The Hand最新文献

{"title":"Risk Factors for Infection Following Total Wrist Arthroplasty and Arthrodesis: An Analysis of 6641 Patients","authors":"Alyssa D. Althoff, Russell A. Reeves, Sophia A. Traven, H. Slone, D. Deal, B. Werner","doi":"10.1177/1558944719890036","DOIUrl":"https://doi.org/10.1177/1558944719890036","url":null,"abstract":"Background: Infection following wrist arthroplasty (WA) or wrist fusion (WF) is an uncommon but difficult complication often resulting in explantation and prolonged courses of antibiotics. The purposes of this study are to: (1) characterize the demographic trends of individuals undergoing WA and WF; (2) determine the incidence of postoperative infection; and (3) identify risk factors for postoperative infection. Methods: The PearlDiver database was used to query 100% Medicare Standard Analytic files from 2005 to 2014. Patients undergoing WA or radiocarpal WF were identified using Current Procedural Terminology (CPT) codes. Diagnosis for infection within 1 year of operative intervention was assessed by International Classification of Diseases, Ninth Revision codes or CPT codes related to infection. Multivariable logistic regression analyses were performed to evaluate the risk factors for postoperative infection. Results: Of the 6641 patients included, 1137 (17.1%) underwent arthroplasty and 5504 (82.9%) underwent arthrodesis. Within 1 year of the index procedure, 3.5% had a diagnosis of, or procedure for, postoperative infection (WA: n = 40 of 1137; WF: n = 192 of 5504). Risk factors for infection following WA include age >85, tobacco use, depression, diabetes mellitus, and chronic kidney disease. Risk factors following radiocarpal WF include male sex, age >85, body mass index <19 kg/m2, depression, diabetes mellitus, and chronic kidney disease. Posttraumatic origin of wrist arthritis was a risk factor for infection following both WA and WF. Conclusions: Infection following WA and WF is relatively uncommon in a nationally representative Medicare database cohort. Risk factors common to both WA and WF include age >85, depression, diabetes mellitus, chronic kidney disease, and posttraumatic arthritis.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"657 - 663"},"PeriodicalIF":0.0,"publicationDate":"2019-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719890036","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45446333","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":"The Anesthetic Effectiveness of J-Tip Needle-Free Injection System Prior to Trigger Finger Injection: A Double-Blind Randomized Clinical Trial","authors":"K. Patel, David Fralinger, Kyle J. MacGillis, Joshua I. Wright-Chisem, Alfonso Mejía","doi":"10.1177/1558944719890035","DOIUrl":"https://doi.org/10.1177/1558944719890035","url":null,"abstract":"Background: The aim of this preliminary study was to evaluate the effectiveness of a J-tip needle-free injection system (JNFS) to reduce pain associated with corticosteroid injection of the tendon sheath for treatment of trigger finger. Methods: Thirty-four consecutive trigger fingers occurring in 28 unique patients who met inclusion/exclusion criteria were consented and enrolled into this double-blind randomized controlled study. Patients were randomly assigned to the control (JNFS loaded with sterile normal saline) or treatment group (JNFS loaded with buffered 1% lidocaine). Both the fellowship-trained hand surgeon and patient were blinded to the allocation group. Prior to each trigger finger injection, each patient rated pain associated with stubbing toe and papercut on the visual analog scale (VAS), in addition to a postprocedure VAS pain score. Results: A total of 28 patients and 34 digits were enrolled in this study. There was no difference in patient demographics or preintervention pain perception between the control and treatment groups. The use of JNFS demonstrated lower mean pain VAS score when comparing the control group (n = 17) with the treatment group (n = 17), with VAS pain scores of 49 (SD = 31) and 39 (SD = 36), respectively. However, this difference was not statistically significant (P = .389). Conclusions: The use of JNFS loaded with 1% buffered lidocaine may reduce pain associated with trigger finger injections, although our results did not find a statistically significant difference. We hypothesize that the pain caused by the acidity of lidocaine is the primary driver of pain and discomfort during injection, and the pain from the needle stick is secondary. As a result, any pain reduction from JNFS is masked by the most painful part of injection—the delivery of injectate. Based on the findings and experience obtained from this study, we hypothesize that a follow-up study using buffered lidocaine may be able to better reveal the benefits of JNFS.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"776 - 780"},"PeriodicalIF":0.0,"publicationDate":"2019-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719890035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41748257","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":"Patient Willingness to Pay for Faster Return to Work or Smaller Incisions","authors":"Aaron Alokozai, Sarah E. Lindsay, Sara L. Eppler, P. Fox, A. Ladd, R. Kamal","doi":"10.1177/1558944719890039","DOIUrl":"https://doi.org/10.1177/1558944719890039","url":null,"abstract":"Background: Value-based health care models such as bundled payments and accountable care organizations can penalize health systems and physicians for excess costs leading to low-value care. Health systems can minimize these extra costs by constraining diagnostic (eg, magnetic resonance imaging utilization) or treatment options with debatable necessity in the setting of clinical equipoise. Instead of restricting more expensive treatments, it is plausible that health systems could instead recoup the extra costs of these treatments by charging patients supplementary out-of-pocket charges (cost sharing). The primary aim of this exploratory study was to assess hand surgery patient willingness to pay supplementary out-of-pocket charges for a procedure that theoretically leads to an earlier return to work or smaller incisions when there are 2 procedures that lead to similar results (clinical equipoise). Methods: A total of 122 patients completed a questionnaire that included demographic information, a financial distress assessment, a series of scenarios asking patients the degree to which they are willing to pay extra for the procedure choice, as well as their perspective of how much insurers should be responsible for these additional costs. Results: Patients were willing to pay out-of-pocket to some degree for a procedure that leads to earlier return to work and smaller incision size when compared with a similar alternative procedure, but noted that insurers should bear a greater burden of costs. Approximately 10% of patients were willing to pay maximum amounts ($2500+) for earlier return to work (3, 7, and 14 days earlier) and smaller incision sizes of any length. Conclusions: Some patients may be willing to pay out-of-pocket and cost share for procedures that lead to earlier return to work and smaller incisions in the setting of clinical equipoise. As such, when developing and implementing alternative payment models, health systems could potentially offer services with debatable necessity in the setting of equipoise for a supplementary out-of-pocket charge.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"811 - 817"},"PeriodicalIF":0.0,"publicationDate":"2019-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719890039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45662788","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 Care Redesign to Improve Value for Trigger Finger Release: A Before-and-After Quality Improvement Study","authors":"Matthew B. Burn, L. Shapiro, Sara L. Eppler, Raj Behal, R. Kamal","doi":"10.1177/1558944719884661","DOIUrl":"https://doi.org/10.1177/1558944719884661","url":null,"abstract":"Background: Trigger finger release (TFR) is a commonly performed procedure. However, there is great variation in the setting, care pathway, anesthetic, and cost. We compared the institutional cost for isolated TFR before and after redesigning our clinical care pathway. Methods: Total direct cost to the health system (excluding the surgeon and anesthesiology costs) and time spent by the patient at the surgery center were collected for 1 hand surgeon’s procedures at an ambulatory surgery center over a 3-year period. We implemented a redesigned pathway that altered phases of care and anesthetic use by transitioning from intravenous (IV) sedation to wide awake local anesthesia with no tourniquet. Cost data were reported as percentage change in the median and compared both pre- to post-implementation and with 2 control surgeons using the traditional pathway within the same center. Power analysis was based on prior work on a carpal tunnel pathway. Significance was defined by a P-value < .05. Results: Ten TFRs (90% local with IV sedation) and 44 TFRs (89% local alone) were performed pre- and post-implementation, respectively. From pre- to post-implementation, the study surgeon’s total direct cost decreased by 18%, while the control surgeons decreased by 2%. Median time spent at the surgery center decreased by 41 minutes post-implementation with significantly shorter setup time in the operating room (OR), total time in the OR, and time spent in recovery prior to discharge. Conclusions: Redesigning the care pathway for TFR led to a decrease in institutional cost and patient time spent at the surgery center.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"624 - 631"},"PeriodicalIF":0.0,"publicationDate":"2019-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719884661","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46805157","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":"Trigger Finger Corticosteroid Injection With and Without Local Anesthetic: A Randomized, Double-Blind Controlled Trial","authors":"J. Randall Patrinely, Shepard P. Johnson, B. Drolet","doi":"10.1177/1558944719884663","DOIUrl":"https://doi.org/10.1177/1558944719884663","url":null,"abstract":"Background: The first-line treatment for trigger finger is a corticosteroid injection. Although the injectable solution is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience more pain at the time of injection. Methods: C Patients with trigger finger were prospectively randomized into 2 cohorts to receive triamcinolone (1 mL, 40 mg) plus 1% lidocaine with epinephrine (1 mL) or triamcinolone (1 mL, 40 mg) plus normal saline (1 mL, placebo). Both patient and surgeon were blinded to the treatment arm. The primary outcome was pain measured using a (VAS) immediately following the injection. Results: Seventy-three patients with a total of 110 trigger fingers were enrolled (57 lidocaine with epinephrine and 53 placebo). Immediate postinjection pain scores were significantly higher for injections containing lidocaine with epinephrine compared with placebo (VAS 3.5 vs 2.0). Conclusions: In the treatment of trigger finger, corticosteroid injections are effective and have relatively little associated pain. This study shows there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, surgeons looking to decrease injection pain should exclude the anesthetic, but they should discuss the trade-off of foregoing short-term anesthesia with patients. Using only a single drug (ie, corticosteroid alone) is not only less painful but is also more simple, efficient, and safe; this has therefore become our preferred treatment method.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"619 - 623"},"PeriodicalIF":0.0,"publicationDate":"2019-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719884663","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42541641","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":"Factors Associated With Poor Outcomes in Acute Forearm Compartment Syndrome","authors":"Dafang Zhang, S. Janssen, Matthew A. Tarabochia, A. V. von Keudell, Brandon E. Earp, N. Chen, P. Blazar","doi":"10.1177/1558944719884662","DOIUrl":"https://doi.org/10.1177/1558944719884662","url":null,"abstract":"Background: There is limited literature on risk stratification of patients with acute forearm compartment syndrome. The primary objective of this study was to identify factors associated with poor outcomes in patients with acute forearm compartment syndrome. Methods: We retrospectively identified 130 patients with acute compartment syndrome of 130 forearms treated with fasciotomies from January 2000 to June 2015 at 2 Level 1 trauma centers. Poor outcome was defined as a composite variable, including: (1) death; (2) limb amputation; (3) persistent neurological deficit; and (4) contracture. Patient- and treatment-related variables were collected. Bivariate analyses were used to screen for variables associated with poor outcome, and explanatory variables with a value of P < .05 were included in our multivariable logistic regression analyses. Results: Of the 130 patients, 43 (33%) with acute forearm compartment syndrome had poor outcomes, including 5 deaths, 5 limb amputations, 21 persistent neurological deficits, and 31 contractures. Multivariable logistic regression analyses showed that elevated serum creatine kinase at presentation (P < .05) was associated with poor outcomes in patients with acute forearm compartment syndrome. Receiver operating characteristic curve analysis showed that a serum creatine kinase cutoff of 300 U/L yields 92% sensitivity and a serum creatine kinase cutoff of 10 000 U/L yields 95% specificity for poor outcomes in acute forearm compartment syndrome. Conclusions: Elevated creatine kinase levels above 300 U/L are a useful screening test for the highest risk patients with acute forearm compartment syndrome. Levels above 10 000 U/L may play a role in informed consent and counseling regarding expectations.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"679 - 685"},"PeriodicalIF":0.0,"publicationDate":"2019-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719884662","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42242893","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":"Inter-relationships of Metacarpals 1 to 5, Regarding Their Length, Metaphyseal Midshaft Width, Articular Surface Area of Head and Base, Age, and Sex: A Cadaveric Study","authors":"A. Sephien, C. Bethel, Danielle Gulick, Christa Nairn, Felicia Ourn, Francisco A. Schwartz‐Fernandes","doi":"10.1177/1558944719880026","DOIUrl":"https://doi.org/10.1177/1558944719880026","url":null,"abstract":"Background: Metacarpal factures are common, comprising up to 50% of hand fractures. More work is needed to further our understanding of metacarpal anatomy to improve fixation techniques and reduce postoperative complications following surgical implants. The purpose of this anatomic study was to evaluate the length, midshaft metaphyseal width, and area of the articular surface of the head (AH) and base (AB) of metacarpals 1 to 5. Methods: This prospective study assessed measures from 17 cadavers at 1 institution’s anatomy lab. The anatomic dimensions of the metacarpals in both the right and left hands were measured. Epidemiological data including sex and age at death were also collected. Results: In all, 29 hands were dissected for metacarpal anatomic measurements, for a total of 145 metacarpals. The second metacarpal was longest, at 69.58 mm. Multivariate analysis of variance revealed a significant effect of sex overall, with greater metacarpal dimensions in men. Increasing age was associated with decreasing dimensions, except for AH of metacarpal 1 (F = 3.43, P = .02) and AB of metacarpal 1 (F = 11.54, P < .001) and 4 (F = 4.21, P = .01). Multiple metacarpal dimensions were also significantly correlated with each other. Conclusion: Our data reveal further information regarding metacarpal dimensions of length, midshaft width, and AH and AB. The results allow for potential to improve surgical management through improving metacarpal implants, developing an optimal plate and screw design, techniques to better accommodate anatomical differences based on age and sex, reducing postoperative complications and improving the standard of care.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"706 - 713"},"PeriodicalIF":0.0,"publicationDate":"2019-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719880026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41715464","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":"Distal Radioulnar Joint Instability: Assessment of Three Intraoperative Radiographic Stress Tests","authors":"J. Gil, Lindsay R. Kosinski, K. Shah, J. Katarincic, S. Kakar","doi":"10.1177/1558944719875487","DOIUrl":"https://doi.org/10.1177/1558944719875487","url":null,"abstract":"Background: The purpose of this study is to describe three radiographic stress tests that could be used to examine for distal radioulnar joint (DRUJ) instability intraoperatively, and to determine their ability to detect DRUJ instability after sequentially sectioning the DRUJ. Methods: Eleven fresh frozen cadaveric upper extremities (mean age 52.6 ± 14.9 years) were obtained. We sequentially sectioned the DRUJ. After each component of the DRUJ was sectioned, we performed three radiographic stress tests—squeeze test, ulnar pull in coronal plane, and simulated DRUJ ballotment test. Results: The squeeze test detected a significant increase in diastasis relative to the intact DRUJ after sectioning of the foveal insertion of the triangular fibrocartilage complex (TFCC; 1.0 mm) and the distal oblique bundle (DOB; 1.2 mm). The ulnar pull test in the coronal plane detected a significant increase in diastasis relative to the intact DRUJ after sectioning of the dorsal and volar radioulnar ligaments (2 mm), the foveal insertion of the TFCC (2.6 mm), and the DOB (4.4 mm). The simulated DRUJ ballotment test detected a significant increase in dorsal translation of the ulna relative to the intact DRUJ with sectioning of the foveal insertion of the TFCC (4.9 mm) and the DOB (5.6 mm). Conclusion: The squeeze test and simulated DRUJ ballotment test detect a significant increase in diastasis after the foveal attachment of the TFCC was sectioned. The ulnar pull test in the coronal plane was the most sensitive test for detecting a significant increase in diastasis relative to the intact DRUJ.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"674 - 678"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719875487","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46845760","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":"Coronal Shear Fractures of the Distal Humerus: A Review of Diagnosis, Treatment, and Outcomes","authors":"Brianna R. Fram, Daniel A. Seigerman, A. Ilyas","doi":"10.1177/1558944719878817","DOIUrl":"https://doi.org/10.1177/1558944719878817","url":null,"abstract":"Fractures of the capitellum and trochlea are uncommon fractures of the elbow and can be challenging to treat due to their size, location, and articular nature. Because of their intra-articular nature and predilection toward displacement, these fractures are typically treated operatively. Furthermore, capitellum fractures have high rates of associated injuries, including radial head fractures or lateral collateral ligament injury in ~30% to 60% of patients. In addition to open reduction internal fixation, operative options include fragment excision, arthroscopic assisted reduction and fixation, and elbow arthroplasty. In this article, we undertake a comprehensive literature review of capitellum fractures of the distal humerus, in an attempt to summarize the existing body of evidence and propose areas of future study.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"577 - 585"},"PeriodicalIF":0.0,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719878817","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42884331","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":"The Minimal Clinically Important Difference for PROMIS Physical Function in Patients With Thumb Carpometacarpal Arthritis","authors":"D. Lee, R. Calfee","doi":"10.1177/1558944719880025","DOIUrl":"https://doi.org/10.1177/1558944719880025","url":null,"abstract":"Background: This study was performed to determine the minimal clinically important difference (MCID) of Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) computer adaptive test (CAT) for patients with thumb carpometacarpal (CMC) arthritis. Methods: This study retrospectively analyzed data from 152 adults receiving surgical and nonsurgical care for unilateral thumb CMC arthritis at a single institution between January 2016 and January 2018. Patients completed PROMIS PF v1.2/2.0 CAT at each visit. At follow-up, patients also completed two 6-item anchor questions assessing the degree of perceived improvement. Statistical testing analyzed the ability of the clinical anchor to discriminate levels of improvement. An anchor-based MCID estimate was calculated as the mean PROMIS PF change score in the mild improvement group. The anchor-based MCID value was examined for the influence of patient age, initial and final PROMIS scores, and follow-up interval. A distribution-based MCID value was calculated incorporating the standard error of measurement and effect size. Results: The change in PROMIS PF scores was significantly different between encounters where patients reported no change, mild improvement, and much improvement. The anchor-based MCID estimate for PROMIS PF was 3.9 (95% confidence interval, 3.3-4.7). Individual MCID values were weakly correlated with the final absolute PROMIS PF score but did not correlate with patient age, time between visits, or the initial absolute PROMIS PF score. The distribution-based MCID value was 3.5 (95% confidence interval, 3.1-3.9). Conclusions: The estimated range of MCID values for PROMIS PF is 3.5 to 3.9 points in patients treated for thumb CMC arthritis.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"638 - 643"},"PeriodicalIF":0.0,"publicationDate":"2019-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719880025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46559706","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}