Journal of Spinal Disorders & Techniques最新文献

{"title":"Body Mass Index as an Indicator of Pulmonary Dysfunction in Patients With Adolescent Idiopathic Scoliosis.","authors":"Leilei Xu,&nbsp;Xu Sun,&nbsp;Zezhang Zhu,&nbsp;Jun Qiao,&nbsp;Saihu Mao,&nbsp;Yong Qiu","doi":"10.1097/BSD.0b013e31825d97df","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31825d97df","url":null,"abstract":"<p><strong>Study design: </strong>Prospective clinical study.</p><p><strong>Objectives: </strong>To investigate the factors correlated with pulmonary function in adolescent idiopathic scoliosis (AIS) patients, and to determine the influence of body mass index (BMI) on the pulmonary function.</p><p><strong>Summary of background data: </strong>Impaired pulmonary function has been reported in patients with AIS. The factors reported to affect pulmonary function included the curve magnitude, location of the apex vertebrae, decrease in thoracic kyphosis, and the number of vertebrae involved. A low BMI has been well confirmed in AIS patients. However, the relationship between BMI and pulmonary function has never been investigated.</p><p><strong>Methods: </strong>One hundred twenty female patients with a single thoracic curve were enrolled in this study. Pulmonary function test and radiographic examination were performed. Several radiographic parameters, including the curve magnitude, the curve type, location of the apical vertebra, the number of vertebrae involved, and the degree of thoracic kyphosis, were recorded. BMI was calculated according to the measurements of standing height and body weight. Patients were divided into 2 groups according to BMI, (group A >17.5 kg/cm and group B ≤17.5 kg/cm), and the pulmonary function was compared between the 2 groups with students t test. Partial correlation analysis and stepwise multiple regression analysis were used to assess the association between BMI and the results of the pulmonary function test. The receiver operating characteristics curve was created to identify the best dividing point for diagnostic variables.</p><p><strong>Results: </strong>The average percentage of predicted vital capacity, forced vital capacity, and forced expiratory volume in 1 second was significantly decreased in patients with a lower BMI. A positive correlation was found between BMI and pulmonary function (r=0.41, P<0.001). The stepwise regression analysis showed that low BMI was significantly associated with pulmonary function impairment (R=0.206, P<0.001). According to the receiver operating characteristics curve, patients with a BMI <17.7 kg/cm are prone to have abnormal pulmonary function.</p><p><strong>Conclusions: </strong>BMI was found to be an important indicator for pulmonary function in AIS patients. The decreased BMI could explain approximately one-fifth of the variation in pulmonary impairment in AIS patients, which might shed some light on the rehabilitation of preoperative pulmonary function.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"226-31"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31825d97df","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30635124","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 Large Database Studies.","authors":"Mitchell G Maltenfort","doi":"10.1097/BSD.0000000000000296","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000296","url":null,"abstract":"<p><p>There are several problems unique to large data sets. Large amounts of biased data are still biased and clinical significance is not always the same as statistical significance. Large number of predictors of outcome can confound conclusions, but there are several ways to manage wide ranging data sets including matching, regression, propensity scores, and randomization. </p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"221"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33413134","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":"Do You Need to Use a Collar After a 2-level Instrumented ACDF?","authors":"Evan O Baird,&nbsp;John M Rhee,&nbsp;Shah-Nawaz M Dodwad,&nbsp;Alpesh A Patel","doi":"10.1097/BSD.0000000000000300","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000300","url":null,"abstract":"A lthough radiographic outcomes do not necessarily correlate with clinical outcomes, achieving a successful arthrodesis remains an intended and desirable goal of anterior cervical discectomy and fusion (ACDF) surgery. One of the main determinants of successful arthrodesis is stable fixation, which immobilizes the segments to be fused. Currently, plating is the most widespread and effective means of accomplishing this goal. External bracing with a collar is another method that was historically more popular as a “stand alone” means of immobilization, but now is typically used adjunctively with plating. The use of cervical collars after ACDF remains a matter lacking consensus among surgeons, as demonstrated by a survey study1 showing that 55% of spine surgeons surveyed reported use of some form of postoperative immobilization after 1-level ACDF, albeit usually a soft collar. This is in contrast to 2level surgery, after which 70% of surgeons reported use of a collar, with the majority selecting a rigid orthosis. Admittedly, in 1-level ACDF surgery, the literature has yet to demonstrate that bracing improves results—although the data are by no means conclusive. A limitation of the Campbell study, for example, is that it centered on the fusion cohort of a cervical disk replacement safety and efficacy trial, and hence was not optimized to detect differences among braced and nonbraced ACDF patients. These patients were not randomized to a braced or nonbraced group, but were retrospectively examined to determine clinical and radiologic outcomes. Furthermore, because the fusion rates of single-level plated ACDF are already relatively high,3 with many studies near or at 100%, currently available studies regarding bracing are likely underpowered to demonstrate an incremental improvement with the addition of a brace. Two-level ACDF, however, represents a more challenging scenario associated with greater biomechanical demands than 1-level surgery. As such, bracing 2-level or more ACDFs may have a greater incremental benefit when used in conjunction with plating. One of the primary dictums in medicine is “primum non nocere”—first do no harm. If a treatment modality not only has minimal risk of causing harm but could also provide tangible benefit, then it should be strongly considered in patient care. We argue that adjunctive bracing of 2-level ACDF is such a modality for the following reasons. First, bracing has been shown to increase immobilization of the spine. In a study by Askins and Eismont,4 the NecLoc cervical orthosis was shown to allow only 17% and 23% of normal range of motion in flexion and extension planes, respectively, whereas also allowing only 27% of normal rotation. Admittedly, bracing does not totally immobilize the spine. However, it clearly decreases motion versus no brace, and it also serves as a reminder to the patient to avoid excessive cervical motion during the initial healing phase of surgery. Prasarn et al5 demonstrated that 2-level A","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"199-201"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000300","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33289912","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":"Acute Spinal Cord Injury.","authors":"Christopher D Witiw,&nbsp;Michael G Fehlings","doi":"10.1097/BSD.0000000000000287","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000287","url":null,"abstract":"<p><p>Our understanding of the pathophysiological processes that comprise the early secondary phases of spinal cord injury such as spinal cord ischemia, cellular excitotoxicity, ionic dysregulation, and free-radical mediated peroxidation is far greater now than ever before, thanks to substantial laboratory research efforts. These discoveries are now being translated into the clinical realm and have led to targeted upfront medical management with a focus on tissue oxygenation and perfusion and include avoidance of hypotension, induction of hypertension, early transfer to specialized centers, and close monitoring in a critical care setting. There is also active exploration of neuroprotective and neuroregenerative agents; a number of which are currently in late stage clinical trials including minocycline, riluzole, AC-105, SUN13837, and Cethrin. Furthermore, new data have emerged demonstrating that the timing of spinal cord decompression after injury impacts recovery and that early decompression leads to significant improvements in neurological recovery. With this review we aim to provide a concise, clinically relevant and up-to-date summary of the topic of acute spinal cord injury, highlighting recent advancements and areas where further study is needed.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"202-10"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33289913","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":"Differentiation, Outcomes, Transparency, and Value-based Insurance Design.","authors":"Stuart H Fine","doi":"10.1097/BSD.0000000000000288","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000288","url":null,"abstract":"<p><p>Practitioners in the surgical and procedural specialties must prepare to differentiate themselves and the performance of their care delivery teams through the use of substantive, objective metrics along with the provision of service guarantees. As purchasers of surgical and procedural services move toward outcomes-focused value-based insurance design (VBID) and purchasing, practitioners must move well beyond branding and process measure-focused \"Value Based Purchasing\" initiatives and be prepared to compete with transparency- not just regionally, but nationally-based upon objectively established outcomes metrics.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"218-20"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33393971","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":"Relationship Between Signal Changes on T2-weighted Magnetic Resonance Images and Cervical Dynamics in Cervical Spondylotic Myelopathy.","authors":"Lipeng Yu,&nbsp;Zitao Zhang,&nbsp;Qingfeng Ding,&nbsp;Yiming Li,&nbsp;Yuwen Liu,&nbsp;Guoyong Yin","doi":"10.1097/BSD.0b013e31829993a8","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31829993a8","url":null,"abstract":"<p><strong>Study design: </strong>Technical note.</p><p><strong>Objective: </strong>To determine the correlation between the high-intensity lesions observed on T2-weighted magnetic resonance images (T2W MRI) and the cervical dynamic characteristics of patients with cervical spondylotic myelopathy (CSM).</p><p><strong>Summary of background data: </strong>Intramedullary high signal intensity is frequently observed on T2W MRI of CSM patients and represents pathologic changes in the spinal cord. However, few studies have attempted to identify the effects on cervical dynamics associated with such changes in MRI signals.</p><p><strong>Methods: </strong>This study included 71 CSM patients who were admitted to our hospital between May, 2009 and May, 2012 (44 men, 27 women; average age, 52.5±11.7 y). They were divided into 3 groups depending on T2W MRI data: group 1, no hyperintensity; group 2, slight hyperintensity; and group 3, bright hyperintensity. The Cobb angle on cervical flexion-extension radiographs was measured as a parameter of cervical spine dynamics.</p><p><strong>Results: </strong>Total hyperflexion, hyperextension curvature, range of movement (ROM), and segmental hyperflexion curvature did not differ among the groups (P>0.05). Segmental hyperextension curvature and ROM were greater in groups 2 and 3 than in group 1 (P<0.05) but did not differ significantly between groups 2 and 3 (P>0.05).</p><p><strong>Conclusions: </strong>Increased segmental hyperextension curvature (≥10 degrees) and ROM are risk factors for high-intensity lesions on T2W MRI in CSM patients.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"E365-7"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31829993a8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31542874","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":"Advantage of Pedicle Screw Placement Into the Sacral Promontory (Tricortical Purchase) on Lumbosacral Fixation.","authors":"Minori Kato,&nbsp;Hiroshi Taneichi,&nbsp;Kota Suda","doi":"10.1097/BSD.0b013e31828ffc70","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31828ffc70","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective clinical study.</p><p><strong>Objective: </strong>To evaluate the clinical outcome of the tricortical method for lumbosacral fixation.</p><p><strong>Summary of background data: </strong>Despite advances in surgical techniques, failure to achieve solid arthrodesis of the lumbosacral junction continues to be significant clinical problems. To overcome these problems, tricortical purchase fixation has recently been advocated and studied. In this method, a trajectory directly into the medial sacral promontory is used to gain purchase in the dorsal, anterior, and superior cortices. This fixation method has been shown to double the insertional torque of the classic bicortical technique.</p><p><strong>Methods: </strong>Patients who had undergone lumbosacral fixation were included in this study. The average area of fusion was 1.7 segments. The patients were divided into a tricortical fixation group (TF, n=98) and a nontricortical fixation group (non-TF, n=33). We examined clinical outcome [Japanese Orthopaedic Association scoring system (JOA score)], fusion status, and the characteristics and safety of pedicle screwing in both groups. To identify risk factors for postoperative loss of lordosis (postoperative loss of >5 degrees in L5/S1 disk angle), risk factor analysis was performed by multivariate logistic regression.</p><p><strong>Results: </strong>In TF and non-TF, the JOA score changed from 13.4 and 13.8 points at surgery to 24.9 and 23.8 points, respectively, at final follow-up, and the recovery rate was 73.7% and 64.2%, respectively. Pseudoarthrosis of the fused L5/S1 occurred in 3 patients in whom the lumbosacral spine had not been fixed by tricortical purchase. The screw angle was 22.0 and 16.1 degrees in TF and non-TF, respectively, that is, a significant difference was shown. Significantly fewer TF cases encountered the risk of injured vascular tissue compared with non-TF. Non-TF (OR, 3.37) and correction of the L5/S1 disk angle (OR, 1.11) were significant risk factors for postoperative loss of lordosis.</p><p><strong>Conclusions: </strong>In patients who underwent short-segment lumbosacral fusion, TF enhanced postoperative stability at the lumbosacral junction. Pseudoarthrosis did not occur in patients who underwent TF, and the risk of vascular injury was less. TF is regarded as a successful technique in short-segment lumbosacral fixation.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"E336-42"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31828ffc70","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31337729","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":"Removing Outer Gloves as a Method to Reduce Spinal Surgery Infection.","authors":"Amina Rehman,&nbsp;Atiq-Ur Rehman,&nbsp;Tausif-Ur Rehman,&nbsp;Casey Freeman","doi":"10.1097/BSD.0b013e31829046ca","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31829046ca","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective cohort study was performed to analyze the effect of a specifically timed glove change on infection rates in lumbar spinal fusion.</p><p><strong>Objectives: </strong>Postoperative infection is a frequent and taxing complication following posterior lumbar spine fusion with instrumentation. This procedure is associated with infection rates up to 9%. The most common organism responsible for infection is Staphylococcus aureus which, along with many of the other common causative organisms, is often part human skin flora. This implicates the surgeon's gloves as the mode of transfer for these organisms from the patient's skin to the wound. The authors conducted a retrospective study to determine if a simple glove change before handling instrumentation could significantly reduce the rate of postoperative infection for this procedure.</p><p><strong>Materials and methods: </strong>A total of 389 patients requiring lumbar spine fusion were enrolled retrospectively and divided into 2 groups: a control group of 179 patients treated with standard protocol for the procedure (group A) and a treatment group of 210 patients in whom, after initially double gloving, the outer pair of gloves was removed before handling the instrumentation. Infection rates were compared up to 1 year postoperatively.</p><p><strong>Results: </strong>There was a statistically significant reduction of infection rate from 3.35% in group A (control) to 0.48% in group B (P=0.0369).</p><p><strong>Conclusion: </strong>This study shows that the removal of an outer pair of gloves before handling instrumentation may be a simple, cost-effective, and practical way to reduce the burden of postoperative infection following lumbar spinal fusion.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 6","pages":"E343-6"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31829046ca","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31337731","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 business of medicine: an introduction.","authors":"William E Aaronson","doi":"10.1097/BSD.0000000000000290","DOIUrl":"https://doi.org/10.1097/BSD.0000000000000290","url":null,"abstract":"The Journal of Spinal Disorders & Techniques has embarked on a bold journey to provide its readership with articles that are compelling and provide clear evidence for more effective medical practice. To practice medicine more effectively, physicians must also pay more attention to the businesses in which they operate. Health care organizations are businesses and just as physicians must increasingly engage in evidence-based practice, health care businesses must increasingly engage in evidence-based business practice. JSDT has introduced a new section to the journal entitled “The Business of Medicine.” This section will provide articles focused on business challenges facing physician practice organizations. We invite articles for consideration that elucidate the business challenges that health care organizations face and provide evidence to support health care innovation and strategy. Such terms as strategic alliances, health care innovation, strategy, value chain management, and consumer behavior must become part of the physician’s lexicon. Trends in the financing and delivery of health care have signaled the need for all participants to become more strategic in their outlook. The business of health care is the practitioner’s business. This section will help you as medical practitioners to understand better and fully engage in the business of health care. There is a growing body of research and anecdotal evidence that the business of health care shares many of the challenges that other economic sectors face. The next sections present examples of the economic and business challenges facing health care providers.","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"190-2"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0000000000000290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33216310","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":"Risk factors of recurrent lumbar disk herniation: a single center study and review of the literature.","authors":"Shinji Miwa,&nbsp;Akio Yokogawa,&nbsp;Tadayoshi Kobayashi,&nbsp;Tatsuya Nishimura,&nbsp;Kentaro Igarashi,&nbsp;Hiroyuki Inatani,&nbsp;Hiroyuki Tsuchiya","doi":"10.1097/BSD.0b013e31828215b3","DOIUrl":"https://doi.org/10.1097/BSD.0b013e31828215b3","url":null,"abstract":"<p><strong>Background: </strong>The recurrence of lumbar disk herniation (LDH) is a major problem in the treatment of LDH. The purpose of this study was to investigate the risk factors for recurrent LDH.</p><p><strong>Methods: </strong>Between April 2005 and March 2008, 298 patients with LDH, who underwent surgical treatment, were enrolled in this study. The patients were divided into a nonrecurrent group (N group) and a recurrent group (R group). We compared their clinical parameters including age, sex, body mass index, smoking, alcohol, sports activity, occupational lifting, and occupational driving. The relationships between the variables and recurrent LDH were evaluated by univariate analysis and multiple logistic regression analysis.</p><p><strong>Results: </strong>The N group had 266 patients (89.3%) and the R group had 32 patients (10.7%). Univariate analysis showed that current smoking (P<0.001) and occupational lifting (P=0.02) significantly correlated with recurrent LDH. Multivariate analysis showed that current smoking significantly related with recurrent LDH (OR, 3.47; 95% CI, 1.55-7.80; P=0.003).</p><p><strong>Conclusions: </strong>Our study suggests that smoking cessation and restraining from lifting may significantly decrease the incidence of recurrent LDH.</p>","PeriodicalId":50043,"journal":{"name":"Journal of Spinal Disorders & Techniques","volume":"28 5","pages":"E265-9"},"PeriodicalIF":0.0,"publicationDate":"2015-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/BSD.0b013e31828215b3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31130797","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}