{"title":"Sensitivity of the shear wave speed-stress relationship to soft tissue material properties and fiber alignment.","authors":"Jonathon L. Blank, D. Thelen, M. Allen, J. Roth","doi":"10.31224/osf.io/54btr","DOIUrl":"https://doi.org/10.31224/osf.io/54btr","url":null,"abstract":"The use of shear wave propagation to noninvasively measure material properties and loading in tendons and ligaments is a growing area of interest in biomechanics. Prior models and experiments suggest that shear wave speed primarily depends on the apparent shear modulus (i.e., shear modulus accounting for contributions from all constituents) at low loads, and then increases with axial stress when axially loaded. However, differences in the magnitudes of shear wave speeds between ligaments and tendons, which have different substructures, suggest that the tissue's composition and fiber alignment may also affect shear wave propagation. Accordingly, the objectives of this study were to (1) characterize changes in the apparent shear modulus induced by variations in constitutive properties and fiber alignment, and (2) determine the sensitivity of the shear wave speed-stress relationship to variations in constitutive properties and fiber alignment. To enable systematic variations of both constitutive properties and fiber alignment, we developed a finite element model that represented an isotropic ground matrix with an embedded fiber distribution. Using this model, we performed dynamic simulations of shear wave propagation at axial strains from 0% to 10%. We characterized the shear wave speed-stress relationship using a simple linear regression between shear wave speed squared and axial stress, which is based on an analytical relationship derived from a tensioned beam model. We found that predicted shear wave speeds were both in-range with shear wave speeds in previous in vivo and ex vivo studies, and strongly correlated with the axial stress (R2 = 0.99). The slope of the squared shear wave speed-axial stress relationship was highly sensitive to changes in tissue density. Both the intercept of this relationship and the apparent shear modulus were sensitive to both the shear modulus of the ground matrix and the stiffness of the fibers' toe-region when the fibers were less well-aligned to the loading direction. We also determined that the tensioned beam model overpredicted the axial tissue stress with increasing load when the model had less well-aligned fibers. This indicates that the shear wave speed increases likely in response to a load-dependent increase in the apparent shear modulus. Our findings suggest that researchers may need to consider both the material and structural properties (i.e., fiber alignment) of tendon and ligament when measuring shear wave speeds in pathological tissues or tissues with less well-aligned fibers.","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"125 1","pages":"104964"},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49130037","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}
Seungjong Lee, N. Ahmad, Kayla M. Corriveau, Cameron J Himel, Daniel Silva, N. Shamsaei
{"title":"Bending properties of additively manufactured commercially pure titanium (CPTi) limited contact dynamic compression plate (LC-DCP) constructs: Effect of surface treatment.","authors":"Seungjong Lee, N. Ahmad, Kayla M. Corriveau, Cameron J Himel, Daniel Silva, N. Shamsaei","doi":"10.21203/RS.3.RS-529184/V1","DOIUrl":"https://doi.org/10.21203/RS.3.RS-529184/V1","url":null,"abstract":"Additive manufacturing of metallic materials, a layer-wise manufacturing method, is currently gaining attention in the biomedical industry because of its capability to fabricate complex geometries including customized parts fitting to patient requirements. However, one of the major challenges hindering the full implementation of additively manufactured parts in safety-critical applications is their poor mechanical performance under cyclic loading. This study investigated both quasi-static bending properties (bending stiffness, bending structural stiffness, and bending strength) and bending fatigue properties of additively manufactured (AM) commercially pure titanium (CPTi) limited contact dynamic compression plate (LC-DCP) constructs based on ASTM International standard for metallic bone plates (ASTM F382). In addition, the effect of post surface treatment methods including single shot-peened (SP), dual shot-peened (DP), and chemically assisted surface enhancement (CASE) on bending fatigue performance was also evaluated. Results indicated that bending stiffness and bending structural stiffness of AM CPTi LC-DCPs are comparable to conventionally manufactured (CM) counterparts; however, the bending strength of AM CPTi LC-DCPs is lower than CM counterparts. While the fatigue strength of as-built AM CPTi LC-DCPs is lower compared to the CM counterparts, AM CPTi LC-DCPs after post surface treatments (SP, DP, and CASE) exhibit statistically comparable fatigue strength to the CM CPTi LC-DCPs.","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"126 1","pages":"105042"},"PeriodicalIF":0.0,"publicationDate":"2021-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46736159","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}
Alexander Thesleff, M. Ortiz-Catalán, R. Brånemark
{"title":"The effect of cortical thickness and thread profile dimensions on stress and strain in bone-anchored implants for amputation prostheses.","authors":"Alexander Thesleff, M. Ortiz-Catalán, R. Brånemark","doi":"10.36227/TECHRXIV.14499759.V1","DOIUrl":"https://doi.org/10.36227/TECHRXIV.14499759.V1","url":null,"abstract":"Skeletal attachment of limb prostheses ensures load transfer between the prosthetic leg and the skeleton. For individuals with lower limb amputation, these loads may be of substantial magnitude. To optimize the design of such systems, knowledge about the structural interplay between implant design features, dimensional changes, and material properties of the implant and the surrounding bone is needed. Here, we present the results from a parametric finite element investigation on a generic bone-anchored implant system of screw design, exposed to external loads corresponding to average and high ambulatory loading. Of the investigated parameters, cortical thickness had the largest effect on the stress and strain in the bone-anchored implant and in the cortical bone. 36%-44% reductions in maximum longitudinal stress in the bone-anchored implant was observed as a result of increased cortical thickness from 2 mm to 5 mm. A change in thread depth from 1.5 mm to 0.75 mm resulted in 20%-22% and 10%-18% reductions in maximum longitudinal stress in the bone-anchored implant at 2 mm and 5 mm cortical thickness respectively. The effect of changes in the thread root radius was less prominent, with 8% reduction in the maximum longitudinal stress in the bone-anchored implant being the largest observed effect, resulting from an increased thread root radius from 0.1 mm to 0.5 mm at a thread depth of 1.5 mm. Autologous transplantation of bone tissue distal to the fixture resulted in reductions in the longitudinal stress in the percutaneous abutment. The observed stress reduction of 10%-31% was dependent on the stiffness of the transplanted bone graft and the cortical thickness of surrounding bone. Results from this investigation may guide structural design optimization for bone-anchored implant systems for attachment of limb prostheses.","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"129 1","pages":"105148"},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46059785","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}
J. Kwieciński, Christopher P. Cheng, R. Uberoi, Mohammed Hadi, P. Hempel, Christoph Degel, Z. You
{"title":"Thoracic aortic parallel stent-graft behaviour when subjected to radial loading.","authors":"J. Kwieciński, Christopher P. Cheng, R. Uberoi, Mohammed Hadi, P. Hempel, Christoph Degel, Z. You","doi":"10.31224/osf.io/3zx2b","DOIUrl":"https://doi.org/10.31224/osf.io/3zx2b","url":null,"abstract":"To manage complex aortic arch disease using minimally invasive techniques, interventionalists have reported the use of multiple stent-graft devices deployed in a parallel configuration. The structural device-device and device-artery interactions arising during aortic arch parallel endografting, also known as chimney thoracic endovascular aortic repair (ch-TEVAR), is not well understood. Through the use of a radial force testing system we sought to characterise both the loading and deformation behaviour of parallel endografts in representative ch-TEVAR configurations. Four commercially available devices (Bentley BeGraft, Gore TAG, Gore Viabahn, and Medtronic Valiant) were subjected to uniform radial load individually, and in six combinations, to quantify loading profiles. Image data collected during testing were analysed to evaluate mechanical deformations in terms of gutters, chimney and main endograft compression, as well as graft infolding. Parallel endografting was found to increase radial loads when compared to standard TEVAR. Chronic outward force during ch-TEVAR was dependent on main endograft manufacturer, with TAG combinations leading to consistently higher loads than Valiant, but independent of chimney graft type. Endograft deformations were dependent on chimney graft type, with Viabahn combinations presenting with lower gutter areas and increased lumen compression than BeGraft. Chimney graft deformations were also influenced by deployment arrangement in the case of double ch-TEVAR. This study emphasizes the significant variability in both radial loads and mechanical deformations between clinically relevant ch-TEVAR configurations.","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"118 1","pages":"104407"},"PeriodicalIF":0.0,"publicationDate":"2020-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41840461","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}
David Berard, Juan David Navarro, Gregg Bascos, Angel Harb, Yusheng Feng, R. D. De Lorenzo, R. L. Hood, D. Restrepo
{"title":"Novel expandable architected breathing tube for improving airway securement in emergency care.","authors":"David Berard, Juan David Navarro, Gregg Bascos, Angel Harb, Yusheng Feng, R. D. De Lorenzo, R. L. Hood, D. Restrepo","doi":"10.21203/rs.3.rs-31211/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-31211/v1","url":null,"abstract":"Life-saving interventions utilize endotracheal intubation to secure a patient's airway, but performance of the clinical standard of care endotracheal tube (ETT) is inadequate. For instance, in the current COVID-19 crisis, patients can expect prolonged intubation. This protracted intubation may produce health complications such as tracheal stenosis, pneumonia, and necrosis of tracheal tissue, as current ETTs are not designed for extended use. In this work, we propose an improved ETT design that seeks to overcome these limitations by utilizing unique geometries which enable a novel expanding cylinder. The mechanism provides a better distribution of the contact forces between the ETT and the trachea, which should enhance patient tolerability. Results show that at full expansion, our new ETT exerts pressures in a silicone tracheal phantom well within the recommended standard of care. Also, preliminary manikin tests demonstrated that the new ETT can deliver similar performance in terms of air pressure and air volume when compared with the current gold standard ETT. The potential benefits of this new architected ETT are threefold, by limiting exposure of healthcare providers to patient pathogens through streamlining the intubation process, reducing downstream complications, and eliminating the need of multiple size ETT as one architected ETT fits all.","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"114 1","pages":"104211"},"PeriodicalIF":0.0,"publicationDate":"2020-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46601109","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}
K. Aycock, J. Weaver, H. Paranjape, K. Senthilnathan, C. Bonsignore, B. Craven
{"title":"Full-field microscale strain measurements of a nitinol medical device using digital image correlation.","authors":"K. Aycock, J. Weaver, H. Paranjape, K. Senthilnathan, C. Bonsignore, B. Craven","doi":"10.31224/osf.io/a3twm","DOIUrl":"https://doi.org/10.31224/osf.io/a3twm","url":null,"abstract":"Computational modeling and simulation are commonly used during the development of cardiovascular implants to predict peak strains and strain amplitudes and to estimate the associated durability and fatigue life of these devices. However, simulation validation has historically relied on comparison with surrogate quantities like force and displacement due to barriers to direct strain measurement-most notably, the small spatial scale of these devices. We demonstrate the use of microscale two-dimensional digital image correlation (2D-DIC) to directly characterize full-field surface strains on a nitinol medical device coupon under emulated physiological and hyperphysiological loading. Experiments are performed using a digital optical microscope and a custom, temperature-controlled load frame. Following applicable recommendations from the International DIC Society, hardware and environmental heating studies, noise floor analyses, and in- and out-of-plane rigid body translation studies are first performed to characterize the microscale DIC setup. Uniaxial tension experiments are also performed using a polymeric test specimen to characterize the strain accuracy of the approach up to nominal stains of 5%. Sub-millimeter fields of view and sub-micron displacement accuracies (9nm mean error) are achieved, and systematic (mean) and random (standard deviation) errors in strain are each estimated to be approximately 1,000μϵ. The system is then demonstrated by acquiring measurements at the root of a 300μm-wide nitinol medical device strut undergoing fixed-free cantilever bending motion. Lüders-like transformation bands are observed originating from the tensile side of the strut that spread toward the neutral axis at an angle of approximately 55°. Despite the inherent limitations of optical microscopy and 2D-DIC, simple and relatively economical setups like that demonstrated herein could provide a practical and accessible solution for characterizing cardiovascular implant micromechanics, validating computational model strain predictions, and guiding the development of next-generation material models for simulating superelastic nitinol.","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"1 1","pages":"104221"},"PeriodicalIF":0.0,"publicationDate":"2020-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46960257","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":"A thermodynamic transient cross-bridge model for prediction of contractility and remodelling of the ventricle.","authors":"Eóin McEvoy, W. Wijns, P. McGarry","doi":"10.31224/osf.io/zfrhq","DOIUrl":"https://doi.org/10.31224/osf.io/zfrhq","url":null,"abstract":"Cardiac hypertrophy is an adaption of the heart to a change in cardiovascular loading conditions. The current understanding is that progression may be stress or strain driven, but the multi-scale nature of the cellular remodelling processes have yet to be uncovered. In this study, we develop a model of the contractile left ventricle, with the active cell tension described by a thermodynamically motivated cross-bridge cycling model. Simulation of the transient recruitment of myosin results in correct patterns of ventricular pressure predicted over a cardiac cycle. We investigate how changes in tissue loading and associated deviations in transient force generation can drive restructuring of cellular myofibrils in the heart wall. Our thermodynamic framework predicts in-series sarcomere addition (eccentric remodelling) in response to volume overload, and sarcomere addition in parallel (concentric remodelling) in response to valve and signalling disfunction. This framework provides a significant advance in the current understanding of the fundamental sub-sarcomere level biomechanisms underlying cardiac remodelling. Simulations reveal that pathological tissue loading conditions can significantly alter actin-myosin cross-bridge cycling over the course of the cardiac cycle. The resultant variation in sarcomere stress pushes an imbalance between the internal free energy of the myofibril and that of unbound contractile proteins, initiating remodelling. The link between cross-bridge thermodynamics and myofibril remodelling proposed in this study may significantly advance current understanding of cardiac disease onset.","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"113 1","pages":"104074"},"PeriodicalIF":0.0,"publicationDate":"2020-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46624337","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":"Understanding the deformation gradient in Abaqus and key guidelines for anisotropic hyperelastic user material subroutines (UMATs).","authors":"David Nolan, C. Lally, Patrick McGarry","doi":"10.31224/osf.io/4ryu2","DOIUrl":"https://doi.org/10.31224/osf.io/4ryu2","url":null,"abstract":"This tutorial paper provides a step-by-step guide to developing a comprehensive understanding of the different forms of the deformation gradient used in Abaqus, and outlines a number of key issues that must be considered when developing an Abaqus user defined material subroutine (UMAT) in which the Cauchy stress is computed from the deformation gradient. Firstly, we examine the \"classical\" forms of global and local deformation gradients. We then show that Abaqus/Standard does not use the classical form of the local deformation gradient when continuum elements are used, and we highlight the important implications for UMAT development. We outline the key steps that must be implemented in developing an anisotropic fibre-reinforced hyperelastic UMAT for use with continuum elements and local orientation systems. We also demonstrate that a classical local deformation gradient is provided by Abaqus/Standard if structural (shell and membrane) elements are used, and by Abaqus/Explicit for all element types. We emphasise, however, that the majority of biomechanical simulations rely on the use of continuum elements with a local coordinate system in Abaqus/Standard, and therefore the development of a hyperelastic UMAT requires an in-depth and precise understanding of the form of the non-classical deformation gradient provided as input by Abaqus. Several worked examples and case studies are provided for each section, so that the details and implications of the form of the deformation gradient can be fully understood. For each worked example in this tutorial paper the source files and code (Abaqus input files, UMATs, and Matlab script files) are provided, allowing the reader to efficiently explore the implications of the form of the deformation gradient in the development of a UMAT.","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"126 1","pages":"104940"},"PeriodicalIF":0.0,"publicationDate":"2019-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47398870","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":"Shear wave speeds track axial stress in porcine collateral ligaments.","authors":"Jonathon L. Blank, D. Thelen, J. Roth","doi":"10.31224/osf.io/ksg2p","DOIUrl":"https://doi.org/10.31224/osf.io/ksg2p","url":null,"abstract":"Ligament tension is an important factor that can affect the success of total knee arthroplasty (TKA) procedures. However, surgeons currently lack objective approaches for assessing tension in a particular ligament intraoperatively. The purpose of this study was to investigate the use of noninvasive shear wave tensiometry to characterize stress in medial and lateral collateral ligaments (MCLs and LCLs) ex vivo and evaluate the capacity of shear wave speed to predict axial load. Nine porcine MCL and LCL specimens were subjected to cyclic axial loading while shear wave speeds were measured using laser vibrometry. We found that squared shear wave speed increased linearly with stress in both the MCL (r2avg = 0.94) and LCL (r2avg = 0.98). Shear wave speeds were slightly lower in the MCL than the LCL when subjected to a comparable axial stress (p < 0.001). Specimen-specific calibrations predicted tension within 13.0 N, or 5.2% of the maximum load. A leave-one-out analysis was also performed and showed that calibrated relationships based on ligament type could predict axial tension within 15% of the maximum load. These observations suggest it may be feasible to use noninvasive shear wave speed measures as a proxy of ligament loading, which in the future might enhance decision making during orthopedic procedures such as TKA.","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"105 1","pages":"103704"},"PeriodicalIF":0.0,"publicationDate":"2019-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46450067","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}
Philip N Hawkins, Yukio Ando, Angela Dispenzeri, Alejandra Gonzalez-Duarte, David Adams, Ole B Suhr
{"title":"Evolving landscape in the management of transthyretin amyloidosis.","authors":"Philip N Hawkins, Yukio Ando, Angela Dispenzeri, Alejandra Gonzalez-Duarte, David Adams, Ole B Suhr","doi":"10.3109/07853890.2015.1068949","DOIUrl":"10.3109/07853890.2015.1068949","url":null,"abstract":"<p><p>Transthyretin (TTR) amyloidosis (ATTR amyloidosis) is a multisystemic, multigenotypic disease resulting from deposition of insoluble ATTR amyloid fibrils in various organs and tissues. Although considered rare, the prevalence of this serious disease is likely underestimated because symptoms can be non-specific and diagnosis largely relies on amyloid detection in tissue biopsies. Treatment is guided by which tissues/organs are involved, although therapeutic options are limited for patients with late-stage disease. Indeed, enthusiasm for liver transplantation for familial ATTR amyloidosis with polyneuropathy was dampened by poor outcomes among patients with significant neurological deficits or cardiac involvement. Hence, there remains an unmet medical need for new therapies. The TTR stabilizers tafamidis and diflunisal slow disease progression in some patients with ATTR amyloidosis with polyneuropathy, and the postulated synergistic effect of doxycycline and tauroursodeoxycholic acid on dissolution of amyloid is under investigation. Another therapeutic approach is to reduce production of the amyloidogenic protein, TTR. Plasma TTR concentration can be significantly reduced with ISIS-TTR(Rx), an investigational antisense oligonucleotide-based drug, or with patisiran and revusiran, which are investigational RNA interference-based therapeutics that target the liver. The evolving treatment landscape for ATTR amyloidosis brings hope for further improvements in clinical outcomes for patients with this debilitating disease.</p>","PeriodicalId":94117,"journal":{"name":"Journal of the mechanical behavior of biomedical materials","volume":"1 1","pages":"625-38"},"PeriodicalIF":4.4,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90688969","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}