Journal of Bone and Joint Surgery, American Volume最新文献

{"title":"Magnetic Intramedullary Lengthening Nails Can Be Lengthened to Their Maximum Capacity with No Increased Nail Complications: A Study of Pediatric and Adult Populations.","authors":"Sandeep S Bains, Reza Katanbaf, Whitney Pettijohn, Daniel Hameed, Jeremy A Dubin, John E Herzenberg, Philip K McClure","doi":"10.2106/JBJS.24.00160","DOIUrl":"https://doi.org/10.2106/JBJS.24.00160","url":null,"abstract":"<p><strong>Background: </strong>Magnetic intramedullary lengthening nails (MILNs) have become an increasingly popular method for long-bone distraction osteogenesis as a means of overcoming the limitations of bone lengthening with an external fixator. While factors such as nail diameter, alignment, and other mechanical characteristics have been associated with an increased risk of nail breakage, the relationship between the percentage of maximum lengthening utilized and nail breakage remains unexplored. We specifically assessed overall complications, with and without the inclusion of contractures, based on the amount of distraction (25% to 60%, 61% to 90%, and 91% to 100% of maximum).</p><p><strong>Methods: </strong>We retrospectively reviewed the records for 176 pediatric patients and 109 adult patients who had undergone limb lengthening and had ≥24 months of follow-up. The cohort was further stratified by the amount of distraction: 25% to 60% (n = 75 children and 30 adults), 61% to 90% (n = 72 children and 29 adults), and 91% to 100% (n = 29 children and 50 adults). The mean ages were 14.53, 13.53, and 12.49 years, respectively, in the pediatric cohorts and 27.1, 34.3, and 23.8 years, respectively, in the adult cohorts. The percentages of males and females were 48% vs. 52%, 54.2% vs. 45.8%, and 48.3% vs 51.7%, respectively, in the pediatric cohorts and 56.7% vs. 43.3%, 51.8% vs. 48.2%, and 58% vs. 42% in the adult cohorts. Complications included contractures, loss of length, bone fracture, axial deviation, nail failure, failure to lengthen, nail fracture/failure, and screw failure. Analysis of variance (ANOVA) was conducted to compare mean complications across the 3 distraction categories, and Tukey pairwise t tests were performed to compare mean complications between individual distraction categories.</p><p><strong>Results: </strong>Without contractures, complication rates were similar between the pediatric cohorts (p = 0.09): 4.0% (25% to 60% distraction), 13.9% (61% to 90% distraction), and 6.9% (91% to 100% distraction). With contractures included, complication rates were greatest in the 61% to 90% pediatric cohort (38.9%), followed by the 91% to 100% cohort (27.6%) and the 25% to 60% cohort (13.3%) (p = 0.002). Similarly, the adult population had a homogeneous rate of complications without the inclusion of contractures (p = 0.13). Likewise, we observed a similarly variable distribution with contractures considered, with the greatest frequency in the 91% to 100% group (36%), followed by the 61% to 90% group (31%) and the 25% to 60% group (10%) (p = 0.04).</p><p><strong>Conclusions: </strong>This is the first study to explore the relationship between the percentage of nail lengthening and nail complications. The speculation that full extension of the nail could lead to increased nail bending or breakage was not consistent with our findings. This finding was consistent whether contractures were included or not.</p><p><strong>Level of evidence:","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight Loss Before Total Joint Arthroplasty Using a Remote Dietitian and a Mobile Application: A Multicenter Randomized Controlled Trial.","authors":"Michael W Seward, Adriana P Liimakka, Matthew P Jamison, Lillian Zhu, Antonia F Chen","doi":"10.2106/JBJS.24.00838","DOIUrl":"https://doi.org/10.2106/JBJS.24.00838","url":null,"abstract":"<p><strong>Background: </strong>Many surgeons recommend weight loss for patients with obesity before total joint arthroplasty (TJA), but few studies have evaluated weight loss interventions. This study compared weight loss using a remote dietitian and a mobile application (app) with weight loss using standard care for patients with severe obesity before TJA.</p><p><strong>Methods: </strong>This multicenter randomized controlled trial included 60 subjects with a body mass index (BMI) of 40 to 47 kg/m2 who had been scheduled for primary total hip or knee arthroplasty from September 2019 to January 2023. The mean age was 61 years, 67% were women, and the mean BMI was 44 kg/m2. The control subjects (n = 29) received standard care; the intervention subjects (n = 31) completed video calls with dietitians and used a mobile app for 12 weeks preoperatively. Weights and surveys were collected at baseline and 12 weeks, with 87% follow-up. Weight loss, patient-reported outcomes, complications, revisions, and reoperations were compared. The mean follow-up was 1.8 years.</p><p><strong>Results: </strong>The intervention subjects lost more weight (-4.1 versus -2.1 kg, p = 0.22) and had larger decreases in BMI (-1.4 versus -0.9 kg/m2, p = 0.36 than the controls, but not significantly so. The intervention subjects had higher odds of achieving a BMI of <40 kg/m2 (odds ratio = 1.9, p = 0.44), but not significantly so. There were no significant differences in the mean change in the Hip disability and Osteoarthritis Outcome Score, the Knee injury and Osteoarthritis Outcome Score, or the Lower Extremity Activity Scale score. At baseline, only 11% had seen a dietitian in the last 3 months. Most subjects (83%) felt that video calls were helpful. There were no differences in complications between the groups; there was a patellar fracture in the control group and a deep venous thromboembolism in the intervention group.</p><p><strong>Conclusions: </strong>A preoperative weight loss intervention using a dietitian and a mobile app was feasible and viewed favorably among patients. Remote dietitians and mobile apps may address gaps in access to obesity treatment before TJA. While the intervention subjects lost more weight and were more likely to achieve a BMI of <40 kg/m2, the differences were not significant. More intensive interventions may be needed to achieve enough weight loss for clinically important improvements in TJA.</p><p><strong>Level of evidence: </strong>Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation Shielding Effect of Surgical Loupes Compared with Lead-Lined Glasses and Plastic Face Shields.","authors":"Kyle Hardacker, Pierce Hardacker, Tucker Callanan, Alan Daniels, Janine Bacic, Rachel Schilkowsky, Michael Oumano, Eren Kuris","doi":"10.2106/JBJS.24.00642","DOIUrl":"https://doi.org/10.2106/JBJS.24.00642","url":null,"abstract":"<p><strong>Background: </strong>Fluoroscopy plays a crucial role in various medical procedures, especially in orthopaedic and spinal surgery. However, concerns have arisen regarding ocular radiation exposure given its association with posterior lens opacities and cataracts. Protective measures are essential to mitigate ocular radiation exposure. During spine surgery, loupes are frequently used but often lack lead lining. The purpose of the present study was to assess the effect of surgical loupes, as compared with lead glasses and plastic face shields, on ocular radiation exposure.</p><p><strong>Methods: </strong>Dosimeters were positioned anterior (unshielded) and posterior (shielded) to the lens of each type of eyewear: lead glasses, surgical loupes, and plastic face shields. Eyewear/dosimeters were exposed directly to the horizontal beam of a C-arm for 2 minutes of continuous fluoroscopy. This was repeated 20 times for each type of eyewear (40 total/eyewear, 120 times overall). Radiation doses were modeled with use of generalized estimating equations with a Gaussian distribution and identity link function. Separate models were employed for each outcome, including eyewear category (lead glasses, loupes, plastic shield) and dosimeter position (anterior/unshielded versus posterior/shielded).</p><p><strong>Results: </strong>Radiation dose was significantly lower in posterior compared with anterior dosimeters for lead glasses (0.00 versus 1,689.80 mRem; p < 0.001) and for loupes (20.27 versus 1,705.95 mRem; p < 0.001). The difference for plastic face shields did not reach significance (1,539.75 versus 1,701.45 mRem; p = 0.06). Lead glasses offered the most protection, followed by surgical loupes and then plastic shields, when comparing the shielded dosimeter readings (0.00 versus 20.27 versus 1,539.75; p < 0.001 for all comparisons). There was no significant difference in radiation dose for dosimeters placed anterior to lead glasses, loupes, and plastic face shields (1,689.80 versus 1,705.95 versus 1,701.45 mRem; p = 0.99).</p><p><strong>Conclusions: </strong>Lead glasses were most effective (∼100% reduction), followed by surgical loupes (97%), whereas plastic face shields showed no significant reduction in radiation dose. Surgical loupes can substantially reduce ocular radiation exposure.</p><p><strong>Clinical relevance: </strong>Surgical loupes may offer ocular radiation protection.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Tourniquet Use and Patient-Reported Outcomes Following Total Knee Arthroplasty: A Multicenter Comparison.","authors":"Brian Gibbs, Jhase Sniderman, Shariq Mohammed, Michael Kain, David Freccero, Ayesha Abdeen","doi":"10.2106/JBJS.24.00266","DOIUrl":"https://doi.org/10.2106/JBJS.24.00266","url":null,"abstract":"<p><strong>Background: </strong>Total knee arthroplasty (TKA) is one of the most commonly performed elective procedures in North America. While advancements have been made in patient optimization, surgical technique, and implant design, tourniquet use remains a contentious issue as it relates to patient outcomes and postoperative experience.</p><p><strong>Methods: </strong>As part of the PEPPER trial, we identified 5,684 patients who underwent primary TKA, of whom 4,866 (85.6%) underwent surgery with a tourniquet (the YT group) and 818 (14.4%) underwent surgery without a tourniquet (the NT group). The cohort was predominantly female (60.8%), White (77%), and of an ethnicity other than Hispanic or Latino (96.8%). The mean age of the patients was 64.6 ± 9.2 years. The primary outcomes were the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR); Patient-Reported Outcomes Measurement Information System Physical Health Summary (PROMIS-PH10); and numeric pain rating scale (NPRS), which were captured preoperatively and at 1, 3, and 6 months postoperatively. The secondary outcomes were length of stay, discharge disposition, analgesic consumption, and postoperative complications. Multivariable analysis was performed to assess the associations between tourniquet use and patient-reported outcome measures (PROMs) following TKA.</p><p><strong>Results: </strong>The percentages of patients achieving the minimal clinically important difference (MCID) for the KOOS JR were significantly different at 1 month only (YT, 55.4%; NT, 47.9%). This difference disappeared at 3 and 6 months. There was no difference between the YT and NT groups in terms of the percentage of patients achieving the MCID for the PROMIS-PH10 or NPRS at any time point. There were no differences between the YT and NT groups at any time point with respect to the KOOS JR, PROMIS-PH10, and NPRS. There were no differences in opioid consumption, operative time, length of stay, wound-related complications, or readmissions postoperatively.</p><p><strong>Conclusions: </strong>Tourniquet use was associated with more patients achieving the MCID for the KOOS JR at 1 month compared with no tourniquet use. This difference disappeared at 3 and 6 months. At 1, 3, and 6 months, there were no differences in opioid consumption, health-care utilization, or complications between patients undergoing TKA with a tourniquet versus without a tourniquet. Tourniquet use did not have a clinically meaningful impact on PROMs in the multivariable analysis. Arthroplasty surgeons may use these data during preoperative discussions with patients regarding tourniquet use as it relates to the surgeon's preference and how it could influence postoperative function.</p><p><strong>Level of evidence: </strong>Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysfunction of the Windlass Mechanism Is Associated with Hallux Rigidus: A Case-Control Study.","authors":"Takumi Kihara, Tadashi Kimura, Naoki Suzuki, Asaki Hattori, Mitsuru Saito, Makoto Kubota","doi":"10.2106/JBJS.24.00437","DOIUrl":"10.2106/JBJS.24.00437","url":null,"abstract":"<p><strong>Background: </strong>The cause of hallux rigidus remains controversial. However, it is assumed that dysfunction of the windlass mechanism and metatarsus primus elevatus play a role in the pathology. Three-dimensional (3D) computed tomography (CT) imaging is ideal for analysis of movements of the foot, which involve 3D and rotational motion. The purpose of the present study was to compare the windlass mechanism in healthy normal feet with that in feet with hallux rigidus by 3D CT imaging.</p><p><strong>Methods: </strong>A total of 17 feet with hallux rigidus and 21 normal feet were selected. Hallux rigidus was classified as grade 1 or 2 with use of the Coughlin and Shurnas system. CT imaging was performed during weight-bearing and non-weight-bearing with the first metatarsophalangeal joint in a neutral position or in 30° of dorsiflexion. We measured the rotation of each joint and the height of the navicular during dorsiflexion and weight-bearing. We also compared changes in the tarsometatarsal joint and metatarsus primus elevatus in the neutral position between the non-weight-bearing and weight-bearing conditions.</p><p><strong>Results: </strong>During dorsiflexion, there were significant differences between the 2 groups in eversion and adduction at the talonavicular and talocalcaneal joints (p < 0.05), with less movement of bones in the hallux rigidus group. There was a significantly greater increase in height of the navicular in the control group than in the hallux rigidus group (1.2 ± 0.6 mm versus 0.7 ± 0.6 mm; p = 0.02). There was also a significant difference in metatarsus primus elevatus during the non-weight-bearing and weight-bearing conditions (p < 0.01).</p><p><strong>Conclusions: </strong>Hallux rigidus restricts the movement of the Chopart joint and hindfoot associated with dorsiflexion of the first metatarsophalangeal joint, suggesting an association between hallux rigidus and windlass mechanism dysfunction.</p><p><strong>Level of evidence: </strong>Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"558-564"},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Antibiotic Release and Mechanical Strength in UHMWPE Antibiotic Blends: The Role of Submicron Gentamicin Sulfate Particles.","authors":"Mehmet D Asik, Eileen Walsh-Rock, Nicoletta Inverardi, Cecilia Nepple, Timothy Zhao, Amita Sekar, Devika Dutta Kannambadi, Matheus Ferreira, Keith K Wannomae, Ebru Oral, Orhun K Muratoglu","doi":"10.2106/JBJS.24.00689","DOIUrl":"10.2106/JBJS.24.00689","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infections (PJIs) are a major complication of total joint replacement surgeries. This study investigated the enhancement of mechanical properties and antibiotic release in ultra-high molecular weight polyethylene (UHMWPE) through the encapsulation of submicron gentamicin sulfate (GS) particles, addressing the critical need for improved implant materials in orthopaedic surgery, particularly in managing PJIs.</p><p><strong>Methods: </strong>The present study involved embedding submicron GS particles into UHMWPE flakes at concentrations of 2% to 10% by weight. These particles were prepared and blended with UHMWPE flakes using a dual asymmetric centrifugal mixer, and the blends were consolidated. The present study compared the mechanical properties and antibiotic release rate of UHMWPE containing submicron, medium (as-received), and large (resolidified) GS particles.</p><p><strong>Results: </strong>UHMWPE samples with submicron GS particles exhibited superior mechanical properties, including higher ultimate tensile and Izod impact strengths, compared with samples with larger particles. Additionally, the submicron GS UHMWPE blends demonstrated a markedly higher and more sustained antibiotic release rate.</p><p><strong>Conclusions: </strong>This study highlights the potential of incorporating submicron GS particles into UHMWPE to drastically improve the feasibility of using these therapeutic and functional spacer implants in expanded indications.</p><p><strong>Clinical relevance: </strong>By offering improved mechanical strength and effective, prolonged antibiotic release, this innovative material could be used as a spacer implant to reduce the considerably high morbidity and mortality associated with PJIs. This material has the potential to prevent PJIs not only in high-risk revision cases but also in primary total joint arthroplasty procedures.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"586-593"},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pragmatic Perspective on Evaluating Ankle Arthritis Treatments: The Challenges of Loss to Follow-up and Its Impact on Study Validity: Commentary on an article by Mark Glazebrook, PhD, MD, FRCSC, et al.: \"Outcomes of Total Ankle Replacement Versus Ankle Arthrodesis for the Treatment of End-Stage Ankle Arthritis. A Concise Follow-up, at a Minimum of 10 Years, of a Previous Report\".","authors":"Bruce Sangeorzan, Daniel Norvell","doi":"10.2106/JBJS.24.01025","DOIUrl":"https://doi.org/10.2106/JBJS.24.01025","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 6","pages":"664"},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Future of PJI Treatment: Will One-Stage Exchange Become the New Gold Standard?: Commentary on an article by Javad Parvizi, MD, FRCS: \"What's Important: Two-Stage Exchange Arthroplasty. The Expiration Date Is Approaching\".","authors":"Mustafa Citak","doi":"10.2106/JBJS.24.01570","DOIUrl":"https://doi.org/10.2106/JBJS.24.01570","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 6","pages":"664"},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Think JBJS.","authors":"Mohit Bhandari","doi":"10.2106/JBJS.25.00095","DOIUrl":"https://doi.org/10.2106/JBJS.25.00095","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":"107 6","pages":"541-542"},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Medicare Payments for Facility Fees and Surgeon Professional Fees for Spine Surgeries.","authors":"Vincent P Federico, Alexander J Acuna, Luis M Salazar, Rajko Vucicevic, Austin Q Nguyen, Logan Reed, William E Harkin, Joseph Serino, Alexander J Butler, Matthew W Colman, Frank M Phillips","doi":"10.2106/JBJS.24.00228","DOIUrl":"10.2106/JBJS.24.00228","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":"657-663"},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}