The Cardiothoracic Surgeon最新文献

{"title":"The influence of preoperative or intraoperative methadone on postcardiac surgery pain and opioid administration: a systematic review and meta-analysis","authors":"Joshua Goldblatt, Lachlan Crawford, Jordan Ross, James Edelman, Warren Pavey","doi":"10.1186/s43057-024-00127-z","DOIUrl":"https://doi.org/10.1186/s43057-024-00127-z","url":null,"abstract":"Opioid analgesia remains a cornerstone of the management of perioperative pain in cardiac surgical patients. Emerging evidence suggests that intermediate and long-term postoperative opioid dependence is underappreciated and associated with adverse patient outcomes. Methadone has emerged in the cardiothoracic and non-cardiothoracic anesthesia literature as an option that may provide lasting analgesic benefit and may be associated with a reduction in overall perioperative opioid requirements. This study was a systematic literature review and meta-analysis that aimed to provide evidence supporting the use of perioperative or intraoperative methadone in adult cardiac surgical patients, particularly with respect to objective measures of postoperative pain and opioid requirements prior to and at discharge from the hospital. Electronic searches of three research databases were performed: PubMed (1972 to October 2023), Ovid MEDLINE (1946 to October 2023), and EMBASE (1978 to October 2023). This search yielded a total of 190 articles, 7 of which met the relevant inclusion and exclusion criteria. This included five randomized controlled trials and two large retrospective cohort studies. Preoperative or intraoperative methadone led to reduced pain scores at 24 h postoperatively and reduced opioid requirements at discharge. Methadone may be effective at reducing perioperative pain scores and opioid requirements postoperatively, including at discharge. The literature on this subject has important limitations, and further research in larger randomized controlled trials is needed.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140889477","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":"Chest ultrasound to detect postoperative pulmonary complications after thoracic surgery: a comparative study","authors":"Ali Zein Elabdein, Ramy Abdelrheim Hassan, Mahmoud Khairy Elhaish, Hussein Elkhayat","doi":"10.1186/s43057-024-00124-2","DOIUrl":"https://doi.org/10.1186/s43057-024-00124-2","url":null,"abstract":"Patients who underwent thoracic surgery procedures were usually subjected to daily chest X-rays until discharge, exposing patients to ionizing radiation and requiring patient movement with chest drains, difficult positioning, and time-consuming. Unlike chest ultrasound, which is a good alternative because it is bedside and accurate in the detection of pulmonary complications. We hypothesize that a thoracic surgery resident with a short training program in chest ultrasound can achieve comparable results to a chest X-ray. Our study aims to analyze the agreement between the two techniques. This is an observational prospective study. Eighty-six adult patients who underwent thoracic surgery were included. Every patient had a chest X-ray and chest ultrasound follow-up on day 0, day 3, and day 5 post-operative. Chest ultrasound examinations were performed by the same resident, and the results were revised by an expert sonographer for the detection of pneumothorax, pleural effusion, pulmonary consolidation, and interstitial pattern. Both diagnostic procedures showed substantial agreement for pneumothorax (K = 0.661). For pleural effusion, they showed moderate agreement (K = 0.448, P < 0.001), and no cases developed an interstitial pattern. Overall, both diagnostic procedures showed perfect agreement (K = 0.838, P < 0.001). The time lag to perform a chest ultrasound was statistically lower than that to perform. chest X-ray, with a median of 7 min versus 80 min, respectively. Performing chest ultrasound by a thoracic surgery resident is a less time-consuming and easy bedside diagnostic tool. Compared chest ultrasound to the postoperative X-ray showed a perfect diagnostic agreement for pulmonary consolidation and moderate agreement for pleural effusion and pneumothorax. NCT04118621","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598257","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":"Efficacy of inhaled iloprost in children with pulmonary hypertension after pediatric cardiac surgery: a case series","authors":"Ergin Arslanoğlu, Shiraslan Bakhshaliyev, Kenan Abdurrahman Kara, Fatih Yiğit, Mehmet Ali Yeşiltaş, Shabnam Huseynzade, Zeynep Gülben Kük Özalp, Ali Rıza Karaci","doi":"10.1186/s43057-024-00125-1","DOIUrl":"https://doi.org/10.1186/s43057-024-00125-1","url":null,"abstract":"The postoperative phase of cardiac surgery in pediatric patients with congenital heart disease often involves the management of pulmonary hypertension, which can significantly affect recovery and long-term prognosis. Inhaled iloprost is a potent acute pulmonary vasodilator with a rapid onset of action and has been shown to be effective and safe in patients with pulmonary arterial hypertension, improving clinical parameters by lowering pulmonary artery pressure. In our study, we will share the results of patients with pulmonary hypertension after pediatric cardiac surgery in whom we used inhaled iloprost. A total of 9 patients who received inhaled iloprost between 2020 and 2023 were included in the retrospective study. The age of the patients ranged between 10 days and 11 months, with a mean of 207.77 days (6.92 months) ± 105.78 days (3.52 months). Five patients were male (55.55%), and four were female (44.45%). Three of the patients had trisomy 21 (33.3%) genetic mutations. The limited number of case series in the literature support the potential of inhaliloprost as an effective and safe therapeutic option for the treatment of pulmonary hypertension in the pediatric population after congenital heart surgery. The findings of this study support the literature and suggest that inhaliloprost is effective. Due to the limited number of patients, further research is needed to determine the safety and efficacy of these drugs, especially to determine the dose, route, and duration of administration in intubated patients.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140598122","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":"Congenital cardiac surgery and diaphragmatic paralysis: efficacy of diaphragm plication","authors":"Ergin Arslanoğlu, Shiraslan Bakhshaliyev, Kenan Abdurrahman Kara, Fatih Yiğit, Mehmet Ali Yeşiltaş, Kaan Altunyuva, Zeynep Gülben Kük Özalp, Ali Rıza Karaci","doi":"10.1186/s43057-024-00126-0","DOIUrl":"https://doi.org/10.1186/s43057-024-00126-0","url":null,"abstract":"Diaphragmatic paralysis due to phrenic nerve injury is a rare but potentially serious complication following congenital cardiac surgery, with reported incidences ranging from 0.28 to 5.6%. Early plication has been recommended for children diagnosed with diaphragmatic paralysis, especially those requiring prolonged respiratory support after cardiopulmonary bypass. It is important to note that late plication may jeopardize the results of successful surgical plication due to diaphragm atrophy. This retrospective study was performed between May 2020 and June 2023. Patients who could not be weaned from the ventilator and underwent diaphragmatic plication in symptomatic patients after phrenic nerve injury were included in the study. During the study period, 22 (3.5%) of 624 pediatric patients operated for congenital heart disease required diaphragm plication. The mean age of the patients ranged from 1 month to 13 years with a mean of 23.88 ± 37.99 months. Fourteen (63.6%) of the patients were female, and 8 (36.4%) were male. Two of the patients (9%) were exited due to ventilator-associated pneumonia and sepsis. In conclusion, diaphragmatic paralysis after congenital heart surgery is a rare but important complication that can lead to serious respiratory and cardiac problems. Diaphragmatic plication has been shown to be an effective intervention for pediatric patients with the potential to improve pulmonary function, reduce dyspnea, and minimize complications associated with diaphragmatic paralysis. Careful consideration of patient selection, timing, and potential complications is crucial in optimizing the outcomes of this surgical intervention.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602100","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":"An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case report","authors":"Hossameldin Hussein, Ahmed Youssef, Ahmed Mahgoub, Noha Gamal, Amr Farrag, Soha Romeih","doi":"10.1186/s43057-024-00123-3","DOIUrl":"https://doi.org/10.1186/s43057-024-00123-3","url":null,"abstract":"Native pulmonary valve (PV) infective endocarditis (IE) is a rare condition with an incidence of 1.5–2%. Although medical therapy is the mainstay of treatment, surgical intervention is still indicated in cases that fail to respond to antibiotics. To date, there is lack of consensus about the best surgical approach for isolated native PV IE. While valve repair is sometimes feasible, most of the cases require valve replacement depending on the extent of tissue damage. A stented bioprosthesis can be used when infection is confined to the valve leaflets. However, extension of damage to the pulmonary root or right ventricular outflow tract usually requires debridement and root replacement. A 30-year-old lady with a long history of restrictive ventricular septal defect (VSD) presented with fever and shortness of breath shortly after vaginal delivery that was diagnosed as isolated PV IE with pulmonary septic emboli. After 1 week of antibiotic therapy, there was no response with persistent infection and complete valve destruction. Heart team discussion recommended PV replacement using a Freestyle valve along with VSD repair. On follow-up after 1 year, she was doing fine with well-functioning Freestyle valve. Unrepaired restrictive VSD can be a predisposing factor for native PV IE. A Freestyle valve in the pulmonary position is a valid option for such cases, with good early outcomes and reasonable durability, particularly when there is extensive tissue infection and homograft is not available. More evidence is still required to evaluate the long-term outcomes of PV Freestyle in cases of IE.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139911034","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":"Pediatric precision: navigating the complexity of mycotic pseudoaneurysms in ascending aorta post-atrial septal defect repair—a case report","authors":"Anand Shankar Soundararajan, Aishwarya Pandiyan, Ezhilnambi Sundaramoorthy, Kathirvel Balasubramani, H. R. Haroon Shakir, G. K. Jaikaran","doi":"10.1186/s43057-024-00122-4","DOIUrl":"https://doi.org/10.1186/s43057-024-00122-4","url":null,"abstract":"This case report elucidates the exceptional rarity and intricacies surrounding mycotic pseudoaneurysms in the ascending aorta, specifically post-pediatric cardiac surgery. The case report presents a distinctive case of a 7-year-old female developing complications 10 days after atrial septal defect repair, characterized by sternal wound infection attributed to Pseudomonas aeruginosa. Imaging revealed a substantial pseudoaneurysm, necessitating a meticulous surgical strategy involving femoral cannulation, redo sternotomy, and adept management of intraoperative challenges, such as a fragile sternum and dense adhesions. The successful postoperative course, marked by weaning and comprehensive management, contributes significant insights into the evolving landscape of mycotic pseudoaneurysms in pediatric populations. The discussion delves into the historical context, mechanisms, and causative organisms, emphasizing the heightened vigilance required in the postoperative care of this vulnerable demographic. This report enhances our understanding of pediatric cases, underscoring the imperative for increased awareness and strategic management in addressing post-cardiac surgery complications.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139470056","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":"Appropriate timing of veno-arterial extracorporeal membrane oxygenation initiation after cardiac surgery","authors":"Mohamed Laimoud, Emad Hakami, Patricia Machado, Michelle Gretchen Lo, Mary Jane Maghirang","doi":"10.1186/s43057-023-00120-y","DOIUrl":"https://doi.org/10.1186/s43057-023-00120-y","url":null,"abstract":"Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can be initiated during cardiac surgery or later in ICU according to the hemodynamic profile and organ perfusion. Our aim was to study the appropriate timing of post-cardiotomy ECMO (PC-ECMO) initiation. We retrospectively analyzed 152 adult patients supported with PC-ECMO in our cardiac center between 2016 and 2022. The patients were divided into two groups: the intra-operative ECMO and the postoperative ECMO groups. The primary outcome was all-and-on-ECMO hospital mortality. The secondary outcomes included ECMO duration, new need for dialysis, cerebrovascular stroke, and length of ICU stay. Our cohort analysis revealed that 81(53.3%) patients were intra-operatively supported with VA-ECMO while 71(46.7%) patients were postoperatively supported in ICU. The postoperative ECMO group had significantly lesser SAVE score (p = 0.001), higher SAVE risk classes (p < 0.001), and higher SOFA score (p = 0.008) compared to the intra-operative ECMO group. The postoperative ECMO group had significantly more frequent hospital mortality (p = 0.003), on-ECMO mortality (p = 0.006), cerebrovascular stroke (p = 0.034), acute renal failure requiring dialysis (p < 0.001), and lesser lactate clearance at 12 h (p = 0.016) and at 24 h (p = 0.023) compared to the intra-operative group. There were statistically insignificant differences between the two groups regarding post-ECMO hospital mortality, cerebral bleeding, limb ischemia, ECMO, and ICU duration. Postponed postoperative ECMO insertion was associated with an increased risk of death (HR 1.628, 95%CI 1.102–2.403, p =0.014) with cox-proportional hazard regression. Logistic multivariable regression showed that atrial fibrillation (OR 6.2, 95% CI 2.71–61.84, p = 0.002), initial SOFA score (OR 1.46, 95% CI 1.041–3.83, p = 0.001), and postoperative ECMO insertion (OR 1.93, 95% CI 1.04–8.73, p = 0.031) were the predictors of hospital mortality. Postponed ECMO insertion in critically sick patients was associated with increased mortality after cardiac surgery. Early intra-operative initiation of PC-ECMO may have the potential to improve outcomes after cardiac surgeries.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139423413","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":"The detailed profile of congenital heart diseases in 254 children with Down syndrome in Saudi Arabia","authors":"Naif Alkhushi","doi":"10.1186/s43057-023-00121-x","DOIUrl":"https://doi.org/10.1186/s43057-023-00121-x","url":null,"abstract":"Down syndrome is the most common chromosomal abnormality in humans. It is associated with several congenital anomalies, including a spectrum of congenital heart diseases. Understanding the true prevalence and distribution of congenital heart diseases is essential for health resource planning, outcomes, and family counseling. This study aimed to assess the prevalence and distribution of congenital heart disease in children with Down syndrome. It is a retrospective cohort review that included all patients treated at King Abdulaziz University Hospital. Frequencies were estimated using the SPSS software and comparisons were made using Student’s t test. The ages of the 254 subjects ranged from less than 1 year to 53 years. Of these, 44.5% were female and 40.6% were Saudi nationals. Congenital heart disease was present in 66.5% with a significant difference between Saudi nationals 44.6%) and non-Saudi nationals 71.5% (P = 0.01). The atrioventricular septal defect was the most common pathology, representing 33.1% of all congenital heart diseases followed by perimembranous ventricular septal defect 18.9%, and right ventricular pathology 10.2%. The prevalence of congenital heart diseases in Saudi children with Down Syndrome is similar to that reported worldwide. Septal defects and right-sided pathologies are the dominant forms of congenital heart diseases, with atrioventricular septal defect and perimembranous ventricular septal defect representing the most common pathologies.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139396600","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":"Dissemination and implementation analysis of the Ross procedure in adults: time to update the guidelines?","authors":"Kyle S. Bilodeau, David C. Mauchley, Scott DeRoo, Christopher R. Burke","doi":"10.1186/s43057-023-00119-5","DOIUrl":"https://doi.org/10.1186/s43057-023-00119-5","url":null,"abstract":"The science of dissemination and implementation (D&I) aims to improve the quality and effectiveness of care by addressing the challenges of incorporating research and evidence-based practice into routine clinical practice. This lens of D&I has challenged the interpretation and incorporation of data, noting that failure of a given therapy may not reflect lack of efficacy, but instead reflect an imperfect implementation. The aim of this manuscript is to review the influence of the Ross procedure’s historical context on its D&I. A contextual baseline of the Ross procedure was defined from the procedure’s original description in the literature to major publications since the 2017 valvular heart disease guidelines. D&I evaluation was conducted using the Consolidated Framework for Implementation Research (CFIR), using constructs from each of the five respective domains to define the main determinants. Each of the five CFIR domains appears to be correlated with a factor influencing the Ross procedure’s varied history of enthusiasm and acceptance. The complex nature of Ross required adaptation for optimization, with a strong correlation of center volume on outcomes that were not considered in non-contemporary studies. Outcomes later published from those studies influenced social and cultural contexts within the aortic surgery community, and led to further organizational uncertainty, resulting in slow guideline incorporation. The D&I of the Ross procedure was a result of inadequate appreciation of technical complexity, effect of patient selection, and complex aortic surgery experience, resulting in dismissal of an efficacious procedure due to a misunderstanding of effectiveness.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138818961","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":"Exploring the rate and reasons for same-day cancellation of cardiac surgery after implementing joint commission international standards: a retrospective cross-sectional study","authors":"Mohammed A. Alanazi, Sherran Milton","doi":"10.1186/s43057-023-00118-6","DOIUrl":"https://doi.org/10.1186/s43057-023-00118-6","url":null,"abstract":"Same-day cancellation of cardiac surgery significantly impacts operating room management efficiency, which can be mitigated by taking preventive measures. This study aimed to explore the same-day cancellation rate of elective adult cardiac surgery, as well as the reasons for those cancellations. A retrospective cross-sectional study reviewed the records of 581 scheduled elective adult cardiac surgical cases at a single cardiac center from June 2017 to May 2018. The same-day cancellation reasons were grouped into four broad categories: nonclinical cancellations, clinical cancellations, patient-related cancellations, and 'other reason' cancellations. A case was considered canceled when it was not performed on the same day as the planned surgery. A total of 581 elective adult cardiac surgeries were scheduled during the study period, and 56 (9.63%) of these were canceled. The highest cancellation rate was due to nonclinical cancellations, with 39% of scheduled cases, followed by clinical cancellations, with a 34% cancellation rate. Patient-related cancellations accounted for 23% of cancellations, while the lowest rate was due to ‘other reasons,’ which accounted for 4% of total cancellations. The most common reason for nonclinical cancellations was the inclusion of emergency cases (n = 8; 14%). The most common reason for clinical cancellations was changes in the patient’s medical condition (n = 8, 14%). The common reason for patient-related cancellations was the refusal of surgery (n = 9; 16%). The lowest rate was for menstruating female patients (n = 2; 4%). The same-day cancellation rate was 9.36%, and most of the cancellation reasons could be mitigated by implementing preventive strategies to improve the efficiency of the operating room. Preoperative preparation clinics and paying particular attention to female patients scheduled for surgery might reduce the rate of elective cardiac surgery cancellation.","PeriodicalId":501458,"journal":{"name":"The Cardiothoracic Surgeon","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138561403","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}