Interdisciplinary cardiovascular and thoracic surgery最新文献

{"title":"Buckberg versus Del Nido in isolated aortic valve replacement: a prospective, two-centre, randomized trial.","authors":"Manel Tauron-Ferrer, Elena Roselló-Díez, Christian Muñoz-Guijosa, Constanza Fernández-DeVinzenzi, José Montiel, Sandra Casellas, Ángela Irabien-Ortiz, Laura Corominas-García, César Piedra, Ignasi Julià, Claudio Fernández, Virginia Cegarra, Nerea Guadalupe, Marta Molina, Juan F Tabilo, Carla Gotsens-Asenjo, Cristina Sobre, Víctor Gomez, Elisabet Berastegui, Antonino J Ginel","doi":"10.1093/icvts/ivaf054","DOIUrl":"10.1093/icvts/ivaf054","url":null,"abstract":"<p><strong>Objectives: </strong>Interest in Del Nido solution is increasing in adult cardiac surgery. This study compared Del Nido with Buckberg cardioplegia in patients undergoing isolated aortic valve replacement.</p><p><strong>Methods: </strong>A prospective, two-centre, randomized trial was conducted from July 2019 to August 2023, with adult patients undergoing first-time isolated aortic valve replacement, and were randomized to receive Buckberg (n = 159) or Del Nido (n = 152) solution. Primary end-point was Creatine Kinase and ultrasensitive Troponin T postoperative peak level.</p><p><strong>Results: </strong>A total of 311 patients were recruited. Total cardioplegia volume was higher in Del Nido group (1000 ml vs 374.5 ml, P < 0.001). No differences were observed in peak Creatine Kinase or Troponin T levels (422 vs 407 U/L and 282 vs 258 ng/L for Buckberg and Del Nido, respectively) or during postoperative days 1-5. After cross-clamp removal, patients in Del Nido group showed higher rates of spontaneous rhythm (66.7% vs 43.1%, P < 0.001) and less ventricular fibrillation requiring defibrillation (23.6% vs 49.7%, P < 0.001). Peak intraoperative glucose levels (128 mg/dl vs 198 mg/dl, P < 0.001) and insulin administration (18.1% vs 51.0%, P < 0.001) were lower in the Del Nido group. No other differences were found.</p><p><strong>Conclusions: </strong>No differences between Del Nido and Buckberg solutions were detected. Del Nido presents better intraoperative glycaemic control, higher spontaneous rhythm, less ventricular fibrillation requiring defibrillation after cross-clamp removal, and more comfortable surgical workflow due to less re-dose interruptions.</p><p><strong>Clinical registration number: </strong>EU-CTR number: 2018-002701-59.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11919445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related differences in systemic inflammatory response and outcomes after cardiac surgery and cardiopulmonary bypass.","authors":"Enrico Squiccimarro, Roberto Lorusso, Vito Margari, Cataldo Labriola, Richard Whitlock, Domenico Paparella","doi":"10.1093/icvts/ivaf066","DOIUrl":"10.1093/icvts/ivaf066","url":null,"abstract":"<p><strong>Objectives: </strong>Differences in inflammatory responses between men and women may contribute to sex disparities in cardiac surgery outcomes. We investigated how sex differences influence systemic inflammatory response syndrome (SIRS) and adverse outcomes after cardiac surgery.</p><p><strong>Methods: </strong>A single-centre retrospective cohort study of patients undergoing cardiac surgery from 2018 to 2020 was performed. SIRS was defined as per the American College of Chest Physicians/Society of Critical Care Medicine. Predictors of SIRS and composite adverse outcomes (death, transient ischaemic attack/stroke, renal therapy, bleeding, postcardiotomy mechanical circulatory support, prolonged Intensive Care Unit stay) were evaluated using multivariable logistic regression. Mediation effects of SIRS were assessed using structural equation modelling.</p><p><strong>Results: </strong>The cohort included 1005 patients, of whom 299 (29.8%) were women. SIRS occurred in 28.1% of patients, and 12.7% experienced the composite end point. Female sex was significantly associated with SIRS (odds ratio 1.56; 95% confidence interval 1.12-2.18, P = 0.009) and the composite outcome (odds ratio 1.72; 95% confidence interval 1.10-2.69, P = 0.017). Baseline left ventricular dysfunction and intraoperative hyperlactatemia were additional common predictors. SIRS mediated 50.8% of the effect of female sex, 17.0% of left ventricular dysfunction and 30.9% of intraoperative hyperlactatemia on the composite outcome.</p><p><strong>Conclusions: </strong>Female sex is independently associated with postoperative SIRS and poorer outcomes. Systemic inflammation, preoperative anaemia and procedural hyperlactatemia are potentially modifiable factors in the mechanisms through which female sex appears to worsen outcome after cardiac surgery.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of short- and long-term outcomes of aortic valve sparing operation at concomitant aortic root and arch repair.","authors":"Yu Hohri, Megan M Chung, Kavya Rajesh, Dov Levine, Christopher He, Elizabeth L Norton, Bradley Leshnower, Yanling Zhao, Paul Kurlansky, Edward P Chen, Hiroo Takayama","doi":"10.1093/icvts/ivaf045","DOIUrl":"https://doi.org/10.1093/icvts/ivaf045","url":null,"abstract":"<p><strong>Objectives: </strong>Concomitant aortic root and arch replacement is a complex procedure. Although valve-sparing root replacement may offer advantages over valve prostheses, the decision to spare the valve may increase the risk profile of this procedure. This study examines the safety of aortic valve-sparing operation in such settings.</p><p><strong>Methods: </strong>All patients who underwent concomitant aortic root and arch replacement between 2004 and 2021 at two aortic centers were reviewed. Patients with aortic stenosis, endocarditis, or a history of previous cardiac surgery were excluded. Inverse probability treatment weighting yielded well-balanced cohorts. The primary end-points were mortality and complications during the index hospital stay, and secondary end-points were long-term survival and aortic valve reintervention rate.</p><p><strong>Results: </strong>A total of 764 patients who underwent concomitant aortic root and arch replacement, including valve-sparing root replacement (n = 311) or composite valve graft root replacement (n = 453), were analyzed. Surgical indication was dissection in 155 (20.2%), and distal extension was total arch replacement in 50 (6.5%). Cardiopulmonary bypass and cross-clamp times were longer in valve-sparing root replacement (P = 0.006, and P < 0.001, respectively). Valve-sparing root replacement demonstrated comparable in-hospital mortality rates (2.5% vs 4.9%, P = 0.195), and showed higher long-term survival rates (P = 0.04) (12-year survival rate; 78.5% [71.7%-86.1%] vs 64.2% [57.4%-71.6%]), which was reconfirmed on multivariable Cox regression analysis (Hazard ratio: 0.505 [0.348-0.734], P < 0.001). The cumulative incidence of reintervention was similar in both groups (P = 0.62).</p><p><strong>Conclusions: </strong>In appropriately selected patients requiring aortic root and arch replacement, a valve-sparing operation may be performed safely without increased operative risk.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560270","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":"Outcomes of surgical management for Kommerell's diverticulum associated with type B aortic dissection.","authors":"Nouman Ahmad, Lingjin Huang, Xuliang Chen, Yingjie Huang, Jiawei Li, Zhongshang Xie","doi":"10.1093/icvts/ivaf015","DOIUrl":"10.1093/icvts/ivaf015","url":null,"abstract":"<p><strong>Objectives: </strong>Kommerell's diverticulum presents a distinctive challenge in clinical management due to its rarity and diverse clinical manifestations, particularly when concurrent with type B aortic dissection. However, a consensus on the optimal treatment strategy has yet to be established. This study presents our experience with an open surgical approach to treating Kommerell's diverticulum associated with type B aortic dissection.</p><p><strong>Methods: </strong>This retrospective study evaluated 10 patients who underwent surgical repair for Kommerell's diverticulum with concurrent type B aortic dissection. Through median sternotomy, under cardiopulmonary bypass and deep hypothermic circulatory arrest + retrograde cerebral perfusion, a frozen elephant trunk stent graft was deployed in the descending thoracic aorta to address the type B aortic dissection and Kommerell's diverticulum. Aberrant subclavian arteries were reconstructed by bypassing the distal portion into the native ascending aorta or carotid artery, accompanied by proximal ligation of the aberrant artery.</p><p><strong>Results: </strong>The median age of the patient was 49 years (interquartile range: 42.2-58.5). There were no in-hospital or 30-day postoperative deaths. All patients were discharged with a median hospital stay of 8.5 days (interquartile range: 7.75-10.5). No cases of stroke or spinal cord ischaemia were observed. Follow-up was completed for all patients, with a mean duration of 27.4 (standard deviation: 15.3) months, during which no adverse events occurred.</p><p><strong>Conclusions: </strong>This surgical approach for managing Kommerell's diverticulum with type B aortic dissection offers a safe and effective option, yielding favourable short-term outcomes. It may provide a durable alternative to traditional surgical methods and overcome limitations associated with endovascular surgeries.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191401","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":"Pulmonary expanded polytetrafluoroethylene conduits with a hand-sewn tricuspid valve.","authors":"Shunsuke Matsushima, Ryota Takahashi, Sara Kubo, Akihiko Higashida, Yoshihiro Oshima, Hironori Matsuhisa","doi":"10.1093/icvts/ivaf020","DOIUrl":"10.1093/icvts/ivaf020","url":null,"abstract":"<p><strong>Objectives: </strong>The biocompatibility of expanded polytetrafluoroethylene in the pulmonary position seems better than allogenic or xenogeneic reactivity. This study reviewed the application of pulmonary expanded polytetrafluoroethylene conduits having a hand-sewn tricuspid valve with diameters of 18-24 mm.</p><p><strong>Methods: </strong>All patients receiving this conduit between 2010 and 2022 were evaluated. A 0.1-mm-thick membrane and a standard-wall tube of expanded polytetrafluoroethylene were used for cusp and conduit material, respectively.</p><p><strong>Results: </strong>Eighty-four consecutive patients were included. The median operative age and weight were 12 (range, 1.2-40) years and 34 (range, 9.1-82) kg, respectively. Eighteen-, 20-, 22- and 24-mm conduits were used in 19, 5, 3 and 57 patients, respectively. The overall survival was 94% at 5 and 10 years with four non-valve-related deaths. There were five conduit replacements, all for 18-mm conduit stenosis. Freedom from conduit replacement was 98% and 83% at 5 and 10 years, respectively. Freedom from conduit stenosis ≥ moderate was 83% and 54% at 5 and 10 years, respectively. Freedom from pulmonary regurgitation ≥ moderate was 98% at 5 and 10 years. Linear mixed-effects models with echocardiographic data implied that 24-mm conduits functioned with a peak velocity <3.0 m/s and without moderate/severe regurgitation in patients with a body weight of up to 75 kg and a body surface area of up to 2.0 m2 for >12 years postoperatively.</p><p><strong>Conclusions: </strong>This conduit has shown favourable clinical outcomes and is a valid alternative, especially in young patients with increased risk for early failure of the existing products.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257521","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":"Implantation of a temporary microaxial left ventricular assist device via the right axillary artery in a patient with aberrant right subclavian artery.","authors":"Gabrielle Amar, Guy Elgar, Junichi Shimamura, Suguru Ohira","doi":"10.1093/icvts/ivaf011","DOIUrl":"10.1093/icvts/ivaf011","url":null,"abstract":"<p><p>A temporary microaxial left ventricular assist device is commonly implanted via the right axillary artery to treat decompensated heart failure or cardiogenic shock. However, limited literature describes implantation in a variant aortic arch anatomy setting. We present a case of implantation via the right axillary artery in a patient with an aberrant right subclavian artery (Arteria Lusoria) as a bridge to heart transplantation.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11814496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transseptal approach for pseudoaneurysms at the aortic root in Loeys-Dietz syndrome.","authors":"Shinichi Ishida, Hajime Sakurai, Akihiko Usui, Toshimichi Nonaka","doi":"10.1093/icvts/ivaf016","DOIUrl":"10.1093/icvts/ivaf016","url":null,"abstract":"<p><p>Loeys-Dietz syndrome involves vascular abnormalities and aortic root aneurysms. This study described a 10-year-old boy who presented with progressively enlarging ascending aortic aneurysm and mild aortic valve regurgitation. He was diagnosed with Loeys-Dietz syndrome and underwent aortic valve-sparing repair. However, 6 months after the surgery, aortic root pseudoaneurysms were detected. Thus, aortic root repair was performed by transseptal approach. The orifices of pseudoaneurysms were closed with double-layer patches composed of autologous and bovine pericardial patches. Based on the findings of this study, we conclude that the transseptal approach is useful for closing aneurysms at the aortic root.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371191","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":"Pericardiectomy using an ultrasonic scalpel in patients with constrictive pericarditis.","authors":"Takashi Yoshinaga, Jun Takaki, Kosuke Nakata, Takafumi Hirota, Hideaki Hidaka, Tatsuya Horibe, Ken Okamoto, Toshihiro Fukui","doi":"10.1093/icvts/ivaf025","DOIUrl":"10.1093/icvts/ivaf025","url":null,"abstract":"<p><strong>Objectives: </strong>Pericardiectomy using an ultrasonic scalpel is the effective operative treatment of chronic pericarditis. However, no consecutive case series of radical pericardiectomy using an ultrasonic scalpel has been reported.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of 10 patients who underwent a radical pericardiectomy with an ultrasonic scalpel between April 2015 and March 2024. Preoperative and postoperative variables were reviewed.</p><p><strong>Results: </strong>The median age was 65 years, and 3 patients were female. Three patients had preoperative atrial fibrillation. Forty percent of patients were in NYHA class 3-4. Three patients underwent urgent operations. An ultrasonic scalpel was used for the dissection and resection of thickened parietal pericardium and visceral pericardium around the heart except in the area of the posterior left atrium in all patients. Three patients underwent the off-pump technique. Coronary artery bypass grafting and tricuspid valve annuloplasty were performed concomitantly in 3 and 1 patients, respectively. There were no operative deaths. Mediastinitis and acute kidney injury were observed in 1 patient each. One patient died of a stroke during the follow-up period. The other patients were in NYHA class I.</p><p><strong>Conclusions: </strong>Radical pericardiectomy is essential in patients with constrictive pericarditis. An ultrasonic scalpel is a useful tool with which to perform a radical resection of pericardium.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375058","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":"Closure of ventricular septal defect in children with trisomy 18: perioperative events and long-term survival.","authors":"Shintaro Nemoto, Kanta Kishi, Hayato Konishi, Akiyo Suzuki, Takahiro Katsumata, Noriyasu Ozaki, Yutaka Odanaka, Atsuko Ashida, Takamichi Uchiyama, Kenji Mine","doi":"10.1093/icvts/ivaf010","DOIUrl":"10.1093/icvts/ivaf010","url":null,"abstract":"<p><strong>Objectives: </strong>This retrospective study aimed to investigate the feasibility of surgical closure of ventricular septal defect in children with trisomy 18 by assessing perioperative events and long-term survival.</p><p><strong>Methods: </strong>From April 2008 to March 2024, 41 consecutive patients were referred to us for ventricular septal defect surgery. The defect was closed in 35 patients at the end (median age, 16 months; median body weight, 5.7 kg), 31 out of 37 patients after the preceding pulmonary artery banding according to our staged surgery policy and 4 patients without the banding. Sixty-five significant non-cardiac lesions existed concurrently, and 14 patients underwent tracheostomy before closure. The investigation was conducted by checking medical records and contacting the primary physician.</p><p><strong>Results: </strong>Four patients died during the inter-stage after banding to closure (10.8%). Two of them were awaiting closure. Concomitant surgeries, 15 right ventricular muscle resections, or 1 arch repair, were performed along with closure. Arrhythmia was the most common adverse event (51.4%). Three patients required extracorporeal membrane oxygenation support. Transient but severe hepatic injury occurred in 11 patients (31.4%). There were two hospital death (5.7%) due to severe respiratory insufficiency or fulminant sepsis. Five patients died after discharge, three pneumonia and two sudden death, resulting in a 5-year estimated survival of 79.5%. Three hepatoblastoma and one hepatoangioma developed, but complete remission was achieved in all patients.</p><p><strong>Conclusions: </strong>Although further studies are mandatory, surgical closure of ventricular septal defect may be an effective treatment option even for children with trisomy 18.</p>","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2024 EACTS/EACTAIC/EBCP Guidelines on cardiopulmonary bypass in adult cardiac surgery.","authors":"Alexander Wahba, Gudrun Kunst, Filip De Somer, Henrik Agerup Kildahl, Benjamin Milne, Gunilla Kjellberg, Adrian Bauer, Friedhelm Beyersdorf, Hanne Berg Ravn, Gerdy Debeuckelaere, Gabor Erdoes, Renard Gerhardus Haumann, Tomas Gudbjartsson, Frank Merkle, Davide Pacini, Gianluca Paternoster, Francesco Onorati, Marco Ranucci, Nemanja Ristic, Marc Vives, Milan Milojevic","doi":"10.1093/icvts/ivaf002","DOIUrl":"10.1093/icvts/ivaf002","url":null,"abstract":"","PeriodicalId":73406,"journal":{"name":"Interdisciplinary cardiovascular and thoracic surgery","volume":"40 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11826094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}