Journal of Hand and Microsurgery最新文献

{"title":"A comparison of handheld versus cart-based ultrasound in the evaluation and diagnosis of carpal tunnel syndrome.","authors":"Shiva D Yagobian, Sean R Wallace, John R Fowler","doi":"10.1016/j.jham.2024.100159","DOIUrl":"10.1016/j.jham.2024.100159","url":null,"abstract":"<p><strong>Background: </strong>Carpal tunnel syndrome (CTS) is responsible for over 90 % of median nerve neuropathies. Though a clinical diagnosis, evaluation of nerve conduction via electrodiagnostic studies (EDX) and median nerve cross sectional area (CSA) through sonographic imaging provides supporting evidence and insight into disease severity. The advent of handheld ultrasound devices offers a portable, cost-effective and non-invasive method for median nerve assessment, yet its accuracy compared to traditional cart-based ultrasound has not been assessed in this setting.</p><p><strong>Methods: </strong>43 consecutive patients who presented to an outpatient orthopedic clinic within a large academic institution for symptoms consistent with CTS between August 2023 and April 2024 were included. Handheld sonography was performed with the Clarius Convex L20 HD3 8-20 MHz transducer. The GE Venue Go with a 4-20 MHz linear transducer was used for conventional cart-based ultrasound evaluation. A paired <i>t</i>-test was performed to compare the mean cross-sectional area (CSA) measured with the GE machine to the mean CSA measured with the Clarius transducer (p < 0.05).</p><p><strong>Results: </strong>The average CSA measurement obtained with the GE was 14.21 ± 4.89 mm². The average CSA measurement obtained with the Clarius handheld transducer was 13.54 ± 4.50 mm². The mean difference between the GE and Clarius groups was 0.62 mm² (95 % CI = -1.47 to 2.71), p = 0.55.</p><p><strong>Conclusion: </strong>CSA measurements of the median nerve obtained by a handheld ultrasound transducer are comparable to those measured by a traditional cart-based ultrasound machine for carpal tunnel diagnosis. The adoption of handheld ultrasounds in clinical settings holds the potential for quicker, more precise diagnoses and broader access to imaging.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100159"},"PeriodicalIF":0.5,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819501","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":"Ganglion cysts of the wrist: A bibliometric analysis review of the top 50 highly cited publications.","authors":"Abdulmalek W Alhithlool, Ibrahim R Halawani, Zainalabden E Jefri, Amjad W AlHithlool, Raghad Yasir Shosho, Maha Sulaiman Albarrak, Mohammed Essam Kattan, Sarah W Alkhonizy, Amr Youssef Arkoubi, Abdulaziz Saleh Almodumeegh, Hatan Mortada","doi":"10.1016/j.jham.2024.100155","DOIUrl":"10.1016/j.jham.2024.100155","url":null,"abstract":"<p><strong>Introduction: </strong>Ganglion cysts (GCs) are a form of benign soft tissue mass commonly seen on the dorsum of the wrist that could also form in the hand. They can cause pain and impede physical activities. Despite extensive studies, there has not been a thorough analysis of the top 50 GC articles. This bibliometric analysis examines the most cited research on GC of the wrist with the aim of uncovering existing trends and future directions in the field.</p><p><strong>Methods: </strong>The authors conducted a comprehensive search utilizing the Web of Science Core Collection on November 16, 2023, to identify the top 50 cited articles on wrist GC published between 1988 and 2023. Subsequently, data were extracted from each article encompassing details such as the title, authors, first/senior authors, publication year, country, journal, total citations, annual average citations, research setting, funding, study design, level of evidence, and primary outcome.</p><p><strong>Results: </strong>The predominant publication venue was identified as The Journal of Hand Surgery, with (44 %) originating from the United States, followed by contributions from the United Kingdom (14 %), South Korea (8 %), and China (4 %). Key findings included surgical techniques, diagnostic investigations, patient outcomes, treatment plans, epidemiology, and comparative analyses. Notably, there was a peak in citations in the early 2010s.</p><p><strong>Conclusion: </strong>In recent decades, significant progress has been made in the study of wrist GC, mostly driven by the United States with an emphasis on surgical techniques and diagnostic investigations.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100155"},"PeriodicalIF":0.5,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819419","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":"WALANT vs standard anaesthesia in the management of flexor tendon injuries: A systematic review and meta-analysis.","authors":"Rahy Farooq, Muhammad Yasir Raufi, Bryan Soe, Amir-Humza Suleman, Shaikh Sanjid Seraj, Abida Arif, Shafiq Rahman, Waseem Bhat","doi":"10.1016/j.jham.2024.100157","DOIUrl":"10.1016/j.jham.2024.100157","url":null,"abstract":"<p><p>Wide awake local anaesthesia no tourniquet (WALANT) surgery has gained increasing popularity in recent years for hand surgery fast-tracked by the COVID pandemic. It involves infiltration of lidocaine with adrenaline to the operative region ensuring a good visual field owing to the vasoconstrictive effects of epinephrine. It has numerous advantages over traditional anaesthetic (TA) for flexor tendon repairs including testing of tendon strength on table as well as immediate revision of the repair if needed. Currently there are a number of studies in the literature evaluating WALANT versus TA in flexor tendon injuries with continuing debate on the optimal modality but no amalgamated synthesis of data. The authors report the first systematic review and meta-analysis on the topic. The authors conducted the review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards (PRISMA) guidelines. All studies comparing flexor tendon repairs under WALANT versus TA were included. The primary outcome measure was range of movement (ROM) with secondary outcomes including adhesions/tenolysis, rupture as well as re-operation rates. OpenMeta[Analyst] software was utilised for data synthesis. Five studies in total met the inclusion criteria with an overall assessment of 624 fingers. There was no significant difference observed between WALANT and TA for tendon rupture; odds ratio 1.027 (0.450, 2.342) p-value = 0.950, the incidence of adhesions/tenolysis; odds ratio 0.601 (0.172, 2.093) p-value = 0.424 or re-operation rates; odds ratio 1.193 (0.544, 2.618) p-value = 0.659. ROM was reported to be better in the WALANT cohort; odds ratio: 1.641 (1.010, 2.669) p-value = 0.046. WALANT offers a safe and effective mode of anaesthetic over traditional modalities with comparable outcomes for flexor tendon repairs. Although ROM appears superior, the number of randomised control trials are currently low and more high quality studies are necessitated to enhance the current evidence base.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100157"},"PeriodicalIF":0.5,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819736","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":"Cross intrinsic transfer for ulnar drift in the rheumatoid hand under wide awake local anesthesia No tourniquet - Surgical technique.","authors":"J Terrence Jose Jerome","doi":"10.1016/j.jham.2024.100154","DOIUrl":"10.1016/j.jham.2024.100154","url":null,"abstract":"<p><p>This article introduces a surgical technique for cross-intrinsic transfers (CIT) to correct ulnar drift in rheumatoid hands performed under wide-awake local anesthesia no tourniquet (WALANT). This approach allows real-time adjustment of tendon transfer tension and active patient participation in hand movements and deformity correction during the procedure. It can be combined with other surgeries such as prosthetic replacement arthroplasties of the MCP joints. The technique was applied to six patients, resulting in a significant reduction of ulnar deviation from an average of 70° preoperatively to 8° postoperatively. All patients reported high satisfaction with good outcomes.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100154"},"PeriodicalIF":0.5,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060899","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":"Comparison of WALANT and general anaesthesia for trapeziectomy and abductor pollicis longus hammock ligamentoplasty.","authors":"Kürşat Reşat Demi R, Feray Karademi R, Egemen Ayhan, Can Emre Baş, Önder Ersan","doi":"10.1016/j.jham.2024.100153","DOIUrl":"10.1016/j.jham.2024.100153","url":null,"abstract":"<p><strong>Background: </strong>Trapeziectomy and abductor pollicis longus hammock ligamentoplasty may be performed in the surgical management of trapeziometacarpal joint osteoarthritis (TMC OA). Several anaesthesia techniques are available for TMC joint surgery, including wide-awake local anaesthesia no tourniquet (WALANT), regional anaesthesia, and general anaesthesia (GA). The aim of this study was to compare the clinical outcomes of trapeziectomy and abductor pollicis longus hammock ligamentoplasty performed under WALANT versus GA.</p><p><strong>Methods: </strong>This retrospective study included 22 patients who underwent surgery for TMC OA between 2017 and 2019. Patients' pre- and post-operative pain intensity, grip and pinch strength, and functional scores were compared. Pain intensity was assessed 1 h after surgery, while overall outcome measures were evaluated one year post-operatively.</p><p><strong>Results: </strong>The results showed that patients who underwent WALANT had significantly lower pain intensity 1 h postoperatively compared to those who received GA. Both groups experienced a reduction in pain, improvement in grip strength, and functional scores after at one year, with no significant differences between them. No significant differences were found between the GA and WALANT groups in terms of postoperative VAS scores, grip strength, and functional scores.</p><p><strong>Conclusions: </strong>We recommend WALANT for trapeziectomy and APL hammock ligamentoplasty due to its effectiveness in reducing early post-operative pain and achieving functional outcomes comparable to those of GA.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 1","pages":"100153"},"PeriodicalIF":0.5,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060896","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":"Maximizing hand function following zone II flexor tendon repair: A systematic review and meta-analysis of rehabilitation strategies.","authors":"Hatan Mortada, Abdulmalek W Alhithlool, Mohammed Essam Kattan, Alanoud Abdulaziz Alfaqih, Danah Mansour Alrajhi, Aseel Abdulkreem Alkhmeshi, Abdulaziz Saleh Almodumeegh, Abdullah Kattan","doi":"10.1016/j.jham.2024.100152","DOIUrl":"10.1016/j.jham.2024.100152","url":null,"abstract":"<p><strong>Introduction: </strong>Injuries to the flexor tendons of the hand pose significant challenges in both surgical repair and postoperative rehabilitation. Despite advancements in techniques, there remains uncertainty about the most effective postoperative rehabilitation protocol/strategy. This study aims to address this debatable issue by evaluating different rehabilitation protocols following surgical repair in zone II flexor tendon repair.</p><p><strong>Methods: </strong>A systematic review and meta-analysis followed PRISMA guidelines, searching databases up to December 2023. Inclusion criteria covered studies on zone II flexor tendon repair in adults, with various rehabilitation strategies and hand function as primary outcomes. Data extraction and bias assessment employed predefined tools.</p><p><strong>Results: </strong>Among 916 initial articles, 28 met the inclusion criteria. Published from 1980 to 2023, these studies involved 1414 patients, predominantly affecting the little, index, and middle fingers. Various suture techniques and materials were used, with early active and passive motion as primary rehabilitation protocols.</p><p><strong>Conclusion: </strong>This review highlights early active and passive motion as common postoperative rehabilitation strategies for zone II flexor tendon repair. While active motion showed greater range of motion improvement, both protocols had comparable reoperation rates and grip strength outcomes. Future research should focus on refining protocols and assessing long-term outcomes to optimize patient care.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100152"},"PeriodicalIF":0.5,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819652","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 two-stage surgery for completely degloving injury of multiple fingers: A retrospective cohort study.","authors":"Hongjun Liu, Tao Guo, Bin Wang, Fan Wu, Wenzhong Zhang, Tao Xu, Jiaxiang Gu, Yiming Lu","doi":"10.1016/j.jham.2024.100151","DOIUrl":"10.1016/j.jham.2024.100151","url":null,"abstract":"<p><strong>Purpose: </strong>The completely degloving injury of multiple fingers is a challenging clinical problem. Based on our technical experience, a novel two-stage surgery of abdominal hypodermal pocket followed by separation and full thickness skin grafting was conducted.</p><p><strong>Methods: </strong>From January 2017 to August 2020, 7 cases (17 fingers) of degloving injury of multiple whole fingers who were treated in a two-stage fashion; an emergency first stage surgery of abdominal hypodermal pocket embedding and a second stage surgery (4 weeks later) of full thickness skin grafting, were retrospectively studied. The results were evaluated according to the patient subjective evaluation, static two-point discrimination and disabilities of the arm, shoulder and hand (DASH) scores and active range of motion (ROM) of metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints.</p><p><strong>Results: </strong>All seven cases healed successfully, although two cases experienced distal phalanx necrosis. The affected fingers recovered with a good appearance and soft texture and the results were either satisfying or acceptable for all participants. The active ROM of MP joint ranged from 55° to 64° with an average of 59.5° three months postoperatively and ranged from 70° to 81° with an average of 77.2° six months postoperatively, while the active ROM of PIP joint ranged from 58° to 69° with an average of 64.1° three months postoperatively and from 76° to 86° with an average of 81° six months postoperatively. One year postoperatively, the static two-point discrimination ranged from 7 to 10 mm with an average of 8.6 mm and DASH scores ranged from 25 to 42 with an average of 37.</p><p><strong>Conclusion: </strong>A novel two-stage surgery of abdominal hypodermal separated pockets followed by full thickness is an effective and worthwhile option for treating the completely degloving injury of multiple fingers.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100151"},"PeriodicalIF":0.5,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819505","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":"Nuances in endoscopic carpal tunnel release a guide to improving outcomes.","authors":"Yao Zu Sean Kong, Yong Chiang Kang","doi":"10.1016/j.jham.2024.100150","DOIUrl":"10.1016/j.jham.2024.100150","url":null,"abstract":"<p><p>Endoscopic technique of carpal tunnel release is widely accepted as successful and safe as long as the surgeon is well-trained. Compared to the traditional open technique, there exists a steep learning curve for familiarisation of equipment, training of hand-eye coordination and appreciating tactile feedback. The available literature and manuals do not illustrate the practical challenges encountered during the procedure. We describe a guide for single-portal technique under local anesthesia, including surgical planning, cautions, and troubleshooting processes based on our experience with 136 cases in Asian hands which is known to be smaller.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100150"},"PeriodicalIF":0.5,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819658","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":"Contribution of ultrasound-assisted surgery coupled with Walant anaesthesia in bilateral carpal tunnel surgery.","authors":"Mahdi Siala, Gorka Usandizaga","doi":"10.1016/j.jham.2024.100118","DOIUrl":"10.1016/j.jham.2024.100118","url":null,"abstract":"<p><strong>Introduction: </strong>The simultaneous bilateral release of carpal tunnels still remains a non-unanimous practice. We prospectively studied the contribution of ultrasound-guided surgery coupled with Walant anaesthesia in the simultaneous release of both carpal tunnels.</p><p><strong>Materials and methods: </strong>Patients who presented bilateral clinical involvement confirmed by electromyogram were operated on in the operating room under Walant anaesthesia by minimally invasive knife section under ultrasound guidance. The follow-up focused on pain immediately after local anaesthesia, when leaving the operating room, on day 1 and then on day 7. Satisfaction on day 0, day 7 and at 3 months, complications as well as the resumption of daily activities, light manual activities then heavy manual activities were reported.</p><p><strong>Results: </strong>10 patients were operated on. The median average pain score was less than 1 after anaesthesia, on day 0 in the immediate postoperative period on day 1 and on day 7. Mean satisfaction was above 9 ​at day 0, day 7 and month 3. There were 2 minor postoperative complications, one spontaneously resolved after 45 days, the other requiring additional intervention on another site of compression of the median nerve upstream. Resumption of light manual activities was 3 days and heavy manual activities 31 days.</p><p><strong>Discussion: </strong>The release of the bilateral carpal tunnel remains a rare surgical practice due to fear of pain and postoperative disability particularly during the initial postoperative period. However, the release of the carpal tunnel in ultrasound-guided surgery under Walant anaesthesia has proven painless and fast function recovery.</p><p><strong>Conclusion: </strong>The release under Walant anaesthesia with ultrasound assistance of simultaneous bilateral carpal tunnel is safe for the patient. Patient satisfaction is high. We recommend this technique in selected patients.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100118"},"PeriodicalIF":0.5,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819509","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":"Biomechanical evaluation of spiral fracture in human metacarpal using chicken humerus model.","authors":"LiYu Alyssa Toh, Abby Choke, Youheng Ou Yang, Yoke Rung Wong","doi":"10.1016/j.jham.2024.100147","DOIUrl":"10.1016/j.jham.2024.100147","url":null,"abstract":"<p><strong>Introduction: </strong>Animal bones have been used as a model to mimic human bones for investigation of fracture patterns and fixation techniques. This study aims to investigate the effects of torsional forces of varying speeds on the spiral fracture in human metacarpal using a chicken humerus model.</p><p><strong>Materials and methods: </strong>Thirty fresh-frozen chicken humerus bones were dissected and equally divided into three groups. The bones were mounted onto a customized jig and subjected to different torsional loading rate at 22.5°/s, 30°/s and 45°/s, respectively. The fracture pattern, angle and length were analysed.</p><p><strong>Results: </strong>Our results concurred with other studies that used mature animal long bones which showed no correlation between spiral fracture morphology and torsional rate. We also noticed differences between mature and immature long bones at various torsional speeds.</p><p><strong>Conclusion: </strong>The chicken humerus model demonstrated a promising alternative to investigate the effect of bone material properties on the spiral fracture pattern. The intent of this study was to expand it as a suitable bone model for resident teaching and research purpose.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"16 5","pages":"100147"},"PeriodicalIF":0.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819507","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}