Khirurgiya最新文献

{"title":"[The use of low-frequency ultrasound in the treatment of patients with infected pancreatic necrosis].","authors":"A M Zainutdinov, I S Malkov, A V Berdnikov","doi":"10.17116/hirurgia202502186","DOIUrl":"10.17116/hirurgia202502186","url":null,"abstract":"<p><strong>Objective: </strong>To improve the treatment of patients with infected pancreatic necrosis by using non-contact ultrasound treatment of purulent-necrotic foci (NUST).</p><p><strong>Material and methods: </strong>We analyzed the results of treatment of 39 patients with infected pancreatic necrosis, admitted to the surgical department No. 2 of the City Clinical Hospital No. 7 in Kazan from 2017 to 2021. The central method of their surgical treatment was open draining operations combined with sequestrectomy. The study group consisted of 20 patients (4 women, 16 men) aged from 39 to 60 years (mean age - 49±9.5 years). In this group, the effectiveness of non-contact ultrasound treatment of purulent-necrotic foci using the SONOCA-185 apparatus was studied.</p><p><strong>Results: </strong>The application of ultrasound treatment of purulent foci of infected pancreatic necrosis in the study group allowed to increase their drainage effectiveness, which was reflected in the dynamics of reparative-proliferative process and relief of systemic inflammatory reaction. Wound healing occurred on the 7-9 day (on average, on the 7.6±2^th day) without resuturing.</p><p><p>The pronounced bactericidal effect of low-frequency ultrasound and its phonophoretic effect are confirmed by the reduction of microbial content of wounds and cavities from 105 CFU and 104 CFU to 102 CFU after 3 sessions.</p><p><p>The sparing ultrasound sequestrectomy allows to remove only devitalized tissues, without causing destructions of the ductal system, vascular wall and hollow organs.</p><p><p>Ultrasound treatment of cavities in the study group resulted in a pronounced increase in transparency indicators and its approximation to reference solution, decreased peripheral blood leukocytosis, temperature reaction in patients on the 3^rd, 7^th, 12^th days compared to the control group, where the temperature response is maintained at this time, and reduction in hospitalization duration on the 2.6±1 day in the study group of patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"86-93"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366163","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":"[Treatment of acute hemorrhoids according to the results of a multicenter observational study].","authors":"V S Groshilin, V K Shvetsov, A A Kolesnichenko, A B Alnikin, M I Sultanmuradov, V E Bardakhchyan, V D Kuznecov, A S Arkhipov","doi":"10.17116/hirurgia2025031112","DOIUrl":"https://doi.org/10.17116/hirurgia2025031112","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The issue of improving hemorrhoid treatment outcomes in outpatient practice is one of the most pressing in the daily work of coloproctologists today. Advances in the treatment of hemorrhoidal disease, the most common pathological condition in general proctology, in recent decades have been associated not only with the adoption of minimally invasive surgical techniques but also with the enhancement of pharmacological therapy. A key component of systemic pharmacotherapy for chronic and acute hemorrhoids is the use of venotonic drugs, including flavonoids which are included in the clinical guidelines. Therefore, a comprehensive and reliable evaluation of the clinical efficacy of diosmin is an important area of research, especially in cases of acute hemorrhoids.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The study aimed to assess the effectiveness of using Phlebodia 600 and evaluate the dynamics of patients' quality of life with acute hemorrhoids of grades I-II in outpatient practice without employing minimally invasive surgical methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;A Russian multicenter prospective observational study was conducted involving an adult population of patients with grade I-II acute hemorrhoids in the city of Rostov-on-Don and the Rostov region. Outpatients (both men and women) aged 18 to 64 with a confirmed diagnosis of grade I-II acute hemorrhoids (thrombosis of external or internal hemorrhoidal nodes, including those with bleeding) established through standardized clinical examination were included. Therapy with Phlebodia 600 (diosmin) commenced no later than three days after the onset of clinical symptoms, which included a dominant set of symptoms such as enlarged hemorrhoidal nodes, pain, bleeding, anal itching, burning, or discomfort. The total sample size analyzed was 220 patients, and the medication was administered for at least 36 days.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The use of Phlebodia 600 for grade I-II acute hemorrhoids allowed for the resolution of complaints and stabilization of all key clinical parameters within the timeframes set by the study design. Following the proposed treatment regimen, early resolution and reduction of complaints such as pain, discomfort, itching, and blood streaks during defecation were observed by the control visit after seven days of therapy, compared to baseline. In 73% of cases, a reduction in the size of hemorrhoidal nodes was noted within this period. The proposed treatment regimen can be considered rational since, after 30 days, not only was there consistent resolution of complaints in the majority of patients, but there was also a significant improvement in quality of life (SF-36). No cases of intolerance to Phlebodia 600 or adverse reactions associated with its use were identified, indicating a high safety profile.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;A 35-40 day course of Phlebodia 600 administered continuously according to the manufacturer's recomm","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"112-123"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658990","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":"[Endoscopic retrograde cholangiopancreatography in patients with surgically altered anatomy after previous gastrectomy, Billroth II procedure or pancreatoduodenectomy].","authors":"K V Sementsov, D K Savchenkov, A V Medvedeva, T E Koshelev, E A Gavrikova","doi":"10.17116/hirurgia202502137","DOIUrl":"10.17116/hirurgia202502137","url":null,"abstract":"<p><strong>Objective: </strong>To research the features of endoscopic treatment of choledocholithiasis and biliary strictures in patients with surgically altered anatomy of the upper gastrointestinal tract.</p><p><strong>Material and methods: </strong>A single-center retrospective study included 19 consecutive patients. Early outcomes including: the success of intubation of the afferent limb, the success of selective cannulation of the biliary ducts, the effectiveness of the performed operations; the frequency of complications; factors related to these indicators.</p><p><strong>Results: </strong>3 (15.7%) patients failed intubation of the afferent limb. In 16 (84.2%) patients, endoscopic treatment was an effective final treatment method - regression of obstructive jaundice was achieved and cholangitis was stopped. 9 (69.2%) of 13 patients with choledocholithiasis, complete one-stage stone extraction was performed; 4 (30.8%) patients staged treatment was performed, during which 3 patients underwent cholangioscopy procedure with lithotripsy (laser and electrohydraulic). 3 patients with benign strictures underwent staged endoscopic treatment - multiple procedures to upsize and number of stents. In 1 (6.3%) 85-year-old patient with choledocholithiasis complicated by cholangitis and abscesses, surgery and complex therapy did not avoid a fatal outcome. There were no other complications.</p><p><strong>Conclusion: </strong>Endoscopic treatment of choledocholithiasis and biliary strictures in patients with surgically altered anatomy is a more difficult task. In a significant proportion of patients endoscopic treatment is effective. The success of the endoscopic treatment is due to the equipment of the hospital and the skills of physicians. It may be advisable to concentrate this technique in a centres with skill and expertise.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"37-43"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366112","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":"[Robotic and thoracoscopic surgeries for anterior mediastinal neoplasms].","authors":"Z A Bagatelia, V D Parshin, D N Grekov, E M Glotov, V N Yakomaskin, S S Lebedev, A K Chekini, E A Chetverikova","doi":"10.17116/hirurgia20250216","DOIUrl":"10.17116/hirurgia20250216","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of robot-assisted (RATS) and video-assisted thoracoscopic (VTS) minimally invasive surgeries for anterior mediastinal neoplasms.</p><p><strong>Material and methods: </strong>The study involved 74 patients who underwent surgeries for anterior mediastinal neoplasms between 2020 and 2023. Patients were divided into two groups: group 1 (RATS, 33 patients) and group 2 (VTS, 41 patients). The following parameters were evaluated: surgery time, incidence of postoperative complications, pain syndrome and recovery time.</p><p><strong>Results: </strong>Duration of RATS was significantly shorter (mean 120 min) compared to VTS (140 min) (<i>p</i>< 0.05). Postoperative pain was also lower in the RATS group (4.5 vs. 6.0 points) (<i>p</i>< 0.05). The incidence of complications was lower in the same group that contributed to earlier recovery.</p><p><strong>Conclusion: </strong>Robot-assisted surgeries are preferable for anterior mediastinal tumors. The advantages of RATS include shorter surgery time, lower pain and complication rate. Thus, this approach is more advisable in high-risk patients.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"6-12"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366159","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":"[Hand burns in pediatrics].","authors":"L I Budkevich, V V Soshkina, V S Zhamnova","doi":"10.17116/hirurgia202503196","DOIUrl":"https://doi.org/10.17116/hirurgia202503196","url":null,"abstract":"<p><p>Burns of the hands in pediatrics are an important topic in combustiology. The hand plays a huge role in the development of mental and physical skills in a child. A retrospective analysis of electronic medical records of 282 victims with hand burns who were treated in Moscow Pediatric Hospital No. 9 named by G.N. Speransky was carried out. The study showed that most often children receive burns of the hands in the first three years of life, the main thermal agent is hot liquid. 35 patients had different types of surgery: excision with one stage or delayed grafting, enzymatic debridement and mechanical debridement. Silver containing atraumatic hydrocolloid dressings were used on all stages of treatment. Clinical examples demonstrate different variants of surgical tactics used in children from 0 till 6 years. Surgery types depend of the depth of damage to the integumentary tissues and deep structures of the hand and fingers. The work highlights diagnostic and clinical approaches to the management of patients with this pathology. The algorithm of conservative and surgical treatment of patients with burns II-III and III degree in the area of the palmar and dorsal surfaces of the hand and fingers is presented. This algorithm also includes tactics at rehabilitation stages restoring functional and aesthetic disorders. Compliance all recommendations contributes to the speedy socialization of patients in this age group.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"96-106"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658923","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":"[Transfusion therapy of the XIX century - the beginning of the formation of parenteral nutrition for surgical patients].","authors":"M S Sergeeva, N N Krylov","doi":"10.17116/hirurgia2025031156","DOIUrl":"https://doi.org/10.17116/hirurgia2025031156","url":null,"abstract":"<p><p>The article highlights the basic experiments of the predecessors, which served as an impetus for the clinical development of transfusiology in surgery in three main directions: hemotransfusion, intravenous transfusion of aqueous solutions of salts and glucose, as well as parenteral administration of natural milk. The immediate results of each of the options are shown, the dangers and complications that accompanied the accumulation of experience are described. The problems that could be solved only with the further development of science are formulated.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"156-163"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658986","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":"[Amputation risk scale in patients with acute limb ischemia].","authors":"N G Khorev, A A Chichvarov, S V Sapelkin, A V Beller","doi":"10.17116/hirurgia202503169","DOIUrl":"https://doi.org/10.17116/hirurgia202503169","url":null,"abstract":"<p><strong>Objective: </strong>To create a scale for predicting amputation in patients with acute limb ischemia.</p><p><strong>Material and methods: </strong>We retrospectively analyzed inpatient treatment data of 1.353 patients over a 22-year period. Patients were divided into two groups depending on limb salvage (<i>n</i>=1.212) and limb loss (<i>n</i>=141). Six factors influencing the risk of limb amputation were identified, and odds ratio for each factor was assessed.</p><p><strong>Results: </strong>A scoring scale including 15 clinical and laboratory parameters was created. Prognostic ability of the scale was assessed using ROC analysis. AUC was 0.794 with 95% CI 0.755-0.833. The median score for group 1 (limb salvage) was 17 [14; 21], for group 2 (amputation) - 23 [19; 26] (<i>p</i><0.0001). We stratified groups of low (up to 4.2%), medium (4.3-19.2%) and high (19.3-55.7%) risk of limb amputation in patients with acute limb ischemia.</p><p><strong>Conclusion: </strong>A simple scale for assessing the probability of limb amputation in patients with acute ischemia was developed. Practical application of this tool is possible in surgical and specialized departments.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"69-75"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658913","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":"[Laparoendoscopic hybrid treatment of a patient with choledocholithiasis, cholecystitis and large duodenal diverticula].","authors":"Yu G Starkov, A I Vagapov, R D Zamolodchikov, S V Dzhantukhanova, P Sh Arabova","doi":"10.17116/hirurgia202501162","DOIUrl":"https://doi.org/10.17116/hirurgia202501162","url":null,"abstract":"<p><p>We present laparoendoscopic hybrid treatment of a patient with choledocholithiasis, cholecystitis and large duodenal diverticula. A 69-year-old patient underwent one-stage hybrid laparoendoscopic intervention. Despite the difficult situation caused by large duodenal diverticula and calculus in terminal part of common bile duct, hybrid technique with rendez-vous procedure allowed successful lithoextraction and cholecystectomy. The follow-up examination found no residual biliary calculi. Hybrid laparoendoscopic intervention in the treatment of a patient with choledocholithiasis, cholecystitis and large duodenal diverticula provided optimal clinical effect, reduced the risk of postoperative complications and shortened in-hospital treatment.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"62-67"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123587","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":"[Prognostic factors and preoperative therapy in resectable intrahepatic cholangiocarcinoma].","authors":"A N Polyakov, Yu I Patyutko, D A Granov, I S Bazin, I O Rutkin, A V Korshak, A S Turlak, D V Podluzhny","doi":"10.17116/hirurgia20250115","DOIUrl":"10.17116/hirurgia20250115","url":null,"abstract":"<p><strong>Objective: </strong>To identify prognostic factors and role of preoperative therapy for resectable intrahepatic cholangiocarcinoma (IHCC).</p><p><strong>Material and methods: </strong>We analyzed the results of surgical and combined treatment of IHCC between 1999 and 2023. Immediate and long-term outcomes were evaluated depending on negative prognostic factors and additional therapy.</p><p><strong>Results: </strong>The study included 195 patients. Postoperative complications grade ≥III were observed in 35 (17.9%) case. Mortality rate was 3.1% (<i>n</i>=6). Thirty-eight patients (19.5%) underwent treatment before surgery, 109 (55.9%) ones - after surgery. The median overall survival was 31 months, 5-year overall survival - 32.0%. The following factors worsened overall survival: node size ≥8 cm (HR 1.45; 95% CI 0.97-2.17), invasion (HR 1.63; 95% CI 1.07-2.47), multiple lesion (HR 1.51; 95% CI 1.00-2.28). R1 resection worsened disease-free survival (HR 1.88; 95% CI 1.14-3.10). Lymph node metastases decreased overall (HR 1.96; 95% CI 1.27- 3.04) and disease-free survival (HR 2.37; 95% CI 1.63-3.44). Two and more negative factors worsened overall (<i>p</i>=0.0013) and disease-free survival (<i>p</i>=0.0005). Absence of adjuvant therapy worsened overall (HR 2.12; 95% CI 1.41-3.20) and disease-free survival (HR 1.42; 95% CI 0.99-2.04). There was a trend towards higher overall (<i>p</i>=0.088) and progression-free survival (<i>p</i>=0.029) in case of preoperative therapy (<i>n</i>=195). In unfavorable prognosis group, preoperative therapy (<i>n</i>=33) was superior to standard treatment (resection+capecitabine after surgery, <i>n</i>=26). There was a trend towards higher overall survival (<i>p</i>=0.066) and significantly better progression-free survival (17 vs 13 months, <i>p</i>=0.018).</p><p><strong>Conclusion: </strong>Negative prognostic factors for resectable IHCC are lesion size ≥8 cm, intrahepatic and regional metastases, invasion into neighboring structures, R1 resection. Combination of negative factors worsened prognosis. Adjuvant therapy improved postoperative outcomes. Preoperative therapy may be advisable in case of negative factors and high risk of R1 resection.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"5-13"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123673","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":"[Universal intestinal suture in rehabilitation of patients with single-layer anastomoses after elective upper gastrointestinal tract surgery].","authors":"S R Bashirov, S S Klokov, V A Korepanov, D V Krinitsky, N S Rudaya, M B Arzhanik","doi":"10.17116/hirurgia202501137","DOIUrl":"https://doi.org/10.17116/hirurgia202501137","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate universal intestinal suture in rehabilitation of patients with single-row anastomoses after elective upper gastrointestinal tract surgery.</p><p><strong>Material and methods: </strong>A single-center study included 142 patients over 8-year period. There were 72 (50.7%) pancreaticoduodenectomies and 70 (49.3%) gastric resections and gastrectomies. The rehabilitation program included single-layer anastomoses using universal intestinal suture, intestinal drainage for decompression and enteral nutrition, therapeutic and diagnostic endoscopy to stimulate motor evacuation function, patency of anastomoses and assessment of anastomositis.</p><p><strong>Results: </strong>Intestinal drainage for decompression and enteral nutrition was used for 6 (4; 7) days after surgery. Intraluminal endoscopy was performed after 9 (7; 11) days. In patients with anastomositis grade 0 (26.5%) and 1 (62.4%), we observed minimal inflammation along intestinal suture line (mean hospital-stay 16 (13; 20) days). In patients with anastomositis grade 2 (8.5%) and 3 (2.6%), we observed surface erosions and ulcers in the anastomosis zone (mean postoperative hospital-stay 20 (16; 27) days). Postoperative complications unrelated to anastomoses were diagnosed in 17.6% of cases; 12% of patients underwent redo surgery. Mortality rate was 2.8%.</p><p><strong>Conclusion: </strong>Universal intestinal suture in rehabilitation of patients with single-layer anastomoses contributed to uncomplicated healing of anastomoses in 88.9% of patients with anastomositis grade 0-1 and reduced the incidence of anastomositis grade 2-3 to 11.1%, as well as hospital-stay after elective upper gastrointestinal tract surgery.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"37-46"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123684","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}