Pub Date : 2025-07-01DOI: 10.1016/j.jmpt.2025.10.031
Chunxia Zhang MD , Tao Pang MD , Yuan Chen MD , Penghui Lai MD , Rongrong Nie MD , Yulong Wang MD , Shaohua Zhang MD
Objective
The purpose of this study was to examine brain function activity changes in patients with left basal ganglia ischemic stroke (LBGIS) in order to identify the specific brain regions associated with motor function.
Methods
The study compared 35 patients with LBGIS and 34 healthy control participants (HCs). Functional connectivity density (FCD) was calculated to explore brain functional activity difference between the 2 groups of participants, and receiver operating characteristics (ROC) curve was used to test the specificity of these different regions. Pearson’s correlation was employed to evaluate relationships between FCD values and clinical scores.
Results
In the LBGIS group, FCD values were increased in the left cerebellum 9 lobe (L_C9), right inferior temporal gyrus (R_ITG), left middle temporal gyrus (L_MTG), and right supplementary motor area (R_SMA) but decreased in the left calcarine sulcus (L_CS), right lingual gyrus (R_LG), right cuneus (R_C), right supramarginal gyrus (R_SG), right inferior frontal gyrus (R_IFG), and left inferior parietal gyrus (L_IPG). ROC curves demonstrated that these designated brain areas alone distinguished between the LBGIS and HC groups with high sensitivity and specificity. In patients with LBGIS, L_C9 and R_SMA displayed significant correlations with the Fugl–Meyer assessment and Barthel index scores.
Conclusions
Patients with LBGIS exhibit changes in the functional activity of multiple brain regions, and L_C9 and R_SMA may be key areas to promote motor function in people with LBGIS.
{"title":"Functional Connectivity Density in Patients with Left Basal Ganglia Ischemic Stroke: A Comparative Study","authors":"Chunxia Zhang MD , Tao Pang MD , Yuan Chen MD , Penghui Lai MD , Rongrong Nie MD , Yulong Wang MD , Shaohua Zhang MD","doi":"10.1016/j.jmpt.2025.10.031","DOIUrl":"10.1016/j.jmpt.2025.10.031","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to examine brain function activity changes in patients with left basal ganglia ischemic stroke (LBGIS) in order to identify the specific brain regions associated with motor function.</div></div><div><h3>Methods</h3><div>The study compared 35 patients with LBGIS and 34 healthy control participants (HCs). Functional connectivity density (FCD) was calculated to explore brain functional activity difference between the 2 groups of participants, and receiver operating characteristics (ROC) curve was used to test the specificity of these different regions. Pearson’s correlation was employed to evaluate relationships between FCD values and clinical scores.</div></div><div><h3>Results</h3><div>In the LBGIS group, FCD values were increased in the left cerebellum 9 lobe (L_C9), right inferior temporal gyrus (R_ITG), left middle temporal gyrus (L_MTG), and right supplementary motor area (R_SMA) but decreased in the left calcarine sulcus (L_CS), right lingual gyrus (R_LG), right cuneus (R_C), right supramarginal gyrus (R_SG), right inferior frontal gyrus (R_IFG), and left inferior parietal gyrus (L_IPG). ROC curves demonstrated that these designated brain areas alone distinguished between the LBGIS and HC groups with high sensitivity and specificity. In patients with LBGIS, L_C9 and R_SMA displayed significant correlations with the Fugl–Meyer assessment and Barthel index scores.</div></div><div><h3>Conclusions</h3><div>Patients with LBGIS exhibit changes in the functional activity of multiple brain regions, and L_C9 and R_SMA may be key areas to promote motor function in people with LBGIS.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 947-955"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to investigate tibial nerve dynamics during the straight leg raise (SLR) test in patients with lumbar disc herniation (LDH) and the relationship between neurological symptoms and dynamics at the radiating pain-occurring (RPO) angle.
Methods
Participants with LDH were 20 adults (10 males, 10 females, average age of 58.4 years, average body mass index [BMI] of 21.9 kg/m2) who visited the orthopedic clinic between November 2019 and December 2020. The SLR test was performed at 20°, 40°, and the RPO angle for patients with LDH. In healthy participants, the test was performed at 20°, 40°, and the maximum elevation angle. The excursion and strain of the proximal and distal ends of the tibial nerve were compared using ultrasound imaging at each angle. Furthermore, the nerve dynamics at the RPO angle were compared between the LDH groups with and without neurological symptoms.
Results
Movement at the proximal and distal ends of the tibial nerves at 20° and 40° leg elevation was smaller in the LDH group than in the healthy group. No significant difference was observed in the amounts of strain at these two angles. In LDH, nerve strain at the RPO angle was lower in the group with neurological symptoms than in the group without. During the SLR test, excursion of the tibial nerve was less in LDH than in healthy participants, suggesting that the sciatic nerve was more strained in LDH.
Conclusion
Our findings show an association between insufficient tibial nerve strain during SLR and neurological symptoms.
{"title":"Dynamics of the Tibial Nerve During Straight Leg Raise Test: A Study of Individuals With Lumbar Disc Herniation","authors":"Atsushi Toribe MS , Kyoji Okada PhD , Akira Saito PhD , Minoru Kimoto PhD , Yoshino Terui PhD","doi":"10.1016/j.jmpt.2025.11.001","DOIUrl":"10.1016/j.jmpt.2025.11.001","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to investigate tibial nerve dynamics during the straight leg raise (SLR) test in patients with lumbar disc herniation (LDH) and the relationship between neurological symptoms and dynamics at the radiating pain-occurring (RPO) angle.</div></div><div><h3>Methods</h3><div>Participants with LDH were 20 adults (10 males, 10 females, average age of 58.4 years, average body mass index [BMI] of 21.9 kg/m<sup>2</sup>) who visited the orthopedic clinic between November 2019 and December 2020. The SLR test was performed at 20°, 40°, and the RPO angle for patients with LDH. In healthy participants, the test was performed at 20°, 40°, and the maximum elevation angle. The excursion and strain of the proximal and distal ends of the tibial nerve were compared using ultrasound imaging at each angle. Furthermore, the nerve dynamics at the RPO angle were compared between the LDH groups with and without neurological symptoms.</div></div><div><h3>Results</h3><div>Movement at the proximal and distal ends of the tibial nerves at 20° and 40° leg elevation was smaller in the LDH group than in the healthy group. No significant difference was observed in the amounts of strain at these two angles. In LDH, nerve strain at the RPO angle was lower in the group with neurological symptoms than in the group without. During the SLR test, excursion of the tibial nerve was less in LDH than in healthy participants, suggesting that the sciatic nerve was more strained in LDH.</div></div><div><h3>Conclusion</h3><div>Our findings show an association between insufficient tibial nerve strain during SLR and neurological symptoms.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 967-976"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145678050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this study was to assess both intra- and inter-examiner reliability of manual muscle testing (MMT) within Applied Kinesiology (AK) practice.
Methods
Comprehensive searches were conducted in Medline, Scopus, Ebsco, and Embase, alongside manual searches of reference lists, with no date restrictions through October 14, 2023. Only studies applying MMT according to AK principles were included. Methodological quality was assessed using QAREL and Part B of the COSMIN checklist. A qualitative data synthesis was done to analyze reliability data.
Results
From 8,720 initial records, 7 studies met the inclusion criteria. Four were rated as good or very good quality, while 3 were rated as poor or inadequate. Intraexaminer reliability was assessed in 3 studies: 1 demonstrated high reliability (ICC > 0.86), while 2 showed poor reliability (k = −0.14 to 0.29, with 27%-40% agreement). Inter-examiner reliability, evaluated in 6 studies, ranged widely from k = −0.51 to 0.91. A subgroup analysis including only studies that used MMT without additional challenge procedures showed inter-examiner reliability ranging from k = −0.05 to 0.91. The piriformis muscle demonstrated the highest reliability (k = 0.7 to 0.91), while the hamstrings had the lowest (k = −0.07 to 0.24).
Conclusion
The reliability of MMT in AK ranged from nonexistent to very strong, depending on the type of analysis. MMT involving nonmusculoskeletal challenges showed nonexistent reliability and therefore not recommended for clinical use. However, MMT without challenges may be clinically useful, particularly for the deltoid, gluteus maximus, piriformis, and iliopsoas, which demonstrated moderate to very strong reliability.
{"title":"Reliability of Manual Muscle Testing in Applied Kinesiology: A Systematic Review","authors":"Jonatan Raabe Soares BsC (Chiro) , Fábio Franciscatto Stieven PhD , Clarice Sperotto dos Santos Rocha PhD , Iã Ferreira Miranda MsC","doi":"10.1016/j.jmpt.2025.10.007","DOIUrl":"10.1016/j.jmpt.2025.10.007","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to assess both intra- and inter-examiner reliability of manual muscle testing (MMT) within Applied Kinesiology (AK) practice.</div></div><div><h3>Methods</h3><div>Comprehensive searches were conducted in Medline, Scopus, Ebsco, and Embase, alongside manual searches of reference lists, with no date restrictions through October 14, 2023. Only studies applying MMT according to AK principles were included. Methodological quality was assessed using QAREL and Part B of the COSMIN checklist. A qualitative data synthesis was done to analyze reliability data.</div></div><div><h3>Results</h3><div>From 8,720 initial records, 7 studies met the inclusion criteria. Four were rated as good or very good quality, while 3 were rated as poor or inadequate. Intraexaminer reliability was assessed in 3 studies: 1 demonstrated high reliability (ICC > 0.86), while 2 showed poor reliability (k = −0.14 to 0.29, with 27%-40% agreement). Inter-examiner reliability, evaluated in 6 studies, ranged widely from k = −0.51 to 0.91. A subgroup analysis including only studies that used MMT without additional challenge procedures showed inter-examiner reliability ranging from k = −0.05 to 0.91. The piriformis muscle demonstrated the highest reliability (k = 0.7 to 0.91), while the hamstrings had the lowest (k = −0.07 to 0.24).</div></div><div><h3>Conclusion</h3><div>The reliability of MMT in AK ranged from nonexistent to very strong, depending on the type of analysis. MMT involving nonmusculoskeletal challenges showed nonexistent reliability and therefore not recommended for clinical use. However, MMT without challenges may be clinically useful, particularly for the deltoid, gluteus maximus, piriformis, and iliopsoas, which demonstrated moderate to very strong reliability.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 862-870"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.jmpt.2025.10.035
Mônica de Oliveira Melo PhD, Marja Bochehin Do Valle MSC, Cláudia Tarragô Candotti PhD, Juliana Adami Sedrez PhD, Edgar Santiago Wagner Neto PhD, Emanuelle Francine Detogni Schmit PhD, Jefferson Fagundes Loss PhD
Objective
The purpose of this study was to evaluate the intra- and inter-rater reproducibility of the Flexicurve for assessing the flexion and extension range of motion of the thoracic and lumbar spine.
Methods
Intrarater reproducibility (n = 35) was assessed by a single rater on 2 different days, and inter-rater reproducibility (n = 37) was assessed on 1 day by 3 different raters. The assessment protocol involved palpation and identification of spinous processes (SP), molding of the Flexicurve along the maximum range of flexion and extension, marking of SP on the Flexicurve, careful removal of the Flexicurve, drawing of the curvature contours obtained by the Flexicurve on paper, identification of SP on the drawing, photographic recording of the drawn contour, and analysis of the photograph using MATLAB 8.5. Data were analyzed using intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (α < 0.05).
Results
Excellent ICCs were obtained for intrarater reproducibility of thoracic and lumbar spine flexion and extension, with SEM ranging from 0.7° to 1.7°. Except for lumbar spine extension, which achieved satisfactory ICC, inter-rater reproducibility showed excellent ICCs for other measures, with SEM ranging from 2° to 5°. Intrarater reproducibility of the software resulted in excellent ICCs, with SEM ranging from 0.7° to 4.4°.
Conclusion
Due to established reproducibility and precision, the Flexicurve can be used for assessments of thoracic and lumbar spinal range of motion. Rigorous methodological care is recommended for its protocol, especially regarding thoracic extension.
{"title":"Reproducibility of the Flexicurve for Assessment of Thoracic and Lumbar Spine Range of Motion","authors":"Mônica de Oliveira Melo PhD, Marja Bochehin Do Valle MSC, Cláudia Tarragô Candotti PhD, Juliana Adami Sedrez PhD, Edgar Santiago Wagner Neto PhD, Emanuelle Francine Detogni Schmit PhD, Jefferson Fagundes Loss PhD","doi":"10.1016/j.jmpt.2025.10.035","DOIUrl":"10.1016/j.jmpt.2025.10.035","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to evaluate the intra- and inter-rater reproducibility of the Flexicurve for assessing the flexion and extension range of motion of the thoracic and lumbar spine.</div></div><div><h3>Methods</h3><div>Intrarater reproducibility (<em>n</em> = 35) was assessed by a single rater on 2 different days, and inter-rater reproducibility (<em>n</em> = 37) was assessed on 1 day by 3 different raters. The assessment protocol involved palpation and identification of spinous processes (SP), molding of the Flexicurve along the maximum range of flexion and extension, marking of SP on the Flexicurve, careful removal of the Flexicurve, drawing of the curvature contours obtained by the Flexicurve on paper, identification of SP on the drawing, photographic recording of the drawn contour, and analysis of the photograph using MATLAB 8.5. Data were analyzed using intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimum detectable change (<em>α</em> < 0.05).</div></div><div><h3>Results</h3><div>Excellent ICCs were obtained for intrarater reproducibility of thoracic and lumbar spine flexion and extension, with SEM ranging from 0.7° to 1.7°. Except for lumbar spine extension, which achieved satisfactory ICC, inter-rater reproducibility showed excellent ICCs for other measures, with SEM ranging from 2° to 5°. Intrarater reproducibility of the software resulted in excellent ICCs, with SEM ranging from 0.7° to 4.4°.</div></div><div><h3>Conclusion</h3><div>Due to established reproducibility and precision, the Flexicurve can be used for assessments of thoracic and lumbar spinal range of motion. Rigorous methodological care is recommended for its protocol, especially regarding thoracic extension.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 750-758"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The purpose of this study was to investigate the inter-rater reliability of the 6-item movement control test battery (MCTB) in individuals with and without chronic non-specific low back pain (CNLBP) using different rating methods, including individual tests, summation, and direction-specific tests, for movement control impairment detection through real-time observation.
Methods
Forty-seven participants with and without CNLBP were recruited. Participants were asked to perform MCTB (flexion-specific tests: waiter’s bow, sitting knee extension, and quadruped rocking backward; extension-specific tests: pelvic tilt, prone knee flexion, and quadruped rocking forward), while 2 raters simultaneously and independently observed the movement control. Inter-rater reliability was analyzed using the chi-square test, percentage agreement (PA), kappa coefficient, and prevalence-adjusted and bias-adjusted kappa (PABAK).
Results
The chi-square showed significant associations (P < .05) between the 2 raters in all tests and grading methods. For PA, all grading methods showed an acceptable level (PA > 70%), except prone knee flexion and extension-specific tests. The acceptable kappa levels (kappa > 0.4) were obtained in the flexion-specific tests and all individual tests except the prone knee flexion. The kappa of the summation did not reach the acceptable agreement level; however, this method yielded acceptable inter-rater reliability after using PABAK (PABAK = 0.62).
Conclusions
The findings support inter-rater reliability of the flexion-specific tests, summation, and most individual tests for clinical use. However, the prone knee flexion and the extension-specific tests should be used with caution.
{"title":"Inter-Rater Reliability of a 6-Item Movement Control Test Battery in Individuals With and Without Chronic Non-Specific Low Back Pain","authors":"Thanwalai Thana-udomnan PT , Wunpen Chansirinukor PT, PhD , Sasithorn Kongoun PT , Katayan Klahan PT , Peemongkon Wattananon PT, PhD","doi":"10.1016/j.jmpt.2025.10.041","DOIUrl":"10.1016/j.jmpt.2025.10.041","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to investigate the inter-rater reliability of the 6-item movement control test battery (MCTB) in individuals with and without chronic non-specific low back pain (CNLBP) using different rating methods, including individual tests, summation, and direction-specific tests, for movement control impairment detection through real-time observation.</div></div><div><h3>Methods</h3><div>Forty-seven participants with and without CNLBP were recruited. Participants were asked to perform MCTB (flexion-specific tests: waiter’s bow, sitting knee extension, and quadruped rocking backward; extension-specific tests: pelvic tilt, prone knee flexion, and quadruped rocking forward), while 2 raters simultaneously and independently observed the movement control. Inter-rater reliability was analyzed using the chi-square test, percentage agreement (PA), kappa coefficient, and prevalence-adjusted and bias-adjusted kappa (PABAK).</div></div><div><h3>Results</h3><div>The chi-square showed significant associations (<em>P</em> < .05) between the 2 raters in all tests and grading methods. For PA, all grading methods showed an acceptable level (PA > 70%), except prone knee flexion and extension-specific tests. The acceptable kappa levels (kappa > 0.4) were obtained in the flexion-specific tests and all individual tests except the prone knee flexion. The kappa of the summation did not reach the acceptable agreement level; however, this method yielded acceptable inter-rater reliability after using PABAK (PABAK = 0.62).</div></div><div><h3>Conclusions</h3><div>The findings support inter-rater reliability of the flexion-specific tests, summation, and most individual tests for clinical use. However, the prone knee flexion and the extension-specific tests should be used with caution.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 853-861"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to evaluate the effects of nonthrust joint mobilization on pain, functional disability, and range of motion in patients with adhesive capsulitis (AC) of the shoulder.
Methods
This meta-analysis included all English-language randomized controlled trials and prospective quasi-experimental studies evaluating the effects of joint mobilization on pain, disability, and range of motion in adult patients with any type of AC. PubMed and SCOPUS were searched for studies published before November 2021. Further studies were identified through manual screening of the reference lists. Cochrane Collaboration tool for risk of bias (RoB 2.0) was used for risk of bias assessment. Results were pooled using random effects meta-analysis.
Results
Nineteen articles involving 812 patients were included in the synthesis. Regarding the effect on pain, the overall weighted mean difference was –1.19 with significant heterogeneity. For functional disability, overall weighted mean differences were –8.69 with significant heterogeneity, 10.11 with significant heterogeneity, and –7.18 with heterogeneity for studies using SPADI, Constant Murley, and DASH scores, respectively. Regarding the effect of shoulder mobilization on flexion, abduction, external, and internal rotations, overall weighted mean differences of 17.71, 13.89, 9.68, and 11.75 degrees, all with significant heterogeneity, were reported.
Conclusions
This meta-analysis found statistically significant improvements in the reduction of pain, improvement in function, and restoring of range of motion among patients with adhesive capsulitis, regardless of the mobilization technique used. However, the results should be interpreted with some caution, because of high levels of heterogeneity and lack of high-quality studies in this field.
{"title":"Effects of Nonthrust Joint Mobilization on Clinical Outcomes of Patients With Adhesive Capsulitis of the Shoulder: A Meta-Analysis","authors":"Farzin Halabchi MD , Behnaz Mahdaviani MD , Nima Bagheri MD , Shaghayegh Rahimi MD , Sakineh Shab-Bidar PhD , Maryam Selk-Ghaffari MD","doi":"10.1016/j.jmpt.2025.10.016","DOIUrl":"10.1016/j.jmpt.2025.10.016","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the effects of nonthrust joint mobilization on pain, functional disability, and range of motion in patients with adhesive capsulitis (AC) of the shoulder.</div></div><div><h3>Methods</h3><div>This meta-analysis included all English-language randomized controlled trials and prospective quasi-experimental studies evaluating the effects of joint mobilization on pain, disability, and range of motion in adult patients with any type of AC. PubMed and SCOPUS were searched for studies published before November 2021. Further studies were identified through manual screening of the reference lists. Cochrane Collaboration tool for risk of bias (RoB 2.0) was used for risk of bias assessment. Results were pooled using random effects meta-analysis.</div></div><div><h3>Results</h3><div>Nineteen articles involving 812 patients were included in the synthesis. Regarding the effect on pain, the overall weighted mean difference was –1.19 with significant heterogeneity. For functional disability, overall weighted mean differences were –8.69 with significant heterogeneity, 10.11 with significant heterogeneity, and –7.18 with heterogeneity for studies using SPADI, Constant Murley, and DASH scores, respectively. Regarding the effect of shoulder mobilization on flexion, abduction, external, and internal rotations, overall weighted mean differences of 17.71, 13.89, 9.68, and 11.75 degrees, all with significant heterogeneity, were reported.</div></div><div><h3>Conclusions</h3><div>This meta-analysis found statistically significant improvements in the reduction of pain, improvement in function, and restoring of range of motion among patients with adhesive capsulitis, regardless of the mobilization technique used. However, the results should be interpreted with some caution, because of high levels of heterogeneity and lack of high-quality studies in this field.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 800-812"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The primary purpose of this study was to investigate the relationship of photographic posture analysis (PPA) with motor performance and trunk, and the reliability of PPA in the sitting position control in children with cerebral palsy (CP).
Methods
Sixty-five children with CP between 5 and 12 years of age were investigated by PPA in a sitting position. The angles calculated for the PPA were the craniovertebral angle, sagittal head tilt, sagittal shoulder-C7 angle, thoracic kyphosis angle, lumbal lordosis angle, coronal head tilt, coronal shoulder angle, and coronal pelvic angle. Trunk control was measured by the Trunk Control Measurement Scale (TCMS), and motor functions were evaluated by the Gross Motor Function Measure (GMFM).
Results
We found that PPA had high intra- and inter-rater reliability in sitting posture in children with CP (ICC: 0.951-0.998). Additionally, “coronal head tilt” and “coronal pelvic angle” had moderate correlations with some TCMS and GMFM scores (P < .05). There was a negative moderate significant correlation between “coronal pelvic angle” and “standing” (r = 0.557, P = .001), “walking/running/jumping” (r = –0.549, P = .001), and “total” (r = –0.535, P = .001) GMFM scores. There was a negative moderate significant correlation between “coronal head tilt” and “static sitting” (r = –0.444, P = .001), “dynamic reach” (r = –0.437, P = .001), and “total” (r = 0.442, P = .001) scores of TCMS. There was a negative moderate significant correlation between “coronal pelvic angle” and “static sitting” (r = –0.479, P = .001) and “total” (r = –0.454, P = .001) scores of TCMS.
Conclusion
PPA was a reliable method for children with CP in a sitting posture. The findings suggest that posture and function may affect each other; in particular, coronal angles and gross motor and trunk functions may be related.
目的：探讨摄影姿势分析（PPA）与脑瘫儿童运动表现和躯干的关系，以及PPA在脑瘫儿童坐姿控制中的可靠性。方法：对65例5 ~ 12岁CP患儿进行坐位PPA检查。PPA计算的角度为颅椎角、矢状头倾斜角、矢状肩- c7角、胸后凸角、腰前凸角、冠状头倾斜角、冠状肩角、冠状骨盆角。躯干控制量表（TCMS）测量躯干控制，大运动功能量表（GMFM）评估运动功能。结果：PPA对CP患儿的坐姿具有较高的信度（ICC: 0.951-0.998）。此外，“冠状面头部倾斜”和“冠状面骨盆角”与部分TCMS和GMFM评分有中度相关性（P < 0.05）。“骨盆冠状角”与“站立”（r = 0.557, P = .001）、“走/跑/跳”（r = -0.549, P = .001）、“总”（r = -0.535, P = .001） GMFM得分呈负中显著相关。“冠状头倾斜”得分与“静坐”得分（r = -0.444, P = .001）、“动态到达”得分（r = -0.437, P = .001）、“总”得分（r = 0.442, P = .001）呈负中显著相关。“盆腔冠状角”评分与“静坐”评分（r = -0.479, P = .001）、“总分”评分（r = -0.454, P = .001）呈负中显著相关。结论：PPA是一种可靠的治疗小儿坐位CP的方法。研究结果表明，姿势和身体机能可能会相互影响；特别是，冠状角与大运动和躯干功能可能有关。
{"title":"Photographic Posture Analysis in Children With Cerebral Palsy and Its Relationship With Motor Performance and Trunk Control","authors":"Nilay Comuk Balci PhD , Betul Erbay Pt, MSc , Mert Demirsoz MSc , Bircan Yucekaya Pt, PhD","doi":"10.1016/j.jmpt.2025.10.021","DOIUrl":"10.1016/j.jmpt.2025.10.021","url":null,"abstract":"<div><h3>Objective</h3><div>The primary purpose of this study was to investigate the relationship of photographic posture analysis (PPA) with motor performance and trunk, and the reliability of PPA in the sitting position control in children with cerebral palsy (CP).</div></div><div><h3>Methods</h3><div>Sixty-five children with CP between 5 and 12 years of age were investigated by PPA in a sitting position. The angles calculated for the PPA were the craniovertebral angle, sagittal head tilt, sagittal shoulder-C7 angle, thoracic kyphosis angle, lumbal lordosis angle, coronal head tilt, coronal shoulder angle, and coronal pelvic angle. Trunk control was measured by the Trunk Control Measurement Scale (TCMS), and motor functions were evaluated by the Gross Motor Function Measure (GMFM).</div></div><div><h3>Results</h3><div>We found that PPA had high intra- and inter-rater reliability in sitting posture in children with CP (ICC: 0.951-0.998). Additionally, “coronal head tilt” and “coronal pelvic angle” had moderate correlations with some TCMS and GMFM scores (<em>P</em> < .05). There was a negative moderate significant correlation between “coronal pelvic angle” and “standing” (<em>r</em> = 0.557, <em>P</em> = .001), “walking/running/jumping” (<em>r</em> = –0.549, <em>P</em> = .001), and “total” (<em>r</em> = –0.535, <em>P</em> = .001) GMFM scores. There was a negative moderate significant correlation between “coronal head tilt” and “static sitting” (<em>r</em> = –0.444, <em>P</em> = .001), “dynamic reach” (<em>r</em> = –0.437, <em>P</em> = .001), and “total” (<em>r</em> = 0.442, <em>P</em> = .001) scores of TCMS. There was a negative moderate significant correlation between “coronal pelvic angle” and “static sitting” (<em>r</em> = –0.479, <em>P</em> = .001) and “total” (<em>r</em> = –0.454, <em>P</em> = .001) scores of TCMS.</div></div><div><h3>Conclusion</h3><div>PPA was a reliable method for children with CP in a sitting posture. The findings suggest that posture and function may affect each other; in particular, coronal angles and gross motor and trunk functions may be related.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 759-769"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145505173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.jmpt.2025.10.059
Yunan He , Xueli Chen MSc , Jie Lin PhD , Huaning Wang , Baolian Wang MSc , Jinbang Xu PhD , Ying Lin PhD
Objective
The purpose of this meta-analysis was to systematically review the effects of acupuncture with letrozole’s effect on polycystic ovary syndrome (PCOS) ovulation and pregnancy outcomes.
Methods
We searched 7 electronic databases for clinical studies of acupuncture combined with letrozole for PCOS published until August 31, 2024. Meta-analysis was done using RevMan 5.4, while funnel plot symmetry was evaluated using Stata 16.0.
Results
Fifteen randomized controlled trials, encompassing 1311 cases, were included. The meta-analysis revealed that acupuncture combined with letrozole significantly improved the clinical efficacy rate (RR = 1.27, 95% CI [1.17, 1.37], P < .001), pregnancy rate (RR = 1.84, 95% CI [1.59, 2.13], P < .001), ovulation rate [RR = 1.30, 95% CI [1.18, 1.43], P < .001), endometrial thickness (MD = 1.05, 95% CI [0.76, 1.34], P < .00001), serum estradiol levels (MD = 8.34, 95% CI [6.71, 9.96], P < .001) and the rate of A-type endometrium (RR = 2.19, 95% CI [1.35, 3.55], P < .001). Additionally, it significantly reduced the miscarriage rate (RR = 0.20, 95% CI [0.08, 0.51], P < .001), serum luteinizing hormone levels (MD = −2.10, 95% CI [−3.58, −0.62], P < .001), serum testosterone levels (MD for treatment ≤3 menstrual cycles = −0.43, 95% CI [−0.49, −0.37], P < .001; MD for treatment >3 menstrual cycles = −3.06, 95% CI [−5.12, −0.99], P < .001), ovarian volume (MD = −2.21, 95% CI [−2.99, −1.43], P < .001), and TCM syndrome scores (MD = −4.33, 95% CI [−5.43, −3.24], P < .001). Begg’s test for publication bias indicated some degree of bias (P ≤ .05).
Conclusion
Current evidence suggests that acupuncture combined with letrozole may be more effective for PCOS than letrozole alone; however, the quality of this evidence is low, necessitating further high-quality research to confirm these findings.
Protocol registration
Registered in PROSPERO on August 23 2024 (ID: CRD42024582344) .
目的：本荟萃分析的目的是系统回顾针刺联合来曲唑对多囊卵巢综合征（PCOS）排卵和妊娠结局的影响。方法：检索截至2024年8月31日发表的7个电子数据库中针灸联合来曲唑治疗PCOS的临床研究。meta分析采用RevMan 5.4，漏斗图对称性评价采用Stata 16.0。结果：纳入15项随机对照试验，共1311例。荟萃分析显示,针灸结合曲唑显著提高临床疗效率(RR = 1.27, 95%可信区间[1.17,1.37],P <措施),怀孕率(RR = 1.84, 95%可信区间[1.59,2.13],P <措施),排卵率(RR = 1.30, 95%可信区间[1.18,1.43],P <措施),子宫内膜厚度(MD = 1.05, 95% CI [0.76, 1.34], P < .00001)、血清雌二醇水平(MD = 8.34, 95% CI [6.71, 9.96], P <措施),a类型子宫内膜(RR = 2.19, 95%可信区间[1.35,3.55],P <措施)。此外，显著降低流产率（RR = 0.20, 95% CI [0.08, 0.51], P < 0.001）、血清黄体生成素水平（MD = -2.10, 95% CI [-3.58, -0.62], P < 0.001）、血清睾酮水平（治疗≤3个月经周期的MD = -0.43, 95% CI [-0.49, -0.37], P < 0.001）；治疗>3个月经周期的MD = -3.06, 95% CI [-5.12, -0.99], P < 0.001)、卵巢体积（MD = -2.21, 95% CI [-2.99, -1.43], P < 0.001）、中医证候评分（MD = -4.33, 95% CI [-5.43, -3.24], P < 0.001）。Begg发表偏倚检验表明存在一定程度的偏倚（P≤0.05）。结论：针刺联合来曲唑治疗PCOS可能比单用来曲唑更有效；然而，这些证据的质量很低，需要进一步的高质量研究来证实这些发现。协议注册：于2024年8月23日在PROSPERO注册（ID: CRD42024582344）。
{"title":"Meta-Analysis of the Effects of Acupuncture Combined With Letrozole on Ovulation Induction and Pregnancy Outcomes in Patients With Polycystic Ovary Syndrome","authors":"Yunan He , Xueli Chen MSc , Jie Lin PhD , Huaning Wang , Baolian Wang MSc , Jinbang Xu PhD , Ying Lin PhD","doi":"10.1016/j.jmpt.2025.10.059","DOIUrl":"10.1016/j.jmpt.2025.10.059","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this meta-analysis was to systematically review the effects of acupuncture with letrozole’s effect on polycystic ovary syndrome (PCOS) ovulation and pregnancy outcomes.</div></div><div><h3>Methods</h3><div>We searched 7 electronic databases for clinical studies of acupuncture combined with letrozole for PCOS published until August 31, 2024. Meta-analysis was done using RevMan 5.4, while funnel plot symmetry was evaluated using Stata 16.0.</div></div><div><h3>Results</h3><div>Fifteen randomized controlled trials, encompassing 1311 cases, were included. The meta-analysis revealed that acupuncture combined with letrozole significantly improved the clinical efficacy rate (RR = 1.27, 95% CI [1.17, 1.37], <em>P</em> < .001), pregnancy rate (RR = 1.84, 95% CI [1.59, 2.13], <em>P</em> < .001), ovulation rate [RR = 1.30, 95% CI [1.18, 1.43], <em>P</em> < .001), endometrial thickness (MD = 1.05, 95% CI [0.76, 1.34], <em>P</em> < .00001), serum estradiol levels (MD = 8.34, 95% CI [6.71, 9.96], <em>P</em> < .001) and the rate of A-type endometrium (RR = 2.19, 95% CI [1.35, 3.55], <em>P</em> < .001). Additionally, it significantly reduced the miscarriage rate (RR = 0.20, 95% CI [0.08, 0.51], <em>P</em> < .001), serum luteinizing hormone levels (MD = −2.10, 95% CI [−3.58, −0.62], <em>P</em> < .001), serum testosterone levels (MD for treatment ≤3 menstrual cycles = −0.43, 95% CI [−0.49, −0.37], <em>P</em> < .001; MD for treatment >3 menstrual cycles = −3.06, 95% CI [−5.12, −0.99], <em>P</em> < .001), ovarian volume (MD = −2.21, 95% CI [−2.99, −1.43], <em>P</em> < .001), and TCM syndrome scores (MD = −4.33, 95% CI [−5.43, −3.24], <em>P</em> < .001). Begg’s test for publication bias indicated some degree of bias (<em>P</em> ≤ .05).</div></div><div><h3>Conclusion</h3><div>Current evidence suggests that acupuncture combined with letrozole may be more effective for PCOS than letrozole alone; however, the quality of this evidence is low, necessitating further high-quality research to confirm these findings.</div></div><div><h3>Protocol registration</h3><div>Registered in PROSPERO on August 23 2024 (ID: CRD42024582344) .</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 935-946"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145564247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.jmpt.2025.09.010
Nada G. Saad Mohamed BSC , Abeer A. Yamany PhD , Amr A. Azzam MD , Mariam O. Grase PhD
Objective
The purpose of this study was to investigate the effects of instrument-assisted soft tissue mobilization (IASTM) and lidocaine phonophoresis combined or separated on trigger points in patients with tension-type headache (TTH).
Methods
A double-blind randomized trial. A total of 60 participants with TTH were randomized into 4 equal groups. All groups received conventional treatment at the National Institute of Neuromotor System. Group A received conventional treatment only; group B received IASTM; group C received lidocaine phonophoresis; and group D received IASTM and phonophoresis. Visual analog scale (VAS), Arabic neck disability index (ANDI), headache frequency, and pressure pain threshold (PPT) were among the outcome measurements. All variables were measured before treatment and 4 weeks post-treatment.
Results
Within the group's analysis, multiple pairwise comparison tests revealed improvements at all measurement variables (P < .01) in all groups. Post-treatment, results showed a significant difference in groups D versus group A, groups B, and C with mean difference (MD) and 95% CI in VAS [3.18 (2.379-3.981), 1.133 (0.332-1.935), and 1.907 (1.105-2.708) respectively], ANDI [10.267 (8.382-12.151), 4.2 (2.316-6.084) 7 (5.116-8.884) respectively], headache frequency [1.9 (1.246-2.554), 0.8 (0.146-1.454), and 1.4 (0.764-2.054) respectively], and PPT. Additionally, there was a significant difference in all variables between group A and group B with MD in VAS, ANID, and headache frequency (2.047, 6.067, and 1.1 respectively) in favor of group B. Moreover, there was a statistically significant difference between group A and group C in VAS, ANDI, and PPT of left the suboccipital muscles on the side of group C. In group B versus group C, there was a statistically significant difference in ANDI and PPT of the left upper fibers of the trapezius muscles as P < .05 in favor of group B.
Conclusion
Both conventional treatments, IASTM, lidocaine phonophoresis, and the combination of IASTM and phonophoresis had statistically significant effects in relieving pain, increasing neck functional ability, decreasing headache frequency, and improving PPT in participants with TTP. Adding IASTM and lidocaine phonophoresis to conventional treatment was more effective than the other treatments.
{"title":"Effect of Instrument-Assisted Soft Tissue Mobilization Combined With Lidocaine Phonophoresis on Tension-Type Headache: A Randomized Clinical Trial","authors":"Nada G. Saad Mohamed BSC , Abeer A. Yamany PhD , Amr A. Azzam MD , Mariam O. Grase PhD","doi":"10.1016/j.jmpt.2025.09.010","DOIUrl":"10.1016/j.jmpt.2025.09.010","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to investigate the effects of instrument-assisted soft tissue mobilization (IASTM) and lidocaine phonophoresis combined or separated on trigger points in patients with tension-type headache (TTH).</div></div><div><h3>Methods</h3><div>A double-blind randomized trial. A total of 60 participants with TTH were randomized into 4 equal groups. All groups received conventional treatment at the National Institute of Neuromotor System. Group A received conventional treatment only; group B received IASTM; group C received lidocaine phonophoresis; and group D received IASTM and phonophoresis. Visual analog scale (VAS), Arabic neck disability index (ANDI), headache frequency, and pressure pain threshold (PPT) were among the outcome measurements. All variables were measured before treatment and 4 weeks post-treatment.</div></div><div><h3>Results</h3><div>Within the group's analysis, multiple pairwise comparison tests revealed improvements at all measurement variables (<em>P</em> < .01) in all groups. Post-treatment, results showed a significant difference in groups D versus group A, groups B, and C with mean difference (MD) and 95% CI in VAS [3.18 (2.379-3.981), 1.133 (0.332-1.935), and 1.907 (1.105-2.708) respectively], ANDI [10.267 (8.382-12.151), 4.2 (2.316-6.084) 7 (5.116-8.884) respectively], headache frequency [1.9 (1.246-2.554), 0.8 (0.146-1.454), and 1.4 (0.764-2.054) respectively], and PPT. Additionally, there was a significant difference in all variables between group A and group B with MD in VAS, ANID, and headache frequency (2.047, 6.067, and 1.1 respectively) in favor of group B. Moreover, there was a statistically significant difference between group A and group C in VAS, ANDI, and PPT of left the suboccipital muscles on the side of group C. In group B versus group C, there was a statistically significant difference in ANDI and PPT of the left upper fibers of the trapezius muscles as <em>P</em> < .05 in favor of group B.</div></div><div><h3>Conclusion</h3><div>Both conventional treatments, IASTM, lidocaine phonophoresis, and the combination of IASTM and phonophoresis had statistically significant effects in relieving pain, increasing neck functional ability, decreasing headache frequency, and improving PPT in participants with TTP. Adding IASTM and lidocaine phonophoresis to conventional treatment was more effective than the other treatments.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 643-655"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-01DOI: 10.1016/j.jmpt.2025.10.001
Braden G. Keil BAppSc (Chiropractic), MChiroSc (Paediatrics), FICC, FACCP, Christian J. Fludder BChiroSc, MChiropractic, DACCP
Objective
The purpose of this study was to record preload force, peak force, and time from preload to peak force used with 4 manipulation techniques in a simulated 3- to 4-month-old infant.
Methods
The project recorded 4 scenarios involving spinal manipulation applied to a mannequin comparable with a 3- to 4-month-old infant by 2 postgraduate trained and experienced practitioners and educators in pediatric spinal manipulation and mobilization. Results for preload force, peak force, time to peak, and rate of force application were determined.
Results
Preload force was less than 10 N in the majority of scenarios. Average peak force in 3 cervical spine scenarios ranged from 35.2 to 79.9 N. Sacral data recorded an average peak force of 34.9 to 41.2 N with a standard distribution of 3.6 to 7.1 N. The time to peak force recorded for the 4 scenarios were under 110 ms. The rate of force production for all but 1 scenario was in excess of 300 N/s. Intrapractitioner data analysis demonstrated peak forces were not significantly different across 3 scenarios, with interpractitioner data not significantly different across 2 scenarios.
Conclusion
Average peak forces recorded were similar to those previously reported. Time to peak recordings were typically under 100 ms and rate of force application above 300 N/s; within the optimal range for muscle spindle receptor and Golgi tendon organ activation. Further research into forces used across the pediatric age ranges is needed.
{"title":"Forces Recorded in Manual Therapy Techniques Applied to a Mannequin Simulating A 3- to 4-Month-Old Infant","authors":"Braden G. Keil BAppSc (Chiropractic), MChiroSc (Paediatrics), FICC, FACCP, Christian J. Fludder BChiroSc, MChiropractic, DACCP","doi":"10.1016/j.jmpt.2025.10.001","DOIUrl":"10.1016/j.jmpt.2025.10.001","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study was to record preload force, peak force, and time from preload to peak force used with 4 manipulation techniques in a simulated 3- to 4-month-old infant.</div></div><div><h3>Methods</h3><div>The project recorded 4 scenarios involving spinal manipulation applied to a mannequin comparable with a 3- to 4-month-old infant by 2 postgraduate trained and experienced practitioners and educators in pediatric spinal manipulation and mobilization. Results for preload force, peak force, time to peak, and rate of force application were determined.</div></div><div><h3>Results</h3><div>Preload force was less than 10 N in the majority of scenarios. Average peak force in 3 cervical spine scenarios ranged from 35.2 to 79.9 N. Sacral data recorded an average peak force of 34.9 to 41.2 N with a standard distribution of 3.6 to 7.1 N. The time to peak force recorded for the 4 scenarios were under 110 ms. The rate of force production for all but 1 scenario was in excess of 300 N/s. Intrapractitioner data analysis demonstrated peak forces were not significantly different across 3 scenarios, with interpractitioner data not significantly different across 2 scenarios.</div></div><div><h3>Conclusion</h3><div>Average peak forces recorded were similar to those previously reported. Time to peak recordings were typically under 100 ms and rate of force application above 300 N/s; within the optimal range for muscle spindle receptor and Golgi tendon organ activation. Further research into forces used across the pediatric age ranges is needed.</div></div>","PeriodicalId":16132,"journal":{"name":"Journal of Manipulative and Physiological Therapeutics","volume":"48 6","pages":"Pages 689-697"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145489057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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