Sofia A. Botsarova, M. Semyonov, S. V. Vissarionov
BACKGROUND: Patients with cleft lip and palate experience significant jaw relationship disorders and pathological bite formation, leading to changes in the motor activity of chewing muscles and postural balance disturbances. Most studies on postural control are conducted on patients with skeletal dentofacial anomalies and deformities without cleft lip and palate. The state of postural balance in children with cleft lip and palate requiring long-term complex medical rehabilitation, including bone-reconstructive operations on the jaw bones, remains poorly understood. AIM: To analyze publications dedicated to the evaluation of postural balance in adolescents with cleft lip and palate combined with jaw relationship disorders and pathological bite formation. MATERIALS AND METHODS: The article includes an analysis and review of several studies that investigated the state of postural balance in adolescents with cleft lip and palate, particularly at the final stages of growth and formation of the musculoskeletal system. Scientific articles published in various medical journals, monographs, dissertations, and materials from scientific symposiums related to this topic were used in the literature review. PubMed, Medline, Scopus, Web of Science, and RSCI were searched without language restrictions. The search depth was 23 years, and 64 studies were selected. RESULTS: The article analyzes literature data related to theories of the mechanism of mutual influence between postural balance and the dentofacial apparatus (disorders and pathological bite formation). The state of postural balance is influenced by various factors, including the craniosacral system and anomalies of the cervical spine. Patients with cleft lip and palate, hemifacial microsomia, and other craniofacial dysostoses with growth disorders of jaw bones experience an imbalance in the entire “descending” chain, causing postural disturbances, increased plantar pressure, increased foot rigidity, and changes in photogrammetry indicators, which should be considered when developing an individual rehabilitation program for these patients. The treatment of these patients without considering postural balance disorders can lead to temporomandibular joint pathologies, unstable results of the conservative orthodontic treatment of bite pathologies, and bone-reconstructive operations on jaws. CONCLUSIONS: The study highlights the ways of adaptation of the musculoskeletal system in the presence of occlusal relationship disorders and emphasizes the need to evaluate this influence comprehensively for the treatment of these patients. The limitations of the presented studies should be emphasized: insufficient sample size, lack of control groups and prospective studies, limited types of examination, and lack of studies dedicated to more severe anomalies of craniofacial development.
{"title":"Postural balance in the comprehensive rehabilitation of adolescents with cleft lip and palate and maxillofacial anomalies: A literature review","authors":"Sofia A. Botsarova, M. Semyonov, S. V. Vissarionov","doi":"10.17816/ptors567935","DOIUrl":"https://doi.org/10.17816/ptors567935","url":null,"abstract":"BACKGROUND: Patients with cleft lip and palate experience significant jaw relationship disorders and pathological bite formation, leading to changes in the motor activity of chewing muscles and postural balance disturbances. Most studies on postural control are conducted on patients with skeletal dentofacial anomalies and deformities without cleft lip and palate. The state of postural balance in children with cleft lip and palate requiring long-term complex medical rehabilitation, including bone-reconstructive operations on the jaw bones, remains poorly understood. \u0000AIM: To analyze publications dedicated to the evaluation of postural balance in adolescents with cleft lip and palate combined with jaw relationship disorders and pathological bite formation. \u0000MATERIALS AND METHODS: The article includes an analysis and review of several studies that investigated the state of postural balance in adolescents with cleft lip and palate, particularly at the final stages of growth and formation of the musculoskeletal system. Scientific articles published in various medical journals, monographs, dissertations, and materials from scientific symposiums related to this topic were used in the literature review. PubMed, Medline, Scopus, Web of Science, and RSCI were searched without language restrictions. The search depth was 23 years, and 64 studies were selected. \u0000RESULTS: The article analyzes literature data related to theories of the mechanism of mutual influence between postural balance and the dentofacial apparatus (disorders and pathological bite formation). The state of postural balance is influenced by various factors, including the craniosacral system and anomalies of the cervical spine. Patients with cleft lip and palate, hemifacial microsomia, and other craniofacial dysostoses with growth disorders of jaw bones experience an imbalance in the entire “descending” chain, causing postural disturbances, increased plantar pressure, increased foot rigidity, and changes in photogrammetry indicators, which should be considered when developing an individual rehabilitation program for these patients. The treatment of these patients without considering postural balance disorders can lead to temporomandibular joint pathologies, unstable results of the conservative orthodontic treatment of bite pathologies, and bone-reconstructive operations on jaws. \u0000CONCLUSIONS: The study highlights the ways of adaptation of the musculoskeletal system in the presence of occlusal relationship disorders and emphasizes the need to evaluate this influence comprehensively for the treatment of these patients. The limitations of the presented studies should be emphasized: insufficient sample size, lack of control groups and prospective studies, limited types of examination, and lack of studies dedicated to more severe anomalies of craniofacial development.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"42 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140716355","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}
O. Agranovich, E. Petrova, S. Trofimova, Andrey V. Sapogovskiy, E. Melchenko, Evgeny D. Blagovechtchenski, K. A. Afonichev
BACKGROUND: Archery is one of the oldest human skills that survived to the present day. At first, it was used for hunting and war and later became a sport. The interest in archery has grown annually. Each type of sport has specific injuries. Information about archery-related injuries will allow us to develop preventive measures and help make this sport safer. The article will be useful for coaches, sports doctors, physiotherapists, and orthopedic surgeons. AIM: To present modern information about frequency, types of archery-related injuries, and preventive methods. MATERIALS AND METHODS: The publication search was performed in the PubMed/MEDLINE databases from 1978 to 2023 using combinations of OR, AND operators, and keywords: archery, archery injuries, rotator cuff injuries, arrow injuries, and overuse. Consequently, we extracted 49 foreign and domestic scientific sources. RESULTS: Archery injuries occur in 4.4 per 10,000 people involved in this sport. Acute injuries in archers are rare, mainly due to shooting errors and most often lead to soft tissue damage because of a fracture of a bow, arrow, or bowstring during a shot (83.3%) or as a result of touching the bowstring with a bow. Chronic injuries occur in 83.9% of archery athletes. The main risk factors for their occurrence include overuse, high repetitions during training, lack of strength of the athlete, and incorrect technique. Overuse (67.9%) is the most common cause of chronic tendon, ligament, and joint injuries. Injuries occurred in 30%–53% of cases in the shoulders (rotator cuff tear, scapular dyskinesia, and shoulder impingement syndrome), 12.8% in the elbow (medial and lateral epicondylitis and traumatic bursitis), 8.9%–19.9% in the spine and forearm (chronic tendovaginitis and tunnel syndromes). CONCLUSIONS: Proper training and safety measures help prevent acute injuries. Practicing archery techniques and strength training are the main measures of preventing muscle overuse and reducing the incidence of chronic injuries.
{"title":"Archery injuries: A literature review","authors":"O. Agranovich, E. Petrova, S. Trofimova, Andrey V. Sapogovskiy, E. Melchenko, Evgeny D. Blagovechtchenski, K. A. Afonichev","doi":"10.17816/ptors625717","DOIUrl":"https://doi.org/10.17816/ptors625717","url":null,"abstract":"BACKGROUND: Archery is one of the oldest human skills that survived to the present day. At first, it was used for hunting and war and later became a sport. The interest in archery has grown annually. Each type of sport has specific injuries. Information about archery-related injuries will allow us to develop preventive measures and help make this sport safer. The article will be useful for coaches, sports doctors, physiotherapists, and orthopedic surgeons. \u0000AIM: To present modern information about frequency, types of archery-related injuries, and preventive methods. \u0000MATERIALS AND METHODS: The publication search was performed in the PubMed/MEDLINE databases from 1978 to 2023 using combinations of OR, AND operators, and keywords: archery, archery injuries, rotator cuff injuries, arrow injuries, and overuse. Consequently, we extracted 49 foreign and domestic scientific sources. \u0000RESULTS: Archery injuries occur in 4.4 per 10,000 people involved in this sport. Acute injuries in archers are rare, mainly due to shooting errors and most often lead to soft tissue damage because of a fracture of a bow, arrow, or bowstring during a shot (83.3%) or as a result of touching the bowstring with a bow. Chronic injuries occur in 83.9% of archery athletes. The main risk factors for their occurrence include overuse, high repetitions during training, lack of strength of the athlete, and incorrect technique. Overuse (67.9%) is the most common cause of chronic tendon, ligament, and joint injuries. Injuries occurred in 30%–53% of cases in the shoulders (rotator cuff tear, scapular dyskinesia, and shoulder impingement syndrome), 12.8% in the elbow (medial and lateral epicondylitis and traumatic bursitis), 8.9%–19.9% in the spine and forearm (chronic tendovaginitis and tunnel syndromes). \u0000CONCLUSIONS: Proper training and safety measures help prevent acute injuries. Practicing archery techniques and strength training are the main measures of preventing muscle overuse and reducing the incidence of chronic injuries.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"13 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140712818","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}
BACKGROUND: The triceps surae is the main muscle that exerts propulsion power during walking and running. Its retraction changes the biomechanics of the foot, alters locomotion, and results in the secondary development of flatfoot deformity. Literature data on the clinical assessment of triceps surae retraction vary. AIM: To assess the threshold value of foot dorsiflexion in different clinical assessment methods of determining Achilles tendon shortening. MATERIALS AND METHODS: The study included the clinical assessment results of foot dorsiflexion in 167 patients (325 feet) with flatfeet aged 7–18 years. The foot dorsiflexion evaluation consisted of the assessment of isolated foot dorsiflexion and foot dorsiflexion with stabilization of the tarsal joints. To determine the involvement of the gastrosoleus complex in the pathological process, foot dorsiflexion was assessed with knee joint flexion and extension. The obtained data were subjected to correlation, regression, and Bland–Altman analyses. RESULTS: Strong correlations were found when foot dorsiflexion was assessed with the same knee joint position (assessment of isolated foot dorsiflexion and foot dorsiflexion with stabilized tarsal joints and knee joint flexion; the same tests with knee joint extension). Moderate correlations were noted when comparing foot dorsiflexion with knee joint extension and flexion. In the regression analysis, formulas were obtained according to which the threshold values of foot dorsiflexion were calculated in various variants during knee joint flexion and extension, indicating the retraction of the triceps surae: isolated foot dorsiflexion with knee joint extension 20°, isolated foot dorsiflexion with knee flexion 36°, and foot dorsiflexion with tarsal joint stabilization and knee extension 23°. CONCLUSIONS: Retraction of triceps surae in children with flatfeet equally involves the gastrocnemius and soleus. Differences in the magnitude of foot dorsiflexion with knee joint flexion and extension are the main factors in the retraction of the triceps surae to the gastrocnemius muscle.
{"title":"Triceps surae shortening in children","authors":"Andrey V. Sapogovskiy","doi":"10.17816/ptors625865","DOIUrl":"https://doi.org/10.17816/ptors625865","url":null,"abstract":"BACKGROUND: The triceps surae is the main muscle that exerts propulsion power during walking and running. Its retraction changes the biomechanics of the foot, alters locomotion, and results in the secondary development of flatfoot deformity. Literature data on the clinical assessment of triceps surae retraction vary. \u0000AIM: To assess the threshold value of foot dorsiflexion in different clinical assessment methods of determining Achilles tendon shortening. \u0000MATERIALS AND METHODS: The study included the clinical assessment results of foot dorsiflexion in 167 patients (325 feet) with flatfeet aged 7–18 years. The foot dorsiflexion evaluation consisted of the assessment of isolated foot dorsiflexion and foot dorsiflexion with stabilization of the tarsal joints. To determine the involvement of the gastrosoleus complex in the pathological process, foot dorsiflexion was assessed with knee joint flexion and extension. The obtained data were subjected to correlation, regression, and Bland–Altman analyses. \u0000RESULTS: Strong correlations were found when foot dorsiflexion was assessed with the same knee joint position (assessment of isolated foot dorsiflexion and foot dorsiflexion with stabilized tarsal joints and knee joint flexion; the same tests with knee joint extension). Moderate correlations were noted when comparing foot dorsiflexion with knee joint extension and flexion. In the regression analysis, formulas were obtained according to which the threshold values of foot dorsiflexion were calculated in various variants during knee joint flexion and extension, indicating the retraction of the triceps surae: isolated foot dorsiflexion with knee joint extension 20°, isolated foot dorsiflexion with knee flexion 36°, and foot dorsiflexion with tarsal joint stabilization and knee extension 23°. \u0000CONCLUSIONS: Retraction of triceps surae in children with flatfeet equally involves the gastrocnemius and soleus. Differences in the magnitude of foot dorsiflexion with knee joint flexion and extension are the main factors in the retraction of the triceps surae to the gastrocnemius muscle.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"23 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140715222","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}
S. Vissarionov, V. A. Koriachkin, D. V. Zabolotskii, R. R. Safin, P. Bortulev, T. Baskaeva, Mikhail N. Dolgopolskii
BACKGROUND: Hip joint surgery is a highly traumatic surgical intervention. Currently, the anesthesia service in the clinic of H. Turner National Medical Research Center uses either prolonged epidural block with catheter placement in the lumbar spine at the LIII–LIV level or prolonged intravenous analgesia as the main method of pain syndrome treatment after hip joint surgery. Moreover, the potential of prolonged psoas compartment block has not been considered until recently. AIM: To evaluate the effectiveness of prolonged psoas compartment block for pain control in the early postoperative period after hip surgery in comparison with traditional methods of pain control. MATERIALS AND METHODS: This study analyzed the results of postoperative analgesia in 14 children after 15 surgeries in the hip joint, including 3 patients with prolonged psoas compartment block, 9 with prolonged epidural block, and 3 who received postoperative analgesia with systemic analgesics. One patient with bilateral congenital hip joint dislocation was anesthetized with prolonged psoas compartment block after the first operation for the first time and with prolonged epidural block after the second similar operation but on the other leg for the second time. Analgesia efficacy was assessed using the Wong–Baker scale, FLACC behavioral scale, and visual analog scale. RESULTS: All three patients with prolonged psoas compartment block required an addition of butorphanol tartrate (tramal) for good analgesia. Additional administration of opioid analgesics was not needed when a prolonged epidural block was initiated. CONCLUSIONS: Due to the continued need for additional administration of butorphanol tartrate, when prolonged epidural block was available, the use of prolonged psoas compartment block in children for pain relief in the early postoperative period after hip surgery was not considered appropriate.
{"title":"Is the psoas compartment block effective in eliminating pain in children after hip surgery?","authors":"S. Vissarionov, V. A. Koriachkin, D. V. Zabolotskii, R. R. Safin, P. Bortulev, T. Baskaeva, Mikhail N. Dolgopolskii","doi":"10.17816/ptors501795","DOIUrl":"https://doi.org/10.17816/ptors501795","url":null,"abstract":"BACKGROUND: Hip joint surgery is a highly traumatic surgical intervention. Currently, the anesthesia service in the clinic of H. Turner National Medical Research Center uses either prolonged epidural block with catheter placement in the lumbar spine at the LIII–LIV level or prolonged intravenous analgesia as the main method of pain syndrome treatment after hip joint surgery. Moreover, the potential of prolonged psoas compartment block has not been considered until recently. \u0000AIM: To evaluate the effectiveness of prolonged psoas compartment block for pain control in the early postoperative period after hip surgery in comparison with traditional methods of pain control. \u0000MATERIALS AND METHODS: This study analyzed the results of postoperative analgesia in 14 children after 15 surgeries in the hip joint, including 3 patients with prolonged psoas compartment block, 9 with prolonged epidural block, and 3 who received postoperative analgesia with systemic analgesics. One patient with bilateral congenital hip joint dislocation was anesthetized with prolonged psoas compartment block after the first operation for the first time and with prolonged epidural block after the second similar operation but on the other leg for the second time. Analgesia efficacy was assessed using the Wong–Baker scale, FLACC behavioral scale, and visual analog scale. \u0000RESULTS: All three patients with prolonged psoas compartment block required an addition of butorphanol tartrate (tramal) for good analgesia. Additional administration of opioid analgesics was not needed when a prolonged epidural block was initiated. \u0000CONCLUSIONS: Due to the continued need for additional administration of butorphanol tartrate, when prolonged epidural block was available, the use of prolonged psoas compartment block in children for pain relief in the early postoperative period after hip surgery was not considered appropriate.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"112 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138959568","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}
BACKGROUND: Nonbacterial osteomyelitis is a chronic autoinflammatory skeletal disorder of unknown origin characterized by sterile bone lesions and presenting more frequently in children. Spinal manifestations are often common in nonbacterial osteomyelitis; however, cases with skull involvement, except for the mandible, are generally rare. CLINICAL CASE: Herein, we report the case of an 11-year-old girl presenting with multifocal thoracic vertebral and frontal bone lesions, which led to destructive sinusitis. Nonbacterial osteomyelitis was diagnosed after a bone biopsy, which showed no evidence of granuloma, malignancy, or histiocytes. The histopathological findings were nonspecific inflammatory changes. Ibandronic acid was used to treat nonbacterial osteomyelitis. Clinical signs begin to improve after the first infusion. After the fourth infusion of ibandronic acid, the inflammation was reduced and frontal bone structure and thoracic vertebrae were restored. DISCUSSION: Bisphosphonate therapy can be used in nonbacterial osteomyelitis when response to nonsteroidal anti-inflammatory drugs is not optimal. The efficacy of bisphosphonate therapy reaches 75%. However, bisphosphonate therapy in nonbacterial osteomyelitis has not been developed. The paper contained literature about rare cases with skull involvement and problems in bisphosphonate therapy in pediatric nonbacterial osteomyelitis. CONCLUSIONS: Nonbacterial osteomyelitis is a treatable condition, whose care depends on a referral to a rheumatologist.
{"title":"Nonbacterial osteomyelitis of the vertebral bodies and frontal bone: A description of a rare clinical case and a review of the literature","authors":"Aleksei N. Kozhevnikov, V. Zorin","doi":"10.17816/ptors529686","DOIUrl":"https://doi.org/10.17816/ptors529686","url":null,"abstract":"BACKGROUND: Nonbacterial osteomyelitis is a chronic autoinflammatory skeletal disorder of unknown origin characterized by sterile bone lesions and presenting more frequently in children. Spinal manifestations are often common in nonbacterial osteomyelitis; however, cases with skull involvement, except for the mandible, are generally rare. \u0000CLINICAL CASE: Herein, we report the case of an 11-year-old girl presenting with multifocal thoracic vertebral and frontal bone lesions, which led to destructive sinusitis. Nonbacterial osteomyelitis was diagnosed after a bone biopsy, which showed no evidence of granuloma, malignancy, or histiocytes. The histopathological findings were nonspecific inflammatory changes. Ibandronic acid was used to treat nonbacterial osteomyelitis. Clinical signs begin to improve after the first infusion. After the fourth infusion of ibandronic acid, the inflammation was reduced and frontal bone structure and thoracic vertebrae were restored. \u0000DISCUSSION: Bisphosphonate therapy can be used in nonbacterial osteomyelitis when response to nonsteroidal anti-inflammatory drugs is not optimal. The efficacy of bisphosphonate therapy reaches 75%. However, bisphosphonate therapy in nonbacterial osteomyelitis has not been developed. The paper contained literature about rare cases with skull involvement and problems in bisphosphonate therapy in pediatric nonbacterial osteomyelitis. \u0000CONCLUSIONS: Nonbacterial osteomyelitis is a treatable condition, whose care depends on a referral to a rheumatologist.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138963120","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}
Svetlana N. Luneva, T. I. Menshchikova, A. Aranovich, E. P. Vykhovanets, Kseniya P. Matveeva
BACKGROUND:The treatment of patients with osteogenesis imperfecta requires dynamic monitoring of the structural state and metabolism of the long bones. In the available literature, practically no data are available on the use of ultrasonography to assess the skeletal system in children with osteogenesis imperfecta. Increased expression of the members of the transforming growth factor-β superfamily in the serum has been described in several congenital bone diseases; however, this has not yet been examined in children with type III osteogenesis imperfecta. AIM:To examine the serum concentrations of growth factors in children with type III osteogenesis imperfecta relative to healthy children and evaluate the informativeness of ultrasonography for assessing the state of the osteoarticular system in type III osteogenesis imperfecta and justify the feasibility of its use in this pathology. MATERIALS AND METHODS: Children aged 3–7 years with type III osteogenesis imperfecta (n= 12) were examined. In the blood serum, bone-mineral metabolism parameters were determined onaHitachi/BM 902 analyzer (Japan), and the contents of growth factors and their receptors were determined by enzyme-linked immunosorbent assay onaThermo Fisher Scientific analyzer (USA). Ultrasound examinations were performed usinganAVISUS Hitachi device (Japan). Statistical processing was carried out using the Attestat program (I.P. Gaidyshev). Quantitative data are presented as medians and quartiles (Me [Q1; Q3]) for samples with non-normal distribution. In cases with normal distribution, quantitative data are presented as M ± σ,p 0.05. RESULTS: In patients with osteogenesis imperfecta, the degree of bone tissue mineralization and bone turnover rates were higher and the collagen content was lower than those of their healthy peers. Fibroblast growth factor-basic underwent the greatest changes; a decrease in the content of the vascular endothelial growth factor (VEGF)-R3 receptor was accompanied by multiple increases in VEGF and VEGF-R2. Ultrasonography identified areas of deformation and multiple fractures in the area of the diaphyses and metaphyses of the femur, tibia, hip, and knee joints. CONCLUSIONS:Predominance was noted toward the production of growth factors responsible for the activation of osteoclastogenesis. The content of growth factors responsible for osteoclast inhibition and osteoblast activation is normal or slightly changed. Ultrasonography has demonstrated high informativeness inadetailed assessment of the osteoarticular system in patients with osteogenesis imperfecta, which allows us to recommend this noninvasive technique for wider use in this disease.
{"title":"Assessment of the serum concentration of growth factors and the informativeness of ultrasonography in studying the structural conditions of the osteoarticular system in children with type III osteogenesis imperfecta","authors":"Svetlana N. Luneva, T. I. Menshchikova, A. Aranovich, E. P. Vykhovanets, Kseniya P. Matveeva","doi":"10.17816/ptors529677","DOIUrl":"https://doi.org/10.17816/ptors529677","url":null,"abstract":"BACKGROUND:The treatment of patients with osteogenesis imperfecta requires dynamic monitoring of the structural state and metabolism of the long bones. In the available literature, practically no data are available on the use of ultrasonography to assess the skeletal system in children with osteogenesis imperfecta. Increased expression of the members of the transforming growth factor-β superfamily in the serum has been described in several congenital bone diseases; however, this has not yet been examined in children with type III osteogenesis imperfecta. \u0000AIM:To examine the serum concentrations of growth factors in children with type III osteogenesis imperfecta relative to healthy children and evaluate the informativeness of ultrasonography for assessing the state of the osteoarticular system in type III osteogenesis imperfecta and justify the feasibility of its use in this pathology. \u0000MATERIALS AND METHODS: Children aged 3–7 years with type III osteogenesis imperfecta (n= 12) were examined. In the blood serum, bone-mineral metabolism parameters were determined onaHitachi/BM 902 analyzer (Japan), and the contents of growth factors and their receptors were determined by enzyme-linked immunosorbent assay onaThermo Fisher Scientific analyzer (USA). Ultrasound examinations were performed usinganAVISUS Hitachi device (Japan). Statistical processing was carried out using the Attestat program (I.P. Gaidyshev). Quantitative data are presented as medians and quartiles (Me [Q1; Q3]) for samples with non-normal distribution. In cases with normal distribution, quantitative data are presented as M ± σ,p 0.05. \u0000RESULTS: In patients with osteogenesis imperfecta, the degree of bone tissue mineralization and bone turnover rates were higher and the collagen content was lower than those of their healthy peers. Fibroblast growth factor-basic underwent the greatest changes; a decrease in the content of the vascular endothelial growth factor (VEGF)-R3 receptor was accompanied by multiple increases in VEGF and VEGF-R2. Ultrasonography identified areas of deformation and multiple fractures in the area of the diaphyses and metaphyses of the femur, tibia, hip, and knee joints. \u0000CONCLUSIONS:Predominance was noted toward the production of growth factors responsible for the activation of osteoclastogenesis. The content of growth factors responsible for osteoclast inhibition and osteoblast activation is normal or slightly changed. Ultrasonography has demonstrated high informativeness inadetailed assessment of the osteoarticular system in patients with osteogenesis imperfecta, which allows us to recommend this noninvasive technique for wider use in this disease.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":"111 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138959118","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}
S. Trofimova, Evgenija A. Kochenova, O. Agranovich, D. S. Buklaev, E. S. Merkuryeva, T. Markova
BACKGROUND: Bruck syndrome is a rare disorder that features osteogenesis imperfecta, combined with severe congenital joint contractures often with pterygia, short stature, severe limb deformities, and progressive scoliosis. Its two forms, Bruck syndrome types 1 and 2, have similar clinical manifestations without osomal recessive inheritance and are caused by pathogenic variants of the nucleotide sequences in the FKBP10 and PLOD2 genes, respectively. CLINICAL CASES: The article demonstrates phenotypic and radiographic features as well as laboratory values of siblings with Bruck syndrome type 2 (a 10-year-old boy and a 13-year-old girl) born to healthy parents in a consanguineous marriage. The boy had congenital flexion contractures of the knee and elbow joints, few fractures, and severe kyphoscoliosis. The girl had no congenital joint contractures but had kyphoscoliosis, more severe osteoporosis, and a history of having more fractures than her younger brother. DISCUSSION: The cases demonstrated the significant phenotypic intrafamilial variability of Bruck syndrome type 2, caused by a newly identified homozygous variant c.1885AG (p.Thr629Ala) in PLOD2, which consists of varying degrees of osteoporosis, and the presence and severity of contractures. CONCLUSIONS: The description of the given clinical observation was made to draw attention to a rare pathology and expand doctors’ knowledge about the variability of clinical manifestations of Bruck syndrome. Genetic diagnostics is necessary for the timely diagnosis of Bruck syndrome, determining the prognosis and developing patient management techniques.
{"title":"Phenotypic variability in children with Bruck syndrome type 2: Clinical cases","authors":"S. Trofimova, Evgenija A. Kochenova, O. Agranovich, D. S. Buklaev, E. S. Merkuryeva, T. Markova","doi":"10.17816/ptors569365","DOIUrl":"https://doi.org/10.17816/ptors569365","url":null,"abstract":"BACKGROUND: Bruck syndrome is a rare disorder that features osteogenesis imperfecta, combined with severe congenital joint contractures often with pterygia, short stature, severe limb deformities, and progressive scoliosis. Its two forms, Bruck syndrome types 1 and 2, have similar clinical manifestations without osomal recessive inheritance and are caused by pathogenic variants of the nucleotide sequences in the FKBP10 and PLOD2 genes, respectively. \u0000CLINICAL CASES: The article demonstrates phenotypic and radiographic features as well as laboratory values of siblings with Bruck syndrome type 2 (a 10-year-old boy and a 13-year-old girl) born to healthy parents in a consanguineous marriage. The boy had congenital flexion contractures of the knee and elbow joints, few fractures, and severe kyphoscoliosis. The girl had no congenital joint contractures but had kyphoscoliosis, more severe osteoporosis, and a history of having more fractures than her younger brother. \u0000DISCUSSION: The cases demonstrated the significant phenotypic intrafamilial variability of Bruck syndrome type 2, caused by a newly identified homozygous variant c.1885AG (p.Thr629Ala) in PLOD2, which consists of varying degrees of osteoporosis, and the presence and severity of contractures. \u0000CONCLUSIONS: The description of the given clinical observation was made to draw attention to a rare pathology and expand doctors’ knowledge about the variability of clinical manifestations of Bruck syndrome. Genetic diagnostics is necessary for the timely diagnosis of Bruck syndrome, determining the prognosis and developing patient management techniques.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":" 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138961822","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}
E. S. Merkuryeva, T. Markova, V. Kenis, V. Kadyshev, Tatiana S. Nagornova, Elena V. Noskova, E. Dadali
BACKGROUND: Osteoporosis–pseudoglioma syndrome (OMIM #259770) is an ultrarare autosomal recessive disease characterized by congenital or infant blindness, severe osteoporosis, and spontaneous bone fractures. The syndrome is caused by pathogenic variants in the LRP5 gene, which encodes a protein involved in the transmission of signals in the Wnt/β-catenin signaling pathway. To date, 77 pathogenic variants associated with osteoporosis–pseudoglioma syndrome have been registered in LRP5, mainly localized in the second and third beta-propeller domains of the protein, which have a high affinity for the Wnt ligand. CLINICAL CASES: Two siblings presented with clinical manifestations of osteoporosis–pseudoglioma syndrome caused by a pathogenic homozygous missense variant c.1481GA (p.Arg494Gln) in LRP5. The phenotype of the patients was characterized by a combination of blindness, low bone-mineral density, short stature, and fractures and deformities of long tubular bones and the spine. DISCUSSION: The rarity of the osteoporosis–pseudoglioma syndrome and the similarity of the clinical manifestations of various skeletal disorders and their genetic heterogeneity lead to a late diagnosis and treatment. CONCLUSIONS: We are the first to present the clinical, radiological, and genetic characteristics of two siblings with clinical manifestations of osteoporosis–pseudoglioma syndrome. Its rarity necessitates detailed description of the clinical and genetic characteristics of this syndrome. Molecular genetic testing is an important part of a comprehensive diagnosis.
{"title":"Clinical and radiological characteristics of two patients with osteoporosis–pseudoglioma syndrome caused by a pathogenic homozygotic variant in the LRP5 gene","authors":"E. S. Merkuryeva, T. Markova, V. Kenis, V. Kadyshev, Tatiana S. Nagornova, Elena V. Noskova, E. Dadali","doi":"10.17816/ptors607380","DOIUrl":"https://doi.org/10.17816/ptors607380","url":null,"abstract":"BACKGROUND: Osteoporosis–pseudoglioma syndrome (OMIM #259770) is an ultrarare autosomal recessive disease characterized by congenital or infant blindness, severe osteoporosis, and spontaneous bone fractures. The syndrome is caused by pathogenic variants in the LRP5 gene, which encodes a protein involved in the transmission of signals in the Wnt/β-catenin signaling pathway. To date, 77 pathogenic variants associated with osteoporosis–pseudoglioma syndrome have been registered in LRP5, mainly localized in the second and third beta-propeller domains of the protein, which have a high affinity for the Wnt ligand. \u0000CLINICAL CASES: Two siblings presented with clinical manifestations of osteoporosis–pseudoglioma syndrome caused by a pathogenic homozygous missense variant c.1481GA (p.Arg494Gln) in LRP5. The phenotype of the patients was characterized by a combination of blindness, low bone-mineral density, short stature, and fractures and deformities of long tubular bones and the spine. \u0000DISCUSSION: The rarity of the osteoporosis–pseudoglioma syndrome and the similarity of the clinical manifestations of various skeletal disorders and their genetic heterogeneity lead to a late diagnosis and treatment. \u0000CONCLUSIONS: We are the first to present the clinical, radiological, and genetic characteristics of two siblings with clinical manifestations of osteoporosis–pseudoglioma syndrome. Its rarity necessitates detailed description of the clinical and genetic characteristics of this syndrome. Molecular genetic testing is an important part of a comprehensive diagnosis.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138962983","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}
Dmitrii B. Barsukov, P. Bortulev, I. Pozdnikin, T. Baskaeva
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is one of the most severe hip joint diseases in children. It is characterized by the development of unilateral or bilateral deformity of the proximal femoral epimetaphysis of varying degrees. The pronounced deformity of the femoral component of the affected joint leads to pelvic retroversion, decreased lumbar lordosis, increased thoracic kyphosis (TK), and formation of type I (hypolordotic) vertical posture according to the Roussouly classification, contributing to degenerative and dystrophic processes in the lumbosacral spine. At present, no data in the literature present the effect of surgical treatment on frontal and sagittal spine–pelvis relationships in the patients examined. AIM:To performacomparative radiological evaluation of the sagittal spine–pelvis relationship in children with severe SCFE before and after the modified Dunn procedure. MATERIALS AND METHODS:The study included 30 patients (30 hip joints) aged 14–18 years with severe SCFE characterized byaposterior epiphysis displacement of 60° and downward of no more than 10° in one of the joints and no displacement (preslip stage) in the other. All children underwent the modified Dunn procedure on one side and fixation of the epiphysis of the femoral head withacannulated screw on the other side. Before and after surgery, the patients underwent clinical and radiologic examinations. Standing radiographs were used to evaluate lumbar lordosis, TK, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA). The obtained data were analyzed statistically. RESULTS:At the examination 3–3.5 years after the abovementioned interventions,apronounced increase was noted in the mean PI value, which began to correspond to type III (harmonious) of upright posture according to the Roussouly classification.Achange was noted in the mean values of positional indices PT (decreased) and SS (increased), and pelvic retroversion disappeared. The mean global lumbar lordosis (GLL) and lumbar lordosis increased, which led toadecrease in TK and the mean value of TK. All clinical observations showedasignificant decrease in the mean global sagittal balance index (the sagittal vertical axis (SVA)) and absence of torso imbalance. CONCLUSIONS:After performing the modified Dunn procedure on the one side and fixation of the epiphysis of the femoral head withascrew on the other side, children with severe SCFE demonstrated improvements in all the studied indices of sagittal spine–pelvis ratios. Consequently, the type of vertical posture according to the Roussouly classification changes from type I (hypolordotic) to type III (harmonious), and the probability of degenerative and dystrophic process development in the lumbosacral spine decreases.
背景：股骨头骺滑脱（SCFE）是儿童最严重的髋关节疾病之一。其特点是股骨近端骨骺出现不同程度的单侧或双侧畸形。受累关节股骨部分的明显畸形会导致骨盆后倾、腰椎前凸减少、胸椎后凸（TK）增加，并根据 Roussouly 分类法形成 I 型（脊柱后凸）垂直姿势，从而导致腰骶椎的退行性和萎缩过程。目前，文献中还没有数据显示手术治疗对受检患者的正面和矢状脊柱骨盆关系的影响。目的：对重度SCFE患儿在改良Dunn手术前后的脊柱骨盆矢状面关系进行比较放射学评估。材料与方法：该研究纳入了30名年龄在14-18岁的重度SCFE患者（30个髋关节），其特征是其中一个关节的骨骺后方移位60°且向下不超过10°，另一个关节无移位（前唇阶段）。所有患儿均接受了一侧的改良Dunn手术和另一侧的股骨头骨骺用annaculated螺钉固定术。手术前后，患者接受了临床和放射学检查。立位X光片用于评估腰椎前凸、TK、骨盆内陷（PI）、骨盆倾斜（PT）、骶骨斜度（SS）和矢状纵轴（SVA）。获得的数据将进行统计分析。结果：在进行上述干预3-3.5年后的检查中，PI的平均值明显增加，根据Roussouly分类法，开始符合直立姿势的III型（和谐）。总体腰椎前凸（GLL）和腰椎前凸的平均值增加，导致 TK 和 TK 平均值下降。所有临床观察结果表明，平均整体矢状平衡指数（矢状垂直轴（SVA））显著下降，且无躯干失衡。结论：一侧实施改良邓恩手术，另一侧使用螺钉固定股骨头骨骺后，重度SCFE患儿的矢状脊柱-骨盆比例的所有研究指标均有所改善。因此，根据罗苏里（Roussouly）分类法，垂直姿势的类型从 I 型（脊柱发育不良）变为 III 型（和谐），腰骶椎发生退行性病变和萎缩性病变的概率降低。
{"title":"Influence of the modified Dunn procedure on the spine–pelvis relationship in children with severe slipped capital femoral epiphysis","authors":"Dmitrii B. Barsukov, P. Bortulev, I. Pozdnikin, T. Baskaeva","doi":"10.17816/ptors585183","DOIUrl":"https://doi.org/10.17816/ptors585183","url":null,"abstract":"BACKGROUND: Slipped capital femoral epiphysis (SCFE) is one of the most severe hip joint diseases in children. It is characterized by the development of unilateral or bilateral deformity of the proximal femoral epimetaphysis of varying degrees. The pronounced deformity of the femoral component of the affected joint leads to pelvic retroversion, decreased lumbar lordosis, increased thoracic kyphosis (TK), and formation of type I (hypolordotic) vertical posture according to the Roussouly classification, contributing to degenerative and dystrophic processes in the lumbosacral spine. At present, no data in the literature present the effect of surgical treatment on frontal and sagittal spine–pelvis relationships in the patients examined. \u0000AIM:To performacomparative radiological evaluation of the sagittal spine–pelvis relationship in children with severe SCFE before and after the modified Dunn procedure. \u0000MATERIALS AND METHODS:The study included 30 patients (30 hip joints) aged 14–18 years with severe SCFE characterized byaposterior epiphysis displacement of 60° and downward of no more than 10° in one of the joints and no displacement (preslip stage) in the other. All children underwent the modified Dunn procedure on one side and fixation of the epiphysis of the femoral head withacannulated screw on the other side. Before and after surgery, the patients underwent clinical and radiologic examinations. Standing radiographs were used to evaluate lumbar lordosis, TK, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA). The obtained data were analyzed statistically. \u0000RESULTS:At the examination 3–3.5 years after the abovementioned interventions,apronounced increase was noted in the mean PI value, which began to correspond to type III (harmonious) of upright posture according to the Roussouly classification.Achange was noted in the mean values of positional indices PT (decreased) and SS (increased), and pelvic retroversion disappeared. The mean global lumbar lordosis (GLL) and lumbar lordosis increased, which led toadecrease in TK and the mean value of TK. All clinical observations showedasignificant decrease in the mean global sagittal balance index (the sagittal vertical axis (SVA)) and absence of torso imbalance. \u0000CONCLUSIONS:After performing the modified Dunn procedure on the one side and fixation of the epiphysis of the femoral head withascrew on the other side, children with severe SCFE demonstrated improvements in all the studied indices of sagittal spine–pelvis ratios. Consequently, the type of vertical posture according to the Roussouly classification changes from type I (hypolordotic) to type III (harmonious), and the probability of degenerative and dystrophic process development in the lumbosacral spine decreases.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":" 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138963057","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}
A. S. Shabunin, Margarita V. Savina, Timofey S. Rybinskikh, Anna D. Dreval, Vladislav D. Safarov, Platon А. Safonov, Andrej M. Fedyuk, D. Sitovskaia, Nikita M. Dyachuk, Alexandra S. Baidikova, Lidia S. Konkova, Olga L. Vlasova, S. Vissarionov
BACKGROUND: Contemporary experimental models for spinal cord injury studies are mainly based on spinal cord injury in rats and mice. Modeling of experimental spinal cord injuries is generally performed from the dorsal approach, which excludes its injury as a result of compression by the fragments of the fractured vertebral body and significantly restricts the application of the results obtained from clinical practice. AIM: To develop and create contusional spinal cord injury model from the ventral approach with its subsequent comparison with the contusional spinal cord injury model from the dorsal approach. MATERIALS AND METHODS: The study examined 20 female Soviet Chinchilla rabbits weighing 3.5–4.5 kg. The rabbits were subjected to standardized spinal cord injuries from the ventral and dorsal approaches at the LII level. Somatosensory- and motor-evoked potentials, H-reflex, were recorded in all experimental animals before injury, immediately after, and 3 and 8 h after injury. Histological studies were also performed using qualitative and semiquantitative analyses of biopsy samples of damaged areas and assessing the number of dystrophic neurons over time. The results of neurophysiological and histological examinations of the spinal cord in cases of ventral and dorsal trauma were statistically processed. RESULTS: When modeling spinal cord injury from the ventral approach, in comparison with the model from the dorsal approach, more significant damage is detected. As a result of the injury factor, the dysfunction of both neurons at the traumatization level and peripheral neurons below the injury zone was revealed; however, as histological examinations have shown, in contrast to the dorsal approach, mild hemorrhage was observed in the ventral approach. CONCLUSIONS: The results obtained indicate a more significant and strict contusion mechanism of the spinal cord injury model from the ventral approach and the maximum proximity of the resulting model in a clinical situation. In the future, the experimental model of the contusional spinal cord injury in a laboratory animal can be used in chronic experiments.
{"title":"Comparative evaluation of contusion spinal cord injury models from ventral and dorsal approaches in rabbits in an experiment","authors":"A. S. Shabunin, Margarita V. Savina, Timofey S. Rybinskikh, Anna D. Dreval, Vladislav D. Safarov, Platon А. Safonov, Andrej M. Fedyuk, D. Sitovskaia, Nikita M. Dyachuk, Alexandra S. Baidikova, Lidia S. Konkova, Olga L. Vlasova, S. Vissarionov","doi":"10.17816/ptors568295","DOIUrl":"https://doi.org/10.17816/ptors568295","url":null,"abstract":"BACKGROUND: Contemporary experimental models for spinal cord injury studies are mainly based on spinal cord injury in rats and mice. Modeling of experimental spinal cord injuries is generally performed from the dorsal approach, which excludes its injury as a result of compression by the fragments of the fractured vertebral body and significantly restricts the application of the results obtained from clinical practice. \u0000AIM: To develop and create contusional spinal cord injury model from the ventral approach with its subsequent comparison with the contusional spinal cord injury model from the dorsal approach. \u0000MATERIALS AND METHODS: The study examined 20 female Soviet Chinchilla rabbits weighing 3.5–4.5 kg. The rabbits were subjected to standardized spinal cord injuries from the ventral and dorsal approaches at the LII level. Somatosensory- and motor-evoked potentials, H-reflex, were recorded in all experimental animals before injury, immediately after, and 3 and 8 h after injury. Histological studies were also performed using qualitative and semiquantitative analyses of biopsy samples of damaged areas and assessing the number of dystrophic neurons over time. The results of neurophysiological and histological examinations of the spinal cord in cases of ventral and dorsal trauma were statistically processed. \u0000RESULTS: When modeling spinal cord injury from the ventral approach, in comparison with the model from the dorsal approach, more significant damage is detected. As a result of the injury factor, the dysfunction of both neurons at the traumatization level and peripheral neurons below the injury zone was revealed; however, as histological examinations have shown, in contrast to the dorsal approach, mild hemorrhage was observed in the ventral approach. \u0000CONCLUSIONS: The results obtained indicate a more significant and strict contusion mechanism of the spinal cord injury model from the ventral approach and the maximum proximity of the resulting model in a clinical situation. In the future, the experimental model of the contusional spinal cord injury in a laboratory animal can be used in chronic experiments.","PeriodicalId":37631,"journal":{"name":"Pediatric Traumatology, Orthopaedics and Reconstructive Surgery","volume":" 1010","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138960379","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}
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