Journal of Hand Surgery-American Volume最新文献

{"title":"Delivery of Hand Care to Patients With High Anxiety Burden.","authors":"Caellagh D Catley, Sarah C Romans, Abby L Cheng, Ryan P Calfee","doi":"10.1016/j.jhsa.2024.08.005","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.08.005","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether patients presenting with Patient-Reported Outcome Measurement Information System (PROMIS) anxiety scores at >95th percentile of the US population undergo elective hand surgery at rates different from patients with less anxiety. Secondarily, we aimed to assess surgeon notation of these patients' emotional states and incidences of postoperative complications.</p><p><strong>Methods: </strong>This single-center retrospective cohort study analyzed data from new adult patients presenting for hand care between January 2019 and December 2020. Patients with initial PROMIS anxiety scores ≥70 were identified as the high anxiety burden (HAB) group. For each patient with HAB presenting with carpal tunnel syndrome, trigger finger, and distal radius fractures (n = 45), three controls were matched (n = 135). After matching, bivariate statistical analysis compared outcome variables of interest between patient groups. Sentiment analysis was used to explore if patient anxiety was realized and considered in surgical decision making.</p><p><strong>Results: </strong>After matching, patients with HAB averaged baseline PROMIS scores in every assessed domain that were ≥1 SD worse than unaffected patients. Patients with HAB and control patients were offered surgery at a comparable rate (58% vs 47%). Among those offered surgery, patients with HAB were less likely to undergo surgery (73% vs 92%). Postoperative complications occurred more frequently in the patients with HAB (32% vs 8%). Sentiment analysis of office notes revealed that the patients with HAB had their emotional state explicitly noted more often (40% vs 24%), but the majority of patients with HAB did not have this addressed in records.</p><p><strong>Conclusions: </strong>Patients with HAB both underwent surgery offered less frequently and when undergoing surgery, experienced more complications. Surgeons are likely to miss opportunities to positively influence extreme patient anxiety as most patients with HAB were treated without mention of their emotional state. Future investigations should explore whether preoperative anxiety alleviation could diminish these disparities.</p><p><strong>Type of study/level of evidence: </strong>Symptom prevalence III.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301277","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":"Evaluating the Effectiveness of Commercially Available Antiadhesion Tendon Protector Sheets in Tendon Repair Surgery Versus Tendon Repair Surgery Alone: A Preclinical Model Study.","authors":"Rou Wan, Gongyin Zhao, Elameen A Adam, Omar A Selim, Aida K Sarcon, Ramona L Reisdorf, Alexander Meves, Chunfeng Zhao, Steven L Moran","doi":"10.1016/j.jhsa.2024.08.002","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.08.002","url":null,"abstract":"<p><strong>Purpose: </strong>Adhesion formation is the major complication after tendon repairs that halts functional restoration and causes disability in patients. This study aimed to compare the antiadhesion efficacy of two tendon protector sheets using a previously established turkey flexor tendon model.</p><p><strong>Methods: </strong>Twenty-four adult Bourbon Red turkeys were randomized into three groups: (1) control, (2) type I collagen-glycosaminoglycan (Collagen-GAG), and (3) hyaluronic acid. In each group, the flexor digitorum profundus tendon of the middle digit was sharply lacerated at the proximal interphalangeal joint level. All operated feet were immobilized until sacrifice 6 weeks after the surgery. After sacrifice, the repaired and normal digits were collected for biomechanical testing, adhesion scores, histological examination, and adhesion-related gene expression analysis.</p><p><strong>Results: </strong>At 42 days after tendon repair, the normalized work of flexion of the repaired digit was the lowest in the Collagen-GAG group. The Collagen-GAG group also had the lowest gross adhesion score, indicating minimal adhesion. The hyaluronic acid group showed lower adhesion scores compared with the control, but the difference was not statistically significant. Microscopically, the Collagen-GAG group had a significantly lower histological adhesion score than the control group. In the Collagen-GAG group, the gene expression levels of WNT3A, WNT5A, and WNT7A were suppressed.</p><p><strong>Conclusions: </strong>In an avian model of flexor tendon repair, the application of tendon protector sheets reduces peritendinous fibrotic tissue formation histologically.</p><p><strong>Clinical relevance: </strong>There are currently limited commercially available products to reduce postoperative peritendinous adhesions. Further validation is needed to confirm the effectiveness of tendon protector sheets in improving surgical outcomes following tendon repairs.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301281","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 Community Engagement to Enhance Research and Practice in Hand Surgery.","authors":"Noelle Thompson, Rachel C Hooper","doi":"10.1016/j.jhsa.2024.07.022","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.022","url":null,"abstract":"<p><p>Health disparities related to race, ethnicity, gender, level of education, and other social determinants of health remain prevalent in medicine and surgery. Understanding the impact of health disparities on treatment decisions and outcomes among common hand surgery conditions has been a major focus of the American Society for Surgery of the Hand. Creative strategies are necessary to go beyond the description of disparities and move toward the proposal of actionable solutions. Community engagement research is one feasible approach that can help hand surgeons narrow these gaps and improve health care outcomes. With this approach, hand surgeons can improve patient-provider communication, increase knowledge of specific hand conditions among community members, and help guide subsequent initiatives to improve access and usage of hand surgery treatment. Community members can take on various roles ranging from participants to partnered investigators, enhancing the overall process to identify actionable solutions with the end user in mind. Additionally, the creation of community-academic partnerships through community engagement research is an excellent way to dismantle the historical mistrust among underrepresented groups through the deliberate inclusion of community members in the research design and execution.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301285","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":"Increasing Prevalence of Xylazine and Worsening Upper-Extremity Wounds in Injection Drug Use: A Local Phenomenon With National Implications.","authors":"Kirin Naidu, Carrie Z Morales, Elizabeth B Card, Ines C Lin","doi":"10.1016/j.jhsa.2024.07.017","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.017","url":null,"abstract":"<p><p>The rising presence of xylazine in Philadelphia's fentanyl supply has led to various upper-extremity complications in individuals who inject drugs. Sociogeographic trends predict that our current local phenomenon will spread nationally. We aim to discuss the drug's impact on clinical presentation and patient care via a cohort of five patients with upper-extremity wounds related to drug use. Interventions included local wound care, revascularization, compartment release, free flap reconstruction, and amputation. Successful treatment of these patients, who are often in challenging psychosocial environments, requires an individualized and interdisciplinary approach including surgical services, infectious disease, wound care, addiction medicine, psychiatry, social services, and prosthetic services.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301282","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":"Establishing the Patient-Acceptable Symptom State for the Numeric Rating Scale-Pain Score in a Postoperative Non-Shoulder Hand and Upper-Extremity Population.","authors":"Joshua R Daryoush, Miranda J Rogers, James C Hubbard, Jantz Arbon, Chong Zhang, Angela P Presson, Brittany N Garcia, Nikolas H Kazmers","doi":"10.1016/j.jhsa.2024.07.020","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.020","url":null,"abstract":"<p><strong>Purpose: </strong>The patient-acceptable symptom state (PASS) is a threshold score on a patient-reported outcome measurement beyond which patients consider themselves \"well.\" Our purpose was to establish the PASS for the numeric rating scale (NRS) for pain in a 1-year postoperative hand surgery population.</p><p><strong>Methods: </strong>This retrospective study included adult patients undergoing non-shoulder upper-extremity surgery at a single, tertiary medical center identified over a 9-month period. At 1 year after surgery, NRS pain and responses to a pain-specific anchor question were collected. Patients were dichotomized based on achieving \"PASS(+)\" or failing to achieve \"PASS(-)\" an acceptable symptom state based upon their response to a pain-specific anchor question. Threshold values of a PASS(+) state were calculated for the NRS pain score using the following three methods: (1) mean score of PASS(+) patients, (2) Tubach method (75th percentile threshold for PASS(+) patients), and (3) the Youden index (receiver operating curve analysis to maximize sensitivity and specificity).</p><p><strong>Results: </strong>Of 233 included patients, mean age was 54 years (±17), and 58% (n = 136) were women. Mean NRS pain scores differed between PASS(+) and PASS(-) patients (0.7 ± 1.2 vs 3.8 ± 2.7, respectively). PASS(-) patients were more likely to be non-White and have a diagnosed psychiatric comorbidity. Patient-acceptable symptom state estimates ranged from 0.73 to 2.1 for NRS pain, depending on the calculation method (0.73 for the mean score method, 1.0 for the Tubach method, and 2.1 for the Youden index). The area under the curve for the Youden index method was 0.86 consistent with excellent discrimination.</p><p><strong>Conclusions: </strong>We propose the value of 2.1 to represent the PASS threshold for the NRS pain score in this population.</p><p><strong>Clinical relevance: </strong>This PASS value should be used when interpreting NRS pain score outcomes at a population level. This threshold is expected to yield excellent discrimination for patient satisfaction when applied to a postoperative hand surgery population.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301280","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":"Pain Interference Prior to and 1 Year After Surgery for Adult Traumatic Brachial Plexus Injury.","authors":"Christopher J Dy, David M Brogan, Bryan J Loeffler, Steve K Lee, Harvey Chim, Mihir J Desai, Sami H Tuffaha, Yusha Liu","doi":"10.1016/j.jhsa.2024.08.001","DOIUrl":"10.1016/j.jhsa.2024.08.001","url":null,"abstract":"<p><strong>Purpose: </strong>Pain after brachial plexus injury (BPI) can be severely debilitating and is poorly understood. We hypothesized that pain interference (PI) (\"the extent to which pain hinders engagement in life\") would be predicted by depression, anxiety, severity of pain symptoms, and poorer preoperative muscle function.</p><p><strong>Methods: </strong>Among patients in a prospective multicenter BPI cohort study, 37 completed Patient-Reported Outcomes Measurement Information System (PROMIS) PI questionnaires before and 1 year after surgery. At both times, participants completed anxiety and depression questionnaires and BPI-specific measures of pain symptoms, physical limitations, and emotional recovery. Surgeon-graded muscle testing, injury severity, age at the time of injury, body mass index, and time from injury to surgery were included. We performed a bivariate analysis of predictors for preoperative and 1-year PROMIS PI followed by multivariable regression modeling using stepwise selection and Bayesian Information Criterion to select covariates.</p><p><strong>Results: </strong>Before surgery, the mean PROMIS PI score was 60.8 ± 11.0, with moderate correlations between PROMIS PI and depression, as well as between PROMIS PI and functional limitations. At 1 year after surgery, the mean PROMIS PI score was 59.7 ± 9.5. There was no difference in preoperative and 1-year PROMIS PI. There were strong correlations between PROMIS PI and pain symptoms, functional limitations, and emotional aspects of recovery at the 1-year follow-up that remained significant in multivariable regression. There were no notable associations between muscle testing and PI.</p><p><strong>Conclusions: </strong>Pain interference remained substantial and elevated in BPI patients 1 year after surgery. We noted strong associations between PI and pain symptoms, functional limitations, and emotional aspects of recovery. These findings demonstrate the persistence of pain as a feature throughout life after BPI and that its treatment should be considered a priority alongside efforts to improve extremity function.</p><p><strong>Type of study/level of evidence: </strong>Prognosis IV.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301284","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":"Direct Variable Cost Comparison of Monitored Anesthesia Care Versus Wide Awake Local Anesthesia No Tournique Carpal Tunnel Release: A Time-Driven Activity-Based Costing Analysis.","authors":"Terence L Thomas, Calista S Stevens, Graham S Goh, Justin M Kistler, Asif M Ilyas","doi":"10.1016/j.jhsa.2024.07.021","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.021","url":null,"abstract":"<p><strong>Purpose: </strong>Time-driven activity-based costing (TDABC) provides a more accurate and granular estimation of direct variable costs compared with traditional accounting methods. This study used TDABC to quantitatively compare the same-day facility costs of open carpal tunnel release (CTR) performed under monitored anesthesia care (MAC) versus wide awake local anesthesia no tourniquet (WALANT).</p><p><strong>Methods: </strong>We retrospectively identified 474 unilateral CTR (182 MAC and 292 WALANT) performed at an orthopedic specialty hospital between 2015 and 2021. Itemized facility costs were calculated using a TDABC algorithm. Patient demographics, surgical characteristics, and itemized costs were compared between those treated under MAC (MAC-CTR) and WALANT (WALANT-CTR). Multivariable regression was performed to determine the independent effect of MAC on true facility costs.</p><p><strong>Results: </strong>Total facility costs were $170 higher in MAC-CTR compared with WALANT-CTR ($652 vs $482). Monitored anesthesia care-CTR cases had higher personnel costs ($537 vs $394), likely because of higher surgery personnel ($303 vs $185) and postanesthesia care unit personnel costs ($117 vs $95). Monitored anesthesia care-CTR cases also had higher supply costs ($119 vs $81). When controlling for demographics and comorbidities, MAC-CTR was independently associated with an increase in personnel costs by $150.65 (95% CI, $131.09-$170.21), supply costs by $24.99 (95% CI, $9.40-$40.58), and total facility costs by $175.66 (95% CI, $150.18-$201.09) per case.</p><p><strong>Conclusions: </strong>Using TDABC, MAC-CTR was found to be 35% more costly to the facility compared with WALANT-CTR. Notably, WALANT-CTR facility costs presented here do not include additional cost savings from anesthesiologist service fees or preoperative laboratory clearance required for MAC-CTR surgeries. To reduce costs related to CTR surgery, greater efforts should be made to reduce the number of intraoperative personnel and maximize the use of WALANT-CTR in an outpatient setting.</p><p><strong>Type of study/level of evidence: </strong>Economic and Decision Analysis II.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301278","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":"Articular Fragment Escape and Carpal Subluxation Following Distal Radius Fracture Fixation.","authors":"Remy V Rabinovich, Daniel B Polatsch, Steven Beldner","doi":"10.1016/j.jhsa.2024.07.018","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.018","url":null,"abstract":"<p><p>Surgical fixation of distal radius fractures is among the more common procedures performed by hand surgeons. The approach to surgical management is based on a variety of factors including injury mechanism, fracture pattern, patient characteristics, bone quality, soft tissue injury, and surgeon preference. For the majority of fracture types, volar locking plate fixation has become the most commonly used method of fracture fixation. Although uncommon, complications can arise following this form of treatment, one of which is escape of an articular fragment with resultant carpal instability. More often seen in conjunction with poorly reduced or captured displaced volar lunate facet fragments, fixation failure and carpal instability can occur with other fracture patterns that have garnered less attention, particularly those involving the radial column or dorsal lunate facet. Thorough preoperative planning to recognize fracture patterns that lead to this complication is paramount. Proper selection of implants used to secure the fracture and the choice as well as duration of postoperative immobilization is critical to minimizing this complication. We aim to (1) describe the relevant anatomy involved with this complication, (2) organize and classify the various distal radius articular fragment escape patterns that can occur following fracture fixation, and (3) discuss strategies that can help prevent this complication.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301274","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":"Over-the-Top Foveal Triangular Fibrocartilage Complex Repair.","authors":"Sanjeev Kakar, Lauren E Dittman, Andreas Rozenits, Robert Kalapos","doi":"10.1016/j.jhsa.2024.07.015","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.07.015","url":null,"abstract":"<p><p>There are many techniques that address triangular fibrocartilage complex foveal injuries, which are typically performed with an outside to inside technique. In this article, we describe an inside to outside triangular fibrocartilage complex repair technique that may result in more accurate suture passage and mitigate the risk of fracture from ulna tunnels.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301283","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":"Campanacci Grade 2 or 3 Giant Cell Tumor of the Phalanges: En Bloc Resection and Matched Nonvascularized Toe Phalangeal Transfer.","authors":"Binu Prathap Thomas, Sreekanth Raveendran, Samuel Cr Pallapati, Kiran Sasi P","doi":"10.1016/j.jhsa.2024.06.013","DOIUrl":"https://doi.org/10.1016/j.jhsa.2024.06.013","url":null,"abstract":"<p><strong>Purpose: </strong>The goal of the study was to assess the result of en bloc resection and matched nonvascularized toe phalangeal transfer in Campanacci grade 2 or 3 giant cell tumors of the phalanges.</p><p><strong>Methods: </strong>Seven patients with Campanacci grade 2 and 3 phalangeal giant cell tumors were treated by en bloc resection and matched nonvascularized toe phalangeal transfer between June 2004 and May 2021. The patients were followed up by X-rays, Patient-Rated Hand and Wrist scores, Foot Function Index, Quick Disabilities of the Arm, Shoulder, and Hand questionnaire, and total active motion measurements.</p><p><strong>Results: </strong>The minimum follow-up was 18 months (range: 18-230 months; mean: 110 ± 81). There were three males and four females, with age ranging from 13 to 48 years (mean: 24.14 ± 11.74). The right:left hand ratio was 3:4. The thumb was involved in one patient, the index finger in two, the middle finger in one, and the ring finger in three patients. The mean total active motion was 201.70 (range: 190°-240°). The mean patient-rated hand and wrist score was 15.2 (range: 10-35). The mean quick disabilities of the arm, shoulder and hand questionnaire score was 1.3 (range: 0-9). The mean foot function index on follow-up was 2.86 (range: 2-3). There was no tumor recurrence. One patient had a pathological fracture with resultant shortening of the finger on follow-up.</p><p><strong>Conclusions: </strong>In our series en bloc resection and matched nonvascularized toe phalangeal transfer resulted in a functional tumor-free digit with a low complication rate and no recurrences.</p><p><strong>Type of study/level of evidence: </strong>Therapeutic V.</p>","PeriodicalId":54815,"journal":{"name":"Journal of Hand Surgery-American Volume","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301275","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}