Developmental Medicine and Child Neurology最新文献

{"title":"Eating and drinking abilities and respiratory and oral health in children and young adults with cerebral palsy.","authors":"Alexandra Sorhage, A Marie Blackmore, Catherine A Byrnes, Caitlin Agnew, Emily F M Webster, Anna Mackey, Jimmy Chong, Timothy M Hill, Dug Yeo Han, Ngaire Susan Stott","doi":"10.1111/dmcn.16262","DOIUrl":"https://doi.org/10.1111/dmcn.16262","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the potential risk factors of respiratory illness (ethnicity, oral health, and eating and drinking ability) in children and young adults with cerebral palsy (CP).</p><p><strong>Method: </strong>This was an observational study using a validated CP Respiratory and Oral Health questionnaire with 90 participants (median age 12 years [range: 1-26 years]; 51 males; and 26 New Zealand Māori).</p><p><strong>Results: </strong>Multivariate analysis, accounting for ethnicity and Gross Motor Function Classification System (GMFCS) levels, showed that those participants who were classified in Eating and Drinking Ability Classification System (EDACS) levels III to V reported more previous respiratory disease episodes (odds ratio [OR] = 4.13, 95% confidence interval [CI] = 1.12-15.2, p = 0.033), increased daily/weekly respiratory symptoms (OR = 9.14, 95% CI = 2.03-41.2, p = 0.004), and increased mealtime respiratory symptoms (OR = 13.8, 95% CI = 2.48-76.8, p = 0.002). Both EDACS levels III to V and GMFCS levels IV and V were independently associated with increased propensity to reflux or seizures (OR = 8.16, 95% CI = 1.77-37.5, p = 0.007; OR = 3.37, 95% CI = 1.09-10.4, p < 0.034). Mealtime symptoms of vomiting or regurgitation (relative risk = 1.58, 95% CI = 1.17-2.13, p = 0.032) and daily coughing (relative risk = 1.55, 95% CI = 1.14-2.11, p = 0.023) were associated with a higher risk of reporting one or more oral health symptoms. Toothache was more common in participants classified in EDACS levels III to V (χ², p = 0.021).</p><p><strong>Interpretation: </strong>Children with CP classified in EDACS levels III to V are at a higher risk of respiratory disease and toothache and should be screened appropriately. Regurgitation or vomiting of food and daily coughing are linked with poorer oral health.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training intensity of robot-assisted gait training in children with cerebral palsy","authors":"","doi":"10.1111/dmcn.16283","DOIUrl":"10.1111/dmcn.16283","url":null,"abstract":"<p>To enhance active participation and independence in daily living, a key therapeutic goal for patients with cerebral palsy (CP) is to improve walking ability. Recent advances in technology suggested that robot-assisted gait training (RAGT) may be an alternative method of treatment. The authors compared three different intensities of RAGT for achieving favourable outcomes in children with CP. This study was conducted using a randomized controlled, single-blind design, which is set up so that the treatment each participant receives is not known by the participants but is known by the researchers.</p><p>Thirty children with CP classified in Gross Motor Function Classification System levels II and III were assigned to three different RAGT intensity groups: (1) high-intensity (fastest walking speed and lowest body weight support [BWS]); (2) low-intensity (slowest speed and highest BWS); and (3) comfortable intensity (intermediate speed and intermediate BWS).</p><p>The RAGT intervention was performed three times a week for 6 weeks with each group using the Walkbot-K system. The Walkbot-K is a trajectory-controlled, treadmill-tethered, robot-assisted locomotor training device with a built-in ankle actuator to assist ankle motion.</p><p>The Gross Motor Function Measure (GMFM) is an observational clinical tool designed to evaluate change in gross motor function in children with CP. The 88-item GMFM was significantly improved after training in the high-intensity and comfortable intensity groups, whereas gait speed was improved in the comfortable intensity group, without statistically significant group differences. Only the low-intensity group showed improvement on the stability index. Everyday functional performance significantly improved in all three groups, with the comfortable intensity group showing the greatest improvement.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 4","pages":"e90"},"PeriodicalIF":3.8,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16283","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The risk of epilepsy after neonatal seizures.","authors":"Jeanette Tinggaard, Signe V Pedersen, Mads L Larsen, Andreas K Jensen, Gorm Greisen, Bo M Hansen, Christina E Hoei-Hansen","doi":"10.1111/dmcn.16255","DOIUrl":"https://doi.org/10.1111/dmcn.16255","url":null,"abstract":"<p><strong>Aim: </strong>To estimate the cumulative risk of epilepsy after neonatal seizures and identify subpopulations at increased risk.</p><p><strong>Method: </strong>This was a nationwide register-based cohort study including all children born in Denmark between 1997 and 2018. The cumulative risk of epilepsy in children with and without neonatal seizures was compared. Furthermore, neonatal seizures were stratified according to aetiology.</p><p><strong>Results: </strong>We followed 1 294 377 children and identified 1998 neonatal survivors with neonatal seizures. The cumulative risk of epilepsy was 20.4% (95% confidence interval [CI] = 18.5-22.3) among children with neonatal seizures, compared to 1.15% (95% CI = 1.12-1.18) among children without. Epilepsy was diagnosed before 1 year of age in 11.4% of children with neonatal seizures, in an additional 4.5% between 1 year and 5 years, 3.1% between 5 years and 10 years, and 1.4% between 10 years and 22 years. The aetiologies of neonatal cerebral infarction, haemorrhage, or malformations (adjusted hazard ratio = 2.49, 95% CI = 1.98-3.14) and low Apgar score (1.49, 95% CI = 1.12-1.98) were associated with the highest risk of epilepsy, compared to children with seizures of unknown aetiology.</p><p><strong>Interpretation: </strong>Epilepsy after neonatal seizures is common and remains a substantial risk throughout childhood. Aetiological risk factors are identifiable and relevant when planning appropriate information for parents and follow-up.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of cortical activity, functional connectivity, and neuroplasticity in cerebral palsy using functional near-infrared spectroscopy: A scoping review.","authors":"Owais A Khan, Simin Rahman, Kanishka Baduni, Christopher M Modlesky","doi":"10.1111/dmcn.16238","DOIUrl":"https://doi.org/10.1111/dmcn.16238","url":null,"abstract":"<p><strong>Aim: </strong>To map and critically appraise the literature on the feasibility and current use of functional near-infrared spectroscopy (fNIRS) to assess cortical activity, functional connectivity, and neuroplasticity in individuals with cerebral palsy (CP).</p><p><strong>Method: </strong>A scoping review methodology was prospectively registered and reported following Preferred Reporting Items for Systematic review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was conducted in four databases. Empirical studies using fNIRS to assess neural activity, functional connectivity, or neuroplasticity in individuals with CP aged 3 years or older were included.</p><p><strong>Results: </strong>Sixteen studies met the inclusion criteria. Individuals with CP (age range = 3-43 years; 70% unilateral CP) underwent fNIRS-based assessment for task-evoked activity (studies [n] = 15) and/or resting-state functional connectivity (n = 3). Preliminary observations suggest greater magnitude, extent, and ipsilateral hemispheric lateralization of sensorimotor cortex activity in CP, while magnitude and patterns of prefrontal cortex activity in CP appear dependent on task demands. Normalization of fNIRS-based activity metrics observed postintervention (n = 3) paralleled improvements in functional outcomes, highlighting their potential as promising biomarkers for functional gains in CP.</p><p><strong>Interpretation: </strong>This review details the use of fNIRS in CP, highlights research gaps and technical limitations, and offers recommendations to support fNIRS implementation for ecologically valid functional neuroimaging in individuals with CP.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participation in activities of daily living after the Akwenda Intervention Program for children and young people with cerebral palsy in Uganda: A cluster-randomized trial.","authors":"Elizabeth Asige, Gillian Saloojee, Godfrey Wanjala, Carin Andrews, Lukia H Namaganda, Angelina Kakooza-Mwesige, Diane L Damiano, Hans Forssberg","doi":"10.1111/dmcn.16258","DOIUrl":"https://doi.org/10.1111/dmcn.16258","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the efficacy of the Akwenda Intervention Program on participation attendance and involvement of children and young people with cerebral palsy (CP) in rural Uganda.</p><p><strong>Method: </strong>This was a cluster-randomized, controlled, single-blind, interventional study of 100 participants with CP (aged 2-23 years; 48 females; allocated to the intervention or waiting list control group). Picture My Participation interviews assessed participation attendance and involvement in 20 home and community activities. Group differences were analysed using a Mann-Whitney U test and effect sizes were calculated. Change in attendance was related to age and functional level, and to improvements in child functioning, which was published in a previous report from the same study.</p><p><strong>Results: </strong>Attendance increased more in the intervention compared to the control group (p < 0.001; r = 0.48; z = -4.62) and across both Gross Motor Function Classification System (GMFCS) subgroups and two age subgroups (2-5 years and 13-23 years). Positive correlations were found between increases in attendance and higher GMFCS levels (ρ = 0.25, p = 0.03) and with all three caregiver assistance scales and the social function child scale of the Ugandan version of the Pediatric Evaluation of Disability Inventory. The intervention group had larger increases in involvement than the controls (p < 0.001; r = 0.41; z = -3.95), although positive changes were seen in both groups.</p><p><strong>Interpretation: </strong>The Akwenda Intervention Program, which intervened at the level of the child, family, and community, was successful in enhancing participation for children with CP.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gross Motor Function Measure-66 Item Sets for use with infants and toddlers at high risk for cerebral palsy: Construct validity and responsiveness.","authors":"Natalie A Koziol, Christiana D Butera, Lin-Ya Hsu, Silvana Alves Pereira, Stacey C Dusing","doi":"10.1111/dmcn.16259","DOIUrl":"https://doi.org/10.1111/dmcn.16259","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the construct validity and responsiveness of the Gross Motor Function Measure-66 Item Set (GMFM-66-IS), a standardized criterion-referenced observational measure, for use with children younger than 24 months with or at high risk for cerebral palsy (CP).</p><p><strong>Method: </strong>Non-experimental integrative data analysis was performed on secondary data from three clinical trials involving children with or at high risk for CP (n = 79, 42 males, mean corrected age = 11.3 months [SD = 4.9]), and one observational study of typically developing children (n = 32, 14 males, mean age = 5.7 months [SD = 0.8]). The GMFM-66-IS and comparator instrument (gross motor subtest from the Bayley Scales of Infant and Toddler Development, Third Edition [Bayley-III] or Bayley Scales of Infant and Toddler Development, Fourth Edition [Bayley-4], depending on the study) were administered at baseline and 3 months later. Comparator groups were based on neurological impairment, clinical rating of gross motor change, and CP status. Correlations (r) and regression-adjusted standardized mean differences (Hedges' g) were computed.</p><p><strong>Results: </strong>GMFM-66-IS and Bayley scores were correlated at baseline (r = 0.83), 3 months later (r = 0.88), and across time (r = 0.83). Children with mild impairment had higher mean GMFM-66-IS scores at baseline (g = 0.87) and 3 months later (g = 0.95). Children rated as demonstrating greater than expected gross motor change had larger mean GMFM-66-IS change scores than children demonstrating less than expected change (g = 0.62). Typically developing children had larger mean GMFM-66-IS change scores (g = 1.00).</p><p><strong>Interpretation: </strong>GMFM-66-IS scores were supported by evidence of strong construct validity and moderate responsiveness.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the GMFM-66 Item Set optimal to measure progress in young infants at high risk of cerebral palsy?","authors":"Virginia Knox","doi":"10.1111/dmcn.16261","DOIUrl":"https://doi.org/10.1111/dmcn.16261","url":null,"abstract":"","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143417045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain in adults with cerebral palsy: A systematic review.","authors":"Jennifer M Ryan, Jessica Burke, Rachel Byrne, Emily Capellari, Adrienne Harvey, Neil E O'Connell, Donna Omichinski, Elisabet Rodby-Bousquet, Mark Peterson","doi":"10.1111/dmcn.16254","DOIUrl":"https://doi.org/10.1111/dmcn.16254","url":null,"abstract":"<p><strong>Aim: </strong>To describe the prevalence and incidence of pain, identify prognostic factors for pain, determine psychometric properties of tools to assess pain, and evaluate effectiveness of interventions for reducing pain among adults with cerebral palsy (CP).</p><p><strong>Method: </strong>Six databases were searched to identify studies published since 1990 in any language that met eligibility criteria defined for each objective. Titles, abstracts, and full texts were screened by two independent reviewers.</p><p><strong>Results: </strong>Sixty-three studies were identified; 47 reporting prevalence, 28 reporting prognostic factors, four reporting psychometric properties, five evaluating intervention effectiveness. Pain prevalence ranged from 24% to 89%. Prevalence was higher among adults with CP than in adults without it. Communication function, sex, and age were prognostic factors for pain prevalence. Numerical, verbal, and pictorial rating scales were valid for assessing pain intensity in adults with CP. Pharmacological and surgical interventions had no effect on pain. An active lifestyle and sports intervention reduced pain in adults with CP compared with usual care.</p><p><strong>Interpretation: </strong>Many adults with CP experience pain, although prevalence estimates vary considerably. The quality of evidence for prognostic factors and interventions is very low to low. There is a lack of evidence about effective pain management among adults with CP.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reproducibility of the Motor Optimality Score-Revised in infants with an increased risk of adverse neurodevelopmental outcomes.","authors":"Carly Luke, Arend F Bos, Michelle Jackman, Robert S Ware, Anya Gordon, Christine Finn, Dyvonne H Baptist, Katherine A Benfer, Margot Bosanquet, Roslyn N Boyd","doi":"10.1111/dmcn.16256","DOIUrl":"https://doi.org/10.1111/dmcn.16256","url":null,"abstract":"<p><strong>Aim: </strong>To determine reproducibility of the Motor Optimality Score-Revised (MOS-R) to assess infants at high risk of adverse neurodevelopmental outcomes, including cerebral palsy (CP), autism, and developmental delays.</p><p><strong>Method: </strong>Thirty infants (18 males, 12 females, gestational age mean [range] = 32.5 [23-41] weeks) were randomly selected, according to 2-year outcome (typically developing; CP; or adverse neurodevelopmental outcome [ad-NDO]) from a prospective cohort. Participants had two General Movements videos between 12 weeks and 15 + 6 weeks corrected age. Six assessors, masked to history and outcomes, independently scored the MOS-R from videos. Assessors scored either one (Group 1; n = 3) or two videos for each infant (Group 2; n = 3). Intraclass correlation coefficient (ICC), Gwet's agreement coefficient, and limits of agreement were calculated.</p><p><strong>Results: </strong>Combined interassessor reliability (IRR) over six assessors for total MOS-R was 'fair' (ICC = 0.56, 95% confidence interval [CI] 0.41-0.72), and 'excellent' with consensus agreement (ICC = 0.99, 95% CI 0.98-0.99). Analyses demonstrated a mean interrater difference of 0.316 (95% limits of agreement -11.51, 12.14) over 450 comparisons (15 pairs). IRR was 'moderate' to 'almost perfect' across subcategories, with the highest reliability 'movement patterns' (Gwet's agreement coefficient = 0.73-1.00) and the lowest 'postural patterns' (0.45-0.73). Assessors who scored two videos (Group 2) demonstrated higher reproducibility. IRR for total MOS-R was 'excellent' when infants were typically developing (ICC = 0.90), and 'good' for CP (0.74) and ad-NDO (0.68).</p><p><strong>Interpretation: </strong>The MOS-R is a highly reproducible tool for assessing infants at high risk of ad-NDOs and is feasible for implementation in clinical settings. Reproducibility is best when the tool is used by experienced assessors to gain consensus agreement.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consciousness trajectories and functional independence after acute brain injury in children with prolonged disorder of consciousness","authors":"","doi":"10.1111/dmcn.16265","DOIUrl":"10.1111/dmcn.16265","url":null,"abstract":"<p>Prolonged disorders of consciousness (PDoC) refer to a state of unconsciousness that persists for a minimum of 4 weeks following an acute brain injury. While there is an increasing amount of evidence regarding the management and prognosis for adults, research on the assessment of consciousness trajectories (i.e. how consciousness has changed over time) and related factors in children has been limited. In this retrospective cohort study, the consciousness trajectories and functional independence in children with PDoC after acute brain injury were investigated.</p><p>This study included 152 cases from 1st January 2014 to 31st June 31 2021. The most common cause of brain injury was intracranial infection (caused by bacteria, viruses, or fungi), followed by trauma and hereditary/metabolism, hypoxic–ischemic encephalopathy (a type of brain damage caused by a lack of oxygen to the brain before or shortly after birth), and inflammation. The rates of consciousness recovery at 3 months, 6 months, and 12 months post-injury were 21.6%, 36.6%, and 48.5% respectively, and most children regained consciousness around 4 months after injury.</p><p>Factors included onset age of 3 years or older, the cause of brain trauma, electroencephalogram (EEG) grade IV or below, and the absence of bilateral impairments in the posterior cingulate (controlling state of arousal) and basal ganglia (responsible primarily for motor control) were identified as predictors of consciousness recovery. Additionally, EEG grade IV or below, the absence of bilateral impairments in the frontal lobes (high cognitive function), and occipital lobes (responsible for visual perception) were associated with favorable functional outcome.</p>","PeriodicalId":50587,"journal":{"name":"Developmental Medicine and Child Neurology","volume":"67 4","pages":"e82"},"PeriodicalIF":3.8,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/dmcn.16265","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}