Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"Associations Between Tumor Characteristics, Postoperative Complications, and Early Versus Late Discharge After Endoscopic Endonasal Pituitary Adenoma Resection.","authors":"Gage A Guerra, Apurva Prasad, Ishan Shah, David J Cote, David Gomez, Racheal Peterson, Mark Shiroishi, John Carmichael, Robert G Briggs, Gabriel Zada","doi":"10.1227/ons.0000000000001667","DOIUrl":"10.1227/ons.0000000000001667","url":null,"abstract":"<p><strong>Background and objectives: </strong>Enhanced recovery after surgery protocols have resulted in a paradigm change in perioperative care with applications in cranial neurosurgery. Protocols have been implemented to increase rates of early discharge with length of stay being an important metric after pituitary adenoma (PA) resection. The aim of this study was to assess characteristics associated with early discharge on postoperative day 1 or 2 (POD 1-2) after endoscopic endonasal surgery (EES) for PA.</p><p><strong>Methods: </strong>An analysis was performed of 524 patients undergoing EES for PA resection from December 2012 to December 2022. Patients discharged POD 1 were compared with POD >2 patients to determine associations with tumor and patient characteristics, preoperative symptoms, and postoperative complications.</p><p><strong>Results: </strong>Among 524 patients (mean age 51.7 years, 55.3% female), 267 (51.0%) were discharged POD 1-2. These patients were less likely to present with headaches (odds ratio [OR] = 0.61, 95% CI: 0.43-0.86, P = .007), vision loss (OR = 0.46, 95% CI: 0.32-0.65, P < .001), and cranial nerve palsy (OR = 0.42, 95% CI: 0.21-0.83, P = .02). Early discharge patients had smaller (22.7 vs 27.7 mm diameter, P < .001) and less invasive tumors (Knosp 3-4: OR = 0.66, 95% CI: 0.45-0.97, P = .04). Late discharge patients were more likely to have intraoperative cerebrospinal fluid leaks (OR = 2.40, 95% CI: 1.65-3.50, P < .001), transient diabetes insipidus (OR = 4.94, 95% CI: 2.23-10.88, P < .001), and more often received additional treatment such as hydrocortisone (OR = 3.23, 95% CI: 2.14-4.86, P < .001) or reoperation (OR = 11.18, 95% CI: 2.59-48.34, P < .001). In our multivariable analysis, smaller tumors were positively associated with early discharge (OR = 0.96, 95% CI: 0.94-0.98 per mm, P < .001), whereas transient diabetes insipidus was inversely associated (OR = 0.27, 95% CI: 0.10-0.53, P < .001). There was no significant association between readmission and early vs late discharge (8.3% vs 13.3%, P = .09).</p><p><strong>Conclusion: </strong>Tumor characteristics and presenting symptoms may assist in determining patients who are appropriate for early discharge after EES for PA resection. POD 1-2 discharge seems to be a practical option for many patients after EES, without additional risk of readmission or further complications.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304327","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":"Bedside Sonographic Ventricular Monitoring Through a Sonolucent Cranial Implant for Weaning of External Ventricular Drain After Aneurysmal Subarachnoid Hemorrhage.","authors":"Jonathan Rychen, Christian Ferreira, Griffin Thomas, Zoey Croft, Arevik Abramyan, Marcio Yuri Ferreira, Raphael Bertani, Vadim Zhigin, Artur Shlifer, Netanel Ben-Shalom, Heustein Lu Sy, David Jonathan Langer","doi":"10.1227/ons.0000000000001669","DOIUrl":"10.1227/ons.0000000000001669","url":null,"abstract":"<p><strong>Background and objectives: </strong>The development of sonolucent cranial implants has led to the possibility of sonographic visualization of intracranial structures. The use of ultrasound instead of computed tomography imaging for ventricular monitoring during external ventricular drain (EVD) weaning has not yet been described. This study aims to describe the feasibility of bedside sonographic ventricular monitoring for EVD weaning after aneurysmal subarachnoid hemorrhage and to report our preliminary clinical experience.</p><p><strong>Methods: </strong>A 24-mm sonolucent cranial implant was incorporated in the bone flap after clipping of a ruptured aneurysm. Baseline sonographic measurements of ventricular size were obtained with the EVD set at 10 cm. After raising the EVD to 15 cm for 24 hours, a second sonographic assessment was performed. If ventricular size, intracranial pressure and the examination remained stable, the EVD was clamped. A third sonographic assessment was conducted 24 hours after clamping. If ventricular size, intracranial pressure, and the examination remained stable, the EVD was removed. A fourth sonographic assessment was performed 24 hours after removal, with 1 final assessment before discharge of the patient.</p><p><strong>Results: </strong>A total of 6 patients underwent the placement of an EVD, surgical clipping, and sonographic weaning of the EVD. Adequate sonographic visualization of the ventricles for EVD weaning was obtained in all 6 patients. Sonographic increase in ventricular size, accompanied by clinical deterioration, was observed in 3 patients, leading to the decision to place a ventriculoperitoneal shunt. There were no instances of missed ventricular enlargement nor postoperative infection or need for revision within the mean follow-up period of 6 weeks.</p><p><strong>Conclusion: </strong>Bedside sonographic ventricular monitoring through a sonolucent cranial implant represents a new and valid method for weaning of EVD after aneurysmal subarachnoid hemorrhage. Using ultrasound instead of computed tomography offers several advantages, including enhanced safety by avoiding intrahospital transport, reduced costs, and elimination of radiation exposure.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304364","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":"A Validation of the Tarlov Cyst Quality-of-Life Survey in Men Surgically Treated for Symptomatic Spinal Tarlov Cysts.","authors":"Frank Feigenbaum, Susan E Parks, Madelene P Martin, Tanishu M Deckard-Ross, Onesica P Coleman, Kristina M Kupanoff","doi":"10.1227/ons.0000000000001666","DOIUrl":"10.1227/ons.0000000000001666","url":null,"abstract":"<p><strong>Background and objectives: </strong>Health-related quality-of-life (HRQoL) surveys have been used to assess general quality of life in many areas of medicine including neurosurgery. Disease-specific quality-of-life surveys can be used to more accurately describe nuances of disease progression or improvement. The Tarlov Cyst Quality-of-Life (TCQoL) scale is a disease-specific HRQoL scale that has been validated in women who were surgically treated for symptomatic spinal Tarlov cysts. The purpose of this article was to validate the TCQoL in male patients who underwent surgical treatment of symptomatic Tarlov cysts.</p><p><strong>Methods: </strong>Male patients who underwent surgical treatment of Tarlov cysts in our clinic between 2016 and 2023 were surveyed preoperatively and 3 months postoperative. Surveys included established and validated Oswestry Disability Index (ODI), and the Short Form-36 (SF-36) and the disease-specific TCQoL. Psychometric analyses to assess internal consistency, discriminative validity, sensitivity to clinical change, and construct validity were performed to validate the TCQoL using the ODI and SF-36.</p><p><strong>Results: </strong>Our sample consisted of 46 male patients surgically treated for Tarlov cysts and completed preoperative and postoperative surveys including the 11-item TCQoL. Internal consistency was good, Cronbach α = 0.85. Nine of the 11 items showed significant improvement at follow-up demonstrating the discriminative ability of the scale. The TCQoL significantly correlated with the ODI ( P < .001) and the following subscales of the SF-36: physical function ( P < .001), bodily pain ( P = .010), vitality ( P = .011), and social functioning ( P = .008), suggesting concurrent validity.</p><p><strong>Conclusion: </strong>We validated the TCQoL as a disease-specific HRQoL measure that can be used with male patients who undergo surgical treatment for sacral Tarlov cysts. Our validation demonstrates good internal validity and discriminative validity, is sensitive to clinical change, and has strong construct validity.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304326","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":"Optimizing Extradural Exposure in the Posterior Petrosal Approach: The Role of Endolymphatic Sac Peeling.","authors":"Tancredo Alcântara, Jerold Justo, Tingting Jiang, Arianna Fava, Bruno Costa, Emmanuel Mandonnet, Thibault Passeri, Sébastien Froelich","doi":"10.1227/ons.0000000000001663","DOIUrl":"10.1227/ons.0000000000001663","url":null,"abstract":"<p><strong>Background and objectives: </strong>The posterior petrosal approach is a technically challenging procedure used to treat complex, deep-seated lesions. The petrosal ridge, located between the middle and posterior fossae, can be anatomically compared with the sphenoid ridge, which separates the anterior and middle fossae. Analogous to the orbitotemporal periosteal fold, which connects the orbit to the middle fossa dura, the endolymphatic sac (ELS) acts as a fold connecting the vestibule to the posterior fossa dura. This fold presents an obstacle to further elevating the dura from the posterior surface of the petrous bone. The objective of this study is to provide anatomic details and key landmarks for the preservation and safe peeling of the ELS, thereby expanding the surgical field during posterior petrosectomy and combined petrosal approaches.</p><p><strong>Methods: </strong>Five formalin-fixed cadaveric heads were injected with colored silicone, and 10 sides were used for cadaveric dissections.</p><p><strong>Results: </strong>At the level of the superomedial margin of the operculum, the periosteal layer is incised to enter a surgical plane between the dura propria and the ELS. The dura is then peeled away from the posterior aspect of the ELS, and the periosteal layer is further incised along the ELS. A dural thickening continuing medially from the operculum, corresponding to the Tubingen line, allows access to the plane between the dural leaflets before reaching the full extent of the ELS.</p><p><strong>Conclusion: </strong>Analogous to the orbitotemporal periosteal fold in anterior approaches, the ELS can be safely peeled from the dura of the posterior fossa, thereby enhancing the extradural exposure in these approaches.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304367","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":"Awake Versus Asleep Craniotomy for Glioma: A Comparison of Survival and Costs Using Time-Driven Activity-Based Costing.","authors":"Advith Sarikonda, D Mitchell Self, Matthews Lan, Karim Hafazalla, Steven Glener, Arbaz Momin, Ashmal Sami Kabani, Danyal Quraishi, Emily L Isch, Antony A Fuleihan, Pranav Jain, Ayra Khan, Justin Santos, Conor Dougherty, Nicholas Clark, James J Evans, Kevin D Judy, Christopher J Farrell, Ahilan Sivaganesan","doi":"10.1227/ons.0000000000001676","DOIUrl":"10.1227/ons.0000000000001676","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gliomas are among the most common primary brain tumors. Based on proximity to eloquent structures, surgeons may perform an awake craniotomy (AC) or an asleep craniotomy under general anesthesia (GA). To date, no study has used time-driven activity-based costing to compare costs of these procedures.</p><p><strong>Methods: </strong>We identified all GA (n = 298) and AC (n = 67) performed for glioma resection at our institution from 2017 to 2022. Total costs were determined through interdepartmental collaboration (sterile processing, pharmacy, and plant operations departments) and automated extraction from the electronic medical record. Multivariable generalized linear mixed models were performed to compare costs between AC and GA, accounting for patient and tumor-specific factors. Differences in survival were evaluated using Kaplan-Meier curves and Cox proportional hazards models.</p><p><strong>Results: </strong>The median total cost of surgery was $6600 (IQR: $2875), most of which was driven by the cost of supplies (median: $3178, IQR: $1798) and personnel (median: $3141, IQR: $1155). Although GA patients were older ( P = .025), no differences were found in World Health Organization tumor grade distribution ( P = .55) or extent of resection ( P = .17). After adjusting for confounders, AC was associated with $2175 of additional intraoperative cost ( P < .001) compared with GA. Kaplan-Meier analysis demonstrated greater overall survival (OS) for AC compared with GA (log-rank; P = .011), with no significant difference in progression-free survival (PFS) (log-rank; P = .106). However, when adjusting for confounders, multivariable Cox hazards ratios (HRs) revealed no significant differences in OS (HR = 0.84, P = .48) or PFS (HR = 0.9, P = .66) between the 2 modalities.</p><p><strong>Conclusion: </strong>Although AC was significantly more expensive than GA, it was not associated with a corresponding improvement in OS or PFS after adjusting for confounders. Continual reassessment of the cost-effectiveness of novel brain tumor approaches will be increasingly important in the era of value-based care.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304363","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":"Minimally Invasive L5/S1 Far Lateral Decompression and Microdiskectomy: 2-Dimensional Operative Video.","authors":"Ryan M Glynn, Vincent N Nguyen, William M Mangham","doi":"10.1227/ons.0000000000001679","DOIUrl":"10.1227/ons.0000000000001679","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304366","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":"Complex Single-Stage Juvenile Nasopharyngeal Angiofibroma Resection: A Hybrid Pediatric Endoscopic Endonasal and Transmaxillary Approach.","authors":"Bastien A Valencia-Sanchez, Hector Fuentes Plata, Michael G Brandel, Jeeho D Kim, Danielle Levy, Javan J Nation, J Scott Pannell, Michael L Levy, Vijay A Patel","doi":"10.1227/ons.0000000000001662","DOIUrl":"10.1227/ons.0000000000001662","url":null,"abstract":"<p><strong>Background and importance: </strong>Juvenile nasopharyngeal angiofibroma (JNA) is a rare, locally aggressive vascular tumor that primarily affect adolescent males. This work illustrates a step-by-step surgical approach of an advanced-stage JNA resection in a prepubescent 5-year-old child, utilizing a hybrid endoscopic endonasal and transmaxillary approach that provides highly effective results without employing traditional open techniques.</p><p><strong>Clinical presentation: </strong>A previously healthy 5-year-old male presented with one-year history of nasal obstruction, mouth breathing, and recurrent otitis media. The patient was found to have a large, space-occupying hypervascular tumor obstructing the nasopharynx. Preoperative radiographic imaging revealed an extensive heterogeneous, avidly enhancing mass that occupied the nasopharynx, right pterygopalatine fossa, infratemporal fossa, masticator space, and middle cranial fossa. Following superselective endovascular embolization, a hybrid endoscopic endonasal approach was planned for JNA resection, incorporating an anterior maxillotomy to allow for direct access to lateral compartments not classically amenable to conventional transnasal corridors.</p><p><strong>Conclusion: </strong>This study demonstrates the technical feasibility of a combined endoscopic endonasal and transmaxillary approach for single-stage JNA resection with intracranial extension in pediatric patients. Key principles include tumor embolization, dynamic endoscopic visualization, avoidance of brain retraction, direct access to critical neurovascular structures, and minimizing craniofacial morbidity.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304365","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":"Transdural Approach for Repair of a Spontaneous Ventral Thoracic Cerebrospinal Fluid Leak Using Muscle Plug: 2-Dimensional Operative Video.","authors":"Edoardo Centofanti, Evgenii Belykh, Jonathan R Pace","doi":"10.1227/ons.0000000000001677","DOIUrl":"10.1227/ons.0000000000001677","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304368","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":"Commentary: Bilateral High-Riding Persistent First Cervical Intersegmental Arteries in a Case of Klippel-Feil Syndrome: The Technique of Vertebral Artery Mobilization for C1-C2 Reduction and Fusion for Atlantoaxial Dislocation and Basilar Invagination: 2-Dimensional Operative Video.","authors":"Xin Zhou, Huasheng Jiang, Qing Chen, Jianming Liang, Li Nie, Kai Xu, Shuizhen Chen, Haiyang Qing, Wenchao Yang","doi":"10.1227/ons.0000000000001652","DOIUrl":"10.1227/ons.0000000000001652","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":"319-320"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259920","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 Jugular Foramen is Rather a Canal With Distinctive Morphological Configuration Concerning Its Clinical Anatomy and Surgical Implications: Morphological Analysis.","authors":"Azzat Al-Redouan, Michaela Racanska, Isabela M C Oliveira, Oluwatoba Mark Oni, Veronika Vanatkova, Barbora Musilová, Zahrah Issufo Bacar, Sarka Salavova, Marek Joukal, David Kachlik","doi":"10.1227/ons.0000000000001654","DOIUrl":"https://doi.org/10.1227/ons.0000000000001654","url":null,"abstract":"<p><strong>Background and objectives: </strong>The jugular foramen (JF) is rather a complex anatomical structure with internal configuration. Its osteomorphology was assessed to redefine this rather long bony passage as a jugular canal (JC) based on its morphometric data.</p><p><strong>Methods: </strong>The JF was endocranially and exocranially observed and measured by a digital Vernier caliper bilaterally in 402 dry skulls with opened cranial cavity. The following parameters were measured and analyzed statistically: (1) external and internal widths in the mediolateral dimension, (2) external and internal lengths in the anteroposterior dimension, and (3) depth between the external and internal planes of the foramen. The JF/canal was classified based on its appearance and its morphometric features.</p><p><strong>Results: </strong>The mean length of the JC was approximately 12 mm (12.25 mm-right, 11.76 mm-left) and was longer on the right side (P = .05, 95% CI). Its external opening was found to be slightly larger than the internal opening (P = .07-right, P = .06-left). The JC took 3 distinctive course patterns of straight (47.6%), curved (45.5%), and angulated (6.9%). Its openings exhibited 3 types based on their morphometric analysis: 14.4% Type-I (width = length ±1 mm), 9.8% Type-II (width > length), and 75.9% Type-III (width < length). The size of the external opening into the JC was larger than its internal opening (straight: P = .08-right and P = .07-left), (curved: P = .03-right and P = .03-left), (angulated: P = .03-right and P = .04-left).</p><p><strong>Conclusion: </strong>The JF should be regarded clinically as a canal. It is composed of internal and external openings where the jugular fossa resides in between. The provided osteomorphological variations of the JC would enhance the diagnostics and surgical planning in JF syndromes radioimaging and surgical interventions.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144268462","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}