Archives of Bone and Joint Surgery-ABJS最新文献

{"title":"An Efficiency Model for Decreasing Operative Room Turnover Time for Total Joint Arthroplasties.","authors":"Kathryn Hedden, Samantha Harrer, Jong Hyun Choi, Pietro M Gentile, Alisina Shahi, Matthew L Brown","doi":"10.22038/ABJS.2024.77381.3575","DOIUrl":"10.22038/ABJS.2024.77381.3575","url":null,"abstract":"<p><strong>Objectives: </strong>Despite an increased demand for total joint arthroplasty (TJA), rising health-care costs and bundling of payments by payers have shifted the focus to improving operating room (OR) efficiency. This study aimed to assess the efficacy of an efficiency model that optimized instrument trays on decreasing OR turnover time (TOT) and the benefits made possible by this improved efficiency.</p><p><strong>Methods: </strong>All primary TJA procedures performed by a single fellowship-trained surgeon from January 2022 to August 2023 were reviewed. The surgeon partnered with Zimmer Biomet to condense the total knee and total hip arthroplasty instrument trays from seven to three trays each. Patient in OR time and patient out of OR times were collected and used to calculate TOT. Mean TOTs pre-efficiency model implementation (January - October 2022) and post-efficiency model implementation (March - August 2023) were compared. Annual cost savings were calculated based on an average cost per one minute of OR time of $47.99 and an average cost for the Sterile Processing Department (SPD) to process a single TJA tray of $79.41.</p><p><strong>Results: </strong>Following implementation of the efficiency model, the average OR TOT significantly decreased by 19 minutes (P < 0.0001), a greater than 44% reduction in TOT. At this surgeon's current case volume, conservatively estimated at 280 primary TJA cases per year, annual savings in OR and SPD processing costs were $169,597 and $88,939, respectively. Moreover, this led to increased case volume per operative day.</p><p><strong>Conclusion: </strong>A small-scale intervention such as optimizing instrument trays for TJA is a valuable and sustainable solution to improve efficiency in the OR by decreasing OR TOT, thereby generating considerable cost-savings and opportunity to increase surgical volume.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 9","pages":"660-664"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577032","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":"Pre-operative Anemia and Hyponatremia Increase the Risk of Mortality in Elderly Hip Fractures.","authors":"Jaiben George, Vijay Sharma, Kamran Farooque, Samarth Mittal, Vivek Trikha, Rajesh Malhotra","doi":"10.22038/ABJS.2024.76024.3512","DOIUrl":"10.22038/ABJS.2024.76024.3512","url":null,"abstract":"<p><strong>Objectives: </strong>Pre-operative assessment is routinely performed for all hip fractures, and include a thorough clinical examination and multiple pre-operative tests. While abnormalities are often detected in many tests, they have varied effect on mortality. The purpose of the study was to assess the prevalence and impact of these abnormal tests and comorbidities.</p><p><strong>Methods: </strong>This was a prospective study of 283 consecutive hip fracture patients aged above 50 years admitted in a major trauma hospital from February 2019 to December 2019. The prevalence of abnormalities in the following tests were assessed: chest x-ray, electrocardiogram, complete blood count, serum electrolytes, renal function test, prothrombin time/international normalized ratio, and serum bilirubin. Also, presence of comorbidities were recorded. Mortality within 90 days of admission was assessed.</p><p><strong>Results: </strong>91.5% (N= 259/283) of the patients had at least one abnormal investigation. The most common abnormal investigation was anemia (70.3%, N= 199/283), followed by deranged sodium (36.4%, N= 103/283). 17.7% (N= 50/283) of the patients had at least one new comorbidity diagnosed after admission. The most common newly diagnosed comorbidity was hypertension (10.6%, N= 30/283). Anemia (p=0.044), deranged sodium (p=0.002), raised urea (p=0.018), raised creatinine (p=0.002), renal disease (p=0.015), neurological diseases (p=0.024), and charlson comorbidity index (p=0.004) were associated with increased mortality in multivariate analysis.</p><p><strong>Conclusion: </strong>Pre-operative hemoglobin, sodium, urea, and creatinine were the most important tests influencing mortality, and derangements of these should therefore be carefully evaluated and managed. Hip fracture care pathways should focus on correction of these abnormalities.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 5","pages":"342-348"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11134264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180588","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":"Re-revision Total Knee Arthroplasty: Causes, Risk Factors and Results.","authors":"E Carlos Rodriguez-Merchan","doi":"10.22038/ABJS.2024.75456.3490","DOIUrl":"10.22038/ABJS.2024.75456.3490","url":null,"abstract":"<p><p>The rate of re-revision total knee arthroplasty (TKA) ranges between 4% and 10%, depending on the cause of the procedure. Periprosthetic joint infection (PJI) and periprosthetic fracture are the main causes of re-revision TKA. The likelihood of implant survival of re-revision TKA diminishes with each subsequent revision, with PJI being the main cause of multiple revisions. Acute early aseptic revision TKA (within 90 days of surgery) involves a high risk of re-revision at 2 years and a high risk of subsequent PJI. The use of antibiotic-loaded cement is associated with lower risk of re-revision. Patients younger than 50 years experiencing aseptic revision TKA have a 1 in 3 risk of re-revision. Patients revised for instability or having prior TKA revisions have the highest risk of re-revision at 10 years. Patients younger than 55 years experiencing revision TKA have a 5-year revision-free survival of 80%.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 5","pages":"328-332"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11134262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141181829","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":"Ambiguity of Primary Patellar Tuberculous Osteomyelitis as a Pre-Patellar Bursitis: A Case Report.","authors":"Sandeep Suresh Patil","doi":"10.22038/ABJS.2024.77845.3597","DOIUrl":"10.22038/ABJS.2024.77845.3597","url":null,"abstract":"<p><strong>Case: </strong>A 47-year-old male with swelling over the patella and associated pain, subsiding with medicines but recurring after a few days. Diagnosed as prepatellar bursitis by the family physician, it eventually turns out to be osteomyelitis of the patella. Treated with curettage, biopsy, and placement of bio-composite mixed with antibiotics. Intra-operative findings and histopathology confirmed tuberculosis of the patella. On follow-up after 6 years and the completion of anti-tuberculosis treatment, the patient showed full functional and radiological recovery without recurrence.</p><p><strong>Conclusion: </strong>Early treatment with antibiotics and surgery gives excellent results. Identifying it as a tuberculous osteomyelitis is challenging when the condition is closely resembles pre-patellar bursitis.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 6","pages":"444-448"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11195031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451918","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 Outcomes of Distraction Osteogenesis over an Intramedullary Nail for the Treatment of Bone Defects in Infectious Nonunions.","authors":"Farzad Amouzadeh Omrani, Mohammad Mahdi Sarzaeem, Mohsen Noorbakhsh, Mojtaba Baroutkoub, Sina Afzal, Hasan Barati, Ali Panjeshahi","doi":"10.22038/ABJS.2023.73572.3407","DOIUrl":"10.22038/ABJS.2023.73572.3407","url":null,"abstract":"<p><strong>Objectives: </strong>The concurrent utilization of an external fixator and intramedullary nail (IMN) for segment transportation may potentially decrease the duration of external fixator implementation and reduce associated complications. This study aimed to report the outcomes of bone transport utilizing a combination of IMN and Ilizarov frame in a cohort of individuals who had tibia or femur critical-sized bone deficiency resulting from nonunion.</p><p><strong>Methods: </strong>The present research used a single-arm clinical trial design to enroll a series of patients presenting with critical-sized bone defects resulting from infectious nonunion of the tibia or femur. The study was conducted during the period of 2017-2020 in a referral Orthopedic Surgery Center located in Tehran, Iran. The management of patients with infectious nonunion was carried out through two main stages, including infection eradication and bone transportation. The process of bone healing and segment transportation was evaluated by radiographic assessment throughout the follow-up period.</p><p><strong>Results: </strong>A total of 39 patients with bone defects in the tibia (19 cases) or femur (20 cases) with a mean age of 31.44 (±11.95, range=18-60) were included in this study. Twenty-nine (74.3%) patients had open fractures. The bone defect exhibited an average size of 6.31 ± 1.95 cm. The mean of the consolidation index (CI) was 0.97 (range=0.51-1.32) mo/cm, and the mean of the external fixator index was 0.67 (range=0.41-1.10). Although the CI was longer in patients with open fracture compared to those with closed fracture, the difference was not statistically significant (P=0.353). After the end of the two-year follow-up, complete union was observed in 35 patients (89.7%).</p><p><strong>Conclusion: </strong>Intercalary segmental bone transportation using the Ilizarov technique over an IMN, as well as preserving the advantages of the conventional callotasis method, reduces the complications of long-term use of the Ilizarov frame and increases patient adherence to treatment.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 3","pages":"204-210"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10989721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140874920","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":"Arthroscopic Posteromedial Corner Reconstruction: A Novel Technique and Case Series.","authors":"Mohammad Razi, Saeed Razi, Haleh Dadgostar, Peyman Arasteh, Mohammad Soleimani, Faezeh Khazaee","doi":"10.22038/ABJS.2023.76118.3534","DOIUrl":"10.22038/ABJS.2023.76118.3534","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to introduce a novel arthroscopic treatment for medial and posteromedial instability of the knee and present the primary and follow-up results.</p><p><strong>Methods: </strong>All patients who underwent the arthroscopic approach to treat medial and posteromedial corner instability from 2007 to 2017 were included in this report. Overall, 45 patients were included, among which 75.6% were male. The mean age of patients was 32.2 ± 8.4 years. Overall, 44.4% and 15.6% of patients had associated meniscal injuries and chondral lesions, respectively. The mean follow-up duration of patients was 84.2 ± 25.3 months.</p><p><strong>Results: </strong>Overall, 37 patients developed a full range of motion (82.2%), and most patients (95.6%) showed excellent quadriceps strength (grades 4 and 5). All patients had a normal or 1+ posterior drawer test, Pivot shift test, and Lachman test on physical examination. Moreover, 60% had an associated isolated anterior cruciate ligament injury, 17.8% had an isolated posterior collateral ligament injury, and 17.6% had a combination of more than one ligament injury. One patient developed septic arthritis. Two patients experienced pain, and one pain patient developed pain with a bony spur formation in the medial epicondyle. Three patients showed a 2+ medial collateral ligament (MCL) test (moderate instability) at the final follow-up, all of whom had multi-ligament injuries. All patients, except the three patients who had a failed MCL reconstruction, returned to their previous activities.</p><p><strong>Conclusion: </strong>This study described a novel arthroscopic treatment of MCL injury, and the results showed acceptable postoperative and clinical outcomes. As the use of minimally invasive surgery may minimize multiple complications associated with open surgery, it is suggested that further studies be conducted regarding this approach when faced with patients who have MCL injuries requiring surgery.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 4","pages":"245-255"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11070674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877632","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":"Discoid LaterL Meniscus: A Concise Literature Update.","authors":"E Carlos Rodriguez-Merchan","doi":"10.22038/ABJS.2023.73940.3422","DOIUrl":"10.22038/ABJS.2023.73940.3422","url":null,"abstract":"<p><p>Discoid lateral meniscus (DLM) is the most frequent congenital variant of the lateral meniscus, which is prone to degeneration and tears, and frequently causes knee osteoarthritis. The purpose of this article has been to analyze the publications made during 2023 on DLM. The main conclusions of the analysis were as follows: MRI assessment might be helpful to diagnose DLM and detect the presence of instability: two main factors in the decision to perform surgery. Arthroscopic assessment should be utilized in conjunction with MRI findings for complete DLM diagnosis. Restoring the normal shape, retaining adequate width and thickness, and ensuring the stability of the remnant DLM is essential to sustaining the physiological function of the meniscus and preserving the knee. Partial meniscectomy with or without repair should be the first-line treatment when feasible, given that the clinical and radiological long-run results of total or subtotal meniscectomy are worse.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 4","pages":"288-295"},"PeriodicalIF":1.3,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11070678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877634","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":"Effect of Axillary Radiograph Rotation and Medial Scapular Visualization on Glenoid Retroversion Measurement.","authors":"Liam T Kane, Alayna Vaughan, Surena Namdari, Eitan Kohan","doi":"10.22038/ABJS.2024.73142.3388","DOIUrl":"https://doi.org/10.22038/ABJS.2024.73142.3388","url":null,"abstract":"<p><strong>Objectives: </strong>Axillary radiographs enable the measurement of glenoid retroversion, which is associated with worsened clinical outcomes and glenoid loosening following total shoulder arthroplasty. Due to the variability in radiographic technique, this study aims to determine if the accuracy of retroversion measured by axillary radiograph is affected by 1) scapular rotation and/or 2) proper visualization of the medial scapula.</p><p><strong>Methods: </strong>Using five cadaveric scapulae, investigators obtained axillary radiographs in true neutral position as well as in 10° and 20° of anterior and posterior rotation. For each radiograph, two fellowship trained shoulder surgeons measured glenoid retroversion with complete visualization of the scapula (Technique 1) and with visualization limited to the lateral half of scapula (Technique 2). The observers also measured glenoid retroversion by CT scan to use as a gold standard technique. Spearman's Rho was used to assess agreement between measurements.</p><p><strong>Results: </strong>Average glenoid retroversion of the five scapulae assessed by CT scan was 3.8° (R: 1.5-6.9). Measurements obtained using Technique 1 demonstrated improved levels of interobserver agreement (ICC: 0.412) compared to measurements obtained with Technique 2, which demonstrated no agreement (ICC: 0.103). Scapular rotation was inconsistently associated with agreement using both techniques.</p><p><strong>Conclusion: </strong>The reliability of glenoid retroversion measurements was limited by incomplete visualization of the medial scapular spine. When measuring retroversion to the base of the scapular spine, improved agreement and accuracy were seen with various degrees of scapular rotation.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 8","pages":"597-602"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11353142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113318","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":"Internal Rotation Measurements: Correlation between Vertebral Body Level and Goniometer Measurements on Functional Outcome Scores.","authors":"Eric J West, Derek T Dixon, Thomas W Throckmorton, David L Bernholt, Frederick M Azar, Tyler J Brolin","doi":"10.22038/ABJS.2024.77880.3588","DOIUrl":"https://doi.org/10.22038/ABJS.2024.77880.3588","url":null,"abstract":"<p><strong>Objectives: </strong>Reverse total shoulder arthroplasty (rTSA) has shown success in the treatment of end-stage glenohumeral pathology. However, one major shortcoming has been the lack of internal rotation (IR), which can have significant functional consequences. Much research has been conducted to maximize IR after rTSA, but the literature is unclear which measurement of IR represents the \"gold standard\" between vertebral level and goniometer-based measurements.</p><p><strong>Methods: </strong>Patients were prospectively enrolled into one of three groups: postoperative from rTSA, subacromial pain (SA), and normal. IR measurements were obtained either by the vertebral body level, by which radiographic markers indicated the highest level that the patient was able to reach on the body midline; or by using a goniometer while the shoulder was in 90-degree abduction as the patient stood upright.</p><p><strong>Results: </strong>Comparisons between the radiographic vertebral level and goniometer IR measurements showed significant correlations within the normal (r = - 0.43, P = 0.02) and SA pain groups (r = - 0.44, P = 0.02). The rTSA group did not quite reach statistical significance (P = 0.11), but had a moderate correlation coefficient (r = - 0.33). Accuracy of visual IR measurements was also significant. All rTSA group vertebral level measurements were within two vertebral levels, while only 84.6% of IR measurements by goniometer were within 15 degrees. Visual vertebral level measurements were found to be more accurate for the SA pain group (86.2 vs 66.7%).</p><p><strong>Conclusion: </strong>A comparison of the two primary IR measurement methods for shoulders was shown to have a correlation. This would allow for direct comparison of different literature using only one measurement method. While the correlation is not yet strong enough to allow for conversion between the two measurement types, creating a matched cohort taking into account other factors may lead to the correlation reaching this point.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 8","pages":"558-566"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11353147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113319","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":"Painful Unicompartmental Knee Arthroplasty: Etiology, Diagnosis and Management.","authors":"Justin M Walsh, Robert A Burnett, Joseph Serino, Tad L Gerlinger","doi":"10.22038/ABJS.2024.61787.3030","DOIUrl":"https://doi.org/10.22038/ABJS.2024.61787.3030","url":null,"abstract":"<p><p>Unicompartmental knee arthroplasty (UKA) is an increasingly common procedure. Patients with persistent or new postoperative pain can present a challenge for surgeons to accurately diagnose and treat. The purpose of this study is to provide a comprehensive review of the presentation, diagnosis, and management of the various pathologies contributing to pain after UKA. The most common causes of a painful UKA include aseptic component loosening and progression of osteoarthritis. Both of these conditions may be treated with either revision UKA or conversion to total knee arthroplasty. While technically challenging, these procedures are often associated with favorable outcomes. Other causes of pain after UKA include infection, atraumatic tibial component subsidence, periprosthetic fracture and malalignment. Careful clinical, radiographic, and laboratory evaluation is therefore critical to accurately identify the source of pain and guide appropriate management.</p>","PeriodicalId":46704,"journal":{"name":"Archives of Bone and Joint Surgery-ABJS","volume":"12 8","pages":"546-557"},"PeriodicalIF":1.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11353146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142113321","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}