SVOA Orthopaedics最新文献

{"title":"Hip Preservation in Sequelae of Septic Arthritis in the Newborn, Case Report","authors":"Mauricio Vergara, José Pablo Riquelme, Alejandra Rivadeneira, María Catalina Gaggero","doi":"10.58624/svoaor.2024.04.071","DOIUrl":"https://doi.org/10.58624/svoaor.2024.04.071","url":null,"abstract":"Septic arthritis of the hip in newborn may cause severe sequelae that has a negative impact on daily living activities. We present a patient with septic arthritis of the right hip in the newborn period (NB) classified as type IV-A according to Choi, in order to increase coverage to prevent progression of subluxation and improve joint containment and stability, a Dega-type acetabuloplasty was performed at the age of 5 years old. The patient lost follow-up for five years, she consulted again and after clinical and radiological evaluation a pelvic support osteotomy was planned and performed at the age of 15 for hip preservation. We share the postoperative outcomes observed in a rare case with complications, following hip preservation surgery, with the long-term follow-up until 22 years old. This case shows that maintaining a stable hip between the femoral epiphysis and the acetabulum, allows to reduce complications, like lower limb length discrepancy (LLD) and worsening of the activity of daily living (ADL) and postponing, or preventing hip replacement at younger ages.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"71 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141353015","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":"A Novel Approach to The Use of Flowable Human Amniotic Fluid for Diabetic Foot Ulcers in High-Risk Veterans Affairs Patients","authors":"Gavin T. Glover, Jodi L. Walters, Valarie N. Samoy, James Dancho","doi":"10.58624/svoaor.2024.04.069","DOIUrl":"https://doi.org/10.58624/svoaor.2024.04.069","url":null,"abstract":"As of 2017, there are 425 million people worldwide who suffer and are affected by Diabetes Mellitus. Among those 425 million people, approximately 34% of people go on to develop diabetic foot ulcers with more than 50% becoming infected. There are many causes of ulcers, including metabolic, biomechanical, traumatic, or post-operative complications. The use of human amniotic fluid has the potential to be an additional treatment for pedal wounds in patients with diabetes mellitus. Indications may include wounds which have prolonged or delayed healing as a result of biomechanical complications, co-morbidities, or failed conservative treatment. This case series explores the effectiveness at topical application of flowable human amniotic fluid in 3 different high risk diabetic patients who all suffered from a pedal ulcer. Each patient had a different location and circumstance for their wound allowing for some variety in surgical planning and wound care decision making. Two of the three patients were able to heal completely within 3 months of initial consult with the remaining patient healing within 4 months of initial consult. Per chart reviewing, all three patients have remained healed at the 1 year follow-up with no evidence of reoccurrence. This series hopes to open a discussion regarding the novel use of topical application of human amniotic tissue as an advanced wound care option for those who may have failed conservative therapy or may be looking for alternative methods to help heal pedal ulcers.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"230 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140730376","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":"Variance of Alpha Angle with Use of Intramedullary Guide – Long or Short Intramedullary Alignment Guide (IAG)","authors":"Sandeep Krishna Avulapati","doi":"10.58624/svoaor.2024.04.063","DOIUrl":"https://doi.org/10.58624/svoaor.2024.04.063","url":null,"abstract":"Introduction: Total Knee Replacement is common surgery to treat osteoarthritis in present day. This is important to restore the daily activities of living and at times it also helps to patients to go further with daily activities of earning in their old age. This surgery also reduces the burden of old people in the society. With advancements in TKR surgery, every aspect of alignment of prosthesis needs to be measured to determine acceptability of implant. Further this can help in refinement to improve the movement and acceptance of implant, better patient satisfaction. Aim: We here by propose null hypothesis that use of long or short Intramedullary Alignment Guide (IAG) during the distal femur cut cannot influence the alpha angle of femur. Materials and Methods: This is a radiological evaluation study done in BIRRD (T) Hospital. All the patients admitted into BIRRD for TKR in unit III were evaluated pre operatively. Surgery was performed by different surgeons based upon their training and using of IAG (short or long). There were no indications for use of short or long IAG. This is totally based on surgeon preference on using. Later alpha angle was measured post operatively. Observation and Results: A total of 243 patients were included into the study. Data was collected based the surgeons experience and preference in use of long and short IAG device. There were 96 and 147 patients were long and short IAG devices used respectively. It was found that alpha angle of 93.6o (+ 2.7) and 93.4o (+ 3.04) respectively with long and short IAG. Conclusion: We found that there is no significant statistical difference in alpha angle with use of long and short IAG during femur cuts in TKR. Hence null hypothesis is accepted.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"65 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139390569","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":"Osteomyelitis of the Ischium in a Hemodialysis Dependent Adult – A Rare Case Report","authors":"Rosana Pinheiro, Diana Pedrosa, Natália Barbosa, José Miguel Araújo, Raul Cerqueira, Paulo Montanha, António Andrade, Afonso Ruano","doi":"10.58624/svoaor.2023.03.057","DOIUrl":"https://doi.org/10.58624/svoaor.2023.03.057","url":null,"abstract":"Introduction: Osteomyelitis of the pelvis is rare, and the correct diagnosis may be missed during the early stage when the correct treatment would be most beneficial. Osteomyelitis requires multidisciplinary treatment to cure or control symptoms. Case Presentation: A 71-year-old woman, with end stage renal disease on hemodialysis, presented in emergency department for purulent drainage of a right buttock swelling. A pelvic computer tomography (CT) revealed a collection of the gluteal musculature and an activated chronic osteomyelitis with one osteolytic lesion on right ischiopubic branch. The patient underwent surgical treatment, with need of two interventions. First, she was only submitted to surgical drainage of the abscess. She completed a cycle of antibiotic therapy, with good response. Two months later, she returns with fever and drainage of the surgical wound. A pelvic CT showed an area of bone destruction at right ischium, with an increase in bone sequestration. She underwent a partial orchiectomy and surgical debridement of necrotic tissues. A Klebsiella oxytoca, Proteus mirabilis and multidrug-resistant Staphylococcus epidermidis was isolated. She was on antibiotic therapy for 4 months. Three years later, she remains without new symptoms or signs of active osteomyelitis. Conclusion: Pelvic osteomyelitis represents a diagnostic challenge, because the symptoms and signs vary, depending on the initial site of infection, its duration and the direction of its spread. Osteomyelitis of the ischium is generally diagnosed in the late stage with complications. Treatment of pelvic osteomyelitis is challenging due to the anatomic constraints of the pelvis and the high degree of comorbidity in affected patients. A multidisciplinary approach is often required. This case of a chronic abscess with osteomyelitis of the ischium is rare and was neglected for months because of the absence of constitutional symptoms in a hemodialysis dependent woman.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"73 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135975744","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":"Surgical Fasciotomies for Pediatric Acute Compartment Syndrome, and Overview","authors":"Nguyen Vu Hoang, Hoang Hai Duc, Le Tuan Anh, Phung Cong Sang, Nguyen Vu Hoang","doi":"10.58624/svoaor.2023.03.056","DOIUrl":"https://doi.org/10.58624/svoaor.2023.03.056","url":null,"abstract":"Introduction: The goal of treatment is firstly to save the patient's life and secondly to save the damaged climb. Fasciectomy is the only accepted treatment for compartment syndrome and should be performed promptly after the diagnosis is made. The results after fasciectomy are best when there is no delay in treatment. Method: Clinically determined according to the \"5 P's\" and measured Intracompartmental Pressure (ICP) with P ≥ 30 mmHg. Perform traditional Fasciotomies surgery on all patients. Results: There were four patients; Mean age: 54 months ± 31.749; Girl: 03; Boy: 01; Fall from hight: 2; Sport trauma: 01; Pedestrian in a car accident: 01; Mean - Intracompartmental Pressure (ICP): 53.75 mmHg.The most common mechanisms of injury are pedestrians struck by motor vehicles, falls, sports, and vehicle occupants in motor vehicle crashes. Forearm fractures are the most common cause in the upper extremity, and fractures of the tibia and/or fibula are most common in the lower extremity. Conclusions: Fractures significantly increase the risk of developing compartment syndrome in both forearm and leg fractures. The patients were transferred directly from the emergency room to the operating room, suggesting that the remaining developed compartment syndrome after admission or late diagnosis.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"73 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135975743","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":"Improving Wake-Up Times for Spine Surgery Using New OR Team Checklist Protocol and Communication","authors":"Lloyd A. Hey, George M. Edwards, Gabriel Brotzman, Bryan Max, Kristina Stanson, Kristy Tyndall, Arturo Suarez, Kirsten Darroch, Craig Fowler","doi":"10.58624/svoaor.2023.03.058","DOIUrl":"https://doi.org/10.58624/svoaor.2023.03.058","url":null,"abstract":"Introduction: Prolonged post-anesthesia wake-up times present a threat to patient safety. Shorter wake-up times allow for intraoperative physical exams and potential to re-operate quickly in case of detected neurologic deficits, which may allow for a better neurologic outcome. Furthermore, shorter wake-ups may reduce length of hospital stay, lowering healthcare costs. Methods: We studied how a standardized spine deformity surgery checklist and new OR team communication impacted post-anesthesia wake-up times after scoliosis surgery. We used a Kruskal-Wallis one-way ANOVA to compare 17 wake-up times recorded prior to using the new surgery checklist and teamwork protocol to 468 wake-up times recorded over three years after implementation of the new protocol. We used a Pearson correlation coefficient to analyze how wake-up times varied based on surgical duration with the new protocol. Results: After one year of the new protocol, wake-up times reduced from an average of 16.6 minutes to an average of 7.6 minutes. Wake-up times further declined to an average of 6.0 minutes by years two and three of the new protocol, with significant reductions in these years (p=0.024 and p=0.030, respectively). Improvements to the protocol were made over time in response to outliers. Nearly 75% of wake-up times were less than five minutes with the new protocol. Wake-up times recorded using the new protocol showed a significant weak positive correlation with surgical duration (r=0.092, p=0.047). Conclusion: The standardized surgery checklist and new team communication promotes significantly shorter post-anesthesia wake-up times, irrespective of surgical duration. While using a comprehensive surgery checklist may take a few more minutes up front, that time is saved at the end with shorter wake-up time, creating net time savings while improving safety. Key steps to promoting a shorter intraoperative wake-up include: 1) using a bispectral index monitor (BIS) with a goal in the 50s, 2) standardized target anesthetic dosing parameters, 3) eliminated anesthetic drug variability, 4) every-thirty-minute timeouts to monitor patient status, and 5) sub-three-minute pre-surgery wake-up time goals verbalized to the OR team.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"73 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135975745","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":"Comparison of the Effects of Extracorporeal Shock Wave Therapy and Dry Needing on Spasticity in Poststroke Patients: A Randomized Controlled Trial","authors":"Mehmet Hanifi Kaya","doi":"10.58624/svoaor.2023.03.055","DOIUrl":"https://doi.org/10.58624/svoaor.2023.03.055","url":null,"abstract":"Introduction: The effective treatment of spasticity following a stroke is a critical and pressing concern. Various therapeutic approaches, such as physiotherapy (7, 8) and medication (9, 10), have been employed. In recent years, external corporeal shockwave therapy (ESWT) and dry needling (DN) have gained popularity for managing spasticity and post-stroke pain. This study aims to conduct a comparative analysis of the effectiveness of ESWT and DN in addressing spasticity, pain, as well as upper limb function and sensation in individuals with hemiplegia. Methods: In this study, individuals with hemiplegia were randomly assigned in a 1:1 ratio to either the External Corporeal Shockwave Therapy (ESWT) group (n = 10) or the Dry Needling (DN) group (n = 10). We assessed Upper Extremity Functions, Sensation, Spasticity, and Pain. All measurement indicators were evaluated before treatment and immediately after a single treatment session. To determine the presence of a group *time interaction effect on the treatment's impact for each outcome variable, we used mixed-model repeated-measures ANOVAs. The between-subjects variable was the group, and time served as the within-subjects variable. Results: Both Dry Needling (DN) and External Corporeal Shockwave Therapy (ESWT) demonstrated significant reductions in spasticity within the biceps brachii muscle, along with notable improvements in upper extremity function tests. Moreover, both DN and ESWT led to significant enhancements in the forearm, arm, and finger; however, the same level of improvement was not observed for the hand. Tactile sensitivity, pain sensation, and light touch did not show significant improvements in either treatment group. Nonetheless, both groups experienced a significant reduction in pain levels. When we conducted a comparative analysis between these two treatment groups across all measures, no significant differences were observed (p > 0.05). Conclusion: In individuals with hemiplegia, both External Corporeal Shockwave Therapy (ESWT) and Dry Needling (DN) have demonstrated the ability to effectively reduce pain and spasticity while enhancing upper extremity function. As a result, these treatments may be regarded as viable alternative methods for addressing the needs of individuals with hemiplegia.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135942850","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":"A Case of Cavus: Tackling Post Operative Recurrence","authors":"Dhavel Chauhan","doi":"10.58624/svoaor.2023.03.054","DOIUrl":"https://doi.org/10.58624/svoaor.2023.03.054","url":null,"abstract":"Pes cavovarus deformities of the foot and ankle pose significant challenges for patients and clinicians, often leading to debilitating symptoms and sequelae. This case study presents a 67-year-old female patient who underwent multiple surgical corrections for recurrent cavus foot deformity. The initial surgery involved Tendo-Achilles Lengthening, Dwyer Calcaneal Osteotomy, and Total Ankle Arthroplasty. However, over time, the deformity migrated to the forefoot and midfoot, necessitating further interventions, including dorsiflexory wedge osteotomy and IPJ fusion. Despite these efforts, the cavus deformity recurred in the rearfoot in 2022, leading to a comprehensive surgical approach. The procedures included soft tissue and osseous corrections, such as posterior tibial tendon lengthening, deltoid release, hardware removal, lateral calcaneal sliding osteotomy, and polyethylene replacement of the ankle arthroplasty. The patient experienced pain relief and improved function following this intervention. The study highlights the challenges associated with managing cavovarus deformities and the importance of a systematic approach to address both soft tissue contractures and osseous abnormalities. Furthermore, it underscores the potential for recurrence in such cases, necessitating vigilant postoperative monitoring and adaptable treatment strategies. While the patient achieved positive outcomes twelve months postoperatively, this case emphasizes the need for careful pre-operative planning and consideration of various surgical techniques to effectively manage pes cavovarus deformities and their recurrent nature.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136057906","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":"Salvage and Reconstruction of the Mangled Hand: A Case Study Utilizing a Multi-Composite Tissue Product Reconstructive Approach","authors":"Neil Nazar Al-Saidi, Abdalmajid Katranji","doi":"10.58624/svoaor.2023.03.052","DOIUrl":"https://doi.org/10.58624/svoaor.2023.03.052","url":null,"abstract":"Objective: To evaluate the efficacy of a novel reconstructive approach utilizing Multiple Composite Tissue Products (MCTPs) in severe hand injuries with risk of amputation. Methods: A comprehensive, single MCTP operation was performed at a single institution involving three tissue products to salvage the nerves, tendons, bone, and skin. This patient case study exemplifies the successful reconstruction of a mangled hand. Results: The application of three tissue products resulted in securing the integrity of the mangled hand’s structures and preservation of basic hand and wrist function, obviating the need for amputation. The patient regained significant restoration substantiating the safety and efficacy of this approach for structural, functional, and cosmetic outcomes. Discussion: Preoperative assessment and multi-disciplinary coordination of care was imperative in optimizing the successful outcomes. The patient’s medical history was complicated by diabetes mellitus, neuropathy, and osteonecrosis. Intensive postoperative rehabilitation, including Passive and Active Range of Motion (PROM, AROM), contributed to recovery and outcomes. Significance: The MCTP reconstructive approach is a promising avenue for optimizing tissue viability to recover from mangled hand injuries. The amelioration of adhesion formation directs proper tissue recovery which conserves tissue that might otherwise necessitate further excision, and possibly amputation. Per patient centered outcomes, this strategy mitigated extensive pain and minimized scarring, which enhanced the cosmetic appeal of reconstructing the mangled hand. These findings underscore the reconstructive potential of a MCTP approach in complex hand salvage, contributing to the recovery of function and cosmetic appeal. Future research should aim to validate similar findings of this case study strategy in a larger cohort.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"141 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135487451","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 Outcome of Surgical Centralization for Radial Club Hand in Children","authors":"Nguyen Ngoc Hung, Hoang Hai Duc, Le Tuan Anh, Phung Cong Sang","doi":"10.58624/svoaor.2023.03.053","DOIUrl":"https://doi.org/10.58624/svoaor.2023.03.053","url":null,"abstract":"Background: Various types of osteotomy have been proposed to treat Radial club hand. We reviewed the results of Ulnar osteotomy, Centralization, and tendon transfer. Methods: Between 2000 and 2011, we treated 32 cases of Radial club hand with two Variants Variation 1 (n= 23): ulnar osteotomy; Variation 2 (n=9): without osteotomy; There were 23 patients. Male 10 and Female: 13. Unilateral: 14. Bilateral: 9. Mean age at Operation: 33 months and Follow Up: 56 months. We compared Wrist-Forearm, Hand-Forearm angles before and after surgery, range of motion for all patients. Results: Surgical Centralization on all patients, and Ulnar Osteotomy on 23 forearms. The Patients was Operated according to separated two Variants; there were 23 Variant 1, mean Ulnar bow: 38.68° ±3.583 (33.6° – 45.2°); and there were 9 Variant 2. mean Ulnar bow: 28.15° ± 3.176 (25.7°—28.4°)without ulnar osteotomy. There were 14 patients with unilateral: 8 (57.1%) in V1, and 6 (42.9%) in V2. There were 9 patients with bilateral (18 radial club hand): 15 (83.3%) in V1, and 3 (16.7%) in V2. Compared results on V1 and V 2 with P-values are not significant. Conclusion: Centralization and Ulnar osteotomy technique for operative treatment of the radial club hand is presented. The improved mechanical forces are further stabilized by transposition of the radial wrist extensor and flexor; this favors a better muscle balance.","PeriodicalId":472191,"journal":{"name":"SVOA Orthopaedics","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135487450","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}