Shawn M. Robbins , Evangelos Tyrpenou , Soomin Lee , Patrick Ippersiel , John Antoniou
{"title":"Impact of combined lumbar spine fusion and total hip arthroplasty on spine, pelvis, and hip kinematics during a sit to stand task","authors":"Shawn M. Robbins , Evangelos Tyrpenou , Soomin Lee , Patrick Ippersiel , John Antoniou","doi":"10.1016/j.jelekin.2024.102871","DOIUrl":"https://doi.org/10.1016/j.jelekin.2024.102871","url":null,"abstract":"<div><p>Lumbar fusion is a risk factor for hip dislocation following total hip arthroplasty (THA). The objective was to compare joint/segment angles during sit-stand-sit in participants that had a THA with and without a lumbar fusion. The secondary objective was to compare pain, physical function, disability, and quality of life. This cross-sectional study includes participants that had THA and lumbar fusion (THA-fusion; n = 12) or THA only (THA-only; n = 12). Participants completed sit-stand-sit trials. Joint/segment angles were measured using electromagnetic motion capture. Angle characteristics were determined using principal component analysis. Hierarchical linear models examined relationships between angle characteristics and groups. Pain, physical function, and disability were compared using Mann-Whitney U tests. Upper lumbar spine was more extended during sit-stand-sit in the THA-fusion group (b = 42.41, <em>P</em> = 0.04). The pelvis was more posteriorly and anteriorly tilted during down and end sit-stand-sit phases, respectively, in the THA-fusion group (b = 12.21, <em>P</em> = 0.03). There were no significant associations between group and other angles. THA-fusion group had worse pain, physical function, disability, and quality of life. Although differences in spine joint, pelvis segment, and hip joint angles existed, these findings are unlikely to account for the increased incidence of hip dislocation after total hip arthroplasty in patients that had spine fusion.</p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"75 ","pages":"Article 102871"},"PeriodicalIF":2.5,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1050641124000154/pdfft?md5=3635de969fdb0d3358adace0cc3b4254&pid=1-s2.0-S1050641124000154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140062115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael J. Marsala , David A. Gabriel , J. Greig Inglis , Anita D. Christie
{"title":"How many motor units is enough? An assessment of the influence of the number of motor units on firing rate calculations","authors":"Michael J. Marsala , David A. Gabriel , J. Greig Inglis , Anita D. Christie","doi":"10.1016/j.jelekin.2024.102872","DOIUrl":"https://doi.org/10.1016/j.jelekin.2024.102872","url":null,"abstract":"<div><p>The number of motor units included in calculations of mean firing rates varies widely in the literature. It is unknown how the number of decomposed motor units included in the calculation of firing rate per participant compares to the total number of active motor units in the muscle, and if this is different for males and females. Bootstrapped distributions and confidence intervals (CI) of mean motor unit firing rates decomposed from the tibialis anterior were used to represent the total number of active motor units for individual participants in trials from 20 to 100 % of maximal voluntary contraction. Bootstrapped distributions of mean firing rates were constructed using different numbers of motor units, from one to the maximum number for each participant, and compared to the CIs. A probability measure for each number of motor units involved in firing rate was calculated and then averaged across all individuals. Motor unit numbers required for similar levels of probability increased as contraction intensity increased (<em>p</em> < 0.001). Increased levels of probability also required higher numbers of motor units (<em>p</em> < 0.001). There was no effect of sex (<em>p</em> ≥ 0.97) for any comparison. This methodology should be repeated in other muscles, and aged populations.</p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"75 ","pages":"Article 102872"},"PeriodicalIF":2.5,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140052584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dario G. Liebermann , Jonas L. Markström , Jonas Selling , Charlotte K. Häger
{"title":"Spatiotemporal lower-limb asymmetries during stair descent in athletes following anterior cruciate ligament reconstruction","authors":"Dario G. Liebermann , Jonas L. Markström , Jonas Selling , Charlotte K. Häger","doi":"10.1016/j.jelekin.2024.102868","DOIUrl":"https://doi.org/10.1016/j.jelekin.2024.102868","url":null,"abstract":"<div><h3>Purpose</h3><p>This study evaluated motor control recovery at different times following anterior cruciate ligament reconstruction (ACLR) by investigating lower-limb spatiotemporal symmetry during stair descent performances.</p></div><div><h3>Methods</h3><p>We used a cross-sectional design to compare asymptomatic athletes (Controls, n = 18) with a group of people with ACLR (n = 49) divided into three time-from-ACLR subgroups (Early: <6 months, n = 17; Mid: 6–18 months, n = 16; Late: ≥18 months, n = 16). We evaluated: “temporal symmetry” during the stance subphases (single-support, first and second double-support) and “spatial symmetry” for hip-knee-ankle intra-joint angular displacements during the stance phase using a dissimilarity index applied on superimposed 3D phase plots.</p></div><div><h3>Results</h3><p>We found significant between-group differences in temporal variables (p ≤ 0.001). Compared to Controls, both Early and Mid (p ≤ 0.05) showed asymmetry in the first double-support time (longer for their injured vs. non-injured leg), while Early generally also showed longer durations in all other phases, regardless of stepping leg. No statistically significant differences were found for spatial intra-joint symmetry between groups.</p></div><div><h3>Conclusion</h3><p>Temporal but not spatial asymmetry in stair descent is often present early after ACLR; it may remain for up to 18 months and may underlie subtle intra- and inter-joint compensations. Spatial asymmetry may need further exploration.</p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"75 ","pages":"Article 102868"},"PeriodicalIF":2.5,"publicationDate":"2024-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1050641124000129/pdfft?md5=ec5d40beed2a2b4129c4d5b6f79451e2&pid=1-s2.0-S1050641124000129-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139738375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kara-Lyn Harrison, Zachariah Henderson, Josée Rochon, Sarah Bohunicky, Trisha Scribbans
{"title":"Excitation distribution of the trapezius changes in response to increasing contraction intensity, but not repeated contractions","authors":"Kara-Lyn Harrison, Zachariah Henderson, Josée Rochon, Sarah Bohunicky, Trisha Scribbans","doi":"10.1016/j.jelekin.2024.102866","DOIUrl":"10.1016/j.jelekin.2024.102866","url":null,"abstract":"<div><p>Upper trapezius (UT) excitation redistributes with experimentally-induced muscle pain, fatigue, and repeated contractions. Excitation distribution variability is proposed to reduce the likelihood of shoulder pain and pathology by reducing cumulative stress on musculoskeletal structures. While the middle (MT) and lower (LT) trapezius are pivotal in scapular stabilization, it remains unclear whether they display similar excitation distribution variability with repeated or increasing contraction intensity. We determined if excitation distribution of the UT, MT, and LT differ: 1) during isometric contractions at different intensities (30 % and 60 % of maximum voluntary isometric contraction (MVIC)); and 2) with repeated contractions at 60 % MVIC. Nineteen individuals completed MVICs and submaximal contractions for the UT, MT, and LT while high-density electromyography was collected. Statistical parametric mapping t-tests were performed between intensities and the 1st and 5th repetition at 60 % MVIC. UT, MT, and LT excitation distribution changed with increasing contraction intensity in 358 (∼92 % of the map), 54 (∼14 %), and 270 pixels (∼70 %), respectively. No pixels exceeded significance with repeated contractions for any muscle. Barycentre analyses revealed no significant results. These results suggest that regions of the trapezius muscle use different neuromuscular strategies in response to changes in contraction intensity and repeated contractions.</p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"75 ","pages":"Article 102866"},"PeriodicalIF":2.5,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1050641124000105/pdfft?md5=106f59e2a854fcadd97b8504c8f23399&pid=1-s2.0-S1050641124000105-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139669513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel P. Armstrong, Justin B. Davidson, Steven L. Fischer
{"title":"Determining whether biomechanical variables that describe common ‘safe lifting’ cues are associated with low back loads","authors":"Daniel P. Armstrong, Justin B. Davidson, Steven L. Fischer","doi":"10.1016/j.jelekin.2024.102867","DOIUrl":"10.1016/j.jelekin.2024.102867","url":null,"abstract":"<div><p>Lift technique training programs have been implemented to help reduce injury risk, but the underlying content validity of cues used within these programs is not clear. The objective of this study was to determine whether biomechanical variables, that commonly used lifting cues aim to elicit, are associated with resultant low back extensor moment exposures. A sample of 72 participants were recruited to perform 10 repetitions of a floor-to-waist height barbell lift while whole-body kinematics and ground reaction forces were collected. Kinematic, kinetic, and energetic variables representative of characteristics commonly targeted by lifting cues were calculated as predictor variables, while peak and cumulative low back moments were calculated as dependent measures. Multiple regression revealed that 56.6–59.2% of variance in low back moments was explained by predictor variables. From these regression models, generating motion with the legs (both greater hip and knee work), minimizing the horizontal distance of the body to the load, maintaining a stable body position, and minimizing lift time were associated with lower magnitudes of low back moments. These data support that using cues targeting these identified variables may be more effective at reducing peak low back moment exposures via lift training.</p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"75 ","pages":"Article 102867"},"PeriodicalIF":2.5,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1050641124000117/pdfft?md5=331cb89065147b5e66587b1dbd11a54c&pid=1-s2.0-S1050641124000117-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139677859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Lower extremity muscle patterns and frontal plane biomechanics are altered in the contralateral knee of adults with osteoarthritis compared to asymptomatic adults","authors":"Sarah Remedios , Derek Rutherford","doi":"10.1016/j.jelekin.2024.102865","DOIUrl":"10.1016/j.jelekin.2024.102865","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare knee joint muscle activity during gait between the contralateral<span> limb of individuals with knee osteoarthritis (OA) and an asymptomatic older adult group. A secondary objective was to compare frontal and sagittal plane moment and sagittal plane motion features between groups.</span></p><p>Scope: 84 individuals with moderate knee OA (61 ± 6 years, 43 % female, BMI 29.2 ± 5.7 kg/m<sup>2</sup>), and 45 asymptomatic older adults (61 ± 7 years, 49 % female, BMI 25.0 ± 3.4 kg/m<sup>2</sup><span>) participated. Participants walked at a self-selected pace on a dual belt treadmill. Surface electromyograms of the quadriceps, hamstrings, and gastrocnemius, segment motions and ground reaction forces were recorded. Principal component analyses identified amplitude and temporal electromyogram features. Sagittal plane motion and net external sagittal and frontal plane moments were calculated. Analysis of Variance models using Bonferroni corrections determined between and within group differences in these gait features.</span></p></div><div><h3>Conclusions</h3><p>The contralateral knee showed prolonged lateral hamstring activation and altered temporal features of the gastrocnemius and greater knee adduction moments compared to asymptomatic adults. Group, muscle, or interaction effects were not found for the quadriceps. These findings highlight the importance of exploring the implications of contralateral knee function of individuals with moderate knee OA, particularly considering the altered antagonist muscle activations, and heightened frontal plane moments.</p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"75 ","pages":"Article 102865"},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139669269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haopeng Wang , Berj Bardizbanian , Ziling Zhu , He Wang , Chenyun Dai , Edward A. Clancy
{"title":"Evaluation of generic EMG-Torque models across two Upper-Limb joints","authors":"Haopeng Wang , Berj Bardizbanian , Ziling Zhu , He Wang , Chenyun Dai , Edward A. Clancy","doi":"10.1016/j.jelekin.2024.102864","DOIUrl":"10.1016/j.jelekin.2024.102864","url":null,"abstract":"<div><p>Advanced single-use dynamic EMG-torque models require burdensome subject-specific calibration contractions and have historically been <em>assumed</em> to produce lower error than generic models (i.e., models that are identical across subjects and muscles). To investigate this assumption, we studied generic one degree of freedom (DoF) models derived from the ensemble median of subject-specific models, evaluated across subject, DoF and joint. We used elbow (<em>N</em> = 64) and hand-wrist (<em>N</em> = 9) datasets. Subject-specific elbow models performed statistically better [5.79 ± 1.89 %MVT (maximum voluntary torque) error] than generic elbow models (6.21 ± 1.85 %MVT error). However, there were no statistical differences between subject-specific vs. generic models <em>within</em><span> each hand-wrist DoF. Next, we evaluated generic models across joints. The best hand-wrist generic model had errors of 6.29 ± 1.85 %MVT when applied to the elbow. The elbow generic model had errors of 7.04 ± 2.29 %MVT when applied to the hand-wrist. The generic elbow model was statistically better in both joints, compared to the generic hand-wrist model. Finally, we tested Butterworth filter models (a simpler generic model), finding no statistical differences between optimum Butterworth and subject-specific models. Overall, generic models simplified EMG-torque training without substantive performance degradation and provided the possibility of transfer learning between joints.</span></p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"75 ","pages":"Article 102864"},"PeriodicalIF":2.5,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139669110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Steven Phu , Daina L. Sturnieks , Patrick Y.H. Song , Stephen R. Lord , Yoshiro Okubo
{"title":"Treadmill induced belt-accelerations may not accurately evoke the muscle responses to obstacle trips in older people","authors":"Steven Phu , Daina L. Sturnieks , Patrick Y.H. Song , Stephen R. Lord , Yoshiro Okubo","doi":"10.1016/j.jelekin.2024.102857","DOIUrl":"10.1016/j.jelekin.2024.102857","url":null,"abstract":"<div><h3>Background</h3><p>Treadmill belt-accelerations are a commonly utilised surrogate for tripping, but their physiological validity is unknown. This study examined if a treadmill belt-acceleration induces lower limb muscle activation responses similar to a trip on a walkway.</p></div><div><h3>Methods</h3><p>38 older people (65+ years) experienced one treadmill belt-acceleration and one walkway obstacle trip in random order. Muscle responses were assessed bilaterally using surface electromyography on the rectus femoris (RF), tibialis anterior (TA), semitendinosus (ST) and gastrocnemius medial head (GM). Unperturbed muscle activity, post-perturbation onset latency, peak magnitude, time to peak and co-contraction index (CCI) were examined.</p></div><div><h3>Results</h3><p>Muscle activity in the right ST was greater during unperturbed walking on the treadmill compared to walkway (<em>P</em>=0.011). Compared to a treadmill belt-acceleration, a walkway trip elicited faster onset latencies in all muscles; greater peak magnitudes in the left RF, TA, GM and right GM; faster time to peaks in the left TA and right GM; and lower knee and ankle muscle CCI (<em>P</em><0.05).</p></div><div><h3>Conclusions</h3><p>Walkway trips and treadmill belt-accelerations elicit distinct muscle activation patterns. While walkway trips induced faster and larger muscle responses, treadmill belt-accelerations involved greater co-contraction. Therefore, treadmill belt-accelerations may not accurately simulate the muscle responses to trips.</p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"75 ","pages":"Article 102857"},"PeriodicalIF":2.5,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139554717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Uri Gottlieb, Roee Hayek, Jay R. Hoffman, Shmuel Springer
{"title":"Exercise combined with electrical stimulation for the treatment of chronic ankle instability – A randomized controlled trial","authors":"Uri Gottlieb, Roee Hayek, Jay R. Hoffman, Shmuel Springer","doi":"10.1016/j.jelekin.2023.102856","DOIUrl":"10.1016/j.jelekin.2023.102856","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To compare the short, medium, and long-term effects of balance exercises combined with either peroneal neuromuscular electrical stimulation (NMES) or peroneal </span>transcutaneous electrical nerve stimulation<span> (TENS) on dynamic postural control and patient reported outcome measures (PROMs) in patients with chronic ankle instability (CAI).</span></p></div><div><h3>Methods</h3><p>Thirty-four participants with CAI were randomly assigned to a 12-session home based exercise program combined with NMES (Ex-NMES) or TENS (Ex- TENS). Baseline postural control was tested with the modified Star Excursion Balance Test (mSEBT) and time to stabilization (TTS) after a single-leg drop-jump. The self-reported function was measured using the Cumberland Ankle Instability Tool (CAIT), the Identification of Functional Ankle Instability (IdFAI), and the Sports subscale of the Foot and Ankle Ability Measure (FAAM<sub>Sport</sub>).</p></div><div><h3>Results</h3><p>Both groups showed significant improvements in all self-reported outcome measures at the 12-month follow-up. Subjects in the Ex-NMES group had significantly better IdFAI (-4.2 [95% CI −8.1, −0.2]) and FAAM<sub>Sport</sub> (13.7 [95% CI 2.2, 25.2]) scores at 6- and 12-month follow-up, respectively, compared to the Ex-TENS group. Medium to large between-group effect sizes were observed in self-reported functional outcomes and the mSEBT.</p></div><div><h3>Conclusion</h3><p>The consistent trend of improvement in self-reported functional outcomes when training is combined with NMES compared with training with TENS may indicate a potential benefit that should be further investigated as a treatment for patients with CAI.</p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"74 ","pages":"Article 102856"},"PeriodicalIF":2.5,"publicationDate":"2023-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139069355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alessandro Piras , Matteo Bertucco , Francesco Del Santo , Andrea Meoni , Milena Raffi
{"title":"Postural stability assessment in expert versus amateur basketball players during optic flow stimulation","authors":"Alessandro Piras , Matteo Bertucco , Francesco Del Santo , Andrea Meoni , Milena Raffi","doi":"10.1016/j.jelekin.2023.102855","DOIUrl":"10.1016/j.jelekin.2023.102855","url":null,"abstract":"<div><p>We evaluated the role of visual stimulation<span> on postural muscles and the changes in the center of pressure (CoP) during standing posture in expert and amateur basketball players. Participants were instructed to look at a fixation point presented on a screen during foveal, peripheral, and full field optic flow stimuli. Postural mechanisms and motor strategies were assessed by simultaneous recordings of stabilometric, oculomotor, and electromyographic data during visual stimulation. We found significant differences between experts and amateurs in the orientation of visual attention. Experts oriented attention to the right of their visual field, while amateurs to the bottom-right. The displacement in the CoP mediolateral direction showed that experts had a greater postural sway of the right leg, while amateurs on the left leg. The entropy-based data analysis of the CoP mediolateral direction exhibited a greater value in amateurs than in experts. The root-mean-square and the coactivation index analysis showed that experts activated mainly the right leg while amateurs the left leg. In conclusion, playing sports for years seems to have induced some strong differences in the standing posture between the right and left sides. Even during non-ecological visual stimulation, athletes maintain postural adaptations to counteract the body oscillation.</span></p></div>","PeriodicalId":56123,"journal":{"name":"Journal of Electromyography and Kinesiology","volume":"74 ","pages":"Article 102855"},"PeriodicalIF":2.5,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139069289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}