The occurrence of the Peregrine's ulcer is scientifically explainable but its miraculous healing in one night cannot be explained by the current scientific knowledge. The long history of fluid mechanics, anatomic and pathophysiologic discoveries led to the better knowledge of hemodynamics in pathophysiology. The last technologies provided strong means to the assessment of venous insufficiency, especially Duplex Ultrasound. Renewed hemodynamic concepts provide a better explanation of the pathophysiology of venous leg ulcers as well as reliable outcomes and less recurrences for varicose veins and ulcers.
{"title":"Venous hemodynamics, knowledge and miracles","authors":"C. Franceschi","doi":"10.24019/jtavr.83","DOIUrl":"https://doi.org/10.24019/jtavr.83","url":null,"abstract":"The occurrence of the Peregrine's ulcer is scientifically explainable but its miraculous healing in one night cannot be explained by the current scientific knowledge. The long history of fluid mechanics, anatomic and pathophysiologic discoveries led to the better knowledge of hemodynamics in pathophysiology. The last technologies provided strong means to the assessment of venous insufficiency, especially Duplex Ultrasound. Renewed hemodynamic concepts provide a better explanation of the pathophysiology of venous leg ulcers as well as reliable outcomes and less recurrences for varicose veins and ulcers.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86877810","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}
A curious case of contemporary skin lesion of hand and foot, showing the healing at the hand site versus worsening and inflammation at the foot after ten days, gives the occasion of analysing the different behaviour of the capillary circulation related to hydrostatic pressure (HP). In fact, HP at the foot, higher than at the hand, causes an increase of capillary pressure, accompanied by increase of transmicrovascular filtration while that arteriovenous pressure gradient is maintained; however, the accumulation of fluids is resisted by a number of edema safety factors that work in concert to limit edema formation (Lymphatic flow, decrease osmotic pressure, reduce the number of capillaries, myogenic constriction of arterioles, venous bulging). It seems evident that this complex balance may easily be broken by modern everyday life common events.
{"title":"Healing times in a clinical case with similar and simultaneous lesions of hand and foot","authors":"S. Ricci, Mihail Georgev","doi":"10.24019/jtavr.74","DOIUrl":"https://doi.org/10.24019/jtavr.74","url":null,"abstract":"A curious case of contemporary skin lesion of hand and foot, showing the healing at the hand site versus worsening and inflammation at the foot after ten days, gives the occasion of analysing the different behaviour of the capillary circulation related to hydrostatic pressure (HP). In fact, HP at the foot, higher than at the hand, causes an increase of capillary pressure, accompanied by increase of transmicrovascular filtration while that arteriovenous pressure gradient is maintained; however, the accumulation of fluids is resisted by a number of edema safety factors that work in concert to limit edema formation (Lymphatic flow, decrease osmotic pressure, reduce the number of capillaries, myogenic constriction of arterioles, venous bulging). It seems evident that this complex balance may easily be broken by modern everyday life common events.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91116733","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}
Sclerotherapy is performed in virtually every phlebology practice daily. It is a pillar of current varicose veins management. Practising phlebology without sclerotherapy is like using a table with one leg missing! Sclerotherapy is a safe and effective treatment method of chemically ablating troublesome refluxing superficial leg veins, and also unwanted cutaneous reticular and spider veins and to treat venous malformations. Liquid or foamed sclerosants cause destruction of the endothelial vein lining, with possibly damage also to the media, producing vein spasm, fibrosis and eventual sclerosis. I prefer to think of it as more of an art form than a science, and heavily dependent on the patient’s response to what is injected.
{"title":"Foreseeable Evolution in Sclerotherapy","authors":"GM Malouf","doi":"10.24019/jtavr.86","DOIUrl":"https://doi.org/10.24019/jtavr.86","url":null,"abstract":"Sclerotherapy is performed in virtually every phlebology practice daily. It is a pillar of current varicose veins management. Practising phlebology without sclerotherapy is like using a table with one leg missing! Sclerotherapy is a safe and effective treatment method of chemically ablating troublesome refluxing superficial leg veins, and also unwanted cutaneous reticular and spider veins and to treat venous malformations. Liquid or foamed sclerosants cause destruction of the endothelial vein lining, with possibly damage also to the media, producing vein spasm, fibrosis and eventual sclerosis. I prefer to think of it as more of an art form than a science, and heavily dependent on the patient’s response to what is injected.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77925693","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}
A phantom is a physical object to simplify device testing and clinical training. An industrial device is more reliable for device testing in quality control procedures, though it is expensive. When precision requirements are not so strict as it occurs in training, people prefer to use home-made phantoms, though many of these artisanal methods use animal products. The current paper illustrates a few alternative vegetal phantoms. Agar is a widely used material in laboratory investigations and can be used to contain ultrasound targets. Another quick and effective alternative is given by tofu. Target sizes and flow ultrasound measurements can be easily effected using a phantom and training can be planned and repeated as much as required. The current paper shows how low-cost animal phantoms can be perfectly replaced by low-cost vegetal ones for clinical and training purposes. Vegetal phantoms can be classified as possible realizations of the Replace, the 1st of the 3Rs pre-requisites for non-animal experiments.
{"title":"Non-animal ultrasound phantoms for device testing and training","authors":"F. Passariello","doi":"10.24019/JTAVR.26","DOIUrl":"https://doi.org/10.24019/JTAVR.26","url":null,"abstract":"A phantom is a physical object to simplify device testing and clinical training. An industrial device is more reliable for device testing in quality control procedures, though it is expensive. When precision requirements are not so strict as it occurs in training, people prefer to use home-made phantoms, though many of these artisanal methods use animal products. The current paper illustrates a few alternative vegetal phantoms. Agar is a widely used material in laboratory investigations and can be used to contain ultrasound targets. Another quick and effective alternative is given by tofu. Target sizes and flow ultrasound measurements can be easily effected using a phantom and training can be planned and repeated as much as required. The current paper shows how low-cost animal phantoms can be perfectly replaced by low-cost vegetal ones for clinical and training purposes. Vegetal phantoms can be classified as possible realizations of the Replace, the 1st of the 3Rs pre-requisites for non-animal experiments.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79359538","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}
F. Boccardo, S. Dessalvi, G. Villa, C. Campisi, C. Campisi
Background A side-effect of axillary lymph node excision and radiotherapy for breast cancer is arm lymphedema in about 25% patients (ranging from 13 to 52%). Sentinel lymph node (SLN) biopsy has reduced the severity of swelling to nearly 6% patients (from 2 to 7%) and, in case of positive SLN, complete axillary dissection (AD) is still required. That is why Axillary Reverse Mapping method (ARM) was developed aiming at identifying and preserve lymphatics draining the arm. Leaving in place lymph nodes related to arm lymphatic drainage would decrease the risk of arm lymphedema, but not retrieving all nodes, the main risk is to leave metastatic disease in the axilla. Based on long term experience in lymphatic-venous anastomoses (LVA) for lymphedema treatment, Authors conceived and carried out preventive LVA during nodal dissection (Lymphatic Microsurgical Preventing Healing Approach LY.M.P.H.A. technique). Methods 78 patients underwent axillary nodal dissection for breast cancer treatment and in 74 of them LY.M.P.H.A. procedure was performed. Indications to LY.M.P.H.A. technique were based on clinical and lymphoscintigraphic parameters. All blue nodes were resected and 2 to 4 main afferent lymphatics from the arm could be prepared and used for anastomoses. Lymphatics were introduced inside the vein cut-end by a U-shaped stitch. Volumetry was performed preoperatively in all patients and after 1, 6, 12 months and once a year. Lymphoscintigraphy was performed in 45 patients preoperatively and in 30 also postoperatively after at least over 1 year. Results Seventy-one patients had no sign of lymphedema. In 3 patients, lymphedema occurred after 8-12 months postoperatively. The incidence of secondary arm lymphedema after LY.M.P.H.A. technique was therefore 4.05%. Conclusion LVA proved not only to prevent lymphedema but also to reduce early lymphatic complications (i.e. lymphorrhea, lymphocele). LY.M.P.H.A. technique is also useful in patients with melanoma of the trunk and vulvar cancer, in whom it is possible to perform preventive LVA simultaneously with inguinal lymphadenectomy. Lymphedema is a consequence of cancer treatment. The use of the blue dye and of LVA helps to solve the problem of preventing secondary arm and leg lymphedema. LY.M.P.H.A. represents a rational approach to the prevention of lymphedema following axillary and groin surgery in the therapy of breast cancer, melanoma, vulvar cancer and other tumors.
{"title":"Surgical prevention of Lymphedema following lymph node dissection: LY.M.P.H.A. technique.","authors":"F. Boccardo, S. Dessalvi, G. Villa, C. Campisi, C. Campisi","doi":"10.24019/jtavr.41","DOIUrl":"https://doi.org/10.24019/jtavr.41","url":null,"abstract":"Background A side-effect of axillary lymph node excision and radiotherapy for breast cancer is arm lymphedema in about 25% patients (ranging from 13 to 52%). Sentinel lymph node (SLN) biopsy has reduced the severity of swelling to nearly 6% patients (from 2 to 7%) and, in case of positive SLN, complete axillary dissection (AD) is still required. That is why Axillary Reverse Mapping method (ARM) was developed aiming at identifying and preserve lymphatics draining the arm. Leaving in place lymph nodes related to arm lymphatic drainage would decrease the risk of arm lymphedema, but not retrieving all nodes, the main risk is to leave metastatic disease in the axilla. Based on long term experience in lymphatic-venous anastomoses (LVA) for lymphedema treatment, Authors conceived and carried out preventive LVA during nodal dissection (Lymphatic Microsurgical Preventing Healing Approach LY.M.P.H.A. technique). Methods 78 patients underwent axillary nodal dissection for breast cancer treatment and in 74 of them LY.M.P.H.A. procedure was performed. Indications to LY.M.P.H.A. technique were based on clinical and lymphoscintigraphic parameters. All blue nodes were resected and 2 to 4 main afferent lymphatics from the arm could be prepared and used for anastomoses. Lymphatics were introduced inside the vein cut-end by a U-shaped stitch. Volumetry was performed preoperatively in all patients and after 1, 6, 12 months and once a year. Lymphoscintigraphy was performed in 45 patients preoperatively and in 30 also postoperatively after at least over 1 year. Results Seventy-one patients had no sign of lymphedema. In 3 patients, lymphedema occurred after 8-12 months postoperatively. The incidence of secondary arm lymphedema after LY.M.P.H.A. technique was therefore 4.05%. Conclusion LVA proved not only to prevent lymphedema but also to reduce early lymphatic complications (i.e. lymphorrhea, lymphocele). LY.M.P.H.A. technique is also useful in patients with melanoma of the trunk and vulvar cancer, in whom it is possible to perform preventive LVA simultaneously with inguinal lymphadenectomy. Lymphedema is a consequence of cancer treatment. The use of the blue dye and of LVA helps to solve the problem of preventing secondary arm and leg lymphedema. LY.M.P.H.A. represents a rational approach to the prevention of lymphedema following axillary and groin surgery in the therapy of breast cancer, melanoma, vulvar cancer and other tumors.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83943068","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":"Answers to the invited commentaries on 'The hypothesis of the toxic effects of the venous collateral circulation' by F Passariello","authors":"F. Passariello","doi":"10.24019/JTAVR.45","DOIUrl":"https://doi.org/10.24019/JTAVR.45","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86885728","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}
Klippel-Trenaunay syndrome (KTS) is a complex vascular malformation that involves extensively the lower limb and may be combined with lymphatic and capillary defects. Very little has been published about hemodynamic of this disease. In this paper, we studied with duplex scan the hemodynamics in a group of 52 patients affected by KTS. In a former study, we recognized the following vascular venous defects: dysplastic venous areas infiltrating tissues, dysplastic superficial veins, hypoplasia and aplasia of deep veins, presence of marginal vein and presence of sciatic vein . The study demonstrates several hemodynamic defects, like venostasis and reflux in superficial dysplastic veins, blood stasis in infiltrating, mainly intramuscular, venous malformations, reflux and venostasis in large marginal veins, no main reflux in sciatic vein and dilatation of calf veins with some stasis but no reflux. Duplex scan study is mandatory in KTS but need to be an oriented exam in order to find out main defects existing in KTS. Standard examination, like in varicose veins, is not a correct study as it may ignore some main defects.
{"title":"Hemodynamics in Klippel-Trenaunay Syndrome","authors":"R. Mattassi, W. Pozzoli","doi":"10.24019/jtavr.48","DOIUrl":"https://doi.org/10.24019/jtavr.48","url":null,"abstract":"Klippel-Trenaunay syndrome (KTS) is a complex vascular malformation that involves extensively the lower limb and may be combined with lymphatic and capillary defects. Very little has been published about hemodynamic of this disease. In this paper, we studied with duplex scan the hemodynamics in a group of 52 patients affected by KTS. In a former study, we recognized the following vascular venous defects: dysplastic venous areas infiltrating tissues, dysplastic superficial veins, hypoplasia and aplasia of deep veins, presence of marginal vein and presence of sciatic vein . The study demonstrates several hemodynamic defects, like venostasis and reflux in superficial dysplastic veins, blood stasis in infiltrating, mainly intramuscular, venous malformations, reflux and venostasis in large marginal veins, no main reflux in sciatic vein and dilatation of calf veins with some stasis but no reflux. Duplex scan study is mandatory in KTS but need to be an oriented exam in order to find out main defects existing in KTS. Standard examination, like in varicose veins, is not a correct study as it may ignore some main defects.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87738378","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}
Recent findings suggest that inflammatory processes are involved in the structural remodelling in venous valves and in the vein wall, leading to valve incompetence and the development of varicose veins. This has been shown by several authors who found infiltration of valve leaflets and the venous wall by leukocytes (monocytes and tissue macrophages) in all valve specimens from patients with chronic venous disease (CVD) and in none from controls.
{"title":"Chronic venous disorders: from macrocirculation to microcirculation","authors":"P. Antignani","doi":"10.24019/JTAVR.49","DOIUrl":"https://doi.org/10.24019/JTAVR.49","url":null,"abstract":"Recent findings suggest that inflammatory processes are involved in the structural remodelling in venous valves and in the vein wall, leading to valve incompetence and the development of varicose veins. This has been shown by several authors who found infiltration of valve leaflets and the venous wall by leukocytes (monocytes and tissue macrophages) in all valve specimens from patients with chronic venous disease (CVD) and in none from controls.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73243365","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}
Aim The study started from the observation of complete recanalization of thrombus in subjects with DVT treated with rivaroxaban after 1-2 weeks. Aim of this clinicalinstrumental observational retrospective research is to evaluate clinically and by means of Echo color Duplex the fibrinolytic effect of Rivaroxaban in patients with recent and previous DVT. Methods We evaluated two populations of patients: 1st group: 27 patients males (range of age 50-73 years) with popliteal-femoral DVT (12 months before) treated with standard anticoagulant therapy. In this patients we found a complete superficial femoral recanalization and partial recanalization of the popliteal vein (30% of residual thrombus). The patients had normal creatinine clearance and liver function. The patients switched from warfarin to rivaroxaban for no compliance to warfarin. 2nd group: 19 patients (range of age 65-85 years) with previous popliteal-femoral DVT and complete common femoral veins recanalization (already know or documented). The patients presented recent superficial femoral vein re-thrombosis (1 week before). The patients had normal creatinine clearance and liver function. Results 1st group: we observed in all patients the complete recanalization of the popliteal veins. 2nd group: we observed in all patients the complete recanalization of the superficial femoral veins after 2 weeks of the therapy of Rivaroxaban and complete recanalization of the popliteal veins after 4 weeks. No adverse events for both groups were observed. Conclusion According to our results, we consider that Rivaroxaban could have a fibrinolytic effect not only on recent thrombus but also on organized thrombus with, as result, a complete recanalization of affected veins and consequent reduction of incidence of post-thrombotic syndrome saving the valves structure.
{"title":"Does Rivaroxaban have a fibrinolytic effect?","authors":"P. Antignani, C. Allegra","doi":"10.24019/JTAVR.46","DOIUrl":"https://doi.org/10.24019/JTAVR.46","url":null,"abstract":"Aim The study started from the observation of complete recanalization of thrombus in subjects with DVT treated with rivaroxaban after 1-2 weeks. Aim of this clinicalinstrumental observational retrospective research is to evaluate clinically and by means of Echo color Duplex the fibrinolytic effect of Rivaroxaban in patients with recent and previous DVT. Methods We evaluated two populations of patients: 1st group: 27 patients males (range of age 50-73 years) with popliteal-femoral DVT (12 months before) treated with standard anticoagulant therapy. In this patients we found a complete superficial femoral recanalization and partial recanalization of the popliteal vein (30% of residual thrombus). The patients had normal creatinine clearance and liver function. The patients switched from warfarin to rivaroxaban for no compliance to warfarin. 2nd group: 19 patients (range of age 65-85 years) with previous popliteal-femoral DVT and complete common femoral veins recanalization (already know or documented). The patients presented recent superficial femoral vein re-thrombosis (1 week before). The patients had normal creatinine clearance and liver function. Results 1st group: we observed in all patients the complete recanalization of the popliteal veins. 2nd group: we observed in all patients the complete recanalization of the superficial femoral veins after 2 weeks of the therapy of Rivaroxaban and complete recanalization of the popliteal veins after 4 weeks. No adverse events for both groups were observed. Conclusion According to our results, we consider that Rivaroxaban could have a fibrinolytic effect not only on recent thrombus but also on organized thrombus with, as result, a complete recanalization of affected veins and consequent reduction of incidence of post-thrombotic syndrome saving the valves structure.","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78119891","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":"Invited commentary on 'The hypothesis of the toxic effects of the venous collateral circulation' by F Passariello. The venous collateral circulation","authors":"Byung-Boong Lee","doi":"10.24019/jtavr.39","DOIUrl":"https://doi.org/10.24019/jtavr.39","url":null,"abstract":"","PeriodicalId":17406,"journal":{"name":"Journal of Theoretical and Applied Vascular Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79177692","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}
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