Journal of Knee Surgery最新文献

{"title":"Joint Injection or Aspiration before Total Knee Arthroplasty: Does It Increase the Risk of Periprosthetic Joint Infection?","authors":"Darren Z Nin, Ya-Wen Chen, Carl T Talmo, Brian L Hollenbeck, David Mattingly, Yoav Zvi, Ruijia Niu, David C Chang, Eric L Smith","doi":"10.1055/a-2451-8845","DOIUrl":"10.1055/a-2451-8845","url":null,"abstract":"<p><p>Injections are a common preoperative treatment for patients who eventually undergo total knee arthroplasty (TKA). However, recent studies have shown a relationship between preoperative injections and adverse outcomes following surgery. The purpose of this study was to characterize the type of intra-articular procedure patients receive in the acute period prior to surgery and determine their association with postoperative periprosthetic joint infection (PJI).An observational cohort study was conducted using the Merative MarketScan databases. Patients who underwent primary TKA between April 1, 2019, and July 4, 2021, were included in the study. Patients were grouped according to the type of intra-articular procedure they received within the 90-day period prior to TKA: (i) intra-articular hyaluronic acid (IA-HA), (ii) intra-articular corticosteroid (IA-CS), (iii) aspiration, and (iv) no drug injections or aspirations. The primary outcome was the postoperative 180-day PJI rate.A total of 43,219 patients were included in the study. About 11.8% of patients were found to have received at least one injection or aspiration in the 90 days prior to their TKA. The most common injection performed was IA-CS (78.3%), followed by aspiration (13.0%) and IA-HA (8.7%). No image guidance was performed for 92.3% of injections, with most being administered between 61 and 90 days before surgery (93.6%). Rates of PJI at 180 days were similar between patients with and without injections (OR = 1.11, <i>p</i> = 0.569). Neither drug type nor image guidance had an effect on the overall postoperative PJI rate.Injections performed prior to TKA do not increase the risk of developing postoperative PJI.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"195-200"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Cruciate Ligament Allograft Reconstruction in Females Can Produce Outcomes Comparable to Those of Autografts in Male Counterparts.","authors":"Sung Bae Park, Yong Seuk Lee","doi":"10.1055/a-2451-6685","DOIUrl":"10.1055/a-2451-6685","url":null,"abstract":"<p><p>There are unique anatomical and geometric risk factors that contribute to higher injury rates of the anterior cruciate ligament (ACL) in women. Allografts are an important alternative option for female patients.Patients who underwent primary ACL reconstruction were retrospectively evaluated. The case group comprised female patients with ACL allograft reconstruction, and the control group comprised male patients with ACL reconstruction. Functional and clinical evaluations were based on the pre- and postoperative Cybex test, Lysholm score, International Knee Documentation Committee subjective and objective measurement criteria, and Tegner Activity Scale questionnaires. Radiological comparisons were performed using the femorotibial angle (FTA), posterior tibial slope (PTS), and intercondylar notch width (INW). The roof inclination angle (RIA) was assessed using magnetic resonance imaging.The two groups (female [44] and male [88]) had an average follow-up period of 57.9 ± 19.3 months and average ages of 36.5 ± 10.9 and 35.2 ± 11.7 years, respectively. Functional and clinical outcomes showed no differences between the groups, except that the return to the preinjury activity level was higher in the female group (95% vs. 77%, <i>p</i> < 0.001). The female group showed larger FTA and PTS and smaller INW and RIA than those of the male group (<i>p</i> < 0.001, 0.008, <0.001, and 0.035, respectively).Female ACL allograft reconstruction showed comparable outcomes to those of their male counterparts, and the return to preinjury activity levels was significantly higher in women. However, women showed lower activity levels and were more vulnerable to geometric risk factors than their male counterparts.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"170-179"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcomes after Surgery for Pigmented Villonodular Synovitis in the Knee: A Cohort Study.","authors":"Ryan J Lashgari, Bruce W Chen, Dominic J Ventimiglia, Leah E Henry, Matthew P Kolevar, Natalie L Leong, Sean J Meredith, Jonathan D Packer, R Frank Henn","doi":"10.1055/s-0044-1793939","DOIUrl":"10.1055/s-0044-1793939","url":null,"abstract":"<p><p>Pigmented villonodular synovitis (PVNS) is a rare neoplastic proliferation of large joints, including the knee, with both localized PVNS (LPVNS) and diffuse PVNS (DPVNS) types. DPVNS is known to recur at a higher rate following resection; however, there is little evidence comparing patient-reported outcomes (PROs) between the two types. The purpose of this study was to compare PROs between patients with LPVNS and DPVNS involving the knee 2 years after surgical resection. We hypothesized that DPVNS would have worse 2-year PROs than LPVNS.Sixteen patients who underwent arthroscopic resection of pathology-confirmed PVNS involving the knee were enrolled in a prospective registry. Several PROs, including six Patient-Reported Outcomes Measurement Information System (PROMIS) domains and the International Knee Documentation Committee (IKDC) Subjective Knee Form, were assessed at baseline and at 2 years postoperatively. Mean scores between LPVNS and DPVNS groups were compared using a Wilcoxon exact test, while categorical variables were compared using a Fisher's exact test.Eleven patients (seven LPVNS and four DPVNS) completed both the baseline and 2-year PRO surveys. There were no significant differences in the demographic variables between groups, including age, body mass index, or prior surgical history (<i>p</i> < 0.05). There was a trend toward higher mean PRO scores in the DPVNS group at 2 years postoperatively in all measures, despite lower reported baseline levels of activity as measured by Marx Activity Rating Scale (26.3 vs. 76.7, <i>p</i> = 0.02). The DPVNS group also trended toward more improvement in PROMIS Physical Function (9.7 vs. -2.7), PROMIS Pain Interference (-9.0 vs. -2.5), PROMIS Anxiety (-5.4 vs. -4.4), and IKDC (26.7 vs. 18.9). However, these differences did not reach statistical significance (<i>p</i> < 0.05). There were two recurrences in the DPVNS group and none in the LPVNS group.Patients with knee DPVNS do not report worse outcomes 2 years after arthroscopic resection compared with LPVNS patients.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"180-187"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Retrospective Review of Revision and Re-revision Patella Osteosynthesis Performed for Failure of Fixation of Initial Comminuted Fracture Patterns: Very High Complication Rates.","authors":"Wayne Hoskins, Charles Gusho, Rown Parola, Steven DeFroda, Douglas Haase","doi":"10.1055/a-2451-6924","DOIUrl":"10.1055/a-2451-6924","url":null,"abstract":"<p><p>Literature on revision osteosynthesis for failed patella fracture fixation is extremely limited. This study reviews the treatment options and outcomes for revision and re-revision osteosynthesis at a Level 1 trauma center. All patella revision osteosynthesis cases between January 2021 and March 2024 were identified using Current Procedural Terminology codes at a single tertiary care academic center. Medical records, operative reports, and radiographs were reviewed to collect details regarding patient demographics, initial injury and fracture management, indications for revision surgery, revision construct, postoperative weight bearing and range-of-motion restrictions, and outcomes. The primary outcome was major failure defined as loss of fixation or further surgery for nonunion or infection. Ten patients underwent revision osteosynthesis for failed fixation. All fractures were initially comminuted fracture patterns (AO/OTA 34-C3), with nine (90%) initially treated with a 2.7-mm patella-specific variable angle locking plate (Synthes, Paoli, PA). Half (<i>n</i> = 5) of the patients were revised with the same patella-specific plate and half with an all suture transosseous fibertape tension band (Arthrex, Naples, FL). Additional fixation in the form of bony augmentation was performed in 20% (<i>n</i> = 2) of cases and soft tissue augmentation in 70% (<i>n</i> = 7). There was a 70% (<i>n</i> = 7) major failure rate, mostly due to loss of inferior pole fixation. There were four re-revision procedures performed with surgical fixation. Two of these subsequently developed infection, one united and the other had no radiographic signs of union and was lost to follow-up, but was without complication. Regardless of the chosen fixation construct, revision osteosynthesis for failed fixation of initial comminuted fracture patterns has an extremely high rate of failure. Complications increase with further revision surgery. Level of evidence: therapeutic level 3.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"188-194"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Isolated Lateral Extra-Articular Tenodesis for Ongoing Instability Following Anterior Cruciate Ligament (ACL) Reconstruction with an Intact Graft is Effective and Has Low Surgical Morbidity.","authors":"Peter S E Davies, Cameron Muirhead, Alistair I W Mayne, Jay R Ebert, Peter K Edwards, Ashley Simpson, Andy Williams, Peter D'Alessandro","doi":"10.1055/a-2481-8771","DOIUrl":"10.1055/a-2481-8771","url":null,"abstract":"<p><p>The management of persisting instability following anterior cruciate ligament reconstruction (ACLR) includes isolated lateral extra-articular tenodesis (LEAT). The present study investigates the outcomes following isolated LEAT to address ongoing instability following ACLR without LEAT. Patients with ongoing symptomatic instability following ACLR with a radiologically intact and well-positioned graft who underwent an isolated LEAT between January 2017 and March 2022 were retrospectively recruited. Patients completed patient-reported outcome measures at baseline and mean 26 months postoperatively. Twelve knees in 11 patients underwent an isolated LEAT. All Knee Injury and Osteoarthritis Outcome Score domains improved significantly between pre- and postoperative measurements (pain 60.9-91.7, <i>p</i> = 0.002; symptoms 62.5-93.8, <i>p</i> = 0.003; activities of daily living 64.3-95.2, <i>p</i> = 0.002; sport 61.9-82.5, <i>p</i> = 0.012; quality of life 17.2-80.2, <i>p</i> = 0.002). One patient required revision ACL surgery 19 months following their subsequent LEAT procedure. An isolated LEAT demonstrated clinically significant improvements in patient function and activity with acceptable surgical morbidity and should be considered as an option for appropriate cases with instability despite an intact ACL graft. LEVEL OF EVIDENCE:  Level IV prospective case series.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":"207-215"},"PeriodicalIF":1.6,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote Patient Monitoring after TKA - What Surgeons Need to Know.","authors":"Kevin Chun Luk Chang, John P Stelmach, Giles R Scuderi","doi":"10.1055/a-2545-5121","DOIUrl":"https://doi.org/10.1055/a-2545-5121","url":null,"abstract":"<p><p>Multiple new technologies have been introduced in recent years to allow for remote patient monitoring after total knee arthroplasty. These tools allow for the recording and transmission of various types of data from the patient to the surgeon throughout a recovery course without necessitating an in-person office visit. Remote patient monitoring has the ability to improve patient outcomes and experience throughout the rehabilitation period by providing much more data on patient progress than has been available in the past. However, these technologies are available in many forms, and different formats provide different types of data that may be of variable utility depending on surgeon preference and training. In this article, we will review different forms of remote patient monitoring; benefits associated with each; and recommendations for incorporating remote patient monitoring into a knee arthroplasty practice.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Benefit of Combining Kinematic Alignment and a Medial Pivot Implant in Total Knee Arthroplasty, The KA-MP Knee: Why and How.","authors":"Robert N Steensen","doi":"10.1055/a-2544-4116","DOIUrl":"https://doi.org/10.1055/a-2544-4116","url":null,"abstract":"<p><p>Kinematic alignment (KA) has emerged as an alternative alignment technique for total knee arthroplasty with the goal of duplicating the pre-arthritic joint surface. Medial pivot (MP) total knee implants duplicate the medial stability of the natural knee and recreate the medial rotational axis of the knee. Each has had favorable results. Combining the two, the KA-MP knee, creates a synergy and achieves better results than KA or MP alone.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of the Serial Alignment Change after Opening-Wedge High Tibial Osteotomy Based on Coronal Plane Alignment of the Knee Using Machine Learning Algorithm.","authors":"Joon Hee Cho, Hee Seung Nam, Seong Yun Park, Jade Pei Yuik Ho, Yong Seuk Lee","doi":"10.1055/a-2525-4622","DOIUrl":"10.1055/a-2525-4622","url":null,"abstract":"<p><p>Categorization of alignment into phenotypes can be useful for predicting and analyzing postoperative alignment changes after opening-wedge high tibial osteotomy (OWHTO). The purposes of this study were to (1) develop a machine learning model for the predicting the Coronal Plane Alignment of the Knee (CPAK) phenotypes of final alignment after OWHTO, and (2) analyze predictive factors for final alignment phenotypes. Data were retrospectively collected from 163 knees that underwent OWHTO between March 2014 and December 2019. Each data were assessed at three time points: preoperatively, at 3 months postoperatively, and the final follow-up. Constitutional alignment was also evaluated. Machine learning models were developed using two independent feature sets consisting of serial radiologic parameters and CPAK phenotypes. The area under the receiver-operating characteristic curve (AUC) was used as a primary metric to determine the best model. To evaluate the feature importance, Shapley additive explanation (SHAP) analysis was also performed on the best model. Multilayer perceptron (MLP) was the best prediction model, with the highest AUC of 0.867 based on radiologic parameters and 0.783 based on CPAK phenotypes. Joint line obliquity (JLO) at 3 months postoperatively was the most important factor among the radiologic parameters for predicting the final CPAK phenotypes. The features of constitutional and preoperative alignments also contributed, although the features of alignments at 3 months postoperatively were the highest contributing predictors. In conclusion, the developed machine learning models of the MLP showed excellent performance in predicting the final CPAK phenotypes after OWHTO. Postoperative JLO was the most important radiologic parameter for predicting the final alignment. The combination of features of the constitutional, preoperative, and postoperative periods enabled high accuracy and performance in predicting the final alignment.A retrospective cohort study with the level of evidence as level III.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior cruciate ligament revision surgery: Outcomes, failure rates, and complications. A systematic review of the literature.","authors":"Riccardo D'Ambrosi, Alessandro Carrozzo, Fabrizio Di Feo, Edna Skopljak, Srinivas Bs Kambhampati, Manish Attri, Amit Meena","doi":"10.1055/a-2542-2417","DOIUrl":"https://doi.org/10.1055/a-2542-2417","url":null,"abstract":"<p><strong>Purpose: </strong>To synthesise and qualitatively assess the currently available evidence in the literature regarding the revision of posterior cruciate ligament (PCL) reconstruction.</p><p><strong>Methods: </strong>A systematic review was conducted on the basis of the PRISMA guidelines. The outcome data extracted from the studies were the Lysholm score, Orthopadische Arbeitsgruppe Knie (OAK) scoring system, KT-2000, International Knee Documentation Committee (IKDC) subjective and objective, radiological changes, rate of return to sports, complications, and failures and/or revision surgeries.</p><p><strong>Results: </strong>The cohort consisted of 54 patients (42 [77.8%] men and 12 [22.2%] women), with a mean age of 33.14 ±3.67 years (range 17-48 years). The mean postoperative follow-up was 71.8 ±45.32 months, whereas the mean time from primary surgery to revision was 41.7 ±4.5 months. All studies reported a clinical improvement from preoperative to final follow-up in terms of the Lysholm, OAK, KT-2000, and IKDC scores (p<0.05). Posterior displacement was significantly improved in all studies, demonstrating the stability of the knee. The mean posterior displacement ranged from a preoperative value of 10.68 ±0.7 mm to a final value of 2.7 ±0.2 mm (p<0.05). A total of two (3.7%) failures were reported, and there were also eight (14.8%) revision surgeries.</p><p><strong>Conclusions: </strong>Studies on posterior cruciate ligament reconstruction revisions have shown satisfactory clinical outcomes and a high level of knee stability, with a minimal risk of new reruptures. However, the rate of returning to preinjury sports activity is relatively low. Whenever possibile, it is recommended to perform the ligament revision in a single stage.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcome Measure Collection for TKA: What Surgeons Need to Know.","authors":"Matthew T Geiselmann, Mathew J Whittaker, Giles R Scuderi","doi":"10.1055/a-2542-7534","DOIUrl":"https://doi.org/10.1055/a-2542-7534","url":null,"abstract":"<p><p>As the population ages and the prevalence of knee osteoarthritis increases, total knee arthroplasty (TKA) is expected to grow in demand. Traditionally, the success of TKA has been measured through clinical assessments, imaging, and the incidence of postoperative complications. Over the past decade, patient-reported outcome measures (PROMs) have become crucial in evaluating clinical outcomes. PROMs are soon to be tied to financial incentives in value-based payment programs as a measure of the quality of care provided. Centers for Medicare & Medicaid Services (CMS) has implemented a nationwide policy to enhance and standardize the collection of PROMs for those undergoing total joint arthroplasty. The policy is titled Patient Reported Outcome-based Performance Measure or \"PRO-PM\". This requires mandatory reporting in 2025, and by 2028, hospital payment evaluations will incorporate this data. CMS will require hospitals to achieve at least 50% postoperative PROM collection rates to qualify for full annual payment in 2028. Providers are incentivized to improve scores on PROMs, such as pain levels and physical function after procedures, as higher PROM scores often correlate with better reimbursement rates under these programs. Recent advancements in interactive technology, including mobile apps and telemedicine platforms, have enabled the collection of PROMs from patients without requiring or prior to a clinic visit. Looking ahead, the mandatory PROM reporting requirements set by the CMS highlight the urgency of adopting scalable, technology-driven solutions. Literature suggests women, individuals with lower socioeconomic status, lower educational attainment, and non-English speakers have significantly lower PROM response rates. While these mandates aim to standardize care quality, they also risk exacerbating disparities if underserved populations face barriers to participation. Equity-focused strategies, alongside continued investment in technology, will be critical to achieving widespread adoption and maximizing the benefits of PROMs in TKA care. Ultimately, the integration of electronic and adaptive PROM systems has the potential to transform the TKA landscape, offering a model for leveraging technology to enhance patient engagement, optimize care delivery, and improve outcomes across diverse populations.</p>","PeriodicalId":48798,"journal":{"name":"Journal of Knee Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}