Journal of Spinal Disorders & Techniques最新文献

{"title":"Minimally Invasive Posterior Cervical Foraminotomy.","authors":"Junyoung Ahn,&nbsp;Ehsan Tabaraee,&nbsp;Daniel D Bohl,&nbsp;Kern Singh","doi":"10.1097/BSD.0000000000000318","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000318","url":null,"abstract":"<p><p>The minimally invasive posterior cervical foraminotomy procedure has become a common and successful procedure for the treatment of cervical radiculopathy. Specifically, the minimally invasive approach allows for decreased postoperative pain, blood loss, and length of hospitalization by preserving the surrounding soft tissue as compared with the traditional open approach. This article and accompanying video demonstrates the technique for a primary, single-level minimally invasive posterior cervical foraminotomy as performed through a tubular retractor. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"295-7"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000318","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34134270","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":"Usefulness of Noninvasive Positive-pressure Ventilation During Surgery of Flaccid Neuromuscular Scoliosis.","authors":"Hyon Su Chong,&nbsp;Mary Ruth Alfonso Padua,&nbsp;Jun Sik Kim,&nbsp;Hwan Mo Lee,&nbsp;Sung Hwan Moon,&nbsp;Kyung Soo Suk,&nbsp;Hak Sun Kim","doi":"10.1097/BSD.0000000000000234","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000234","url":null,"abstract":"<p><strong>Study design: </strong>This is a retrospective study.</p><p><strong>Objective: </strong>To assess the effects of noninvasive positive-pressure ventilation (NIPPV) through evaluations of outcomes and incidences of postoperative pulmonary complications among patients with flaccid neuromuscular scoliosis for pulmonary support in the perioperative periods.</p><p><strong>Background data: </strong>There is no report on the effects of NIPPV on neuromuscular scoliosis patient during the perioperative periods.</p><p><strong>Methods: </strong>We retrospectively reviewed 73 patients diagnosed with neuromuscular scoliosis who underwent staged anterior and posterior spinal surgery and instrumentations for deformity correction from 2003 to 2010. A total of 73 patients were divided depending on whether they had received NIPPV treatment or not during the perioperative period. Twenty-eight patients who received NIPPV for respiratory support and 45 patients with no mechanical ventilation were compared according to age, sex, body mass index, number of fusion levels, and end-tidal pressure of CO(2) and forced vital capacity values. The incidence of pulmonary complications associated with either group (pneumonia, atelectasis, pneumothorax, prolonged ventilator support, and postoperative tracheostomy) was then evaluated.</p><p><strong>Results: </strong>In between the 2 groups, the forced vital capacity (41% vs. 64%, P<0.0001) were observed to be significantly decreased with the use of NIPPV. End-tidal pressure of CO(2) was not statistically different between the 2 groups. Although statistically not significant, patients in the non-NIPPV group had a higher incidence of pulmonary complications (38% vs. 21%, P=0.1584). None of the aforementioned patients required tracheostomy. In addition, no other mortality or neurological complications were noted postoperatively.</p><p><strong>Conclusions: </strong>There is a definite advantage of using NIPPV, because the incidence of postoperative pulmonary complications and the need for tracheostomy in patients with severely decreased pulmonary function are not increased from the use of NIPPV.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"298-300"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000234","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33015211","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 Anterior Decompression and Fusion With Posterior Laminoplasty for Multilevel Cervical Compressive Myelopathy: A Systematic Review and Meta-Analysis.","authors":"Lianghai Jiang, Mingsheng Tan, Liang Dong, Feng Yang, Ping Yi, Xiangsheng Tang, Qingying Hao","doi":"10.1097/BSD.0000000000000317","DOIUrl":"10.1097/BSD.0000000000000317","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review and meta-analysis.</p><p><strong>Objective: </strong>To evaluate anterior decompression and fusion compared with posterior laminoplasty when treating multilevel cervical compressive myelopathy.</p><p><strong>Summary of background data: </strong>Satisfactory results have been reported with both anterior decompression and fusion and posterior laminoplasty in the treatment of multilevel cervical compressive myelopathy. However, which method is safer and more effective remains controversial.</p><p><strong>Methods: </strong>MEDLINE, EMASE, and the Cochrane library databases were searched for relevant controlled studies up to December 2014 that compared anterior decompression and fusion with posterior laminoplasty for the treatment of multilevel cervical compressive myelopathy. The following outcome measures were extracted for analysis: preoperative and postoperative Japanese Orthopedic Association scores, neurological recovery rate, preoperative and postoperative overall Cobb angle, blood loss, operative time, surgical complications, and reoperation rate.</p><p><strong>Results: </strong>A total of 19 studies representing 1279 patients were included in this analysis. The results indicated that anterior decompression and fusion was associated with better postoperative neurological function (P=0.001), a higher recovery rate (P<0.01), and better cervical alignment (P<0.01) than posterior laminoplasty in the treatment of multilevel cervical compressive myelopathy. However, anterior decompression and fusion was also associated with higher postoperative complication (P<0.01) and reoperation (P<0.01) rates. Intraoperative blood loss (P<0.01) was higher and operative times (P<0.01) were longer in the anterior decompression and fusion group compared with the posterior laminoplasty group.</p><p><strong>Conclusion: </strong>On the basis of this meta-analysis, anterior decompression and fusion is associated with better recovery of neurological function, better postoperative cervical alignment, higher postoperative complication and reoperation rates, more blood loss, and longer operative times compared with posterior laminoplasty.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"282-90"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33965695","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":"Clinical Outcome and Changes of Foraminal Dimension in Patients With Foraminal Stenosis After ACDF.","authors":"Kyung-Soo Suk,&nbsp;Sang-Hun Lee,&nbsp;Si-Young Park,&nbsp;Hak-Sun Kim,&nbsp;Seong-Hwan Moon,&nbsp;Hwan-Mo Lee","doi":"10.1097/BSD.0000000000000256","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000256","url":null,"abstract":"<p><strong>Study design: </strong>Prospective study.</p><p><strong>Objective: </strong>To determine the clinical outcome and change in foraminal dimension after anterior cervical discectomy and fusion (ACDF) and to investigate the correlation between clinical outcome and foraminal dimension.</p><p><strong>Summary of background data: </strong>No previous studies have evaluated the correlation between clinical outcome and foraminal dimension after ACDF in foraminal stenosis.</p><p><strong>Methods: </strong>A consecutive series of 44 patients (114 foramina) undergoing planned ACDF due to foraminal stenosis were studied. Clinical outcomes included the neck pain visual analogue scale (VAS), arm pain VAS, neck disability index (NDI), subjective improvement rate, dysphasia, and donor site pain. Radiologic outcomes included anterior and posterior disk height, height of foramen and anterior-posterior diameter of the foramen, and the Cobb angle of the fusion segment. Foraminal dimension was calculated.</p><p><strong>Results: </strong>The neck pain VAS decreased from 3.7 preoperatively to 2.3 postoperatively. Likewise, arm pain VAS decreased from 7.2 to 2.2, and NDI decreased from 31.0% to 17.2%. Mild dysphasia occurred in 3 patients. There was no donor site pain. Subjective improvement rate was 79.3%. The anterior disk height increased from 4.75 mm preoperatively to 7.01 mm postoperatively. Likewise, posterior disk height increased from 4.11 to 5.74 mm, height of foramen increased from 7.30 to 9.25 mm, anterior-posterior diameter of foramen increased from 3.56 to 4.92 mm, dimension of foramen increased from 20.50 to 35.58 mm, and segmental angle of fusion segment increased from 2.87 to 4.95 degrees. Posterior disk height was positively correlated with foraminal dimension. An increased segmental angle was negatively correlated with foraminal dimension. The foraminal dimension was negatively correlated with the arm pain VAS.</p><p><strong>Conclusions: </strong>ACDF in cervical foraminal stenosis was a useful surgical option to improve clinical outcomes and widen the foraminal dimension. The foraminal dimension was negatively correlated with the arm pain. Restoration of posterior disk height was necessary to widen the foraminal dimension, whereas increased lordosis of the fusion segment did not help to widen the foraminal dimension.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"E449-53"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000256","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34091340","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":"Understanding a Value Chain in Health Care.","authors":"Alok D Sharan,&nbsp;Gregory D Schroeder,&nbsp;Michael E West,&nbsp;Alexander R Vaccaro","doi":"10.1097/BSD.0000000000000319","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000319","url":null,"abstract":"<p><p>As the US health care system transitions toward a value-based system, providers and health care organizations will have to closely scrutinize their current processes of care. To do this, a value chain analysis can be performed to ensure that only the most efficient steps are followed in patient care. Ultimately this will produce a higher quality or equal quality product for less cost by eliminating wasteful steps along the way. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"291-3"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000319","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34059944","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":"The Cost Effectiveness of Polyetheretheketone (PEEK) Cages for Anterior Cervical Discectomy and Fusion.","authors":"Sohrab S Virk,&nbsp;J Bradley Elder,&nbsp;Harvinder S Sandhu,&nbsp;Safdar N Khan","doi":"10.1097/BSD.0b013e3182aa3676","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182aa3676","url":null,"abstract":"<p><strong>Study design: </strong>Cost-effectiveness analysis using a Markov model with inputs from published literature.</p><p><strong>Objective: </strong>To learn which graft or hardware option used in a single-level anterior cervical discectomy and fusion (ACDF) is most beneficial in terms of cost, quality of life, and overall cost effectiveness. Options studied were autograft, allograft, and polyetheretherketone (PEEK) cages for cervical fusion.</p><p><strong>Summary of background data: </strong>ACDF is commonly used to treat cervical myelopathy and/or radiculopathy. No study has compared the cost effectiveness of autograft, allograft, and PEEK in 1-level ACDF.</p><p><strong>Materials and methods: </strong>A literature review provided inputs into a Markov decision model to determine the most effective graft or hardware option for 1-level ACDF. Data regarding rate of complications, quality-adjusted life years (QALYs) gained, and cost for each procedure type was collected. The Markov model was first run in a base case, using all currently available data. The model was then tested using 1-way and 2-way sensitivity analyses to determine the validity of the model's conclusions if specific aspects of model were changed. This model was run for 10 years postoperatively.</p><p><strong>Results: </strong>The cost per QALY for each option in the base case analysis was $3328/QALY for PEEK, $2492/QALY for autograft, and $2492/QALY for allograft. All graft/hardware options are cost effective ways to improve outcomes for patients living with chronic neck pain. For graft/hardware options the most cost-effective option was allograft. The incremental cost-effectiveness ratio for PEEK compared with autograft or allograft was >$100,000/QALY.</p><p><strong>Conclusions: </strong>Allograft is the most cost-effective graft/hardware option for ACDF. Compared with living with cervical myelopathy and/or radiculopathy, ACDF using any graft or hardware option is a cost-effective method of improving the quality of life of patients. PEEK is not a cost-effective option compared with allograft or autograft for use in ACDF.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"E482-92"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182aa3676","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32203687","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":"An Algorithmic Approach to Venous Thromboembolism Prophylaxis in Spine Surgery.","authors":"Scott M Eskildsen,&nbsp;Stephan Moll,&nbsp;Moe R Lim","doi":"10.1097/BSD.0000000000000321","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000321","url":null,"abstract":"<p><p>Venous thromboembolic embolism (VTE) is a potentially serious and life-threatening complication in spine surgery. However, VTE incidence and prophylaxis in spine surgery remains controversial. Current recommendations for VTE prophylaxis address \"spine surgery\" as a single broad category and mainly consider patient factors when determining risk. We performed a literature review to determine the varying VTE and bleeding risks within spine surgery to develop an individualized prophylactic algorithm. Our review suggests that the current guidelines on VTE prophylaxis for spine surgery from NASS and ACCP are suboptimal. Consideration of (1) patient-related VTE risks, (2) procedure-related VTE risks, and (3) the risk of neurological compromise from bleeding complications will more appropriately balance safety and effectiveness when choosing a VTE prophylaxis method. To better individualize VTE prophylaxis, we have developed the VTE Prophylaxis Risk/Benefit Score that considers this currently available best evidence to arrive at a recommendation for the most appropriate form of VTE prophylaxis. This algorithm informs the surgeon to help make a more nuanced and individualized determination of prophylaxis. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"275-81"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000321","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33965697","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":"Understanding Bayesian Statistics.","authors":"Mitchell G Maltenfort","doi":"10.1097/BSD.0000000000000320","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000320","url":null,"abstract":"<p><p>Modern computing power has given us the ability to approach statistical questions in a manner which was previously impossible because of the time-consuming nature of the calculations required. Computer power has enabled the use of Bayesian inference techniques, based on 18th century theory, to frame statistical questions in probability. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"294"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000320","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33946287","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":"Clinical Outcomes and Complications After Pedicle-anchored Dynamic or Hybrid Lumbar Spine Stabilization: A Systematic Literature Review.","authors":"Marion Prud'homme, Carlos Barrios, Philippe Rouch, Yann Philippe Charles, Jean-Paul Steib, Wafa Skalli","doi":"10.1097/BSD.0000000000000092","DOIUrl":"10.1097/BSD.0000000000000092","url":null,"abstract":"<p><strong>Study design: </strong>A systematic medline review.</p><p><strong>Objective: </strong>An overview of pedicle-based dynamic stabilization devices clinical outcomes.</p><p><strong>Summary of background data: </strong>Fusion is the standard instrumentation for many pathologies of the lumbar spine. Worrying rates of failure, including adjacent segment degeneration (ASD), have consistently been reported. The interest for dynamic stabilization came from the need of minimizing the long-term complications related to the restriction of the lumbar motion. However, pedicle-based dynamic stabilization advantages and drawbacks remain controversial.</p><p><strong>Materials and methods: </strong>Articles about the clinical outcomes were identified by a comprehensive Medline search. The inclusion criteria were a minimum follow-up of 12 months, indications for lumbar dynamic stabilization, and assessment of clinical outcomes and adverse events. The studied parameters included self-reported outcomes (pain, disability, and satisfaction) and complications.</p><p><strong>Results: </strong>A total of 46 articles fulfilling the inclusion criteria were reviewed providing results for 2026 patients with a mean follow-up of 33 months. The postoperative improvements in terms of pain and disability were significant. Subjective assessment showed an overall patient satisfaction of 83.4%. Radiographic ASD occurred in 0%-34% of patients. Device breakage occurred in 0%-30%, and device loosening in 0%-72% of patients. The global amount of revision surgeries reached 9.4% mainly for breakage, ASD, or persistent pain, not always associated with screw loosening.</p><p><strong>Conclusions: </strong>Dynamic stabilization seems as safe and effective but benefits might partly come from decompressive gestures. Reported clinical outcomes seems to be comparable with outcomes published for fusion and no clear evidence of protection of the adjacent segments emerge from this mid-term review. Technical failures are design related but also linked with patient specificities. Relationships between sagittal balance and surgery outcomes are still rarely reported. Dynamic stabilization might display advantages in selected indications, such as moderate degeneration and beginning instability associated with clinical symptoms, but further clinical studies are needed.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"E439-48"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32562154","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":"Quantitative Analysis of Cervical Flexion-Extension Radiographs in Rheumatoid Arthritis Patients.","authors":"Lee M Reichel,&nbsp;John Hipp,&nbsp;Angie Fuentes,&nbsp;Charles A Reitman","doi":"10.1097/BSD.0b013e3182aa290f","DOIUrl":"https://doi.org/10.1097/BSD.0b013e3182aa290f","url":null,"abstract":"<p><strong>Study design: </strong>Diagnostic retrospective case series.</p><p><strong>Objective: </strong>To evaluate cervical intersegmental motion in rheumatoid arthritis patients using specialized tracking software (QMA) and compare the findings with a previously published cohort of \"normal\" subjects.</p><p><strong>Summary of background data: </strong>Rheumatoid arthritis follows 3 patterns of cervical involvement, atlantoaxial subluxation, atlantoaxial impaction, and subaxial subluxation. Deformities present are sometimes considered \"unstable\" to the point where surgery can be recommended based on the interpretation of cervical radiographs.</p><p><strong>Methods: </strong>Cervical flexion-extension radiographs of 99 subjects with rheumatoid arthritis were evaluated. Angular and translational segmental motions were determined at each level using specialized tracking software. Findings were compared with previously published normative data using the same device.</p><p><strong>Results: </strong>Relative to controls, patients with rheumatoid arthritis demonstrated significantly less overall sagittal motion. Segmental analysis at C1-C2 demonstrated a 10% prevalence of dynamic motion outside the 95% confidence interval for \"normal\" patients. In contrast, segmental analysis at C2-C7 demonstrated no intersegmental motion outside the 95% confidence interval for \"normal\" subjects.</p><p><strong>Conclusions: </strong>In patients with rheumatoid arthritis, abnormal motion at C1-C2 was consistent with truly dynamic deformity and should be closely evaluated. Conversely, subaxial subluxations, although frequently present, were relatively fixed deformities and in most cases, may not represent an unstable condition.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 8","pages":"E478-81"},"PeriodicalIF":0.0,"publicationDate":"2015-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e3182aa290f","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31706815","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}