Journal of Bone and Joint Infection最新文献

{"title":"Early switch to oral antibiotic therapy for the treatment of patients with bacterial native vertebral osteomyelitis: a quaternary center experience, systematic review, and meta-analysis.","authors":"Matteo Passerini,&nbsp;Julian Maamari,&nbsp;Tarek Nayfeh,&nbsp;Leslie C Hassett,&nbsp;Aaron J Tande,&nbsp;Mohammad H Murad,&nbsp;Zelalem Temesgen,&nbsp;Elie F Berbari","doi":"10.5194/jbji-7-249-2022","DOIUrl":"https://doi.org/10.5194/jbji-7-249-2022","url":null,"abstract":"<p><p>Recent data suggest that oral therapy can be effective for bone infections. We aim to assess the efficacy of an early switch to oral therapy ( <math><mrow><mo><</mo> <mn>2</mn></mrow> </math>  weeks) compared to a non-early switch in bacterial native vertebral osteomyelitis. We conducted a cohort study at Mayo Clinic, Rochester (MN), between 2019-2021 combined with a systematic review, which queried multiple databases. Data were analyzed using a random-effects model. The cohort study included 139 patients: two received an early switch. Of 3708 citations, 13 studies were included in the final analysis. Meta-analysis demonstrated no difference in treatment failure (odds ratio  <math><mo>=</mo></math>  1.073, 95 % confidence interval 0.370-3.116), but many studies presented high risk of bias. Current evidence is insufficient to conclude the proportion of patients with failure or relapse is different in the two groups. High-quality studies are warranted before early switch can be routinely recommended.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"7 6","pages":"249-257"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9752704/pdf/jbji-7-249.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10766456","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}

{"title":"Timing of debridement, antibiotics, and implant retention (DAIR) for early post-surgical hip and knee prosthetic joint infection (PJI) does not affect 1-year re-revision rates: data from the Dutch Arthroplasty Register.","authors":"Barry van der Ende,&nbsp;Jakob van Oldenrijk,&nbsp;Max Reijman,&nbsp;Peter D Croughs,&nbsp;Liza N van Steenbergen,&nbsp;Jan A N Verhaar,&nbsp;P Koen Bos","doi":"10.5194/jbji-6-329-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-329-2021","url":null,"abstract":"<p><p>Debridement, antibiotics, and implant retention (DAIR) is a procedure to treat a periprosthetic joint infection (PJI) after total hip arthroplasty (THA) or total knee arthroplasty (TKA). The timing between the primary procedure and the DAIR is likely a determinant for its successful outcome. However, the optimal timing of a DAIR and the chance of success still remain unclear. We aimed to assess the risk of re-revision within 1 year after a DAIR procedure and to evaluate the timing of the DAIR in primary THA and TKA. We used data from the Dutch Arthroplasty Register (LROI) and selected all primary THA and TKA in the period 2007-2016 which underwent a DAIR within 12 weeks after primary procedure. A DAIR was defined as a revision for infection in which only modular parts were exchanged. A DAIR was defined as successful if not followed by a re-revision within 1 year after DAIR; 207 DAIRs were performed <math><mrow><mo><</mo> <mn>4</mn></mrow> </math>  weeks after THA, of which 16 (8 %) received a complete revision within 1 year. DAIR procedures performed between 4 and 12 weeks ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>98</mn></mrow> </math> ) had a failure rate of 9 % ( <math><mrow><mi>n</mi> <mo>=</mo> <mn>9</mn></mrow> </math> ). After TKA 126 DAIRs were performed in less than <math><mn>4</mn></math>  weeks, of which 11 (9 %) received a complete revision within 1 year; 83 DAIRs were performed between 4 and 12 weeks, of which 14 (17 %) were revised. There was no significant difference in 1-year re-revision rate after a DAIR procedure by timing of the DAIR procedure for total hip and knee arthroplasty based on Dutch registry data.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 8","pages":"329-336"},"PeriodicalIF":0.0,"publicationDate":"2021-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39409713","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":"Systematic review of risk prediction studies in bone and joint infection: are modifiable prognostic factors useful in predicting recurrence?","authors":"Maria Dudareva, Andrew Hotchen, Martin A McNally, Jamie Hartmann-Boyce, Matthew Scarborough, Gary Collins","doi":"10.5194/jbji-6-257-2021","DOIUrl":"10.5194/jbji-6-257-2021","url":null,"abstract":"<p><p><b>Background</b>: Classification systems for orthopaedic infection include patient health status, but there is no consensus about which comorbidities affect prognosis. Modifiable factors including substance use, glycaemic control, malnutrition and obesity may predict post-operative recovery from infection. <b>Aim</b>: This systematic review aimed (1) to critically appraise clinical prediction models for individual prognosis following surgical treatment for orthopaedic infection where an implant is not retained; (2) to understand the usefulness of modifiable prognostic factors for predicting treatment success. <b>Methods</b>: EMBASE and MEDLINE databases were searched for clinical prediction and prognostic studies in adults with orthopaedic infections. Infection recurrence or re-infection after at least 6 months was the primary outcome. The estimated odds ratios for the primary outcome in participants with modifiable prognostic factors were extracted and the direction of the effect reported. <b>Results</b>: Thirty-five retrospective prognostic cohort studies of 92 693 patients were included, of which two reported clinical prediction models. No studies were at low risk of bias, and no externally validated prediction models were identified. Most focused on prosthetic joint infection. A positive association was reported between body mass index and infection recurrence in 19 of 22 studies, similarly in 8 of 14 studies reporting smoking history and 3 of 4 studies reporting alcohol intake. Glycaemic control and malnutrition were rarely considered. <b>Conclusion</b>: Modifiable aspects of patient health appear to predict outcomes after surgery for orthopaedic infection. There is a need to understand which factors may have a causal effect. Development and validation of clinical prediction models that include participant health status will facilitate treatment decisions for orthopaedic infections.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 7","pages":"257-271"},"PeriodicalIF":0.0,"publicationDate":"2021-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9518173","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":"Extensive skin necrosis after periprosthetic knee infection: a case that highlights the possibility of complications induced by low-molecular-weight heparin.","authors":"Hélder Fonte,&nbsp;André Carvalho,&nbsp;João Rosa,&nbsp;Cláudia Pereira,&nbsp;Alexandre Pereira,&nbsp;Ricardo Sousa,&nbsp;Further Members Of The Porto Bone And Joint Infection Unit","doi":"10.5194/jbji-6-235-2021","DOIUrl":"https://doi.org/10.5194/jbji-6-235-2021","url":null,"abstract":"<p><p>We describe a case of a patient with atrial fibrillation, anticoagulated with dabigatran, that developed severe knee skin necrosis in the setting of an acute periprosthetic knee infection, after initiating low-molecular-weight heparin. A wide range of etiology hypotheses was discussed within a multidisciplinary team. The complex approach consisted of treating the underlying infection, multiple types of soft-tissue management, and stopping enoxaparin.</p>","PeriodicalId":15271,"journal":{"name":"Journal of Bone and Joint Infection","volume":"6 6","pages":"235-240"},"PeriodicalIF":0.0,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39162856","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}