Journal of Manual & Manipulative Therapy最新文献

{"title":"Reliability and measurement properties of upper cervical flexion-extension range of motion testing in people with cervicogenic headache and asymptomatic controls.","authors":"Kiran Satpute, Rashi Rathod, Toby Hall","doi":"10.1080/10669817.2023.2251869","DOIUrl":"10.1080/10669817.2023.2251869","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to determine reliability of sagittal plane range of motion (ROM) assessment in a healthy population and in people with cervicogenic headache (CGH).</p><p><strong>Methods: </strong>Upper cervical flexion/extension ROM was measured using an iPhone magnetometer sensor and retraction/protraction ROM measured by linear displacement. Two independent raters evaluated these movements in 33 subjects with CGH and 33 age and gender matched asymptomatic healthy controls on two occasions. Measurement procedures were standardized; and the order of testing randomized. Reliability, standard error of measurement (SEM) and minimum detectable change (MDC) were calculated.</p><p><strong>Results: </strong>Subjects comprised 30 females and 36 males. The iPhone method demonstrated high reliability (ICC >0.82) with SEM values ranging from 0.62 to 1.0 and MDC values ranging from 1.70 to 4.81 respectively. Evaluation of linear displacement demonstrated moderate reliability (ICC >64). with SEM values ranging from 0.38 to 1.91 and MDC values ranging from 1.05 to 1.63 respectively. Compared to healthy controls, upper cervical flexion, retraction and protraction ROM was significantly less in the CGH group with mean difference of 6.50°, 1.52 cm and 2.34 cm respectively.</p><p><strong>Discussion: </strong>Upper cervical spine sagittal plane ROM can be measured with moderate to high reliability and was found to be more restricted in people with CGH.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"182-189"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112040","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":"An investigation of neurological and/or biomechanical factors underpinning the effect of a thrust manipulation on chronic ankle symptoms: an observational study.","authors":"Emily J Slaven, Nick Alarcio, Chandler Fields, Mallory Hayes, Emily Weiss, Nathanial R Eckert","doi":"10.1080/10669817.2023.2251864","DOIUrl":"10.1080/10669817.2023.2251864","url":null,"abstract":"<p><strong>Background: </strong>Ankle sprains are a commonly occurring musculoskeletal injury potentially resulting in persistent pain and/or altered motion. Thrust manipulation may serve as an interventional strategy but limited evidence exists on the mechanism(s) by which a change to symptoms might occur.</p><p><strong>Objective: </strong>The study sought to quantify the immediate effect of a thrust manipulation to the ankle to determine a mechanism by which change to symptoms occurred.</p><p><strong>Methods: </strong>Eleven participants (6 m/5f, 26.09 ± 4.25 yrs) with a history of ankle sprain that occurred greater than three months ago with recurring pain and/or altered motion were recruited. Participants underwent neurophysiological testing to assess any pain alterations and instrumented gait analysis (IGA) for biomechanical assessment pre-post thrust manipulation to the ankle.</p><p><strong>Results: </strong>There were no significant differences in ankle dorsiflexion (DF) (<i>p</i> = 0.62), plantarflexion (PF) (<i>p</i> = 0.23), ground reaction force (GRF), or velocity (<i>p</i> = 0.63) following thrust manipulation compared to baseline; however, pre- and post-data did show differences in pain pressure threshold (<i>p</i> = 0.046). There were no significant differences in dynamic pain measurements.</p><p><strong>Conclusions: </strong>Ankle sprains that result in persistent pain and/or altered motion can be impacted by a thrust manipulation which appears to act through neurophysiological mechanisms.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"198-205"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10194411","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":"Can upper cervical manual therapy affect the blink reflex in subjects with migraine and neck pain?","authors":"Mehdi Jafari, Farid Bahrpeyma, Mansoureh Togha, Toby Hall, Fahimeh Vahabizad, Elham Jafari","doi":"10.1080/10669817.2023.2250172","DOIUrl":"10.1080/10669817.2023.2250172","url":null,"abstract":"<p><strong>Background: </strong>Neck pain is a common complaint among migraineurs possibly due to the anatomic connections between cervical and trigeminal afferents in the trigeminocervical complex (TCC). Manual therapy (MT) is used in the management of headache disorders, with demonstrable neurophysiological effects. The blink reflex (BR) is one method of analyzing neurophysiological effects in headache patients. The purpose of this study was to investigate the effect of upper cervical spine MT on BR in subjects with migraine and neck pain.</p><p><strong>Methods & materials: </strong>Twenty subjects were assigned to a medication plus MT (MedMT) group (<i>n</i> = 10) and medication plus sham MT (sham MT) group (<i>n</i> = 10). After random assignment, all patients underwent testing for the BR (R1, R2, R2c responses). Then, subjects in group MedMT and group sham MT received either 4 sessions of MT or sham MT to the upper cervical spine. After completion of the intervention, BR testing was repeated.</p><p><strong>Results: </strong>There were no significant differences in both side R1 latency between group MT and group sham MT (<i>P</i> > 0.050). For both sides, R2 latencies were significantly prolonged in MedMT group compared with sham MT group (<i>P</i> < 0.050). Subjects in MedMT group showed significant prolongation in right and left R2c latency compared with sham MT group (<i>P</i> < 0.050).</p><p><strong>Discussion: </strong>The present study demonstrated that upper cervical MT affected trigeminal nociceptive neurotransmission in subjects with migraine and neck pain as reflected by changes in the BR. The increase in BR late response latencies of BR indicates an inhibitory effect of upper cervical spine MT on the TCC in these subjects. Trial Registration: The trial design was registered at the Iranian Registry of Clinical Trials (IRCT ID: IRCT20160621028567N2, url: https://www.irct.ir/) before the first patient was enrolled.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"190-197"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10484287","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":"Integrated neuromuscular inhibition technique versus spray and stretch technique in neck pain patients with upper trapezius trigger points: a randomized clinical trial.","authors":"Ali Mohamed Ali Ismail, Alshaymaa Shaaban Abd El-Azeim, El-Sayed Essam El-Sayed Felaya","doi":"10.1080/10669817.2023.2192899","DOIUrl":"10.1080/10669817.2023.2192899","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the difference between the integrated neuromuscular inhibition technique (INIT) and spray and stretch technique in patients with neck pain and upper trapezius active trigger points. Methods: A convenience sample of 60 patients with neck pain and active trigger points were recruited from physiotherapy students and allocated randomly to three groups INIT plus stretching exercise spray and stretch technique plus stretching exercise, and stretching exercise only. Treatment was three times per week for four weeks. Pain intensity by visual analogue scale (VAS), pain pressure threshold (PPT), neck disability by Arabic neck disability index (ANDI), and muscle amplitude in the form of root mean square (RMS) by electromyography (EMG) were measured at baseline and after four weeks. Results: Between groups analysis; the results revealed statistical significant difference between three groups after four weeks of intervention as <i>p</i> =0.0001. Within the group analysis, post hoc tests reported improvement at all variables in both INIT and spray and stretch technique groups with mean differences 64.5 and 65.1 in VAS, 20 and 18.15 in ANDI, -1.45 and -0.81 in PPT, and 2.47 and 1.88 in muscle amplitude, respectively. But there was no statistically significant difference in stretching only group in all variables except VAS.</p><p><strong>Conclusion: </strong>Both INIT and spray and stretch techniques had a clinical and statistical effects on pain, function, PPT, and RMS. According to results, there were statistical significant differences between INIT and spray and stretch groups at post-treatment in all variables except VAS with more favor to INIT group, but there were no clinical differences between INIT and spray and stretch groups.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"141-149"},"PeriodicalIF":2.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956923/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9162110","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":"Development of a diagnostic support tool for predicting cervical arterial dissection in primary care.","authors":"Lucy Caroline Thomas, Elizabeth Holliday, John R Attia, Christopher Levi","doi":"10.1080/10669817.2023.2250164","DOIUrl":"10.1080/10669817.2023.2250164","url":null,"abstract":"<p><strong>Objectives: </strong>Cervical arterial dissection (CAD) is an important cause of stroke in young people which may be missed because early features may mimic migraine or a musculoskeletal presentation. The study aimed to develop a diagnostic support tool for early identification of CAD.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Tertiary hospital.</p><p><strong>Participants: </strong>Radiologically confirmed CAD cases (<i>n</i> = 37), non-CAD stroke cases (<i>n</i> = 20), and healthy controls (<i>n</i> = 100).</p><p><strong>Main outcome measures: </strong>The presence of CAD is confirmed with imaging. Predictive variables included risk factors and clinical characteristics of CAD. Variables with a p-value <0.2 included in a multivariable model. Predictive utility of the model is assessed by calculating area underthe ROC curve (AUC).</p><p><strong>Results: </strong>The model including four variables: age 40-55 years (vs < 40), trauma, recent onset headache, and > 2 neurological features, demonstrated excellent discrimination: AUC of 0.953 (95% CI: 0.916, 0.987). A predictive scoring system (total score/7) identified an optimal threshold of ≥ 3 points, with a sensitivity of 87% and specificity of 79%.</p><p><strong>Conclusions: </strong>The study identified a diagnostic support tool with four variables to predict increased risk of CAD. Validation in a clinical sample is needed to confirm variables and refine descriptors to enable clinicians to efficiently apply the tool.Optimum cutoff scores of ≥ 3/7 points will help identify those in whom CAD should be considered and further investigation instigated. The potential impact of the tool is to improve early recognition of CAD in those with acute headache or neck pain, thereby facilitating more timely medical intervention, preventing inappropriate treatment, and improving patient outcomes.Wordcount: 3195.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"173-181"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10128025","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":"Ultrasound verification of palpation-based dry needling techniques of rotator cuff muscles: a prospective feasibility trial.","authors":"Michael Vitt, Sarah Macaraeg, Zachary Stapleton, Angeli Mata, Brendon S Ross","doi":"10.1080/10669817.2023.2244735","DOIUrl":"10.1080/10669817.2023.2244735","url":null,"abstract":"<p><strong>Objectives: </strong>The primary purpose of this study is to investigate the feasibility of using ultrasound to verify the placement of narrow-gauge dry needles within the supraspinatus and infraspinatus muscles utilizing palpation-based dry needle techniques.</p><p><strong>Methods: </strong>This is a prospective observational study with 10 participants recruited. Each participant had a dry needle placed within the infraspinatus and supraspinatus muscles by a trained physical therapist utilizing palpation-based methods. Following needle placement, ultrasound examination was then performed to determine the feasibility of needle tip visualization within the targeted tissues.</p><p><strong>Results: </strong>The needle tip was successfully visualized on ultrasound in 19/20 cases. The needle tip accurately resided in the targeted muscle tissue in each of the 19 cases it was successfully visualized.</p><p><strong>Conclusions: </strong>Narrow-gauge dry needles used in physical therapy practice can be consistently visualized in the supraspinatus and infraspinatus muscles using ultrasound imaging. Also, the palpation method utilized is an accurate means of guiding dry needles into the targeted rotator cuff muscles. These are significant findings because most physical therapy clinics do not have the benefit of real-time imaging guidance and must rely solely on palpation-based needling methods.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"166-172"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9981502","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":"Spinal displacement during thoracic manipulative therapy in mechanical neck pain patients: an observational study.","authors":"Phak Niamsuwan, Duangporn Suriyaamarit, Adit Chiradejnant","doi":"10.1080/10669817.2023.2230010","DOIUrl":"10.1080/10669817.2023.2230010","url":null,"abstract":"<p><strong>Introduction: </strong>Thoracic manipulative therapy (TMT) is recommended for treating patients with mechanical neck pain (MNP). However, there are multiple proposed recommendations for the mechanism for neck pain reduction.</p><p><strong>Objective: </strong>To investigate displacement of the cervicothoracic spine during the application of TMT in patients with MNP.</p><p><strong>Methods: </strong>Thirty-five male patients with MNP were recruited. Displacements of C₃, C₅, C₇, T₂, T₄ and T₆ were measured using a motion capture system while a therapist applied a grade III central posteroanterior TMT (cpa-TMT) to T₆.</p><p><strong>Results: </strong>Mean (SD) displacement ranged from 2.2 (0.62) to 5.5 (1.1) mm. A significant decrease in neck pain intensity at rest was found after the application of the cpa-TMT (mean difference 17 mm, <i>p</i> < 0.001). A downward trend in spinal displacement was noted, with the largest and smallest displacement occurring at T₆ and C₃, respectively. Correlations between the displacement of T₆ and adjacent spinal levels were moderate to high (Pearson's <i>r</i> range 0.70-0.90, <i>p</i> < 0.001). It was showed that cpa-TMT applied to T₆ produced the PA displacement toward the upper cervical spine.</p><p><strong>Conclusion: </strong>TMT produces spinal segmental displacements toward the upper cervical spine in MNP patients. These segmental displacements would activate the alleviation effect at both the spinal and supraspinal levels resulting in neck pain reduction. These findings would provide supporting evidence for the use of TMT in neck pain reduction.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"159-165"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9730711","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":"Pain neuroscience education through cultural lens: insights, challenges and future implications.","authors":"Muskan Bhojwani, Vaibhavi Walimbe, Rinkle Malani","doi":"10.1080/10669817.2024.2317513","DOIUrl":"10.1080/10669817.2024.2317513","url":null,"abstract":"","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"127-130"},"PeriodicalIF":1.6,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10956911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933555","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":"Changes in biochemical markers following a spinal manipulation - a systematic review update.","authors":"Kesava Kovanur Sampath, Loïc Treffel, Oliver P Thomson, Jerry Draper Rodi, Michael Fleischmann, Steve Tumilty","doi":"10.1080/10669817.2023.2252187","DOIUrl":"10.1080/10669817.2023.2252187","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population.</p><p><strong>Methods: </strong>This is a systematic review update. Various databases were searched (inception till May 2023) and fifteen trials (737 participants) that met the inclusion criteria were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. Outcome measure data were synthesized using standard mean differences and meta-analysis for the primary outcome (biochemical markers). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest.</p><p><strong>Results: </strong>There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled). There was low-quality evidence of significant difference that spinal manipulation is better (SMD -0.42, 95% CI - 0.74 to -0.1) than control in eliciting changes in cortisol levels immediately after intervention. Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine.</p><p><strong>Conclusion: </strong>Spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"28-50"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10795611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10164909","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":"Effectiveness of spinal manipulation in influencing the autonomic nervous system - a systematic review and meta-analysis.","authors":"Kesava Kovanur Sampath, Steve Tumilty, Liana Wooten, Suzie Belcher, Gerard Farrell, Angela Spontelli Gisselman","doi":"10.1080/10669817.2023.2285196","DOIUrl":"10.1080/10669817.2023.2285196","url":null,"abstract":"<p><strong>Background: </strong>Spinal manipulation (SM) has been hypothesized to influence the autonomic nervous system (ANS). Further, it has been proposed that the effects may vary depending on the segment manipulated. The aim of this systematic review was to synthesize the current level of evidence for SM in influencing the ANS in healthy and/or symptomatic population.</p><p><strong>Methods: </strong>Various databases (<i>n</i> = 8) were searched (inception till May 2023) and 14 trials (<i>n</i> = 618 participants) were included in the review. Two authors independently screened, extracted and assessed the risk of bias in included studies. The data were synthesized using standard mean differences and meta-analysis for the primary outcome measures. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of the body of evidence for each outcome of interest.</p><p><strong>Results: </strong>Overall, there was low quality evidence that SM did not influence any measure of ANS including heart rate variability (HRV), oxy-hemoglobin, blood pressure, epinephrine and nor-epinephrine. However, there was low quality evidence that cervical spine manipulation may influence high frequency parameter of HRV, indicating its influence on the parasympathetic nervous system.</p><p><strong>Conclusion: </strong>When compared with control or sham interventions, SM did not alter the ANS. Due to invalid methodologies and the low quality of included studies, findings must be interpreted with great caution. Future studies are needed which employ rigorous data collection processes to verify the true physiological implications of SM on ANS.</p>","PeriodicalId":47319,"journal":{"name":"Journal of Manual & Manipulative Therapy","volume":" ","pages":"10-27"},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10795624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478964","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}