Foot & ankle specialist最新文献

{"title":"Tendoscopic-Assisted Repair of Distal Peroneus Longus Rupture: A Novel Approach and 2 Case Reports.","authors":"David Pontell, Matthew Greenblatt","doi":"10.1177/19386400221129322","DOIUrl":"10.1177/19386400221129322","url":null,"abstract":"<p><p>Surgical approaches have been described to treat isolated peroneus longus (PL) injuries when the ruptured tendon ends do not allow for direct end-to-end reapproximation due to distal location beneath the cuboid or beyond. Among these are proximal PL-to-peroneus brevis tenodesis and PL transfer to the lateral border of the calcaneus or cuboid (with or without excision of an associated os peroneum). While these procedures may have utility, it is unlikely that the aforementioned restore the active, simultaneous eversion, abduction, and dynamic plantarflexion of the normal PL muscle-tendon unit. A procedure is described which may be capable of restoring PL function in the presence of these more distal ruptures. This procedure begins with tendoscopic confirmation of the rupture, followed by externalization and debridement of the proximal tendon stump, whip suture preparation, and reinsertion under estimated physiologic tension into the first metatarsal base by way of nonabsorbable suture and endobutton. Two patients whose surgery utilized this technique with a minimum of 7 years follow-up are presented.Levels of Evidence:<i>Level IV: Case Series</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"178-184"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40341446","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 Cognitive Load on Stride-to-Stride Variability During Walking Among Participants With and Without Functional Ankle Instability.","authors":"Tina Banakheiri, Zahra Mohammadzadeh, Aliyeh Daryabor, Zahra Ebrahim-Abadi, Sedigheh Sadat Naimi, Leila Rahnama","doi":"10.1177/19386400251325963","DOIUrl":"https://doi.org/10.1177/19386400251325963","url":null,"abstract":"<p><p>BackgroundStudying the dynamics of nonlinear systems under dual-task conditions in people with functional ankle instability (FAI) can provide additional information about the variability of the structure of the system. However, how the cognitive load affects the stride-to-stride variability in the lower extremities throughout walking in those with and without FAI using nonlinear evaluation tools is unknown.MethodsEighteen volunteers with FAI and 19 healthy individuals were recruited for this study. The participants walked on a motor-driven treadmill at their preferred speed, with or without completing a cognitive task involving an auditory Stroop test. A passive retroreflective marker motion-capture system recorded the lower extremity gait kinematics in the sagittal, frontal, and transverse planes. The largest Lyapunov exponent (LyE) characterizes the variability of the temporal structure in walking patterns. Cognitive task performance was analyzed using error ratio and average reaction time in walking and sitting conditions.ResultsDuring walking with cognitive load, the group with FAI exhibited lower values for the LyE in knee kinematics in the sagittal plane than the normal walking (95% confidence interval [CI]: 0.44-0.92, P < .001). During normal walking (single task), participants with FAI demonstrated higher knee flexion-extension LyE (95% CI: 0.52-0.93, P = .04) than healthy people. The 2 groups had no significant differences regarding the LyE values for other kinematic variables (P > .05). Regarding cognitive performance, both FAI and healthy groups had remarkably longer reaction times (P < .001) while walking (mean ± SD: 0.92 ± 0.06) compared with the sitting condition (mean ± SD: 0.77 ± 0.03).ConclusionThe reduced variability observed in the walking patterns of individuals with FAI during walking with an added cognitive load suggests a compensatory mechanism due to sensorimotor constraints, highlighting the altered motor control strategies. Dual task and cognitive training may help correct these patterns and improve responses.Levels of Evidence:Level II.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251325963"},"PeriodicalIF":0.0,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732624","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":"Learning Curve for Minimally Invasive Surgery (MIS) for the Treatment of Hallux Valgus.","authors":"Chase Gauthier, Yianni Bakaes, Rodrigo Encinas, Tyler Gonzalez, J Benjamin Jackson","doi":"10.1177/19386400251325605","DOIUrl":"https://doi.org/10.1177/19386400251325605","url":null,"abstract":"<p><p>IntroductionCorrection of hallux valgus through minimally invasive surgery (MIS) has grown in popularity in recent years. Despite the increase in use, there has been limited research into the learning curve associated with the procedure, which has been documented extensively for other MIS procedures. Our study looked to determine the learning curve associated with MIS hallux valgus surgery.MethodsA retrospective review was conducted of patients who underwent MIS hallux valgus surgery, performed by 2 foot and ankle fellowship-trained orthopaedic surgeons, between November 2021 and April 2023. Demographic information, procedure data, and postoperative data were collected for each patient. A multivariable analysis was conducted for each surgeon to determine the relationship between case number and operative duration, patient-reported outcomes, and complications. Findings were significant if P < .05.ResultsCase number was found to have a significant negative relationship with operative duration for both of our surgeons (β = -0.578, -0.736, R² = 0.637, 0.426, P < .001, .02). There was no significant relationship between case number and patient-reported outcomes (P = .49, .408) or complications (P = .319, .387) for either surgeon.ConclusionWe established the presence of a learning curve for operative duration, but not for patient-reported outcomes or complications. Overall, our results are conflicting regarding the presence of a learning curve for MIS hallux valgus procedures. Further study with other institutions is needed to further elucidate the presence of a learning curve.Level of Evidence:<i>III</i>.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251325605"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702362","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":"Effect of Preoperative Dehydration on Postoperative Complications Following Ankle Fracture Open Reduction Internal Fixation.","authors":"Alexander S Guareschi, William N Newton, Jared J Reid, Joshua L Morningstar, Christopher E Gross, Daniel J Scott","doi":"10.1177/19386400251323432","DOIUrl":"https://doi.org/10.1177/19386400251323432","url":null,"abstract":"<p><p>IntroductionThis study aims to analyze the effect of preoperative fluid status on 30-day complication, readmission, reoperation, and mortality rates following ankle fracture procedures.MethodsThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried to identify 27 175 patients undergoing open reduction and internal fixation (ORIF)of ankle fracture. Patients were stratified by hydration status (normal = 18 761, dehydrated = 8414) with preoperative dehydration, defined as a blood urea nitrogen (BUN)-to-creatinine (Cr) ratio (BUN/Cr) greater than 20.ResultsDehydrated patients had increased rates of cardiac arrest (dehydrated = 0.2%, normal = 0.1%; P = .023), myocardial infarction (dehydrated = 0.3%, normal = 0.1%; P = .007), bleeding requiring transfusion (dehydrated = 1.3%, normal = 0.9%; P = .001), pulmonary embolism (dehydrated = 0.5%, normal = 0.3%; P = .023), and urinary tract infections (dehydrated = 1.4%, normal = 0.9%; P = .001). No significant differences in 30-day readmission or reoperation were observed between groups. Multivariable regression found hydration status was not significantly predictive of any adverse outcome, length of hospital stay (β = -0.020; 95% confidence interval [CI] = -0.132 to 0.92; P = .725), nor total operative time (β = 0.318; 95% CI = -0.968 to 1.604; P = .725).ConclusionThis study found dehydrated patients undergoing ankle fracture ORIF experience a higher rate of complications, but this effect was not found with multivariate analysis. Thus, we conclude dehydration status was not predictive of increased risk of short-term postoperative complications, readmission, reoperation, or mortality.Level of Evidence:Level III, Retrospective cohort study.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251323432"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652468","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":"Clinical Outcomes of Avulsion Fractures of the Cuboid and Navicular After Supination Trauma.","authors":"Maarten P Cornelissen, Mirte I Muntel, Pieter B A A Van Driel, Roelina Munnik-Hagewoud, Rutger G Zuurmond","doi":"10.1177/19386400251321875","DOIUrl":"https://doi.org/10.1177/19386400251321875","url":null,"abstract":"<p><p>Supination trauma-related avulsion fractures of the foot are seen frequently, with cuboid and navicular fractures being among the most frequent types encountered. Nevertheless, the prognosis of these fractures remains largely unknown. This study was conducted to evaluate the clinical outcomes of the 2 most prevalent avulsion fractures-cuboid and navicular. A retrospective cohort consisting of patients who sustained a cuboid or navicular avulsion fracture after supination trauma between 2017 and 2020 was compiled and baseline characteristics along with retrospective data were collected. To gain data on clinical outcome 2 questionnaires, the Numerical Rating Scale (NRS) for pain and the Foot and Ankle Ability Measure (FAAM), were completed by participants 2 to 5 years after the fracture. Thirty-seven participants consented to participate, 25 experienced a cuboid fracture and 12 a navicular fracture. Cuboid fracture patients had a median week-average NRS score of 0 (range 0-7) and a median FAAM score of 105 (range 62-116), on average 40.8 months (SD 7.74) after treatment. Five out of 25 (21%) patients experienced persisting foot pain (NRS of ≥2). Navicular fracture patients had a median week-average NRS score of 1.5 (range 0-5) and a median FAAM score of 104 (range 55-116), a median 37.25 (range 27-47) months after treatment. Five out of 12 (42%) patients had a persisting NRS score of ≥2. Avulsion fractures of the cuboid and navicular bones generally have a favorable clinical outcome. However, a substantial portion of patients with both fracture types experienced persistent foot pain ≥24 months after the fracture.<b>Levels of Evidence:</b> Level II: Retrospective cohort study with prospective follow-up design.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251321875"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652467","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":"Lisfranc Fixation Utilizing Dorsomedial Plating Technique.","authors":"James L Iandoli, Daniel T DeGenova, Anthony J Perugini, Zachary P Hill, Matthew T Glazier, Benjamin C Taylor","doi":"10.1177/19386400251316922","DOIUrl":"https://doi.org/10.1177/19386400251316922","url":null,"abstract":"<p><p>Ideal treatment for Lisfranc injuries is often debated, but ultimately the 2 main pillars of surgical intervention consist of open reduction and internal fixation versus arthrodesis. When adhering to the principles of rigid fixation and anatomic reduction, both interventions yield similar results and patient satisfaction. The purpose of this article and associated video is to simplify operative intervention of this complex injury pattern into a reliable biomechanically stable plating technique using a dorsomedial approach that results in good patient outcomes and is largely joint sparing. The cohort used for this technique guide consists of 31 patients with at least 12-month follow-up. Notable results include mean operative room time of 81 minutes, median time to union 198 days, and 1 non-union. Complications included 4 superficial infections and 1 deep infection, 7 patients with broken hardware, 1 non-union, and 15 patients elected to have hardware removed although not necessary for this technique.<b>Level of Evidence:</b> Therapeutic Level IV: Case Series.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251316922"},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652470","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":"Syndesmotic Screw Fixation Versus Suture Button Versus Tibiotalocalcaneal Nail Treatment in Syndesmotic Ankle Fractures: A Meta-Analysis.","authors":"Thomas Cho, Helen R Yan, Michael Uematsu, Christian Harter, Jiayong Liu","doi":"10.1177/19386400251318965","DOIUrl":"https://doi.org/10.1177/19386400251318965","url":null,"abstract":"<p><strong>Background: </strong>Syndesmotic ankle fractures occur when damage to the syndesmosis complex is combined with a malleolar fracture. This can result in severe pain, weakness, and instability. Surgical interventions include syndesmotic screw fixation (SS), suture button fixation (SB), and tibiotalocalcaneal nail (TTC). This meta-analysis aims to compare the outcomes of these treatment methods for syndesmotic ankle fractures.</p><p><strong>Methods: </strong>A literature search was conducted on PubMed and Embase for comparison studies that included at least 2 surgical interventions and at least one of the relevant functional outcomes and/or complication metrics until June 2024. The Olerud-Molander Ankle Score (OMAS) was used to compare functional outcomes, and it is a self-reported outcome measure that evaluates the symptoms and function of those with ankle fractures, while infections and reoperations were reported to compare complication outcomes. Statistical analyses were performed using Review Manager 5.4. A P-value ≤ .05 was considered statistically significant. The risk of bias was assessed with Review Manager 5.4. and the Newcastle-Ottawa scale.</p><p><strong>Results: </strong>A total of 18 studies with a total of 1,040 patients were ultimately included in this study. The SS had a significantly higher OMAS 2-year follow-up compared to TTC. The TTC had a significantly lower infection rate compared to SS. The SB had a significantly higher OMAS at both 1-year and 2-year follow-ups than SS. The SB had a significantly lower reoperation rate compared to SS. The SB had a significantly higher OMAS at both 1-year and 2-year follow-ups than TTC. The SB had a significantly lower infection rate compared to TTC.</p><p><strong>Conclusion: </strong>The SB emerges as the preferred treatment method for syndesmotic ankle fractures, while TTC stands as a viable alternative. The SB is recommended as the primary surgical intervention for patients with syndesmotic ankle fractures due to its superior clinical benefits when compared to TTC and SS.</p><p><strong>Levels of evidence: </strong>3.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251318965"},"PeriodicalIF":0.0,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525357","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":"Asymptomatic Preaxial Polydactyly of Bifid Hallux Without a Supernumerary Digit Presenting With Earlobe Malformations: A Rare Case Report.","authors":"Chanel Houston Perkins","doi":"10.1177/19386400251315886","DOIUrl":"https://doi.org/10.1177/19386400251315886","url":null,"abstract":"<p><p>Syndactyly-polydactyly-ear lobe (SPEL) syndrome is a rare, genetic, congenital limb malformation syndrome that can be characterized by 6 different human phenotypes. We report a rare case of SPEL syndrome in a young woman with right earlobe malformations and asymptomatic preaxial polydactyly with partial duplication of the right hallucal distal phalanx without a supernumerary toe. Unique aspects of our patient's clinical presentation include lack of a supernumerary digit with a bifurcated distal phalanx, associated earlobe malformations, adult age, and no reported familial history of SPEL syndrome. Syndactyly-polydactyly-ear lobe syndrome has not been reported in the literature since 1976, making the present case particularly noteworthy.<b>Level of Evidence:</b> Level 5, Case Report.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251315886"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525352","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":"Correction of Distal Metatarsal Articular Angle in Hallux Valgus Surgery Utilizing a Minimally Invasive Extra-Articular Metaphyseal Distal Transverse Osteotomy.","authors":"Rodrigo Encinas, SarahRose Hall, David Edelman, Tucker McMillen, Deborah Hurley, Jonathan R M Kaplan, Oliver N Schipper, J Benjamin Jackson, Tyler A Gonzalez","doi":"10.1177/19386400251317597","DOIUrl":"https://doi.org/10.1177/19386400251317597","url":null,"abstract":"<p><p>Hallux valgus deformity frequently presents with an increased distal metatarsal articular angle (DMAA) which may require additional correction. Minimally invasive hallux valgus surgery is often used in patients with increased DMAA. We hypothesized that the triplanar correction with the minimally invasive extra-articular metaphyseal distal transverse osteotomy (META) would improve the DMAA, in addition to the hallux valgus angle (HVA), intermetatarsal angle (IMA), and patient-reported outcomes. A retrospective chart review was performed on patients who underwent an META procedure for hallux valgus correction. The DMAA, HVA, IMA were measured on preoperative, 2-week postoperative, and final follow-up radiographs. Patient demographics, complications, and Patient-Reported Outcomes Measure Information System (PROMIS) pain, function, and mobility scores were recorded. Univariate analysis and t-test were used to describe measurements between DMAA, HVA, and IMA. Twenty-seven META osteotomies were performed on 25 patients. At the final follow-up, mean DMAA, HVA, IMA decreased from 9.73 ± 1.96 to 4.35 ± 0.85 degrees, 30.45 ± 7.91 to 6.59 ± 2.75 degrees, and 15.37 ± 3.67 to 3.72 ± 1.84 degrees, respectively (P < .001). The PROMIS pain scores significantly improved from 58.96 ± 6.00 to 49.69 ± 9.35 at the final follow-up (P < .001). These observations imply successful resolution of hallux valgus, with a single META procedure. This approach may be an alternative to open or multiple corrections of hallux valgus, while preserving improvement in functional outcomes.<b>Level of Evidence:</b> Level IV.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251317597"},"PeriodicalIF":0.0,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525354","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":"ChatGPT Achieves Only Fair Agreement with ACFAS Expert Panelist Clinical Consensus Statements.","authors":"Dominick J Casciato, Joshua Calhoun","doi":"10.1177/19386400251319567","DOIUrl":"https://doi.org/10.1177/19386400251319567","url":null,"abstract":"<p><strong>Introduction: </strong>As artificial intelligence (AI) becomes increasingly integrated into medicine and surgery, its applications are expanding rapidly-from aiding clinical documentation to providing patient information. However, its role in medical decision-making remains uncertain. This study evaluates an AI language model's alignment with clinical consensus statements in foot and ankle surgery.</p><p><strong>Methods: </strong>Clinical consensus statements from the American College of Foot and Ankle Surgeons (ACFAS; 2015-2022) were collected and rated by ChatGPT-o1 as being inappropriate, neither appropriate nor inappropriate, and appropriate. Ten repetitions of the statements were entered into ChatGPT-o1 in a random order, and the model was prompted to assign a corresponding rating. The AI-generated scores were compared to the expert panel's ratings, and intra-rater analysis was performed.</p><p><strong>Results: </strong>The analysis of 9 clinical consensus documents and 129 statements revealed an overall Cohen's kappa of 0.29 (95% CI: 0.12, 0.46), indicating fair alignment between expert panelists and ChatGPT. Overall, ankle arthritis and heel pain showed the highest concordance at 100%, while flatfoot exhibited the lowest agreement at 25%, reflecting variability between ChatGPT and expert panelists. Among the ChatGPT ratings, Cohen's kappa values ranged from 0.41 to 0.92, highlighting variability in internal reliability across topics.</p><p><strong>Conclusion: </strong>ChatGPT achieved overall fair agreement and demonstrated variable consistency when repetitively rating ACFAS expert panel clinical practice guidelines representing a variety of topics. These data reflect the need for further study of the causes, impacts, and solutions for this disparity between intelligence and human intelligence.</p><p><strong>Level of evidence: </strong>Level IV: Retrospective cohort study.</p>","PeriodicalId":73046,"journal":{"name":"Foot & ankle specialist","volume":" ","pages":"19386400251319567"},"PeriodicalIF":0.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143477288","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}