The international journal of lower extremity wounds最新文献

{"title":"Diabetic Foot Amputations: Engagement Still Needed to Improve Outcomes.","authors":"Alfred Gatt, Cynthia Formosa, Nikolaos Papanas","doi":"10.1177/15347346251316041","DOIUrl":"10.1177/15347346251316041","url":null,"abstract":"","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"5-6"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143049375","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":"Comparative Analysis of Bone Resection Versus Bone Curettage in Diabetic Foot Osteomyelitis.","authors":"Shaima Kmari-El-Ghazouany, Aroa Tardáguila-García, Mateo López-Moral, Marta García-Madrid, Yolanda García-Álvarez, José Luis Lázaro-Martínez","doi":"10.1177/15347346231206448","DOIUrl":"10.1177/15347346231206448","url":null,"abstract":"<p><p>This study aims to describe the healing times of patients who underwent bone resection compared to bone curettage for managing diabetic foot osteomyelitis and to compare short- and long-term complications. This analytical retrospective observational cohort study collected clinical records of patients from a specialized diabetic foot clinic who underwent resection or bone curettage between January 2017 and January 2022. After surgery, a 1-year follow-up was conducted to record healing times and short- and long-term complications. The study included thirty-one patients, with 19 (61.29%) undergoing resections and 11 (38.71%) undergoing bone curettages. The resection cohort had a mean healing time of 5.70 ± 6.05 weeks, whereas the curettage cohort had a mean healing time of 14.45 ± 11.78 weeks, showing a statistically significant difference (<i>P</i> = 0.011). No significant differences were observed in terms of short- and long-term complications. In the resection cohort, 12 (63.20%) experienced short-term complications, compared to eight (66.70%) in the curettage cohort (<i>P</i> = 0.842, χ² = 0.40, OR = 1.16). In the resection cohort, n = 6 (31.60%) had long-term complications, while n = 3 (25.00%) in the curettage cohort experienced long-term complications (<i>P</i> = 0.694, χ² = 0.155, OR = 0.72). Although there were no significant differences in short- and long-term complications between resection and curettage, the resection group showed shorter healing times.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"143-148"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41184692","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":"Rapid Access From Primary Care to a Multidisciplinary Clinic at Tertiary Care Improves Clinical Outcomes for Patients With Diabetic Foot Ulcers: Results From Diabetic Foot in Primary and Tertiary (DEFINITE) Care's Lower Extremity Amputation Prevention Program (LEAPP) Clinic.","authors":"Jaime H X Lin, Lixia Ge, Huiling Liew, Elaine Tan, Jeremy Hoe, Enming Yong, Zhiwen Loh, Tiffany Chew, Mohd F M Farhan, Zhang Li, Donna Tan, Yi Bing Loh, Julia Zhu, Pauline Ang, Claris Shi, Dexter Yak Seng Chan, Chelsea Law, Nadiah Raman, Joseph Molina, Gary Ang, Hui Yan Koo, Kai Qiang Low, Julia Choo, Cin Yee Tan, Jo Ann Lim, James Siow, Shaun Wy Chan, Sadhana Chandraskear, Daniel Chew, Zhiwen Joseph Lo","doi":"10.1177/15347346241252200","DOIUrl":"10.1177/15347346241252200","url":null,"abstract":"<p><p>Diabetic Foot in Primary and Tertiary (DEFINITE) Care is an inter-institutional, multidisciplinary team (MDT) program for patients with diabetic foot ulcers (DFU) within a healthcare cluster in Singapore. This is one of our subgroup analyses within DEFINITE Care, assessing clinical outcomes of lower extremity amputation prevention program (LEAPP), a multidisciplinary diabetic foot clinic, and non-LEAPP patients within the program. From June 2020 to June 2022, 2798 patients within the DEFINITE cohort completed a minimum of 12-month follow up. Of these patients, 20.6% were managed by LEAPP, whereas 79.4% were non-LEAPP patients. Patients in the LEAPP cohort were older with co-existing metabolic conditions and complications of diabetes. Using non-LEAPP cohort as the reference group and after adjusting for age, gender, ethnicity, comorbidities, and medications, there was a significantly lower risk of death (odds ratio [OR] 0.60, <i>P</i> = .001) and composite major lower extremity amputation (LEA) or death (OR 0.66, <i>P</i> = .002) among LEAPP patients at 1 year with longer mean days from enrollment to minor LEA, major LEA, and death. The adjusted 1-year healthcare utilization outcomes for LEAPP patients demonstrated an increase in inpatient admissions, primary care polyclinic visits, hospital specialist outpatient clinic (SOC) visits and elective day surgery procedures. Despite the increased in inpatients admissions, cumulative hospital length of stay in LEAPP patients were lower. This subgroup analysis has demonstrated that the MDT approach to caring for patients with DFU in tertiary centers not only improves mortality by 40%, but also delayed the incidence of minor LEA, major LEA, and death.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"102-108"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946764","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":"Effectiveness of a Multidisciplinary Limb Preservation Program in Reducing Regional Hospitalization Rates for Patients With Diabetes-Related Foot Complications.","authors":"Ali Manji, Reza Basiri, Francois Harton, Kenton Rommens, Karim Manji","doi":"10.1177/15347346241238458","DOIUrl":"10.1177/15347346241238458","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the toe and flow model (TFM), a limb preservation program led by podiatric surgeons in Alberta, Canada, for its impact on hospitalization rates and length of stay (LOS) in patients with diabetic foot complication (DFC). Diabetes, a leading cause of non-traumatic lower extremity amputations (LEAs) in Canada, often results in diabetic foot ulcers (DFUs), a major cause of infection, amputation, and hospitalization. TFM has reportedly reduced amputation rates by 39% to 56%.</p><p><strong>Methods: </strong>The study analyzed Alberta's health database from 2007 to 2017, focusing on diabetes patients aged 20 and above. It included patients with various DFCs and compared outcomes in regions using TFM and standard of care (SOC). The study also examined data from two major cities, one with TFM and the other without, including rural referrals to Calgary and Edmonton. The data were normalized for the diabetic population and analyzed using a standard Student's <i>t</i>-test.</p><p><strong>Results: </strong>TFM regions showed significantly lower hospitalization rates (<i>p</i> = 1.22E-12) than SOC regions. Over 11 years, TFM maintained lower average and median LOS by 0.13 and 0.26 days, respectively. TFM access reduced hospitalization risk by up to 30%, and patients in TFM regions had a 21% shorter LOS compared to SOC regions.</p><p><strong>Conclusion: </strong>Despite similar demographics and healthcare systems, the TFM region benefited from a dedicated multidisciplinary program and comprehensive limb preservation services. The study shows that TFM effectively reduces hospitalizations and LOS for DFCs, with significantly better outcomes in the TFM region than in SOC regions.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"117-123"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11863509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140178553","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":"Skin Micro-Fragments for the Management of Diabetic Foot Ulcers: A Case Series.","authors":"José Luis Lázaro-Martínez, Marta García-Madrid, Mateo López-Moral, Esther García-Morales, Raúl J Molines-Barroso, Aroa Tardáguila-García","doi":"10.1177/15347346241311046","DOIUrl":"10.1177/15347346241311046","url":null,"abstract":"<p><p>This prospective case series evaluated the clinical outcomes of skin micro-fragment therapy in managing hard-to-heal diabetic foot ulcers (DFU). A total of ten patients with chronic DFU, who were treated in a specialized diabetic foot unit, were included in this study. The primary outcome was the wound healing rate at 12 weeks. Secondary outcomes comprised the time to complete epithelialization, wound area reduction (WAR) at 4 and 12 weeks, and the incidence of adverse events. After treatment with hy-tissue micrograft (HT-MG), 6 (60%) of patients achieved complete wound closure within 12 weeks. The mean healing time was 7.8 ± 2.4 weeks. The mean WAR at 4 and 12 weeks was 67.2% ± 23.5% and 87.5% ± 24% respectively. The procedure was well tolerated with no complications observed in the donor site such as pain or infection. No adverse effects related to the infiltration procedure at wound site were recorded with a promising wound healing rate during the follow-up period. These results suggest that HT-MG could be a safe and effective treatment option for chronic DFU, promoting noteworthy wound healing and reducing healing times. Further studies are required to confirm these findings and assess long-term outcomes.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"51-58"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960897","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":"Associations Between Systolic Pressure, Vascular Waveform, and Volume Flow with Debridement or Amputation Treatment Decisions in Diabetic Foot Ulcer Patients.","authors":"Patrianef Darwis, Ahmad Syaifudin, Raden Suhartono, Akhmadu Muradi, Dedy Pratama, Dian Kusuma Dewi, Alif Hamzah","doi":"10.1177/15347346241233364","DOIUrl":"10.1177/15347346241233364","url":null,"abstract":"<p><strong>Introduction: </strong>Diabetic foot ulcer disease, affecting 6.3% of the global population, necessitates crucial decisions regarding debridement and amputation, with substantial cost, morbidity, and mortality implications. This study's primary goal is to determine effective vascular examination modalities, including systolic blood pressure, vascular waveforms, and blood volume flow to guide optimal treatments for diabetic foot patients.</p><p><strong>Method: </strong>This cross-sectional study at Cipto Mangunkusumo General Hospital aimed to identify effective vascular examination modalities, such as systolic blood pressure, vascular waveforms, and blood volume flow, to guide treatment choices for diabetic foot patients. The study included 38 subjects, equally split between debridement and amputation groups.</p><p><strong>Results: </strong>Notably, the presence of a biphasic pattern in popliteal artery vascular examinations was associated with the decision for amputation in diabetic foot patients (p < 0.05). The Chi-square test revealed that a biphasic ultrasound pattern served as a predictive factor for amputation among diabetic foot patients, with three times more biphasic patients choosing amputation over debridement. Conversely, assessments of popliteal artery systolic pressure, common femoral artery waveform, popliteal artery volume flow, and common femoral artery volume flow showed no significant correlations with the choice of debridement or amputation treatment for diabetic foot patients.</p><p><strong>Conclusion: </strong>In summary, ultrasound assessment of vascular waveform in the popliteal artery emerges as a predictive factor for amputation or debridement in diabetic foot patients.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"124-129"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934960","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":"Comparison of Negative-Pressure Wound Therapy and Gradual Wound Approximation Treatments for Infected Fasciotomy Wounds.","authors":"Yener Yoğun, Uğur Bezirgan, Mehmet Batu Ertan, Merve Dursun Savran, Peri Kindan, Mahmut Kalem, Mehmet Armangil","doi":"10.1177/15347346241266652","DOIUrl":"10.1177/15347346241266652","url":null,"abstract":"<p><p>Negative-pressure wound therapy (NPWT) and gradual wound approximation (GWA) are effective and reliable methods of treating fasciotomy wounds. However, the effectiveness of these 2 methods in treating infected wounds remains unclear. The aim of our study was to compare these 2 delayed primary closure methods of treating infected fasciotomy wounds on the limbs. Patients who underwent fasciotomy surgery on the extremities after sustaining crushing injuries in the 2023 Kahramanmaraş-centered earthquakes and who were referred owing to infected open wounds during follow-up were included in the study. Patients who completed the wound closure process at our clinic were divided into 2 groups: the NPWT and GWA groups. Using retrospectively collected data, the groups were compared in terms of demographic characteristics, time until wound closure, number of surgeries, skin graft requirements, and complications. Laboratory parameters were also examined. Thirteen patients, (with 21 wounds) who underwent NPWT and 14 (with 22 wounds) who underwent GWA, were examined. The average age of the NPWT group was 32.85 ± 18.37 years, whereas that of the GWA group was 25.21 ± 16.31 years. The number of surgeries in the NPWT and GWA groups were 5.38 ± 2.11 and 4.23 ± 1.27, respectively, and the difference was statistically significant (<i>P</i> = .040). The average wound closure times of the NPWT and GWA groups (<i>P</i> = .0210) (11.00 ± 4.86 days and 8.27 ± 2.41 days, respectively) also differed significantly. Skin grafting was performed in 5 patients in the NPWT group and 2 in the GWA group. There were no significant differences between the 2 groups in terms of skin graft requirements or complication rates. NPWT and GWA are effective and reliable methods of closing infected fasciotomy wounds. Closure of these wounds can be achieved in a shorter time and with fewer surgeries using GWA than using NPWT.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"92-101"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141736233","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":"Early Tissue Resection Versus Watchful Waiting After Revascularization for Chronic Limb-Threatening Ischemia: A Meta-Analysis.","authors":"Xu Xu, Qiang Guo","doi":"10.1177/15347346241279517","DOIUrl":"10.1177/15347346241279517","url":null,"abstract":"<p><p>No consensus or guideline has been established regarding the optimal timing of tissue resection after revascularization in patients with chronic limb-threatening ischemia (CLTI). This study aimed to compare early tissue resection and watchful waiting after revascularization regarding the outcomes of patients with CLTI. We searched PubMed, the Cochrane Library, and EMBASE for relevant randomized trials and observational studies published from their inception to May 1, 2024. In total, five articles were analyzed. The results showed that the early tissue resection group had a higher wound healing rate than the watchful waiting group (I²= 26%, odds ratio [OR] = 2.80, 95% confidence interval [CI] 1.32 to 5.92, <i>P </i>= 0.007). However, the rate of major amputation was significantly higher in the early tissue resection group than in the watchful waiting group (I²= 5%, OR = 1.48, 95% CI 1.18 to 1.86, <i>P </i>< 0.001), and wound recurrence rate in the early tissue resection group was relatively higher than that in the watchful waiting group (I²= 0%, OR = 2.42, 95% CI: 0.99 to 5.93, <i>P </i>= 0.05). No statistical significance was found in the rate of postoperative mortality (I²= 2%, OR = 0.99, 95% CI: 0.69 to 1.41, <i>P </i>= 0.94) and wound healing time (I²= 97%, standardized mean difference = -105.92, 95% CI -232.96 to 21.13, <i>P </i>= 0.10) between the early tissue resection and watchful waiting groups. For patients without signs of infection, a watchful waiting strategy could reduce the risk of major amputation.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"74-81"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082996","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":"Replicating Success in Conservative Surgery for Diabetes-Related Forefoot Osteomyelitis: A Comparative Study Between Two Diabetic Foot Units in Spain and Costa Rica.","authors":"Gerardo Víquez-Molina, José María Rojas-Bonilla, Javier Aragón-Sánchez","doi":"10.1177/15347346251323104","DOIUrl":"https://doi.org/10.1177/15347346251323104","url":null,"abstract":"<p><p>To evaluate whether the adoption of conservative surgical techniques in Costa Rica, facilitated by international collaboration and training, achieved outcomes comparable to those in a reference unit in Spain. This retrospective study included 199 patients with histologically confirmed diabetes-related forefoot osteomyelitis: 110 from Costa Rica and 89 from Spain. Data were extracted from two standardized databases. Infection severity was classified according to IWGDF/IDSA criteria. Surgical procedures were categorized as conservative surgery, minor amputation, or major amputation. Antibiotic use and hospitalization rates were compared between cohorts. Statistical analyses included Chi-squared and Mann-Whitney U tests. Patients in Costa Rica were younger and exhibited poorer metabolic control, while patients in Spain had higher rates of comorbidities. Despite more severe infections in Costa Rica, characterized by higher inflammatory markers and soft tissue involvement, 39.1% of Costa Rican patients were treated without postoperative antibiotics, and the median antibiotic duration was significantly shorter (14 vs 30 days, p < 0.001). The rates of conservative surgery were similar in both groups (62.7% in Costa Rica vs 65.2% in Spain, p = 0.63). When excluding cases with soft tissue involvement, conservative surgery was performed in 86.0% of Costa Rican cases and 96.0% of Spanish cases (p = 0.167). This study demonstrates that structured training and international collaboration enabled the adoption of surgical strategies comparable to those in a reference unit in Spain, achieving similar clinical outcomes. The findings highlight the potential for conservative surgery and antibiotic stewardship to optimize care in resource-limited settings while reducing unnecessary interventions.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251323104"},"PeriodicalIF":0.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517769","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 Role of Clinicians' Self-Efficacy in Exercise Promotion for Adults with Venous Leg Ulcers: A Cross-Sectional Study.","authors":"Jane O'Brien, Damhnat McCann, Christina N Parker, Kathleeen Finlayson, Andrew Jull","doi":"10.1177/15347346251321550","DOIUrl":"https://doi.org/10.1177/15347346251321550","url":null,"abstract":"<p><strong>Introduction: </strong>Physical activity is recognised for its functional, physical, and psychological benefits in managing venous leg ulcers. Despite these advantages, individuals with venous leg ulcers often remain inactive, largely due to fear of exacerbating their condition and a lack of comprehensive guidance. Clinicians play a crucial role in promoting physical activity, providing support to patients to engage in safe and beneficial exercises. This study aimed to assess clinicians' knowledge, attitudes, and practices toward physical activity in adults with venous leg ulcers to inform clinical practice and the development of targeted physical activity strategies.</p><p><strong>Methods: </strong>An online questionnaire was developed to assess clinicians' familiarity with physical activity guidelines, their confidence in recommending physical activity, and the barriers they encountered in practice.</p><p><strong>Results: </strong>A total of 141 clinicians, predominantly nurses (99%), completed the survey, with 83% reporting awareness of clinical guidelines for venous leg ulcer management. However, only 25% regularly recommended a general increase in physical activity, 27% recommended calf strengthening exercises, and 38% consistently recommended ankle joint mobility exercises. Key barriers; 1) insufficient training to recommend specific exercises, 2) lack of evidence-based information to provide to patients and 3) limited access to exercise specialists for referrals. Statistical modelling showed that self-efficacy significantly influenced recommendations for ankle mobility exercises; clinicians with higher confidence were 7.6 times more likely to make such recommendations (p < .001). Although attitudes toward prescribing ankle exercises to adults with venous leg ulcers in compression were not statistically significantly related to reported practice (p = .087), they demonstrated relevance to clinical decision making and warrant further investigation.</p><p><strong>Conclusion: </strong>While clinicians recognise the importance of physical activity for adults with venous leg ulcers, gaps in knowledge, resources, and training limit their ability to provide specific exercise recommendations. Addressing these gaps through large-scale implementation of structured physical activity strategies is essential.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251321550"},"PeriodicalIF":0.0,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143506689","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}