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

{"title":"Risk of Postoperative Nausea and Vomiting After Total Hip or Knee Arthroplasty Under Spinal Anesthesia: Randomized Trial Comparing Conventional Antiemetics with or without the EmeTerm Bracelet.","authors":"Yidan Yang, Chunping Wang, Guorui Cao, Hongjun Li, Lanbo Yang, Jianing Xi, Chaojun Sun, Huamei Lu, Youwen Liu, Jiayi Guo, Chen Yue","doi":"10.2106/JBJS.24.00773","DOIUrl":"https://doi.org/10.2106/JBJS.24.00773","url":null,"abstract":"<p><strong>Background: </strong>Acupoint stimulation has been shown to reduce the risk of postoperative nausea and vomiting (PONV) after various types of surgeries involving general anesthesia, but whether the same is true after orthopaedic surgery involving spinal anesthesia is unclear. The purpose of this study was to compare PONV rates and the quality of recovery between patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) under spinal anesthesia receiving conventional antiemetics alone and those receiving antiemetics combined with use of a transcutaneous electrical acupoint stimulation bracelet (EmeTerm; WAT Medical Enterprise).</p><p><strong>Methods: </strong>Patients at moderate or high risk for PONV, including 195 patients undergoing THA and 153 patients undergoing TKA, were randomized to receive routine antiemetics (dexamethasone and ondansetron) alone or with use of the EmeTerm bracelet. The primary outcome was the PONV incidence within 24 hours postoperatively; secondary outcomes included the rates of severe PONV, antiemetic rescue, adverse events, and Quality of Recovery scores.</p><p><strong>Results: </strong>Combining antiemetics with the EmeTerm bracelet significantly reduced PONV (16.0% compared with 31.2%; p = 0.001), severe PONV (1.1% compared with 8.1%; p = 0.002), and antiemetic rescue (3.4% compared with 13.9%; p = 0.001). Use of the bracelet reduced the risk of PONV within 24 hours by 61% (adjusted hazard ratio, 0.39; 95% confidence interval [CI], 0.24 to 0.63), and its benefit became significant at 0 to 3 and 3 to 6-hour intervals after surgery. The complete response rate was higher for the bracelet + antiemetics group compared with the group with antiemetics alone (84.0% compared with 68.8%; p = 0.001), with better Quality of Recovery scores at 24 hours in the bracelet + antiemetics group.</p><p><strong>Conclusions: </strong>The EmeTerm bracelet enhanced the efficacy of antiemetics in reducing PONV after THA and TKA under spinal anesthesia and may improve short-term recovery.</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":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736093","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":"Monitoring Sleep-Breathing Disorders in Patients with Idiopathic Scoliosis.","authors":"Erwei Feng, Junduo Zhao, Wenhao Cao, Yang Jiao, Haoyu Cai, Zhen Wang, Xu'an Huang, Yi Xiao, Jianxiong Shen","doi":"10.2106/JBJS.24.00867","DOIUrl":"https://doi.org/10.2106/JBJS.24.00867","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic scoliosis (IS) is the most common spinal deformity and is often accompanied by abnormal respiratory function.</p><p><strong>Methods: </strong>This study investigated the correlations among radiographic parameters, pulmonary function tests, and sleep-breathing monitoring in patients with IS. The clinical data of patients with IS admitted to our hospital for scoliosis surgery between January 2020 and March 2022 were retrospectively collected. Radiographic measurements, including scoliosis and thoracic malformation parameters, were performed. Pulmonary function measurements and sleep-breathing monitoring results were collected for correlation analysis.</p><p><strong>Results: </strong>Overall, 19.8% of the 81 participants were diagnosed with obstructive sleep apnea. The sleep-breathing monitoring results showed a significant correlation between the main thoracic curvature and the lowest oxygen saturation (SpO2) (r = -0.233; p = 0.036). The degree of thoracic kyphosis significantly correlated with FEV1/FVC (forced expiratory volume in 1 second/forced vital capacity) and FEV1. FEV1 was significantly correlated with the oxygen desaturation index (ODI) (r = -0.242; p = 0.03), as was FVC.</p><p><strong>Conclusions: </strong>In this study, 19.8% of the patients with thoracic IS had obstructive sleep apnea. In patients with IS, the severity of pulmonary function decline and SpO2 during sleep-breathing correlated with the severity of thoracic scoliosis, whereas the decline in pulmonary function correlated with the ODI during sleep-breathing.</p><p><strong>Level of evidence: </strong>Prognostic Level IV. 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":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730195","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":"Access to Orthopaedic Devices in Low and Middle-Income Countries: Challenges and Opportunities.","authors":"Myles Dworkin, Pierre Marie Woolley, Faseeh Shahab, McKenna C Noe, Rachid Barry, Dorcas Chomba, Emmanuel Makasa, Nabees Man Singh Pradhan, Jean Claude Byiringiro, Kiran J Agarwal-Harding","doi":"10.2106/JBJS.24.00997","DOIUrl":"https://doi.org/10.2106/JBJS.24.00997","url":null,"abstract":"<p><p>➢ Musculoskeletal injuries constitute a substantial proportion of worldwide disease, with access limited to many due to the availability and cost of devices. A multifaceted approach is needed to improve system-level access to care.➢ Although a number of procurement policies are utilized, providers in low and middle-income countries often struggle with inconsistent supply chains, leading to delays in care or less desirable management strategies.➢ Partnerships between governments, academic institutions, and nongovernmental agencies are needed to improve access to devices by providing funds for patients and creating regulatory bodies to ensure product quality and availability.➢ There should be a focus on local and regional manufacturing as well as job creation within low and middle-income countries to achieve sustainable access to orthopaedic devices.➢ High-quality research initiatives are needed to provide evidence-based solutions. This includes a focus on outcomes-based studies to determine best management practices within the low and middle-income countries' context and operations research to optimize systems for device procurement.</p>","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730192","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":"What's Important (Arts & Humanities): Lessons Learned in Medicine and Life.","authors":"Robert C Schenck","doi":"10.2106/JBJS.24.01334","DOIUrl":"https://doi.org/10.2106/JBJS.24.01334","url":null,"abstract":"","PeriodicalId":15273,"journal":{"name":"Journal of Bone and Joint Surgery, American Volume","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730199","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":"Stacked Cone Constructs for the Treatment of Extensive Tibial Bone Loss in Revision Total Knee Arthroplasty: A Series of 22 Patients.","authors":"Nathanael D Heckmann, Kevin C Liu, Brandon S Gettleman, Annabel Kim, Donald B Longjohn, Daniel A Oakes","doi":"10.2106/JBJS.24.00299","DOIUrl":"https://doi.org/10.2106/JBJS.24.00299","url":null,"abstract":"<p><strong>Background: </strong>Highly porous metaphyseal cones have emerged as a promising fixation strategy to address extensive proximal tibial bone loss in the multiply revised knee. Despite a paucity of literature regarding stacked cone constructs, they have gained popularity. This study reports on the early outcomes of stacked tibial cone constructs that are used during revision total knee arthroplasty (TKA).</p><p><strong>Methods: </strong>A single-institution retrospective observational study was performed to identify patients who had been treated with a stacked cone construct during revision TKA between January 2010 and December 2022. Demographic, operative, clinical, and radiographic data were collected and assessed. Kaplan-Meier estimates were used to assess survival with all-cause reoperation, tibial-sided revision, and radiographic loosening as end points. In total, 22 stacked cone constructs were identified: 15 (68.2%) of the patients were men; the demographics included a mean age of 64.1 years (range, 42.8 to 87.8 years), a body mass index of 34.2 kg/m2 (range, 20.4 to 51.9 kg/m2), a median of 4 prior surgeries (range, 1 to 12 prior surgeries), and a mean follow-up of 22.6 months (range, 6.8 to 79.1 months).</p><p><strong>Results: </strong>Twenty patients received 2-cone constructs, and 2 patients received 3-cone constructs. Patients received the stacked cone constructs during revision TKA for the following indications: periprosthetic joint infection (n = 11), aseptic loosening (n = 9), tibial stem pain (n = 1), and periprosthetic fracture (n = 1). At a median time of 2.9 months (range, 0.4 to 37.3 months), 5 patients underwent reoperation for the following indications: extensor mechanism failure (n = 2), femoral component loosening (n = 1), superficial wound dehiscence (n = 1), and postoperative hematoma (n = 1). At the 3-year follow-up, no patients had undergone revision for tibial component loosening (1 patient had radiographic evidence of loosening at the 15-month follow-up but did not undergo revision).</p><p><strong>Conclusions: </strong>Stacked cone constructs are a viable option during revision TKA when extensive metaphyseal bone loss is encountered.</p><p><strong>Level of evidence: </strong>Therapeutic Level IV. 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":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700542","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":"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":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;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":"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":"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}