British Journal of Neurosurgery最新文献

{"title":"Interventions and strategies for enhancing the consent process in neurosurgery. A systematic review of the literature.","authors":"Ashraf Elmahdi, David Smith","doi":"10.1080/02688697.2024.2421833","DOIUrl":"https://doi.org/10.1080/02688697.2024.2421833","url":null,"abstract":"<p><strong>Background: </strong>The informed consent process in neurosurgery aims to support patient autonomy and provide comprehensive information for decision-making. However, gaps in communication and understanding between patients and surgeons persist, that need to be addressed. This systematic review examined the interventions and strategies which to enhance the process of consent in neurosurgery.</p><p><strong>Methods: </strong>A comprehensive search of databases and relevant sources to identify relevant studies for inclusion. Systematic review of prospective and retrospective studies that assess the effect of interventions which improve the consent process. Data collection and analysis involved independent reviewers assessing eligibility, study quality, and risk of bias. Findings from the included studies were used to write the review.</p><p><strong>Main results: </strong>The reviewed identified seven studies notably revealed an educational and interactive consent process involving strategies like booklets, videos, multiple interviews, and interactive websites showed improvements in patient knowledge. Recall of risks decreased over time, and factors like age, education, and timing of consent influenced recall.</p><p><strong>Authors’ conclusions: </strong>To maximise informed consent, neurosurgeons should consider various strategies. Tailoring communication-based on patient's health literacy and treatment knowledge, involving their support system, and using a bullet-point consent form is essential. Utilising multiple modalities like verbal, static, and dynamic visuals improve information retention. Creative and memorable visual aids enhance comprehension. Allowing time for questions and team approach is superior.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2024-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142567463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncomplicated linear skull fractures in the paediatric population: a retrospective observational study in a UK Major Trauma Centre.","authors":"Vesta S Najmi, Sivasri Krishna Yellamraju, Emma Toman, Mostafa Elmaghraby, William Lo, Pasquale Gallo, Guirish Solanki, Desiderio Rodrigues, Fardad T Afshari, Joshua Pepper","doi":"10.1080/02688697.2024.2418498","DOIUrl":"https://doi.org/10.1080/02688697.2024.2418498","url":null,"abstract":"<p><strong>Purpose: </strong>National Institute of Clinical Excellence (NICE) guidelines advise that paediatric patients with linear skull fractures do not require admission in the absence of intracranial injury. Despite this, a period of inpatient neuro-observation has become the standard advice and practice in the UK for fear of deterioration. Our experience is that these children rarely deteriorate or require neurosurgical intervention. The primary aim of this study was to describe the incidence of neurological deterioration in patients referred to our paediatric neurosurgery unit with linear skull fractures.</p><p><strong>Methods: </strong>We identified all patients with a linear skull fracture referred to neurosurgery at a paediatric major trauma centre between 2018 and 2023. Patients with intracranial injury, skull base fracture or major trauma were excluded. Demographic and clinical data were collected. The primary outcome was deterioration which was defined as drop in Glasgow Coma Scale (GCS) score, unplanned repeat cranial imaging, neurosurgical intervention performed, or the patient died.</p><p><strong>Results: </strong>Two hundred and ninety-four patients were identified in our referral database. Infants were the age group most commonly referred (44.2%) and falls from under 2 m in height the most common mechanism of injury (71.4%). Ninety-seven children had specific advice documented regarding neuro-observation; of these, the majority (<i>n</i> = 53) were advised 24 hours of inpatient observation. No patients experienced deterioration.</p><p><strong>Conclusions: </strong>This is the largest cohort of linear skull fractures in children described in the UK. None of our patients experienced neurological deterioration, mirroring findings from international studies and supporting current NICE guidance. In addition, at a cost of £360 per 24-hour admission, this has a cost implication for a resource-scarce NHS. We propose that UK trauma networks should devise protocols to support the safe discharge from ED of such patients without the need for discussion with a neurosurgical department.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-4"},"PeriodicalIF":1.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards net-zero operating in neurosurgery.","authors":"Rebecca Hodnett, Megan Murphy, Adam Williams, Naomi Slator, Sarah Love-Jones, Crispin Wigfield","doi":"10.1080/02688697.2024.2418931","DOIUrl":"https://doi.org/10.1080/02688697.2024.2418931","url":null,"abstract":"<p><strong>Background: </strong>The climate crisis is one of the greatest threats to public health and surgery is a significant contributor to carbon emissions generated by the NHS. In this paper, we describe our experience of sustainable operating by using evidence-based methods to reduce our carbon footprint across three neurosurgical theatres during our 'Green operating day'.</p><p><strong>Methods: </strong>The Green operating day was run at a single site over a 12-hour operative day and included 10 neurosurgical cases. Following discussions with the theatre, anaesthetic and sustainability team, each operative case was reviewed and changes in the consumables, surgical instruments and utilities recorded. Carbon footprint was calculated using an environmentally extended input-output model for baseline and Green operating day. Qualitative data was collected on the participants of the Green operating day to assess attitudes and behaviours towards sustainability in neurosurgery.</p><p><strong>Results: </strong>There was a total reduction of carbon emissions by 31%, equivalent to 1.04 tonnes CO₂e. Reductions were seen across different aspects of surgery including anaesthetics, surgical instruments, waste and utilities.</p><p><strong>Discussion: </strong>This study demonstrates the feasibility of carbon footprint reduction within neurosurgical theatres which was not associated with increases in operative duration or adverse patient outcomes. This study advocates for environmentally conscious decision making in neurosurgical procedures.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategic insights and survival outcomes: a systematic review of CNS metastases in uterine cervical cancer.","authors":"Giuseppe Corazzelli, Luca Zanuttini, Damiano Balestrini, Sara Quercia, Matteo Martinoni","doi":"10.1080/02688697.2024.2418490","DOIUrl":"https://doi.org/10.1080/02688697.2024.2418490","url":null,"abstract":"<p><strong>Introduction: </strong>Uterine cervical cancer, predominantly caused by HPV, is the fourth most common malignancy in women, rarely leading to Central Nervous System (CNS) metastases with a poor prognosis. This study analyzes 137 cases, focusing on the clinical progression, treatment efficacy, and survival outcomes, highlighting the need for a multi-disciplinary approach to extend patient survival in the face of inconsistent evidence and management practices.</p><p><strong>Materials and methods: </strong>This systematic review meticulously adhered to PRISMA guidelines, analysing all existing evidence on CNS metastasis from Uterine Cervical Cancer (UCC) through a comprehensive literature search up to August 2023. Articles were selected based on stringent criteria, including compliance with CARE and STROBE guidelines. The study employed rigorous statistical analyses, including the Shapiro-Wilk, T-Student, and ANOVA tests, alongside Kaplan-Meier curves, to evaluate variables like patient age, lesion location, and treatment efficacy.</p><p><strong>Results: </strong>A review of 137 UCC patients revealed CNS metastases predominantly in the cerebral lobes, with headache and hemiparesis as common symptoms. The study found no significant survival difference across histopathological subtypes, but surgery, with or without WBRT, significantly improved outcomes. Age over 50 was associated with better survival, while the FIGO stage at diagnosis correlated with recurrence-free survival. Overall, surgical intervention on CNS lesions was the most significant factor for improved survival.</p><p><strong>Conclusion: </strong>This study reveals that CNS metastases from UCC are critical, with younger patients at worse prognosis. It suggests surgery plus WBRT or SRS as effective treatments and calls for targeted CNS screening and more research for better outcomes.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-14"},"PeriodicalIF":1.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142495517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chiari malformation type I and craniosynostosis in adults: Retrospective analysis over a 10 year period in a tertiary care Centre.","authors":"Adharsh Suraj Prasad, Peter Barron, Akkhash Sivakumar, Phillip Correia Copley, Pasquale Gallo, Chandrasekaran Kaliaperumal","doi":"10.1080/02688697.2024.2413139","DOIUrl":"https://doi.org/10.1080/02688697.2024.2413139","url":null,"abstract":"<p><strong>Background: </strong>Chiari malformation type 1 (CM1) pathophysiology remains uncertain. One theory involves small posterior fossa volumes leading to tonsillar herniation. Craniosynostosis causes suture fusion, which can limit skull growth, and has been investigated in paediatric CM1 cohorts. We aimed to identify the prevalence of concurrent craniosynostosis in adult CM1 patients.</p><p><strong>Methods: </strong>Surgically managed CM1 patients were identified from a pre-existing Edinburgh neurosurgical centres database spanning 10 years. Patients aged 16 years of age or older had their case notes reviewed retrospectively. Cross sectional imaging identified and classified craniosynostosis, tonsillar herniation and the presence of hydrocephalus or syrinxes.</p><p><strong>Results: </strong>35 cases met inclusion criteria. Seven cases (20%) had craniosynostosis, all of which were sagittal synostosis. There was no significant association between the presence of craniosynostosis and the degree of tonsillar herniation, presence of hydrocephalus or syrinx formation.</p><p><strong>Conclusion: </strong>This is the first study to evaluate the prevalence of craniosynostosis in a cohort of surgically managed adult CM1 patients. Future studies should potentially investigate whether conservatively managed adult CM1 patients have similar rates of craniosynostosis and also lack significant associations to known CM1-related complications.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and early Evaluation of a novel tool for assessment of individualised risk tolerance during surgical consent.","authors":"James Booker, Jack Penn, Nicola Newall, David Rowland, Siddharth Sinha, Hani J Marcus","doi":"10.1080/02688697.2024.2413453","DOIUrl":"https://doi.org/10.1080/02688697.2024.2413453","url":null,"abstract":"<p><strong>Purpose: </strong>The legal interpretation of consent has transitioned over the last decade. Surgeons must identify what patients value to individualise surgical consent. This presents a considerable challenge during busy ward rounds or outpatient clinics. We aimed to develop and evaluate a novel risk tolerance tool to aid surgical consent.</p><p><strong>Methods: </strong>This prospective, longitudinal cohort study evaluated the views of adult, elective surgical patients from a single centre. Attitudes to the existing surgical consent process were assessed (n = 48) and responses underwent thematic analysis. From these responses and a stakeholder focus group, a novel risk tolerance tool was developed. The risk tool was evaluated using questionnaires in 25 pre-operative patients. Post-operatively, the same cohort were followed-up with a telephone clinic 6-8 weeks after discharge.</p><p><strong>Results: </strong>Overall patients were satisfied with the current consent process, but negative themes emerged including that it is generalised, impersonal, and time pressured. The developed risk tool contained six domains: death, pain, loss of physical function, loss of cognitive function, need for repeat medical interventions, and social disability. Loss of physical function (mean = 34.0, SD = 12.8) and loss of cognitive function (mean = 34.0, SD = 6.1) had lowest risk tolerance, and need for repeat medical interventions (mean = 18.8, SD = 10.9) had the highest risk tolerance. Thirteen (93%) patients had a positive experience of the consent process vs 85% of patients in pre-consent tool cohort.</p><p><strong>Conclusions: </strong>The tool demonstrated good patient acceptability and patient reported experience. The tool gathered data that may enhance understanding of patient risk tolerance and personalise the surgical consent process.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous speech: a robust measurement before, during and after awake brain surgery in patients with glioma.","authors":"E Collée, A J P E Vincent, L C Jiskoot, E M Bos, J W Schouten, C M F Dirven, D Satoer","doi":"10.1080/02688697.2024.2413438","DOIUrl":"https://doi.org/10.1080/02688697.2024.2413438","url":null,"abstract":"<p><strong>Background: </strong>Patients with glioma often report language complaints with devastating effect on daily life. Analysing spontaneous speech can help to understand underlying language problems. Spontaneous speech monitoring is also of importance during awake brain surgery: it can guide tumour resection and contributes to maintaining language function. We aimed to investigate the spontaneous speech of patients with glioma in the perioperative period and the additional value of spontaneous speech analyses compared to standardised language testing.</p><p><strong>Methods: </strong>We elicited and transcribed spontaneous speech of eight patients with glioma elected for awake brain surgery preoperatively, intraoperatively and 2.0-3.5 months postoperatively. Linguistic errors were coded. Type Token Ratio, Mean Length of Utterance of words, minimal utterances, and errors were extracted from the transcriptions. Patients were categorised based on total error patterns: stable, decrease or increase during surgery. Reliable Change Index scores were calculated for all spontaneous speech variables to objectify changes between time points. Language performance on language tests was compared to spontaneous speech variables.</p><p><strong>Results: </strong>Most errors occurred in lexico-syntax, followed by phonology/articulation, syntax, and semantics. The predominant errors were Repetitions, Self-corrections, and Incomplete sentences. Most patients remained stable over time in almost all spontaneous speech variables, except in Incomplete sentences, which deteriorated in most patients postoperatively compared to intraoperatively. Some spontaneous speech variables (total errors, MLUw, TTR) gave more information on language change than a standard language test.</p><p><strong>Conclusions: </strong>While the course of spontaneous speech over time remained relatively stable in most patients, Incomplete sentences seems to be a robust marker of language difficulties patients with glioma. These errors can be prioritised in spontaneous speech analysis to save time, especially to determine intra- to postoperative deterioration. Importantly, spontaneous speech analyses can give more information on language change than standardised language testing and should therefore be used in addition to standardised language tests.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of acute symptomatic seizures during awake craniotomy for tumour resection.","authors":"Brin E Freund, Maria L Barrios, Anteneh M Feyissa, David Sabsevitz, Sanjeet S Grewal, William D Freeman, Erik H Middlebrooks, Jesus E Sanchez-Garavito, Alfredo Quinones-Hinojosa, William O Tatum","doi":"10.1080/02688697.2024.2410774","DOIUrl":"https://doi.org/10.1080/02688697.2024.2410774","url":null,"abstract":"<p><strong>Purpose: </strong>Awake craniotomy (AC) is a procedure often performed concomitantly with direct electrical cortical stimulation (DES) and electrocorticography (ECoG) during functional brain mapping. Patients undergoing AC are at risk of acute symptomatic seizures, including intraoperative (IS) and early postoperative seizures (EPS) which can lead to higher risk of morbidity. Predicting those who are at risk of IS and EPS could alert clinicians and provide the ability to closely monitor and consider management changes in the acute setting to prevent seizures.</p><p><strong>Materials and methods: </strong>This is a narrative review of previous studies on IS and EPS during awake craniotomy, including a summary of studies from our center using a novel circular grid electrode.</p><p><strong>Results and conclusions: </strong>There are a number of clinical features with variable association with a higher risk of EPS and IS. Surgeries involving the anterior and central head regions are a risk factor for IS. EPS is more likely to occur in patients with perioperative intracranial hemorrhage. Improving grid/electrode technology for ECoG can allow for better sensitivity of detecting epileptiform activity which can help to diagnose and predict perioperative seizures.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":1.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142458525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arachnoid webs causing rostral syrinx due to ball-valve effect: an illustrative report of two cases.","authors":"Aditya M Mittal, Edward G Andrews, Kamil W Nowicki, Daniel A Wecht, Vikas Agarwal, Edward A Monaco","doi":"10.1080/02688697.2022.2154749","DOIUrl":"10.1080/02688697.2022.2154749","url":null,"abstract":"<p><p>An arachnoid web is a pathological formation of the arachnoid membrane. It is a rare phenomenon but is known to lead to syrinx formation in the spinal cord along with pain and neurological deficits. On imaging, the 'scalpel sign' is pathognomonic for an arachnoid web. The etiology of syrinx formation from an arachnoid web is currently unknown. This report documents the only two cases of arachnoid webs with an extensive syrinx in which a likely pathophysiologic mechanism is identified. Both cases presented with motor deficits. The patients had no history of trauma or infection. After extensive workup in both patients and observation of the scalpel sign an arachnoid web was suspected. In both cases, the patients were treated surgically after an arachnoid web was suspected. Intra-operative ultrasound visualized in both cases demonstrates a fenestration in the web that allowed passage of cerebrospinal fluid in a rostral-caudal direction due to a ball-valve effect.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1174-1179"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usability of mixed reality in awake craniotomy planning.","authors":"Richard D C Moon, Neil U Barua","doi":"10.1080/02688697.2022.2152429","DOIUrl":"10.1080/02688697.2022.2152429","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to describe our institutional use of a commercially available mixed reality viewer within a multi-disciplinary planning workflow for awake craniotomy surgery and to report an assessment of its usability.</p><p><strong>Materials and methods: </strong>Three Tesla MRI scans, including 32-direction diffusion tensor sequences, were reconstructed with BrainLab Elements auto-segmentation software. Magic Leap mixed reality viewer headsets were registered to a shared virtual viewing space to display image reconstructions. System Usability Scale was used to assess the usability of the mixed reality system.</p><p><strong>Results: </strong>The awake craniotomy planning workflow utilises the mixed reality viewer to facilitate a stepwise discussion through four progressive anatomical layers; the skin, cerebral cortex, subcortical white matter tracts and tumour with surrounding vasculature. At each stage relevant members of the multi-disciplinary team review key operative considerations, including patient positioning, cortical and subcortical speech mapping protocols and surgical approaches to the tumour.The mixed reality system was used for multi-disciplinary awake craniotomy planning in 10 consecutive procedures over a 5-month period. Ten participants (2 Anaesthetists, 5 Neurosurgical trainees, 2 Speech therapists, 1 Neuropsychologist) completed System Usability Scale assessments, reporting a mean score of 71.5. Feedback highlighted the benefit of being able to rehearse important steps in the procedure, including patient positioning and anaesthetic access and visualising the testing protocol for cortical and subcortical speech mapping.</p><p><strong>Conclusions: </strong>This study supports the use of mixed reality for multidisciplinary planning for awake craniotomy surgery, with an acceptable degree of usability of the interface. We highlight the need to consider the requirements of non-technical, non-neurosurgical team members when involving mixed reality activities.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":" ","pages":"1139-1143"},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10751941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}