Journal of Arthroplasty最新文献

{"title":"Perioperative Hematological Outcomes of Simultaneous Double Total Joint Arthroplasty for Hemophilic Arthritis of the Hip and Knee: A Retrospective Study.","authors":"Yucan Ju, Wenyu Jiang, Huansheng Liu, Jinwei Xie, Qiang Huang, Zongke Zhou, Fuxing Pei","doi":"10.1016/j.arth.2024.11.056","DOIUrl":"https://doi.org/10.1016/j.arth.2024.11.056","url":null,"abstract":"<p><strong>Background: </strong>Double total joint arthroplasty (TJA) can reduce repeat hospitalizations and total coagulation factors usage in hemophilic arthritis (HA) patients who have multiple joint involvement, but the risk of perioperative adverse events with double TJA must be considered.</p><p><strong>Methods: </strong>We reviewed 50 patients who had hemophilia A, including 26 single TJA (STJA) (13 total knee arthroplasty [TKA] and 13 total hip arthroplasty [THA]) and 24 simultaneous double TJA (Sim-DTJA) (including 10 bilateral TKAs, 10 bilateral THAs, and four patients who had simultaneous THA and TKA). Length of hospitalization, blood loss, total exogenous coagulation factor VIII (FVIII) usage, perioperative FVIII levels, perioperative activated partial thromboplastin time (APTT), perioperative transfusion rates, and postoperative complications were assessed and compared.</p><p><strong>Results: </strong>Perioperative FVIII levels and APTT were not different between Sim-DTJA and STJA. Total blood loss (1,216.0 ± 450.4 mL) and hidden blood loss (1,020.0 ± 419.9 mL) were slightly higher in Sim-DTJA than in STJA (1,062.0 ± 371.8 mL and 929.9 ± 351.6 mL, respectively) (P = 0.192, P = 0.416, respectively). The length of hospitalization between the Sim-DTJA (10.6 ± 1.8 days) and the STJA (10.4 ± 1.7 days) was not different (P = 0.802). The perioperative FVIII usage was 30,063 ± 6,466 IU for Sim-DTJA and 26,077 ± 12,524 IU for STJA (P = 0.008). No postoperative adverse events and prosthesis-related complications were reported in any of the patients. The two cohorts had no perioperative transfusion of erythrocyte and platelets.</p><p><strong>Conclusion: </strong>In HA patients who had multiple joint involvement, Sim-DTJA can achieve clinical efficacy without significantly increasing perioperative blood loss, length of hospitalization, and postoperative complications.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip Abductor Muscle Strength in Patients After Total Knee Arthroplasty: A Systematic Review and Meta-analysis.","authors":"Roman Stocker, Matthias Wittauer, Peter Kvarda, Corina Nüesch, Christian Appenzeller-Herzog, Florian Halbeisen, Annegret Mündermann, Petros Ismailidis","doi":"10.1016/j.arth.2024.11.057","DOIUrl":"https://doi.org/10.1016/j.arth.2024.11.057","url":null,"abstract":"<p><strong>Introduction: </strong>Impaired hip abductor muscle strength indirectly leads to changes in knee kinematics and may cause pain or functional limitations after total knee arthroplasty (TKA). This study aimed to evaluate and quantify hip abductor muscle strength deficits after TKA and investigate external factors influencing hip abductor muscle strength after TKA.</p><p><strong>Methods: </strong>A comprehensive literature search was performed, and clinical studies reporting hip abductor muscle strength after primary TKA were included. We performed meta-analyses to assess the relative hip muscle strength of the operated leg compared to the contralateral limb and the change from preoperative to postoperative values across multiple time points. We also assessed the pooled absolute hip muscle strength across the following time points: preoperatively, up to two months, two to six months, and more than six months postoperatively.</p><p><strong>Results: </strong>There were 15 studies involving 823 patients that met our inclusion criteria. Compared with preoperative values, patients had a mean strength deficit of 18.0% (95% confidence interval (CI) [-30.8 to -5.2] at up to two months postoperatively, a non-significant deficit of 11.3% (CI [-32.7 to 10.2]) at two to six months postoperatively and an increase of 18.4% (CI [2.7 to 34.1]) at ≥ six months postoperatively. Compared with the contralateral side, patients had a mean abductor strength deficit of 11.5% (CI [-16.2 to -6.9]) preoperatively, 23.2% (CI [-27.6 to -18.8]) at up to two months postoperatively, a non-significant deficit of 10.8% (CI [-23.2 to 1.6]) at two to six months postoperatively and no difference (0.6% (CI [-4.2 to 5.4]) more than six months postoperatively. The study quality was low to moderate.</p><p><strong>Conclusion: </strong>Hip abductor muscle strength is reduced preoperatively in patients undergoing TKA, continues to decrease in the immediate postoperative period, but fully recovers within six to 12 months. Although these data can be used to guide patient education and rehabilitation planning, they should be interpreted with caution due to the heterogeneous and limited high-quality evidence.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Single Preoperative Low Dose of Dexamethasone Is Efficacious in Improving Early Postoperative Pain, Function, Nausea, and Vomiting After Primary Total Knee Arthroplasty: A Randomized, Double-Blind, Placebo-Controlled Trial.","authors":"Mohammed A Abdelhameed, Ahmed A Khalifa, Mohamed A Mahran, David N Kameel, Hatem M Bakr, Mohammad K Abdelnasser","doi":"10.1016/j.arth.2024.11.061","DOIUrl":"10.1016/j.arth.2024.11.061","url":null,"abstract":"<p><strong>Background: </strong>The primary objective was to evaluate a single preoperative low-dose (8 mg) dexamethasone (DXM) efficacy in relieving postoperative pain in patients undergoing total knee arthroplasty (TKA). The secondary objectives were to assess its effect on postoperative nausea and vomiting (PONV), C-reactive protein (CRP) levels, and early wound complications incidence.</p><p><strong>Methods: </strong>This was a single-center, double-blind, randomized controlled trial. We included 86 unilateral primary TKA divided equally into two groups (placebo [Group A] and DXM [Group B], as a single intravenous dose given after anesthesia). Postoperative pain was assessed as the primary outcome at rest and while walking using a visual analog scale (VAS). Secondary outcomes included PONV evaluated using VAS for postoperative nausea. The following variables were evaluated: the Time Up and Go test, serum CRP, quadriceps muscle power, and wound complications. All outcomes were reported in the first three days and at 14 days follow-up visit.</p><p><strong>Results: </strong>Both groups' baseline data were comparable. Group B reported significantly less pain at rest and walking throughout all time points (P < 0.001). Group B had fewer vomiting episodes on postoperative days one and two (P = 0.195 and 0.747, respectively) and no difference in PONV VAS score. Group B had significantly lower Time Up and Go test scores for postoperative days one and two (P = 0.029 and 0.016, respectively) and significantly better quadriceps muscle power on postoperative days two and three (P = 0.042 and 0.019, respectively). The Serum CRP levels were significantly less in Group B throughout all follow-up time points (P < 0.001) except on day three (P = 0.302). No wound complications were reported in any patient.</p><p><strong>Conclusions: </strong>Preoperative single low dose (eight mg) DXM intravenous in patients undergoing unilateral TKA is safe (early postoperatively) and effective for reducing postoperative pain scores, improving early mobility, and reducing inflammatory markers. However, the effect on PONV was less evident.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Patient-Specific Opioid Taper Calculator for Total Hip and Knee Arthroplasty: A Pre- and Post-Implementation Study.","authors":"Roberto A Guzman, Jordan Ammons, Jerald R Westberg, Andrew Schmidt","doi":"10.1016/j.arth.2024.11.040","DOIUrl":"10.1016/j.arth.2024.11.040","url":null,"abstract":"<p><strong>Background: </strong>Given the association between high opioid use and postoperative complications after total joint arthroplasty, it is important to prescribe opioids responsibly in the postoperative period. While many pain regimen protocols exist to try and limit opioid use, an optimal approach to narcotic prescription for arthroplasty patients is yet to be established. This study evaluated the effects of using an individualized opioid taper calculator for patients undergoing elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). We hypothesized that using the calculator would lead to a decrease in the amount and variability of opioids prescribed postoperatively.</p><p><strong>Methods: </strong>All primary THAs (117 precalculator and 105 postcalculator) and TKAs (172 precalculator and 139 postcalculator) meeting study inclusion and exclusion criteria were reviewed at a single academic hospital from January 2016 to December 2018 (precalculator) and January 2020 to December 2022 (postcalculator). The primary outcome measure was the quantity of opioids prescribed at discharge in morphine milligram equivalents between the two groups. Secondary measures included opioid refills, visual analog scale pain scores, and emergency department presentations or clinic calls due to pain. Statistical significance was defined as P <0.05.</p><p><strong>Results: </strong>Implementation of the opioid taper calculator resulted in a 40% decrease in the median morphine milligram equivalent prescribed at discharge for both THA (450 versus 270; P < 0.0001) and TKA (450 versus 270; P < 0.0001) patients, respectively. There was no significant difference within the THA or TKA cohorts when comparing visual analog scale pain scores (THA, 3 versus 4; P = 0.47; TKA; 5 versus 6, P = 0.26), and no increase in percentage of patients who had emergency department visits (THA, 5.98 versus 0.95%; P = 0.069; TKA, 6.40 versus 11.5%; P = 0.155) or calls to the clinic for pain (THA, 17.1 versus 24.8%; P = 0.186; TKA, 36.6 versus 37.4%; P = 0.906) between the precalculator and postcalculator groups.</p><p><strong>Conclusions: </strong>Our findings support the use of a patient-specific opioid taper calculator to decrease the volume and variability of narcotics prescribed postoperatively for THA and TKA pain management. Our findings confirmed the general applicability and effectiveness of the opioid taper calculator outside of its institution of origin.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip Resection Arthroplasty as Definitive Treatment: Indications, Outcomes, and Complications in Paraplegic and Non-paraplegic Patients.","authors":"Matthew Nester, Ameer Tabbaa, Peter Simon, Steven Lyons, Brian Palumbo, Thomas Bernasek","doi":"10.1016/j.arth.2024.11.060","DOIUrl":"https://doi.org/10.1016/j.arth.2024.11.060","url":null,"abstract":"<p><strong>Background: </strong>Hip resection arthroplasty (HRA) serves as a salvage treatment option for various conditions affecting paraplegic patients, such as arthritis pain, infection, and spasticity. In non-paraplegic individuals, it is often utilized to manage complex infections. There exists a paucity of studies comparing outcomes between paraplegic and non-paraplegic patients undergoing HRA as definitive treatment. This study aimed to address this gap by analyzing the demographics, indications, outcomes, and complications in these two patient groups.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 65 patients who underwent definitive HRA, divided into paraplegic (n = 25) and non-paraplegic (n = 40) groups. Data encompassed demographics, preoperative indications, postoperative complications, and outcomes.</p><p><strong>Results: </strong>Paraplegic patients exhibited distinct characteristics compared to non-paraplegic counterparts, including younger age (P < 0.001), lower comorbidity scores (P = 0.013), fewer prior hip operations (P = 0.002), and a higher proportion of men (P < 0.001). Septic arthritis emerged as the primary indication for definitive HRA in both groups, constituting 64% (16 of 25) of paraplegic and 42.5% (17 of 40) of non-paraplegic cases. Non-paraplegic patients experienced a significant reduction in pain scores postoperatively (P < 0.001), with a notable improvement in mobility. Infection eradication rates were comparable between the two groups, with 82 and 92% success rates in paraplegic and non-paraplegic cases, respectively. However, paraplegic patients exhibited a higher reoperation rate (P = 0.041), while non-paraplegic individuals encountered increased major systemic complications (P = 0.052). Although the total complication rate was slightly higher in the non-paraplegic group (75 versus 56%), the difference was not statistically significant (P = 0.211).</p><p><strong>Conclusion: </strong>Hip resection arthroplasty (HRA) was the definitive treatment that successfully treated infection in both groups. In the non-paraplegic group, it led to enhanced ambulatory capacity and decreased pain. Paraplegic patients experienced higher rates of reoperation, whereas non-paraplegic patients suffered from greater rates of major systemic complications. These findings provide valuable insights for clinicians considering HRA as a definitive treatment.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of Comorbidities With Total Knee Arthroplasty Health Care Utilization.","authors":"William G ElNemer, Myung-Jin Cha, Eve R Glenn, John P Avendano, Daniel Badin, Uma Srikumaran, Savya Thakkar, Matthew J Best","doi":"10.1016/j.arth.2024.11.052","DOIUrl":"10.1016/j.arth.2024.11.052","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing total knee arthroplasty (TKA) tend to have comorbidities such as obesity, hypertension, and cancer, which are associated with advanced age. This study aimed to elucidate the associations of these comorbidities with hospital charge (HC), hospital costs (HCos), and length of stay (LOS).</p><p><strong>Methods: </strong>A national database was queried for patients who underwent primary TKA from 2012 to 2020. There were 30 comorbidities classified using the Elixhauser comorbidity index. For each comorbidity of interest, patients were matched to another patient by age, sex, and all other comorbidities except the comorbidity of interest. Matched cohorts were analyzed via multivariable regression analyses controlled for age, sex, procedure year, hospital location, and comorbidities to predict increases in HC, HCo, and LOS. A total of 1,014,831 patients were included.</p><p><strong>Results: </strong>Mean HC, HCo, and LOS were $64,097, $17,299, and 2.5 days, respectively. Weight loss, blood loss anemia, coagulopathies, and fluid and electrolyte disorders were associated with the largest increases in HC, with 6, 5, 5, and 5% increases, respectively (P < 0.05). Pulmonary hypertension, non-metastatic tumors, paralysis, and obesity were associated with increased HCo, with 6, 4, 4, and 4% increases, respectively (P < 0.05). All comorbidities except hypothyroidism were associated with increased LOS. Pulmonary hypertension, weight loss, paralysis, fluid and electrolyte disorders, and human immunodeficiency virus/acquired immunodeficiency syndrome were associated with were associated with 53, 21, 15, 14, and 12%, respectively, increased odds of having LOS greater than or equal to 4 days' increase (P < 0.05).</p><p><strong>Conclusion: </strong>This study offers targets for the reduction of HC, HCo, and LOS for patients with these ailments through protocol change. Optimization programs targeting malnourished patients, patients with pulmonary hypertension, and other comorbidities are encouraged. These results also provide clinicians with a quantifiable way to communicate financial burden and recovery time after TKA to patients' unique problem lists.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Traumatic Stress Disorder as a Risk Factor for Adverse Outcomes in Total Knee Arthroplasty.","authors":"William J Hlavinka, Mohammed S Abdullah, Tarun R Sontam, Hetsinhji Chavda, Aymen Alqazzaz, Neil P Sheth","doi":"10.1016/j.arth.2024.11.055","DOIUrl":"10.1016/j.arth.2024.11.055","url":null,"abstract":"<p><strong>Background: </strong>There is a scarcity of literature concerning individuals who have existing post-traumatic stress disorder (PTSD) and their outcomes after primary total knee arthroplasty (TKA). This study compared outcomes in patients undergoing primary TKA who have a previous history of PTSD.</p><p><strong>Methods: </strong>An electronic health care database was used to identify patients diagnosed with PTSD undergoing TKA. Through 1:1 ratio propensity matching, these patients were matched with a cohort of non-PTSD (NPTSD) individuals. Postoperative parameters, including health care visits and prescriptions, were assessed within a 1-month time frame following surgery. Complications and revision rates were evaluated after one month, 6 months, one year, 2 years, and 5 years. A total of 646,186 patients undergoing primary TKA were identified. Ultimately, 7,381 patients who had PTSD were propensity matched to 7,381 NPTSD patients.</p><p><strong>Results: </strong>Patients who had PTSD presented to the emergency department at a higher rate than NPTSD patients within 7 days (OR [odds ratio]: 1.5; CI [confidence interval]: 1.0 to 2.4) postoperative. Within one month, cohorts were prescribed opioid analgesics at similar rates (OR: 0.9; CI: 0.8 to 1.1). Patients who had PTSD were found to have a higher number of infections within one month (OR: 1.7; CI: 1.2 to 2.6) and 5 years (OR: 1.2; CI: 1.0 to 1.5), periprosthetic fractures at 6 months (OR: 2.1; CI: 1.0 to 4.5) and one year (OR: 2.1; CI: 1. to 4.0), and higher revision rates at all time points.</p><p><strong>Conclusions: </strong>Patients diagnosed with PTSD exhibited higher rates of periprosthetic infections at one month and 5 years and increased periprosthetic fracture rates at 6 months and one year after TKA compared to NPTSD patients. These findings underscore the importance of tailored early postoperative education and understanding outcomes for patients who have PTSD in contrast to those who do not have a diagnosis of PTSD.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conflict of Interest Statement","authors":"","doi":"10.1016/S0883-5403(24)01223-3","DOIUrl":"10.1016/S0883-5403(24)01223-3","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 1","pages":"Page IBC"},"PeriodicalIF":3.4,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Letter Re: Metal Ion Release in Cancer Patients Following Megaprosthesis Salvage Surgery","authors":"Manel Fa-Binefa MD,&nbsp;Roger Rojas-Sayol MD","doi":"10.1016/j.arth.2024.09.036","DOIUrl":"10.1016/j.arth.2024.09.036","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 1","pages":"Pages e2-e3"},"PeriodicalIF":3.4,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Metal Ion Release in Cancer Patients Following Megaprosthesis Salvage Surgery","authors":"Maria A. Smolle MD,&nbsp;Andreas Leithner MD","doi":"10.1016/j.arth.2024.08.060","DOIUrl":"10.1016/j.arth.2024.08.060","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":"40 1","pages":"Page e1"},"PeriodicalIF":3.4,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}