The Hand最新文献

{"title":"Hemiresection Interposition Arthroplasty of the Distal Radioulnar Joint: A Long-term Outcome Study","authors":"F. Nawijn, S. Verhiel, J. Jupiter, N. Chen","doi":"10.1177/1558944719873430","DOIUrl":"https://doi.org/10.1177/1558944719873430","url":null,"abstract":"Background: The aim of this study was to assess factors associated with long-term patient-reported functional, pain, and satisfaction scores in patients who underwent (Bowers) hemiresection interposition technique (HIT) arthroplasty of the distal radioulnar joint (DRUJ). The secondary aims were to determine the complication and reoperation rates. Methods: A retrospective study with long-term follow-up of patients undergoing HIT arthroplasty was performed. Demographic, disease, and treatment characteristics were collected for the 66 included patients. Thirty-one patients completed all surveys, which were the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), our custom-made HIT arthroplasty questionnaire, Numeric Rating Scale (NRS) for pain, and NRS for satisfaction. The mean interval between surgery and follow-up by means of questionnaires was 8.6 ± 3.4 years. Results: The mean QuickDASH score was 31.0 ± 20.2. The mean score of the HIT arthroplasty questionnaire was 2 ± 2. The median NRS for pain was 1 (interquartile range [IQR], 0-3), and the median NRS for satisfaction was 9 (IQR, 8-10). The complication rate and reoperation rate were 14% and 8%, respectively. Conclusion: Overall, patients expressed satisfaction with HIT arthroplasty, despite a mean QuickDASH score of 31.0. In our cohort, patients with inflammatory arthritis had higher satisfaction and lower pain scores. Patients who had prior trauma, prior surgery, or DRUJ subluxation are generally less satisfied. Men, older patients, and posttraumatic patients had higher long-term pain scores; however, posterior interosseous nerve neurectomy is associated with improved pain scores. Our findings support the use of HIT arthroplasty in patients with inflammatory arthritis.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"664 - 673"},"PeriodicalIF":0.0,"publicationDate":"2019-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873430","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44397192","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":"Long-term Reoperation Rate for Cubital Tunnel Syndrome: Subcutaneous Transposition Versus In Situ Decompression","authors":"D. Hutchinson, Ryan Sullivan, Micah K. Sinclair","doi":"10.1177/1558944719873153","DOIUrl":"https://doi.org/10.1177/1558944719873153","url":null,"abstract":"Background: The purpose of this study was to compare the long-term revision rate of in situ ulnar nerve decompression with anterior subcutaneous transposition surgery for idiopathic cubital tunnel syndrome. Methods: This retrospective, multicenter, cohort study compared patients who underwent ulnar nerve surgery with a minimum 5 years of follow-up. The primary outcome studied was the need for revision cubital tunnel surgery. In total, there were 132 cases corresponding to 119 patients. The cohorts were matched for age and comorbidity. Results: The long-term reoperation rate for in situ decompression was 25% compared with 12% for anterior subcutaneous transposition. Seventy-eight percent of revisions of in situ decompression were performed within the first 3 years. Younger age and female sex were identified as independent predictors of need for revision. Conclusions: In the long-term follow-up, in situ decompression is seen to have a statistically significant higher reoperation rate compared with subcutaneous transposition.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"447 - 452"},"PeriodicalIF":0.0,"publicationDate":"2019-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873153","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47813880","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":"Analysis of 3 Different Operative Techniques for Extra-articular Fractures of the Phalanges and Metacarpals","authors":"Ignacio Esteban-Feliu, I. Gallardo-Calero, S. Barrera-Ochoa, A. Lluch-Bergadà, Sergi Alabau-Rodriguez, X. Mir-Bulló","doi":"10.1177/1558944719873144","DOIUrl":"https://doi.org/10.1177/1558944719873144","url":null,"abstract":"Background: Several techniques have been described for treating metacarpal and phalangeal fractures. We sought to compare the 3 techniques most frequently used for extra-articular metacarpal and phalangeal fractures: plate screw (PS), Kirschner wire (KW), and retrograde intramedullary screw (RIS) fixation. We aimed to determine whether using an RIS provides better clinical outcomes than using either a PS or a KW fixation. Methods: We conducted a retrospective review of patients who underwent surgical treatment of metacarpal and phalangeal fractures from January 2011 to December 2017 in our department. Only patients with an acutely displaced short oblique or transverse extra-articular metacarpal or phalangeal fracture were included. Patients were classified into 3 groups depending on the treatment they received: PS, KW, or RIS fixation. The duration of each procedure was recorded. Clinical assessments included measuring total active motion (TAM), grip strength, and an evaluation of plain radiographs through to ultimate healing. A Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was collected on all patients. Data were analyzed by analysis of variance or Kruskal-Wallis rank test, as indicated. Results: A total of 253 fractures (202 metacarpal and 51 phalangeal) in 230 patients were included in analysis. In all, 135 fractures (53.3%) underwent PS fixation; 53 (20.9%), KW fixation; and 65 (25.6%), RIS fixation. In the KW fixation group, Bouquet pinning was performed for metacarpal fractures and cross pinning for phalangeal fractures. When more than 1 fracture coexisted in the same patient, they were considered separate instances. No differences among the 3 groups were observed when evaluating mean time to radiological union, grip strength, TAM, or QuickDASH score. Mean surgery time was significantly shorter with KW (20 minutes) and RIS (25 minutes), than with PS (32 minutes). Mean return to work or routine activities time was significantly less in the RIS (7.8 weeks) group than in the PS and KW groups (8.3 and 9.2 weeks, respectively). Conclusions: Surgical treatment is recommended in patients with unstable metacarpal and phalangeal fractures. The use of RIS was associated with shorter mean surgery duration and return to work times than PS and KW, respectively.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"595 - 603"},"PeriodicalIF":0.0,"publicationDate":"2019-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48641686","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":"Surgical Management of Proximal Interphalangeal Joint Fracture-Dislocations: A Review of Outcomes","authors":"Cory Demino, M. Yates, J. Fowler","doi":"10.1177/1558944719873152","DOIUrl":"https://doi.org/10.1177/1558944719873152","url":null,"abstract":"Background: Treatment of proximal interphalangeal joint (PIPJ) fracture-dislocations is difficult given the potential long-term complications of the involved finger and entire hand. Several surgical methods have been utilized for management of these injuries, none of which have shown consistently favorable results. The purpose of this systematic review of the literature is to report the post-operative outcomes of multiple treatment modalities for PIPJ fracture-dislocations in various studies. Methods: A literature review of PubMed and EMBASE databases was performed for all articles on PIPJ fracture-dislocations. Outcomes of interest included PIPJ range of motion, grip strength (% of contralateral hand), and quick disabilities of arm, shoulder, hand (QuickDASH). Articles were distributed into 5 groups by surgical method: open reduction, percutaneous fixation, dynamic external fixation, extension-block pinning, and hemi-hamate arthroplasty. Results: Forty-eight of 1679 total screened articles were included. The weighted means of post-operative range of motion (ROM; degrees) at final follow-up were open reduction 84.7 (n = 146), percutaneous fixation 86.5 (n = 32), dynamic external fixation 81.7 (n = 389), extension-block pinning 83.6 (n = 85), and hemi-hamate arthroplasty 79.3 (n = 52). Dorsal fracture-dislocations, regardless of surgical method, had an average ROM of 83.2 (n = 321), grip strength 91% (n = 132), and QuickDASH of 6.6 (n = 59) while pilon injuries had an average ROM of 80.2 (n = 48), grip strength 100% (n = 13), and QuickDASH of 11.4 (n = 13). Conclusion: Percutaneous fixation yielded the highest post-operative ROM at final follow-up while extension-block pinning resulted in the greatest grip strength. While dorsal fracture-dislocations produced higher average ROM and lower QuickDASH score, pilon fractures produced a higher grip strength. No treatment method or fracture type yielded consistently better outcomes than another.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"453 - 460"},"PeriodicalIF":0.0,"publicationDate":"2019-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44913380","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":"Acute-Phase Reactants in Operatively Treated Upper Extremity Infections: A Retrospective Review","authors":"Erich M. Gauger, P. Mitchell, S. Halverson, D. O’Neill, Kaitlyn Reasoner, Mihir J. Desai, Donald H. Lee","doi":"10.1177/1558944719873147","DOIUrl":"https://doi.org/10.1177/1558944719873147","url":null,"abstract":"Background: There are limited data on the use of acute-phase markers in the diagnosis of upper extremity infections. The goal of this study was to determine the percentage of patients with elevated white blood cell (WBC) count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in the setting of an upper extremity infection requiring operative debridement. Methods: In a retrospective review over 12 years, 61 patients who met the inclusion criteria were identified. Results: C-reactive protein was the most sensitive test in the detection of culture-positive infection compared with ESR and WBC (P < .001, P < .0001, respectively). Ninety percent of patients (55 of 61) presented with an abnormal CRP value. The WBC count and ESR were abnormal in 54% and 67% of our cohort, respectively. Conclusions: C-reactive protein is the most sensitive laboratory test when evaluating upper extremity infections that necessitate debridement. The WBC count and ESR should be interpreted with caution and can be normal even in the presence of an infection.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"546 - 550"},"PeriodicalIF":0.0,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719873147","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46594530","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":"Epidemiology of Trigger Finger: Metabolic Syndrome as a New Perspective of Associated Disease","authors":"Junot H S N, Anderson Hertz A. F. L., Gustavo Vasconcelos G. R., Debora C Esquerdo C da Silveira, Paulo Nelson B., S. F. Almeida","doi":"10.1177/1558944719867135","DOIUrl":"https://doi.org/10.1177/1558944719867135","url":null,"abstract":"Objective: The aim of this study was to identify the main diseases related to trigger finger. Methods: A retrospective, observational study was performed with data obtained through a computerized record of 75 patients with trigger finger diagnosis between July 2011 and October 2015. The diagnosis of metabolic syndrome was performed following National Cholesterol Education Program Adult Treatment Panel III (2001). Results: Patients’ ages ranged from 50 to 84 years, with a mean age of 63 years. The ring finger was the most affected, followed by the middle finger, index finger, and little finger. Most had a grade 2 trigger finger classified by Green; the right hand involvement was more prevalent, as was the dominant hand. The incidence in women was twice as high as in men. Arterial hypertension, diabetes mellitus, and dyslipidemia were shown to be important associated diseases, but metabolic syndrome was the main association found. Conclusions: Metabolic syndrome in the group of patients studied in this scientific article seems to be the main associated disease.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"542 - 545"},"PeriodicalIF":0.0,"publicationDate":"2019-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719867135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48477073","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":"Implementing Prescribing Guidelines for Upper Extremity Orthopedic Procedures: A Prospective Analysis of Postoperative Opioid Consumption and Satisfaction","authors":"Jenna R. Adalbert, A. Ilyas","doi":"10.1177/1558944719867122","DOIUrl":"https://doi.org/10.1177/1558944719867122","url":null,"abstract":"Background: A lack of established opioid-prescribing guidelines has prompted recent studies to propose preliminary guidelines to mitigate inadvertent overprescribing, diversion, and abuse. The purpose of our study was to assess the efficacy of a specific set of opioid-prescribing guidelines by prospective evaluation of patient consumption and satisfaction. Methods: During a consecutive period, all patients undergoing outpatient upper extremity surgical procedures were postoperatively prescribed opioids based on published guidelines that were specific to the anatomical location and procedure being performed. At the first postoperative visit, surgical details, opioid consumption patterns, and prescription efficacy and satisfaction were recorded. Results: A total of 201 patients reported any amount of prescription use, resulting in a mean consumption of 5.5 pills. Patients who underwent soft tissue procedures reported the lowest requirement (4.2 pills) compared with those who underwent fracture repairs (6.7 pills) or arthroscopy and arthroplasty/fusion procedures (8.7 pills). Patients undergoing hand procedures consumed fewer opioids (3.9 pills) compared with those undergoing wrist (6.3 pills) or elbow (8.1 pills) procedures. Of the patients requiring opioids, 82% reported being satisfied or at least neutral to the prescribed quantity (P < .001), and 92% reported being satisfied or at least neutral to the prescribed opioid analgesic efficacy (P < .001). Overall, the study refill request rate was 13%. Conclusions: Although the proposed guidelines tended to exceed patient need, the study confirmed strong patient satisfaction and an overall refill request rate of only 13%. We conclude that following anatomical and procedure-specific opioid-prescribing guidelines is an effective method of prescribing opioids postoperatively after upper extremity.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"491 - 497"},"PeriodicalIF":0.0,"publicationDate":"2019-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719867122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42575957","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":"Pediatric Hand and Upper Extremity Injuries Presenting to Emergency Departments in the United States: Epidemiology and Health Care–Associated Costs","authors":"Alfred Lee, David L. Colen, J. Fox, B. Chang, Ines C. Lin","doi":"10.1177/1558944719866884","DOIUrl":"https://doi.org/10.1177/1558944719866884","url":null,"abstract":"Background: Upper extremity injuries represent one of the most common pediatric conditions presenting to emergency departments (EDs) in the United States. We aim to describe the epidemiology, trends, and costs of pediatric patients who present to US EDs with upper extremity injuries. Methods: Using the National Emergency Department Sample, we identified all ED encounters by patients aged <18 years associated with a primary diagnosis involving the upper extremity from 2008 to 2012. Patients were divided into 4 groups by age (≤5 years, 6-9 years, 10-13 years, and 14-17 years) and a trauma subgroup. Primary outcomes were prevalence, etiology, and associated charges. Results: In total, 11.7 million ED encounters were identified, and 89.8% had a primary diagnosis involving the upper extremity. Fracture was the most common injury type (28.2%). Dislocations were common in the youngest group (17.7%) but rare in the other 3 (range = 0.8%-1.6%). There were 73.2% of trauma-related visits, most commonly due to falls (29.9%); 96.9% of trauma patients were discharged home from the ED. There were bimodal peaks of incidence in the spring and fall and a nadir in the winter. Emergency department charges of $21.2 billion were generated during the 4 years studied. While volume of visits decreased during the study, associated charges rose by 1.21%. Conclusions: Pediatric upper extremity injuries place burden on the economy of the US health care system. Types of injuries and anticipated payers vary among age groups, and while total yearly visits have decreased over the study period, the average cost of visits has risen.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"519 - 527"},"PeriodicalIF":0.0,"publicationDate":"2019-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719866884","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48719961","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":"Biomechanical Analysis of Thumb Ulnar Collateral Ligament Tear Kinematics","authors":"Charles C. Lin, Nilay A. Patel, Y. Itami, M. McGarry, S. Shin, T. Lee","doi":"10.1177/1558944719868518","DOIUrl":"https://doi.org/10.1177/1558944719868518","url":null,"abstract":"Background: Thumb ulnar collateral ligament (UCL) injuries are common, but the kinematics of these injuries have not been comprehensively described, especially regarding kinematic changes with progressive UCL injury. Methods: Eleven cadaveric thumbs underwent kinematic testing under 4 conditions: intact, partial tear (50%) of the proper UCL, full tear of the proper UCL, and complete tear of both the proper and accessory UCL. Kinematic testing parameters included varus/valgus stress, pronation/supination, and volar/dorsal translation at −10 degree, 0 degree, 15 degree, and 30 degree of metacarpophalangeal flexion. Results: Partial tear of the proper UCL did not result in significant increases in laxity in any direction compared with intact (P ≥ .132). Full tear of the proper UCL resulted in a significant increase in valgus angulation (18.8° ± 1.7° vs 11.5° ± 1.5°; P = .024) and pronation (15.4° ± 2.5° vs 12.6° ± 2.3°; P = .034) at 30 degree of flexion relative to intact. Complete tear of both the proper and accessory collateral ligaments resulted in increased valgus angulation at all degrees of flexion (P < .001). Complete tear also resulted in a significant volar translation at 0 degree, 15 degree, and 30 degree of flexion (P ≤ .016). Conclusion: Partial tear of the proper UCL does not significantly affect the stability of the joint, but full tear of the proper UCL increases valgus instability at 30 degree of flexion. Complete tear of the UCL is necessary for increased varus/valgus instability at all degrees of flexion and results in significant increases in pronation/supination and volar translation.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"467 - 473"},"PeriodicalIF":0.0,"publicationDate":"2019-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719868518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45241466","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":"Risk Factors for a False-Negative Examination in Complete Upper Extremity Nerve Lacerations","authors":"Scott N. Loewenstein, Reed Wulbrecht, V. Leonhard, Sarah E. Sasor, Julia A. Cook, L. Timsina, Joshua M. Adkinson","doi":"10.1177/1558944719866865","DOIUrl":"https://doi.org/10.1177/1558944719866865","url":null,"abstract":"Background: Many patients with complete nerve lacerations after upper extremity trauma have a documented normal peripheral nerve examination at the time of initial evaluation. The purpose of this study was to determine whether physician-, patient-, and injury-related factors increase the risk of false-negative nerve examinations. Methods: A statewide health information exchange was used to identify complete upper extremity nerve lacerations subsequently confirmed by surgical exploration at 1 pediatric and 2 adult level I trauma centers in a single city from January 2013 to January 2017. Charts were manually reviewed to build a database that included Glasgow Coma Scale score, urine drug screen results, blood alcohol level, presence of concomitant trauma, type of injury, level of injury, laterality, initial provider examination, and initial specialist examination. Bivariate and multivariable analyses were performed to evaluate risk factors for a false-negative examination. Results: Two hundred eighty-eight patients met inclusion criteria. The overall false-negative examination rate was 32.5% at initial encounter, which was higher among emergency medicine physicians compared with extremity subspecialists (P < .001) and among trauma surgeons compared with surgical subspecialists (P = .002). The false-negative rate decreased to 8% at subsequent encounter (P < .001). Risk factors for a false-negative nerve examination included physician specialty, a gunshot wound mechanism of injury, injury at the elbow, and age greater than 71 years. Conclusion: There is a high false-negative rate among upper extremity neurotmesis injuries. Patients with an injury pattern that may lead to nerve injury warrant prompt referral to an upper extremity specialist in an effort to optimize outcomes.","PeriodicalId":76630,"journal":{"name":"The Hand","volume":"16 1","pages":"432 - 438"},"PeriodicalIF":0.0,"publicationDate":"2019-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1558944719866865","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47338472","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}