out.</p><p><strong>Results: </strong>There were 328 patients, with 109 (33.23%) women and 219 (66.76%) men. Of these patients, 294 (89.6%) had cirrhotic liver. The 5-year survival was 6.09% (n:20/328) in stage A and 0.914% (n:3/328) in stage B.</p><p><strong>Conclusion: </strong>The epidemiology of hepatocellular carcinoma in Tucumán, Argentina was updated; coinciding with the literature. From the epidemiological point of view it showed; a higher prevalence of the disease in males than in females; that stage D at the time of diagnosis was the most prevalent; and that the majority of patients suffered from previous liver diseases.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 3","pages":"283-290"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Chronic Intestinal Pseudo-Obstruction Associated with Type A Intestinal Neuronal Dysplasia].","authors":"Josué Vázquez Arizmendi, Ulises Palacios Morejón, Brenda Martínez Luna, Carlos Domínguez Alvarez, Orlando Zamora Santana, Daniela Ariza Acuña","doi":"10.52787/agl.v53i3.317","DOIUrl":"10.52787/agl.v53i3.317","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic intestinal pseudo-obstruction is a clinical entity with multiple causes. One of them is intestinal neuronal dysplasia, a rare disease with two subtypes: A and B.</p><p><strong>Objective: </strong>To present a clinical case of a patient diagnosed with idiopathic gastroparesis associated with type A intestinal neuronal dysplasia.</p><p><strong>Clinical case: </strong>A 30-year-old female patient with a diagnosis of idiopathic gastroparesis of a long evolution, with multiple hospitalizations and significant weight loss. She developed a aorto-mesenteric compass syndrome that was treated surgically with partial and temporary improvement. A jejunostomy was performed for feeding when symptoms recurred. During this surgical procedure, gastric and jejunal biopsies were performed and a diagnosis of intestinal neuronal dysplasia type A was made.</p><p><strong>Conclusion: </strong>In the presence of symptoms of intestinal pseudo-obstruction or a diagnosis of idiopathic gastroparesis, it is necessary to consider the involvement of the gastrointestinal plexus. Obtaining an adequate tissue sample and evaluating it with appropriate techniques is of paramount importance to diagnosing the neurogenic etiology of the entity.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 3","pages":"309-313"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Use of Hemospray^® in Upper Gastrointestinal Bleeding due to Gastric Ischemia].","authors":"Manuel Alejandro Mahler, Florencia Soldano Malvar, Tomás Manuel Pérez, Juan Eduardo Pizzala, Sebastián Durán, María Del Pilar Mancini, Fernando Giménez, Dante Manazzoni, Víctor Hugo Abecia, Mariano Marcolongo","doi":"10.52787/agl.v53i3.310","DOIUrl":"10.52787/agl.v53i3.310","url":null,"abstract":"<p><p>We present a case of a patient with a history of unresec-table pancreatic adenocarcinoma who required biliodigestive diversion surgery with Roux-en-Y reconstruction. Due to the presence of portal cavernomatosis, and recurrent episodes of upper gastrointestinal bleeding, gastric devascularization surgery was performed. The patient experienced an initial episode of gastrointestinal bleeding with cardiopulmonary arrest as a complication. After resuscitation, an upper gastrointestinal endoscopy was performed which showed a visible vessel at the gastroenteroanastomosis; a hemostatic clip was placed, and the bleeding stopped. After 72 hours, the patient presented a new episode of hematemesis which led to another upper gastrointestinal endoscopy revealing an area of congestive, friable mucosa with deposits of fibrin and profuse bleeding on the greater gastric curvature; the suspected diagnosis was ischemic gastropathy This area had been recently evaluated by endoscopy and had shown normal characteristics. Endoscopic treatment was performed using TC-325 hemostatic powder (Hemospray ^® , Cook), and the bleeding stopped. The patient responded well to the applied treatment and had a favorable outcome.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 3","pages":"320-323"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential Beneficial Effect of Rifaximin in the Prevention of Hepatocellular Carcinoma through the Modulation of the Microbiota in an Experimental Model of Non-alcoholic Fatty Liver Disease.","authors":"Jéssica Tonin Ferrari, Gabriel Tayguara Silveira Guerreiro, Larisse Longo, Themis Reverbel da Silveira, Carlos Thadeu Schmidt Cerski, Erica Tozawa, Cláudia P Oliveira, Mário Reis Álvares-da-Silva, Carolina Uribe-Cruz","doi":"10.52787/agl.v53i3.329","DOIUrl":"10.52787/agl.v53i3.329","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the effects of rifaximin through microbiota modulation in a model of hepatocellular carcinoma secondary to non-alcoholic fatty liver disease.</p><p><strong>Methods: </strong>Three groups of 8 adult male Sprague-Dawley rats each were divided as follows: the HCC group: rats fed a high-fat and choline-deficient diet plus diethylnitrosamine as a carcinogen, the hepatocellular carcinoma treated group: rats fed a high-fat and choline-deficient diet plus diethylnitrosamine and treated with rifaximin and the control group: animals fed standard diet and water. The rats were euthanized after 16 weeks. We performed analyses of liver pathology for non-alcoholic fatty liver disease severity and cancer grading, gene expression in intestinal and hepatic tissues and fecal microbiota.</p><p><strong>Results: </strong>All animals in the hepatocellular carcinoma group had non-alcoholic fatty liver disease and developed hepatocellular carcinoma lesions. Rifaximin animals showed less intense non-alcoholic fatty liver disease (assessed by non-alcoholic fatty liver disease activity score [NAS]) compared to the hepatocellular carcinoma group. Both the hepatocellular carcinoma and hepatocellular carcinoma + rifaximin groups showed areas of fibrosis as assessed by picrosirius red. Three animals in the rifaximin group did not develop cancerous lesions. Gut microbiota analyses revealed differences in diversity and composition in the control group vs hepatocellular carcinoma and rifaximin groups. Twelve differentially abundant genera were identified between the hepatocellular carcinoma and rifaximin groups. In the rifaximin group, gene expression of intestinal tight junctions decreased.</p><p><strong>Conclusions: </strong>In a rodent model of non-alcoholic fatty liver disease-related hepatocellular carcinoma, rifaximin reduces the histological severity of non-alcoholic fatty liver disease and the occurrence of hepatocellular carcinoma, probably by modulating the gut microbiota independently of markers of intestinal permeability.</p>","PeriodicalId":35700,"journal":{"name":"Acta Gastroenterologica Latinoamericana","volume":"53 3","pages":"265-282"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12500194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}