Foot & ankle specialist最新文献

{"title":"Technical Tip: The Use of Arthroscopic Portals to Safeguard Medial Neurovascular Structures During Suture Button Fixation.","authors":"Magnolia Livingston, W Reed Bigham, Ian Savage-Elliott","doi":"10.1177/19386400251341821","DOIUrl":"https://doi.org/10.1177/19386400251341821","url":null,"abstract":"<p><p>IntroductionAnkle fractures with concurrent syndesmotic instability are commonly encountered orthopaedic injuries. Suture button syndesmotic fixation has emerged as a favorable alternative to traditional screw fixation due to its comparable biomechanical stability and reduced hardware removal rates. However, concerns persist regarding potential injury to medial neurovascular structures during tibial cortical button deployment and a medial incision is often recommended for verification.TechniqueThis paper describes a safe and reproducible technique for suture button fixation that offers an alternative to a medial incision. Using an anteromedial arthroscopy portal, indirect visualization, and palpation ensure safe tibial button placement, avoiding neurovascular structure impingement or soft tissue entrapment.DiscussionVia cadavers, we confirmed the absence of neurovascular or soft tissue injury. Anecdotally, this approach has been successfully implemented in multiple clinical cases without observed intraoperative complications or immediate post-operative neurovascular injuries. However, further studies with more rigorous follow-up are needed to confirm its safety and efficacy in a clinical setting. By utilizing an anteromedial arthroscopic portal, this technique offers a potential alternative for confirming button placement without requiring an additional medial incision. Avoiding a medial incision may reduce risks associated with wound healing, infection, and morbidity in the medial ankle-an area prone to soft tissue breakdown. Further research is necessary to assess long-term clinical outcomes and validate the broader applicability of this approach.ConclusionThe described arthroscopic-assisted technique provides a safe, efficient method for suture button fixation in syndesmotic injuries without requiring a medial incision. By utilizing indirect visualization and palpation, it minimizes risks of neurovascular injury and surgical morbidity while preserving the benefits of suture button constructs. This technique provides a reproducible and efficient alternate approach to managing syndesmotic instability in ankle fractures.Level of Evidence:V.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251341821"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327975","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":"Does Fragment-Specific Fixation Provide Better Functional Outcomes Following Trimalleolar Ankle Fractures?","authors":"Danuksha K Amarasena, Upamanyu Nath, Abhirun Das, Thomas Collins, Anand Pillai","doi":"10.1177/19386400251343745","DOIUrl":"https://doi.org/10.1177/19386400251343745","url":null,"abstract":"<p><p>BackgroundFractures to the ankle account for nearly 10% of all fractures. The trimalleolar configuration of ankle fracture is a notoriously unstable injury encompassing injury to the medial, lateral, and posterior malleolus, often occurring as a result of rotational force to the ankle. Historically, poorer outcomes have been associated with fractures of the posterior malleolar component, which were broadly categorized as a single homogenous group. Recent advancements and greater appreciation of fracture pathomechanisms have aided fragment classification and hence tailored fixation. Aims. Our study compares the post-operative functional outcomes following novel fragment-specific plating (Volition) against conventional plating during the surgical fixation of trimalleolar ankle fractures. Post-operative functional outcomes were measured at 12 months using the Foot and Ankle Disability Index (FADI) and Manchester-Oxford Foot Questionnaire (MOXFQ) as patient-reported outcome measures (PROMs).MethodsWe conducted a retrospective cohort study of patients admitted to our orthopaedic department for a corrective surgery following a trimalleolar ankle fracture. Each fracture was confirmed via computed tomography (CT) imaging and corrected using either fragment-specific or conventional plating. Post-operatively, patients were followed up functionally and radiologically.ResultsOur study included 22 matched pairs of patients, each of who required surgical fixation for a trimalleolar ankle fracture. The FADI and MOXFQ questionnaires were conducted to assess functional outcomes during the post-operative period. The PROM data indicated that there were statistically significant superior outcomes in both the activity and pain subscales of the FADI (P > .05). However, no significant differences were observed in the MOXFQ scores.ConclusionThis study concludes that fragment-specific plating of the posterior malleolar component provides superior functional outcomes in terms of pain and activity levels following trimalleolar ankle fractures, as measured by the FADI. Larger studies with longer follow-up are needed to confirm these results and guide standardized treatment protocols.Level of Evidence:Level 2.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251343745"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327974","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":"Anatomic Insights Into Lateral Intersection Syndrome in the Foot and Ankle.","authors":"Steven R Cooperman, Vincent G Vacketta, Christopher F Hyer","doi":"10.1177/19386400251345529","DOIUrl":"https://doi.org/10.1177/19386400251345529","url":null,"abstract":"<p><p>Lateral intersection syndrome, or fibularis intersection syndrome, is an uncommon overuse condition affecting the lateral aspect of the foot involving the intersection of the peroneus longus and brevis tendons. While intersection syndromes have been described in other anatomic locations, such as the wrist and medial foot/ankle, this pathology remains underreported. This cadaveric study aimed to establish baseline anatomical measurements relevant to lateral intersection syndrome. Eight thawed fresh-frozen cadaveric lower limbs, 4 matched pairs, were dissected, and measurements of key lateral foot structures were recorded, including plantar fascia width, peroneus brevis width, the distance between the peroneus brevis and the plantar fascia, and the distance between the cuboid groove and the fifth metatarsal. The average (mean) plantar fascial width was 4.99 mm, whereas the peroneus brevis width averaged 6.64 mm. A notable laterality difference was identified, with right-sided specimens consistently showing larger measurements compared with the left. Limitations include a small sample size and the use of cadaveric models, which may not replicate in vivo tissues. This study serves as a foundational reference for further research into lateral intersection syndrome and highlights the need for increased clinical recognition of the pathology.<b>Levels of evidence:</b> <i>Level IV Cadaveric Study</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251345529"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318798","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":"Stepping Up Informed Consent: Navigating Foot and Ankle Orthopedics.","authors":"Suraj Jain, Zachary Chanmin, Janice Havasy, Benjamin Hershfeld, Brandon Klein, Randy M Cohn, Adam D Bitterman","doi":"10.1177/19386400251336807","DOIUrl":"https://doi.org/10.1177/19386400251336807","url":null,"abstract":"<p><p>Orthopaedic foot and ankle surgeons have an ethical obligation to obtain proper informed consent, ensuring that their patients are thoroughly educated about their diagnosis, risks, benefits, and alternatives of all possible treatment options. This study explores several critical aspects of the informed consent process in foot and ankle orthopedics, including: (1) its current state; (2) barriers that hinder the acquisition of adequate informed consent; and (3) potential solutions based on these identified barriers. The current literature suggests effective approaches to improve the quality of informed consent include using patient-appropriate language, standardized education materials, extended physician-patient visit times, and translation assistance. Utilizing plain language and supplemental materials, such as animated videos and standardized reading materials, enhance patient comprehension and decision-making. Integrating these methods with personalized patient-surgeon discussions results in optimal informed consent quality and patient satisfaction. Additionally, extended visit times, ideally 15 to 30 minutes, improve understanding, while interpreter services ensure clear communication for nonnative speakers. The findings of this study reveal significant deficiencies in the current informed consent process for foot and ankle orthopaedic surgery, which compromise patient autonomy. Implementing solutions to improve the quality of informed consent is necessary to protect patient autonomy and protect surgeons from litigation.<b>Level of Evidence:</b> IV.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251336807"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210399","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":"Sex Differences in Patient-Reported Outcomes and Range of Motion After Total Ankle Arthroplasty.","authors":"Kathy M McGurk, Daniel J Scott, Caroline Hoch, Federico G Usuelli, Andrew Hsu, Christopher E Gross","doi":"10.1177/19386400231168737","DOIUrl":"10.1177/19386400231168737","url":null,"abstract":"<p><p>BackgroundAs the popularity of total ankle arthroplasty (TAA) increases, there is a growing need to examine the effects of sex on postoperative outcomes. This study compares patient-reported outcome measures and ankle range of motion (ROM) in the postoperative period, as stratified by sex.MethodsPatients who underwent TAA during 2013 to 2018 with a minimum follow-up of 2 years were included (N = 133). American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Visual Analog Scale (VAS), and 12-Item Short-Form Survey (SF-12) were administered preoperatively and at 6 months, 1 year, and 2 years postoperatively. ROM was recorded at these same time points.ResultsPreoperatively and at 6 months postoperatively, the cohorts did not differ in any of the measured outcomes. At 1 year postoperatively, females had lower SF-12 Physical Composite Scores (female = 44.1, male = 47.1, P = .019) and less plantarflexion (female = 20.5 degrees, male = 23.5 degrees, P = .029). By 2 years postoperative, females had lower AOFAS scores (female = 80.3, male = 85.4, P = .040). A greater complication rate amongst the female cohort approached significance at 18.6% versus 9% for males (P = .124).DiscussionThese results support TAA as a reliable means of treating ankle arthritis in both sexes, despite important differences. Understanding these outcome differences is critical for effectively managing expectations and treating both female and male populations.Levels of Evidence:Level III: Retrospective cohort study.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"229-235"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9752796","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":"Short-term Adverse Events Following Ankle Arthroplasty and Ankle Arthrodesis: A Matched Analysis of Recent Nationally Representative Data.","authors":"Haleigh M Hopper, Chase T Nelson, James R Satalich, Kevin A Wu, Albert T Anastasio, Conor N O'Neill, Tejas T Patel, Andrew E Hanselman, Karl M Schweitzer, Samuel Adams","doi":"10.1177/19386400251318906","DOIUrl":"10.1177/19386400251318906","url":null,"abstract":"<p><p>BackgroundSurgical management of ankle osteoarthritis (AOA) includes Ankle Arthrodesis (AA) or Total Ankle Arthroplasty (TAA). The purpose of this study was to analyze data from the National Surgical Quality Improvement Project (NSQIP) to elucidate differences in outcomes between TAA and AA.MethodsPatients who underwent TAA or AA from January 2010 to December 2020 were included in this analysis. Matched cohorts were created using 1:1 propensity score matching to match patients according to patient demographics. Independent sample t-tests and chi-square tests were used to determine whether there was a difference between groups. A binary logistic regression was performed to determine the odds ratio (OR) and 95% confidence intervals for any adverse event as related to patient demographics and comorbidities.ResultsThere were 2,053 TAA and 359 AA in the unmatched cohorts. The matched cohorts included 359 patients in each group. In the matched cohorts, there was an increase in transfusions, urinary tract infection (UTI), and return to the operating room in the arthrodesis group compared with the arthroplasty group (1.95%, 0.28%, P = .038; 1.11%, 0.00%, P = .045, 3.90%, 1.11%, P = .017). The logistic regression revealed that length of hospital stay (OR = 1.157) and insulin-dependent diabetes (OR = 6.043) had an increased risk of any adverse event for TAA or AA.ConclusionIdentification of complication rates and patient risk factors for adverse events after TAA and AA can assist surgeons and patients in their choice of treatment for AOA.Levels of Evidence:III (retrospective cohort study).</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"319-329"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143470090","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":"Exploring Revision Total Ankle Arthroplasty Failures: A Comparison Between Failed and Successful Revision Cases.","authors":"Kevin A Wu, Albert T Anastasio, James K DeOrio, James A Nunley, Mark E Easley, Samuel B Adams","doi":"10.1177/19386400241274551","DOIUrl":"10.1177/19386400241274551","url":null,"abstract":"<p><p>This study assesses the comorbidities that are associated with failed revision total ankle arthroplasty (TAA) and explores the outcomes following a failed revision TAA. A retrospective analysis was conducted on a cohort of patients who underwent a revision TAA at a single institution from 2008 to 2022. Patients were identified as having revision failure if they required explantation, below-knee amputation (BKA), or a revision of either metal component. Statistical analysis was performed to identify any significant differences and summarize outcomes. The study included a total of 87 patients who underwent revision TAA with 12 patients who subsequently experienced revision failure. The revision TAA failure rate was 13.8%. There were higher rates of former smokers (58.3%; n = 7) and a history of diabetes (33.3%; n = 4) in the failure cohort, although these differences did not reach statistical significance. Limb salvage procedures were achieved in 11 cases (91.7%). Approaches for failed revision TAAs included arthrodesis (n = 5) with 2 isolated ankle arthrodesis (AA) and 3 tibio-talo-calcaneal (TTC) arthrodesis, an additional revision arthroplasty (n = 6), or amputation (n = 1). Ankle arthroplasty retention was successful in 6 cases (50.0%). Our results demonstrate that a second revision approach was chosen in half of the cases, underscoring its viability as a successful intervention according to patient preferences.<b>Level of Evidence:</b> III.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"286-294"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302488","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":"Effects of Travel Distance on Complications and Outcomes in Total Ankle Arthroplasty.","authors":"Isabel Shaffrey, Emily Teehan, Kristin Caolo, Scott Ellis, Jonathan Deland, Jensen Henry, Constantine Demetracopoulos","doi":"10.1177/19386400241233637","DOIUrl":"10.1177/19386400241233637","url":null,"abstract":"<p><p>Owing to the last decade's increase in the number of total ankle arthroplasty (TAA) procedures performed annually, there is a concern that the disproportionate distribution of orthopaedic surgeons who regularly perform TAA may impact complications and/or patient satisfaction. This study examines patient-reported outcomes and complications in TAA patients who had to travel for surgery compared to those treated locally. This is a single-center retrospective review of 160 patients undergoing primary TAA between January 2016 and December 2018, with mean age 65 (range: 59-71) years, mean body mass index (BMI) 28.7 kg/m², 69 (43.1%) females, and mean 1.5 (SD = 0.51) years follow-up. Patients were grouped by distance traveled (<50 miles [n = 89] versus >50 miles traveled [n = 71]). There were no significant differences in rate or type of postoperative complications between the <50 mile group (16.9%) and the >50 mile group (22.5%) (P = .277). Similarly, there were no significant difference in postoperative PROMIS scores between the groups (P = .858). Given uneven distribution of high-volume surgeons performing TAA, this is important for patients who are deciding where to have their TAA surgery and for surgeons on how to counsel patients regarding risks when traveling longer distances for TAA care.Levels of Evidence: <i>Level III: Retrospective Cohort Study</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"279-285"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051177","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":"Effects of Parallax and Distortion in Total Ankle Arthroplasty.","authors":"Joseph R Brown, Zachary P Hill, Ross Groeschl, Brian Steginsky, Robert W Mendicino","doi":"10.1177/19386400241274262","DOIUrl":"10.1177/19386400241274262","url":null,"abstract":"<p><p>BackgroundSurgeons rely on intraoperative fluoroscopy to assist in placement of implant components during total ankle arthroplasty (TAA). Parallax alters the direction of an object when viewed from two different points, resulting in image distortion. The purpose of this study was to evaluate parallax/distortion in intraoperative fluoroscopic images during TAA.MethodsA retrospective review of all TAAs performed by two surgeons (R.W.M. and B.S.) from August 2019 to April 2023 were reviewed. Intraoperative fluoroscopic anteroposterior (AP) ankle views were evaluated for any obvious parallax image distortion. Cases with obvious parallax distortion were included for angular evaluation of AP intraoperative fluoroscopic and first postoperative plain films. The tibia was marked at 2-centimeter intervals to create zones from the proximal stem of the implant. The anatomical axis of the tibia (AAT) was drawn at the mid-diaphysis. The anatomic lateral distal tibial angle (aLDTA) and anatomic axis deviation (AAD) were measured for each zone.ResultsA total of 22 TAAs were performed during the study period. Four cases were excluded due to inadequate imaging, leaving a total of 18 TAAs for review. We found 6 of 18 (33.3%) cases had obvious parallax distortion. We found the average aLDTA was 90.9° (84°-101°). At the most proximal tibial zone, the average aLDTA was 94° (91°-101°). We found the average AAD was 4.7 (0.5-17.2) mm. The AAD ranged from 0.5 to 17.2 mm lateral to 0.8 to 8.2 mm medial. Postoperative plain film radiographs displayed a normal aLDTA and an AAT centered within the ankle joint.ConclusionParallax can distort the appearance of the tibia on fluoroscopic images. Deviation from the normal aLDTA and anatomical axis should be anticipated. Surgeons should be aware of the potential impact of parallax and ways to mitigate these effects.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"305-310"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373695","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":"Nationally Representative Trends in Incidence of Procedures Done Concomitantly With Primary and Revision Total Ankle From 2012 to 2020.","authors":"Albert T Anastasio, Kempland C Walley, Billy I Kim, Mikhail A Bethell, Samuel B Adams","doi":"10.1177/19386400231216330","DOIUrl":"10.1177/19386400231216330","url":null,"abstract":"<p><p>BackgroundAs new literature emerges and practice patterns fluctuate, there is a significant potential for variation with regard to adjunctive procedures performed with primary total ankle arthroplasty (pTAA) and revision total ankle arthroplasty (rTAA). Our study aims to evaluate yearly trends in the incidence of concomitant procedures and compare the incidence of adjunctive procedures between pTAA and rTAA.MethodsThe 2012-2020 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all pTAA and rTAA. The number of concurrent procedures was compared between pTAA and rTAA and compared across years available in the most current version of the NSQIP database (2012-2020).ResultsPatients undergoing pTAA had a higher mean age than patients undergoing rTAA (64 vs 61 years; P < .001), and patients undergoing rTAA had higher wound class (P < .001), indicating higher levels of contamination. Concurrent procedures were performed significantly less frequently with pTAA than rTAA (mean procedures 0.82 vs 1.30; P < .001). Removal of deep implants was more commonly coded with rTAA than pTAA (9.0% vs 17.7%; P < .001). Gastrocnemius recession was more frequently performed with pTAA than rTAA (10.4% vs 3.0%; P = .001).ConclusionAs pTAA and rTAA increase in incidence throughout the United States, there is increased importance on furthering our understanding of these procedures. This study provides a nationally representative analysis of adjunctive procedures with pTAA and rTAA from 2012 to 2020. Generally, more adjunctive procedures are performed with rTAA versus pTAA, confirming the high complexity of rTAA.Levels of Evidence:Level III.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"269-278"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813727","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}