Archives of Pediatric Neurosurgery最新文献

{"title":"Review of surgical spproaches for posterior fossa tumors in pediatric population and illustrative cases","authors":"Alick Durão Moreira, Antonio Rosa Bellas, Marcelo Pousa, Tatiana Cervantes Protzenko","doi":"10.46900/apn.v5i3.202","DOIUrl":"https://doi.org/10.46900/apn.v5i3.202","url":null,"abstract":"Introduction/Background: Posterior fossa tumors are common in the pediatric population, and various surgical approaches have been described to reach them based on their specific location. This paper aims to review the most common posterior fossa approaches in pediatric patients and present illustrative cases to provide insights into their successful application in specific clinical scenarios. Case report: Three cases are presented, each demonstrating a different approach and surgical outcome. Case 1 involved a telovelar approach for the resection of a medulloblastoma, resulting in complete removal without neurological deficits. Case 2 required a combination of telovelar and supracerebellar infratentorial approaches to achieve gross total resection of a pilocytic astrocytoma. In Case 3, an occipital transtentorial approach was utilized to access and completely resect an atypical teratoid rhabdoid tumor. Connclusion: The paper discusses the telovelar and transvermian approaches, the supracerebellar infratentorial approach, the transtentorial suboccipital approach, and intraventricular endoscopy as individual or combined approaches for posterior fossa tumors. The presented cases highlight the importance of tailoring the surgical approach to each patient and provide valuable insights for neurosurgeons managing similar clinical scenarios.","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136312815","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":"Cerebellar Mutism after posterior fossa tumor surgery: is it predictable, preventable, treatable?","authors":"Carlos Eduardo Barros Jucá, Gabrielle Benevides Lima, Pâmella Christine de Souza Munhoz, Patrícia Pereira De Andrade, Francisco Gleison Albuquerque Ribeiro, Júlia Praciano Lopes","doi":"10.46900/apn.v5i3.208","DOIUrl":"https://doi.org/10.46900/apn.v5i3.208","url":null,"abstract":"Introduction: Posterior fossa tumors pose challenges in pediatric neurosurgery and can lead to complications such as cerebellar mutism, affecting speech and motor abilities. This study aims to describe the evolution of cerebellar mutism and identify relevant factors in its pathophysiology and prognosis. Methods: A review was conducted on three cases of children who underwent surgery for posterior fossa tumors by the same surgical team and developed postoperative cerebellar mutism. The study analyzed preoperative clinical presentation, mutism manifestation, and recovery. Additionally, a literature review was performed on the emergence, evolution, and prognosis. Results: Case 1 involved a 3-year-old girl with medulloblastoma who experienced mutism, behavioral changes, and self-mutilation after surgery. Symptoms resolved after one month but recurred with a subsequent operation, resolving again after a month. Case 2 featured a 15-year-old girl who developed severe posterior fossa syndrome, including mutism, dysarthria, aphasia, and motor impairments. With support care, she gradually improved over a year. Case 3 involved a 4-year-old boy with cerebral palsy and a posterior fossa tumor. He experienced akinetic mutism, resolved over time with rehabilitation therapies. Discussion: Cerebellar mutism following posterior fossa surgery has implications for patient recovery. It primarily involves impairment of cerebellar outflow pathways rather than direct brainstem or cortical lesions. Identifying at-risk patients remains challenging, though younger age and specific tumor characteristics may increase the likelihood of mutism. Rehabilitation, including physical and speech therapies, plays a crucial role in promoting recovery. Effective communication and support for patients and their families are essential during the recovery process.","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135691372","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":"Posterior Fossa Tumors: Special Issue","authors":"Patricia Alessandra Dastoli, Sergio Cavalheiro","doi":"10.46900/apn.v5i3.224","DOIUrl":"https://doi.org/10.46900/apn.v5i3.224","url":null,"abstract":"This edition of APN is entirely dedicated to posterior fossa tumors. Very common in the daily routine of pediatric neurosurgeons, these tumors remain one of the most challenging pathologies we must face. The importance and complexity of the anatomical structures of the posterior fossa, associated with the enormous histological variety of neoplastic lesions in this region, make its therapeutic approach difficult and even more challenging. The degree of surgical resection plays a determining role in the prognosis and cure possibilities for the children with posterior fossa tumors; on the other hand, gross total resection is related to the much feared cerebellar mutism syndrome, related to serious cognitive and behavioral sequelae. Every pediatric neurosurgeon's nightmare, this subject deserves special attention in our edition. Ballestero and Juca review the literature, discuss the concepts of mutism, predisposing factors, pathophysiology, and available treatments.
 However, mutism prevention after surgical resection is essential. In addition to excellent mastery of microneurosurgery techniques and in-depth anatomical knowledge of the structures of the posterior fossa, pediatric neurosurgeons must use all the most advanced technologies to protect their patients and obtain the best results. Therefore, Kodangeski and Pinheiro discuss the use of electrophysiological monitoring during resection surgeries for posterior fossa tumors. Ahmed also emphasizes the importance of neuronavigation in these surgeries, as a significant tool to reduce morbidity and mortality.
 Around 70 to 90% of posterior fossa tumors present with hydrocephalus. The treatment of hydrocephalus before, during or after tumor resection is a very controversial subject, with different approaches among groups. Mandic retrospectively applies the success scores of endoscopic third ventriculocysternostomy in a group of patients with posterior fossa tumors and analyzes its efficiency.
 Costa pays special attention to posterior fossa ependymomas. Despite the explosion of genomic and epigenomic knowledge of these tumors in recent decades, surgery still plays an essential role in their treatment because the main objective as gross total resection represents a great technical challenge for the neurosurgeon.
 Besides to medulloblastomas, astrocytoma and ependymomas, more rarely other histological types can involve the posterior fossa and should be considered as differential diagnosis of these lesions. Therefore, Lopez presents clinical cases of choroid plexus papilloma and Rabelo Rodrigues reviews the cases of hemangioblastomas found in the literature.
 Even though posterior fossa tumors are predominant in children of preschool and school age, Dassi presents a series of cases in patients under two years of age, highlighting the histological characteristics and treatment strategies in this age group.
 The final result of this edition is a set of articles that highlight ","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135734161","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":"Posterior Fossa Tumors in Infants: 13-year single center retrospective review.","authors":"Natália Dassi, Carolina Silva De Aguiar, Patricia Dastoli, Nasjla S Silva, Sergio Cavalheiro, Andrea M Cappellano","doi":"10.46900/apn.v5i3.206","DOIUrl":"https://doi.org/10.46900/apn.v5i3.206","url":null,"abstract":"Introduction/Background: Central nervous system (CNS) tumors in infants are rare, ranging between 1 and 10% of all pediatric CNS tumors. The infratentorial location is a challenge to neuro-oncologist and -surgeons due their subtle clinical presentation, different histopathological types, biological behaviors, and anesthetic-surgery difficulties.
 Methods: Single center retrospective study of infants diagnosed with posterior fossa tumors between 2010 and 2023.
 Results: Nineteen patients were included. Mean age 8.8 months; eight males. The most common presenting symptom was torticollis (n-6, 31.6%), followed by vomiting (n-3, 15.8%) and increased head circumference (n-3, 15.8%). Atypical Teratoid Rhabdoid Tumor (AT/RT) was the most common subtype (n-11, 57.9%), followed by Medulloblastoma (MB). Metastatic disease at diagnosis was evident in five cases. Seventeen patients initially underwent correction of hydrocephalus. Regarding surgical resection, one (5.3%) patient underwent biopsy, 13 (68.4%) complete resection, four (21%) partial resection. Only one patient, diagnosed with ependymoma, did not receive chemotherapy after surgery, 14/19 received high-dose chemotherapy, eight of these followed by autologous bone marrow transplantation (ABMT). Focal radiotherapy (RT) was performed in four patients with AT/RT and in one ependymoma, following ABMT and complete resection, respectively. Event-free survival at 2 and 5 years was 64.9% and overall survival 63.2% and 54.2% respectively.
 Conclusion: Despite aggressive histological subtypes, neurosurgical challenges, and limitation of adjuvant therapy, we have shown acceptable survival rates in this challenging group of patients showing the importance of appropriate supportive care, improvement in surgical techniques and a multi-professional approach.","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135734884","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":"Postoperative pediatric cerebellar mutism syndrome: A literature review","authors":"Matheus Ballestero, Rodrigo Inácio Pongeluppi, Ricardo Santos de Oliveira","doi":"10.46900/apn.v5i3.207","DOIUrl":"https://doi.org/10.46900/apn.v5i3.207","url":null,"abstract":"Introduction: Postoperative pediatric cerebellar mutism syndrome (POPCMS) is a significant complication observed after posterior fossa surgery for tumors, particularly in pediatric neurosurgery. This paper presents a literature review on the physiopathology, diagnosis, treatment, and long-term outcomes of POPCMS.
 Methods: A systematic review following PRISMA guidelines, searching for articles published in PubMed, Web of Science, and Lilacs in the last ten years. Inclusion criteria involved studies on human subjects under 18 years of age, focusing on the pathophysiology, diagnosis, treatment, and outcome of POPCMS.
 Results: The review identified 34 studies on POPCMS for final inclusion. Preoperative risk factors commonly associated with cerebellar mutism included midline tumor location, diagnosis of medulloblastoma, younger age at diagnosis, preoperative language impairment, brainstem infiltration, and tumor histology. The SHH subgroup was found to reduce the risk of CMS. Diagnostic criteria for POPCMS included language impairment, emotional lability, hypotonia, oropharyngeal dysfunction, dysphagia, cerebellar motor syndrome, cerebellar cognitive affective syndrome, and brainstem dysfunction. Treatment approaches varied, with medications showing potential benefits. Rehabilitation options for speech and language deficits were limited. Cognitive remediation programs showed promise in improving academic achievement and attention. A significant proportion of patients experienced clinical improvement. 
 Conclusion: POPCMS remains a challenging complication following posterior fossa surgery. Further research is needed to develop standardized diagnostic criteria, effective treatments, and rehabilitation strategies to improve long-term outcomes for patients with POPCMS.","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135691524","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":"Clinical Presentation, MRI findings and Molecular insights in Diffuse Intrinsic Pontine Gliomas (DIPGs): A Comprehensive Review.","authors":"Gustavo Novelino Simao","doi":"10.46900/apn.v5i3.217","DOIUrl":"https://doi.org/10.46900/apn.v5i3.217","url":null,"abstract":"Diffuse intrinsic pontine glioma (DIPG) is a highly aggressive and the most common brainstem tumor affecting pediatric patients, with a poor prognosis and limited treatment options. Despite extensive research, the median overall survival remains low, and current treatment mainly relies on radiotherapy. Recent discoveries of recurrent somatic mutations, particularly in histone 3 variants, have led to a reclassification of pediatric diffuse gliomas. However, the relationship between genetic alterations, imaging features, and prognosis is not yet fully understood. This review provides an overview of DIPG, including its clinical presentation, typical imaging findings (with a focus on MRI techniques), diagnostic challenges, treatment modalities, and recent advancements in molecular understanding. DIPG presents with characteristic neurological symptoms and often manifests as an expansile intra-axial mass in the pons, usually exhibiting typical MRI findings. Diffusion-weighted imaging and magnetic resonance spectroscopy can provide additional insights. Pathologically, most DIPGs are pediatric type of diffuse high-grade gliomas, with specific histological features and occasional leptomeningeal spread. Radiotherapy remains the mainstay treatment. However, clinical trials with new agents are ongoing, trying to improve outcomes for DIPG patients.","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135690256","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":"Infratentorial choroid plexus tumors in children: Case report and review of literature","authors":"Amanda de Oliveira López, Patricia Dastoli, João Gabriel Ribeiro Gomes, Jardel Mendonça Nicácio, Marcos Devanir Silva Da Costa, Sergio Cavalheiro","doi":"10.46900/apn.v5i3.214","DOIUrl":"https://doi.org/10.46900/apn.v5i3.214","url":null,"abstract":"Background: Infratentorial choroid plexus tumors are rare lesions in the pediatric population. At diagnosis, they most often present with signs of intracranial hypertension and cranial nerve deficits. The main objective of the surgery is total resection and the prognosis is favorable in most cases.Case Report: A 16-year-old boy with gait disturbance, headaches and left side hypoacusia had a diagnosis of posterior fossa tumor with hypertensive hydrocephalus. He underwent urgent placement of a ventriculoperitoneal shunt and subsequently microsurgery with gross total resection. At follow up, the patient was asymptomatic and without deficits.Conclusion: Choroid plexus tumors should be included in the differential diagnosis of posterior fossa tumors in childhood. Preoperative planning, choosing the best surgical approach and interruption of the lesion's vascular supply as the initial step of surgery are fundamental strategies for successful treatment.","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"360 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135690652","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":"Posterior fossa ependymomas in children and adolescents - the state of the art","authors":"Marcos Devanir Silva Da Costa, Carolina Torres Soares, Patricia Alessandra Dastoli, Jardel Mendonça Nicácio, Frederico Adolfo Benevides Silva, Maria Teresa de Seixas Alves, Michael Jenwei Chen, Andrea Maria Cappellano, Nasjla Saba Silva, Sergio Cavalheiro","doi":"10.46900/apn.v5i3.210","DOIUrl":"https://doi.org/10.46900/apn.v5i3.210","url":null,"abstract":"Central nervous system tumors in pediatric patients represent the most frequent solid tumor type in this age group, especially ependymomas, which comprise 5% of childhood intracranial tumors, and occur mainly in the posterior fossa. The MEDLINE and ClinicalTrials databases were searched for studies on posterior fossa ependymomas, 64 studies met the search criteria. 
 Symptoms include ataxia, vertigo, headache, vomiting, cranial nerve palsies, or papilledema, resulting from intracranial hypertension due to obstruction of CSF circulation. Imaging examination often reveals posterior fossa ependymomas in the fourth ventricle or cerebellopontine angle; they may extend through the foramina of Luschka, Magendie, and/or magnum. These tumors cause a significant mass effect, displacing rather than invading the hidbrain, and may involve vessels or cranial nerves, making surgical resection difficult. Various radiological features have been studied to distinguish between ependymomas and other histological types, as well as between ependymoma subtypes. 
 The 2021 WHO classification of central nervous system tumors classifies ependymomas by location. Three types occur in the posterior fossa: subependymomas, PF-A, and PF-B. These are differentiated by the degree of DNA methylation and CpG islands, which can be assessed by immunohistochemical analysis with H3K27me3. 
 The consensus on the treatment of posterior fossa ependymomas in children advocates the maximum possible surgical resection, followed by radiotherapy in patients >1 year. Chemotherapy remains controversial, with no survival gain. Recent studies suggest molecular subgroups as an independent prognostic factor in posterior fossa ependymomas. The therapeutic challenge of ependymomas requires new treatment options, based on new technologies and molecular discoveries.","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135691174","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":"Evaluation of the ETV success score to improve decision making on the management of hydrocephalus secondary to pediatric posterior fossa tumors: A feasibility study","authors":"Leopoldo Mandic Furtado, José Aloysio Da Costa Val Filho, Aieska Kellen Dantas dos Santos, Jaime Xavier De Oliveira Neto, Márcio Júnior Pena, Cristiano Frattesi Bernardes, Mariana Gonçalves Lima de Paula, Anne Ribeiro Magalhães, Alice Izabel Costa Silva","doi":"10.46900/apn.v5i3.200","DOIUrl":"https://doi.org/10.46900/apn.v5i3.200","url":null,"abstract":"Introduction: Hydrocephalus is frequently seen in children with posterior fossa tumors (PFT), and endoscopic third ventriculostomy (ETV) prior to tumor resection can improve surgical conditions by treating the hydrocephalus. Moreover, a scoring system predicting the success of ETV could aid in decision-making for this procedure.
 Objective: This study aims to evaluate the efficacy of ETV in the treatment of hydrocephalus related to PFT and to evaluate the accuracy of the ETV success score in predicting ETV success.
 Methods: Patients under 18 years of age who underwent ETV before PFT resection between 1996 and 2021 were included in a retrospective study. The ETV success score was retrospectively obtained for all patients, and its predictive capacity was compared to the actual success observed.
 Results: Of the 59 surgical cases, a global success rate of 62.7% was observed in the first 6 months following ETV. This rate dropped to 50.8% for those patients reassessed one year after surgery. There was no correlation between the success rate and the histological grade of the tumor or the age of the patient. The ETV success score presented acceptable accuracy at both time points (AUC = 0.671 at 6 months, AUC = 0.649 at one year).
 Conclusion: ETV proved be a safe procedure, capable of treating hydrocephalus in patients with PFT, and the ETV success score is useful for indicating probable success of the endoscopic procedure.","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135734170","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":"Posterior fossa tumor resection in children: a case report and the role of intraoperative neurophysiologic monitoring","authors":"Charles Kondageski, Humberto Kluge Schroeder, Antonio Cesar de Melo Mussi, Cezar Massaru Guiotoku, Marcela de Moraes Barros Sousa, Jean Costa Nunes","doi":"10.46900/apn.v5i3.220","DOIUrl":"https://doi.org/10.46900/apn.v5i3.220","url":null,"abstract":"Introduction/Background: Surgery plays a crucial role in the surgical management of posterior fossa tumors in children, but maximizing the resection while preserving function remains challenging. Along with other tools available to the surgeon, intraoperative neuromonitoring aims at improving safety during these complex interventions. This case report highlights the role of real-time intraoperative neuromonitoring during surgery and its impact on the surgeon's decision-making process. Case report: We present the case of a 10-year-old boy with a fourth ventricle medulloblastoma, who underwent microneurosurgical resection under intraoperative neuromonitoring. The use of neurophysiological monitoring yielded relevant information during the tumor dissection of the floor of the fourth ventricle, the most crucial step of surgery, thus helping the surgeon to change tactics to minimize long-term neurological deficits. Conclusion: In combination with meticulous microneurosurgery techniques, modern anesthetic regimens, and ultrasonic aspiration, intraoperative neuromonitoring adds up to the surgeon's armamentarium for increasing safety and improving outcomes following surgery for pediatric patients bearing posterior fossa tumors.","PeriodicalId":491452,"journal":{"name":"Archives of Pediatric Neurosurgery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135734375","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}