Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"Surgical techniques for the management of severe rigid scoliosis","authors":"Stephane Owusu-Sarpong ,&nbsp;Tejas Subramanian ,&nbsp;Han Jo Kim","doi":"10.1016/j.jcot.2025.103293","DOIUrl":"10.1016/j.jcot.2025.103293","url":null,"abstract":"<div><div>Severe rigid scoliosis presents some unique challenges with respect to surgical techniques and complications. Anterior and posterior techniques, as well as combined approaches, can be employed for the surgical management of this condition. The purpose of this article is to describe severe rigid scoliosis as an entity and to delve into the surgical tools that may be utilized for the treatment of this complex condition. Specific techniques are presented in detail, including preoperative halo-gravity/halo-pelvic traction, as well as correction maneuvers such as anterior release, thoracoplasty, concave rib osteotomy, and posterior vertebral column resection. Preoperative halo traction improves curve flexibility and pulmonary status, anterior release and concave rib osteotomy enhance mobilization, thoracoplasty addresses rib prominence, and posterior vertebral column resection provides powerful single-stage correction. Collectively, these techniques expand surgical options and mitigate neurologic and cardiopulmonary risks in severe rigid scoliosis.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103293"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839735","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":"Single vs. dual plating for distal femur periprosthetic fractures post-total knee arthroplasty: A comparative analysis of functional and radiographic outcomes","authors":"Abhijit Das,&nbsp;Babaji Sitaram Thorat,&nbsp;Avtar Singh Kamboj,&nbsp;Arcot Reddy Vamsi Krishna,&nbsp;Kshitij Srivastav,&nbsp;Arshid H. Wani","doi":"10.1016/j.jcot.2025.103308","DOIUrl":"10.1016/j.jcot.2025.103308","url":null,"abstract":"<div><h3>Background</h3><div>Periprosthetic distal femur fractures following total knee arthroplasty (TKA) are increasingly encountered and present considerable reconstructive challenges, with internal fixation remaining the mainstay of management. This retrospective comparative study examines the clinical and radiological outcomes of single locked plating versus dual plating in Rorabeck type I and II fractures.</div></div><div><h3>Methods</h3><div>A total of 45 patients treated between August 2017 and August 2024 were included (31 single plating; 14 dual plating). Functional outcome (Oxford Knee Score), union characteristics, weight-bearing timelines, and complications were compared.</div></div><div><h3>Results</h3><div>The study included 45 patients (30 females, 15 males), with a mean age of 67 ± 8.7 years. All fractures achieved union (100 % union rate) with a mean time to union of 4.4 ± 1.2 months. Dual plating achieved earlier fracture union (3.71 ± 1.35 months) and permitted earlier full weight-bearing (3.18 ± 1.22 months) compared with single plating (4.77 ± 0.85 months and 4.18 ± 0.84 months, respectively). Dual plating yielded significantly better functional outcomes than single plating, with progressively higher Oxford Knee Scores at 1, 3, and 6 months of follow-up (p &lt; 0.05). Complication rates were comparable between groups (superficial infection 3 cases; deep infection 1; delayed union 3; malunion 1).</div></div><div><h3>Conclusion</h3><div>Dual plating is better than single locked plating for such injuries, as it provides a stable construct, anatomical reduction, early fracture union, early mobilization, excellent outcomes, and minimal complications.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103308"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839743","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":"Hospital volume is not associated with clinically meaningful PROM achievement following primary total hip arthroplasty","authors":"Khaled A. Elmenawi ,&nbsp;Benjamin E. Jevnikar ,&nbsp;Arjun Dinesh ,&nbsp;Yuxuan Jin ,&nbsp;Nicolas S. Piuzzi","doi":"10.1016/j.jcot.2025.103303","DOIUrl":"10.1016/j.jcot.2025.103303","url":null,"abstract":"<div><h3>Background</h3><div>As the United States healthcare system transitions toward value-based care, patient-reported outcomes (PROMs) have become central to defining surgical quality and guiding reimbursement. Under the Centers for Medicare &amp; Medicaid Services (CMS) Patient-Reported Outcomes Performance Measure (PRO-PM) initiative, hospitals are required to collect and report PROMs following total hip arthroplasty (THA). However, it remains unclear whether patients treated at high- and low-volume hospitals achieve comparable rates of clinically meaningful improvement.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 4962 Medicare beneficiaries who underwent primary THA within a large integrated health system between 2016 and 2023. Hospitals were stratified by procedural volume (≥500 vs &lt; 500 THAs annually). Patient-reported outcomes were assessed using the Hip Disability and Osteoarthritis Outcome Score for Pain, Physical Function (PS), and Joint Replacement (JR). Clinically meaningful thresholds included the minimal clinically important difference (MCID), patient acceptable symptom state (PASS) threshold, substantial clinical benefit (SCB), and satisfaction. Multivariable logistic regression evaluated associations between hospital volume and failure to achieve each PROM threshold, adjusting for demographic and clinical covariates.</div></div><div><h3>Results</h3><div>Hospital procedural volume was not associated with differences in PROM achievement. The odds of failing to reach MCID, PASS, or SCB thresholds, or to report satisfaction, were comparable between high- and low-volume hospitals across all HOOS domains (all <em>P</em> &gt; 0.05).</div></div><div><h3>Conclusions</h3><div>Patients achieved similar rates of meaningful improvement following THA regardless of hospital volume. As CMS increasingly ties reimbursement to PROM-based benchmarks, these findings support the equitable implementation of PRO-PM initiatives across diverse care settings and reinforce that standardized, evidence-based care, rather than procedural volume, drives high-value arthroplasty outcomes.</div></div><div><h3>Level of evidence</h3><div>II (prospective)</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103303"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839742","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":"Radiological assessment in cervical spine myelopathy","authors":"Shanmuganathan Rajasekaran ,&nbsp;Gnanaprakash Gurusamy ,&nbsp;Pushpa Bhari Thippeswamy ,&nbsp;Karthik Ramachandran ,&nbsp;Stefano Conti","doi":"10.1016/j.jcot.2025.103301","DOIUrl":"10.1016/j.jcot.2025.103301","url":null,"abstract":"<div><div>Degenerative cervical myelopathy (DCM) is the most common cause of non-traumatic spinal cord dysfunction in adults, resulting from conditions such as cervical spondylosis, ossification of the posterior longitudinal ligament (OPLL), and disc degeneration. Radiological evaluation is essential to diagnosis, surgical planning, and prognosis. This review outlines the current role of imaging modalities, ranging from plain radiographs and computed tomography (CT) to magnetic resonance imaging (MRI), in the assessment of DCM. Plain radiographs and CT scans provide valuable information on cervical alignment, instability, and ossification patterns, while MRI remains the gold standard for evaluating spinal cord compression and changes in signal intensity. Advanced techniques, including diffusion tensor imaging (DTI), magnetic resonance spectroscopy (MRS), and functional MRI (fMRI), offer additional insights into spinal cord integrity and metabolic alterations, though their clinical application remains limited. A systematic and multimodal imaging approach enhances diagnostic precision, helps in surgical decision-making, and supports individualized treatment strategies in patients with cervical myelopathy.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103301"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839814","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":"Salvage options following failed surgical hip fracture repair: Part II, extracapsular proximal femoral fractures","authors":"Bradley A. Lezak ,&nbsp;Meghan Maseda ,&nbsp;Alexander J. Egol ,&nbsp;Nathaniel P. Mercer ,&nbsp;Kenneth A. Egol","doi":"10.1016/j.jcot.2025.103265","DOIUrl":"10.1016/j.jcot.2025.103265","url":null,"abstract":"<div><div>Surgical repair of extracapsular hip fractures is associated with a higher rate of successful healing compared to intracapsular fractures; however, a small subset of patients may still experience complications or treatment failure. Potential modes of failure include nonunion, peri-implant fracture, malalignment, cortical impingement or perforation and hardware failure with or without lag screw cutout. Factors determining salvage method include physiologic age, functionality, bone quality, and fracture stability. In this review, potential complications of extracapsular hip fracture repair are described with proposed solutions and supporting literature, when available.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103265"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145580506","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":"Changes in sagittal spinopelvic parameters following S2-alar-iliac screw fixation in adult degenerative scoliosis: A one-year radiographic analysis of 80 patients","authors":"Abhishek Soni ,&nbsp;Vaibhav Sinha ,&nbsp;Vidyadhara S ,&nbsp;Balamurugan T","doi":"10.1016/j.jcot.2025.103278","DOIUrl":"10.1016/j.jcot.2025.103278","url":null,"abstract":"<div><h3>Background</h3><div>S2-alar-iliac (S2AI) screws are widely used for spinopelvic fixation due to their biomechanical advantages. Although pelvic incidence (PI) is traditionally considered fixed after skeletal maturity, emerging evidence suggests that surgical procedures involving the sacroiliac joint may alter pelvic parameters. This study aimed to evaluate the effect of S2AI screw fixation on spinopelvic parameters and analyse variations based on preoperative PI values.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted of 80 consecutive patients (160 screws) who underwent spinopelvic fusion for adult degenerative scoliosis between January 2020 and December 2023. Standing radiographs obtained preoperatively and at one-year follow-up were analysed for PI, pelvic tilt (PT), sacral slope (SS), and lumbar lordosis (LL). Patients were classified by preoperative PI as low (&lt;40°), normal (40°–60°), or high (&gt;60°). Changes &gt;6° were considered clinically significant. Statistical analyses used paired t-tests and chi-squared tests (p &lt; 0.05).</div></div><div><h3>Results</h3><div>PI significantly decreased from 50.45° ± 11.42°–46.18° ± 10.81° (p &lt; 0.001), and PT decreased from 21.46° ± 10.45°–16.50° ± 9.19° (p &lt; 0.001), while SS remained unchanged (p = 0.403). PI–LL mismatch improved from 18.26° ± 11.30°–8.07° ± 5.88° (p &lt; 0.001). Clinically significant PI reduction (&gt;6°) occurred in 40 % of patients, most frequently in those with high preoperative PI (64.7 % vs. 36.5 % normal, 18.2 % low; p = 0.043). ODI scores improved from 77.2 ± 12.1 to 33.9 ± 15.0 (p &lt; 0.001), representing a 56 % reduction in disability, with all patients achieving the minimal clinically important difference. Hardware failure occurred in four screws (2.5 %) without related symptoms or need for revision, and alignment was maintained.</div></div><div><h3>Conclusion</h3><div>S2AI screw fixation significantly modifies spinopelvic parameters, challenging the concept of fixed PI after skeletal maturity. Greater PI reduction in patients with high preoperative PI highlights its relevance for surgical planning in adult spinal deformity correction.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103278"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624497","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":"Posterior-only versus combined anterior–posterior approaches in severe rigid scoliosis: A systematic review and meta-analysis","authors":"Anil Regmi ,&nbsp;Bishwa Bandhu Niraula","doi":"10.1016/j.jcot.2025.103306","DOIUrl":"10.1016/j.jcot.2025.103306","url":null,"abstract":"<div><h3>Background</h3><div>The optimal surgical strategy, whether to proceed with posterior-only or combined anterior-posterior correction for severe, rigid scoliosis, remains a topic of debate. This systematic review and meta-analysis compared radiological correction and perioperative outcomes between these two techniques.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis (PROSPERO: CRD420251142691) of PubMed, Embase, and Scopus identified studies of patients with severe rigid scoliosis treated by posterior-only or AP approaches. Data on demographics, deformity features, operative parameters, hospital stay, correction rates, and complications were extracted. Quality was assessed using the Newcastle–Ottawa Scale. A meta-analysis of operative and radiographic outcomes was performed using a random-effects model with inverse variance, pooling raw means or standardized mean differences (SMD), and assessing heterogeneity with I² and Chi².</div></div><div><h3>Results</h3><div>Posterior-only and combined anterior–posterior (AP) approaches both achieved significant correction of coronal (SMD 4.58, 95 % CI 3.86–5.30) and sagittal (SMD 1.38, 95 % CI 0.13–2.63) Cobb angles. Posterior-only approaches were associated with shorter operative time (356.7 min) and lower intraoperative blood loss (2306 mL) compared with combined AP approaches. Hospital stay varied across studies (mean 18.7 days). Post-operative coronal and sagittal balance showed no significant differences from pre-operative alignment. Heterogeneity across studies was substantial, reflecting variations in technique and patient selection.</div></div><div><h3>Conclusion</h3><div>Posterior-only correction achieves comparable deformity correction and spinal balance to combined anterior–posterior approaches, with shorter operative time and lower blood loss. Careful patient selection remains essential, and further prospective studies are needed to validate these findings.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103306"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145839640","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":"BMI extremes predict distinct trajectories following hip fracture","authors":"Benjamin Hammond ,&nbsp;Alexander Lashgari ,&nbsp;Abhishek Ganta ,&nbsp;Steven Rivero ,&nbsp;Sanjit Konda ,&nbsp;Kenneth Egol","doi":"10.1016/j.jcot.2025.103262","DOIUrl":"10.1016/j.jcot.2025.103262","url":null,"abstract":"<div><h3>Background</h3><div>While extremes of body mass index (BMI) are known to influence surgical risks, their distinct impacts on short- and long-term outcomes following hip fracture remain poorly defined. This study compared outcomes in severely underweight, normal weight, and obese elderly patients.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted using a prospectively collected hip fracture database (2014–2024) at a single academic medical center. Patients with BMI ≤16.5 (severely underweight) or ≥35 (class 2+ obesity) were compared to a randomly selected cohort of normal-weight controls (BMI 18.5–25.0). Outcomes included complications, discharge disposition, mortality, and functional recovery.</div></div><div><h3>Results</h3><div>A total of 282 patients were included. Obese patients had significantly higher odds of intensive care unit (ICU) admission compared to normal weight patients (OR 5.75 [2.00–16.39], p = .001) and were less likely to be discharged home (OR 0.31 [0.14–0.66], p = .003). In contrast, underweight status was significantly associated with increased six-month mortality compared to normal weight (OR 4.95 [1.34–18.18], p = .016). No significant differences were found in healing or functionality across groups.</div></div><div><h3>Conclusion</h3><div>Obese patients were more likely to require ICU admission but did not face increased long-term mortality. Severely underweight patients demonstrated the opposite pattern, with minimal short-term morbidity but significantly higher risk of death at six months. These findings suggest that short- and long-term risks after hip fracture diverge at the extremes of BMI and highlight the need for tailored perioperative strategies based on metabolic status.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103262"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145499920","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":"Prognostic significance of biomarker expression on immunohistochemistry for overall survival in osteosarcoma: An overview of systematic reviews","authors":"Duddukunta Vishal Reddy,&nbsp;Aritra Chattopadhyay,&nbsp;Madhubari Vathulya,&nbsp;Mohit Dhingra","doi":"10.1016/j.jcot.2025.103264","DOIUrl":"10.1016/j.jcot.2025.103264","url":null,"abstract":"<div><h3>Background</h3><div>To summarize evidence from systematic reviews on the prognostic value of tissue immunohistochemistry biomarkers in predicting overall survival in patients with osteosarcoma.</div></div><div><h3>Methodology</h3><div>The Overview was prospectively registered on PROSPERO (ID Number: CRD42024615273), and a comprehensive search of Cochrane Database, PubMed, EMBASE, and Web of Science was conducted for all systematic reviews (SRs) published in English using the term ‘osteosarcoma’. Eligible SRs reported survival prognostication of IHC-detected tumor biomarkers using hazard ratios (HR) as the effect measure. These SRs contained primary studies exclusively involving participants with bone and soft tissue sarcomas. The AMSTAR-2 tool was used to assess the risk of bias, and the GRADE framework was applied to evaluate the certainty of synthesized evidence.</div></div><div><h3>Results</h3><div>The search yielded 1467 systematic reviews, of which 10 SRs comprising 5288 participants met the inclusion criteria. Overexpression of Ezrin (HR: 3.15 [2.39–4.14], p &lt; 0.001), HIF-1α (HR: 2.6 [2.09–3.24], p &lt; 0.001), p53 (HR: 2.49 [1.50–4.12], p &lt; 0.001), VEGF (HR: 2.42 [1.87–3.11], p &lt; 0.001), IGF-1R (HR: 2.2 [1.36–3.03], p &lt; 0.001), CXCR4 (HR: 2.13 [1.78–2.55], p &lt; 0.001), HER2 (HR: 2.03 [1.36–3.03], p &lt; 0.001), PD-L1 (HR: 1.72 [1.30–2.28], p &lt; 0.001), and CD44V6 (HR: 1.53 [1.25–1.88], p &lt; 0.001) was significantly associated with poorer survival outcomes. Conversely, p16 expression (HR: 0.33 [0.02–5.74], p = 0.448) suggested a protective effect, though not statistically significant. The certainty of evidence varied from very low to high, while AMSTAR-2 ratings for the included SRs ranged from critically low to low.</div></div><div><h3>Conclusions</h3><div>Overexpression of VEGF, HIF-1α, Ezrin, and p53 was strongly associated with increased mortality risk in osteosarcoma. These findings may guide patient counselling, biomarker panel optimization, and the development of targeted therapies.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103264"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145529062","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":"Reviewer Acknowledgment-2025","authors":"","doi":"10.1016/j.jcot.2025.103332","DOIUrl":"10.1016/j.jcot.2025.103332","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"72 ","pages":"Article 103332"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145938791","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}