Spine deformity最新文献

{"title":"Translation and validation of the Swedish version of the early-onset scoliosis 24-item questionnaire.","authors":"I Green-Petersen, T Cheng, S Blixt, P Gerdhem","doi":"10.1007/s43390-025-01064-5","DOIUrl":"https://doi.org/10.1007/s43390-025-01064-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to translate and validate the Early-Onset Scoliosis 24-Item Questionnaire (EOSQ-24) into Swedish.</p><p><strong>Methods: </strong>Following international guidelines, the EOSQ-24 was double forward translated by independent translators, reviewed by experts, and distributed to caregivers. A single back translation was performed, and the Swedish version was finalized. The Swedish EOSQ-24 was made available online for clinically active spinal surgeons to use during outpatient visits, where it was distributed to caregivers of early-onset scoliosis (EOS) patients aged 0-15 years. Internal consistency was assessed using Cronbach's alpha, item-total correlation, and analysis of floor and ceiling effects. Convergent validity was examined using the EuroQol-5D 3 level (EQ-5D) and the Scoliosis Research Society 22-Item Questionnaire revised (SRS-22r).</p><p><strong>Results: </strong>Responses from 140 caregivers were collected. Ceiling effects ranged from 21 to 74%, with no floor effects > 15%. Internal consistency was excellent (Cronbach's alpha = 0.9), except for two domains: \"General Health\" (0.6) and \"Pulmonary Function\" (0.4). The item-total correlation was poor for \"Pulmonary Function\". EOSQ-24 domains showed significant convergent validity with SRS-22r (Spearman's rho 0.5 to 0.8) and the EQ-5D (Spearman's rho -0.6 to -0.8). Stepwise regression showed lower scores for patients with neuromuscular scoliosis, indicating sensitivity for scoliosis etiology.</p><p><strong>Conclusion: </strong>The Swedish EOSQ-24 is a valid, disease-specific questionnaire with excellent internal consistency suitable for use in a clinical setting. Minor inconsistencies are not unique for the Swedish translation.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the social determinants of health on adolescent idiopathic scoliosis: a systematic review.","authors":"Rohit Paradkar, Ria Paradkar, Manjot Singh, Ashley Knebel, Mariah Balmaceno-Criss, Jinseong Kim, Joseph E Nassar, Michael J Farias, Bassel G Diebo, Alan H Daniels","doi":"10.1007/s43390-025-01065-4","DOIUrl":"https://doi.org/10.1007/s43390-025-01065-4","url":null,"abstract":"<p><strong>Purpose: </strong>Adolescent idiopathic scoliosis (AIS) has been associated with significant physical and psychosocial burdens. Social determinants of health play a well-documented role in treatment and outcomes of various conditions, including AIS. As such, it is crucial to understand the multifaceted socioeconomic factors that may affect its prevalence and severity.</p><p><strong>Methods: </strong>A comprehensive search of major bibliographic databases such as Medline, Embase, and Cochrane Library was conducted from inception to August 2024 for studies examining AIS in marginalized populations. Demographical and clinical outcomes data were extracted for quantitative and qualitative analyses.</p><p><strong>Results: </strong>Our initial search identified 479 articles, of which 14 met the eligibility criteria. The mean age was 14.1 years, 76.8% were females, 59.6% were White, and 73.6% had private insurance. Black adolescents with AIS presented with more severe forms of the condition that necessitated surgical management. Furthermore, lower socioeconomic status, along with residence in socioeconomically disadvantaged neighborhoods and enrollment in public insurance programs, often contributed to delayed clinical presentation, more severe curves at initial presentation, and delayed treatment.</p><p><strong>Conclusion: </strong>This systematic review revealed disparities in the diagnosis and management of AIS based on race, ethnicity, language, insurance status, and socioeconomic status. These disparities highlight the urgent need for a multifaceted approach to improve equity in AIS care. Addressing these challenges requires systemic reforms targeted towards enhancing access and treatment for marginalized populations. Focused interventions should consider the unique social determinants that contribute to these disparities, ultimately promoting a more equitable healthcare system for all adolescents affected by idiopathic scoliosis.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building consensus: development of a best practice guideline (BPG) for avoiding errors in robotic-assisted spine surgery (RASS).","authors":"Michael G Vitale, Ritt R Givens, Matan S Malka, Kevin Lu, Thomas M Zervos, Joseph Lombardi, Zeeshan Sardar, Ronald Lehman, Lawrence Lenke, Rajiv Sethi, Stephen Lewis, Daniel Hedequist, Themistocles Protopsaltis, A Noelle Larson, Sheeraz Qureshi, Brandon Carlson, Terrence T Kim, David Skaggs","doi":"10.1007/s43390-025-01060-9","DOIUrl":"https://doi.org/10.1007/s43390-025-01060-9","url":null,"abstract":"<p><strong>Introduction: </strong>With the rapid increase in the use of robotic-assisted spine surgery (RASS), reports describing complications have inevitably emerged. This study builds on previous work done to identify, characterize, and classify potential sources of error in spine surgery performed with enabling technology in the operating room. The goal of this study is to leverage expert opinion to develop a set of best practice guidelines that can be employed to minimize complications and optimize patient safety, specifically as it relates to RASS.</p><p><strong>Methods: </strong>After assembling a group of attending spine surgeons experienced in the use of RASS across the country, formal consensus regarding the best practices was developed using the Delphi method and nominal group technique. After a review of the relevant literature and evidence, an initial survey of study group members (n=12) helped frame potential areas for investigation. Statements were subsequently edited, removed, or elaborated upon during four iterative rounds of live discussion with the opportunity for panelists to propose new guidelines at any point in the process. Respondents were able to suggest modifications and refine the statements until consensus, defined as ≥ 80% agreement, was achieved.</p><p><strong>Results: </strong>After a three-round iterative survey and video conference Delphi process, followed by an in-person meeting at the Summit for Safety in Spine Surgery, consensus was achieved on 27 best practice guideline statements. This BPG had the key focus areas of 1) general protocols, 2) screw planning/execution, 3) optimization of surgical technique, and 4) areas for robotic improvement. (available at https://safetyinspinesurgery.com/ ).</p><p><strong>Conclusion: </strong>This work provides expert insight into the best practices for minimizing errors in RASS with the presentation of 27 recommendations that can serve to reduce practice variability, optimize safety, and guide future research.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body mass index adjustments in children with early onset scoliosis: arm span BMI.","authors":"Michael Trask, Scott Yang, Apeksha Gupta, Burt Yaszay, Jennifer M Bauer, Gregory Redding","doi":"10.1007/s43390-025-01056-5","DOIUrl":"https://doi.org/10.1007/s43390-025-01056-5","url":null,"abstract":"<p><strong>Purpose: </strong>Body mass index (BMI), is a nutritional index based on standing height and weight. Children with early onset scoliosis (EOS) have shorter height due to their spine curvature. In these patients' pulmonary function tests, which are also based off height, arm span is standardly used as a surrogate for height to allow for normative comparisons. Arm span has not been used for nutritional assessments in children with EOS.</p><p><strong>Methods: </strong>We used both arm span and measured height to calculate BMI, and BMI as a percent of predicted published norms (BMI%ile) to assess the error produced using height in this population of children. We used a Wilcoxon signed-rank test to compare standard height BMI (BMI) vs arm span BMI (asBMI) and BMI%iles, Spearman correlation to assess the influence of age or coronal curve angle on any differences, and an adjusted linear model for the coronal curve's impact on BMI.</p><p><strong>Results: </strong>BMI and BMI%ile consistently over-estimated nutritional status compared to asBMI with substitution of arm span for height. 15.6% of patients had a BMI%ile of < 1% using height compared to 44.4% using arm span. The difference between BMI and asBMI correlated with the coronal curve magnitude but not with age. The adjusted linear model showed that for each degree of Cobb angle, the difference between BMI and asBMI increased by 0.0294 kg/m² (p = 0.0062).</p><p><strong>Conclusion: </strong>Arm span BMI reveals lower, more accurate nutritional status in children with EOS than standard height BMI.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical site infection risk in neuromuscular scoliosis patients undergoing posterior spinal fusion.","authors":"Ryan Sefcik, Michael Kreft, Kenzie Lundqvist, Richard Steiner, Todd Ritzman, Lorena Floccari","doi":"10.1007/s43390-024-01015-6","DOIUrl":"https://doi.org/10.1007/s43390-024-01015-6","url":null,"abstract":"<p><strong>Purpose: </strong>Scoliosis in neuromuscular scoliosis (NMS) is a spinal deformity often treated with posterior spinal fusions (PSF). There is a relatively high risk to develop surgical site infection (SSI) after PSF in NMS compared to adolescent idiopathic scoliosis (AIS) patients. The purpose of this retrospective cohort study was to determine perioperative risk factors for NMS patients undergoing PSF.</p><p><strong>Methods: </strong>The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Pediatric database was queried for patients who underwent PSF for NMS and/or cerebral palsy from 2015 to 2020. Statistical analysis of patient characteristics was completed utilizing likelihood ratio chi-squared test for categorical factors and median test or Wilcoxon rank sum test for quantitative factors. Logistic regression was used for odds ratios for quantitative factors.</p><p><strong>Results: </strong>4145 patients underwent PSF for NMS, and 102 developed an SSI (2.5%). Identified risk factors include American Society of Anesthesiologists (ASA) ≥ 3 (p = 0.030, odds ratio 2.4), preoperative corticosteroids (p = 0.049, odds ratio 2.4), preoperative ostomy (p = 0.026, odds ratio 1.6), prolonged anesthetic time (p = 0.045, odds ratio 1.09 per 60 min), prolonged operative time (p = 0.043, odds ratio 1.1 per 60 min), and postoperative development of urinary tract infection (UTI) (p < 0.001, odds ratio 4.5). Patients with SSI had higher body mass index (p = 0.047, odds ratio 1.3 per 5 kg/m²).</p><p><strong>Conclusion: </strong>The prevalence of deep SSI was 2.5% in this cohort, and risk factors include ASA ≥ 3, preoperative ostomy, prolonged anesthetic or operative time, and postoperative UTI. Large multicenter database studies can help identify and stratify risk factors for SSI in this high-risk patient population.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pelvic asymmetry in children with neuromuscular scoliosis: a computed tomography-based 3D analysis.","authors":"Arispe Juan Pablo, Carlos Tello, Piantoni Lucas, Galaretto Eduardo, Remondino Rodrigo, Calcagni Julián, Noel Mariano","doi":"10.1007/s43390-024-01025-4","DOIUrl":"https://doi.org/10.1007/s43390-024-01025-4","url":null,"abstract":"<p><strong>Purpose: </strong>Pelvic fixation in pediatric neuromuscular patients with scoliosis is performed when significant pelvic obliquity is present. Instrumentation to the pelvis can be technically demanding and challenging, often associated with a high complication rate, prolonged operative time, increased radiation exposure, and increased intraoperative bleeding. The high complexity of the pelvic instrumentation technique, particularly in severe cases, led us to develop computed tomography (CT)-based 3D in a series of 53 consecutive neuromuscular patients. This analysis aimed to improve the understanding of pelvic asymmetry and preoperatively simulate pelvic instrumentation.</p><p><strong>Methods: </strong>A CT-based 3D analysis of all pelvises was performed using Mimics software (version 21), segmenting them for analysis in all three planes. We proceeded with the simulation of pelvic instrumentation with iliac screws, obtaining the angle values and corresponding orientations in the three planes for each screw. A total of 53 CT scans were analyzed, corresponding to 36 patients with myelodysplasia and 17 with neuromuscular disorders.</p><p><strong>Results: </strong>Pelvic asymmetry was observed in 88.6% (47 CT scans) of the patients. This asymmetry indicated that the weight-bearing hemipelvis underwent anatomical changes compared to the contralateral hemipelvis, including opening or closing of the pelvis relative to the sacroiliac joint, pivoting of the hemipelvis in a cephalocaudal or caudocephalic direction, and shortening of the innominate line.</p><p><strong>Conclusion: </strong>The shape of the weight-bearing hemipelvis is closely related to pelvic asymmetry. A distinct pattern was identified, characterized by cephalic or caudal pivoting, greater prominence of the iliac crest, increased distance from the sciatic spine to the coccyx, and shortening of the innominate line. This finding is relevant for surgical planning and pelvic fixation.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial 13#2.","authors":"John E Lonstein","doi":"10.1007/s43390-025-01061-8","DOIUrl":"https://doi.org/10.1007/s43390-025-01061-8","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143450121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing blood volume returned with use of intraoperative cell salvage in adult spinal deformity correction.","authors":"Katherine D Drexelius, Lindsey E Miller, Rebecca J DeCarlo, Trent A VanHorn, Michael A Bohl","doi":"10.1007/s43390-025-01055-6","DOIUrl":"https://doi.org/10.1007/s43390-025-01055-6","url":null,"abstract":"<p><strong>Purpose: </strong>While multiple studies have evaluated the role of intraoperative red blood cell salvage (IOCS) in instrumented posterior spinal fusion as a method to reduce allogenic blood transfusion and its associated risks and cost, few studies have quantified the blood available for return to the patient when using IOCS. Given this paucity of data, the purpose of this study was to evaluate the relationship between estimated blood loss and cell saver volume returned.</p><p><strong>Methods: </strong>Patients aged 18 years or older who underwent elective spinal fusion for correction of deformity requiring six or more levels of fusion were included. Demographic data, surgical details, EBL as measured by cell saver, and cell saver blood volume returned were recorded.</p><p><strong>Results: </strong>138 consecutive patients were included in the study. Average EBL as measured by cell saver across 138 cases was 734 cc. Based on patients' height, weight, and sex, the average percentage of estimated circulating blood volume lost during surgery was 15.9%. Average EBL per level was 84.2 cc.; mean percentage of total blood volume lost per level was 1.8%. Average blood volume returned was 256 cc., resulting in an average 34.9% of blood loss returned to the patient via IOCS.</p><p><strong>Conclusions: </strong>On average, 34.9% of blood lost was subsequently transfused. While literature on this topic is very limited, this finding was similar to smaller cohorts that have examined IOCS autologous transfusion volumes. A better understanding of the available fraction of blood for return may allow providers to predict the need for allogenic blood transfusion or more clearly evaluate cost effectiveness of IOCS.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there any difference in the perioperative outcome between male and female adolescent idiopathic scoliosis patients undergoing posterior spinal fusion? A propensity score matching analysis study of 570 patients.","authors":"Chee Kidd Chiu, Siti Mariam Abd Gani, Yuki Mihara, Mohd Shahnaz Hasan, Chris Yin Wei Chan, Mun Keong Kwan","doi":"10.1007/s43390-025-01057-4","DOIUrl":"https://doi.org/10.1007/s43390-025-01057-4","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the perioperative outcome differences between male and female AIS patients who underwent posterior spinal fusion (PSF) surgeries.</p><p><strong>Methods: </strong>This was a retrospective study of 570 patients (84 male, 486 female). Patients were divided into male and female groups. A propensity score matching analysis was performed with match tolerance of 0.005. Preoperative data collected were age, height, weight, body mass index (BMI), Lenke curve classification, preoperative Cobb angle, and preoperative flexibility. Intraoperative data collected were operation duration, intraoperative blood loss, amount of salvaged blood, number of patients required transfusion, number of screws and fusion level. Postoperative data collected were postoperative hemoglobin, postoperative Cobb angle, correction rate, length of postoperative hospital stay and perioperative complications.</p><p><strong>Results: </strong>Before matching, age, height, weight, and fusion level showed significant difference between genders (p < 0.05). After matching, there was no difference in the perioperative outcome parameters. When matched patients excluding height and weight, males had significantly longer wound, higher intraoperative blood loss and more blood salvaged from cell saver. When matched patients excluding fusion levels, males had significantly higher intraoperative blood loss. When matched patients excluding age, we found no significant differences.</p><p><strong>Conclusion: </strong>Male AIS patients who underwent PSF surgeries were older, taller, heavier and had longer fusion levels but there was no difference in perioperative outcomes between matched male and female patients.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal deformity transitional care from pediatric to adult population: a descriptive study.","authors":"Mélanie Ta, Marc Khalifé, Christophe Glorion, Pierre Guigui, Stéphanie Pannier, Emmanuelle Ferrero","doi":"10.1007/s43390-024-01024-5","DOIUrl":"https://doi.org/10.1007/s43390-024-01024-5","url":null,"abstract":"<p><strong>Background: </strong>Spinal deformity can develop in childhood and adulthood. There is often a loss of follow-up for these patients during the transition to adulthood. The aim of this study was to describe the management of those patients. Hypothesis transitional care enhances patient's adherence to long-term follow-up.</p><p><strong>Methods: </strong>A consultation was organized between two orthopedic surgery departments, one pediatric and the other adult, to ensure a transitional follow-up. All patients followed up in the pediatric department for spinal deformity between 2019 and 2021 were included (Ped group). Patients referred to the adult department were analyzed (Ped_Ad group). Data collected included type of deformity, age at first and last consultation, overall follow-up time, and number lost to follow-up (LTFU).</p><p><strong>Results: </strong>Overall, 383 patients were included: 11% were referred to an adult center (Ped_Ad), and 89% remained in pediatrics (Ped). Age at first and last consultation was significantly higher in the Ped_Ad group. Mean follow-up time was 4 years in both groups. In the Ped group, 18% of patients had undergone surgery, versus 61% in the Ped_Ad group. The rate of LTFU was twice higher in the Ped group (25%) than in the Ped_Ad group (12%), but the difference was not significant (p = 0.07). Among LTFU, patients aged between 14 and 16 years were the most represented (53%), and they were most often unoperated patients in the Ped group.</p><p><strong>Conclusion: </strong>When adult follow-up was organized, adherence to follow-up was better. This would enable patients to be managed earlier, in the event of worsening of an unoperated deformity.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}