Journal of Bone and Joint Infection最新文献

{"title":"Mid-term clinical results of chronic cavitary long bone osteomyelitis treatment using S53P4 bioactive glass: a multi-center study.","authors":"Tom A G Van Vugt,&nbsp;Jeffrey Heidotting,&nbsp;Jacobus J Arts,&nbsp;Joris J W Ploegmakers,&nbsp;Paul C Jutte,&nbsp;Jan A P Geurts","doi":"10.5194/jbji-6-413-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-413-2021","url":null,"abstract":"<p><p><b>Introduction</b>: Chronic osteomyelitis is a challenging condition in the orthopedic practice and traditionally treated using local and systemic antibiotics in a two-stage surgical procedure. With the introduction of the antimicrobial biomaterial S53P4 bioactive glass (Bonalive^®), chronic osteomyelitis can be treated in a one-stage procedure. This study evaluated the mid-term clinical results of patients treated with S53P4 bioactive glass for long bone chronic osteomyelitis. <b>Methods</b>: In this prospective multi-center study, patients from two different university medical centers in the Netherlands were included. One-stage treatment consisted of debridement surgery, implantation of S53P4 bioactive glass, and treatment with culture-based systemic antibiotics. If required, wound closure by a plastic surgeon was performed. The primary outcome was the eradication of infection, and a secondary statistical analysis was performed on probable risk factors for treatment failure. <b>Results</b>: In total, 78 patients with chronic cavitary long bone osteomyelitis were included. Follow-up was at least 12 months (mean 46; standard deviation, SD, 20), and 69 patients were treated in a one-stage procedure. Overall infection eradication was 85 %, and 1-year infection-free survival was 89 %. Primary closure versus local/muscular flap coverage is the only risk factor for treatment failure. <b>Conclusion</b>: With 85 % eradication of infection, S53P4 bioactive glass is an effective biomaterial in the treatment of chronic osteomyelitis in a one-stage procedure. A major risk factor for treatment failure is the necessity for local/free muscle flap coverage. These results confirm earlier published data, and together with the fundamentally different antimicrobial pathways without antibiotic resistance, S53P4 bioactive glass is a recommendable biomaterial for chronic osteomyelitis treatment and might be beneficial over other biomaterials.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":" ","pages":"413-421"},"PeriodicalIF":0.0,"publicationDate":"2021-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39644567","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":"Value of ultrasound-guided aspiration of hip arthroplasties performed in an orthopedic clinic by orthopedic surgeons.","authors":"Holly Duck,&nbsp;Suzanne Tanner,&nbsp;Debra Zillmer,&nbsp;Douglas Osmon,&nbsp;Kevin Perry","doi":"10.5194/jbji-6-393-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-393-2021","url":null,"abstract":"<p><p><b>Background</b>: Total joint arthroplasties continue to increase as do periprosthetic joint infections (PJIs). Ultrasound-guided aspiration can yield useful synovial fluid for analysis while avoiding radiation exposure. This study presents a high-yield, ultrasound-guided technique with analysis of aspiration results. <b>Methods</b>: All consecutive ultrasound-guided aspirations of hip arthroplasties performed from May 2016 through to April 2019 were retrospectively reviewed. Patient demographic information, component specifics, presence of draining sinus, and inflammatory markers were recorded. Results of aspiration including volume, appearance, lavage use, synovial fluid differential leukocyte count, synovial neutrophil percent, and culture results were recorded. Surgical results, specimen cultures, and surgeon description of purulence were recorded. Aspiration results were compared to the surgical specimen results in all patients who underwent reoperations. <b>Results</b>: Review of 349 hip aspirations demonstrated accuracy of 87 %, sensitivity of 83 %, specificity of 89 %, positive predictive value of 79 %, and negative predictive value 91 %. Surgical and aspiration cultures matched in 81 % of cases. Bloody aspirates and aspirates obtained after lavage had less accuracy at 69 % and 60 %, respectively. Specificity was 100 % for cultures obtained with lavage and 91 % for bloody aspirates. Synovial leukocyte count and neutrophil percentage was obtained in 85 % of aspirations, and cultures were obtained in 98 % of aspirates. Contamination rate was 2 %. <b>Conclusion</b>: Ultrasound-guided aspirations aid in the diagnosis of PJI. The use of lavage to obtain fluid is helpful when aspiration cultures are positive. Bloody aspirates are less accurate but have high specificity. A low contamination rate and 88 % accuracy results with this meticulous technique.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":" ","pages":"393-403"},"PeriodicalIF":0.0,"publicationDate":"2021-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39644133","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":"Fabrication of antibiotic-loaded dissolvable calcium sulfate beads: an in vitro mixing lab utilizing various antibiotic mixing formulas.","authors":"Edward J McPherson,&nbsp;Matthew V Dipane,&nbsp;Madhav Chowdhry,&nbsp;Andrew J Wassef","doi":"10.5194/jbji-6-405-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-405-2021","url":null,"abstract":"<p><p>Chronic periprosthetic joint infection (PJI) is a devastating complication that requires an aggressive eradication protocol. Local antimicrobial delivery via dissolvable calcium sulfate (CaSO <math><msub><mi></mi> <mn>4</mn></msub> </math> ) using small-sized beads (3-8 mm) has been utilized as an adjunctive treatment combined with implant exchange, radical debridement, and antimicrobial loaded acrylic spacers. The non-exothermic setting of CaSO <math><msub><mi></mi> <mn>4</mn></msub> </math> theoretically allows for any antimicrobial agent to be used, so long as mixing methods provide a consistent fabrication within a reasonable set time. This study performed the first in vitro mixing study, in which various antimicrobial agents, used singularly and in combination, were mixed with a synthetic CaSO <math><msub><mi></mi> <mn>4</mn></msub> </math> product to observe and document their interactions. The study was performed in a simulated operating room environment. We report a standard mix formula with set times, testing 22 different antimicrobial agents, combinations, and doses. For some antimicrobials and combinations, set times using the standard formula were either too fast or exceedingly slow. For these 14 antimicrobial agents and combinations, we were able to arrive at individualized mixing methods. We present all mixing formulas and set times. In all, we were able to establish mixing methods that incorporate all antimicrobial agents and combinations that we have seen utilized via surgeon-directed use.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":" ","pages":"405-412"},"PeriodicalIF":0.0,"publicationDate":"2021-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8600463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39644566","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":"Sternoclavicular joint septic arthritis in a healthy adult: a rare diagnosis with frequent complications.","authors":"Rui Barbeiro Gonçalves,&nbsp;André Grenho,&nbsp;Joana Correia,&nbsp;João Eurico Reis","doi":"10.5194/jbji-6-389-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-389-2021","url":null,"abstract":"<p><p>We report a case of complicated sternoclavicular joint septic arthritis in a previously healthy adult with no risk factors. An 83-year-old female presented to the emergency with a 1-week history of right shoulder pain followed by fever and prostration in the last 48 h. Computed tomography (CT) scan findings were consistent with right sternoclavicular joint (SCJ) septic arthritis complicated by periarticular abscess. Emergent surgical debridement was performed by a surgical team composed of orthopaedic and thoracic surgeons, followed by 6 weeks of antibiotic treatment. This case highlights the diagnosis and surgical treatment of a rare septic arthritis location but with frequent complications as well as the importance of multidisciplinary collaboration.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":" ","pages":"389-392"},"PeriodicalIF":0.0,"publicationDate":"2021-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39598006","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":"Long-term outcome of two-stage revision surgery after hip and knee prosthetic joint infections: an observational study.","authors":"Yorrick P Bourgonjen,&nbsp;J Fred F Hooning van Duyvenbode,&nbsp;Bruce van Dijk,&nbsp;F Ruben H A Nurmohamed,&nbsp;Ewout S Veltman,&nbsp;H Charles Vogely,&nbsp;Bart C H van der Wal","doi":"10.5194/jbji-6-379-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-379-2021","url":null,"abstract":"<p><p><b>Introduction</b>: Two-stage revision surgery is the most frequently performed procedure in patients with a chronic periprosthetic joint infection (PJI). The infection eradication rates in the current literature differ between 54 % and 100 %, which could be attributed to different treatment strategies. The aim of this study was to retrospectively evaluate the infection eradication rate in patients with chronic PJI treated with two-stage revision surgery of the hip or knee in primary and re-revision cases. <b>Methods</b>: All patients treated with a two-stage revision for chronic PJI between 2005 and 2011 were analysed. Patient and infection characteristics were retrieved. Primary outcome was successful infection eradication at last follow-up. Successful eradication is specified as no need for subsequent revision surgery or suppressive antibiotic treatment. <b>Results</b>: Forty-seven patients were treated with a two-stage revision. Infection eradication was achieved in 36 out of 47 cases. Thirty-eight patients had positive cultures: 35 monomicrobial infections and 3 polymicrobial infections. Nine cases of culture-negative infections were identified. Accompanying eradication rates were 26 out of 35 cases, 2 out of 3 cases, and 8 out of 9 cases respectively. Mean follow-up was 128 (27-186) months. For hip and knee revisions the eradication rates were 22 out of 31 cases and 14 out of 16 cases respectively. After primary arthroplasty the infection was eradicated in 29 out of 38 cases and after re-revision in 7 out of 9 cases. <b>Conclusion</b>: In this study, the infection eradication rate for two-stage revision surgery after PJI of the hip and knee in primary and re-revision cases was 77 %. No statistically significant patient, infection and micro-organism characteristics were found which influence the infection eradication rates at long-term follow-up of 128 (27-186) months.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 8","pages":"379-387"},"PeriodicalIF":0.0,"publicationDate":"2021-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8564768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39598019","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":"Diagnosis of orthopaedic-implant-associated infections caused by slow-growing Gram-positive anaerobic bacteria - a clinical perspective.","authors":"Diana Salomi Ponraj, Thomas Falstie-Jensen, Nis Pedersen Jørgensen, Christen Ravn, Holger Brüggemann, Jeppe Lange","doi":"10.5194/jbji-6-367-2021","DOIUrl":"10.5194/jbji-6-367-2021","url":null,"abstract":"<p><p>Slow-growing Gram-positive anaerobic bacteria (SGAB) such as <i>Cutibacterium acnes</i> are increasingly recognized as causative agents of implant-associated infections (IAIs) in orthopaedic surgeries. SGAB IAIs are difficult to diagnose because of their non-specific clinical and laboratory findings as well as the fastidious growth conditions required by these bacteria. A high degree of clinical suspicion and awareness of the various available diagnostic methods is therefore important. This review gives an overview of the current knowledge regarding SGAB IAI, providing details about clinical features and available diagnostic methodologies. In recent years, new methods for the diagnosis of IAI were developed, but there is limited knowledge about their usefulness in SGAB IAI. Further studies are required to determine the ideal diagnostic methodology to identify these infections so that they are not overlooked and mistakenly classified as aseptic failure.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 8","pages":"367-378"},"PeriodicalIF":1.8,"publicationDate":"2021-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39526765","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":"Viewpoint: Periprosthetic joint infection and dental antibiotic prophylaxis guidelines.","authors":"Miao Xian Zhou,&nbsp;Elie F Berbari,&nbsp;Cory G Couch,&nbsp;Scott F Gruwell,&nbsp;Alan B Carr","doi":"10.5194/jbji-6-363-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-363-2021","url":null,"abstract":"<p><p>The purpose of this viewpoint is to provide a framework that is used within the Mayo Clinic to align recommendations from infectious disease experts, dental specialists, and orthopedic surgeons with regards to need for antibiotic prophylaxis prior to invasive dental procedures.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 8","pages":"363-366"},"PeriodicalIF":0.0,"publicationDate":"2021-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8498598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39516057","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":"Mortality, functional outcomes and quality of life after hip fractures complicated by infection: a case control study.","authors":"Antonios A Koutalos,&nbsp;Christos Baltas,&nbsp;Vasileios Akrivos,&nbsp;Christina Arnaoutoglou,&nbsp;Konstantinos N Malizos","doi":"10.5194/jbji-6-347-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-347-2021","url":null,"abstract":"<p><p><b>Introduction</b>: Infection is a detrimental complication of operatively treated hip fractures. The objective of this retrospective case-control study was to evaluate the mortality, the physical function and the quality of life of hip fractures complicated with infection and determine risk factors for deep infection in hip fractures. <b>Patients and methods</b>: All patients with hip fractures (31A and 31B OTA/AO) that were operatively managed over a 10-year period that subsequently developed deep infection were included in the study. Thirty-nine patients met the inclusion criteria. These patients were compared with a matched control group of 198 patients without infection. Minimum follow-up was 1 year. Mortality, Barthel index score, EQ-5D-5L, Parker mobility score and visual analogue scale (VAS) pain score were compared between groups. <b>Results</b>: Mortality at 1 month was 20.5 % and 43 % at 1 year. Half of the infections were acute and 28 % were polymicrobial. Mortality was greater in the infection group (43 % vs. 16.5 %, <math><mrow><mi>p</mi> <mo><</mo> <mn>0.0014</mn></mrow> </math> ), and Barthel index was inferior in the infection group (14 vs. 18, <math><mrow><mi>p</mi> <mo><</mo> <mn>0.0017</mn></mrow> </math> ) compared to control group. Logistic regression analysis revealed that time from admission to surgery was a negative factor that predisposed to infection. <b>Conclusions</b>: Patients complicated with infection after a hip fracture have higher mortality and inferior functional results. Delay from admission to surgery predisposes to infection.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 8","pages":"347-354"},"PeriodicalIF":0.0,"publicationDate":"2021-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39490602","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":"Left hand extensor tenosynovitis due to <i>Histoplasma capsulatum</i> complicated by immune reconstitution inflammatory syndrome.","authors":"Talha Riaz,&nbsp;Mark Collins,&nbsp;Mark Enzler,&nbsp;Marco Rizzo,&nbsp;Audrey N Schuetz,&nbsp;Julia S Lehman,&nbsp;Douglas Osmon,&nbsp;Irene G Sia","doi":"10.5194/jbji-6-355-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-355-2021","url":null,"abstract":"<p><p>We describe a case of left hand extensor tenosynovitis due to histoplasmosis in a patient with dermatomyositis on chronic immunosuppression. Treatment involved surgical debridement and antifungal therapy. The patient experienced paradoxical worsening of tenosynovial inflammation during de-augmentation of immunosuppression felt to be immune reconstitution inflammatory syndrome.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 8","pages":"355-361"},"PeriodicalIF":0.0,"publicationDate":"2021-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39490604","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":"Cost of off-label antibiotic therapy for bone and joint infections: a 6-year prospective monocentric observational cohort study in a referral centre for management of complex osteo-articular infections.","authors":"Truong-Thanh Pham,&nbsp;Eugénie Mabrut,&nbsp;Philippe Cochard,&nbsp;Paul Chardon,&nbsp;Hassan Serrier,&nbsp;Florent Valour,&nbsp;Laure Huot,&nbsp;Michel Tod,&nbsp;Gilles Leboucher,&nbsp;Christian Chidiac,&nbsp;Tristan Ferry","doi":"10.5194/jbji-6-337-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-337-2021","url":null,"abstract":"<p><p><b>Introduction</b>: Costs related to bone and joint infection (BJI) management are increasing worldwide, particularly due to the growing use of off-label antibiotics that are expensive treatments (ETs), in conjunction with increasing incidence of multi-drug-resistant pathogens. The aim of this study was to evaluate the whole costs related to these treatments during the patient route, including those attributed to the rehabilitation centre (RC) stay in one regional referral centre in France. The total annual cost of ETs for managing complex BJIs in France was then estimated. <b>Material and methods</b>: A prospective monocentric observational study was conducted from 2014 to 2019 in a referral centre for BJI management (CRIOAc - Centre de Référence des Infections OstéoArticulaires complexes). Costs related to expensive treatments (\"old\" ETs, i.e. ceftaroline, ertapenem, daptomycin, colistin, tigecycline, and linezolid and \"new\" ETs, defined as those used since 2017, including ceftobiprole, ceftazidime-avibactam, ceftolozane-tazobactam, tedizolid, and dalbavancin) were prospectively recorded. In all cases, the use of these ETs was validated during multidisciplinary meetings. <b>Results</b>: Of the 3219 patients treated, 1682 (52.3 %) received at least one ET, and 21.5 % of patients who received ET were managed in RCs. The overall cost of ETs remained high but stable (EUR 1 033 610 in 2014; EUR 1 129 862 in 2019), despite the increase of patients treated by ETs (from 182 in 2014 to 512 in 2019) and in the cumulative days of treatment (9739 to 16 191 d). Daptomycin was the most prescribed molecule (46.2 % of patients in 2014 and 56.8 % in 2019, with 53.8 % overall), but its cost has decreased since this molecule was genericized in 2018; the same trend was observed for linezolid. Thus, costs for old ETs decreased overall, from EUR 1 033 610 in 2014 to EUR 604 997 in 2019, but global costs remained stable due to new ET utilization accounting for 46.5 % of overall costs in 2019. Tedizolid, used as suppressive antimicrobial therapy, represented 77.5 % of total new ET costs. In our centre, dalbavancin was never used. The cost paid by RCs for ETs and the duration of ET remained stable overall between 2016 and 2019. <b>Conclusions</b>: A high consumption of off-label ET is required to treat patients with BJIs in a CRIOAc, and the consequence is a high cost of antimicrobial therapy for these patients, estimated to be almost EUR 10 million in France annually. Costs associated with ET utilization remained stable over the years. On the one hand, the introduction of the generic drugs of daptomycin and linezolid has significantly decreased the share of old ETs, but, on the other hand, the need for new ETs to treat infections associated with more resistant pathogens has not led to decrease in the overall costs. A drastic price reduction of generic drugs is essential to limit the costs associated with more complex BJIs.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 8","pages":"337-346"},"PeriodicalIF":0.0,"publicationDate":"2021-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39409714","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}