Bone & Joint Open最新文献

{"title":"Task-specific determinants of one-year performance after unilateral primary total knee arthroplasty.","authors":"Yoshitomo Saiki, Naoyuki Kubo, Tomohiro Ojima","doi":"10.1302/2633-1462.78.BJO-2025-0366.R1","DOIUrl":"10.1302/2633-1462.78.BJO-2025-0366.R1","url":null,"abstract":"<p><strong>Aims: </strong>This study aimed to investigate the associations between performance-based outcomes (walking, sit-to-stand, and stair climbing) and impairment-level measures one year after primary unilateral total knee arthroplasty (TKA) using an analytic framework that mitigates multicollinearity.</p><p><strong>Methods: </strong>Prospectively collected data were analyzed in a cross-sectional design. We included 142 patients who underwent primary unilateral TKA. The performance-based outcomes one year postoperatively were the 40 m fast-paced walk test (FPWT), 30 s chair stand test (CST), and 11-step stair-climbing test (SCT). Explanatory variables included age, sex, BMI, one-year postoperative muscle strength (bilateral quadriceps and hamstring strength), pain visual analogue scale (VAS) score, and knee flexion range of motion (ROM; SCT model only). We performed multivariate analyses using multiple linear regression and additionally applied ridge regression to mitigate multicollinearity. Relative importance was quantified using the Lindeman-Merenda-Gold (LMG) method.</p><p><strong>Results: </strong>For the FPWT, the primary determinants were bilateral quadriceps strength, contralateral hamstring strength, and age, while sex and pain VAS scores were lower-importance contributors. For CST, bilateral quadriceps strength, age, and contralateral hamstring strength were the primary determinants, with BMI contributing secondarily. For SCT, contralateral quadriceps strength and age were the main determinants, whereas pain VAS score and knee flexion ROM were additional, lower-importance contributors.</p><p><strong>Conclusion: </strong>One year after TKA, bilateral quadriceps strength played a central role across all tasks. Walking and sit-to-stand performances were additionally associated with contralateral hamstring strength and age, whereas stair performance was influenced by pain control and adequate knee flexion ROM. These findings support personalized rehabilitation strategies that prioritize bilateral quadriceps strengthening and layer-task-specific requirements.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1015-1025"},"PeriodicalIF":3.3,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13441491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual versus robotic-assisted revision total knee arthroplasty for instability : a one-year cohort analysis.","authors":"Alexander Burbelo, William Stone, Trace Clark, Andrew B Huffman, Andrew Murphy, Christopher E Potts, Matthew Bullock, Alexander Caughran","doi":"10.1302/2633-1462.78.BJO-2026-0018.R1","DOIUrl":"10.1302/2633-1462.78.BJO-2026-0018.R1","url":null,"abstract":"<p><strong>Aims: </strong>Revision total knee arthroplasty (rTKA) is a treatment option for failed primary TKA but is associated with higher complication rates and technical challenges. Robotic-assisted rTKA (rarTKA) is an emerging technique that may improve component alignment and surgical precision. However, its effect on early postoperative outcomes in rTKA for instability remains unclear.</p><p><strong>Methods: </strong>A total of 133 consecutive rTKAs for instability (82 manual and 51 robotic) performed by two fellowship-trained arthroplasty surgeons at a single institution were retrospectively analyzed. All rarTKAs used the MAKO robotic-arm system. Operating time, length of stay (LOS), joint line change, posterior condylar offset (PCO) change, and all-cause 30-/90-day complications were compared using univariable analyses. Revision implant constructs were also compared. The Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) and range of motion (ROM) were assessed at three months and one year, respectively. Kaplan-Meier analysis assessed one-year reoperation-free survival.</p><p><strong>Results: </strong>RarTKA achieved a greater mean increase in PCO (3.4 mm vs 1.5 mm; p = 0.014), but required a longer operating time (186 minutes vs 173 minutes; p = 0.037). Joint line change, LOS, three-month KOOS-JR, and ROM did not differ significantly. The 30-day (4.9% vs 7.8%) and 90-day (7.3% vs 11.8%) complication rates and one-year reoperation-free survival (91.5% vs 94.1%; p = 0.900) were comparable. Although offset couplers were not used, rarTKA constructs incorporated augments more frequently.</p><p><strong>Conclusion: </strong>RarTKA demonstrated early postoperative outcomes and complication rates comparable to those of conventional manual rTKA, while achieving improved PCO restoration despite longer operating times. LOS, functional outcomes, and one-year survivorship were similar between groups. Overall, rarTKA appears to be safe and effective; however, further investigation is required to determine the long-term benefits and clinical significance.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1007-1014"},"PeriodicalIF":3.3,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13437100/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148686321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for scaphoid nonunion in acute fractures treated with cast immobilization.","authors":"Benjamin J F Dean, Farid Saedi, Nicholas D Riley, Sarim Ather, Biruk Tsegaye, Paula Dhiman, Christopher Little, Warren Sheehan, Matt L Costa","doi":"10.1302/2633-1462.78.BJO-2026-0012.R1","DOIUrl":"10.1302/2633-1462.78.BJO-2026-0012.R1","url":null,"abstract":"<p><strong>Aims: </strong>There is a lack of published evidence relating to the risk factors for nonunion seen in acute scaphoid fractures. We aimed to describe the risk factors for nonunion in adult patients (aged ≥ 16 years) treated with cast immobilization for acute scaphoid fractures.</p><p><strong>Methods: </strong>We conducted a single centre cohort study of patients with an acute scaphoid fracture and who were followed up with a CT scan to assess union. Data were gathered retrospectively. Outcomes were classified as union or nonunion based on CT scan follow-up. Descriptive and regression analyses were performed.</p><p><strong>Results: </strong>Of 502 patients, there were 50 nonunions (10%), of which 39 (78%) were male. The risk of nonunion tripled when fracture displacement was ≥ 1 mm compared with < 1 mm displacement (odds ratio (OR) 3.10; 95% CI 1.42 to 6.71. There was strong evidence that age was a risk factor for nonunion and the relationship between age and nonunion was non-linear. The reference age was 26 years and the highest risk of nonunion was in the 26- to 36-year age group. The risk of nonunion steadily reduced as age increased above aged 36 years; for example, patients aged 40 years older (66 years old) had a 91% lower risk of nonunion respectively relative to the reference age group.</p><p><strong>Conclusion: </strong>The two risk factors for scaphoid nonunion in those treated with cast immobilization were fracture displacement and age. Further assessment and research could help inform clinical decision making and may help guide future research to improve clinical pathways of care.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"1001-1006"},"PeriodicalIF":3.3,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13433010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consent: Doctor, can you please do my operation?","authors":"Neil Ranjan L Wickramasinghe, Nick D Clement, Josephine T V Greenbrook","doi":"10.1302/2633-1462.78.BJO-2025-0294.R1","DOIUrl":"10.1302/2633-1462.78.BJO-2025-0294.R1","url":null,"abstract":"","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"997-1000"},"PeriodicalIF":3.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13429284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted arthroplasty paradox: the disconnect between precision and patient-perceived outcomes.","authors":"Nick D Clement, Andrew D Duckworth, Fares S Haddad","doi":"10.1302/2633-1462.78.BJO-2026-0164","DOIUrl":"10.1302/2633-1462.78.BJO-2026-0164","url":null,"abstract":"","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 8","pages":"994-996"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13427426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of analgesic techniques in total hip arthroplasty : a systematic review and network meta-analysis of more than 100 randomized studies incorporating minimal clinically important difference.","authors":"Tim Cheok, Morgan Berman, William Jordan, Alexander Beveridge, Thomas Smith, Craig Morrison, Mehul Mayank, Ruurd L Jaarsma, Job N Doornberg","doi":"10.1302/2633-1462.77.BJO-2026-0093.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0093.R1","url":null,"abstract":"<p><strong>Aims: </strong>We compared the analgesic efficacy of commonly used analgesic techniques in patients undergoing total hip arthroplasty (THA). This included femoral nerve block, supra- and infrainguinal fascia iliaca block, lumbar plexus block (LPB), intrathecal morphine (ITM), periarticular injection (PAI), pericapsular nerve group block (PENG), iliopsoas block (IPB), anterior, lateral, and posterior quadratus lumborum block (QLA/QLL/QLP), lateral femoral cutaneous nerve block (LFCNB), and placebo.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, The Cochrane Library, and Web of Science from their date of inception through to December 2025 was performed. The primary outcome of interest was postoperative day 1 (POD1) pain scores. Secondary outcomes of interest include pain levels at 12 hours postoperatively, opioid consumption within 24 hours after surgery, time to first mobilization, and hospital length of stay. Clinical and statistical significance were evaluated for each outcome.</p><p><strong>Results: </strong>We identified 112 studies. No analgesic technique demonstrated a clinically meaningful reduction in POD1 pain scores. IPB + PAI showed clinically meaningful reduction in 12-hour pain scores when compared with placebo. Similarly, both ITM and IPB + PAI showed clinically meaningful reduction in opioid consumption. Statistically significant reduction in time to first mobilization was seen in the PENG + LFCNB, QLL, PENG, and suprainguinal fascia iliaca block groups as compared with placebo. The hospital length of stay was shorter in the ITM and PENG groups as compared with placebo.</p><p><strong>Conclusion: </strong>Within the limitations of this study, clinically meaningful reduction in pain scores was not observed in most analgesic techniques following THA. ITM demonstrated reduction in 24-hour opioid consumption with a shorter length of hospital stay, while PENG demonstrated shorter time to mobilization as well as a shorter length of hospital stay. Interpretation of these results should consider the substantial heterogeneity encountered in the measurement of 24-hour morphine consumption, as well as the potential side effects of ITM.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"979-993"},"PeriodicalIF":3.3,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148537296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of nonunion after open tibia fractures in Malawi : associated factors and Radiographic Union Score for Tibial fractures reliability.","authors":"Alexander Thomas Schade, Richard Dimock, Thomas Mendes da Costa, Nyamulani Nohakhelha, Kaweme Mwafulirwa, Vincent Mkochi, Chiku Mpanga, Leonard Banza Ngoie, Maureen Sabawo, Andrew John Metcalfe, William James Harrison, Peter MacPherson","doi":"10.1302/2633-1462.77.BJO-2026-0083.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0083.R1","url":null,"abstract":"<p><strong>Aims: </strong>Open tibia fractures are a common and severe injury in low-income countries (LICs), and worsened by fracture-related infection (FRI). The Radiographic Union Score for Tibial fractures (RUST) is widely used to assess fracture healing, but its reliability and factors associated with nonunion in LICs remain unclear.</p><p><strong>Methods: </strong>We conducted a multicentre prospective cohort study in six hospitals across Malawi, enrolling 287 adults with open tibia fractures between February 2021 and March 2022. Participants underwent standardized clinical and radiological follow-up at three, six, and 12 months post-injury. Fracture union at follow-up was assessed independently by two reviewers using the RUST score. Patient function was measured using the Short Musculoskeletal Function Assessment (SMFA) score. Multilevel regression models examined associations between RUST scores, functional outcomes, baseline factors, and treatment methods.</p><p><strong>Results: </strong>Participants had a median age of 34 years (IQR 25 to 44), and 84% (248/287) were male. Overall, 45/177 (25.4%) of participants with open tibia fractures had a nonunion at one year, with 34.2% (13/38) with FRI having nonunion compared with 15.4% (20/130) no FRI (p = 0.001). After adjusting for other variables, compared with external fixation, intramedullary nailing (odds ratio (OR) 1.35, 95% credible interval (CrI) 0.98 to 1.93) and plaster of Paris (POP) fixation (OR 2.05, 95% CrI 1.29 to 3.64) were associated with higher RUST scores. Each one-point increase in RUST score was associated with -4.1 (95% CrI -6.2 to -2.1) SMFA score, reflecting better function. Interobserver reliability of RUST was moderate (ICC 0.51, 95% CI 0.28 to 0.61), despite 74% of radiographs being of suboptimal quality at one year.</p><p><strong>Conclusion: </strong>Nonunion is common after open tibia fracture in Malawi, particularly with external fixation and FRI. The RUST score is reliable and correlates with patient function in LIC settings, even with variable radiograph quality. Poor function should prompt a careful assessment for nonunion and consideration of intervention where appropriate.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"971-978"},"PeriodicalIF":3.3,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13381068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of social deprivation and ethnicity on patient-reported outcome measures in primary and revision hip and knee arthroplasty.","authors":"James Edward Archer, Akash D Sharma, David J Dunlop, Adrian Gardner, Yuvraj S Agrawal","doi":"10.1302/2633-1462.77.BJO-2025-0401.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2025-0401.R1","url":null,"abstract":"<p><strong>Aims: </strong>There is a paucity in the literature on the impact of social deprivation and ethnicity on patient-reported outcome measures (PROMs) in hip and knee arthroplasty. This study aimed to assess the impact of social deprivation and ethnicity on PROMs after hip and knee arthroplasty in a healthcare system which is free at the point of care.</p><p><strong>Methods: </strong>We reviewed collected data on patient demographic details, comorbidities, and PROMs (EuroQol five-dimension questionnaire, Oxford Hip Score, and Oxford Knee Score), in patients who underwent hip and knee arthroplasty procedures, both primary and revision. The primary outcome was impact of social deprivation on PROMs. Secondary outcomes included the impact of ethnicity, religion, and comorbidities on PROMs.</p><p><strong>Results: </strong>We identified 10,646 hip arthroplasties and 8,138 knee arthroplasties from the database. Of these, 6,093 patients who underwent hip arthroplasty and 4,681 patients who underwent knee arthroplasty were included. Patients from the most deprived areas, ethnic minorities, and in those for whom English is not their first language had lower preoperative PROMs. Higher levels of social deprivation were associated with higher levels of comorbidity. The trends are similar in revision hip and knee arthroplasty, but the net improvement in the PROMs was significantly lower in patients who underwent revision procedures when compared with a primary procedure.</p><p><strong>Conclusion: </strong>This study highlights that healthcare inequality exists in the UK among those undergoing hip and knee arthroplasty procedures. This is despite the substantial benefit these procedures can provide, irrespective of social deprivation, ethnicity, or first language.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"956-970"},"PeriodicalIF":3.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining joint arthroplasty care pathways : why equity depends on what happens before and after surgery.","authors":"Gareth Stephens, Julia Gauly, Adrian Gardner, Amy Grove, Arabella Scantlebury, Michael Mansfield","doi":"10.1302/2633-1462.77.BJO-2026-0085.R1","DOIUrl":"10.1302/2633-1462.77.BJO-2026-0085.R1","url":null,"abstract":"","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"952-955"},"PeriodicalIF":3.3,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13375384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148473055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cement compression device for cemented total knee arthroplasty : a randomized controlled trial.","authors":"Anne J Brouwer, Brechtje Hesseling, Hennie Verburg, Richard H M Goossens, Nina M C Mathijssen","doi":"10.1302/2633-1462.77.BJO-2025-0242.R2","DOIUrl":"10.1302/2633-1462.77.BJO-2025-0242.R2","url":null,"abstract":"<p><strong>Aims: </strong>Optimal fixation of the tibial component is crucial to prevent aseptic loosening in total knee arthroplasty (TKA). This involves cement penetrating the tibia by 3 mm to 4 mm. Cement application is not standardized, and ideal penetration depth is not achieved frequently. Therefore, a cement compression device (CCD) was developed. The CCD is positioned around the tibial component, prevents cement leakage, and compresses cement into the tibia. It is hypothesized that the CCD enhances cement penetration and distribution in TKA.</p><p><strong>Methods: </strong>Patients were randomized into two groups: cement application using the finger-packing technique or the CCD. A CT scan was performed postoperatively to determine the percentage of cemented surface (PCS) per quadrant in the proximal tibia, up to 7 mm from the tibial baseplate. Differentiation between bone, cement, and prosthesis on the CT scans was performed using a previously validated method in MATLAB, based on differences in Hounsfield units. PCS was compared per quadrant for the mean of 3 mm and 4 mm depth slices and for each millimetre up to 7 mm depth. Additionally, operating time was compared.</p><p><strong>Results: </strong>In 16 patients, the finger-packing technique was used and in 16 patients, the CCD. In the anterolateral and posterolateral quadrants, PCS was 54% in the finger-packing group versus 72% in the CCD group (95% CI -28.85 to -8.17; p < 0.001), and 34% versus 46% (95% CI -22.78 to -2.05; p = 0.025), respectively. In the posteromedial quadrant, PCS was 28% versus 39% (95% CI -22.39 to -0.15; p = 0.047). In the anteromedial quadrant, PCS was higher in the CCD group, but the difference was not significant. Operating time was 66 minutes in the finger-packing group, compared with 68 minutes in the CCD group (95% CI -8.0 to 3.4; p = 0.416).</p><p><strong>Conclusion: </strong>The CCD results in improved cement penetration and distribution in TKA at the mean of 3 mm to 4 mm and reaching up to 7 mm depth from the tibial baseplate. Implementing the CCD does not prolong the procedure.</p>","PeriodicalId":34103,"journal":{"name":"Bone & Joint Open","volume":"7 7","pages":"944-951"},"PeriodicalIF":3.3,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13372479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}