Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders最新文献

{"title":"Patients Prescribed Anakinra for Acute Gout Have Baseline Increased Burden of Hyperuricemia, Tophi, and Comorbidities, and Ultimate All-Cause Mortality.","authors":"Ena Sharma,&nbsp;Brian Pedersen,&nbsp;Robert Terkeltaub","doi":"10.1177/1179544119890853","DOIUrl":"https://doi.org/10.1177/1179544119890853","url":null,"abstract":"<p><strong>Objective: </strong>The interleukin-1 (IL-1) receptor antagonist anakinra is an effective, off-label option in acute gout flares, when conventional therapy options are narrowed. We performed a retrospective, randomized, case-controlled study to gain clinical insight on baseline factors for gout patients most likely to receive anakinra, and ultimate mortality of those who received anakinra.</p><p><strong>Methods: </strong>Of 1451 gout patients seen between January 2003 and January 2015 in a Veterans Affairs (VA) rheumatology group practice, under stringent managed care principles, 13 (100% male), who received anakinra at least once for flares, were compared with 1:4 age- and sex-matched gout controls. Each patient's first rheumatology encounter was studied by factor analysis for variables associated with later anakinra.</p><p><strong>Results: </strong>At baseline, patients that received anakinra had higher urate burden (palpable tophi [10/13] vs controls [16/52], <i>P</i> = .003), serum urate ([10.6 mg/dL] vs controls [7.6 mg/dL], <i>P</i> < .0001), and East Asian descent ([7/13] vs [16/52], <i>P</i> = .041). The anakinra group had higher ultimate all-cause mortality ([6/13] vs controls [7/52], relative risk [RR] = 3.43, 95% confidence interval [CI] = 1.39-8.48, <i>P</i> = .0076). Factor analysis showed baseline visit palpable tophus and statin use to be most strongly associated with later anakinra use. Increased mortality of anakinra users, as per a factorial analysis, was linked more strongly to comorbidities than to anakinra.</p><p><strong>Conclusions: </strong>At baseline rheumatology gout encounter, higher urate, palpable tophi, statin prescription, and East Asian descent were associated with later anakinra use for flares. Mortality was more closely associated to the presence of comorbidities at baseline rheumatology visit than to anakinra prescription.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"12 ","pages":"1179544119890853"},"PeriodicalIF":2.6,"publicationDate":"2019-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544119890853","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37459564","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":"Safety of Intra-articular Methotrexate Injection With and Without Electroporation for Inflammatory Small Joints in Patients With Rheumatoid Arthritis","authors":"M. Tada, K. Inui, T. Okano, K. Mamoto, T. Koike, Hiroaki Nakamura","doi":"10.1177/1179544119886303","DOIUrl":"https://doi.org/10.1177/1179544119886303","url":null,"abstract":"The general disease activity of patients with rheumatoid arthritis (RA) is well controlled by disease-modifying antirheumatic drugs, but local inflammation often remains in a few small joints. Electroporation, making small pores in cell membranes, has proven useful for drug delivery. The safety of a combination therapy of methotrexate (MTX) and electroporation for local joint inflammation in RA was investigated in a prospective, randomized, double-blind, placebo-controlled, exploratory study (UMIN000016606). The patients were randomly allocated to groups receiving a combination of MTX and electroporation (True-EP) and MTX alone (False-EP) groups. The MTX solution was injected into finger joints under ultrasound guidance. The True-EP group underwent electroporation with MTX, and the False-EP group was given MTX but only pinched using the electrode. The ultrasound grade, disease activity, and safety were evaluated from baseline to 26 weeks. Five patients (3 True-EP and 2 False-EP) with a mean age of 57.4 years and disease duration of 10.2 years were enrolled. The grey-scale grade was unchanged in 3 cases (2 True-EP and 1 False-EP) and increased in 2 cases (1 True-EP and 1 False-EP). Disease activity was alleviated in 3 cases (2 True-EP and 1 False-EP). No patients experienced burned skin or electroshock. The combination therapy of electroporation and MTX was safe for RA patients.","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"21 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74860227","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":"Reliability and Accuracy of MRI in Orthopedics: A Survey of Its Use and Perceived Limitations.","authors":"Andrew Hong,&nbsp;Joseph N Liu,&nbsp;Anirudh K Gowd,&nbsp;Aman Dhawan,&nbsp;Nirav H Amin","doi":"10.1177/1179544119872972","DOIUrl":"https://doi.org/10.1177/1179544119872972","url":null,"abstract":"<p><p>Over the past decade, the use of magnetic resonance imaging (MRI) as a diagnostic tool has been increasing significantly in various fields of medicine due to its wide array of applications. As a result, its diagnostic efficacy and reliability come into question. Specifically, in the field of orthopedics, there has been little discussion on the problems many physicians face while using MRIs in practice. To gauge the perceived limitations of MRI, we designed a decision analysis to analyze the utility of MRIs and estimate the number of inconclusive MRIs ordered within an orthopedic practice to explore potential alternative avenues of diagnosis. A survey of 100 board-certified practicing orthopedic surgeons given at 2 national conferences was designed to assess the value, reliability, and diagnostic utility of MRIs in preoperative planning in shoulder and knee surgery. Of those surveyed, 93% reported that there was believed to be a problem with the accuracy of an MRI in the setting of a prior surgery and/or if previous hardware was present specifically pertaining to the knee or shoulder. The most common indications of concern regarding knee or shoulder MRI reliability among this sample group were previous patient hardware (19%), a previous surgery (16%), and a chondral defect (11%). In addition, when asked how many MRIs were believed to be inconclusive based on previous surgery/hardware alone in the last 6 months of practice, an average of 19 inconclusive MRIs was reported. This study summarizes some of the concerns of MRI use in the orthopedic community and attempts to add a unique perspective on the attitudes, decision-making, and apparent economic problems that they face as well as uncover specific instances where MRIs were determined to be unreliable and incomplete in aiding the diagnosis and treatment algorithm.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"12 ","pages":"1179544119872972"},"PeriodicalIF":2.6,"publicationDate":"2019-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544119872972","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41193595","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":"Colchicine-Induced Rhabdomyolysis: Clinical, Biochemical, and Neurophysiological Features and Review of the Literature.","authors":"Marcos Edgar Fernández-Cuadros,&nbsp;Gabriela Goizueta-San-Martin,&nbsp;Blanca Varas-de-Dios,&nbsp;Luz Otilia Casique-Bocanegra,&nbsp;Pablo Manrique-de-Lara-Cadiñanos,&nbsp;María Jesus Albaladejo-Florin,&nbsp;Ruben Algarra-López,&nbsp;Olga Susana Pérez-Moro","doi":"10.1177/1179544119849883","DOIUrl":"https://doi.org/10.1177/1179544119849883","url":null,"abstract":"<p><p>We report the case of a 46-years-old man with long-term asymptomatic hyperuricemia who started taking colchicine (0.5 mg/day) and allopurinol (100 mg/d) for normalization of biochemical values. After the third week of starting treatment, acute weakness was present; and by the fifth week, profound weakness in lower extremities and tenderness and cramps on thighs and calves with inability to climb stairs were also observed. Biochemical evaluation showed elevated muscle enzymes (creatinine kinase [CK] raised to five-folds its normal value) and electromyographic features were consistent with myopathy (at rest, fibrillations, positive sharp waves, high-frequency myotonic discharges; motor unit action potentials [MUAPs] of small amplitude, small duration, increased polyphasic Index and occasional satellite potentials; at maximal effort, interferential recruitment pattern with reduced amplitudes were observed). Normal motor and sensitive nerve conduction studies and normal late <i>F</i>-responses and <i>H</i>-reflex discarded neuropathy. Rapid improvement in muscle strength and prompt resolution of abnormal elevated muscle enzymes was observed after withdrawal of both medications. Colchicine is associated with some cases of myotoxicity but very small cases of colchicine-induced rhabdomyolysis are reported on the literature. Colchicine-induced rhabdomyolysis is related to the concomitant use of drugs (statins, steroids, erythromycin, and cyclosporine), renal, and/or hepatic impairment. To the best of our knowledge, this is an uncommon presentation of a case of colchicine-induced rhabdomyolysis reported in a patient without renal or hepatic dysfunction. Therefore, patients receiving colchicine even in the absence of renal insufficiency should be monitored for the development of myopathy and more rarely to rhabdomyolysis.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"12 ","pages":"1179544119849883"},"PeriodicalIF":2.6,"publicationDate":"2019-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544119849883","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37106352","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":"Progressive Akin Osteotomy.","authors":"Enrique Martinez Gimenez,&nbsp;Carmen Verdu Roman,&nbsp;Javier Sanz-Reig,&nbsp;Manuel Morales Santías,&nbsp;David Bustamante Suarez de Puga,&nbsp;Jesus Mas Martinez","doi":"10.1177/1179544119852099","DOIUrl":"https://doi.org/10.1177/1179544119852099","url":null,"abstract":"<p><p>The most common complication associated to Akin osteotomy is the intraoperative fracture of the lateral cortex of the proximal phalanx. We present a progressive Akin osteotomy that preserves the lateral cortex of the proximal phalanx and allows to remove the exact wedge size to achieve the preoperative planned correction.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"12 ","pages":"1179544119852099"},"PeriodicalIF":2.6,"publicationDate":"2019-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544119852099","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37048446","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":"Pseudoaneurysm of the Second Dorsal Metatarsal Artery: Case Report and Literature Review.","authors":"Christopher W Kinter,&nbsp;Christopher W Hodgkins","doi":"10.1177/1179544119849886","DOIUrl":"https://doi.org/10.1177/1179544119849886","url":null,"abstract":"<p><p>Pseudoaneurysms are a rare complication of foot and ankle surgeries that can potentially lead to serious sequelae, especially when there is delay in the diagnosis. Due to the rarity of this occurrence, guidelines for management are limited for orthopedic surgeons. Once diagnosed, the surgeon has to decide quickly on many options for how to best manage the patient. In this case report, we present the occurrence of a dorsal second metatarsal artery pseudoaneurysm that occurred after removal of hardware. We also discuss the most current literature on the subject to help guide other surgeons in the diagnosis and management of this condition.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"12 ","pages":"1179544119849886"},"PeriodicalIF":2.6,"publicationDate":"2019-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544119849886","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37339180","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":"Exploring Neuromuscular Electrical Stimulation Intensity Effects on Multifidus Muscle Activity in Adults With Chronic Low Back Pain: An Ultrasound Imaging-Informed Investigation.","authors":"Jaclyn Megan Sions,&nbsp;DeJ'a Chyanna Crippen,&nbsp;Gregory Evan Hicks,&nbsp;Abdulmohsen Meshari Alroumi,&nbsp;Tara Jo Manal,&nbsp;Ryan Todd Pohlig","doi":"10.1177/1179544119849570","DOIUrl":"https://doi.org/10.1177/1179544119849570","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Background: </strong>Neuromuscular electrical stimulation (NMES) is an effective tool for stimulating multifidus muscle contractions. Ultrasound imaging (USI) is valid and reliable for quantifying multifidus activity represented by percent thickness change from a resting to contracted state. Thus, USI may be used to help determine optimal NMES intensity.</p><p><strong>Objectives: </strong>To explore NMES intensity effects on multifidus thickening in adults with chronic low back pain (CLBP).</p><p><strong>Methods: </strong>Sixty patients with CLBP participated. L4/5 multifidus ultrasound images were obtained and percent thickness change from a resting to a contracted state was determined at baseline with a limb lift and during NMES application. During NMES, the examiner recorded the intensity, in milliampere, when the multifidus first started to thicken as observed with USI. The examiner also recorded the NMES intensity that resulted in no further multifidus thickening (ie, high-tolerance group) or, in cases where maximal thickening was not observed, the NMES intensity of the submaximal contraction (ie, low-tolerance group). Differences between participants with high versus low NMES tolerance were evaluated.</p><p><strong>Results: </strong>During NMES, the multifidus began thickening at a higher intensity for the high-tolerance group (n = 39), that is, 34 mA, compared with the low-tolerance group (n = 21), that is, 32 mA (<i>P</i> = .001). A greater mean intensity in the high-tolerance group, that is, 62 mA, as compared to 45 mA in the low-tolerance group, resulted in a larger percent thickness change, that is, 30.89% compared to 20.60%, respectively (<i>P</i> < .001).</p><p><strong>Conclusions: </strong>Results provide clinicians with NMES intensity targets to facilitate multifidus muscle thickening, which provides insight into muscle activity.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"12 ","pages":"1179544119849570"},"PeriodicalIF":2.6,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544119849570","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37339179","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":"Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? A Pilot Randomised Controlled Trial.","authors":"Thomas W Wainwright,&nbsp;Louise C Burgess,&nbsp;Robert G Middleton","doi":"10.1177/1179544119849024","DOIUrl":"https://doi.org/10.1177/1179544119849024","url":null,"abstract":"<p><strong>Aim: </strong>Following soft tissue ankle injury, patients are often referred for out-patient physiotherapy and present symptoms including pain, reduced range of movement and function, and oedema. In this study, we assess the use of a neuromuscular electrical stimulation (NMES) device as an adjunctive therapy to reduce oedema in patients recovering from grade I and II ankle sprains.</p><p><strong>Methods: </strong>This was a single-centre, pilot randomised controlled study, recruiting patients referred to physiotherapy following an ankle sprain. Participants presenting with oedema were randomised to one of two treatment groups: (1) the current standard of care and (2) the current standard of care plus NMES use. Participants were identified in an emergency department and referred to a physiotherapy department for treatment 1 to 5 days following the injury and returned to clinic 7 days later.</p><p><strong>Results: </strong>Twenty-two participants completed the study and had full data sets for analysis (11 in each group). Mean volumetric displacement was reduced in the intervention group in comparison to the standard care group (<i>P</i> = .011); however, there were no between-group differences in figure of eight measurements, function or pain scores. The device was well tolerated, with no device-related adverse events recorded.</p><p><strong>Conclusions: </strong>In this pilot, randomised controlled trial, NMES was well tolerated by patients following ankle sprain and demonstrated statistically significant improvements in oedema reduction as measured by fluid displacement. No other changes were observed. Further work will need to confirm the clinical significance and effect on longer term recovery post-ankle sprain.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"12 ","pages":"1179544119849024"},"PeriodicalIF":2.6,"publicationDate":"2019-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544119849024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37339178","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":"Comparison of Bone Mineral Densitometry at 2 Sites Versus 3 Sites in Patients Suspicious for Osteoporosis.","authors":"Ahad Azami,&nbsp;Hasan Anari,&nbsp;Manouchehr Iranparvar,&nbsp;Amin Azizi,&nbsp;Afshin Habibzadeh","doi":"10.1177/1179544119849017","DOIUrl":"https://doi.org/10.1177/1179544119849017","url":null,"abstract":"<p><strong>Objectives: </strong>In this study, we aim to evaluate the bone mineral density (BMD) results of 2 standard sites with 3 sites including wrist in diagnosing osteoporosis.</p><p><strong>Methods: </strong>We evaluated the BMD results of 1272 individuals referred for suspected osteoporosis between 2012 and 2015. Those individuals were included with BMD at lumbar spine, femur neck, and wrist. Bone mineral density was measured using a dual-energy X-ray absorptiometry (DXA) device. Bone mineral density and <i>T</i> score were measured for all 3 sites.</p><p><strong>Results: </strong>There was significant correlation between wrist <i>T</i> score with hip <i>T</i> score (<i>r</i> = 0.606, <i>P</i> < .001) and lumbar <i>T</i> score (<i>r</i> = 0.527, <i>P</i> < .001). With BMD of 2 sites, patients had osteopenia in 46.3% and osteoporosis in 23.7%, while by adding wrist T-BMD, subjects had osteopenia in 46.6% and osteoporosis in 33%. Between BMD at 2 sites and 3 sites, there was concordance in 81.9%, minor discordance in 17.6%, and major discordance in 0.5%.</p><p><strong>Conclusions: </strong>We observed discordance between BMD measurements of 2 sites and 3 sites, with latter detecting more cases with osteoporosis. In fact, measurement of <i>T</i> scores of wrist along with lumbar and femur neck improves the diagnosis.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"12 ","pages":"1179544119849017"},"PeriodicalIF":2.6,"publicationDate":"2019-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544119849017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37339177","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":"Supartz (Sodium Hyaluronate) for the Treatment of Knee Osteoarthritis: A Review of Efficacy and Safety.","authors":"Amy Bronstone,&nbsp;Jacob T Neary,&nbsp;Todd H Lambert,&nbsp;Vinod Dasa","doi":"10.1177/1179544119835221","DOIUrl":"https://doi.org/10.1177/1179544119835221","url":null,"abstract":"<p><p>As concerns about the safety of systemic oral pharmacologic treatments for knee osteoarthritis (OA) mount, clinicians have increased the use of intra-articular hyaluronic acid (IA-HA) in managing mild-to-moderate knee OA. Supartz (sodium hyaluronate; Seikagaku Corporation, Tokyo, Japan) is the first IA-HA product to be approved in the world and has the longest history of global use. In this review, we summarize evidence supporting Supartz efficacy and safety, including data from pivotal clinical trials that resulted in approval of Supartz in the United States and Japan, the safety of single and repeated courses of Supartz, and Supartz efficacy using objective outcomes and in special populations. There is strong evidence that single 5-week courses of Supartz provide clinically meaningful reductions in pain and improved function for up to 6 months without risk of serious side effects or complications. Repeated courses of Supartz are as safe as single courses and have an extremely low risk of infection. Findings from promising initial studies, which suggest that Supartz may improve muscle strength, gait pattern, and balance, should be confirmed in randomized controlled trials.</p>","PeriodicalId":10443,"journal":{"name":"Clinical Medicine Insights. Arthritis and Musculoskeletal Disorders","volume":"12 ","pages":"1179544119835221"},"PeriodicalIF":2.6,"publicationDate":"2019-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1179544119835221","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37183578","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}