International Journal of Spine Surgery最新文献

{"title":"Risk Factors for Postoperative Urinary Tract Infection in Patients Undergoing Arthrodesis for Spinal Deformity of Different Levels.","authors":"Hannah Shelby, Tara Shelby, Zoe Fresquez, Jeffrey C Wang, Raymond Hah","doi":"10.14444/8724","DOIUrl":"https://doi.org/10.14444/8724","url":null,"abstract":"<p><strong>Background: </strong>While studies have identified urinary tract infection (UTI) as a complication after spine fusion, UTI is understudied in the context of fusion for spinal deformity. This study sought to determine both UTI incidence after multilevel posterior fusion for spinal deformity and whether pooled risk factors (RFs) increased UTI risk.</p><p><strong>Methods: </strong>Patients who had posterior fusion for spinal deformities between 2010 to 2019 were queried from the PearlDiver database, separated by the number of levels operated on (<7, 7-12, and >12), matched for age/gender, and analyzed for UTI incidence within 1 week and 1, 2, and 3 months. Any patient with a note of diabetes, obesity, rheumatoid arthritis, or coronary artery disease within 1-year prior to surgery and who contracted UTI within 1 month after fusion was included in the RF group for each level span. Patients of each level span with any RF were compared with those without any RFs. <i>χ</i> ² tests were used for statistical analyses.</p><p><strong>Results: </strong>A total of 20,893 patients underwent posterior fusion for spinal deformities from 2010 to 2019. After matching, each level set had 2239 patients. At 1, 2, and 3 months, the >12 levels subgroup showed statistically higher UTI incidence than the 7 to 12 and <7 levels subgroups. At 3 months, UTI was similar between the <7 and 7 to 12 subgroups, with 3.8% and 3.9%, respectively (<i>P</i> = 0.41), and UTI was statistically higher in the >12 subgroup at 4.6% (<7 vs 7-12: <i>P</i> = 0.005; <7 vs >12: <i>P</i> < 0.001). For each level group, the RF groups had significantly higher UTI rates at 1, 2, and 3 months. ORs were significantly greater than 1 for RF groups across all level subgroups (<7 OR = 2.8, <i>P</i> < 0.001; 7-12 OR = 2.1, <i>P</i> < 0.001; >12 OR = 2.3, <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Diabetes, obesity, rheumatoid arthritis, and coronary artery disease were associated with a higher risk of UTI after posterior fusion for spinal deformity for all level sets. patients who underwent procedures for more than 12 levels had the highest rate of UTI. This is the first study to analyze and compare UTI incidence following fusion for spinal deformity.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516830","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":"Segmental Interbody, Muscle-Preserving, Ligamentotaxis-Enabled Reduction: \"SIMPLER\" Technique for cMIS Correction of ASD.","authors":"Jerry Robinson, David Gendelberg, Andrew Chung, Jose H Jimenez-Almonte, Babak Khandehroo, Neel Anand","doi":"10.14444/8714","DOIUrl":"10.14444/8714","url":null,"abstract":"<p><strong>Background: </strong>Correction of adult spinal deformity (ASD) through minimally invasive techniques is a challenging endeavor and has typically been reserved for experienced surgeons. This publication aims to be the first high-resolution technique guide to demonstrate a reproducible technique for ASD correction utilizing circumferential minimally invasive surgery (cMIS) without an osteotomy. The Segmental Interbody, Muscle-Preserving, Ligamentotaxis-Enabled Reduction (SIMPLER) technique is a novel ligamentotaxis-based scoliosis surgery that represents a paradigm shift from traditional osteotomies toward patient-specific correction.</p><p><strong>Methods: </strong>The senior author's (N.A.) cMIS technique for ASD correction without an osteotomy is described using high-resolution photographs, computer-generated imagery (CGI), and a case example. Step-by-step intraoperative photographs document a novel muscle-preserving posterior spinal exposure, spinal robotic safety protocol for instrumentation, dedicated deformity instrumentation system, rod reduction sequence, and minimally invasive fusion technique. CGI assists to reinforce technical considerations described by intraoperative photographs.</p><p><strong>Results: </strong>The SIMPLER technique is documented from incision to closure with high-resolution pictures including CGI to highlight concepts documented in photographs. Technical considerations were detailed for all aspects involved in the planning and execution of an osteotomy-free deformity correction.</p><p><strong>Conclusion: </strong>This represents the first in-depth technical description of ligamentotaxis-based, osteotomy-free, ASD scoliosis correction. The SIMPLER approach is reproducible and minimally invasive and can be done routinely for appropriately selected deformity candidates. This technique serves as a foundation to externally validate previously described cMIS ASD deformity correction outcomes.</p><p><strong>Clinical relevance: </strong>Circumferential minimally invasive spinal deformity correction is reproducible and can be achieved reliably through the use of the SIMPLER technique, without the use of an osteotomy.</p><p><strong>Level of evidence: 5: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S37-S54"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967229","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":"Master Techniques in Minimally Invasive Spine Surgery: Lumbar Endoscopic Spine Surgery.","authors":"Choll W Kim","doi":"10.14444/8715","DOIUrl":"10.14444/8715","url":null,"abstract":"<p><p>The difficult learning curve remains the major obstacle to adoption of lumbar endoscopic spine surgery (LESS) techniques. Detailed, step-by-step techniques are described for the uniportal transforaminal technique, as well as uniportal and biportal interlaminar approaches. Special emphasis is placed on specific areas of the learning curve that pose obvious challenges to the completion of successful surgery. Logistical challenges of the first case are addressed with electronic checklists with interactive photographs of key instruments and equipment for easy identification by staff, interactive animations of the room set-up, and interactive animations of the surgical anatomy. This technique guide is part of a comprehensive training program with the goal to \"make the first case go well.\"</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S55-S75"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053107/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400304","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":"Editor's Introduction: State of the Art in Minimally Invasive Spine Surgery-Detailed Techniques and Pearls of Wisdom From the Masters.","authors":"Neel Anand","doi":"10.14444/8710","DOIUrl":"10.14444/8710","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S6"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053218/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459981","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":"Lateral Transpsoas Interbody Fusion.","authors":"T Barrett Sullivan, Angel Ordaz, Frank M Phillips","doi":"10.14444/8711","DOIUrl":"10.14444/8711","url":null,"abstract":"<p><p>The lateral transpsoas approach to lumbar interbody fusion has gained widespread adoption for a variety of indications. This approach to the interbody space allows for a favorable fusion environment, disc and neuroforaminal height restoration, and powerful alignment correction. Despite its minimally invasive nature, this procedure carries unique risks, the most severe of which include bowel injury, major vascular injury, and lumbosacral plexopathy. This poses a marked learning curve and requires rigorous attention to detail in technique. In this review, we provide a detailed description of our approach to preoperative imaging, patient positioning, and surgical technique, with an emphasis on patient safety and evidence-based decision-making. A brief description of intraoperative neuromonitoring techniques follows. The lateral transpsoas approach to interbody fusion has demonstrated reliable outcomes in regard to fusion rates, pain and function, and deformity correction, all across a widespread variety of lumbar spine pathologies. Here, we depict techniques, pearls, and pitfalls that are critical for any surgeon considering whether to add this technique to their practice.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S7-S18"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956410","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":"Nuances of the Minimally Invasive Transforaminal Lumbar Interbody Fusion: A Technical Review.","authors":"Daivik B Vyas, Brian J Park, Michael Y Wang","doi":"10.14444/8713","DOIUrl":"10.14444/8713","url":null,"abstract":"<p><strong>Background: </strong>Transforaminal lumbar interbody fusion (TLIF) achieves anterior and posterior spinal arthrodesis through a single approach. Minimally invasive surgery (MIS) methods reduce surgical morbidity while achieving positive outcomes.</p><p><strong>Methods: </strong>The major MIS-TLIF techniques, from tubular to endoscopic approaches, are reviewed with a discussion on the incorporation of new technologies and a comparative review of their outcomes.</p><p><strong>Results: </strong>MIS-TLIF approaches span a spectrum of visualization methods, with technical nuances related to patient and surgeon-specific factors determining optimal fit. To date, the superiority of 1 technique has yet to be definitively determined. Existing techniques may be integrated in a personalized manner to optimize surgical utility.</p><p><strong>Conclusions: </strong>Selection of an MIS-TLIF modality relies on a calculus between patient characteristics and surgeon faculty; proper selection can offer significant benefits to patients with spine disease.</p><p><strong>Clinical relevance: </strong>Emerging technologies for MIS-TLIF comprise a major source of development and clinical translation, while the safe and effective use of these techniques promises greater patient benefit in the right populations.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S28-S36"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052857/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956412","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":"Prone Lateral Transpsoas Approach to the Spine: A Technical Guide for Mastery.","authors":"Juan P Giraldo, Winward Choy, Juan S Uribe","doi":"10.14444/8712","DOIUrl":"10.14444/8712","url":null,"abstract":"<p><strong>Background: </strong>The single-position prone transpsoas (PTP) lateral interbody fusion represents an alternative approach to the traditional lateral lumbar interbody fusion (LLIF) typically performed with the patient in the lateral decubitus position. Advantages of PTP surgery include improved segmental lordosis, single-position surgery, and ease of performing posterior techniques as needed. However, the learning curve of PTP is distinct from that of traditional LLIF surgery performed with the patient in the lateral decubitus position. Here, we highlight the senior author's approach to PTP surgery. The authors review key strategies of the preoperative workup, patient selection, operative techniques, and intraoperative pearls. This technical guide aims to shorten the learning curve for new adopters, optimize workflow for the surgeon, and maximize patient safety.</p><p><strong>Methods: </strong>A detailed analysis of the PTP approach was conducted, incorporating preoperative imaging and planning strategies and technical adjustments in patient positioning to accommodate access following the senior author's technical pearls. The workflow was structured to streamline transitions between levels, minimize time requirements, and reduce physical strain on the surgical team.</p><p><strong>Results: </strong>The application of PTP has demonstrated successful segmental lordosis correction and stable fusion across lumbar levels without requiring patient repositioning. The integrated workflow enabled sequential access and mastery of the PTP technique. These technical pearls have improved the efficiency of the PTP approach, according to the surgeon's expertise.</p><p><strong>Conclusion: </strong>The PTP technical strategies offer a viable and effective alternative to traditional LLIF. Surgeons can enhance the safety and efficiency of the PTP approach, maximize procedural benefits, and minimize potential risks using these technical strategies for preoperative planning, patient positioning, and intraoperative monitoring.</p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":"S19-S27"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053243/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013511","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":"Passing the Editor in Chief Baton: A Time for Reflection and Future Vision.","authors":"Charles L Branch","doi":"10.14444/8703","DOIUrl":"https://doi.org/10.14444/8703","url":null,"abstract":"","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143190474","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":"Spinopelvic Fixation Using an Osseointegrative Implant: Analysis of Postmarket Surveillance to Determine the Failure Rate.","authors":"Robert K Eastlack, Richard P Menger, Jay D Turner, Kara R Ashcraft, W Carlton Recking, Christopher J Kleck","doi":"10.14444/8720","DOIUrl":"https://doi.org/10.14444/8720","url":null,"abstract":"<p><strong>Background: </strong>Adult spinal deformities, affecting up to 60% of individuals older than 60 years, often require long segment fusions. Constructs spanning the lumbosacral junction commonly include pelvic fixation. Despite robust pelvic fixation, distal junctional failure, such as pseudoarthrosis, bone fracture, and instrumentation failure, occurs in 24%-34% of these cases. A novel implant designed for both durable pelvic fixation and sacroiliac joint fusion was recently cleared by the US Food and Drug Administration. This implant is engineered to address some of the pelvic fixation failure mechanisms by reducing motion at the lumbosacral junction and sacroiliac joint while decreasing stress on S1 pedicle screws and S2AI implants.</p><p><strong>Objective: </strong>To determine the failure rate of a novel osseointegrative implant for spinopelvic fixation/fusion.</p><p><strong>Study design: </strong>Analysis of manufacturer postmarket surveillance database.</p><p><strong>Methods: </strong>A postmarket surveillance database was analyzed to determine the type and rate of complaints and revisions of a novel osseointegrative implant. These were then compared with the published literature.</p><p><strong>Results: </strong>A total of 15,628 implants were identified in 6907 patients. The postmarket surveillance of the novel screw fusion device revealed a low complaint rate of 0.75% and no postoperative implant breakage. Revision procedures were mostly due to set screw dissociation (0.4%) and implant loosening (0.15%), which was primarily linked to pre-existing conditions or infection. The mean (SD) time from index procedure to the complaint was 7.1 (5.4) months.</p><p><strong>Conclusions: </strong>Compared with published literature, this novel osseointegrative implant demonstrates a significantly lower incidence of set screw dissociation than traditional pelvic screws with no incidence of breakage or back out, underscoring its durable integration with bone, with low rates of revisions and mechanical failures.</p><p><strong>Clinical relevance: </strong>A novel osseointegrative implant offers reduced rates of mechanical failures and revisions, helping to reduce complications in pelvic fixation procedures.</p><p><strong>Level of evidence: 4: </strong></p>","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075712","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":"Comparison of Clinical Efficacy in the Treatment of Lumbar Degenerative Disease: Posterior Lumbar Interbody Fusion, Posterior Lumbar Fusion, and Hybrid Surgery.","authors":"Zhenbiao Zhu, Anwu Xuan, Cheng Xu, Chaofeng Wang, Qing He, Liang Tang, Dike Ruan","doi":"10.14444/8659","DOIUrl":"10.14444/8659","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Numerous studies have confirmed that both posterior lumbar interbody fusion (PLIF) and posterior lumbar fusion (PLF), have their advantages and disadvantages. However, the inconsistent results of these studies make it difficult to reach a consensus on which fusion method is superior.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To compare the clinical outcomes of PLIF, PLF, and hybrid surgery combining PLIF and PLF in the treatment of lumbar degenerative disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review was conducted, collecting clinical records and radiological data of patients with lumbar degenerative disease from 2014 to 2022. Patients were divided into 3 groups based on surgical strategy: PLIF group, PLF group, and hybrid group. Clinical data included patient-reported outcomes such as the Japanese Orthopedic Association score, Oswestry Disability Index score, visual analog scale score, 36-item Short Form Health Survey score, and the occurrence of complications. Radiological data included Cobb angle, fusion rate, adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), and cage subsidence.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 378 patients were divided into 3 groups: PLIF group (&lt;i&gt;n&lt;/i&gt; = 122), PLF group (&lt;i&gt;n&lt;/i&gt; = 126), and hybrid group (&lt;i&gt;n&lt;/i&gt; = 130). The baseline characteristics were balanced among the 3 groups. As the follow-up time increased, visual analog scale scores showed varying degrees of improvement (all &lt;i&gt;P&lt;/i&gt; &lt;sub&gt;measure time&lt;/sub&gt; &lt; 0.001), but there were no significant differences observed between the groups (all &lt;i&gt;P&lt;/i&gt; &lt;sub&gt;measure time * group&lt;/sub&gt; &gt; 0.05). Oswestry Disability Index scores improved over time (&lt;i&gt;F&lt;/i&gt; &lt;sub&gt;measure time&lt;/sub&gt; = 939, &lt;i&gt;P&lt;/i&gt; &lt;sub&gt;measure time&lt;/sub&gt; &lt; 0.001), with the hybrid group showing more significant improvement (&lt;i&gt;F&lt;/i&gt; &lt;sub&gt;measure time * group&lt;/sub&gt; = 2.826, &lt;i&gt;P&lt;/i&gt; &lt;sub&gt;measure time * group&lt;/sub&gt; = 0.006). The 36-item Short Form Health Survey scores and Cobb angles also improved significantly during the follow-up period, with no significant differences observed among the groups. The overall fusion rates for the hybrid group and PLIF group were 93% and 91%, significantly higher than the fusion rate of the PLF group (84%; &lt;i&gt;P&lt;/i&gt; = 0.031). The postoperative complication rate was significantly higher in the PLIF group (24.4%) compared with the PLF group (16.4%) and the hybrid group (12.5%; &lt;i&gt;P&lt;/i&gt; = 0.022). There was no significant difference in the overall 5-year ASDeg occurrence rate (38% vs 36%) and ASDis occurrence rate (11.3% vs 8.3%) between the PLIF group and PLF group for single-level fusion (&lt;i&gt;P&lt;/i&gt; &gt; 0.05). The occurrence rate of ASDeg for multilevel fusion in the hybrid group was 29%, significantly lower than that in the PLIF group (42%) and PLF group (37%; &lt;i&gt;P&lt;/i&gt; = 0.044). The overall 5-year ASDis occurrence rates for multilevel fusion were 12.3%, 9.9%, and 7.6% for the PLIF group, PLF group, and hybrid g","PeriodicalId":38486,"journal":{"name":"International Journal of Spine Surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818831","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}