Cureus最新文献

{"title":"Impact of Obesity on Surgical Outcomes in Patients Undergoing Emergency Laparotomy: A Prospective Observational Study.","authors":"Sudhir Marahanumaiah, Nitish Suresh, Bhoomika Rajkumar, Anubhav Priyadarshi","doi":"10.7759/cureus.85887","DOIUrl":"10.7759/cureus.85887","url":null,"abstract":"<p><strong>Background and aim: </strong>Obesity significantly impacts the outcomes of patients undergoing emergency laparotomy. It complicates emergency laparotomy by prolonging operative times, increasing risks due to comorbidities, impairing wound healing, and heightening respiratory complications, leading to higher morbidity, mortality, and healthcare costs. This study aimed to evaluate the impact of obesity on post-operative outcomes in patients undergoing emergency laparotomy at Kempegowda Institute of Medical Sciences (KIMS) Hospital and Research Centre, Bangalore. It focused on the association between body mass index (BMI) and the incidence of post-operative complications, length of hospital stay, and operative time.</p><p><strong>Materials and methods: </strong>A total of 72 emergency laparotomy patients were grouped by BMI, normal vs. obese, as per the World Health Organization (WHO) classification. Comorbidities and surgical procedures were recorded, excluding laparoscopic cases and underweight patients. Post-operative complications were classified (Clavien-Dindo) and a comprehensive complication index assessed morbidity/mortality during hospitalization.</p><p><strong>Results: </strong>The study included patients aged 18-88 years, with 48 having normal BMI and 24 classified as obese. Post-operative complications occurred more frequently in obese patients with comorbidities - diabetes (58.3%), hypertension (50%), CKD (4.2%), and IHD (4.2%) - compared to those with normal BMI (diabetes: 14.6%, hypertension: 20%). Notably, 66.7% of normal BMI patients had no complications. Obese patients had significantly longer operative times (by 44.23 minutes) and hospital stays (by 3.5 days).</p><p><strong>Conclusion: </strong>The study demonstrates a significant impact of obesity on post-operative outcomes in patients undergoing emergency laparotomy. Additionally, the data show that a majority of patients with a normal BMI (66.7%), regardless of whether they had comorbid conditions, did not encounter any complications.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85887"},"PeriodicalIF":1.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304076","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":"Coil Migration After Embolization of Hepatic Artery Pseudoaneurysm Due to Biliary Stent Erosion.","authors":"Carter E Edmunds, Lindsay Duy, Clancy J Clark, Rishi Pawa, Swati Pawa","doi":"10.7759/cureus.85877","DOIUrl":"10.7759/cureus.85877","url":null,"abstract":"<p><p>Coil embolization migration is a rare complication of transcatheter arterial embolization intervention. This report describes a 69-year-old male who experienced massive hematemesis due to an iatrogenic hepatic artery pseudoaneurysm caused by erosion from a metal biliary stent. His pseudoaneurysm was treated by coil embolization, initially with resolution of bleeding, but was later complicated by intra-abdominal infections in the setting of the coil migration into the gastrointestinal tract. Consequently, the coil was removed endoscopically with resolution of symptoms. Currently, there are no standardized guidelines for managing migrated coils; however, symptomatic cases often require intervention due to the risk of bleeding, perforation, or infection if not addressed. This case highlights the importance of monitoring patients after undergoing transcatheter arterial embolization and considering endoscopic removal as a practical management consideration.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85877"},"PeriodicalIF":1.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304071","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":"Systemic Sarcoidosis Presenting With Hypercalcemia, Acute Kidney Injury, and Diffuse Lymphadenopathy: Unlocking Pandora's Box.","authors":"Virginia Geladari, Paraskevi Liaveri, Georgios Liapis, Georgios Moustakas, Nikolaos Sabanis","doi":"10.7759/cureus.85882","DOIUrl":"10.7759/cureus.85882","url":null,"abstract":"<p><p>Sarcoidosis is a rare granulomatous disease with complex pathogenesis, nonspecific manifestations, and systemic sequelae leading to difficulties in differential diagnosis and increased potential for misdiagnosis. Renal involvement consists of an uncommon and underreported condition, especially in the absence of other extra-renal manifestations. Herein, we describe the case of a 58-year-old Caucasian female who presented with acute kidney injury alongside persistent hypercalcemia, diffuse lymphadenopathy, and B symptoms, namely, unintentional weight loss, fever, and fatigue. The laboratory findings revealed elevated creatinine and calcium levels, suppressed intact parathyroid hormone (iPTH) and increased calcitriol and angiotensin-converting enzyme (ACE) levels, raising suspicion of sarcoidosis. Renal biopsy revealed the presence of non-necrotizing granulomas, a pattern compatible with the diagnosis of sarcoidosis granulomatous interstitial nephritis (sGIN). Combined therapy with corticosteroids and hydroxychloroquine was initiated, and the patient's follow-up showed significant improvement in kidney function without relapses, highlighting the importance of early disease recognition and intervention. This case study unveils the diagnostic odyssey of the clinician to establish the diagnosis of sarcoidosis and prompts them to include such a diagnosis in their differential diagnosis algorithm in patients presenting with acute kidney injury, diffuse lymphadenopathy, and non-PTH-mediated hypercalcemia.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85882"},"PeriodicalIF":1.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304084","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":"Identification of Factors Predicting False-Negative Results in Sentinel Lymph Node Biopsy in Patients Undergoing Surgery for Breast Cancer: A Single-Center Retrospective Study.","authors":"Sümeyra Bölük, Salih Bölük","doi":"10.7759/cureus.85891","DOIUrl":"10.7759/cureus.85891","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Background In breast cancer surgery, sentinel lymph node biopsy (SLNB) is routinely utilized for axillary assessment. Frozen section examination of the sentinel lymph node (SLN) is used to guide the decision for axillary dissection. Adjuvant treatment is also planned based on the final pathological examination of the axilla and the mastectomy/breast-conserving surgery specimen. In rare cases, even when the frozen section examination of the SLN is negative, micrometastases and macrometastases can still be detected in the final pathologic examination. In our study, we aimed to analyze the characteristics of patients who underwent surgery for breast cancer and were found to have false-negative results in SLNB. We aimed to identify potential predictive markers for false-negative results in SLNB. Methodology A total of 206 patients with breast cancer who underwent surgery in our department between January 2018 and September 2023 were evaluated retrospectively. In total, 12 patients with false-negative SLNB results and 12 patients with true-negative SLNB results were reviewed. Demographic information of the patients, type of breast malignancy, hormone receptor status, the number of lymph nodes dissected in SLN sampling, and whether the patients received neoadjuvant treatment were recorded. Results The results of 12 cases with false-negative results in SLNB were compared with 12 cases with true-negative results. The ages of the cases ranged from 33 to 80 years, and the mean age was 57.00 ± 12.55 years. The mean age was 59.92 ± 9.72 years in the group with false-negative SLNB results and 54.08 ± 14.71 in the group with true-negative SLNB results. No significant difference was found between the groups (p &gt; 0.05). No statistically significant difference was determined in tumor size, stage, estrogen receptor, progesterone receptor (PR), C-ERB, HER-2, and E-cadherin between the groups (p &gt; 0.05). It is noteworthy that PR was detected at a higher rate in the false-negative SLNB group. In cases with false-negative results in SLNB, the absence of treatment response in the postoperative pathological examination was found to be statistically significantly higher. On the other hand, complete response and partial response rates were significantly higher in the SLNB true-negative group (p = 0.011 and p &lt; 0.05). However, because response rates cannot be assessed preoperatively, they cannot be considered a predictive factor. Mean Ki-67 (%) of the cases with true-negative SLNB results was statistically significantly higher than the false-negative group (p = 0.017 and p &lt; 0.05). Conclusions SLNB is routinely performed in breast cancer for the evaluation of the axilla. Examining a single blue-stained lymph node may be sufficient for SLN assessment. In the preoperative period, there is no imaging method, pathological finding, or data that can definitively predict the probability of a positive SLN. Even when the patient has received neoadjuvant therapy, unnecessary l","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85891"},"PeriodicalIF":1.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12165741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304075","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":"Atypical Presentation of Pancreatic Cancer Mimicking IgG4-Related Disease.","authors":"Yazan Sallam, Mir Zulqarnain, Anas Al-Sadi, Chase Branstetter, Ashir Mir","doi":"10.7759/cureus.85876","DOIUrl":"10.7759/cureus.85876","url":null,"abstract":"<p><p>Pancreatic cancer often presents with vague, nonspecific symptoms such as painless jaundice, weight loss, and fatigue. Imaging can be diagnostic in pancreatic cancer. However, in rare cases, pancreatic cancer may present without a detectable mass, mimicking conditions like autoimmune pancreatitis (AIP). Supraclavicular lymph node metastasis, commonly associated with breast, lung, gastric, and esophageal cancers, is rarely reported in cases of pancreatic cancer. Even more unusual is the finding of an isolated Virchow's node in such cases. Here, we present a unique case of pancreatic adenocarcinoma characterized by an isolated, enlarged left supraclavicular lymph node without any clear evidence of a pancreatic mass on imaging.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85876"},"PeriodicalIF":1.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12162384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304069","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":"Perforation of the Large Intestine by a Fish Bone Mimicking Cancer: A Rare Case Report.","authors":"Daniel Herrera Hernández, Estefany Marlen Barragán Jiménez, Pablo Cano Cabrera, Pablo Patricio Flores García, Ivan Yahir Paternina Gonzalez, Diana Laura Páramo Hernández, Ricardo Burciaga Castañeda, Jimena Celeste Treviño Flores","doi":"10.7759/cureus.85867","DOIUrl":"10.7759/cureus.85867","url":null,"abstract":"<p><p>This case report details an 80-year-old male who presented with a 12-day history of progressive left lower quadrant abdominal pain. Imaging studies revealed a mass adjacent to the sigmoid colon with signs suggestive of an abscess, but no foreign body was identified preoperatively. Surgical exploration uncovered a sigmoid colon perforation associated with a sharp foreign object, later confirmed to be a fish bone. Histopathological examination demonstrated an inflammatory response without evidence of malignancy. The patient underwent a segmental colectomy with favorable postoperative recovery. This case underscores the diagnostic challenge of foreign body perforation of the colon, particularly when initial imaging fails to identify the foreign object. It highlights the importance of considering ingested fish bones in the differential diagnosis of colonic perforation in elderly patients, especially those with risk factors such as denture use. The report emphasizes the role of surgical intervention in the diagnosis and management of such rare cases, which can mimic neoplastic processes.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85867"},"PeriodicalIF":1.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304079","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":"Reducing Delays, Improving Flow: The Importance of a Dedicated Discharge Coordinator in Hospital Discharge Planning.","authors":"George Bechir, Angelina Bechir","doi":"10.7759/cureus.85879","DOIUrl":"10.7759/cureus.85879","url":null,"abstract":"<p><p>Hospital discharge remains one of the most vulnerable stages of inpatient care, frequently delayed not by clinical need but by fragmented coordination of tasks such as imaging, consults, documentation, and transportation. These bottlenecks contribute to prolonged length of stay (LOS), emergency department crowding, higher healthcare costs, and decreased patient satisfaction. In this article, we examine the critical role of a dedicated discharge coordinator - a nurse, nurse practitioner, or case manager - who is tasked solely with tracking and resolving same-day discharge barriers in real time. Drawing on findings from 20 peer-reviewed studies, we synthesize evidence demonstrating that such centralized oversight reduces LOS (often by 0.5 to 1 day), improves patient throughput, decreases readmission rates, and enhances communication between care teams. We explore various coordination models, ranging from unit-based facilitators to electronic health record (EHR)-integrated tracking tools, and present real-world examples where minor misalignments in timing, such as delayed dialysis or unscheduled imaging, led to avoidable hospital days, reinforcing the need for structured and accountable discharge management. The discharge coordinator acts as the operational \"traffic controller\" of inpatient flow, ensuring timely, safe, and coordinated transitions of care. In today's strained hospital systems, this role is essential for maintaining safety, efficiency, and capacity.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85879"},"PeriodicalIF":1.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304080","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":"Atypical Presentation of Zieve Syndrome: A Case Report and Literature Review.","authors":"Olaniyi Fadeyi, Helai Hussaini, Saviz Saghari, Nii Tetteh","doi":"10.7759/cureus.85772","DOIUrl":"10.7759/cureus.85772","url":null,"abstract":"<p><p>Zieve syndrome is a rare pathology usually diagnosed in patients with a history of alcohol-related liver disease. It is characterized by a triad of Coombs-negative hemolytic anemia, cholestatic jaundice, and hyperlipidemia. Patients usually present with abdominal pain, nausea, jaundice, and ill-defined symptoms. While Zieve syndrome is associated with alcohol-induced liver injury, its mechanism of action is still poorly understood. Nevertheless, most patients respond well to alcohol abstinence, blood transfusions, and supportive care. Herein, we report the case of a 33-year-old female patient who presented to the ED with complaints of abdominal discomfort, intermittent melanotic stools, and hematemesis. Gastroenterology and Oncology were consulted for further evaluation and management. The patient was subsequently diagnosed with Zieve syndrome. In this report, we review this unique case and discuss different atypical forms of presentation in Zieve syndrome, as highlighted in previous studies.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85772"},"PeriodicalIF":1.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12163057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144304070","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":"Knowledge, Attitudes, and Practices of Community Pharmacists About Nutrition and Lifestyle Medications and Counseling in the Aseer Region of Saudi Arabia: A Cross-Sectional Study.","authors":"Sultan M Alshahrani","doi":"10.7759/cureus.85757","DOIUrl":"10.7759/cureus.85757","url":null,"abstract":"<p><strong>Introduction: </strong>Community pharmacists possess a distinctive capability to provide lifestyle and nutrition counseling; however, their integration into public health systems in Saudi Arabia is still constrained.</p><p><strong>Aim: </strong>The objective of this study was to evaluate the knowledge, attitudes, and practices (KAP) of community pharmacists in the Aseer region about lifestyle medications and nutritional counseling.</p><p><strong>Methods: </strong>A cross-sectional study was performed, including 257 licensed community pharmacists utilizing a self-administered, structured questionnaire consisting of six items each on KAP. Descriptive statistics were employed to explore demographic characteristics and Likert-scale responses. Multivariable linear regression was conducted to determine predictors of attitude and practice scores.</p><p><strong>Results: </strong>Participants exhibited moderate expertise, particularly excelling in BMI interpretation and drug-nutrient interactions, alongside generally positive attitudes; 174 respondents (67.7%) agreed that pharmacists can positively impact food habits. However, deficiencies in practice were noted where merely 54 (21.0%) indicated patient follow-up, and 105 (40.9%) regularly utilized BMI evaluation during counseling.</p><p><strong>Conclusion: </strong>Although pharmacists demonstrate willingness and foundational knowledge to offer lifestyle counsel, actual implementation is constrained. Reforms in pharmacy education, ongoing training, and incorporation into national preventive healthcare initiatives are necessary. Empowering pharmacists is consistent with the objectives of Saudi Vision 2030 to enhance public health and chronic illness management.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85757"},"PeriodicalIF":1.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277125","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":"Coronavirus Disease 2019 and Influenza Vaccination Compliance Among Healthcare Workers at the Primary Health Care Corporation, Qatar, 2020-2024: A Retrospective Study.","authors":"Sameera Alhajri, Anees A Alyafei, Sandy Semaan, Asma A AlNuaimi, Maryam A Al Muslemani","doi":"10.7759/cureus.85761","DOIUrl":"10.7759/cureus.85761","url":null,"abstract":"<p><p>Background Healthcare workers (HCWs) are a priority population for vaccination due to their high exposure risk and critical role in maintaining healthcare system resilience. While COVID-19 vaccination campaigns have achieved notable success globally, seasonal influenza vaccine uptake remains inconsistent. This study assesses COVID-19 and seasonal influenza vaccination coverage among HCWs at the Primary Health Care Corporation (PHCC) in Qatar between 2020 and 2024, and identifies associated demographic and occupational determinants. Methods A retrospective, observational study was conducted using data extracted from PHCC's electronic medical records system (EMRS) and Human Resources Database (HRD), encompassing 31 health centers. All HCWs employed for ≥3 months were included. Descriptive statistics were used to summarize vaccination rates, and chi-square tests were applied to assess associations between vaccine uptake and variables such as age, gender, nationality, job role, years of service, and educational attainment. Results Among 7,463 eligible HCWs (100%), COVID-19 vaccine uptake was high (94.05%), with 18,844 doses administered. Seasonal influenza vaccine coverage was comparatively lower at 65.20%, representing 4,866 HCWs, with 16,533 doses given. Higher age, non-Qatari nationality, female gender (for COVID-19), and shorter service duration were significantly associated with increased uptake (p < 0.05). Educational attainment showed statistically significant associations for both vaccines, although coverage rates were similar across qualification levels. Clinical role was not significantly associated with influenza uptake, but it was significant for COVID-19 vaccination. Conclusion COVID-19 vaccination compliance among HCWs at PHCC was robust and aligned with high-income country benchmarks. However, seasonal influenza vaccination remains below the WHO-recommended 75% threshold. Findings underscore the need for sustained institutional efforts to address vaccine fatigue and promote annual influenza immunization, particularly among younger, Qatari, and longer-serving HCWs. Tailored strategies, education, and institutional mandates may enhance future vaccine compliance and protect healthcare system integrity.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 6","pages":"e85761"},"PeriodicalIF":1.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12153236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144277123","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}