Global Spine Journal最新文献

{"title":"The \"20-minute Rule\" in Lateral Lumbar Interbody Fusion. Fact or Fiction? A Multi-Center Analysis of 658 Patients.","authors":"Ashish Patel, Michael R McDermott, Gregory M Mundis, Robert K Eastlack, Aaron J Buckland, Cristiano M Menezes, Matthew L Miller, Chester J Tyson, Alfred-John Bayaton, J Alex Thomas","doi":"10.1177/21925682251321490","DOIUrl":"10.1177/21925682251321490","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort Study.ObjectiveLateral lumbar interbody fusion (LLIF) is a treatment option for correcting lumbar degenerative pathologies that uses a retroperitoneal, transpsoas corridor to the disc space. Conventional teaching of the LLIF technique has been to perform the procedure 'as efficiently as possible', with a goal of keeping the total retractor time to less than 20 minutes to prevent injuries. This study aims to examine the sensitivity of the \"20-minute\" rule for predicting postoperative femoral nerve palsy.MethodsA multicenter, retrospective cohort of patients who underwent an LLIF was established. Retractor time was recorded and compared to postoperative motor exams for its relationship to motor injury.Results658 total patients were included in the study. The most frequently operated level was L4-5 (71.7%). The average retractor time was 17.5 ± 8.0 minutes. The injury rate of the cohort was 1.8% (12/658). There was no difference in average retractor time for non-injured vs injured patients (17.5 ± 8.0 min vs 19.6 ± 11.2 min, <i>P</i> = 0.367). Analysis of the \"20-minute\" rule for LLIF revealed a sensitivity of 50%, a specificity of 73.8%, and a positive predictive value of 3.4%. There were 174 patients with retractor times >20 minutes and six injuries, yielding a false positive rate of 96.6%.ConclusionPost-operative quadriceps motor palsy after lateral lumbar interbody fusion does not appear to be caused by prolonged retractor time greater than 20 minutes. The authors recommend surgical efficiency without the need to rush through the procedure because the \"20-Minute\" threshold is approaching. Limiting retractor time to under 20 minutes was a poor predictor of post-operative quadriceps injury.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251321490"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Traumatic Spinal Cord Injury and Psychiatric Disorders, Mental Illness and Dementia: A Systematic Review and Meta-Analysis.","authors":"Li Li, Tiantian Wang, Huimin Du, Yuantong Zang","doi":"10.1177/21925682241307597","DOIUrl":"10.1177/21925682241307597","url":null,"abstract":"<p><p>Study DesignSystematic review and meta-analysis.ObjectivesMeta-analysis was used to evaluate the association between traumatic spinal cord injury and mental disorders, psychological disorders, and dementia onset, and to provide a scientific basis for the prevention of traumatic spinal cord injury.MethodsA computerized search of English databases such as PubMed, Web of Science, Embase, and other English databases for retrospective studies on the associations between traumatic spinal cord injury and psychiatric disorders, mental illnesses, and dementia was carried out within a timeframe of from the creation of the databases to 7 April 2024, and two researchers independently carried out the screening of the literature, extracted and collated the baseline and endpoint indicators, and assessed the quality of the literature, before conducting meta-analysis by using the Stata 15.1 software for meta-analysis.ResultsEleven papers were included, and meta-analysis showed that patients with traumatic spinal cord injury were at significantly higher risk of anxiety, depression, psychosis, dementia, insomnia, adjustment disorders, mood disorders, personality disorders, alcohol-related disorders, substance-use disorders, adjustment reactions, drug dependence, and central pain relative to patients with nontraumatic spinal cord injury (<i>P</i> < 0.05); there was no significant correlation between traumatic spinal cord injury and PTSD.ConclusionsTraumatic spinal cord injury may increase the risk of developing anxiety, depression, psychiatric disorders, and dementia; with national regional differences in the risk of developing anxiety. Clinical staff should be alert to the possibility of co-existence of psychiatric disorders, psychological disorders and dementia when diagnosing patients with traumatic spinal cord injury.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682241307597"},"PeriodicalIF":2.6,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11910731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"3D Sagittal Parameters Can Guide the Indications for Anterior Release in Thoracic AIS ≥70°.","authors":"Taylor J Jackson, Carrie E Bartley, Tracey P Bryan, Michael P Kelly, Suken A Shah, Stefan Parent, Firoz Miyanji, Peter O Newton","doi":"10.1177/21925682251325833","DOIUrl":"10.1177/21925682251325833","url":null,"abstract":"<p><p>Study DesignRetrospective, multicenter.ObjectivesThis study aims to evaluate the immediate postoperative effect of, and define indications for, an anterior release (discectomy) in large AIS curves utilizing 3D deformity analysis.MethodsA multicenter registry was queried for AIS patients with main thoracic curves ≥70° treated with either anterior/posterior (AP) or posterior-only surgery and biplanar stereoradiographic pre-operative and first-erect (FE) postoperative images. Standard 2D radiographic and 3D parameters were analyzed using custom MATLAB software. 3D thoracic kyphosis (3DTK) was calculated by removing the error induced by axial rotation and coronal deformity.Results109 patients were included, 21 AP and 88 posterior-only. The AP group had larger (89° vs 76°, <i>P</i> < .001), less flexible (9% vs 21%, <i>P</i> = .001) curves, though greater percent correction (79% vs 71%, <i>P</i> = .003), producing similar postoperative curve magnitude (19° vs 22°, <i>P</i> = 0.1). The AP group had less preoperative 3DTK (-15° vs -3°, <i>P</i> < .001), though similar postoperative 3DTK (24° vs 20°, <i>P</i> = .1), nearly double the improvement (39° vs 23°, <i>P</i> < .001). No cases with preoperative 3DTK < -18° achieved postoperative 3DTK >25° without anterior release. Segmental data of each motion segment demonstrated anterior release led to greater change in the coronal (<i>P</i> < .001) and sagittal (<i>P</i> = .003) planes, though not axial rotation of the apical vertebra (<i>P</i> = .157).ConclusionIn a cohort of AIS patients with thoracic curve magnitude >70°, 3D analysis comparing anterior/posterior vs posterior-only approach demonstrated improved correction in the coronal and sagittal, but not the axial plane. If 3DTK preop was <-18° only anterior release patients achieved postoperative 3DTK >25°.Level of EvidenceIII.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251325833"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Controlled Single-Centre Pilot Study to Evaluate the Effect of Prophylactic Surgery in Asymptomatic Degenerative Cervical Cord Compression.","authors":"Zdenek Kadanka, Martin Nemec, Richard Chaloupka, Ludek Ryba, Karel Maca, Dusan Matejicka, Tomas Rohan, Milos Kerkovsky, Tomas Horak, Magda Horakova, Eva Vlckova, Josef Bednarik","doi":"10.1177/21925682251323862","DOIUrl":"10.1177/21925682251323862","url":null,"abstract":"<p><p>Study DesignSingle-centre controlled pilot study.ObjectivesTo evaluate the effect of prophylactic surgery and to review the biases of a therapeutic trial in asymptomatic degenerative cervical cord compression (ADCC) patients.MethodsPatients with ADCC and at least 1 predictor of progression to symptomatic degenerative cervical cord myelopathy (DCM) were offered either prophylactic surgery or standard structured rehabilitation. Recruited patients were clinically followed to detect the development of symptomatic DCM.ResultsForty-one patients treated surgically and 68 patients treated non-surgically completed the minimum 36 months' follow-up; 3 recruited patients were lost from evaluation. The surgical group had a higher Neck Disability Index score and more severe MRI compression. A matched subgroup of 41 non-surgical patients was created to reduce potential bias. During the follow-up period we observed progression to symptomatic DCM in 1 surgical case (2.4%) compared to 9 patients in the non-surgical group (13.2%, <i>P</i> = 0.054) and 7 cases in the matched non-surgical group (17.1%, <i>P</i> = 0.029). We observed non-serious early postoperative complications in 4 patients, which resolved spontaneously or after surgical revision. In 9 patients with progression to DCM, the myelopathy was mild with mJOA scale 15-17. One patient in the non-surgical group and 1 patient in the surgical group who progressed to DCM underwent surgery with a good outcome.ConclusionsProphylactic surgery led to a significant decrease in proportion of ADCC patients with progression to DCM. The results justify the organisation of a large randomized multicentre trial that may demonstrate the benefit of prophylactic surgery in ADCC patients.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251323862"},"PeriodicalIF":2.6,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11909656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Proclaim (Best Available) Truth From the Rooftops\": A Community Doc's Alternate View on Dissemination & Implementation of AO Spine/Praxis' 2024 Acute Spinal Cord Injury Guidelines.","authors":"Cristian Arvinte","doi":"10.1177/21925682251326931","DOIUrl":"10.1177/21925682251326931","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251326931"},"PeriodicalIF":2.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: 'The Safety of Spinal Surgery in Patients Over 80 Years of Age: Propensity Score Matching Study' by Bang C et al.","authors":"Yabin Liu, Xiaohua Jiang, Xicun Han, Guowu Chen","doi":"10.1177/21925682251327367","DOIUrl":"10.1177/21925682251327367","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251327367"},"PeriodicalIF":2.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion in the Treatment of Degenerative Cervical Myelopathy: Patient Characteristics and Surgical Outcomes in a National Administrative Database.","authors":"Charles N de Leeuw, Won Hyung Andrew Ryu, Jung Yoo, Josiah N Orina","doi":"10.1177/21925682251325823","DOIUrl":"10.1177/21925682251325823","url":null,"abstract":"<p><p>Study DesignA retrospective cohort utilizing the PearlDiver Patient Claims Database.ObjectiveCervical disc arthroplasty (CDA) is accepted treatment for cervical radiculopathy; however, it may also be safe and effective in myelopathy. Thus, we compared clinical characteristics and outcomes in patients undergoing CDA and anterior cervical discectomy and fusion (ACDF) for degenerative cervical myelopathy (DCM) specifically.MethodsPatients undergoing CDA or ACDF between 2015-2019 were identified with follow-up through 2021. Univariate and multivariable analyses were performed to identify factors associated with either procedure. Reoperation rates were compared using propensity-matched analysis.ResultsWe identified n = 2391 CDA and n = 50 845 ACDF procedures for DCM. Factors favoring CDA included: female sex, younger age, lower CCI, lower incidence of obesity, osteoporosis, diabetes, or smoking (<i>P</i> ≤ .001); remaining significant after multivariable logistic regression except for sex (<i>P</i> = .06). Single-level surgery was more predictive for undergoing CDA. CDA patients had lower 90-day readmissions, complications, and lower opioid utilization. The overall reoperation rate was 5%. Predictors of reoperation included: male sex, younger age, greater CCI, obesity, osteoporosis, diabetes, smoking, and multi-level surgery; all remaining significant after multivariable analysis except for diabetes (<i>P</i> = .23) and CCI (<i>P</i> = .05). After propensity-matching CDA and ACDF patients (n = 2391), there was no difference in re-operation rates (<i>P</i> = .47).ConclusionsCDA patients were healthier (less obesity, smoking, diabetes, better CCI) and represented 4.5% of anterior procedures for DCM. In univariate analysis, readmission rates, medical complications, and opioid use were lower in CDA patients, despite a similar reoperation rate. Considering these findings, CDA might be used very selectively for DCM.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251325823"},"PeriodicalIF":2.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Proclaim (Best Available) Truth From the Rooftops\": A Community Doc's Alternate View on Dissemination& Implementation of AO Spine/Praxis' 2024 Acute Spinal Cord Injury Guidelines.","authors":"Michael G Fehlings, Nathan Evaniew, Andrea C Skelly, Lindsay A Tetreault, Brian K Kwon","doi":"10.1177/21925682251326926","DOIUrl":"10.1177/21925682251326926","url":null,"abstract":"","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251326926"},"PeriodicalIF":2.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparative Analysis of Revision Rates in Surgical Treatments for Lumbar Isthmic Spondylolisthesis.","authors":"Wesley M Durand, Theodore Quan, Yesha Parekh, S Tim Yoon, Patrick C Hsieh, Hai Le, Philip K Louie, Stipe Corluka, Hardeep Singh, Samuel K Cho, Sathish Muthu, Zori Buser, Waeel Hamouda, Andreas K Demetriades, Gianluca Vadalà, Amit Jain","doi":"10.1177/21925682251326914","DOIUrl":"10.1177/21925682251326914","url":null,"abstract":"<p><p>Study DesignRetrospective Cohort Study.ObjectiveIsthmic spondylolisthesis is frequently encountered in spine surgical practice, though there is a significant variation in surgical management strategies. We sought to evaluate revision rates between patients who underwent anterior-approach lumbar interbody fusion (ALIF) alone, posterolateral fusion (PLF) alone, PLIF/TLIF, and ALIF+PSF.MethodsThis retrospective study utilized a large commercial insurance claims database of patients ≤65 years-old. Patients with isthmic spondylolisthesis who underwent single-level instrumented arthrodesis were included, and those who underwent revision surgery, surgery for deformity, multi-level surgery, or surgery for traumatic, infectious, or neoplastic etiologies were excluded, as determined by ICD-10-CM and CPT codes. Patients were assigned to surgical cohorts of ALIF alone, PLF alone, PLIF/TLIF, and ALIF+PSF based on CPT codes. Additional independent variables included age, sex, decompression at index surgery, and region. The primary outcome was revision arthrodesis or decompression, defined using CPT codes. Kaplan-Meier analysis and Cox Proportional Hazards regression were utilized to assess differences in revision occurrence between cohorts.Results1014 patients who underwent single-level arthrodesis for isthmic spondylolisthesis were included. The mean age was 48.6 years, with a mean follow-up of 637.6 days. The majority of patients underwent PLIF/TLIF (60.6%, n = 614), followed by ALIF+PSF (18.5%, n = 188), PLF alone (14.4%, n = 146), and ALIF alone (6.5%, n = 66). The 5-year revision-rate was 11.0% for all patients in the Kaplan-Meier analysis. In multivariable analysis adjusting for confounding factors, ALIF-alone demonstrated significantly higher occurrence of revision compared to both ALIF+PSF (HR 5.0, <i>P</i> = 0.0026) and PLIF/TLIF (HR 5.8, <i>P</i> < 0.0001) groups. Similarly, PLF alone demonstrated significantly higher occurrence of revision surgery compared to PLIF/TLIF (HR 2.4, <i>P</i> = 0.0379) while other comparisons were not statistically significant.ConclusionsIn this analysis of single-level arthrodesis for isthmic spondylolisthesis, patients who underwent ALIF alone had higher revision rates than those who underwent PLIF/TLIF and ALIF+PSF surgery, and those who underwent PLF alone had higher revision rates than those who underwent PLIF/TLIF. Surgical strategies providing both anterior and posterior column support resulted in lower real-world revision rates.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251326914"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Metastatic Spine Tumor Research: A Review of AO Spine Knowledge Forum Tumor's Scientific Contributions Derived From the EPOSO Network, 2014-2024.","authors":"Joost Phj Rutges, Scott L Zuckerman, Paul M Arnold, Chetan Bettegowda, Stefano Boriani, Michelle J Clarke, Michael G Fehlings, Ziya L Gokaslan, Aron Lazary, Laurence D Rhines, Arjun Sahgal, Daniel M Sciubba, James M Schuster, Michael H Weber, Ilya Laufer, Charles G Fisher","doi":"10.1177/21925682251326515","DOIUrl":"10.1177/21925682251326515","url":null,"abstract":"<p><p>Study DesignNarrative Review.ObjectivesTo summarize the work of the AO Spine Knowledge Forum Tumor, specifically studies from the Epidemiology, Process and Outcomes in Spine Oncology (EPOSO) study.MethodsA narrative review of all published manuscripts from the EPOSO study was undertaken. EPOSO represents a multicenter, prospective registry effort across 10 North American and European sites to enroll patients with metastatic disease of the spine.ResultsThe current review summarized all studies from the EPOSO network, divided into the following five sections: (1) quality of life and satisfaction, (2) overall survival, (3) spinal instability, (4) neurologic outcome in patients with metastatic epidural spinal cord compression or radicular pain, and (5) patient and tumor-specific factors. Several important findings were elucidated. Patient evaluation should include SINS, nutritional status, severity and duration of neurologic deficit, extent of metastatic tumor burden, and differentiation of axial from radicular pain. Moreover, SOSGOQ2.0 serves as a useful and validated instrument for patient-reported outcome instrument. Despite the palliative nature of metastatic spine surgery, clear improvement in quality-of-life is seen. Even in patients with short-survival, the remaining weeks and months of life result in improved quality-of-life. Metastatic spine surgery often improves neurologic function, potentially enhancing survival through increased performance status.ConclusionsSeveral noteworthy results have come from the EPOSO network, highlighting important trends in metastatic spine care. The AO Spine Knowledge Forum Tumor has helped advancing metastatic spine tumor research as well as ensure these new findings reach and benefit clinicians and their patients.</p>","PeriodicalId":12680,"journal":{"name":"Global Spine Journal","volume":" ","pages":"21925682251326515"},"PeriodicalIF":2.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11907629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143614375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}