Journal of the American Podiatric Medical Association最新文献

{"title":"Bilateral Distal Tibial Fractures with Preexisting Long-Stem Knee Prostheses Treated with Closed Retrograde Intramedullary Nails: A Case Report.","authors":"Ryan Lerch, Jeffrey Manway","doi":"10.7547/22-099","DOIUrl":"https://doi.org/10.7547/22-099","url":null,"abstract":"<p><p>Recently there has been expanded interest in the management of fractures of the ankle in the elderly. This case presentation demonstrates an alternative treatment choice for bilateral distal tibial fractures in a comorbid patient. This is a novel case of interest because low-energy bilateral distal tibial fracture in the elderly and comorbid population is a relatively infrequent occurrence. Several case series have demonstrated the efficacy and safety of closed retrograde nailing of distal tibial fractures. The patient was an 80-year-old woman with a medical history that included hypertension, hyperlipidemia, type 2 diabetes, rheumatoid arthritis, chronic obstructive pulmonary disease, coronary artery disease status post stenting, heart failure with preserved ejection fracture, chronic kidney disease, and a history of a transient ischemic attack. The patient's case was further complicated by the presence of preexisting long-stem bilateral knee prostheses. The patient had been living independently when she experienced a ground-level fall in which imaging showed bilateral distal tibial fractures. The decision to perform closed bilateral concomitant stabilization via retrograde intramedullary nails was based on the need for early ambulation, stability, and the presence of extensive preexisting tibial prostheses. Ultimately, the patient healed uneventfully, returning to a similar level of independence and ambulation as before her injury.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Comparison of Single- and Double-Twist Tension Band, Cancellous Screw, and Single-Screw Tension Band Models in Medial Malleolus Fractures.","authors":"Gurdal Nusran, Onur Yılmaz, İbrahim Mutlu, Tolgahan Kuru, H Yener Erken","doi":"10.7547/22-172","DOIUrl":"https://doi.org/10.7547/22-172","url":null,"abstract":"<p><strong>Background: </strong>Models using a double-twist tension band, two partially threaded cancellous screws, a single-twist tension band, and a single-screw tension band were biomechanically compared for fixation of medial malleolus fractures.</p><p><strong>Methods: </strong>All 72 composite cortical tibial bones used in the study were osteotomy suitable for medial malleolus fracture. They were divided into four groups: double-twist tension band (group 1), two partially threaded cancellous screws (group 2), single-twist tension band (group 3), and single-screw tension band (group 4), with 18 composite tibial bones in each group. Bones in each group were divided into three subgroups and subjected to biomechanical tests by applying force as tension, transverse, and axial loading.</p><p><strong>Results: </strong>In the tension and transverse loading tests, the highest mean stiffness was in groups 1 and 4. Group 4 had statistically significantly higher stiffness values than groups 2 and 3. All of the other groups had statistically significantly higher stiffness values than group 2. A statistically significant difference was found comparing group 4 (with the highest value in the axial loading test) with the other groups. No significant difference was found between groups 1 and 3 in any of the biomechanical tests.</p><p><strong>Conclusions: </strong>Tension band method did not make a difference biomechanically when applied as a double or single twist. Single-screw tension band was found to be the most stable fixation method in tension, transverse, and axial loading tests. We think that the single-screw tension band method is a stable and suitable fixation method and should find more place in current surgical practices.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Case of Osteomyelitis Caused by Achromobacter xylosoxidans.","authors":"Christopher P Girgis, Tyler L Coye, Elizabeth Ansert, Amanda L Killeen, Peter A Crisologo","doi":"10.7547/22-213","DOIUrl":"https://doi.org/10.7547/22-213","url":null,"abstract":"<p><p>Achromobacter xylosoxidans is a rare opportunistic aerobe that has rarely been documented in the literature as a causative agent for osteomyelitis. It can present with antibiotic resistance, making treatment without operative management challenging. We present the case of a 51-year-old male with a past medical history of uncontrolled type 2 diabetes. The patient presented to a clinic with a grade 2 infection to the right fifth digit, as defined by the International Working Group on the Diabetic Foot, and was subsequently admitted for intravenous antibiotics and operative management. Magnetic resonance imaging revealed abnormal signal of the phalanges of the fifth toe with sparing of the base of the proximal phalanx, consistent with osteomyelitis. An arthroplasty of the digit yielded pathology consistent with acute osteomyelitis and culture of Achromobacter xylosoxidans. Surgical debridement and culture-directed antibiotic therapy resulted in clinical cure. In chronic diabetic foot ulcerations, osteomyelitis should be considered, and Achromobacter xylosoxidans should be acknowledged as a potentially resistant organism. Therefore, it is paramount that a multidisciplinary approach is used when treating this condition.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed Tomography Scanographic Analysis of Symptomatic Limb Length Discrepancy.","authors":"Alex Fleischman, Michael An, Wendy Young","doi":"10.7547/23-179","DOIUrl":"https://doi.org/10.7547/23-179","url":null,"abstract":"<p><strong>Background: </strong>Limb length discrepancy (LLD) is diagnosed when one limb is noted to be longer than the other. Symptomatic LLD is defined as the appearance of symptoms secondary to the compensatory mechanisms of LLD with a measured limb length differential. Several studies have been conducted analyzing LLD through plain radiographs, yet there are only a few studies analyzing LLD using computed tomography (CT) scanography.</p><p><strong>Methods: </strong>We conducted a retrospective baseline study of patients between December 2007 and December 2017 in order to reinforce the side dominance and associated measurements of lower-extremity limb lengths through CT scanograms. The average femoral, tibial, and total limb length was calculated for each extremity. Paired sample t tests were conducted between each osseous component and total limb length.</p><p><strong>Results: </strong>Following institutional review board review and exemption, 400 charts that met the inclusion criteria were reviewed. The left limb was significantly longer than the right limb by approximately 0.10 cm (P < .05). The left femur was significantly longer than the right femur by approximately 0.07 cm (P < .05). There was no significant difference in the tibial length (P > .05).</p><p><strong>Conclusions: </strong>There was a significant limb length differential in which the left limb was longer than the right limb secondary to increased femoral length. Although our results may seem imperative to our understanding of LLD, it is important to state that all of our differentials were similar, with large SDs, indicating low power of the study. Future research with an increased number of participants is warranted to reinforce the findings.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcomes After Congenital Toe Syndactyly Repair with a Plantar Triangular Flap.","authors":"Kaylee O'Connor, Sofia Gereta, Sarah A Frommer, Steven L Henry","doi":"10.7547/22-043","DOIUrl":"https://doi.org/10.7547/22-043","url":null,"abstract":"<p><strong>Background: </strong>Syndactyly of the toes is a common congenital malformation, yet there are few reports of long-term outcomes after toe syndactyly repair and its effect on well-being. In this study, we surveyed patients and parents of patients who underwent toe syndactyly repair to investigate the functional and psychological outcomes of their surgery.</p><p><strong>Methods: </strong>We reviewed the medical records of all of the patients who underwent toe syndactyly repair using a plantar flap technique between January 1, 2010, and January 1, 2021. Parents or patients completed a survey assessing their opinion regarding cosmesis, function, and overall satisfaction. Independent observers used a modified Vancouver Scar Scale to evaluate surgical scars.</p><p><strong>Results: </strong>A plantar flap technique was used for 19 syndactylous webs in nine patients. Complications included one instance of mild cellulitis and one instance of web creep requiring revision. Average follow-up time was 5.5 years. Overall, 88% of survey respondents were very or moderately satisfied with the surgical outcome. No patients had unwanted hair growth or a bothersome groin site scar. Average modified Vancouver Scar Scale score was 3.2. There was a perceived improvement in toe range of motion and hygiene after surgery. Patients who underwent first web space release could wear flip-flops. All of the respondents would recommend surgery for another child with toe syndactyly.</p><p><strong>Conclusions: </strong>Toe syndactyly repair can be performed with minimal complications and high parent/patient satisfaction. Survey results indicate that there may be functional and psychological benefits to undergoing toe syndactyly repair.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Site Infection Rate from Office-Based Foot and Ankle Surgeries: A Retrospective Analysis.","authors":"Lucas Adams, Nevin Joseph, Clayton Cassidy, Christina Pratt, Mark Razzante","doi":"10.7547/21-238","DOIUrl":"https://doi.org/10.7547/21-238","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to present data about the incidence of postoperative infections after procedures performed in a podiatric medicine private practice office setting. The COVID-19 pandemic placed a burden on the health-care system. Performing procedures in a clinic or office setting played a role in providing a continued high level of patient care for foot and ankle surgeons.</p><p><strong>Methods: </strong>We conducted a retrospective review of 205 procedures in 121 patients who had undergone elective podiatric medical/orthopedic procedures performed in an office setting from February 1, 2018, through July 31, 2021. No patients were given preoperative antibiotics. The following data were extracted: patient age, sex, history of diabetes mellitus, peripheral neuropathy, development of postoperative infection, severity of infection, follow-up time in weeks, and antibiotic use prophylactically and if used postoperatively.</p><p><strong>Results: </strong>The overall infection rate for this study was 1.95%, all of which were superficial infections. The most common procedure performed was a flexor tenotomy, followed by hardware removal. Removing flexor tenotomy procedures, the incidence of postoperative infection was 3.3%.</p><p><strong>Conclusions: </strong>Performing procedures in an office clinical setting is an effective and safe means to treat patients with similar if not lower infection rates compared with a hospital or surgery center in modern literature.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Large Fiber Neuropathy in Nondiabetic Older Adults Seeking Routine Foot Care.","authors":"Todd O'Brien","doi":"10.7547/23-220","DOIUrl":"https://doi.org/10.7547/23-220","url":null,"abstract":"<p><strong>Background: </strong>Older adults qualifying for routine foot care (RFC) under the Medicare program are often diagnosed with diabetes, peripheral artery disease (PAD), or neuropathy. Specifically, large fiber neuropathy (LFN) has been shown to increase during the aging process, rendering patients more susceptible to unperceived trauma because of loss of protective sensation and an increased fall risk because of balance deficits. This study assessed the prevalence of LFN as diagnosed by the timed vibration test (TVT) in the nondiabetic segment of the Medicare population seeking RFC. A comparison was made between this group and those patients identified with PAD.</p><p><strong>Methods: </strong>A retrospective electronic medical record review of Medicare patients seeking RFC (Current Procedural Terminology codes 11720, 11721, and 11055) was conducted in a community health center-based podiatry clinic over a 5-year period. The prevalence of LFN as diagnosed by the TVT (International Statistical Classification of Diseases, Tenth Revision code G62.9 and TVT ≤4 sec at the hallux) and PAD as diagnosed per Medicare class findings for vascular impairment (International Statistical Classification of Diseases, Tenth Revision codes I70.203 and I73.9) was identified in nondiabetic Medicare patients seeking RFC.</p><p><strong>Results: </strong>The prevalence of LFN and PAD within the nondiabetic Medicare population seeking RFC was found to be 21.1% (91 of 431) and 27.6% (119 of 431), respectively. There was a 6.5% difference between the proportions of the LFN and PAD groups, which was significantly different (P = .026, confidence interval = 0.77-12.2%). A total of 10.9% of the population was found to have LFN and PAD concurrently. There was no significant difference between the ages of patients in the LFN and PAD groups (P = .36, standard deviation [SD] = 1.65), the LFN and LFN/PAD groups (P = .3, SD = 1.95), or the PAD and LFN/PAD groups (P = .07, SD = 1.95).</p><p><strong>Conclusions: </strong>LFN and PAD are both present in substantial proportions in nondiabetic Medicare patients seeking RFC. The prevalence of LFN in this at-risk population highlights the importance of accurate diagnosis and implementation of preventative measures designed to mitigate unperceived foot trauma and potential falls. This is especially relevant, as neuropathy in geriatric patients has been associated with earlier mortality.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Altered Foot Progression Angle and Rearfoot Loading in Patellofemoral and Tibiofemoral Osteoarthritis: A Comparative Cross-Sectional Study.","authors":"Nazli Busra Cigercioglu, Zilan Bazancir-Apaydin, Gul Baltaci, Hande Guney-Deniz","doi":"10.7547/l23-018","DOIUrl":"https://doi.org/10.7547/l23-018","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this study was to investigate the differences in plantar loading distribution and functional levels between patellofemoral osteoarthritis (PFOA) and tibiofemoral osteoarthritis (TFOA) patients, and to compare them with healthy individuals.</p><p><strong>Methods: </strong>Sixty patients with knee osteoarthritis and 30 age-matched, healthy individuals (control group) were included in the study. The patients were divided into two groups, the PFOA group (n = 31) and the TFOA group (n = 29), based on the Kellgren Lawrence classification system. The maximum foot pressure of the foot (FPmax), forefoot weight ratio, rearfoot weight ratio, total load on foot, and foot progression angle (FPA) were determined by pedobarographic analysis. Functional level was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).</p><p><strong>Results: </strong>There was a significant difference in FPA (F(2,79) = 22.322, P < .001) and rearfoot weight ratio (F(2,77) = 7.694, P = .001) among the groups. The FPA in the PFOA group was lower than in the TFOA group (P <. 001). The rearfoot weight ratio was higher in the PFOA group than in the TFOA group (P <. 05). No significant difference was found in FPmax (P = .457), forefoot weight ratio (P = .183), and total load on the foot (P = .226) among the groups. Also, no difference was found in the WOMAC total score and subscales between the PFAO and TFAO groups (P > .05).</p><p><strong>Conclusions: </strong>The results suggest that the FPA and rearfoot loading were altered in patients with PFOA compared to those with TFOA and healthy individuals. Clinicians need to consider the effect of altered foot position and loading on the knee biomechanics in their treatment approach regarding foot orthoses or gait modification in patients with PFOA.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local Anesthetic Duration, Not Onset, Linked to MC1R Genotype in Redheads and Brunettes.","authors":"Mark Dalman, Marie Mantini Blazer, Rocco Petrozzi, Bria Pallas, Sophia Huynh, Cham Alden, Tulsi Menaria, Junrui Lin, Alex Pixton, Naagashiv Nagajothi","doi":"10.7547/24-029","DOIUrl":"10.7547/24-029","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that redheaded individuals react differently to local anesthetics, but there is no defined human genotype associated with local anesthetic response. As red hair has been associated with unique mutations of the melanocortin-1 receptor (MC1R), we tested the hypothesis that local anesthetic onset and duration of action were significantly modified in red haired individuals as related to the single nucleotide polymorphism (SNP) genotype.</p><p><strong>Methods: </strong>Ninety-two participants between the ages of 18 and 65 years were enrolled and assigned to one of four experimental groups: lidocaine-redhead, lidocaine-brunette hair, bupivacaine-redhead, and bupivacaine-brunette hair. Onset and duration of action were quantified in response to sharp sensation. Sputum samples were collected, gDNA was extracted and subjected to the Illumina CoreExome-24 SNP array (Illumina, San Diego, California). Twenty-five MC1R sequence polymorphisms were analyzed. A two-way analysis of variance (ANOVA) test was used to examine treatment and hair color effects, and their interaction on onset and duration time respectively; P ≤ .05 was considered statistically significant.</p><p><strong>Results: </strong>Overall mean onset of action was statistically significant (P = .042) when comparing red hair to brunette responses between anesthesia (lidocaine versus bupivacaine: 2.68 ± 0.28 minutes versus 3.60 ± 0.30 minutes, and 4.46 ± 0.49 minutes versus 5.14 ± 0.46 minutes, respectively). The redhead mean duration times were statistically shorter (P = .007) than brunettes (lidocaine and bupivacaine: 72.5 ± 6.3 min versus 97.6 ± 12.1 min, and 367.7 ± 21.4 minutes versus 455.5 ± 30.2 minutes, respectively). There were no statistical interactions between treatment and hair color on either onset or duration (P = .761 and P = .120, respectively). Interestingly, bupivacaine-injected redhead participants did show a significantly shorter duration (P = .004). Of 25 SNPs from MC1R assayed from the Illumina CoreExome-24 array, two missense mutations at loci rs1805007 (R151C) and rs1805008 (R160W) significantly predicted phenotypic responses to local analgesics. A two-way ANOVA indicated that these SNPs were significantly associated with reduced onset and duration time (P = .014, P = .047, respectively). Additionally, χ2 tests demonstrated a significantly strong correlation between red hair and these SNPs: R151C (P < .001, Power = 1.000) and R160W (P = .016, Power = 0.732).</p><p><strong>Conclusions: </strong>To our knowledge there are no published studies that associate the effect of hair color with local anesthetic function on onset and duration of action via SNP genotyping. The SNP genotyping reaffirmed functional results, and points to the complimentary impact that precision medicine will have on clinical decision making and patient comfort with future studies to unravel the degree to which SNPs affect these responses.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ankle Arthroscopy in Early-Stage Ankle Tuberculosis: A Case Report.","authors":"Ali Yüce, Mustafa Yerli, Nazım Erkurt, Tahsin Olgun Bayraktar","doi":"10.7547/22-220","DOIUrl":"https://doi.org/10.7547/22-220","url":null,"abstract":"<p><p>Ankle tuberculosis (TBC) is observed in 8 to 10% of the patients with skeletal TBC and 0.1 to 0.3% with extrapulmonary TBC. The ankle joint is an unusual place for TBC arthritis. Due to the lack of TBC-pathognomonic symptoms in ankle cases, it may imitate other diseases. It caused a delay in diagnosis. The present study aimed to examine a case in which joint debridement was applied, and the early-stage ankle tuberculosis diagnosis was made with an arthroscopic biopsy.</p>","PeriodicalId":17241,"journal":{"name":"Journal of the American Podiatric Medical Association","volume":"115 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}