Foot and Ankle Surgery最新文献

{"title":"Bone mass distribution of 892 distal tibiae and implications for the treatment of medial malleolar fractures.","authors":"Holger Kleinertz, Elena Mueller, Leon-Gordian Leonhardt, Darius M Thiesen, Bernhard Hofstätter, Andreas Petersik, Karl-Heinz Frosch, Carsten Schlickewei","doi":"10.1016/j.fas.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>The medial malleolus is involved in up to 50 % of ankle fractures. When surgery is required, a thorough understanding of bone mass distribution within the distal tibia is crucial for selecting and positioning screws to ensure stable fixation. Despite its clinical significance, data on the bone mass distribution in the distal tibia remains limited.</p><p><strong>Methods: </strong>A total of 892 anonymized computed tomography data sets were analyzed to assess bone mass distribution in the distal tibia. Patients were categorized based on age, sex and stratified into those with normal (Hounsfield units (HU) ≥ 122) and reduced (HU < 122) bone density. Utilizing color-coded thermal maps, bone density and bone mass distribution in the distal tibia was visualized. Subsequently, simulation of potential screw trajectories for medial malleolar fracture treatment were conducted and bone density along those trajectories measured.</p><p><strong>Results: </strong>Patients exhibiting reduced bone density (n = 442) were significantly older (69 (IQR 60-78)) than those with regular bone density (n = 450) aged (62 (IQR 47-72)) and more often female (p < 0.0001). The highest bone density was located within the proximal one centimeter from the distal tibial articular surface. Another region of dense bone was found at the transition from the distal tibia to the medial malleolus. Bone density was lowest at the distal tibial shaft region beginning at around 30 mm (in females) and 33 mm (in males) from the tip of the medial malleolus.</p><p><strong>Conclusion: </strong>Our data highlights the areas with the highest bone density in the distal tibia. When fixing medial malleolar fractures with unicortical partially threaded screws, this data suggests that screws with a length between 36 and 41 mm should be used at the anterior colliculus and intercollicular. However, regardless of our findings, fracture morphology must be considered, and the AO principles of fracture fixation should be adhered to.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative anxiety and depression are associated with poorer patient-reported outcomes following total ankle replacements.","authors":"Phui Yuen Wong, Jun Min Leow, Mathew Smith, Reka Kovacs, Nicholas D Clement, Hisham S Shalaby, John C McKinley","doi":"10.1016/j.fas.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.006","url":null,"abstract":"<p><strong>Introduction: </strong>It is unclear how pre-operative anxiety/depression affects patient reported outcome measures (PROMs) following total ankle replacements (TAR). We investigated the effects of anxiety/depression on PROMs using the Manchester-Oxford Foot Questionnaire (MOXFQ) following TAR.</p><p><strong>Methods: </strong>PROMs data for primary TAR patients between 2011 and 2022 were extracted from a single-centre regional registry. Anxiety/depression was self-reported using the EuroQol 5-deminion (EQ-5D-3L) questionnaire. MOXFQ was applied pre-operatively and ≥ 6-months post-operatively.</p><p><strong>Results: </strong>We included 98 TARs with mean follow-up of 2.1 ± 2.0 years. 35(35.7 %) patients reported anxiety/depression pre-operatively. Significant difference between pre-operative MOXFQ-index for the anxiety/depression group (83.8 ± 12.9) and the control group (71.8 ± 12.7, p < 0.001) persisted post-operatively (40.8 ± 30.1, 25.7 ± 24.6, p = 0.008). Both groups experienced significant improvement in MOXFQ-index post-operatively (p < 0.001). Overall improvement was similar between groups after adjustment for confounders (p = 0.42).</p><p><strong>Conclusion: </strong>PROMs are modulated by baseline mental health after TAR. However, both groups report similar post-operative improvement.</p><p><strong>Level of evidence: </strong>Level III Retrospective Cohort Study.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143042637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of peroneal tendon dislocation with talus fracture.","authors":"Elizabeth Cho, Aidimer Perez, Frances Akwuole, Michael S Pinzur, Adam P Schiff, Kamran S Hamid","doi":"10.1016/j.fas.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>Traumatic peroneal tendon dislocation (PTD) is known to occur with pilon and calcaneus fractures, however, literature describing PTD in concurrence with injury to the talus remains limited.</p><p><strong>Methods: </strong>This was a retrospective review of adult patients with operatively treated talus fractures treated at a level I academic trauma center between 2007 and 2021. Charts, radiographs, and advanced imaging, when available, were reviewed for patient demographics, injury characteristics, and complications.</p><p><strong>Results: </strong>126 patients with 128 talus fractures were included. Incidence of PTD after talus fracture was 21.1 % (n = 27). Among isolated talus fractures only (n = 60), incidence of PTD was 16.7 % (n = 10). Peroneal rupture was separately found in 3 instances (2.3 %). PTD was significantly associated with lateral process fractures, making up one-third of total cases of PTD (p = 0.02), with 39 % of lateral process fractures demonstrating PTD. PTD was also associated with presence of fleck sign on injury radiographs (p < 0.00001). Among 27 cases of PTD, 14 (51.9 %) were diagnosed based on advanced imaging only (13 via CT scan and 1 by MRI), 4 (14.8 %) by operative report only, and 9 (33.3 %) based on both imaging and the operative report. Diagnosis was made acutely for 25 (89.3 %) PTDs, whereas 2 (7.4 %) were diagnosed in a delayed fashion. Three PTDs underwent delayed surgical intervention due to delayed diagnosis (n = 1), or missed dislocation by the surgeon although evident on injury scans (n = 2). Fractures with PTD developed higher rates of avascular necrosis (30.4 % versus 12.7 % among fractures without PTD, p = 0.044).</p><p><strong>Conclusion: </strong>PTD with talus fracture is relatively common and was identified in one out of five fractures within the studied cohort. Surgeons and radiologists should be cognizant of this injury, especially in the setting of a lateral process fracture and a positive fleck sign.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of mental health disorders on outcomes following total ankle arthroplasty: A systematic review.","authors":"Nathaniel P Mercer, Bradley A Lezak, Davis Hedbany, James J Butler, Sebastian Krebsbach, David A Bloom, Michael Harrington, Andrew J Rosenbaum, Raymond J Walls, John G Kennedy","doi":"10.1016/j.fas.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.005","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this systematic review was to evaluate the impact of mental health disorders (MHDs) on the clinical and functional outcomes following total ankle arthroplasty (TAA) for the treatment of end-stage ankle arthritis.</p><p><strong>Methods: </strong>A systematic review of the EMBASE, MEDLINE, and Cochrane Library databases was conducted in April 2024 following PRISMA guidelines. Data collected included patient demographics, clinical outcomes, complications, and failures.</p><p><strong>Results: </strong>Six studies published between 2019 and 2023 were included, involving a total of 8772 patients who underwent TAA. Among these, 1076 patients (12.3 %) had a pre-operative MHD. The weighted mean age was 64.1 ± 4.9 years, and the mean postoperative follow-up was 4.6 ± 7.2 months. There were inferior subjective clinical outcomes in patients with an associated MHD, as demonstrated by lower scores in the Self-Administered Foot Evaluation Questionnaire (SAFE-Q), Visual Analogue Scale (VAS), and American Orthopaedic Foot and Ankle Society (AOFAS) scores compared to patients without a MHD. Additionally, patients with MHDs had high complication rates (23.7 %), including 76 prosthetic complications (6.1 %) and 15 cases (1.2 %) requiring revision procedures. However, no significant differences in objective outcomes such as joint mobility or implant failure rates were found between those with and without MHDs.</p><p><strong>Conclusion: </strong>MHDs adversely affect subjective outcomes and complications following TAA, highlighting the need for integrated mental health management in preoperative and postoperative care. Further research is needed to understand the precise role of mental health in TAA outcomes.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mid-term outcomes of talar neck trapezoidal osteotomy for correction of severe rigid neurologic equinovarus foot.","authors":"Jaime Garcia-Fernández, María Galán-Olleros, Manuel Fraga-Collarte, Ana Ramírez-Barragán, Carmen Martínez-González, Ignacio Martínez-Caballero","doi":"10.1016/j.fas.2025.01.001","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.001","url":null,"abstract":"<p><strong>Background: </strong>Severe rigid neurologic equinovarus foot (NEVF) deformity, though rare, significantly limits transfers and orthotic use in pediatric patients with neurological disorders. Standard treatments like arthrodesis or talectomy are highly invasive, especially in young patients. This study assesses the mid-term outcomes of a talar neck trapezoidal osteotomy (TNTO) to correct severe NEVF in non-ambulatory patients.</p><p><strong>Methods: </strong>A retrospective analysis included severe NEVF patients treated with TNTO and muscle rebalancing (2015-2019). Radiographic assessments evaluated alignment and avascular necrosis, while functional outcomes and caregiver satisfaction were recorded RESULTS: Nine patients (56 % male; median age 11, IQR: 9.2-11.2) with a median follow-up of 53.3 months (IQR: 42.4-80.1) showed significant improvements in alignment (p < 0.05) and function (p < 0.05). Caregiver satisfaction was high (100 %), with one patient experiencing asymptomatic partial avascular necrosis.</p><p><strong>Conclusions: </strong>TNTO is a safe, effective option for correcting severe NEVF, achieving positive outcomes in foot alignment, orthotic use, and caregiver satisfaction mid-term.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A finite element analysis to assess tibial bone fracture in malleolar regions following total ankle replacement: Influences of implant designs and implant-bone interfacial conditions.","authors":"Govind Upadhyay, Jyoti, Minku, Gaurav Kumar Sharma, Rajesh Ghosh","doi":"10.1016/j.fas.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.fas.2025.01.003","url":null,"abstract":"<p><strong>Background: </strong>Tibial bone fractures in the malleolar regions are a major concern during the early postoperative period of total ankle replacement (TAR), affecting patient outcomes such as stability and recovery. Design, placement, and anatomic misalignment of implant components can contribute to malleolar fractures. The aim of this study is to understand the influence of implant design features, including keel, peg, stem, and bar type design, and bone-implant interfacial conditions on malleolar fracture following TAR.</p><p><strong>Methods: </strong>Three-dimensional finite element (FE) models were generated for the intact and implanted tibia bone using computer tomography (CT) scan data. In the present study, both bonded (fully osseointegration) and debonded (non-osseointegration) implant-bone interface conditions were considered. The proximal part of the tibia was fixed. Finite element models of the intact and implanted tibia were solved for three distinct loading situations that correspond to three ankle positions throughout the gait cycle (GC). The influences of implant design and implant-bone interface conditions on malleolar fracture were examined by evaluating stress distribution in tibia bone post-implantation.</p><p><strong>Results: </strong>Finite element (FE) analysis revealed that for the medial region, the tibia bone stress elevated to 10 MPa for the medial keel type design, indicating a possible fracture along the medial region. The risk of a medial malleolar fracture is highest for the medial keel type implant design compared to other designs. The bars, central keel, and stem type TAR implant designs also elevate stress on both the medial and lateral regions of the tibia bone. In the case of fully osseointegrated implant-bone interface conditions, the stress is slightly higher than in the case of non-osseointegrated implant-bone interfacial conditions.</p><p><strong>Conclusion: </strong>The study highlights the potential influence of specific implant designs on malleolar fracture. The current findings are crucial for designing new implants to mitigate tibial bone fracture risks and improve TAR outcomes.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical study of the posterior talofibular ligament: A descriptive analysis of its dual-bundle structure.","authors":"Sérgio Soares, Yessica Alba, Riccardo Garibaldi, Angela Seidel, Xavier Martin Oliva","doi":"10.1016/j.fas.2024.12.009","DOIUrl":"https://doi.org/10.1016/j.fas.2024.12.009","url":null,"abstract":"<p><strong>Background: </strong>The lateral ankle ligament complex, consisting of the anterior talofibular ligament (ATFL), calcaneofibular ligament (CFL), and posterior talofibular ligament (PTFL), is essential for ankle stability. While the ATFL and CFL are frequently studied, the PTFL's role remains less explored.</p><p><strong>Methods: </strong>Twelve fresh-frozen ankle specimens were dissected to analyze the PTFL's origin, trajectory, and talar insertion, focusing on its bundles and anatomical relationships.</p><p><strong>Results: </strong>All specimens exhibited a consistent PTFL origin at the lateral malleolar fossa. Two distinct bundles were identified: the pars superficialis (PS) and pars profunda (PP). The PS attached to the posterolateral talus, while the PP attached separately to the posterior aspect of the lateral talar process.</p><p><strong>Conclusion: </strong>The PTFL comprises two distinct bundles with separate talar insertions. This finding challenges the traditional view of a single-bundled PTFL and may influence understanding of lateral ankle instability as well as its treatment.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound assessment of talar cartilage thickness measurements in asymptomatic subjects with pes planus and its relationship with anthropometric parameters","authors":"Orhan Güvener ,&nbsp;Serkan Taş ,&nbsp;Ümit Yüzbaşıoğlu ,&nbsp;Figen Dağ","doi":"10.1016/j.fas.2024.07.006","DOIUrl":"10.1016/j.fas.2024.07.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Individuals with pes planus may have alterations in talar cartilage thickness due to changes in lower extremity alignment. The aim of this study was to measure the talar cartilage thickness of subjects with pes planus and compare the results with those of healthy controls. Another aim of the present study was to evaluate its relationship with anthropometric foot parameters.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 48 individuals (16 males and 32 females) in the pes planus group and 48 individuals in the healthy control group (14 males and 34 females) based on the Navicular Drop (ND) test and the Foot Posture Index (FPI). Talar cartilage thickness (TCT) was measured with ultrasound. Anthropometric foot parameters of the individuals, such as foot length and foot width, were evaluated using a podoscope.</div></div><div><h3>Results</h3><div>TCT was higher in participants with pes planus compared to the control group (dominant side, p = 0.006; non-dominant side, p = 0.002). Foot width and length were similar in both groups for the dominant and non-dominant feet (p &gt; 0.05). TCT on the dominant foot was positively correlated with the FPI score (r = 0.205, p = 0.045), ND score (r = 0.297, p = 0.003), foot width (r = 0.244, p = 0.017) and foot length (r = 0.253, p = 0.013). On the other hand, TCT on the non-dominant side was positively correlated with the FPI score (r = 0.235, p = 0.021), ND score (r = 0.363, p &lt; 0.001), foot width (r = 0.270, p = 0.008) and length (r = 0.303, p = 0.003).</div></div><div><h3>Conclusion</h3><div>The talar cartilage of patients with pes planus seems to be thicker, and this is generally related to body weight, body mass index, foot anthropometrics, and posture characteristics.</div></div><div><h3>Level of evidence</h3><div>Level III, diagnostic comparative study.</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 1","pages":"Pages 85-89"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are large language models a useful resource to address common patient concerns on hallux valgus? A readability analysis","authors":"William J. Hlavinka ,&nbsp;Tarun R. Sontam ,&nbsp;Anuj Gupta ,&nbsp;Brett J. Croen ,&nbsp;Mohammed S. Abdullah ,&nbsp;Casey J. Humbyrd","doi":"10.1016/j.fas.2024.08.002","DOIUrl":"10.1016/j.fas.2024.08.002","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluates the accuracy and readability of Google, ChatGPT-3.5, and 4.0 (two versions of an artificial intelligence model) responses to common questions regarding bunion surgery.</div></div><div><h3>Methods</h3><div>A Google search of “bunionectomy” was performed, and the first ten questions under “People Also Ask” were recorded. ChatGPT-3.5 and 4.0 were asked these ten questions individually, and their answers were analyzed using the Flesch-Kincaid Reading Ease and Gunning-Fog Level algorithms.</div></div><div><h3>Results</h3><div>When compared to Google, ChatGPT-3.5 and 4.0 had a larger word count with 315 ± 39 words (p &lt; .0001) and 294 ± 39 words (p &lt; .0001), respectively. A significant difference was found between ChatGPT-3.5 and 4.0 compared to Google using Flesch-Kincaid Reading Ease (p &lt; .0001).</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate that ChatGPT provided significantly lengthier responses than Google and there was a significant difference in reading ease. Both platforms exceeded the seventh to eighth-grade reading level of the U.S. population.</div></div><div><h3>Level of evidence</h3><div>N/A</div></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 1","pages":"Pages 15-19"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re:Are large language models a useful resource to address common patient concerns on Hallux Valgus? A readability analysis","authors":"William J. Hlavinka,&nbsp;Tarun R. Sontam,&nbsp;Anuj Gupta,&nbsp;Brett J. Croen,&nbsp;Mohammed S. Abdullah,&nbsp;Casey J. Humbyrd","doi":"10.1016/j.fas.2024.09.004","DOIUrl":"10.1016/j.fas.2024.09.004","url":null,"abstract":"","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":"31 1","pages":"Pages 91-93"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142299129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}