Journal of Hand Surgery Global Online最新文献

{"title":"Toe Transfers in Mutilated Hands: Technical Considerations To Get Good Outcomes","authors":"Shanmuganathan Raja Sabapathy MCh, FRCS ,&nbsp;Hari Venkatramani MS, MCh ,&nbsp;Praveen Bhardwaj MS, FNB ,&nbsp;Monusha Mohan MS, FNB ,&nbsp;Vigneshwaran Varadharajan MS, FNB","doi":"10.1016/j.jhsg.2024.10.003","DOIUrl":"10.1016/j.jhsg.2024.10.003","url":null,"abstract":"<div><div>In severe mutilating injuries of the hand, microvascular toe transfers can help gain prehension. Radical debridement and primary wound healing, with or without a flap cover, are the prerequisites for a successful toe transfer. A pedicled groin flap is our preferred method of soft tissue cover. A primary toe transfer can be performed in cases of isolated thumb loss. The metacarpophalangeal joint should be preserved whenever possible. The first web space should be maintained to obtain optimal results. In cases where two toe transfers are required, the authors prefer to do them in two sittings; the thumb is reconstructed first, followed by finger reconstruction. A great toe is used for thumb reconstruction in patients where a part of the palm and multiple fingers are lost. Proper positioning of the thumb and high quality of tendon and nerve repair followed by adequate hand therapy will lead to ideal outcomes.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 362-367"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620409","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":"A Modified Palmar Approach With Tendon Splitting for Distal Phalanx Enchondromas of the Thumb: A Report of Two Cases","authors":"Yukihiro Kokubu MD ,&nbsp;Keisuke Hirose MD ,&nbsp;Toshinori Kurashige MD ,&nbsp;Yoshiaki Ando MD ,&nbsp;Kiyoma Marusugi MD ,&nbsp;Hiroshi Kawaguchi MD, PhD","doi":"10.1016/j.jhsg.2025.01.001","DOIUrl":"10.1016/j.jhsg.2025.01.001","url":null,"abstract":"<div><div>Distal phalanx enchondromas of the thumb are rare and pose unique challenges for surgical management because of the thumb’s critical role in hand function. Traditional dorsal and lateral approaches risk damaging extensor tendons, the nail matrix, limiting interphalangeal mobility, or compromising pinch function. This report presents two cases of thumb distal phalanx enchondromas successfully treated using a modified palmar approach with Bruner’s incision followed by splitting the insertion of the flexor pollicis longus tendon. Both patients achieved complete curettage, bone regeneration, and full preservation of thumb function at the 1-year follow-up. The incision design avoided high-pressure zones of the pulp, reducing postoperative complications while maintaining functionality. Fluoroscopic guidance facilitated effective curettage through the flexor pollicis longus tendon split without extensive exposure. These findings underscore the tendon splitting palmar approach as a viable option in selected cases, highlighting the importance of individualized surgical strategies to optimize outcomes for distal thumb enchondromas.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 249-252"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620923","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":"Mandatory Surgeon Skills for Care of the Mutilated Hand","authors":"Dainn Woo MD ,&nbsp;Caroline Granruth MD ,&nbsp;Benjamin Gundlach MD ,&nbsp;Lawrence S. Levin MD","doi":"10.1016/j.jhsg.2024.07.007","DOIUrl":"10.1016/j.jhsg.2024.07.007","url":null,"abstract":"<div><div>Mangled extremities are complex injuries of the soft tissues, neurovascular structures, and bone that have devastating functional and psychological consequences for affected individuals. Successful management of mangling injuries to the upper extremities requires close collaboration between individuals from diverse training backgrounds. Hand surgery is a surgical discipline with an expansive repertoire of skills and knowledge allowing one to manage bone, joint, tendon, nerve, vasculature, and soft tissue pathology of the upper extremity in adults and children.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 314-318"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620927","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":"Vascularized Bone Graft in Mangled Hand Reconstruction","authors":"Chung-Chen Hsu MD ,&nbsp;Fu-Chan Wei MD","doi":"10.1016/j.jhsg.2024.08.003","DOIUrl":"10.1016/j.jhsg.2024.08.003","url":null,"abstract":"<div><div>Extensive bone defects, especially in conjunction with associated coverage involvement in mangled hands, pose notably challenges to hand and upper-extremity surgeons. Vascularized bone grafts often play a vital role in effective treatment now a days. It not only bypasses the drawbacks of conventional grafts but also allows for simultaneous one-stage reconstruction of its coverage as well as repairs other injured structures. Preoperative evaluation of mangled hand is crucial; the injury extent, including circulation, patient expectations, and clinical reality, should be all taken into consideration before finalizing the reconstruction plan. The fibula bone, along with other vascularized bone flaps such as iliac crest bone, medial femoral condyle, and some others, as well as corresponding spare parts, can provide effective solutions. Considerations such as surgeons’ experience and expertise, donor site morbidity, postoperative care, and rehabilitation are essential for optimal outcomes. In this article, we would like to share our current practicing vascularized bone flaps in mangled hand reconstructions.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 349-355"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620944","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":"Evaluation of a Multispecialty Mobile Health App: Pilot Study","authors":"Ryan Xiao MD ,&nbsp;Roshan Patel BA ,&nbsp;Tamara Rozental MD ,&nbsp;Brian Schurko MD ,&nbsp;Monica Shoji MD ,&nbsp;Carl Harper MD","doi":"10.1016/j.jhsg.2024.12.003","DOIUrl":"10.1016/j.jhsg.2024.12.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Educational mobile apps have been studied in multiple surgical disciplines, evaluating a wide range of possible benefits with varying success in improving overall quality of life after surgery. We hypothesize that utilization of a mobile health app in the perioperative setting will be easy to use and will improve patient satisfaction with care for patients undergoing hand surgery.</div></div><div><h3>Methods</h3><div>Patients were given access to a mobile app at their initial visit to access content about their diagnosis, treatment options, and care instructions for cubital tunnel syndrome, carpal tunnel syndrome, distal radius fracture, trigger finger, or carpometacarpal arthritis. At their initial visit, patients were administered the Short-Form-12 (SF-12) survey to assess subjects' physical component summary (score-12) and mental component summary (score-12)health score, with higher scores indicating better function and with the United States average score at 50. At their 4-week postoperative visit, the participating patients were administered two surveys: the mHealth App Usability Questionnaire (mAUQ) to address the usability and utility of mobile health care apps and SF-12. The mAUQ comprises 21 items rated from 1 (strongly disagree) to 7 (strongly agree).</div></div><div><h3>Results</h3><div>Of the 162 patients enrolled, 120 patients completed all survey items. Patients scored the mAUQ an average 6.2 of 7 regarding ease of use, 5.9 of 7 for system information arrangement, and 4.8 of 7 for usefulness. Comparing pre- to postsurgery SF-12 scores at 4 week follow-up, the patients demonstrated stable physical component summary (score-12) and a trend toward slightly worse mental component summary (score-12).</div></div><div><h3>Conclusions and Clinical Relevance</h3><div>Overall, the patients found the mobile app easy to use, could sufficiently navigate the app, and found the information presented useful to their care. However, the patients did not find improvement in their mental health scores with the app.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 203-206"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620992","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":"Failed Thumb Basal Joint Arthroplasty: An Analysis of Common Etiologies Leading to Reoperation","authors":"Adina Harri BA ,&nbsp;Emily J. Harman MD ,&nbsp;Jennifer Chickering OTR/L, CHT ,&nbsp;Lance G. Warhold MD ,&nbsp;Vincent D. Pellegrini Jr MD","doi":"10.1016/j.jhsg.2024.12.004","DOIUrl":"10.1016/j.jhsg.2024.12.004","url":null,"abstract":"<div><h3>Purpose</h3><div>Hand osteoarthritis contributes considerably to functional disability, and the basal joint is the most common site treated surgically. Procedure choice is largely based on surgeon preference, and causes of primary basal joint arthroplasty failure and prevalence of revision are poorly defined. We seek to understand the etiologies of revision basal joint surgery.</div></div><div><h3>Methods</h3><div>Retrospective medical record review identified 26 reoperations in 24 thumbs in 23 patients by two senior hand surgeons following primary basal joint arthroplasty performed for osteoarthritis from 2014 to 2022. Chart review yielded demographic and historical information, surgical technique of index and revision procedures, presenting symptoms, time to reoperation, and intraoperative revision findings. Radiographic measures included prerevision thumb metacarpal subsidence, radial subluxation, scaphoid impingement, and untreated scaphotrapezoid arthritis.</div></div><div><h3>Results</h3><div>All patients complained primarily of pain on presentation, followed by impaired function (n = 11) and dorsal thumb dysesthesias (n = 2). Physical findings included metacarpophalangeal joint hyperextension (n = 12), axial thumb instability (n = 10), and inability to flatten the palm (n = 5); the latter occurred in four of seven thumbs having index TightRope or swivel-lock procedures and one thumb having ligament reconstruction and tendon interposition with a swivel-lock device. Six patients (25.0%) had “other” pathologies including carpal tunnel syndrome, palpable foreign body, capitate subluxation, and absent EPL function. Radiographs revealed untreated scaphotrapezoid arthritis (18), radial metacarpal base subluxation (18), proximal thumb metacarpal migration (17), and trapezial space height &lt; 5 mm (16). Intraoperative revision findings included proximal thumb metacarpal migration (12), untreated scaphotrapezoid arthritis (9), foreign body granuloma (6), metacarpophalangeal joint hyperextension (5), impinging osteophytes (4), scaphoid-metacarpal impingement (3), and suture anchor pull-out (2).</div></div><div><h3>Conclusions</h3><div>The most common pathologies encountered during revision basal joint arthroplasty include trapeziometacarpal instability, unrecognized scaphotrapezoid arthritis, and untreated metacarpophalangeal joint hyperextension. Dysfunction resulted from iatrogenic inability to flatten the palm associated with use of swivel-lock and TightRope anchor devices to stabilize the thumb metacarpal.</div></div><div><h3>Type of study/level of evidence</h3><div>Differential Diagnosis/Symptom Prevalence Study IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 207-211"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620993","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":"Reconstruction and Regeneration of Composite Fingertip Injuries Using Acellular Bladder Matrix","authors":"Usman Zareef MD ,&nbsp;Anna Green MD ,&nbsp;Caroline Moore PA-C ,&nbsp;Hari Iyer MD ,&nbsp;Brian Katt MD ,&nbsp;Ajul Shah MD","doi":"10.1016/j.jhsg.2024.11.014","DOIUrl":"10.1016/j.jhsg.2024.11.014","url":null,"abstract":"<div><h3>Purpose</h3><div>Traumatic fingertip amputations are one of the most encountered injuries in the emergency department requiring evaluation by a hand surgeon. Current management strategies vary widely. We describe the use of acellular urinary bladder matrix (UBM) in complex distal fingertip injuries involving bone, soft tissue, and nailbed.</div></div><div><h3>Methods</h3><div>A prospective cohort of 47 patients with proximal fingertip amputations (36 Allen zone III and 15 Allen zone IV) underwent UBM application with resultant fingertip regeneration. Patients received the first application in the operating room. Subsequent applications were reapplied weekly in the clinic setting until fibrinous granulation tissue was observed (average 2.5 total applications). Patients performed daily dressing changes until regeneration was achieved.</div></div><div><h3>Results</h3><div>The average time to regeneration was 8.4 weeks. The mean length deficit compared to the contralateral fingertip was 3.6 mm for zone 3 and 4.8 mm for zone 4 injuries. The static 2-point discrimination of the injured fingertip was 1.2 mm less sensitive compared to the contralateral uninjured finger in zone 3 injuries and 1.1 mm in the zone 4 cohort. Overall patient satisfaction measured on a 10-point Likert scale was 9.5. Seven complications were observed: 5 hook nail deformities, one bony exostosis requiring surgical excision, and one case of pyogenic granuloma.</div></div><div><h3>Conclusion</h3><div>Application of UBM is a reliable way to promote composite regeneration of Allen III-IV fingertip injuries. Its use resulted in excellent patient satisfaction with minimal complications encountered. Urinary bladder matrix should be considered for use in the treatment of proximal fingertip amputations.</div></div><div><h3>Level of Evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 186-191"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620989","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":"An Overview Algorithm for Perforator Free Flap Coverage of all Zones of the Mangled Upper Extremity","authors":"Geoffrey G. Hallock MD","doi":"10.1016/j.jhsg.2024.03.015","DOIUrl":"10.1016/j.jhsg.2024.03.015","url":null,"abstract":"<div><div>A truly mangled upper extremity will undoubtedly need composite tissue rearrangement to ensure adequate wound healing; but often also the replacement of missing parts, always with the goal of maximizing functional rehabilitation. Whatever the approach, restoration of the cutaneous envelope surrounding the underlying repaired musculoskeletal system will be mandatory. Vascularized tissues as flaps frequently will be essential to accomplish this goal; however, intrinsic local donor sites not only may not be available due to the injury itself or if chosen would contribute to further injury. Instead, microvascular tissue transfers will play an important role. In this regard, the perforator free flap today has gained prominence as “like can replace like,” sensibility is restored, secondary procedures are more simply approached, and donor site morbidity is reduced since no muscle needs to be sacrificed, maximizing function preservation. However, perforator flap donor sites are highly variable, providing another attribute that, on selection, may best meet the requirements for the involved zone of the upper extremity.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 277-283"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141138772","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":"Unveiling the Upper-Extremity Morbidities of Utility-Terrain Vehicles in Pediatric Riders","authors":"Emily M. Graham MD ,&nbsp;Hunter Frederiksen MD ,&nbsp;Stanley Memmott MD ,&nbsp;Dana Rioux-Forker MD ,&nbsp;Angela A. Wang MD ,&nbsp;Douglas T. Hutchinson MD ,&nbsp;Shaun D. Mendenhall MD","doi":"10.1016/j.jhsg.2024.10.005","DOIUrl":"10.1016/j.jhsg.2024.10.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Off-road vehicles including all-terrain vehicles (ATVs) and utility-terrain vehicles (UTVs) are preventable sources of pediatric upper-extremity (UE) trauma. We hypothesized that UE traumas from UTV accidents in children would be associated with more mutilating hand injuries, amputations, surgeries, and longer hospital and intensive care unit (ICU) admissions compared to ATVs.</div></div><div><h3>Methods</h3><div>Pediatric cases of UE injury because of the use of an ATV or UTV at a trauma I center were identified using International Classification of Disease 9/10 codes and EPIC Boolean logic from 2010 to 2021. Findings were analyzed with Fisher exact tests, multivariate analysis of variance, analysis of variance with post hoc analyses, and multiple linear regressions.</div></div><div><h3>Results</h3><div>Retrospective review identified 42 patients from 5 states (ATV = 25; UTV = 17). Pediatric UTV riders had triple the amount of UE vascular compromise and sustained nearly 7-times more partial hand amputations. No significant differences in time spent in the hospital or ICU were observed based on vehicle type; however, young riders of UTVs required 1.5 additional reconstructive surgeries compared to young riders of ATVs.</div></div><div><h3>Conclusion</h3><div>Accidents caused by UTVs often lead to devastating UE injuries in pediatric riders. Hand surgeons are in a unique position to serve as forerunners to ensure pediatric rider safety and care for the devastating traumas produced by off-road vehicle accidents.</div></div><div><h3>Type of study/level of evidence</h3><div>Therapeutic IV.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 127-134"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620407","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":"The Current State of Outcome Measurements After Peripheral Nerve Injury: A Systematic Review","authors":"Abigail G. Carey-Ewend BS ,&nbsp;Jake H. Goldfarb BA ,&nbsp;Zachary D. Randall BS ,&nbsp;David M. Brogan MD, MSc ,&nbsp;Christopher J. Dy MD, MPH","doi":"10.1016/j.jhsg.2024.12.001","DOIUrl":"10.1016/j.jhsg.2024.12.001","url":null,"abstract":"<div><h3>Purpose</h3><div>The manner in which outcomes are reported after peripheral nerve injury (PNI) varies tremendously and often centers on surgeon-manual muscle testing. The purpose of our systematic review was to quantify the use of outcome measures after PNI in the contemporary literature (published in 2008 and beyond) and to evaluate which domains of recovery are assessed most frequently.</div></div><div><h3>Methods</h3><div>With the assistance of a medical librarian, we performed a systematic review of the literature published in or after 2008 (to represent the last 15 years) for patients with upper-extremity PNI. We excluded articles with &lt;5 participants, minors, brachial plexus or digital nerve injuries, compressive neuropathies, or &lt;6 months of follow-up. Data were extracted to identify which outcome measures were used in each study, categorizing the outcome measures under the domains of motor, sensory, function, and pain.</div></div><div><h3>Results</h3><div>Of the 4 outcome domains (pain, motor, sensory, and function), motor was reported the most frequently, followed by function. Within the motor category, more than two-thirds of the studies used manual muscle testing for assessment. Half of the articles reported outcomes in 2 of the 4 assessed domains. Pain was the least assessed domain, reported in 11 of 68 articles.</div></div><div><h3>Conclusion</h3><div>While there has been incorporation of functional outcomes, the majority of the literature in the last 15 years remains focused on surgeon-reported muscle testing and does not adequately reflect the multiple domains affected by PNI. Pain is the least frequently reported domain, despite being an issue that frequently vexes PNI patients.</div></div><div><h3>Clinical Relevance</h3><div>There is a need for clinicians and researchers to agree upon a common set of outcome measures for PNI that (A) encompass perspectives of clinicians and patients and (B) reflect multiple domains affected by PNI. This will improve the quality of outcome reporting and facilitate future comparative effectiveness studies.</div></div>","PeriodicalId":36920,"journal":{"name":"Journal of Hand Surgery Global Online","volume":"7 2","pages":"Pages 192-195"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143620990","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}