Journal of Foot & Ankle Surgery最新文献

{"title":"The Prevalence of Persistent Toe Walking in Children With and Without Autism Spectrum Disorder and the Odds of Subsequent Surgery","authors":"Michael Chapek BA ,&nbsp;Jeffrey Kessler MD","doi":"10.1053/j.jfas.2024.08.005","DOIUrl":"10.1053/j.jfas.2024.08.005","url":null,"abstract":"<div><div>Persistent toe walking is associated with autism spectrum disorder. The true prevalence of persistent toe walking and odds of progression to surgery in children with and without autism remains unclear. This retrospective descriptive study identified patients ages 3 to 17 years who were enrolled in our healthcare system over a 2-year period. Using international classification of disease codes, we identified all children with autism and persistent toe walking, and excluded children with conditions that may independently cause toe walking. Data on Achilles lengthening surgeries, sex, race and body mass index was gathered. The toe walking prevalence amongst children with and without autism was calculated. Multivariable logistic regression analysis controlling for sex, race and body mass index was used to determine independent risk factors for persistent toe walking and surgery. Of the children who met inclusion criteria (<em>N</em> = 284,925), 4622 (1.6%) had persistent toe walking. Prevalence of persistent toe walking was higher amongst children with autism (6.3% <em>vs</em> 1.5%, <em>p</em> &lt; .01), as were odds of persistent toe walking (OR 4.13, 95% CI 3.74 to 4.56, <em>p</em> &lt; .01). Males and White patients had higher odds of persistent toe walking compared to females and patients of any other race, respectively (<em>p</em> &lt; .01 for all). Although children with autism and toe walking had higher rates of surgery than their counterparts without autism (4.3% <em>vs</em> 2.6%, <em>p</em> = .04), this difference was not significant after controlling for sex, race and BMI (OR 1.59, 95% CI 0.95 to 2.69, <em>p</em> &gt; .05).</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Pages 16-20"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total ankle/total talus replacement – Retrospective comparison of surgeon decision relative to three-dimensional joint health assessment","authors":"Grayson M. Talaski ,&nbsp;Ben Wesorick BSE ,&nbsp;Albert T. Anastasio MD ,&nbsp;Kevin Dibbern PhD ,&nbsp;Cesar de Cesar Netto MD, PhD ,&nbsp;Samuel B. Adams MD ,&nbsp;Mark E. Easley MD ,&nbsp;Ken Gall PhD","doi":"10.1053/j.jfas.2024.08.017","DOIUrl":"10.1053/j.jfas.2024.08.017","url":null,"abstract":"<div><div>Treatment of end-stage ankle conditions is a complex challenge in foot and ankle surgery. The talus is prone to issues such as osteoarthritis (OA) and avascular necrosis (AVN). Patient-specific total ankle and total talus replacement (TATTR) procedures have emerged as potential solutions, but the decision to include subtalar arthrodesis in these surgeries is multifaceted. In this study, we aimed to understand the relationship between past surgeon decisions for fusion with TATTR and three-dimensional joint health assessments using preoperative CT data. Twenty-seven TATTR with subtalar fusion and 19 TATTR without subtalar fusion were analyzed. Each patient underwent a bilateral computed tomography scan, which was segmented prior to surgery. Distance mapping of various subtalar regions was performed, and average distance was reported. For better analysis, the sinus tarsi was divided into four sectors and the calcaneus posterior facet into nine sectors. Statistical analysis involved calculating the difference in means between the fused and unfused cases. The fusion group exhibited significant joint space narrowing in the posterolateral aspect of the sinus tarsi (p = 0.021). Conversely, on the posterior facet of the subtalar joint, the fusion group showed significant joint space widening in both the anteromedial (p = 0.025) and middle/medial (p = 0.032) sections. Surgeons’ decision to perform subtalar arthrodesis in TATTR procedures often aligns with clinical signs of sinus tarsi impingement, as evidenced by significant changes in joint space measurements. While joint health assessments play a pivotal role, other factors, such as surgeon preference and patient-specific considerations, also influence decision-making.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Pages 54-60"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Getting the “Little Things” Correct: Consensus on Toe Amputation Technique from a Survey of Vascular Surgeons","authors":"Megan Power Foley MB BCh BAO, MSc, MSc, MRCS,&nbsp;Stewart R. Walsh MB BCh, MCh, FRCS","doi":"10.1053/j.jfas.2024.06.008","DOIUrl":"10.1053/j.jfas.2024.06.008","url":null,"abstract":"","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Pages 110-111"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Radiological Outcomes of combined Arthroscopic Microfracture and Mesenchymal Stem Cell Injection Versus Isolated Microfracture for Osteochondral Lesions of the Talus: A Meta-Analysis of Comparative Studies","authors":"Michele Mercurio MD ,&nbsp;Roberto Minici MD ,&nbsp;Giovanna Spina MD ,&nbsp;Erminia Cofano MD ,&nbsp;Domenico Laganà MD ,&nbsp;Filippo Familiari MD ,&nbsp;Olimpio Galasso MD ,&nbsp;Giorgio Gasparini MD","doi":"10.1053/j.jfas.2024.08.011","DOIUrl":"10.1053/j.jfas.2024.08.011","url":null,"abstract":"<div><div>We aimed to systematically evaluate the clinical and radiological outcomes reported in comparative studies evaluating combined arthroscopic microfracture and mesenchymal stem cell (MSC) injection versus isolated microfracture for osteochondral lesions of the talus (OLT). A total of 5 studies were included. Demographics, American Orthopaedic Foot and Ankle Society (AOFAS) score, Tegner activity scale score, Foot and Ankle Outcome Scale (FAOS), visual analogue scale (VAS), and Magnetic Resonance Observation of Cartilage Repair Tissue Score (MOCART) were analyzed. A total of 348 patients were evaluated, 171 of whom underwent combined microfracture and MSC injection and 177 of whom underwent isolated microfracture. The frequency-weighted mean ages were 38.9 ± 13.5 and 36.9 ± 11.4 years and the mean follow-up were 36.7 ± 13.3 and 36.2 ± 16.2 months in the combined microfracture and MSC injection and isolated microfracture groups, respectively. The combined microfracture and MSC injection group showed significantly better postoperative AOFAS score (81.5 ± 7.4 vs 68.2 ± 5.1, <em>p</em> &lt; .001), and MOCART score (74.3 ± 16.3 vs 63.9 ± 15.5, <em>p</em> &lt; .001) with differences beyond the minimum clinically important difference. The combination of arthroscopic microfracture and MSC injection significantly improved functionality and radiological outcomes compared to those of isolated microfracture for OLT.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Pages 103-109"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation of The Effectiveness of Extracorporeal Shock Wave Therapy in Patients Diagnosed with Plantar Fasciitis: Comparison of Radial and Focus Applications","authors":"Özge Tezen MD ,&nbsp;Emine Esra Bilir MD ,&nbsp;Hilal Buse Arslan MD ,&nbsp;Emre Adıgüzel MD ,&nbsp;Evren Yaşar MD","doi":"10.1053/j.jfas.2024.08.012","DOIUrl":"10.1053/j.jfas.2024.08.012","url":null,"abstract":"<div><div>The aim of the study was to investigate the effectiveness of radial and focus (extracorporeal shock wave therapy) ESWT treatment on pain, function and size of the calcaneal spur in patients with clinical and radiological diagnosis of plantar fasciitis. A total of 112 patients aged between 18 and 95 years, were divided into 2 groups; group 1, rESWT (2.4 bar 12 hz 2000 beats), group 2 received fESWT (0.14 bar 14 hz 1000 beats) 3 times a week for 3 weeks. All patients were evaluated using the Visual Analog Scale (VAS)-pain and Foot Function Index before and after the treatment, at 4 week and 12 weeks. Calcaneal spur size was measured radiographically in the patients before and after the treatment at the 12th week follow-up. According to our records, VAS scores were found to be similar between the groups before treatment and at follow-ups (all <em>p</em> &gt; .05). In both groups, a significant decrease in VAS scores was found in the follow-ups compared to before treatment (<em>p</em> &lt; .001). FFI total, pain, activity and disability scores were found to be similar between the groups before treatment and at follow-up (all <em>p</em> &gt; .05). In both groups, a significant decrease in Foot Function Index scores was found in the follow-ups compared to before treatment (<em>p</em> &lt; .001). Both of rESWT and fESWT were effective in plantar fasciitis treatment there were no significant difference between 2 modalities in long term.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Pages 36-41"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142121021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Native anterior talo-fibular ligament tensile characteristics compared to allograft, suture tape, and copolymer augmentation elements: A biomechanical study","authors":"David Pedowitz MD ,&nbsp;Sarah J. Ingwer BS ,&nbsp;Ryan Rigby DPM, FACFAS ,&nbsp;Andrew Rosenbaum MD ,&nbsp;Oliver Hauck MS ,&nbsp;Anthony N. Khoury PhD","doi":"10.1053/j.jfas.2024.08.016","DOIUrl":"10.1053/j.jfas.2024.08.016","url":null,"abstract":"<div><div>Surgical augmentation methods have been introduced to the Modified Broström (MB) technique to support native anterior talo-fibular ligament (ATFL) healing and function. This study aimed to investigate the isolated biomechanical performance of common MB augmentation elements, including allograft, suture tape, and copolymer, compared to native ATFL.</div><div>Six cadaveric feet were dissected, isolating the ATFL from all surrounding soft tissue. The fibula and talus were clamped on the testing frame so that the ligament was in line with the load cell. Six samples per augment group were fixed on a test frame with a gauge length of 20 mm to replicate ATFL length. All samples were pulled to failure at 305 mm/min. Biomechanical outcomes included stiffness, elongation, and ultimate load.</div><div>Mean ± standard deviation was reported. Stiffness was highest for suture tape (246.4 ± 52.1N/mm), followed by allograft (114.2 ± 26.2 N/mm), native ATFL (78.6 ± 31.8 N/mm), and copolymer (9.4 ± 2.9 N/mm). Significant differences in stiffness were observed between all groups except when comparing ATFL stiffness to allograft (<em>P</em> = 0.086). Copolymer resulted in significantly larger elongation at ultimate load compared to native ATFL, suture tape, and allograft (<em>P</em> &lt; 0.001). Elongation at ultimate failure was highest for copolymer (30.0 ± 8.7 mm) and significantly greater than all other groups (<em>P</em> &lt; 0.001). Ultimate load was highest for suture tape (544.1 ± 59.7 N), followed by native ATFL (338.5 ± 63.7 N), allograft (308.3 ± 98.5 N) and copolymer (146.7 ± 8.9 N). Suture tape ultimate load was significantly greater than copolymer (<em>P</em> &lt; 0.001).</div><div>Isolated biomechanical data of augment materials can be utilized by foot and ankle surgeons when considering appropriate ligament augmentation options.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Pages 49-53"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Soft tissue tumors of the lower leg, foot and ankle: A cross-sectional observational study analysing 376 cases","authors":"Joanne M. Jenkins BSc (Hons), MBBS, MRCS ,&nbsp;Sanjay Gupta MBBS, MRCS (Glasg), MSc (Orth), MPhil, FRCS (Tr & Orth) ,&nbsp;Ashish Mahendra MSc, MBBS, FRCS (Tr & Orth) ,&nbsp;Christopher Del Balso BSc (Hons), MSc, MBChB, FRCSC ,&nbsp;Sam Park MSc, MBChB, FRCSC ,&nbsp;Timothy Daniels MD, FRCSC ,&nbsp;Mansur Halai BSc (Hons), MBChB, MRCA, MRCS, FRCS (Tr & Orth)","doi":"10.1053/j.jfas.2024.09.005","DOIUrl":"10.1053/j.jfas.2024.09.005","url":null,"abstract":"<div><div>Fewer than 5 % of soft tissue sarcomas arise in the foot and ankle. It can be difficult to distinguish between benign and malignant lesions which leads to a delay in diagnosis. Initial inappropriate procedures limit options for limb salvage and increasing rates of local recurrence. Our aim is to improve understanding of the presentation and management of these rare tumors to reduce delays in diagnosis and decrease the occurrence of inappropriate or unwarranted procedures. A prospectively maintained database of 376 new referrals to the West of Scotland regional musculoskeletal oncology service for soft tissue lesions of the foot, ankle, and lower leg over a 10-year period was analysed retrospectively. An assessment was made of patient demographics, presentation, anatomical location, diagnosis, classification, management, and outcomes for all patients. Of all new referrals, 53.5 % were diagnosed with primary benign soft tissue tumors and 16 % with primary malignant soft tissue tumors. The most common primary benign tumor in our population was schwannoma (15.9 %) and primary malignant tumor was undifferentiated sarcoma (26.7 %). In the foot alone, soft tissue sarcomas most commonly occurred in the forefoot (44.4 %). The most common presenting complaints were rest pain and focal swelling. Symptoms were present for on average 7 months prior to referral. Death from disease in sarcomas was 41.7 % over a 10 year follow up period, higher than other body areas. Soft tissue sarcomas in the foot and ankle remain a diagnostic challenge. Local biopsies should only be performed following discussion with an oncology surgeon. We have provided a management protocol in order to reduce the number of inappropriate procedures performed in this group and expedite referral to specialist centres, optimising clinical outcomes and reducing the cost of litigation to healthcare services.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Pages 72-78"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PA Screw Versus Plate Fixation for Posterior Malleolar Fracture, Systematic Review and Meta-analysis of Complications and Functional Results","authors":"Carlos A. Sánchez MD, MSc ,&nbsp;Natalia Correal MD ,&nbsp;Daniela Caro MD","doi":"10.1053/j.jfas.2024.08.001","DOIUrl":"10.1053/j.jfas.2024.08.001","url":null,"abstract":"<div><div>Fixation methods for posterior malleolar fracture (PMF) are a source of great controversy. This study aims to compare complications, clinical, and radiological outcomes between PA screws and posterior plate in PMF using current literature.</div><div>A systematic search strategy was conducted following the PRISMA protocol. Medline (PubMed), Embase (Elsevier), and Lilacs databases were used to identify complication rates (infection, nonunion, loss of reduction, osteoarthrosis, and sural nerve injury) and to compare reported functional outcomes. The level of evidence in the articles was assessed using the GRADE tool. The studies eligible for meta-analysis were processed using The Review Manager version 5.4.1 software.</div><div>Twelve articles met the inclusion criteria; 5 articles were included for subgroup meta-analysis. Overall infection rate, loss of reduction and sural nerve injury were each 2%. Osteoarthritis rate was 10%. There was no difference in risk reduction for infection rate (RD = 0.01; 95% CI: −0.03 to 0.06; <em>p =</em> .50), loss of reduction (RD = −0.00; 95% CI: −0.03 to 0.03; <em>p =</em> .88), sural nerve injury (RD = 0.01; 95% CI: −0.03 to 0.04; <em>p =</em> .70), osteoarthrosis (RD = −0.00; 95% CI: −0.09 to 0.09; <em>p =</em> .97), functional (MD = 0.70; 95% CI: −1.06 to 2.45; <em>p =</em> .44) or pain scores (MD = 0.12; 95% CI: −0.31 to 0.55; <em>p =</em> .58), nor deficit in dorsiflexion (MD= −0.26; 95% CI: −1.64 to 1.12; <em>p =</em> .71).</div><div>There were no clinical nor radiological significant differences when comparing fixation of PMF with plates or PA screws. With current literature it is not possible to establish the superiority of either fixation.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Pages 91-102"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cover 1 -- cover prints black and PMS 261","authors":"","doi":"10.1053/S1067-2516(24)00283-7","DOIUrl":"10.1053/S1067-2516(24)00283-7","url":null,"abstract":"","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Page CO1"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143137500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic Eluting Bone Void Filler Versus Systemic Antibiotics For Pedal Osteomyelitis","authors":"Vandana Venkateswaran MRCS ,&nbsp;Madhu Tiruveedhula FRCS ,&nbsp;Justin Edwards FRCPath ,&nbsp;Shiva Dindyal MD ,&nbsp;Michael Mulcahy FRCP ,&nbsp;Ankur Thapar PhD","doi":"10.1053/j.jfas.2024.08.010","DOIUrl":"10.1053/j.jfas.2024.08.010","url":null,"abstract":"<div><div>Osteomyelitis complicates 20% of patients with infected diabetic foot ulcers. In this study, 2 strategies for treating pedal osteomyelitis were compared in a pilot study. This was a retrospective, non-randomized, single center 2 arm cohort study, conducted between 2020 and 2022 involving 53 patients at a tertiary limb salvage unit. All patients were managed with debridement and proximal bone biopsy. Group A was treated with systemic antibiotics for up to 6 weeks. Group B had vancomycin or gentamycin eluting bone void filler implanted into the diseased bone medullary cavity(s) and 1 week of oral antibiotics. Patients were followed independently for the primary endpoint of osteomyelitis treatment failure and secondary endpoints of amputation free survival, wound healing, minor amputation, and treatment-limiting side-effects. Survival analysis demonstrated no significant difference in treatment failure (<em>p</em> = .35) or amputation free survival (<em>p</em> = .46). Limb salvage rates were 88% in Group A and 89% in Group B. Wounds healed in 85% in Group A and 89% in Group B. Minor amputations occurred in 21% in Group A and 11% in Group B. Treatment limiting side effects occurred in 6% in Group A and were absent in Group B. In conclusion, the use of antibiotic eluting bone void filler appeared safe without extended systemic antibiotics in this study. Group B had fewer intravenous lines, requirement for home nursing, and treatment limiting side effects. A larger randomized controlled trial examining longer term clinical and radiological efficacy, treatment costs and side effects is warranted.</div></div>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":"64 1","pages":"Pages 30-35"},"PeriodicalIF":1.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}