Journal of Arthroplasty最新文献

{"title":"Patient-Level Factors, Outcomes, and Costs Associated with Facility Transfer following Total Knee Arthroplasty: A Retrospective Database Study.","authors":"William H Young, Blaire C Peterson, Travis M Kotzur, Aaron Singh, Frank Buttacavoli, Chance C Moore","doi":"10.1016/j.arth.2024.10.131","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.131","url":null,"abstract":"<p><strong>Background: </strong>Patient disposition following total knee arthroplasty (TKA) has major implications for patient outcomes and costs. Current studies are limited in sample size and dates of data collection. We evaluated patient factors, outcomes, and costs associated with disposition to a facility following TKA.</p><p><strong>Methods: </strong>This was a retrospective cohort study including 1,906,670 patients undergoing TKA from a national wide database, from the years 2016 to 2020. Of these, 25,485 (1.34%) patients were transferred to a facility for rehabilitation. Demographic data, hospital-related outcomes, and postoperative complications were collected. Multivariate regression was performed to assess outcomes associated with facility transfer for rehabilitation.</p><p><strong>Results: </strong>Patients were more likely to be transferred if they were women (Odds Ratio (OR) = 1.10; P < 0.001), greater than 80 years old (OR = 2.25; P < 0.001), had an increased Elixhauser comorbidity index (OR = 1.38; P < 0.001), or were in the lowest income quartile (OR = 1.38; P < 0.001). Transferred patients were more likely to experience medical (OR = 1.92; P < 0.001) and surgical complications (OR = 2.74; P < 0.001), including vascular complications (OR = 2.07; P < 0.001), neurologic complications (OR = 5.72; P < 0.001), and dislocation (OR = 2.01; P < 0.001). They also had greater hospital lengths of stay (OR = 5.27; P < 0.001) and hospital charges (OR = 1.88; P < 0.001); however, they were less likely to undergo reoperation within 30 days (OR = 0.61; P = 0.002).</p><p><strong>Conclusions: </strong>Elderly, lower-income patients who had more comorbidities are more likely to be transferred to a facility following TKA. While there are associated increased costs, complications, and hospital lengths of stay, there are lower rates of reoperation for those who transferred to a facility after TKA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592077","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":"Moving Beyond Systemic Inflammatory Response Syndrome and Bacteremia: Are Modern Critical Care Calculators Useful in Predicting Debridement, Antibiotics, and Implant Retention Treatment Outcomes in Periprosthetic Joint Infection?","authors":"Mia J Fowler, Elshaday S Belay, Andrew Hughes, Yu-Fen Chiu, Daniel K Devine, Alberto V Carli","doi":"10.1016/j.arth.2024.10.127","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.127","url":null,"abstract":"<p><strong>Background: </strong>In critically ill periprosthetic joint infection (PJI) patients, surgeons need to balance the need for aggressive, definitive treatment against the health state of a potentially unstable patient. A clear understanding of the association between treatment outcomes and assessment scores for sepsis would benefit clinical decision-making in these urgent cases. The current study evaluates the effect of critical illness on debridement, antibiotics, and implant retention (DAIR) outcomes, as defined by systemic inflammatory response syndrome (SIRS) and, for the first time, by contemporary markers quick Sequential Organ Failure Assessment (qSOFA) and Modified Early Warning Score (MEWS).</p><p><strong>Methods: </strong>We retrospectively identified 253 patients who underwent DAIR for PJI at a single institution between 2017 and 2021. The SIRS, qSOFA, and MEWS scores were calculated based on variables on admission. A DAIR treatment failure, defined as reoperation or mortality, was measured at 90 days and two years. Univariate analysis was used to determine the association between elevated critical care scores and DAIR failure.</p><p><strong>Results: </strong>The DAIR treatment success was 59% at two years, with hip procedures and Charlson comorbidity index (CCI) ≥ 1 independently associated with higher odds of DAIR failure. There were 43 patients (16%) who presented with SIRS, however, only four (2%) had positive qSOFA scores. Neither SIRS nor qSOFA were predictive of DAIR failure. For knees only, elevated MEWS scores were predictive of 90-day DAIR failure (P = 0.019).</p><p><strong>Conclusion: </strong>Over one in six patients undergoing DAIR for PJI presented with SIRS, while only one in 50 had a positive qSOFA. The SIRS and qSOFA scores were not predictive of DAIR failure. Elevated MEWS scores were associated with DAIR failure at 90 days postoperatively in knee PJIs only, and should be confirmed in a larger cohort. Our results suggest that SIRS is not predictive of DAIR outcomes, possibly because it overestimates the proportion of critically ill patients.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570020","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":"Does Body Mass Index Affect the Success of Two-Stage Management of Periprosthetic Joint Infection?","authors":"Samuel G Raney, George Haidukewych, Matthew J Williamson, Patrick D Brooks, Benjamin M Stronach, Eric R Siegel, Simon C Mears, Jeffrey B Stambough","doi":"10.1016/j.arth.2024.10.128","DOIUrl":"10.1016/j.arth.2024.10.128","url":null,"abstract":"<p><strong>Introduction: </strong>Obesity is associated with increased infection risk after primary total joint arthroplasty. In this retrospective cohort analysis, we sought to assess the association between body mass index (BMI) and infection recurrence after two-stage revision total joint arthroplasty (TJA) for periprosthetic joint infection (PJI).</p><p><strong>Methods: </strong>Patients were grouped by BMI (< 30, 30 to 40, and ≥ 40) as non-obese, obese, and morbidly obese, and assessed for associations and timing of PJI reinfection as well as readmissions and complications.</p><p><strong>Results: </strong>Following the two-stage revision, PJI reinfections increased from 11.5% in non-obese to 19.0% in obese and 25.9% in morbidly obese patients (P = 0.011). As BMI increased across the three groups, 90-day readmission rates following two-stage PJI revision significantly increased (8.6, 19.7, and 16.7%, respectively (P = 0.042)). The average time to reinfection decreased with obesity tercile (restricted-mean times of 4.5, 4.2, and 3.8 years with non-obese, obese, and morbidly obese, respectively (P = 0.023)).</p><p><strong>Discussion: </strong>The success of PJI management with two-stage arthroplasty is significantly impacted by patient BMI, with morbidly obese subjects having the worst outcomes. Attempts to modify BMI before completion of two-stage PJI treatment should be considered in the morbidly obese given high rates of recurrence.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569962","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":"Data-Driven Approach to Development of a Risk Score for Periprosthetic Joint Infections in Total Joint Arthroplasty Using Electronic Health Records.","authors":"Hilal Maradit Kremers, Cody C Wyles, Joshua P Slusser, Thomas J O'Byrne, Elham Sagheb, David G Lewallen, Daniel J Berry, Douglas R Osmon, Sunghwan Sohn, Walter K Kremers","doi":"10.1016/j.arth.2024.10.129","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.129","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infection (PJI) is an uncommon, but serious complication in total joint arthroplasty. Personalized risk prediction and risk factor management may allow better preoperative assessment and improved outcomes. We evaluated different data-driven approaches to develop surgery-specific PJI prediction models using large-scale data from the electronic health records.</p><p><strong>Methods: </strong>A large institutional arthroplasty registry was leveraged to collect data from 58,574 procedures of 41,844 patients who underwent at least one primary and/or revision hip and/or knee arthroplasty between 2000 and 2019. The registry dataset was augmented with additional clinical, procedural, and laboratory data from the electronic health records for more than 100 potential predictor variables. The main outcome was PJI within the first year after surgery. We implemented both traditional and machine learning methods for model development (lasso regression, relaxed lasso regression, ridge regression, random forest, stepwise regression, extreme gradient boosting, neural network) and used 10-fold cross-validation to calculate measures of model performance in terms of discrimination (c-statistic), cross-entropy loss, and calibration.</p><p><strong>Results: </strong>All models performed similarly in predicting PJI risk, with negligible differences of less than 0.08 between the best and worst-performing models. The relaxed and fully relaxed lasso models using the Cox model structure outperformed the other models with concordances of 0.787 in primary hip arthroplasty and 0.722 in revision hip arthroplasty, with the number of predictors ranging from nine to 41. The concordances with the relaxed lasso models were 0.681 in primary and 0.699 in revision knee arthroplasty, with a higher number of predictors in the models. Predictors included in the models varied substantially across the four surgical groups.</p><p><strong>Conclusions: </strong>The incorporation of additional data from the electronic health records offers limited improvement in PJI risk stratification. Furthermore, improvement in PJI risk prediction was modest with the machine learning approaches and may not justify the added complexity.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569936","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":"Glucagon-Like Peptide-1 Receptor Agonist Use Is Not Associated With Increased Complications After Total Hip Arthroplasty in Patients Who Have Type 2 Diabetes.","authors":"Kevin Y Heo, Rahul K Goel, Alyssa Woltemath, Andrew Fuqua, Bryce T Hrudka, Omar Syed, Emilio Arellano, Ajay Premkumar, Jacob M Wilson","doi":"10.1016/j.arth.2024.10.099","DOIUrl":"10.1016/j.arth.2024.10.099","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 (GLP-1) agonists have emerged as a powerful diabetic treatment adjunct; however, their effects on outcomes following total hip arthroplasty (THA) are not well known. This study aimed to compare the risk of complications in patients who had type 2 diabetes mellitus (DM) who were on GLP-1 agonists with those who were not on these medications.</p><p><strong>Methods: </strong>In total, 14,065 patients who had type 2 DM undergoing primary THA between 2016 and 2021 were retrospectively reviewed using a national database. Propensity score matching was employed at a 1:4 ratio to match patients who used GLP-1 agonists (n = 812) to those who did not (n = 3,248). Patients were matched on age, sex, insulin status, presence of other diabetic medications, comorbidities, and smoking status. Multivariable logistic regressions were performed to examine 90-day and 1-year THA outcomes between groups.</p><p><strong>Results: </strong>Patients who were not on GLP-1 agonists exhibited increased rates of extended hospital stays (≥3 days) (odds ratio 1.25, P = 0.01). Patients who were on GLP-1 agonists exhibited no significant differences in surgical or medical complication rates at 90 days compared to those not on GLP-1 agonists. There were also no significant differences in rates of all-cause revision THA, aseptic revision THA, or periprosthetic joint infection during the 1-year postoperative period.</p><p><strong>Conclusions: </strong>This study demonstrated that GLP-1 agonists were not associated with increased risks for medical or surgical complications in patients who had DM undergoing THA and were associated with lower rates of extended hospital stays after surgery. This study provides additional evidence regarding the association of GLP-1 agonist use before THA with postoperative outcomes. Given the potential for increased glycemic control and weight loss, more data are needed to delineate the role of GLP-1 agonists in the optimization of patients who have DM before THA to minimize postoperative complications.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565101","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":"Unsuspected Positive Intra-Operative Cultures in Aseptic Revision Hip Arthroplasty: Prevalence, Management, and Infection-Free Survivorship.","authors":"Justin Leal, Christine J Wu, Thorsten M Seyler, William A Jiranek, Samuel S Wellman, Michael P Bolognesi, Sean P Ryan","doi":"10.1016/j.arth.2024.10.102","DOIUrl":"10.1016/j.arth.2024.10.102","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to describe the management and outcomes of aseptic revision total hip arthroplasty (arTHA) with unsuspected intraoperative positive cultures (UPCs) compared to those with sterile cultures.</p><p><strong>Methods: </strong>A single tertiary center's institutional database was retrospectively reviewed for arTHA from January 2013 to October 2023. Preoperative Musculoskeletal Infection Society scores were assigned to patients based on available infectious workup, and those who met the criteria for periprosthetic joint infection (PJI), received antibiotic spacers, or had less than 1-year follow-up were excluded. Patients were grouped and compared according to intraoperative culture results as follows: sterile cultures, one unexpected positive culture with a new organism, one UPC with the same organism as prior PJI, ≥ two UPCs with different organisms, and ≥ 2 UPCs with the same organism.</p><p><strong>Results: </strong>There was a total of 604 arTHAs included in this study, of which 0.8% [5 of 604] had ≥ two UPCs with different organisms, 1.5% [9 of 604] had ≥ two UPCs with the same organism, 9.8% [59 of 604] had one UPC with a new organism, 0.2% [one of 604] had one UPC with an organism from prior PJI, and 87.7% [530 of 604] of patients had sterile cultures. When comparing 5-year infection-free survival between patients who had one UPC with a new organism and sterile cultures, there was no difference (P = 0.40); however, patients who had ≥ two UPCs with different organisms (P < 0.001), patients who had ≥ two UPCs with the same organism (P = 0.001), and patients who had one UPC of an organism from prior PJI (P < 0.001) had statistically worse infection-free survival compared to patients with sterile cultures.</p><p><strong>Conclusions: </strong>Infection-free survival at five years was similar between patients who had one UPC with a new organism and those who had sterile cultures; however, ≥ two UPCs and a history of PJI are both significant risk factors for rerevision for infection after arTHA.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559365","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":"Using Porous Tantalum Uncemented Components to Manage Acetabular Defects and to Restore the Hip Center of Rotation in Revision Total Hip Arthroplasty: A Minimum Ten-Year Clinical and Radiological Study.","authors":"Alessandra Cipolla, Martinique Vella-Baldacchino, Marie Le Baron, Jean-Noel Argenson, Xavier Flecher","doi":"10.1016/j.arth.2024.10.110","DOIUrl":"10.1016/j.arth.2024.10.110","url":null,"abstract":"<p><strong>Background: </strong>Managing acetabular defects and restoring the hip center of rotation (COR) in revision hip arthroplasty is considered a complex and challenging surgery. Among many existing options, porous tantalum components have shown favorable short-term (less than ten years) follow-up results. The present study aimed to describe clinical and radiographic outcomes in longer-term follow-up.</p><p><strong>Methods: </strong>Between 2006 and 2013, 98 patients who underwent this surgical technique in our institute were clinically and radiographically reviewed. Rerevisions for aseptic loosening of the acetabular component were examined to consider the survivorship of the implant as the primary endpoint. The clinical outcome was measured using the Harris Hip Score. Radiological signs of osseointegration, radiolucency lines, acetabular stability, and position of the hip COR were evaluated at the immediate postoperative and last follow-up radiographs.</p><p><strong>Results: </strong>The cup survivorship was 96% at a mean follow-up of 14 years (range, 10 to 17). Global survivorship was 83.6% if any reason for rerevisions was considered an endpoint. The most frequent complications were dislocation (13.7%) and infections (12%). Overall, 13 patients died, and 17 patients were lost to follow-up. There were 73 patients available for clinical and radiographic evaluation. The mean Harris Hip Score was 81 (range, 39 to 100). More than 80% of hips showed radiological evidence of osseointegration, and no change was found in COR position at last follow-up radiographs.</p><p><strong>Conclusions: </strong>The use of porous tantalum uncemented components to manage revision hip arthroplasty can be considered a favorable solution for managing acetabular defects and restoring the hip COR with satisfactory clinical and radiological results in a long-term follow-up.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559366","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":"Is There a Role for Reinforcing Soft-Tissue Repairs or Flaps for Patients Who Have Abductor Deficiency?","authors":"Şahin Karalar, İbrahim Azboy, Kerem Basarir, Aasis Unnanuntana, Zhi Yang, Javad Parvizi","doi":"10.1016/j.arth.2024.10.108","DOIUrl":"10.1016/j.arth.2024.10.108","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548822","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":"What are the indications for the use of dual mobility bearing surface for patients undergoing primary total hip arthroplasty?","authors":"Alisina Shahi, Ayman Ebied, Hakan Kocaoğlu, Ruben Limas Telles, Rosa Silva Martínez, Mahmood Shahab Wahhab, Marco Teloken","doi":"10.1016/j.arth.2024.10.122","DOIUrl":"https://doi.org/10.1016/j.arth.2024.10.122","url":null,"abstract":"","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559367","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":"Uncertainty-Aware Deep Learning Characterization of Knee Radiographs for Large-Scale Registry Creation.","authors":"Kellen L Mulford, Austin F Grove, Elizabeth S Kaji, Pouria Rouzrokh, Ryan D Roman, Mete Kremers, Hilal Maradit Kremers, Michael J Taunton, Cody C Wyles","doi":"10.1016/j.arth.2024.10.103","DOIUrl":"10.1016/j.arth.2024.10.103","url":null,"abstract":"<p><strong>Background: </strong>We present an automated image ingestion pipeline for a knee radiography registry, integrating a multilabel image-semantic classifier with conformal prediction-based uncertainty quantification and an object detection model for knee hardware.</p><p><strong>Methods: </strong>Annotators retrospectively classified 26,000 knee images detailing presence, laterality, prostheses, and radiographic views. They further annotated surgical construct locations in 11,841 knee radiographs. An uncertainty-aware multilabel EfficientNet-based classifier was trained to identify the knee laterality, implants, and radiographic view. A classifier trained with embeddings from the EfficientNet model detected out-of-domain images. An object detection model was trained to identify 20 different knee implants. Model performance was assessed against a held-out internal and an external dataset using per-class F1 score, accuracy, sensitivity, and specificity. Conformal prediction was evaluated with marginal coverage and efficiency.</p><p><strong>Results: </strong>Classification Model with Conformal Prediction: F1 scores for each label output > 0.98. Coverage of each label output was > 0.99 and the average efficiency was 0.97. Domain Detection Model:The F1 score was 0.99, with precision and recall for knee radiographs of 0.99. Object Detection Model:Mean average precision across all classes was 0.945 and ranged from 0.695 to 1.000. Average precision and recall across all classes were 0.950 and 0.886.</p><p><strong>Conclusions: </strong>We present a multilabel classifier with domain detection and an object detection model to characterize knee radiographs. Conformal prediction enhances transparency in cases when the model is uncertain.</p>","PeriodicalId":51077,"journal":{"name":"Journal of Arthroplasty","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548824","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}