Arthroplasty Today最新文献

{"title":"Higher Comorbidities are Correlated With Readmission Following Arthroplasty for Femoral Neck Fracture","authors":"Anastasia Gazgalis MD,&nbsp;Shawn Simmons BA,&nbsp;Mary Doucet LCSW,&nbsp;Prakash Gorroochurn PhD,&nbsp;H. John Cooper MD,&nbsp;Carl L. Herndon MD","doi":"10.1016/j.artd.2024.101494","DOIUrl":"10.1016/j.artd.2024.101494","url":null,"abstract":"<div><h3>Background</h3><div>A desire to control cost and improve patient outcomes following arthroplasty led to the introduction of the Center for Medicare and Medicaid Service Comprehensive Care for Joint Replacement Program. Hemi and total hip arthroplasty for femoral neck fracture has been shown to have worse outcomes than those for osteoarthritis. However, little has been studied about the effect of comorbidities on costs associated with arthroplasty for femoral neck fracture. This study investigates how the number of comorbidities influence 90-day outcomes and cost following hemi or total hip arthroplasty for displaced femoral neck fracture in patients covered by the Comprehensive Care for Joint Replacement bundle.</div></div><div><h3>Methods</h3><div>We reviewed all Medicare hip fracture patients undergoing hemi or total hip arthroplasty at our institution between April 2016 and November 2020. Basic demographic and perioperative information was collected. The primary outcome was hospital readmission within 90 days. The data set captured 90-day readmission to any institution, not just within our system. Secondary outcomes included 90-day reoperation and outpatient complications. Multiple logistic regression was used to examine the influence of number of comorbidities on the primary and secondary outcomes while controlling for other variables.</div></div><div><h3>Results</h3><div>The cohort comprised 378 patients (72% female), mean age 82 (±9) years, mean body mass index 23.4 (±4.7) kg/m². For every additional comorbidity, the odds of related readmission without reoperation increased by 1.261 (95% confidence interval [1.055-1.507], <em>P</em> = .011). Odds of reoperation and odds of outpatient complication did not show statistical significance with the available numbers.</div></div><div><h3>Conclusions</h3><div>Increasing preoperative comorbidities results in a higher odd of readmission within 90 days following arthroplasty for femoral neck fracture in this Medicare population.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101494"},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437926","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":"Role of the Conjoined Tendon in Hip Stability Post-Total Hip Arthroplasty: Insights From a Direct Anterior Approach Cadaver Study","authors":"Gongyin Zhao MD, PhD ,&nbsp;Chenyu Zhao MBBS ,&nbsp;Hongwei Bao MD ,&nbsp;Junting Liu MD ,&nbsp;Baojun Zhou MD ,&nbsp;Yuji Wang MD, PhD","doi":"10.1016/j.artd.2024.101487","DOIUrl":"10.1016/j.artd.2024.101487","url":null,"abstract":"<div><h3>Background</h3><div>Hip dislocation represents a significant complication encountered following hip arthroplasty procedures. In this investigation, we conducted a comparative analysis of the biomechanical characteristics exhibited by the piriformis and the conjoined tendon after total hip arthroplasty (THA) via the direct anterior approach (DAA), utilizing cadaveric specimens. The objective is to ascertain the relative significance of the piriformis muscle and the conjoined tendon in mitigating hip dislocation.</div></div><div><h3>Methods</h3><div>A total of 16 hip joints from 8 freshly frozen cadavers were selected and stratified into 2 groups: the piriformis tendon (PT) group and the conjoined tendon (CT) group. Following THA via the DAA, measurements were taken to record the torque required to induce hip dislocation under various conditions. Torque readings were obtained with the tendon in its intact state (intact group) and after preservation or reconstruction of either the PT or the CT.</div></div><div><h3>Results</h3><div>The torques of anterior and posterior dislocation in PT group were 22.24 ± 4.53 N.m and 30.7 ± 15.5 N.m following tendon severed, and 20.04 ± 2.67 N.m and 17.5 ± 6.7 N.m following reconstruction. There were no differences compared to the intact group. The torque decreased in the CT group after CT was severed with the torques dropping from 31.2 ± 7.6 N.m to 8.18 ± 2.6 N.m (<em>P</em> &lt; .0001) for anterior dislocation, and from 34.9 ± 8.3 N.m to 9.8 ± 2.8 N.m (<em>P</em> &lt; .0001) for posterior dislocation. Following reconstruction, the torque required for dislocation significantly increased (<em>P</em> &lt; .0001).</div></div><div><h3>Conclusions</h3><div>This study underscores the preeminent role of the CT in ensuring hip stability following THA via DAA, highlighting the cruciality of its preservation and reconstruction during surgical interventions.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101487"},"PeriodicalIF":1.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142437927","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":"Why Do Early-Career Adult Reconstruction Surgeons Change Jobs? An American Association of Hip and Knee Surgeons Young Arthroplasty Group Survey Study","authors":"Matan Ozery MD ,&nbsp;Elizabeth G. Lieberman MD ,&nbsp;Jenna A. Bernstein MD ,&nbsp;Jesse I. Wolfstadt MD, MSc, FRCSC ,&nbsp;David C. Landy MD, PhD ,&nbsp;Claudia Leonardi PhD ,&nbsp;Anna Cohen-Rosenblum MD, MSc","doi":"10.1016/j.artd.2024.101501","DOIUrl":"10.1016/j.artd.2024.101501","url":null,"abstract":"<div><h3>Background</h3><div>There are high reported rates of burnout and job turnover among orthopedic surgeons. The purpose of this study was to investigate the prevalence of job change among early-career adult reconstruction surgeons and to examine which demographic or practice factors influenced job change.</div></div><div><h3>Methods</h3><div>An electronic survey was distributed to all practicing surgeon members of the American Association of Hip and Knee Surgeons Young Arthroplasty Group. The survey included questions about practice type, demographics, job change, and a validated burnout questionnaire. Survey responses were collected using a secure database. Statistical analysis was performed to examine relationships between respondent characteristics and job change.</div></div><div><h3>Results</h3><div>There were 201/389 responses (51.7%). The most common motivators for job change were better workplace culture (64%), opportunities for career growth (52%), and better alignment with values of the department/institution (45%). There were few female respondents; however, they trended toward reporting higher rates of job change (35.6% female vs 21.3% male, <em>P</em> = .3). Respondents who were considering changing jobs but had not done so were significantly more likely to report symptoms of burnout in all studied subscales: emotional exhaustion (<em>P</em> &lt; .0001), depersonalization (<em>P</em> = .0002), and sense of personal accomplishment (<em>P</em> = .007).</div></div><div><h3>Conclusions</h3><div>Surgeons changing jobs cited social factors such as workplace culture as reasons for leaving. Burnout symptoms were higher in surgeons considering changing jobs but improved in those who had already changed jobs. It is important to identify factors that lead to job change to guide young surgeons in job selection and improve retention.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101501"},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432837","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":"Intraoperative Fluoroscopy Decreases Magnitude and Incidence of Leg-Length Discrepancy Following Total Hip Arthroplasty","authors":"Christopher L. Blum MD ,&nbsp;Andrew J. Luzzi MD ,&nbsp;Jeremy S. Frederick MD ,&nbsp;H. John Cooper MD ,&nbsp;Roshan P. Shah MD, JD ,&nbsp;Jakub Tatka MD ,&nbsp;Jeffrey A. Geller MD ,&nbsp;Carl L. Herndon MD","doi":"10.1016/j.artd.2024.101492","DOIUrl":"10.1016/j.artd.2024.101492","url":null,"abstract":"<div><h3>Background</h3><div>Leg-length discrepancy (LLD) can lead to patient dissatisfaction and decreased function after total hip arthroplasty (THA). This study examines the impact of intraoperative fluoroscopy on the magnitude and incidence of LLD after THA.</div></div><div><h3>Methods</h3><div>Patients undergoing primary THA were identified and stratified into cohorts based on one out of 4 surgical approaches and intraoperative fluoroscopy use. The most recent 100 patients matching each cohort were included. Preoperative and postoperative LLD was assessed radiographically via an interteardrop reference line to lesser trochanter measurement.Magnitude of LLD and the proportion of patients in each cohort with LLD &gt;5 mm, &gt;10 mm, and 15 mm were analyzed.</div></div><div><h3>Results</h3><div>Four hundred patients were stratified into 4 equal cohorts. Overall, THA done with fluoroscopy yielded fewer leg length discrepancies than THA done without fluoroscopy. The anterior-based muscle sparing (ABMS) approach with fluoroscopy had significantly less postoperative LLD than the posterior approach without fluoroscopy (3.4 vs 5.1 mm, <em>P</em> &lt; .01) and the ABMS approach in the lateral position without fluoroscopy (3.4 vs 4.8 mm, <em>P</em> = .03). For LLD &gt;5 mm, the ABMS approach with fluoroscopy cohort had significantly fewer patients compared to the ABMS approach without fluoroscopy (23 vs 41, <em>P</em> &lt; .01). For LLD &gt;10 mm, the ABMS approach with fluoroscopy cohort had significantly fewer patients compared to the posterior approach without fluoroscopy (2 vs 15, <em>P</em> &lt; .01). For LLD &gt;15 mm, relative to the posterior approach without fluoroscopy, all other cohorts had significantly fewer outliers (<em>P</em> &lt; .02).</div></div><div><h3>Conclusions</h3><div>This study supplies evidence that use of intraoperative fluoroscopy is likely beneficial in reducing the magnitude of LLD following THA and reducing the incidence of outlier LLDs &gt;5 mm, &gt;10 mm, and &lt;15 mm.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101492"},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432838","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":"Early Identification of Poorly Performing Implants in Michigan With the Example of the Vanguard XP","authors":"Nicholas B. Frisch MD, MBA ,&nbsp;Michael A. Masini MD ,&nbsp;Huiyong Zheng PhD ,&nbsp;Richard E. Hughes PhD ,&nbsp;Brian R. Hallstrom MD ,&nbsp;David C. Markel MD","doi":"10.1016/j.artd.2024.101478","DOIUrl":"10.1016/j.artd.2024.101478","url":null,"abstract":"<div><h3>Background</h3><div>Arthroplasty registries play a critical role in improving the quality of care and performing post-market surveillance of medical devices. We report the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) findings specific to the Biomet Vanguard XP bicruciate-retaining total knee implant.</div></div><div><h3>Methods</h3><div>Data were collected from MARCQI’s 2019 report (February 15, 2012, through December 31, 2018). Demographic data were analyzed to determine differences between Vanguard XP and all other implants. The cumulative percent revision (CPR) was computed from the survival function, S(t), using CPR(t) = 100∗(1 − S(t)). A log-rank test was used to assess differences in the CPR curve for the Vanguard XP and all other implants.</div></div><div><h3>Results</h3><div>There were 148,832 knee arthroplasty cases in the MARCQI registry and 507 using Vanguard XP implant combinations. The unadjusted cumulative percent revision curve up to 5 years postoperatively for the Vanguard XP differed from all other implants (<em>P</em> &lt; .0001). The hazard ratios for the 3 factors included in the Cox proportional hazards model were all significantly different from unity: implant (2.76, 95% CI: 1.98-3.86), sex (0.80, 95% CI: 0.74-0.85), and age (0.96, 95% CI: 0.96-0.97). The top 3 reasons for revision were pain, arthrofibrosis, and aseptic loosening. All surgeons who used the Vanguard XP experienced higher failure rates.</div></div><div><h3>Conclusions</h3><div>The Vanguard XP experienced higher early failure rates than other TKA implants within the MARCQI registry. The development of thresholds and benchmarks for registry reporting in collaboration with industry could potentially save patients from the morbidity caused by implants that do not perform as well as anticipated.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101478"},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432839","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":"Staged Bilateral Total Hip Arthroplasty in an Adolescent Patient With Multiple Epiphyseal Dysplasia and Bilateral Avascular Necrosis","authors":"Erik M. Hegeman MD ,&nbsp;David B. Carmack MD ,&nbsp;Matthew R. Schmitz MD ,&nbsp;Donald N. Hope MD","doi":"10.1016/j.artd.2024.101524","DOIUrl":"10.1016/j.artd.2024.101524","url":null,"abstract":"<div><div>Multiple epiphyseal dysplasia is a rare congenital disorder characterized by irregular, delayed ossification at multiple epiphyses, typically in the lower extremity. In this arthroplasty in rare conditions case report, we present a 14-year-old female with multiple epiphyseal dysplasia and borderline acetabular dysplasia who developed progressive bilateral femoral head avascular necrosis. She presented with a worsening antalgic gait and bilateral hip pain starting at 10 years of age, which was refractory to nonoperative measures. She was treated with staged bilateral total hip arthroplasty when her triradiate cartilage was closed and is presenting with 3 years of clinical follow-up with excellent reported outcomes. The goal of this case presentation is to discuss the specific surgical challenges related to this patient population and highlight important considerations in the adolescent population undergoing total hip arthroplasty.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101524"},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432836","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":"Dramatic Failure of an OXINIUM Total Knee Arthroplasty With a Massive Pseudotumor Formation","authors":"Marius Ludwig MD,&nbsp;Martin Faschingbauer MD,&nbsp;Heiko Reichel MD,&nbsp;Tobias Freitag MD","doi":"10.1016/j.artd.2024.101479","DOIUrl":"10.1016/j.artd.2024.101479","url":null,"abstract":"<div><div>Since the early 2000s, oxidized zirconium implants have emerged as a valuable option in total hip and knee arthroplasty due to their wear resistance and suitability for patients with metal hypersensitivity. The surface of these components is created through a heating and oxidation process of a zirconium alloy, resulting in a thin layer with favorable wear properties. However, there have been few reports of severe metallosis resulting from inadvertent wear of oxidized zirconium components through various mechanisms, including dissociation of the polyethylene liner and joint instability. We present a case involving a dramatic failure of an oxidized zirconium total knee arthroplasty, necessitating a staged revision arthroplasty.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101479"},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432840","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":"Periprosthetic Femur Fracture Through a Large Osteolytic Lesion After Total Knee Arthroplasty","authors":"Haley Prough DO ,&nbsp;Daniel Mesko DO","doi":"10.1016/j.artd.2024.101446","DOIUrl":"10.1016/j.artd.2024.101446","url":null,"abstract":"<div><div>Osteolysis due to polyethylene wear is a well-known complication associated with total knee arthroplasty (TKA). Here, we present the case of one failure that has been rarely reported. We report the case of a 51-year-old male who fractured through a large osteolytic lesion in his femur after a previous TKA. The patient presented 4 years after revision TKA after a fall and was found to have fractured through the large lesion. After a diagnostic workup, he was treated with open reduction and internal fixation (ORIF) of the distal femur fracture, and the fixation was augmented with a morselized femoral head allograft and ViviGen (LifeNet Health, Virginia Beach, VA). Osteolysis secondary to polyethylene wear and reactions to arthroplasty components continues to be an ever-present complication of TKAs.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101446"},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432841","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":"Modified Iliac Oblique for Intraoperative Evaluation of Dual-Mobility Liner Malseating","authors":"Richard D. Murray MD,&nbsp;Charles W. Powell MD,&nbsp;Joseph R. Duff MD,&nbsp;Dillon L. Morrow MD,&nbsp;Kristopher C. Sanders MD","doi":"10.1016/j.artd.2024.101507","DOIUrl":"10.1016/j.artd.2024.101507","url":null,"abstract":"<div><div>The use of dual-mobility systems in both primary and revision total hip arthroplasty for patients with concern for instability has become increasingly popular. While these systems are an effective means for combating instability, they are not without unique complications, such as liner malseating. We describe an intraoperative technique to evaluate for malseating via fluoroscopy, allowing a surgeon to identify and correct malseating intraoperatively. Reducing the incidence of liner malseating in dual-mobility total hip replacement systems could reduce overall complication rates postoperatively and presumably improve their efficacy.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101507"},"PeriodicalIF":1.5,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427044","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":"Conflict of Interest Disclosure in American Arthroplasty Surgical Literature","authors":"Robert T. Tisherman MD ,&nbsp;Richard A. Wawrose MD ,&nbsp;Aditya M. Mittal BS ,&nbsp;Stephen R. Chen MD ,&nbsp;Joseph Chen BS ,&nbsp;Christopher J. Como MD ,&nbsp;Malcolm Dombrowski MD ,&nbsp;Jeremy D. Shaw MD","doi":"10.1016/j.artd.2024.101493","DOIUrl":"10.1016/j.artd.2024.101493","url":null,"abstract":"<div><h3>Background</h3><div>Relationships between industry and physicians are critical for innovation in the field of arthroplasty surgery. However, these relationships can present a conflict of interest (COI) for medical research and are required to be disclosed by most journals. The rate of accurate disclosures by physicians has not been studied in arthroplasty surgery.</div></div><div><h3>Methods</h3><div>The names of all authors publishing in <em>The Journal of Arthroplasty</em> and <em>Arthroplasty Today</em> between 2014 and 2018 were obtained from MEDLINE. Financial disclosure statements were obtained from the journal websites and manually compared against Open Payments. Statistical comparisons were made using chi-square testing with significance defined as <em>P</em> &lt; .05.</div></div><div><h3>Results</h3><div>From 2014-2018, 3147 articles were published with 4038 authors meeting inclusion criteria. Of authors with financial disclosures, 2298 (57%) authors correctly disclosed. The total value of disclosed COI equaled $1.71 billion. The total value of undisclosed conflicts of interest equaled $334 million. For payments &gt;$1,000,000 physicians disclosed accurately 86% of the time. For payments between $100 and $9999 physicians accurately disclosed 26% of the time. Senior authors disclosed correctly 72% of the time, which was significantly higher compared to middle and first authors.</div></div><div><h3>Conclusions</h3><div>There is a high prevalence of inaccurate disclosures in the field of arthroplasty surgery. This suggests a need to further educate early-career physicians on what constitutes a COI. Standardization of disclosure forms and verifications with the Open Payments Database can help increase the rate of accurate disclosures.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"30 ","pages":"Article 101493"},"PeriodicalIF":1.5,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427045","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}