Asian Spine Journal最新文献

{"title":"Bone density comparison between the normal pedicle trajectory, cortical bone trajectory, and modified cortical bone trajectory using computed tomography: a cross-sectional study.","authors":"Bikash Parajuli, Dipak Shrestha, Kuniyoshi Abumi, Sabik Kayastha, Jagadish Thapa, Sanjay Sharma, Suman Lamichhane, Christian Deininger","doi":"10.31616/asj.2024.0377","DOIUrl":"10.31616/asj.2024.0377","url":null,"abstract":"<p><strong>Study design: </strong>Cross-sectional study.</p><p><strong>Purpose: </strong>To compare bone density by computed tomography Hounsfield unit (CTHU) between the original pedicle trajectory (OPT), cortical bone trajectory (CBT), and modified cortical bone trajectory (MCBT).</p><p><strong>Overview of literature: </strong>The significant pullout strength in CBT is believed to be due to increased screw-cortical bone contact; however, it allows for shorter/less-diameter screw placement, and the fixation is limited to the posterior one-third of the vertebral body, compromising the screw anchorage in the anterior vertebra.</p><p><strong>Methods: </strong>Computed tomography transverse sections of the L1-L5 (1,000 vertebrae) of 200 patients were cut into three planes: (1) horizontal to the pedicle, representing the plane for OPT; (2) in the caudocranial plane in the sagittal plane and divergent in the transverse plane representing the CBT; and (3) the caudocranial plane in the sagittal plane and parallel in the transverse plane representing the MCBT. For each trajectory, the CTHU of four points, namely, posterior cortex, mid-pedicle, midbody, and anterior cortex, were compared within the area of screw insertion.</p><p><strong>Results: </strong>The mean CTHUs of OPT, CBT, and MCBT were 354.2±70 HU, 529.9±75 HU, and 457.3±90 HU, respectively (p <0.01). The CTHU of the posterior cortex in MCBT was 65.6% higher than that in OPT and 14.9% lower than that in CBT. A comparable decline in CTHU with age was noted in CBT and MCBT (Pearson's r : -0.20 vs. -0.22; adjusted R 2: 0.040 vs. 0.047). However, a higher decline in CTHU with age was observed in OPT (Pearson's r =-0.38, adjusted R 2=0.14).</p><p><strong>Conclusions: </strong>MCBT has a significantly higher CTHU than OPT. The density in the posterior cortex in MCBT is comparable to that in the CBT trajectory. MCBT appears to be an alternative trajectory for lumbar spine fixation.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"372-379"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of hospitalization for longer than one day following elective single-level anterior cervical discectomy and fusion: a retrospective case-control database study.","authors":"Sam Han Jiang, James W Nie, Nauman Shaukat Chaudhry, Saavan Patel, Darius Ansari, Ashwin Ganesh, Jeffrey Z Nie, Jaimin Patel, Ankit Indravadan Mehta","doi":"10.31616/asj.2024.0321","DOIUrl":"10.31616/asj.2024.0321","url":null,"abstract":"<p><strong>Study design: </strong>A retrospective case-control study.</p><p><strong>Purpose: </strong>To understand the risk factors for prolonged hospitalization following anterior cervical discectomy and fusion (ACDF) to reduce postoperative complications and better identify optimal candidates for elective ACDF.</p><p><strong>Overview of literature: </strong>Despite the proven safety of ACDF, many patients may experience prolonged postoperative hospitalization.</p><p><strong>Methods: </strong>Data were collected from the American College of Surgeons National Surgical Quality Improvement Program dataset spanning 2017-2019. The primary outcome of interest was the length of stay (LOS). The study population was divided into two cohorts: those with LOS ≤1 day and those with LOS >1 day. Univariate and multivariate analyses were performed to identify predictors of LOS >1 day. Propensity score matching and group comparisons were used to evaluate pre- and post-discharge complication rates between the cohorts.</p><p><strong>Results: </strong>A total of 12,906 patients with ACDF were identified in the database and considered eligible for the study. Of these patients, 69.5% had LOS ≤1 day and 30.5% had LOS >1 day. Factors associated with LOS >1 day included age ≥65 years, female sex, non-White race, American Society of Anesthesiologists classification 3, dependent functional status, and operation length of 120-150 minutes and >150 minutes. Patients with LOS >1 day were more likely to undergo intraoperative or postoperative blood transfusions (0.1% vs. 0.7%, p<0.001), unplanned reoperations (0% vs. 1.7%, p<0.001), and develop pneumonia during hospitalization (0% vs. 0.7%, p<0.001). These patients were also more likely to be readmitted (2.7% vs. 4.3%, p<0.001).</p><p><strong>Conclusions: </strong>Older patients, those with poorer functional status, and those who undergo longer operative times are more likely to experience prolonged postoperative hospitalization. These patients are also at increased risk of complications such as pneumonia, blood transfusions, reoperation, and readmission. Careful patient selection for ACDF is essential to reduce the risk of prolonged hospitalization and associated complications.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"389-398"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to editor: A new classification of atlas fracture based on computed tomography: reliability, reproducibility, and preliminary clinical significance.","authors":"Everpraise Siangshai, Anmol","doi":"10.31616/asj.2025.0185.r1","DOIUrl":"10.31616/asj.2025.0185.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"19 3","pages":"503-504"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144537938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can generative artificial intelligence provide accurate medical advice?: a case of ChatGPT versus Congress of Neurological Surgeons management of acute cervical spine and spinal cord injuries clinical guidelines.","authors":"Michael Saturno, Mateo Restrepo Mejia, Wasil Ahmed, Alexander Yu, Akiro Duey, Bashar Zaidat, Fady Hijji, Jonathan Markowitz, Jun Kim, Samuel Cho","doi":"10.31616/asj.2024.0301","DOIUrl":"10.31616/asj.2024.0301","url":null,"abstract":"<p><strong>Study design: </strong>An experimental study.</p><p><strong>Purpose: </strong>To explore the concordance of ChatGPT responses with established national guidelines for the management of cervical spine and spinal cord injuries.</p><p><strong>Overview of literature: </strong>ChatGPT-4.0 is an artificial intelligence model that can synthesize large volumes of data and may provide surgeons with recommendations for the management of spinal cord injuries. However, no available literature has quantified ChatGPT's capacity to provide accurate recommendations for the management of cervical spine and spinal cord injuries.</p><p><strong>Methods: </strong>Referencing the \"Management of acute cervical spine and spinal cord injuries\" guidelines published by the Congress of Neurological Surgeons (CNS), a total of 36 questions were formulated. Questions were stratified into therapeutic, diagnostic, or clinical assessment categories as seen in the guidelines. Questions were secondarily grouped according to whether the corresponding recommendation contained level I evidence (highest quality) versus only level II/III evidence (moderate and low quality). ChatGPT-4.0 was prompted with each question, and its responses were assessed by two independent reviewers as \"concordant\" or \"nonconcordant\" with the CNS clinical guidelines. \"Nonconcordant\" responses were rationalized into \"insufficient\" and \"contradictory\" categories.</p><p><strong>Results: </strong>In this study, 22/36 (61.1%) of ChatGPT's responses were concordant with the CNS guidelines. ChatGPT's responses aligned with 17/24 (70.8%) therapeutic questions and 4/7 (57.1%) diagnostic questions. ChatGPT's response aligned with only one of the five clinical assessment questions. Notably, the recommendations supported by level I evidence were the least likely to be replicated by ChatGPT. ChatGPT's responses agreed with 80.8% of the recommendations supported exclusively by level II/III evidence.</p><p><strong>Conclusions: </strong>ChatGPT-4 was moderately accurate when generating recommendations that aligned with the clinical guidelines. The model frequently aligned with low evidence and therapeutic recommendations but exhibited inferior performance on topics that contained high-quality evidence or pertained to diagnostic and clinical assessment strategies. Medical practitioners should monitor its usage until further models can be rigorously trained on medical data.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"432-443"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sarcopenia on outcomes following vertebral augmentation for osteoporotic vertebral compression fracture: a systematic review and meta-analysis.","authors":"Bao Tu Thai Nguyen, Tan Thanh Nguyen, Yi-Jie Kuo, Yu-Pin Chen","doi":"10.31616/asj.2024.0467","DOIUrl":"10.31616/asj.2024.0467","url":null,"abstract":"<p><p>Vertebral augmentation is a safe and effective treatment for osteoporotic vertebral compression fractures (OVCFs) in elderly patients. The impact of sarcopenia on post-procedure outcomes has been debated. This meta-analysis examined its effect on outcomes following vertebral augmentation in OVCF patients. Several electronic databases were searched until August 2024 for studies that compared patients with and without sarcopenia after kyphoplasty or vertebroplasty for OVCFs. The outcomes of interest were the rates of vertebral refracture and residual back pain (RBP), clinical outcomes, length of hospital stay, and mortality rate. The pooled results are presented as odds ratios (ORs) or mean differences with corresponding 95% confidence intervals (CIs). Fourteen studies involving 2197 patients with OVCF treated with vertebral augmentation were included. Of these patients, 813 had sarcopenia and 1384 did not, with a mean age of 73.06. Patients with sarcopenia exhibited a higher prevalence of refracture than those without sarcopenia (OR, 2.92; 95% CI, 1.34-6.34; p =0.007). Patients without sarcopenia had a 64% lower risk of RBP than those with sarcopenia (OR, 0.36; 95% CI, 0.23-0.56; p <0.001). Additionally, patients with sarcopenia demonstrated worse postoperative clinical outcomes, longer hospital stays, and a significantly higher risk of mortality. Sarcopenia adversely affects patients undergoing vertebral augmentation for OVCFs. Early diagnosis of sarcopenia in patients with OVCF and the adoption of comprehensive management strategies to improve and maintain muscle health are recommended (PROSPERO registry number: CRD42024578202).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"476-489"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143539959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications and curve progression in EOS patients with extended distraction surgery intervals in growing rod surgery: a retrospective cohort study in China.","authors":"Jianqiang Wang, Haoshuang Geng, Lijin Zhou, Yong Hai","doi":"10.31616/asj.2024.0426","DOIUrl":"10.31616/asj.2024.0426","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective case-control study.</p><p><strong>Purpose: </strong>This study aimed to explore the relationship between the rod-lengthening interval and the incidence of postoperative complications as well as the outcomes in patients with early-onset scoliosis (EOS) undergoing growing rod surgery.</p><p><strong>Overview of literature: </strong>EOS is characterized by a spinal deformity that manifests before the age of 10 years. The growing rod technique allows for spinal curvature correction while preserving spinal growth through periodic lengthening surgeries typically performed every 6 months. However, we found that due to challenges, many patients undergo a 1-year or even longer interval between lengthening surgeries.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 59 patients with EOS who underwent growing rod surgery at our institution between August 2012 and June 2022. We collected radiographic parameters to compare the differences in outcomes and complications between patients who underwent lengthening surgeries at intervals of 12 months versus those with intervals of >12 months.</p><p><strong>Results: </strong>In this study, we found 29 complications in 59 patients. The complication rate was significantly lower in the group with lengthening intervals of 12 months compared with the group with intervals longer than 12 months (35.3% vs. 68%, p <0.05). In addition, patients in the group with intervals of 12 months showed less progression of the main curve, a lower maximum kyphosis angle, and greater increases in height in the fixed segments (d=7.53±3.69 cm, p <0.05). In contrast, patients with lengthening intervals longer than 12 months were more likely to experience sagittal plane imbalance (p <0.05).</p><p><strong>Conclusions: </strong>Lengthening intervals of greater than 12 months have a higher rate of complications and increase the risk of curve progression and spinal imbalance. Increasing the interval time just to minimize the number of surgeries before the final fusion is unwise.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"399-407"},"PeriodicalIF":2.3,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12242249/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon-fiber-reinforced polyetheretherketone instrumentation in metastatic spine tumor surgery: technical considerations and potential pitfalls to avoid.","authors":"Naresh Kumar, Si Jian Hui, Priyambada Kumar, Leow Zihui Gabriel, Rohan Parihar, Jiong Hao Tan, Youheng Ou Yang, Yu-Mi Ryang","doi":"10.31616/asj.2025.0040","DOIUrl":"https://doi.org/10.31616/asj.2025.0040","url":null,"abstract":"<p><p>Carbon-fiber-reinforced polyetheretherketone (CFR-PEEK) instrumentation has been reported in recent years for metastatic spine tumor surgery (MSTS). The benefits of CFR-PEEK include imaging artifact reduction, which enables more efficient follow-up and adjuvant radiotherapy (RT) planning compared with traditional titanium implants. Despite the increase in CFR-PEEK application in the literature, technical guides or considerations in terms of CFR-PEEK usage in MSTS are currently unavailable. This study aimed to highlight various important technical considerations and potential pitfalls for surgeons when applying CFR-PEEK instrumentation in MSTS. This narrative review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online, The Cochrane Library, and Scopus databases through December 31, 2024. This review included all studies related to CFR-PEEK instrumentation in MSTS. The vast personal experiences of the senior authors with the CFR-PEEK instrumentation circumstantiated the concepts emphasized in this paper. This review included 36 articles and discussed various considerations when planning for CFR-PEEK instrumentation in patients undergoing MSTS. Factors include preoperative construct planning, intraoperative CFR-PEEK system handling, and postoperative considerations such as the requirement for RT planning. This review is the first to highlight various considerations for MSTS surgeons when applying CFR-PEEK instrumentation. This serves as an important guide for surgeons performing MSTS, with the continuous evolution of our treatment capacity in metastatic spinal disease (Level of evidence: IV).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972248","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":"Two-year follow-up of unilateral biportal endoscopy assisted extraforaminal lumbar interbody fusion: how to perform indirect decompression and fusion under endoscopy: a retrospective study in Japan.","authors":"Takaki Yoshimizu, Sanshiro Saito, Teruaki Miyake, Tetsutaro Mizuno, Ushio Nosaka, Keisuke Ishii, Mizuki Watanabe, Kanji Sasaki","doi":"10.31616/asj.2025.0071","DOIUrl":"10.31616/asj.2025.0071","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Purpose: </strong>To compare the clinical and radiographic outcomes of unilateral biportal endoscopy-assisted extraforaminal lumbar interbody fusion (BE-ELIF) and oblique lateral interbody fusion (OLIF).</p><p><strong>Overview of literature: </strong>OLIF is widely recognized for its strong realignment capability, achieved through placing a large interbody cage, and its favorable clinical outcomes with indirect decompression. ELIF, similar to OLIF, does not entail exposure of the spinal canal. At our hospital, BE-ELIF involves removing the superior articular processes on both sides, inserting two expandable cages, and performing indirect canal decompression. BE-ELIF is a lumbar interbody fusion technique that provides indirect decompression similar to OLIF. However, no studies have compared the efficacy of ELIF performed under unilateral biportal endoscopy with that of OLIF.</p><p><strong>Methods: </strong>Forty-nine adults who underwent single-level L4/5 interbody fusion for degenerative spondylolisthesis were divided into BE-ELIF (n=27) and OLIF (n=22) groups based on the surgical approach used. Clinical outcomes were assessed using the Visual Analog Scale and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ). Radiographic parameters, including distance of spondylolisthesis, disc height, segmental lordosis, lumbar lordosis, pelvic tilt, and sagittal vertical axis, were evaluated preoperatively and at final follow-up.</p><p><strong>Results: </strong>OLIF provided significantly better relief of pain in lower limbs and buttocks at 1-year follow-up. No significant between-group differences were observed in JOABPEQ domains. BE-ELIF resulted in greater improvements in spondylolisthesis distance and disc height, while other parameters did not differ significantly between the two groups.</p><p><strong>Conclusions: </strong>For L4/5 degenerative spondylolisthesis, BE-ELIF demonstrated superior spondylolisthesis reduction and disc height improvement than OLIF. Although BE-ELIF was associated with some inferior clinical outcomes, it provided satisfactory results, effective realignment, and a low complication risk.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"217-227"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor: Effect of core stabilization exercises on cervical sagittal balance parameters in patients with forward head posture: a randomized controlled trial in Egypt.","authors":"Ahmed Mahmoud Mohamed Shabana, Abeer Farag Hanafy, Ahmad Salamah Yamany, Reda Sayed Ashour","doi":"10.31616/asj.2025.0130.r2","DOIUrl":"10.31616/asj.2025.0130.r2","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"19 2","pages":"328-329"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12077876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to Editor: Effect of furosemide on prevertebral soft tissue swelling after anterior cervical fusion: a comparative study with dexamethasone.","authors":"Sneha Sharma, Sanjay Singh Rawat, Udit Kumar Jayant, Ravikiran Vanapalli, Venkatesh Kumar S, Sujit Kumar Singh","doi":"10.31616/asj.2025.0022.r1","DOIUrl":"https://doi.org/10.31616/asj.2025.0022.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"19 2","pages":"330-331"},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}