Foot and Ankle Surgery最新文献

{"title":"The evolution of patient-reported outcome measures after a first lateral ankle sprain: A prospective study","authors":"","doi":"10.1016/j.fas.2024.04.012","DOIUrl":"10.1016/j.fas.2024.04.012","url":null,"abstract":"<div><h3>Purpose</h3><p>A lateral ankle sprain<span> is the most common musculoskeletal injury<span><span> in the physically active population. However, it is unclear how the clinical condition evolves during the period after the injury and what proportion of patients develops chronic symptoms. Therefore, the purpose of this study is to assess the evolution of patient-reported outcome measures after a first time lateral </span>ankle sprain.</span></span></p></div><div><h3>Methods</h3><p><span>A prospective clinical study assessed the patient-reported outcome measures (PROMs) of a consecutive group of 100 patients during 1 year after a first lateral ankle sprain. The Karlsson score and Foot and Ankle Outcome Score (FAOS) were assessed at 6 weeks, 3 months, 6 months, 9 months and 1 year. The Cumberland Ankle Instability Tool (CAIT)-score was assessed at 6 months, 9 months and 1 year. The difference between the time points of all scores was analysed using the positive change over time (binomial test versus 50%) and the difference in score (signed rank test). The time to sustained excellent level was also assessed overall and in several subgroups: age, gender, degree of injury (2 or 3), </span>avulsion fracture, use of crutches, use of cast. Differences between subgroups were assessed by a generalized log-rank test.</p></div><div><h3>Results</h3><p>All clinical scores demonstrated an improvement up to 12 months after the sprain. The median Karlsson score (interquartile range) improved from 62 (50−80) at 6 weeks to 90 (72−100) at 3 months, to 97 (82−100) at 6 months to 100 (90−100) at 9 months, to 100 (100−100) at 1 year. The analysis of positive change over time demonstrated a significant positive change (P-value &lt;.0005) between all time points except between 6 weeks and 12 weeks when using the FAOS quality score. The difference in score demonstrated a significant change (P-value &lt;.01) between all time points except between 36 weeks and 48 weeks when using the FAOS pain and FAOS sports score. Age and presence of an avulsion fracture were correlated with a slower recovery and worse results. At 1 year, in total 13 patients (13%) had a worse outcome corresponding to a Karlsson score &lt; 81 or CAIT score &lt; 24.</p></div><div><h3>Conclusion</h3><p>The clinical condition after a first ankle sprain demonstrated a significant improvement in PROMs between the different time points in the first year. Twelve months after a first lateral ankle sprain 13% had a fair or poor outcome. Higher age and presence of an avulsion fracture were correlated with a slower recovery and worse results. This information is useful in clinical practice to predict further progression and inform patients. Moreover, it is valuable to improve treatment strategies.</p></div><div><h3>Level of evidence</h3><p>Level II (prospective cohort study)</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877697","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":"Outcomes of the “Calcaneo-stop” procedure for treating symptomatic flexible flatfoot in children: A systematic review and meta-analysis of 2394 feet","authors":"","doi":"10.1016/j.fas.2024.04.011","DOIUrl":"10.1016/j.fas.2024.04.011","url":null,"abstract":"<div><h3>Background</h3><p>This study evaluates the efficacy of the calcaneo-stop (C-Stop) procedure's effectiveness in treating symptomatic flexible flatfoot (FFF) in children.</p></div><div><h3>Methods</h3><p>A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane databases to identify studies until 2023 on the outcomes of the C-Stop procedure in children with FFF. The risk of bias was assessed using MINORS criteria.</p></div><div><h3>Results</h3><p>Of 85 studies screened, 20 involving 2394 feet from 1415 patients (mean age 11.2 ± 1.3 years) were included. Post-procedure, significant improvements were noted in pain reduction (93.5%), heel alignment (95.21%), and radiological measures, including reductions in Kite (7.32º), Meary (11.65º), Costa-Bartani angles (17.11º), talar declination (12.63º) and increase in Calcaneal Pitch Angle (5.92º). AOFAS scores increased by 22.32 points on average, with 94.83% reporting high satisfaction. Complication rate was low (7.8%).</p></div><div><h3>Conclusions</h3><p>The C-Stop procedure is effective for treating FFF in children, offering significant clinical, radiological, and functional improvements with high patient satisfaction and a low complication rate.</p></div><div><h3>Level of evidence</h3><p>Level IV, Systematic review of Level-IV studies</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877696","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 increased pronation angle of the first metatarsus associated with correction loss after hallux valgus surgery: A semi-weight-bearing computed tomography study","authors":"","doi":"10.1016/j.fas.2024.04.010","DOIUrl":"10.1016/j.fas.2024.04.010","url":null,"abstract":"<div><h3>Background</h3><p>The effect of preoperative first metatarsal pronation<span> on postoperative prognosis of hallux valgus<span> (HV) surgery is under investigation. Utilizing semi-weight-bearing computed tomography, the preoperative pronation angle was assessed to quantify its impact on postoperative prognosis.</span></span></p></div><div><h3>Methods</h3><p>In a retrospective analysis of 31 feet, those with re-increased hallux valgus angle postoperatively were classified as the non-maintained group, and the remainder as the maintained group. Preoperative pronation angles were compared to establish a threshold. Subsequently, feet were re-classified into high or low-pronation categories. The relative risk of non-maintenance in high-pronation category was calculated.</p></div><div><h3>Results</h3><p>The non-maintained group exhibited a significantly higher preoperative pronation angle (p = 0.021), with a 28.4º threshold. The high-pronation category had a relative risk of 2.34 for non-maintenance.</p></div><div><h3>Conclusions</h3><p>Increased preoperative first metatarsal pronation angle is associated with correction loss after HV surgery. Utilizing sWBCT to measure the pronation angle provides valuable insights into postoperative prognosis.</p></div><div><h3>Level of evidence</h3><p>III</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140795132","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":"Autologous chondrocyte implantation for the treatment of osteochondral lesions of the talus: What happens after 20 years?","authors":"","doi":"10.1016/j.fas.2024.04.007","DOIUrl":"10.1016/j.fas.2024.04.007","url":null,"abstract":"<div><h3>Background</h3><p>The purpose of this study was to assess the long-term clinical efficacy of first-generation autologous chondrocyte implantation (ACI) technique for osteochondral lesions of the ankle joint.</p></div><div><h3>Methods</h3><p>Eleven patients with symptomatic OLTs underwent ACI from December 1997 to October 2002. A total of 9 patients (5 men, 4 women, age 25.2 ± 6.3) were evaluated at baseline and at 1, 3, 10 years, and at final follow-up of minimum 20 years with AOFAS<span><span> ankle-hindfoot score, NRS for pain, and with the </span>Tegner score.</span></p></div><div><h3>Results</h3><p>The AOFAS score improved significantly from the baseline value of 40.4 ± 19.8 to 82.7 ± 12.9 at the final follow-up (p &lt; 0.0005). The NRS for pain improved significantly from 7.8 ± 0.7 at baseline to 4.8 ± 2.1 at the final follow-up (p &lt; 0.0005). Moreover, the Tegner score underwent a modification from the pre-operative median value of 1 (range: 1–3) and from a pre-injury value of 5 (range: 3–7) to 3 (range: 2–4) at the final follow-up (p &lt; 0.0005).</p></div><div><h3>Conclusions</h3><p>ACI has proven to be an effective treatment option for patients suffering from OLTs, leading to a long-lasting clinical improvement even beyond 20 years of follow-up.</p></div><div><h3>Level of evidence</h3><p>Level IV</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140803447","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":"Safety and exposure area in three different posteromedial surgical approaches for the treatment of ankle fractures. A cadaveric study","authors":"","doi":"10.1016/j.fas.2024.04.009","DOIUrl":"10.1016/j.fas.2024.04.009","url":null,"abstract":"<div><h3>Introduction</h3><p>This study aimed to compare the degree of posterior malleolar exposure, the tension of the flap containing the posteromedial neurovascular bundle (NVB), and the distance between the surgical incision and the NVB using three different posteromedial ankle approaches.</p></div><div><h3>Methods</h3><p>Three approaches were compared: medial posteromedial (MePM) modified posteromedial (MoPM) and posteromedial (PM). We measured the minimal tension of the flap containing the NVB that allowed proper exposure. In the second stage, an axial cut was performed, and we measured the degree of posterior malleolar exposure and the distance between the incision and the NVB</p></div><div><h3>Results</h3><p>There were significant differences between the three approaches examined regarding the degree of posterior malleolar exposure and distance from the incision to the NBV,favoring the PM approach (71,00% ± 1.83 and 25.50 mm ± 4.20). The PM approach provided a significantly lower tension to the flap containing the posteromedial NVB (6.18 N ± 1.28) compared to the other two approaches</p></div><div><h3>Conclusion</h3><p>The PM approach achieved the highest degree of posterior malleolar exposure, the lowest tension to the posteromedial NVB, and the greatest distance between the incision and the NBV. Thus, we believe it should be considered the approach of choicefor large fractures of the posteromedial aspect of the PM.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140762304","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":"Diabetic management and infection risk in total ankle arthroplasty","authors":"","doi":"10.1016/j.fas.2024.04.008","DOIUrl":"10.1016/j.fas.2024.04.008","url":null,"abstract":"<div><h3>Background</h3><p>As total ankle arthroplasty<span> (TAA) increases in popularity nationwide for the management of end-stage arthritis, it is essential to understand ways to mitigate the risk of infection. Diabetes increases the risk of infection due to compromised immunity and impaired wound-healing mechanisms. However, there is limited research on how diabetic management, inclusive of medications and glucose control, may impact infection risks post-TAA. This study aims to demonstrate the impact of diabetic management on the occurrence of periprosthetic joint infection (PJI) following TAA.</span></p></div><div><h3>Methods</h3><p>This was a retrospective study of patients who underwent a TAA at a single academic institution from March 2002 to May 2022. Patients with diabetes who developed an intraarticular infection following TAA were propensity score matched (1:3) to diabetic patients who did not. Data collection included demographics, implant types, diabetic medications, and preoperative hemoglobin A1c<span>. PJI was diagnosed based on Musculoskeletal Infection Society (MSIS) criteria. Statistical analyses assessed differences in medication use, glucose control, and infection rates between groups.</span></p></div><div><h3>Results</h3><p>Of the 1863 patients who underwent TAA, 177 patients had a diagnosis of diabetes. The infection rate in patients with diabetes (2.8%) was higher than the total cohort rate (0.8%). Five patients with diabetes developed a PJI at an average of 2.2 months postoperatively. This cohort (n = 5) was compared to propensity score-matched controls (n = 15). There was no significant difference in diabetic medication use. Patients who developed PJI had higher rates of uncontrolled diabetes (60.0% vs. 6.7%) and average A1c levels (7.02% vs. 6.29%) compared to controls.</p></div><div><h3>Conclusion</h3><p>Our findings suggest that the elevated risk of PJI observed in individuals with diabetes subsequent to TAA may be attributed not solely to the presence of diabetes, but to inadequate glycemic control<span>. Effectively managing blood glucose levels is imperative for achieving favorable outcomes following TAA.</span></p></div><div><h3>Level of evidence</h3><p>III</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140629946","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":"EFAS Score – Validation of Danish Version by the Score Committee of the European Foot and Ankle Society (EFAS)","authors":"Martinus Richter ,&nbsp;Per-Henrik Agren ,&nbsp;Jean-Luc Besse ,&nbsp;Maria Coester ,&nbsp;Hakon Kofoed ,&nbsp;Nicola Maffulli ,&nbsp;Martijn Steultjens ,&nbsp;Mick Nielsen ,&nbsp;Jens Kurt Johansen","doi":"10.1016/j.fas.2024.03.009","DOIUrl":"10.1016/j.fas.2024.03.009","url":null,"abstract":"<div><h3>Background</h3><p>The Score Committee of the European Foot and Ankle Society (EFAS) developed, validated, and published the EFAS Score in 13 languages. Currently, the Danish version completed data acquisition and underwent further validation.</p></div><div><h3>Methods</h3><p>The data were collected pre-operatively and post-operatively at a minimum follow-up of 3 months and mean follow-up of 6 months. Item reduction, scale exploration, confirmatory analyses and responsiveness were executed using classical test theory and item response theory.</p></div><div><h3>Results</h3><p>The internal consistency was confirmed in the Danish version (Cronbach’s Alpha 0.88). The Standard Error of Measurement (SEM) was 0.31 and is similar to other language versions. Between baseline and follow-up, 77.2% of patients showed an improvement on their EFAS score, with adequate responsiveness (effect size 1.05).</p></div><div><h3>Conclusions</h3><p>The Danish EFAS Score version was successfully validated in patients with a wide variety of foot and ankle pathologies. All score versions are freely available at www.efas.net.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140269645","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":"WITHDRAWN: Pronation-Independent Decision-Making for Akin Osteotomy in the Hallux Valgus: Using Proximal–Distal Phalangeal Articular Angle","authors":"Yun Jae Kim, Ho-Seong Lee, Young-Rak Choi","doi":"10.1016/j.fas.2024.03.005","DOIUrl":"https://doi.org/10.1016/j.fas.2024.03.005","url":null,"abstract":"","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140205586","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":"Ankle strength assessed by one repetition maximum: A new approach to detect weaknesses in chronic ankle lateral instability","authors":"Aude Aguilaniu ,&nbsp;Cédric Schwartz ,&nbsp;Guillaume Abran ,&nbsp;Laura Baudoux ,&nbsp;Prof Jean-Louis Croisier","doi":"10.1016/j.fas.2024.02.005","DOIUrl":"10.1016/j.fas.2024.02.005","url":null,"abstract":"<div><h3>Background</h3><p>Ankle muscle strength should be assessed after a lateral ankle sprain (LAS) because a strength deficit can lead to chronic ankle instability (CAI). No field method is available to obtain quantitative ankle dynamic strength values. This study aimed to assess the reliability of the one-repetition maximal (1-RM) method and to compare ankle muscle strength between healthy volunteers and those with CAI using 1-RM strength assessment approach.</p></div><div><h3>Methods</h3><p>We recruited 31 healthy volunteers and 32 with CAI. Dorsiflexor, evertor, and invertor 1-RM were performed twice at a one-week interval. The intraclass correlation coefficient (ICC) and minimal detectable change (MDC) were calculated. Strength values were compared between healthy volunteers and CAI.</p></div><div><h3>Results</h3><p>The 1-RM method is reliable for assessing ankle dorsiflexor, evertor, and invertor strength, with an ICC ranging from 0.76 to 0.88, and MDC ranging from 19 to 31%. Volunteers with CAI obtained evertor (3.0 vs. 3.5 N/kg), invertor (2.9 vs. 3.7 N/kg), and dorsiflexor (5.9 vs. 6.5 N/kg) strength values that were lower than healthy volunteers (p &lt; 0.05).</p></div><div><h3>Conclusion</h3><p>The 1-RM test can be used in practice to assess evertor, invertor, and dorsiflexor strength during the rehabilitation of LAS. This field method could help practitioners to detect a strength deficit and individualize a strengthening programme if necessary.</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139922994","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":"Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis","authors":"Agustin Herber ,&nbsp;Oscar Covarrubias ,&nbsp;Mohammad Daher ,&nbsp;Wei Shao Tung ,&nbsp;Arianna L. Gianakos","doi":"10.1016/j.fas.2024.02.004","DOIUrl":"10.1016/j.fas.2024.02.004","url":null,"abstract":"<div><h3>Introduction</h3><p>Plantar fasciitis (PF) is the most common cause of heel pain in adults. There are numerous non-operative treatments available including platelet rich plasma (PRP) injections. PPR has demonstrated effectiveness for a range of musculoskeletal conditions including plantar fasciitis.</p></div><div><h3>Purpose/Objective</h3><p>To compare the effectiveness of PRP to other conservative treatment options for the management of PF.</p></div><div><h3>Methods</h3><p>A systematic search of PubMed and Google Scholar was performed for randomized control trials (RCT) comparing PRP to other treatment modalities. Studies met inclusion criteria if mean and standard deviations for visual analog scale (VAS) pain scores, plantar fascia thickness (PFT), Foot Function Index (FFI), or American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were reported. Mean differences (MD) were used to compare VAS pain, PFT, FFI, and AOFAS between PRP and other treatments.</p></div><div><h3>Results</h3><p>Twenty-one RCTs which altogether included 1356 patients were included in the meta-analysis. PRP demonstrated significantly greater improvements in VAS pain scores compared to extracorporeal shock wave therapy (ESWT) (SMD: 0.86; CI: [0.30, 1.41]; p = 0.002), corticosteroid injections (CSI) (SMD: 1.08; CI: [0.05, 2.11]; p = 0.04), and placebo (SMD: 3.42; CI: [2.53, 4.31]; p &lt; 0.00001). In terms of FFI, no significant differences existed among PRP, ESWT, CSI, dextrose prolotherapy (DPT), and meridian trigger points (MTP) in enhancing foot functionality. However, PRP demonstrated a marked advantage over phonophoresis, showing a substantial improvement in FFI scores (SMD: 3.07, 95% CI: 2.34–3.81). PRP did not demonstrate superiority over ESWT, CSI, or MTP for improving PFT, but it was notably more effective than phonophoresis (SMD: 3.18, 95% CI: 2.43–3.94). PRP demonstrated significantly greater improvements in AOFAS scores over CSI (SMD: 3.31, CI: [1.35, 5.27], p = 0.0009) and placebo (SMD: 3.75; CI: [2.81, 4.70]; p &lt; 0.00001).</p></div><div><h3>Conclusion</h3><p>PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement.</p></div><div><h3>Level of Evidence</h3><p>Level I Meta-Analysis</p></div>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139890278","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}