Arthroplasty Today最新文献

{"title":"The Anterior-Based Muscle-Sparing Approach for Conversion Total Hip Arthroplasty is Safe and Effective","authors":"Catherine M. Call MD ,&nbsp;Johanna Mackenzie MPH ,&nbsp;Zoë A. Walsh MPH ,&nbsp;Bailey Shevenell BA ,&nbsp;George Babikian MD ,&nbsp;Brian J. McGrory MD, MS ,&nbsp;Adam J. Rana MD","doi":"10.1016/j.artd.2025.101731","DOIUrl":"10.1016/j.artd.2025.101731","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) after prior hip or acetabular fracture fixation is considered higher risk than primary THA, as studies have shown reduced implant survival and higher infection rates. The anterior-based muscle-sparing (ABMS) approach can potentially reduce some of these risks by utilizing a new surgical interval. The goal of this study is to analyze the efficacy of the ABMS approach for conversion to hip arthroplasty surgery after previous fracture fixation with comparison to posterior approach.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included patients with prior hip surgical intervention requiring hardware then converted to a THA using the ABMS or posterior approach at 1 institution between 2013 and 2020. Outcomes studied included postoperative complications, 30-day emergency department visits, 90-day readmission rates, any reoperation and patient-reported outcome measures.</div></div><div><h3>Results</h3><div>A total of 85 patients (51 male and 34 female) in the ABMS group and 17 patients (9 male and 8 female) in the posterior group were included. Within the ABMS group, the mean age was 65.6 years (±16.2) with a mean body mass index of 27.5 kg/m² (±5.4). The average operative time was 85 minutes (±35) and estimated blood loss was 178 mL (±183). There was 1 postoperative complication (dislocation) within 90 days, 1 patient made an emergency department visit within 30 days, and there were 3 readmissions within 90 days; only 1 readmission was orthopaedic in nature. One patient required reoperation (1.2%) over the study period of 5.0 years (±2.1). Patient-reported outcome measures indicate successful return of function. Operative, hospital, and outcome data were similar between patients receiving the ABMS and posterior approach.</div></div><div><h3>Conclusions</h3><div>This study is the first to evaluate outcomes of conversion THA using the ABMS approach, when compared to the posterior approach. Our institution’s experience demonstrates that the ABMS approach is safe and effective for conversion THA after prior fracture fixation.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101731"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144204232","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":"Current Rates and Trends of Venous Thromboembolism After Total Hip and Knee Arthroplasty: An Updated Analysis Utilizing the NSQIP Database","authors":"Hannah Mosher BS ,&nbsp;Hallie B. Remer BS ,&nbsp;Chukwuemeka U. Osondu MD, MPH ,&nbsp;Kevin Smidt MD ,&nbsp;Alexander van der Ven MD, MBA ,&nbsp;Juan C. Suarez MD","doi":"10.1016/j.artd.2025.101737","DOIUrl":"10.1016/j.artd.2025.101737","url":null,"abstract":"<div><h3>Background</h3><div>Total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedure volumes are increasing. Venous thromboembolism (VTE) remains a significant complication, with incidence rates between 0.45% and 5.30%. Enhanced rapid-recovery pathways and chemoprophylaxis evolution may correlate with decreased VTE events over time. This study analyzes recent trends of VTE after THA and TKA.</div></div><div><h3>Methods</h3><div>Adults undergoing THA or TKA between 2009 and 2022 were identified from the National Quality Surgical Improvement Program database using Current Procedural Terminology codes. VTE was defined as the occurrence of a deep vein thrombosis (DVT) and/or pulmonary embolism (PE) event in the same patient. The 30-day incidence data of VTE, DVT, and PE were trended over time. Multivariate regression analyses estimated the adjusted risk of events by year of surgery relative to 2009 and identified associated risk factors.</div></div><div><h3>Results</h3><div>A total of 382,515 THAs and 593,060 TKAs were included with 5713 DVTs and 3807 PEs observed. Trends of 30-day VTE decreased over the study period in THA (0.8%-0.5%, <em>P</em> &lt; .001) and TKA (1.8%-0.9%, <em>P</em> &lt; .001). Significant decreasing trends were observed for both DVT and PE following TKA (both <em>P</em> &lt; .001) and for DVT (<em>P</em> &lt; .001) following THA. Adjusted regression showed significantly lower odds of 30-day DVT (odds ratio 0.68, <em>P</em> &lt; .01) and PE (odds ratio 0.59, <em>P</em> &lt; .01) after TKA in 2022 compared to 2009.</div></div><div><h3>Conclusions</h3><div>The 30-day VTE incidence following THA and TKA has significantly decreased since 2009. Both DVT and PE have decreased in the TKA population, likely due to improved preoperative patient optimization and enhanced recovery pathways, despite shifts toward more selective antiplatelet chemoprophylaxis.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101737"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144242780","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":"Extended Oral Antibiotic Prophylaxis and Periprosthetic Joint Infection–Free Survivorship After Primary Total Hip Arthroplasty","authors":"Andrew A. Fuqua BS ,&nbsp;Jacob A. Worden BS ,&nbsp;Ayomide M. Ayeni BS ,&nbsp;Kyle E. Bundschuh MD ,&nbsp;Jacob M. Wilson MD ,&nbsp;Ajay Premkumar MD, MPH","doi":"10.1016/j.artd.2025.101694","DOIUrl":"10.1016/j.artd.2025.101694","url":null,"abstract":"<div><h3>Background</h3><div>Several studies have presented findings in favor of using extended oral antibiotic (EOA) prophylaxis to reduce periprosthetic joint infection (PJI) after primary total hip arthroplasty (THA) in patients at high risk for infection. To date, there is a paucity of evidence examining this topic from large retrospective databases. This study explored 90-day complication rates and 2-year PJI-free survivorship in a large cohort of patients receiving EOA prophylaxis after primary THA.</div></div><div><h3>Methods</h3><div>A large national database was used to identify patients undergoing primary THA from 2009 to 2022. Patients receiving 7-14 days of EOA were identified and propensity score–matched based on comorbidities to controls not receiving EOA and subsequently stratified into any-risk, high-risk, and standard-risk cohorts based on infection-related risk factors. Complication rates at 90 days were examined, and 2-year PJI-free survivorship was assessed employing Kaplan-Meier curves and Cox regression analysis further adjusting for comorbidity status.</div></div><div><h3>Results</h3><div>A total of 4153 patients receiving EOA prophylaxis after THA were identified. Of those patients, 2154 (52%) were considered high risk for PJI, while 1999 (48%) were considered standard risk. Significant reduction in hazards of PJI with administration of EOA was not seen at 90 days (any-risk: hazard risk [HR]: 0.75, 95% confidence interval [CI]: 0.42-1.35, <em>P</em> = .3; high-risk: HR: 0.85, 95% CI: 0.39-1.85, <em>P</em> = .7; standard-risk: HR: 1.29, 95% CI: 0.44-3.77, <em>P</em> = .6), 1 year (any-risk: HR: 0.99, 95% CI: 0.68-1.44, <em>P</em> &gt; .9; high-risk: HR: 1.24, 95% CI: 0.77-1.99, <em>P</em> = .4; standard-risk: HR: 1.56, 95% CI: 0.73-3.33, <em>P</em> = .3), or 2 years (any-risk: HR: 1.02, 95% CI: 0.73-1.42, <em>P</em> &gt; .9; high-risk: 1.25, 95% CI: 0.82-1.91, <em>P</em> = .3; standard-risk: HR: 1.10, 95% CI: 0.61-2.00, <em>P</em> = .8).</div></div><div><h3>Conclusions</h3><div>No significant increase in PJI-free survivorship at 90 days, 1 year, or 2 years was seen with EOA prophylaxis following primary THA. Reported PJI rates were low across all cohorts, irrespective of baseline risk. Further evidence is needed to adjudicate the efficacy of EOA prophylaxis after THA in addition to possible risks and appropriate indications for use.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101694"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144279498","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":"Evaluating the Disparate Use of Knee Arthroplasty Among Minorities Using Social Vulnerability Index","authors":"Manasa Pagadala BA ,&nbsp;Rachel Bergman MD ,&nbsp;T. Jacob Selph Jr. BS ,&nbsp;Patricia Franklin MD, MPH, MBA ,&nbsp;Adam I. Edelstein MD ,&nbsp;Linda I. Suleiman MD","doi":"10.1016/j.artd.2025.101702","DOIUrl":"10.1016/j.artd.2025.101702","url":null,"abstract":"<div><h3>Background</h3><div>Total knee arthroplasty (TKA) is an effective treatment for advanced osteoarthritis, but disparities in its utilization exist, particularly by gender, race, socioeconomic status, and geography. Social determinants of health may contribute to these disparities. This study examines the relationship among the Social Vulnerability Index (SVI), a measure of social determinants of health, and the likelihood of receiving a surgeon's recommendation for TKA.</div></div><div><h3>Methods</h3><div>This prospective, observational study included 314 patients with primary knee osteoarthritis deemed “appropriate” for TKA based on the American Academy of Orthopaedic Surgeons Appropriate Use Criteria. Patients were recruited from 4 fellowship-trained arthroplasty surgeons at a single academic hospital in Chicago. The primary outcome was whether patients received a surgeon recommendation for TKA, analyzed in relation to their SVI. Bivariate and multivariable analyses were performed, adjusting for patient demographics, body mass index, Charlson Comorbidity Index, and surgeon factors.</div></div><div><h3>Results</h3><div>Of the 314 patients appropriate for TKA by Appropriate Use Criteria guidelines, 39.2% received a surgeon recommendation. Patients with lower SVI scores were more likely to receive a recommendation (0.6596 vs 0.7556, <em>P</em> = .284). Multivariable analysis showed that lower SVI scores were independently associated with higher odds of a surgeon recommendation (odds ratio [OR]: 0.705, <em>P</em> = .028), particularly in the subcategories of socioeconomic status (OR: 0.754, <em>P</em> = .034) and household characteristics (OR: 0.803, <em>P</em> = .049).</div></div><div><h3>Conclusions</h3><div>Lower SVI scores are associated with increased likelihood of receiving a TKA recommendation, highlighting the impact of social vulnerability on clinical decision-making and the need for further investigation into mitigating biases in surgical decisions.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101702"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144242777","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":"Mid-Flexion Sagittal Stability of Total Knee Arthroplasty Implanted With Kinematic Alignment: A Quantitative Radiographic Laxity Study With Single-Radius Posterior-Stabilized and Condylar-Stabilized Implants","authors":"Lauren K. Holbrook MS ,&nbsp;Emma N. Horton BS ,&nbsp;David F. Scott MD","doi":"10.1016/j.artd.2025.101732","DOIUrl":"10.1016/j.artd.2025.101732","url":null,"abstract":"<div><h3>Background</h3><div>Stability between full extension and 90° of flexion is crucial for successful outcomes in total knee arthroplasty (TKA). Thus, we compared the sagittal/anteroposterior (AP) stability of knees implanted with single-radius condylar-stabilized (CS) vs posterior-stabilized (PS) devices from a randomized, prospective study. We hypothesized that the implant group with superior sagittal/AP stability would exhibit better clinical outcomes.</div></div><div><h3>Methods</h3><div>Sixty-five patients underwent primary TKA with a PS (n = 28) or CS (n = 37) device. Outcomes collected 5-7 years postoperatively included Knee Society (KS) Scores, range of motion (ROM), the Lower Extremity Activity Scale, the Forgotten Joint Score, and mechanical and anatomic alignment. Sagittal/AP stability was evaluated in 45° and 90° of flexion via stress radiographs.</div></div><div><h3>Results</h3><div>The CS and PS groups averaged 85.8 and 77.3 months post-TKA, respectively, at evaluation. The CS group demonstrated greater mean AP laxity, especially in 45° mid-flexion. Alignment, ROM, and patient-reported outcome scores were similar. However, women in the CS group demonstrated inferior mean KS Function (<em>P</em> = .02) and Total Composite scores (<em>P &lt;</em> .01) compared to women in the PS group. These scores were not significantly different for men or the combined groups.</div></div><div><h3>Conclusions</h3><div>Mid-flexion sagittal/AP laxity was substantial in both implant groups. With the limited population available, the greater laxity observed in patients with CS implants did not correspond to differences in Forgotten Joint Score, Lower Extremity Activity Scale, ROM, or alignment; however, the difference between the KS Function and Total Composite scores in women revealed an inverse relationship between sagittal laxity and clinical outcomes.</div></div><div><h3>Level of evidence</h3><div>I.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101732"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203598","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":"Evaluating the Impact of Mixed-Reality Technology on Operating Room Time in Total Hip Arthroplasty: A Comparative Study","authors":"Crystal Jing BA ,&nbsp;Matthew K. Stein MD ,&nbsp;David G. Deckey MD ,&nbsp;Michael P. Bolognesi MD ,&nbsp;Samuel S. Wellman MD ,&nbsp;Sean P. Ryan MD","doi":"10.1016/j.artd.2025.101734","DOIUrl":"10.1016/j.artd.2025.101734","url":null,"abstract":"<div><h3>Background</h3><div>To help guide acetabular component positioning in total hip arthroplasty (THA), computer-assisted devices like robotics, navigation, and mixed-reality (MR) have been incorporated into the operating room with variable results. This study aimed to identify the effect of using MR technology on operative time.</div></div><div><h3>Methods</h3><div>This was a retrospective review of patients over the age of 18 years, who underwent primary THA for end-stage osteoarthritis from January 1, 2021, to August 20, 2024, at a single institution with 2 surgeons who incorporated MR into their surgical workflow. Patients that underwent THA with one of these 2 surgeons without HipInsight (Surgical Planning Associates, Inc., Boston, MA) were also included as controls. Demographic data, surgical approach, and operative time were evaluated.</div></div><div><h3>Results</h3><div>There were 411 patients included in this study with 165 patients who underwent surgery with MR and 246 patients who underwent surgery with standard manual instrumentation. The mean operative time in minutes was 89.6 (standard deviation = 12.6) for patients undergoing THA without MR and 89.2 (standard deviation = 13.1) for patients undergoing THA with MR (<em>P</em> &gt; .05).</div></div><div><h3>Conclusions</h3><div>A MR navigation system for THA did not appear to prolong operative times when utilized. Further studies are needed to determine its effect on long-term outcomes.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101734"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144242778","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":"Corrigendum to “Silk Fibroin Closure Eliminates the Incidence of Allergic Contact Dermatitis Compared to Cyanoacrylate Mesh in Total Joint Arthroplasty” <[Arthroplasty Today. Volume 33 (June 2025) 101668]>","authors":"Justin P. Moo Young MD,&nbsp;Viraj A. Deshpande BS,&nbsp;Susanne Porter FNP-BC,&nbsp;Edward J. Quilligan BS,&nbsp;Travis Scudday MD,&nbsp;Steven Barnett MD,&nbsp;Robert Gorab MD","doi":"10.1016/j.artd.2025.101733","DOIUrl":"10.1016/j.artd.2025.101733","url":null,"abstract":"","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101733"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144190105","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":"Highlights of the 2024 American Joint Replacement Registry Annual Report","authors":"Christopher N. Carender MD ,&nbsp;Vishal Hegde MD ,&nbsp;Brett R. Levine MD ,&nbsp;James I. Huddleston III MD ,&nbsp;Anna Cohen-Rosenblum MD","doi":"10.1016/j.artd.2025.101727","DOIUrl":"10.1016/j.artd.2025.101727","url":null,"abstract":"<div><div>The American Joint Replacement Registry continues to grow, as represented by the 4.3 million hip and knee arthroplasties analyzed in the 2024 American Joint Replacement Registry <em>Annual report</em>. Highlights of this report are found in the following article. We encourage readers to access the full report at <span><span>https://www.aaos.org/registries/publications/ajrr-annual-report/</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101727"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261805","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":"115,000 Miles and Counting: Extraordinary Athletic Activity After a Historic Total HipArthroplasty with 39-year Follow-up","authors":"Marguerite L. Gilmore BA,&nbsp;Ansab Khwaja MD,&nbsp;Daniel H. Wiznia MD,&nbsp;Lee E. Rubin MD","doi":"10.1016/j.artd.2025.101711","DOIUrl":"10.1016/j.artd.2025.101711","url":null,"abstract":"<div><div>We present an 81-year-old male who underwent a direct anterior approach total hip arthroplasty (THA) with a ceramic-on-ceramic bearing in 1986. Amazingly, the patient kept meticulous logbooks of his many athletic endeavors, which were tallied after 35 years in 2020. These included 20,797 miles of running, 2323 miles of swimming, 66,349 miles of bicycling, and at least 25,500 miles of walking, amounting to more than 114,969 miles of physical activity. As the average age of patients who undergo index THA decreases, the debate regarding physical activity recommendations after THA has become increasingly relevant for patients, but this topic is inadequately studied and thus remains an unanswered question.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101711"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144253692","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":"Native Knee Septic Arthritis With Mycobacterium Avium Complex Treated With Primary Total Knee Arthroplasty With Antibiotic-Eluting Cement","authors":"Andrew M. Schwartz MD ,&nbsp;David G. Deckey MD ,&nbsp;Danielle S. Chun MD ,&nbsp;Thorsten M. Seyler MD, PhD ,&nbsp;Tyler S. Watters MD","doi":"10.1016/j.artd.2025.101719","DOIUrl":"10.1016/j.artd.2025.101719","url":null,"abstract":"<div><div>Native knee septic arthritis due to <em>Mycobacterium avium</em> complex (MAC) is extremely rare. Disseminated MAC infections are often associated with an immunosuppressed state; however, they can occur in immunocompetent patients. We describe a case of MAC infection in the native knee in an immunocompetent patient resulting in osseous destruction and secondary arthritic changes. Both the infection and destructive arthropathy were successfully treated with a single procedure consisting of radical debridement, primary total knee arthroplasty with high-dose pathogen-specific antibiotic therapy, and subsequent systemic antibiotic therapy. At 3.5 years since surgery, the patient is off antibiotic therapy and continues to have a well-functioning total knee arthroplasty.</div></div>","PeriodicalId":37940,"journal":{"name":"Arthroplasty Today","volume":"33 ","pages":"Article 101719"},"PeriodicalIF":1.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144203597","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}