Pub Date : 2024-03-19DOI: 10.1101/2024.03.19.24304424
Kai Song, Pengfei Chi, Qiang Yang, Cao Yang, Bing Wang, Fangcai Li, Zezhang Zhu, Weishi Li, Jianguo Zhang, Zheng Wang
Objective: To investigate sagittal spinal alignment from the perspective of the overall curvature of the "S" curve of the human spine, and explore the roles of pelvic incidence (PI) and maximal thoracolumbar vertebral tilt(TLmax) in the classification of the sagittal spinal aligment. Methods: The tilt of the sacral, lumbar, and thoracic vertebrae (from Co1, S5, S4... to C7) were measured. The minimal sacral vertebral tilt(Smin), maximal thoracolumbar vertebral tilt(TLmax), and minimal thoracic vertebral tilt (Tmin) were recorded. The concept of lumbosacral lordosis (LSL) was introduced, and the Ferguson method was utilized to measure sagittal spinal parameters both in anatomical segmentation (Ferguson L1-S2, Ferguson T1-T12) and functional segmentation (Ferguson LSLmax, Ferguson TKmax). The subjects were grouped based on pelvic incidence (PI) and TLmax separately, and the mean and standard deviation of each parameter were calculated. Chi-square tests were conducted for statistical analysis. Results: 1. Based on PI grouping: PI for all subjects was 45.4 ± 9.5°(21.7-86.4°). Group A consisted of 117 subjects with a mean PI of 34.7 ± 4.4°, Group B had 158 subjects with a mean PI of 45.2 ± 2.9°, and Group C included 113 subjects with a mean PI of 56.7 ± 5.8°. No statistically significant differences were found in tilt of S2, L1, T1, TLmax, Tmin, and Ferguson L1-S2, Ferguson T1-T12, and Ferguson TKmax among Groups A, B, and C. 2. Based on TLmax grouping: TLmax for all subjects was 110.5 ± 5.5° (94.4-132.0°). Group A had 91 subjects with a mean TLmax of 104.0 ± 2.3°, Group B comprised 216 subjects with a mean TLmax of 110.2 ± 2.1°, and Group C included 81 subjects with a mean TLmax of 118.6 ± 3.8°. Significant statistical differences were observed in tilt of S2, L1, T1, Smin, TLmax, Tmin, and Ferguson L1-S2, Ferguson T1-T12, Ferguson LSLmax, and Ferguson TKmax among Groups A, B, and C. Conclusion: There were no differences in the magnitude of LSL and TK among subjects with different PI, indicating that PI does not affect the overall curvature of the "S" curve in the sagittal spinal aligment. In contrast, TLmax effectively distinguishes the overall curvature of the "S" curve. Keywords: Sagittal spinal alignment; Sagittal spinal curvature; Lumbosacral lordosis; Pelvic incidence; Maximal thoracolumbar vertebral tilt.
{"title":"Sagittal balance of the spine - lumbar lordosis or lumbosacral lordosis?","authors":"Kai Song, Pengfei Chi, Qiang Yang, Cao Yang, Bing Wang, Fangcai Li, Zezhang Zhu, Weishi Li, Jianguo Zhang, Zheng Wang","doi":"10.1101/2024.03.19.24304424","DOIUrl":"https://doi.org/10.1101/2024.03.19.24304424","url":null,"abstract":"Objective: To investigate sagittal spinal alignment from the perspective of the overall curvature of the \"S\" curve of the human spine, and explore the roles of pelvic incidence (PI) and maximal thoracolumbar vertebral tilt(TLmax) in the classification of the sagittal spinal aligment.\u0000Methods: The tilt of the sacral, lumbar, and thoracic vertebrae (from Co1, S5, S4... to C7) were measured. The minimal sacral vertebral tilt(Smin), maximal thoracolumbar vertebral tilt(TLmax), and minimal thoracic vertebral tilt (Tmin) were recorded. The concept of lumbosacral lordosis (LSL) was introduced, and the Ferguson method was utilized to measure sagittal spinal parameters both in anatomical segmentation (Ferguson L1-S2, Ferguson T1-T12) and functional segmentation (Ferguson LSLmax, Ferguson TKmax). The subjects were grouped based on pelvic incidence (PI) and TLmax separately, and the mean and standard deviation of each parameter were calculated. Chi-square tests were conducted for statistical analysis.\u0000Results: 1. Based on PI grouping: PI for all subjects was 45.4 ± 9.5°(21.7-86.4°). Group A consisted of 117 subjects with a mean PI of 34.7 ± 4.4°, Group B had 158 subjects with a mean PI of 45.2 ± 2.9°, and Group C included 113 subjects with a mean PI of 56.7 ± 5.8°. No statistically significant differences were found in tilt of S2, L1, T1, TLmax, Tmin, and Ferguson L1-S2, Ferguson T1-T12, and Ferguson TKmax among Groups A, B, and C. 2. Based on TLmax grouping: TLmax for all subjects was 110.5 ± 5.5° (94.4-132.0°). Group A had 91 subjects with a mean TLmax of 104.0 ± 2.3°, Group B comprised 216 subjects with a mean TLmax of 110.2 ± 2.1°, and Group C included 81 subjects with a mean TLmax of 118.6 ± 3.8°. Significant statistical differences were observed in tilt of S2, L1, T1, Smin, TLmax, Tmin, and Ferguson L1-S2, Ferguson T1-T12, Ferguson LSLmax, and Ferguson TKmax among Groups A, B, and C.\u0000Conclusion: There were no differences in the magnitude of LSL and TK among subjects with different PI, indicating that PI does not affect the overall curvature of the \"S\" curve in the sagittal spinal aligment. In contrast, TLmax effectively distinguishes the overall curvature of the \"S\" curve.\u0000Keywords: Sagittal spinal alignment; Sagittal spinal curvature; Lumbosacral lordosis; Pelvic incidence; Maximal thoracolumbar vertebral tilt.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140169050","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}
Purpose: To clarify the morphological factors of the pelvis in patients with developmental dysplasia of the hip (DDH), three-dimensional (3D) pelvic morphology was analyzed using a template-fitting technique. Methods: Three-dimensional pelvic data of 50 patients with DDH (DDH group) and 3D pelvic data of 50 patients without obvious pelvic deformity (Normal group) were used. All patients were female. A template model was created by averaging the normal pelvises into a symmetrical and isotropic mesh. Next, 100 homologous models were generated by fitting the pelvic data of each group of patients to the template model. Principal component analysis was performed on the coordinates of each vertex (15,235 vertices) of the pelvic homologous model. In addition, a receiver-operating characteristic (ROC) curve was calculated from the sensitivity of DDH positivity for each principal component, and principal components for which the area under the curve was significantly large were extracted (p<0.05). Finally, which components of the pelvic morphology frequently seen in DDH patients are related to these extracted principal components was evaluated. Results: The first, third, and sixth principal components showed significantly larger areas under the ROC curves. The morphology indicated by the first principal component was associated with a decrease in coxal inclination in both the coronal and horizontal planes. The third principal component was related to the sacral inclination in the sagittal plane. The sixth principal component was associated with narrowing of the superior part of the pelvis. Conclusion: The most important factor in the difference between normal and DDH pelvises was the change in the coxal angle in both the coronal and horizontal planes. That is, in the anterior and superior views, the normal pelvis is a triangle, whereas in DDH, it was more like a quadrilateral.
{"title":"Specific pelvic shape in patients with developmental dysplasia of the hip on 3D morphometric homologous model analysis","authors":"Yui Sasaki, Daisuke Suzuki, Ryo Tokita, Hiroyuki Takashima, Hirofumi Matsumura, Satoshi Nagoya","doi":"10.1101/2024.03.08.24303978","DOIUrl":"https://doi.org/10.1101/2024.03.08.24303978","url":null,"abstract":"Purpose: To clarify the morphological factors of the pelvis in patients with developmental dysplasia of the hip (DDH), three-dimensional (3D) pelvic morphology was analyzed using a template-fitting technique.\u0000Methods: Three-dimensional pelvic data of 50 patients with DDH (DDH group) and 3D pelvic data of 50 patients without obvious pelvic deformity (Normal group) were used. All patients were female. A template model was created by averaging the normal pelvises into a symmetrical and isotropic mesh. Next, 100 homologous models were generated by fitting the pelvic data of each group of patients to the template model. Principal component analysis was performed on the coordinates of each vertex (15,235 vertices) of the pelvic homologous model. In addition, a receiver-operating characteristic (ROC) curve was calculated from the sensitivity of DDH positivity for each principal component, and principal components for which the area under the curve was significantly large were extracted (p<0.05). Finally, which components of the pelvic morphology frequently seen in DDH patients are related to these extracted principal components was evaluated.\u0000Results: The first, third, and sixth principal components showed significantly larger areas under the ROC curves. The morphology indicated by the first principal component was associated with a decrease in coxal inclination in both the coronal and horizontal planes. The third principal component was related to the sacral inclination in the sagittal plane. The sixth principal component was associated with narrowing of the superior part of the pelvis.\u0000Conclusion: The most important factor in the difference between normal and DDH pelvises was the change in the coxal angle in both the coronal and horizontal planes. That is, in the anterior and superior views, the normal pelvis is a triangle, whereas in DDH, it was more like a quadrilateral.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140073340","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}
Pub Date : 2024-03-09DOI: 10.1101/2024.03.07.24303832
Shindo I Kilawa, Anthony J Pallangyo, Elifuraha G Maya, Rogers J Temu, Faiton N Mandari, Frank I Olotu, Estomick K Ofunguo, Adnan M Sadiq, Honest H Massawe, Octavian Shirima, Reginald Shoo
Background: Femoral shaft fracture is among the most common causes of paediatric hospitalisation, mortality and morbidity worldwide. There is no clear option that is preferable to other treatment modalities, especially between 5 to 16 years and published studies are scarce on radiological outcomes in Sub-Saharan Africa.This study aimed to determine the pattern, treatment modalities and radiological outcome of the paediatric femoral fractures treated at KCMC. Methodology: A cross-sectional study was conducted for all children with femoral shaft fractures treated at Kilimanjaro Christian Medical Centre from 1st January 2018 to 31st December 2022. The approval to conduct the research was obtained from Kilimanjaro College Research Ethics and Review Committee(CRERC) with ethical clearance Reg NO PG 88/2022. In our study we used secondary data and the permission to conduct the research was obtained from KCMC, hence no formal consent was required from patients/parents. The patient’s information was traced through patient files and the hospital's electronic system. The radiological outcome; shortening, angulations in six weeks and fracture union, 12 weeks post-management were reviewed with the involvement of a consultant radiologist and the orthopaedic surgeon to obtain the precise information and were recorded on the extraction sheet. Results: This study included 230 study participants who met the inclusion criteria. The mean age of participants was 9.1 (5.1) years, 41.3%, was aged 6 – 12 years, 82.2% were males, 45.7% were involved in a MTC, and 83.5% had no health insurance. The commonest fracture type was 92.6% closed, 48.7% transverse, and 65.% right side. Non-operatively was used in 50.9% of which 76.8% were treated with late hip Spica. Of those treated operatively, 61.1% were plating. The majority had good radiological outcomes with acceptable solid union, angulation and shortening. Those patients who were not operated had 94% lower odds of satisfactory radiological outcomes than those who were operated ( AOR=0.06, 95% CI: 0.01 – 0.27 and p<0.001) whereas other factors were not statistically significant. Conclusion: The majority of the study participants were male and were involved in MTC as the commonest mechanism of injury. Most had closed fractures that mainly presented on the right side and transverse fractures were the most common type. The hip Spica was common non-operatively option; however, plating was the most common operative option. Treatment modality substantially affected radiological outcomes and was statistically significant.
{"title":"Pattern, treatment modalities and radiological outcome of pediatric femoral shaft fractures; fractures treated in Northern, Tanzania","authors":"Shindo I Kilawa, Anthony J Pallangyo, Elifuraha G Maya, Rogers J Temu, Faiton N Mandari, Frank I Olotu, Estomick K Ofunguo, Adnan M Sadiq, Honest H Massawe, Octavian Shirima, Reginald Shoo","doi":"10.1101/2024.03.07.24303832","DOIUrl":"https://doi.org/10.1101/2024.03.07.24303832","url":null,"abstract":"Background: Femoral shaft fracture is among the most common causes of paediatric hospitalisation, mortality and morbidity worldwide. There is no clear option that is preferable to other treatment modalities, especially between 5 to 16 years and published studies are scarce on radiological outcomes in Sub-Saharan Africa.This study aimed to determine the pattern, treatment modalities and radiological outcome of the paediatric femoral fractures treated at KCMC. Methodology: A cross-sectional study was conducted for all children with femoral shaft fractures treated at Kilimanjaro Christian Medical Centre from 1st January 2018 to 31st December 2022. The approval to conduct the research was obtained from Kilimanjaro College Research Ethics and Review Committee(CRERC) with ethical clearance Reg NO PG 88/2022. In our study we used secondary data and the permission to conduct the research was obtained from KCMC, hence no formal consent was required from patients/parents. The patient’s information was traced through patient files and the hospital's electronic system. The radiological outcome; shortening, angulations in six weeks and fracture union, 12 weeks post-management were reviewed with the involvement of a consultant radiologist and the orthopaedic surgeon to obtain the precise information and were recorded on the extraction sheet. Results: This study included 230 study participants who met the inclusion criteria. The mean age of participants was 9.1 (5.1) years, 41.3%, was aged 6 – 12 years, 82.2% were males, 45.7% were involved in a MTC, and 83.5% had no health insurance. The commonest fracture type was 92.6% closed, 48.7% transverse, and 65.% right side. Non-operatively was used in 50.9% of which 76.8% were treated with late hip Spica. Of those treated operatively, 61.1% were plating.\u0000The majority had good radiological outcomes with acceptable solid union, angulation and shortening. Those patients who were not operated had 94% lower odds of satisfactory radiological outcomes than those who were operated ( AOR=0.06, 95% CI: 0.01 – 0.27 and p<0.001) whereas other factors were not statistically significant. Conclusion: The majority of the study participants were male and were involved in MTC as the commonest mechanism of injury. Most had closed fractures that mainly presented on the right side and transverse fractures were the most common type. The hip Spica was common non-operatively option; however, plating was the most common operative option. Treatment modality substantially affected radiological outcomes and was statistically significant.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140073441","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}
Pub Date : 2024-02-21DOI: 10.1101/2024.02.20.24303085
Oliver Bremerskov Zielinski, Dennis Winge Hallager, Kasper Yde Jensen, Leah Y Carreon, Mikkel Osterheden Andersen, Louise P Diederichsen, Rune D Bech
Background: Patients with lumbar spinal stenosis may complain of poor balance, decreased physical function and problems maintaining physical activity levels due to radiculopathy. Decompressive surgery is often indicated if conservative management fails to achieve a satisfactory clinical outcome. While surgical management has proven effective at treating radiculopathy, and patients report increased physical function post-operatively, objective measures of postural control and physical activity remains sparse. This study aims to investigate the effects of decompressive surgery on balance and activity levels of elderly patients with lumbar spinal stenosis using objective measurements. Methods and analysis: This is a 24 month, multi-centre, prospective cohort study. Patients at or above 65 years of age with MRI-verified symptomatic lumbar spinal stenosis will be recruited from two separate inclusion centres, and all participants will undergo decompressive surgery for lumbar spinal stenosis. Preoperative data is collected up to 3 months before surgery, with follow-up data collected at 3, 6, 12 and 24 months postoperatively. Balance measurements are performed using the Wii Balance Board, mini Balance Evaluation Systems Test and Tandem test, and data concerning physical activity levels are collected using ActiGraph wGT3XBT accelerometers. Patient reported outcomes regarding quality of life and physical function are collected from the EuroQol5D, 36 Item Short Form Health Survey and Zurich Claudication Questionnaire. Primary outcomes are the change in sway area of centre of pressure and total activity counts per day from baseline to follow-up at 24 months. A sample size of 80 participants has been calculated. Ethics and dissemination The study has been approved by the Regional Ethics Committee of Region Zealand (ID EMN202208110) and the Danish Data Protection Agency (ID REG1002022). All results from the study will be published in international peer reviewed journals and presented at national and international conferences. Study findings will be disseminated through national patient associations. Trial registration number: NCT06075862 & NCT06057428
{"title":"A multi-center investigation on the effect of decompressive surgery on Balance and physical ActiviTy Levels in patients with lumbar Spinal stenosis (B-ATLAS): Protocol for a prospective cohort study.","authors":"Oliver Bremerskov Zielinski, Dennis Winge Hallager, Kasper Yde Jensen, Leah Y Carreon, Mikkel Osterheden Andersen, Louise P Diederichsen, Rune D Bech","doi":"10.1101/2024.02.20.24303085","DOIUrl":"https://doi.org/10.1101/2024.02.20.24303085","url":null,"abstract":"Background:\u0000Patients with lumbar spinal stenosis may complain of poor balance, decreased physical function and problems maintaining physical activity levels due to radiculopathy. Decompressive surgery is often indicated if conservative management fails to achieve a satisfactory clinical outcome. While surgical management has proven effective at treating radiculopathy, and patients report increased physical function post-operatively, objective measures of postural control and physical activity remains sparse. This study aims to investigate the effects of decompressive surgery on balance and activity levels of elderly patients with lumbar spinal stenosis using objective measurements. Methods and analysis:\u0000This is a 24 month, multi-centre, prospective cohort study. Patients at or above 65 years of age with MRI-verified symptomatic lumbar spinal stenosis will be recruited from two separate inclusion centres, and all participants will undergo decompressive surgery for lumbar spinal stenosis. Preoperative data is collected up to 3 months before surgery, with follow-up data collected at 3, 6, 12 and 24 months postoperatively. Balance measurements are performed using the Wii Balance Board, mini Balance Evaluation Systems Test and Tandem test, and data concerning physical activity levels are collected using ActiGraph wGT3XBT accelerometers. Patient reported outcomes regarding quality of life and physical function are collected from the EuroQol5D, 36 Item Short Form Health Survey and Zurich Claudication Questionnaire. Primary outcomes are the change in sway area of centre of pressure and total activity counts per day from baseline to follow-up at 24 months. A sample size of 80 participants has been calculated. Ethics and dissemination\u0000The study has been approved by the Regional Ethics Committee of Region Zealand (ID EMN202208110) and the Danish Data Protection Agency (ID REG1002022). All results from the study will be published in international peer reviewed journals and presented at national and international conferences. Study findings will be disseminated through national patient associations. Trial registration number:\u0000NCT06075862 & NCT06057428","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139923909","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}
Pub Date : 2024-02-09DOI: 10.1101/2024.02.08.24302319
Mehrdad Davoudi, Firooz Salami, Robert Reisig, Dimitrios Patikas, Sebastian Wolf
This study aimed to investigate how electromyography (EMG) cluster analysis of the rectus femoris (RF) could help to better interpret gait analysis in patients with cerebral palsy (CP). The retrospective gait data of CP patients were categorized into two groups: initial examination (E1, 881 patients) and subsequent examination (E2, 377 patients). Envelope-formatted EMG data of RF were collected. Using PCA and a combined PSO-K-means algorithm, main clusters were identified. Patients were further classified into crouch, jump, recurvatum, stiff and mild gait for detailed analysis. The clusters (labels) were characterized by a significant peak EMG activity during mid-swing (L1), prolonged EMG activity during stance (L2), and a peak EMG activity during loading response (L3). Notably, L2 contained 76% and 92% of all crouch patients at E1 and E2, respectively. Comparing patients with a crouch gait pattern in L2-E1 and L2-E2, two subgroups emerged: patients with persistent crouch (G1) and patients showing improvement at E2 (G2). The minimum activity of RF during 20-45% of the gait was significantly higher (p= 0.025) in G1 than in G2. A greater chance of improvement from crouch gait might be associated with lower RF activity during the stance phase. Using our findings, we could potentially establish an approach to improve clinical decision-making regarding treatment of patients with CP.
{"title":"Rectus Femoris Electromyography Signal Clustering: Data-Driven Management of Crouch Gait in Patients with Cerebral Palsy","authors":"Mehrdad Davoudi, Firooz Salami, Robert Reisig, Dimitrios Patikas, Sebastian Wolf","doi":"10.1101/2024.02.08.24302319","DOIUrl":"https://doi.org/10.1101/2024.02.08.24302319","url":null,"abstract":"This study aimed to investigate how electromyography (EMG) cluster analysis of the rectus femoris (RF) could help to better interpret gait analysis in patients with cerebral palsy (CP). The retrospective gait data of CP patients were categorized into two groups: initial examination (E1, 881 patients) and subsequent examination (E2, 377 patients). Envelope-formatted EMG data of RF were collected. Using PCA and a combined PSO-K-means algorithm, main clusters were identified. Patients were further classified into crouch, jump, recurvatum, stiff and mild gait for detailed analysis. The clusters (labels) were characterized by a significant peak EMG activity during mid-swing (L1), prolonged EMG activity during stance (L2), and a peak EMG activity during loading response (L3). Notably, L2 contained 76% and 92% of all crouch patients at E1 and E2, respectively. Comparing patients with a crouch gait pattern in L2-E1 and L2-E2, two subgroups emerged: patients with persistent crouch (G1) and patients showing improvement at E2 (G2). The minimum activity of RF during 20-45% of the gait was significantly higher (p= 0.025) in G1 than in G2. A greater chance of improvement from crouch gait might be associated with lower RF activity during the stance phase. Using our findings, we could potentially establish an approach to improve clinical decision-making regarding treatment of patients with CP.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139762579","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}
Pub Date : 2024-01-28DOI: 10.1101/2024.01.27.24301867
Atta Taseh, Evan Sirls, George Casey, Sarah Hearns, Job N Doornberg, Santiago A Lozano-Calderon, Mitchel B Harris, Soheil Ashkani-Esfahani
Background: The Fracture Risk Assessment Tool (FRAX), widely used for predicting the 10-year likelihood of hip fractures, does not incorporate factors like prior falls and sociodemographic characteristics, notably the Social Vulnerability Index (SVI). Recognizing these limitations, we aim to evaluate the predictive accuracy of FRAX by integrating fall frequency, fall energy, and SVI into the model for assessing the risk of fall-induced hip fractures. Methods: A retrospective case-control study was conducted, and patients aged ≥ 40 years with a documented diagnosis of a fall-induced hip fracture were age-matched with controls with a history of falls without an associated hip fracture. Basic demographic data, along with information about the number of prior falls and the energy of the current falls, were collected. The FRAX and SVI were calculated accordingly. Logistic regression analysis was employed to identify significant predictors. The performance of the models was evaluated and reported using appropriate metrics. Baseline characteristics of the dataset were presented as medians with interquartile ranges (IQR) or as percentages, where applicable. The significance of the identified variables was quantified using Odds Ratio (OR) along with their 95% Confidence Interval (CI). A p-value threshold of 0.05 was set for statistical significance. Results: A total of 261 patients per group were included with a median age of 74 (IQR 67-80) and 72 (IQR 62-83) years. The FRAX score was significantly associated with the likelihood of experiencing a fall-induced hip fracture, as indicated by an OR of 1.06 (CI: 1.03-1.09). Participants with a one-time history of falls had an OR of 1.58 (CI: 1.02-2.37), compared to 1.84 (CI: 1.09-3.1) for those with multiple falls. The white race, along with the Housing Type and Transportation domain of the SVI, also demonstrated to play a role (OR= 2.85 (CI: 1.56-5.2) and OR= 0.3 (CI: 0.12-0.8), respectively). Conclusion: This study underscored the significance of factors such as fall frequency, SVI, and race in predicting fall-induced hip fractures. It also highlighted the need for further refinement of the FRAX tool. We recommend that future research should be focused on validating the impact of these sociodemographic and fall characteristics on a broader scale, along with exploring the implications of clinical surrogates related to falls. Keywords: FRAX; Fall; Hip Fracture
背景：骨折风险评估工具（FRAX骨折风险评估工具（FRAX）被广泛用于预测10年髋部骨折的可能性，但该工具并没有将先前跌倒和社会人口特征等因素纳入其中，特别是社会脆弱性指数（SVI）。认识到这些局限性，我们旨在通过将跌倒频率、跌倒能量和 SVI 纳入模型来评估 FRAX 的预测准确性，从而评估跌倒诱发髋部骨折的风险：方法： 我们进行了一项回顾性病例对照研究，将年龄≥40 岁、确诊为跌倒诱发髋部骨折的患者与有跌倒史但未伴有髋部骨折的对照组进行年龄配对。研究人员收集了基本的人口统计学数据、先前跌倒的次数和当前跌倒的能量等信息。并据此计算出 FRAX 和 SVI。采用逻辑回归分析来确定重要的预测因素。使用适当的指标对模型的性能进行评估和报告。数据集的基线特征以中位数和四分位数间距 (IQR) 或百分比（如适用）表示。已确定变量的显著性使用比值比（OR）及其 95% 置信区间（CI）进行量化。统计显著性的 p 值阈值设定为 0.05：每组共纳入 261 名患者，中位年龄分别为 74 岁（IQR 67-80）和 72 岁（IQR 62-83）。FRAX 评分与跌倒导致髋部骨折的可能性有明显相关性，OR 值为 1.06（CI：1.03-1.09）。有过一次跌倒史的参与者的 OR 值为 1.58（CI：1.02-2.37），而有过多次跌倒史的参与者的 OR 值为 1.84（CI：1.09-3.1）。白种人以及SVI的住房类型和交通领域也显示出了一定的作用（OR= 2.85（CI：1.56-5.2）和OR= 0.3（CI：0.12-0.8））：本研究强调了跌倒频率、SVI 和种族等因素在预测跌倒诱发髋部骨折方面的重要性。研究还强调了进一步完善 FRAX 工具的必要性。我们建议今后的研究应侧重于在更大范围内验证这些社会人口学特征和跌倒特征的影响，同时探索与跌倒相关的临床代用指标的影响。关键词FRAX；跌倒；髋部骨折
{"title":"Modified FRAX Score for Prediction of Fall-induced Hip Fractures; The Added Value of Fall Energy, Number, and Social Vulnerability Index","authors":"Atta Taseh, Evan Sirls, George Casey, Sarah Hearns, Job N Doornberg, Santiago A Lozano-Calderon, Mitchel B Harris, Soheil Ashkani-Esfahani","doi":"10.1101/2024.01.27.24301867","DOIUrl":"https://doi.org/10.1101/2024.01.27.24301867","url":null,"abstract":"Background: The Fracture Risk Assessment Tool (FRAX), widely used for predicting the 10-year likelihood of hip fractures, does not incorporate factors like prior falls and sociodemographic characteristics, notably the Social Vulnerability Index (SVI). Recognizing these limitations, we aim to evaluate the predictive accuracy of FRAX by integrating fall frequency, fall energy, and SVI into the model for assessing the risk of fall-induced hip fractures.\u0000Methods: A retrospective case-control study was conducted, and patients aged ≥ 40 years with a documented diagnosis of a fall-induced hip fracture were age-matched with controls with a history of falls without an associated hip fracture. Basic demographic data, along with information about the number of prior falls and the energy of the current falls, were collected. The FRAX and SVI were calculated accordingly. Logistic regression analysis was employed to identify significant predictors. The performance of the models was evaluated and reported using appropriate metrics. Baseline characteristics of the dataset were presented as medians with interquartile ranges (IQR) or as percentages, where applicable. The significance of the identified variables was quantified using Odds Ratio (OR) along with their 95% Confidence Interval (CI). A p-value threshold of 0.05 was set for statistical significance.\u0000Results: A total of 261 patients per group were included with a median age of 74 (IQR 67-80) and 72 (IQR 62-83) years. The FRAX score was significantly associated with the likelihood of experiencing a fall-induced hip fracture, as indicated by an OR of 1.06 (CI: 1.03-1.09). Participants with a one-time history of falls had an OR of 1.58 (CI: 1.02-2.37), compared to 1.84 (CI: 1.09-3.1) for those with multiple falls. The white race, along with the Housing Type and Transportation domain of the SVI, also demonstrated to play a role (OR= 2.85 (CI: 1.56-5.2) and OR= 0.3 (CI: 0.12-0.8), respectively).\u0000Conclusion: This study underscored the significance of factors such as fall frequency, SVI, and race in predicting fall-induced hip fractures. It also highlighted the need for further refinement of the FRAX tool. We recommend that future research should be focused on validating the impact of these sociodemographic and fall characteristics on a broader scale, along with exploring the implications of clinical surrogates related to falls. Keywords: FRAX; Fall; Hip Fracture","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139588191","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}
Pub Date : 2024-01-25DOI: 10.1101/2024.01.25.24301714
A. Schraplau, W. Petersen, M. Herbort, B. Lischke, J. Höher, R. Becker, N. Streich, U. Stöckle, C. Schmidt-Lucke
The following report was prepared as part of a trial guideline in accordance with Section 137e (1) SGB V to evaluate the benefits of the use of CAM splints for self-application by patients in the post-surgical rehabilitative treatment of ruptures of the anterior cruciate ligament.
以下报告是根据《标准组织法》第 137e (1) V 条编写的试验指南的一部分，旨在评估在前十字韧带断裂的术后康复治疗中，患者自行使用 CAM 夹板的益处。
{"title":"Study report CAMOPED study","authors":"A. Schraplau, W. Petersen, M. Herbort, B. Lischke, J. Höher, R. Becker, N. Streich, U. Stöckle, C. Schmidt-Lucke","doi":"10.1101/2024.01.25.24301714","DOIUrl":"https://doi.org/10.1101/2024.01.25.24301714","url":null,"abstract":"The following report was prepared as part of a trial guideline in accordance with Section 137e (1) SGB V to evaluate the benefits of the use of CAM splints for self-application by patients in the post-surgical rehabilitative treatment of ruptures of the anterior cruciate ligament.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139588306","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}
Introduction: Musculoskeletal pathologies affecting shoulder girdle joints, other than gleno-humeral joints such as acromioclavicular joint arthritis, tendonitis, subacromial bursitis, subdeltoid bursitis, and osteochondritis dissecans, are relatively rare. In the Middle East and Asian countries, public health services are generally availed by a large number of patients in primary health centers, rural hospitals, and district hospitals, but the scarcity of specialist orthopedic surgeons in such hospitals usually leads to misdiagnosis of rare musculoskeletal pathologies, which may result in complications and morbidity. Objectives: To determine the presentation, progression, diagnostic evaluation, and treatment of musculoskeletal pathologies affecting the shoulder girdle and develop an algorithm to screen such pathologies. Methods: A systematic literature search of four medical databases (PubMed, Scopus, Web of Science and Google Scholar) was conducted, from 1st January 1950 to 31st December 2022. Studies (case reports, prospective studies, review articles) reporting pathological conditions affecting shoulder girdles, with a focus on clinical presentation, physical examination tests required for diagnostic evaluation, and management, were included. The relevant data was extracted from the selected studies and tabulated for analysis. Results and Discussion: Seventeen studies were included in the final analysis. Several case reports, case series, and review articles showed that very few musculoskeletal conditions can be correctly diagnosed based on only physical examination tests. The radiological and anatomical basis of each of the cases were discussed. Conclusion: Based on clinical presentation and examination findings, an algorithm was prepared to help diagnose shoulder girdle pathologies.
导言：除盂肱关节外，影响肩关节的其他肌肉骨骼病变，如肩锁关节炎、肌腱炎、肩峰下滑囊炎、盾牌下滑囊炎和骨软骨炎等，都相对罕见。在中东和亚洲国家，大量患者通常在初级保健中心、农村医院和地区医院享受公共卫生服务，但这些医院骨科专科医生稀缺，通常会导致罕见的肌肉骨骼病症被误诊，从而可能导致并发症和发病率。研究目的确定影响肩部的肌肉骨骼病变的表现、进展、诊断评估和治疗方法，并制定筛选此类病变的算法：方法：对 1950 年 1 月 1 日至 2022 年 12 月 31 日期间的四个医学数据库（PubMed、Scopus、Web of Science 和 Google Scholar）进行了系统的文献检索。研究（病例报告、前瞻性研究、综述性文章）均被纳入其中，这些研究报告了影响肩腰部的病理情况，重点关注临床表现、诊断评估所需的体格检查测试以及治疗方法。从所选研究中提取相关数据并制表分析。结果与讨论：共有 17 项研究被纳入最终分析。一些病例报告、系列病例和综述文章显示，仅凭体格检查测试就能正确诊断出的肌肉骨骼疾病少之又少。研究还讨论了每个病例的放射学和解剖学依据：根据临床表现和检查结果，制定了一套有助于诊断肩部病变的算法。
{"title":"Musculoskeletal Pathologies Affecting Shoulder Girdle: A Systematic Review with Anatomical and Radiological Validation","authors":"Sundip Charmode, Sudhir Shyam Kushwaha, Abhishek Kumar Mishra, Nirav Nimavat, Lalit Ratanpara, Simmi Mehra, Satish Kumar Ravi","doi":"10.1101/2024.01.20.24301508","DOIUrl":"https://doi.org/10.1101/2024.01.20.24301508","url":null,"abstract":"Introduction: Musculoskeletal pathologies affecting shoulder girdle joints, other than gleno-humeral joints such as acromioclavicular joint arthritis, tendonitis, subacromial bursitis, subdeltoid bursitis, and osteochondritis dissecans, are relatively rare. In the Middle East and Asian countries, public health services are generally availed by a large number of patients in primary health centers, rural hospitals, and district hospitals, but the scarcity of specialist orthopedic surgeons in such hospitals usually leads to misdiagnosis of rare musculoskeletal pathologies, which may result in complications and morbidity. Objectives: To determine the presentation, progression, diagnostic evaluation, and treatment of musculoskeletal pathologies affecting the shoulder girdle and develop an algorithm to screen such pathologies.\u0000Methods: A systematic literature search of four medical databases (PubMed, Scopus, Web of Science and Google Scholar) was conducted, from 1st January 1950 to 31st December 2022. Studies (case reports, prospective studies, review articles) reporting pathological conditions affecting shoulder girdles, with a focus on clinical presentation, physical examination tests required for diagnostic evaluation, and management, were included. The relevant data was extracted from the selected studies and tabulated for analysis. Results and Discussion: Seventeen studies were included in the final analysis. Several case reports, case series, and review articles showed that very few musculoskeletal conditions can be correctly diagnosed based on only physical examination tests. The radiological and anatomical basis of each of the cases were discussed.\u0000Conclusion: Based on clinical presentation and examination findings, an algorithm was prepared to help diagnose shoulder girdle pathologies.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139560674","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}
Pub Date : 2024-01-10DOI: 10.1101/2024.01.09.24300808
ZHAO WANG, Shuyi Zhang, Hongyang Gong, Guoxu Zhao, Hong Xiao, Shuai Yuan, Wenhao Wu, Pai Xu, Yihong Chen, Yihong Chen, Mei Yang, Chan Kang
Background: Cardiovascular disease (CVD) may have some association with osteoporosis (OP). This Mendelian randomization (MR) investigation aimed to explore the potential causal linkage between CVD and OP. Methods: Utilizing genome wide association study data from individuals of European descent, we pinpointed Single Nucleotide Polymorphisms (SNPs) relevant to CVD, including those for coronary heart disease (CHD) with 64,762 cases and 22,233 controls, heart failure (HF) comprising 47,309 cases against 930,014 controls, and stroke with a case-control tally of 3,611 to 18,084, to serve as the instrumental variables. Later, we searched for total body bone mineral density (BMD) statistics which were used as phenotypes for OP(sample size = 56,284). In this paper, the traditional inverse variance weighting (IVW) method, the weighted median estimation method, and the MR Egger method are used to estimate different results. The MR Egger intercept test, outlier (Mr PRESSO) test and Cochran Q statistic are used to detect potential directional pleiotropy and heterogeneity, while we also draw the scatter plot, funnel plot and forest plot. Additionally, a reverse direction MR analysis was performed to explore the potential for reverse causation. Results: The IVW analysis showed that CHD could significantly impact total body BMD levels, and every higher standard deviation in the risk of CHD decreased the average total body BMD by 0.0459 units in the IVW analysis. Reverse MR analysis showed no significant correlation of the change of total body BMD on the prevalence effect of CHD. No particular relationship exists between HF and total body BMD. There was no significant effect between the changes in total body BMD induced by stroke. Reverse MR analysis revealed no significant correlation between alterations in total body BMD on stroke. Conclusion: Our analysis points to a substantial causative link between CHD and the vulnerability to OP, potentially paving the way for innovative approaches in treating and preventing OP.
{"title":"Cardiovascular disease and Osteoporosis : A Mendelian randomization study","authors":"ZHAO WANG, Shuyi Zhang, Hongyang Gong, Guoxu Zhao, Hong Xiao, Shuai Yuan, Wenhao Wu, Pai Xu, Yihong Chen, Yihong Chen, Mei Yang, Chan Kang","doi":"10.1101/2024.01.09.24300808","DOIUrl":"https://doi.org/10.1101/2024.01.09.24300808","url":null,"abstract":"Background: Cardiovascular disease (CVD) may have some association with osteoporosis (OP). This Mendelian randomization (MR) investigation aimed to explore the potential causal linkage between CVD and OP. Methods: Utilizing genome wide association study data from individuals of European descent, we pinpointed Single Nucleotide Polymorphisms (SNPs) relevant to CVD, including those for coronary heart disease (CHD) with 64,762 cases and 22,233 controls, heart failure (HF) comprising 47,309 cases against 930,014 controls, and stroke with a case-control tally of 3,611 to 18,084, to serve as the instrumental variables. Later, we searched for total body bone mineral density (BMD) statistics which were used as phenotypes for OP(sample size = 56,284). In this paper, the traditional inverse variance weighting (IVW) method, the weighted median estimation method, and the MR Egger method are used to estimate different results. The MR Egger intercept test, outlier (Mr PRESSO) test and Cochran Q statistic are used to detect potential directional pleiotropy and heterogeneity, while we also draw the scatter plot, funnel plot and forest plot. Additionally, a reverse direction MR analysis was performed to explore the potential for reverse causation. Results: The IVW analysis showed that CHD could significantly impact total body BMD levels, and every higher standard deviation in the risk of CHD decreased the average total body BMD by 0.0459 units in the IVW analysis. Reverse MR analysis showed no significant correlation of the change of total body BMD on the prevalence effect of CHD. No particular relationship exists between HF and total body BMD. There was no significant effect between the changes in total body BMD induced by stroke. Reverse MR analysis revealed no significant correlation between alterations in total body BMD on stroke. Conclusion: Our analysis points to a substantial causative link between CHD and the vulnerability to OP, potentially paving the way for innovative approaches in treating and preventing OP.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139411832","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}
Pub Date : 2023-12-21DOI: 10.1101/2023.12.18.23299488
Kevin Christian Tjandra, Robin Novriansyah, I Nyoman Sebastian Sudiasa, Ardiyana Ar, Nurul Azizah Dian Rahmawati, Ismail Hadisoebroto Dilogo
Background Mesenchymal stem cells (MSCs) can help repair damaged cartilage in osteoarthritis (OA) and prevent disability. Combining MSCs with platelet-rich plasma (PRP) and hyaluronic acid (HA) might make this treatment more effective. This study aims to find out how well MSCs, PRP, and different HA doses work together, what's the best source of MSCs, and how many MSCs to use for treating osteoarthritis and regenerating cartilage. Method The sources included were original articles published from 2013 until 2023 from 4 databases. Studies included were original research of clinical trials or randomized controlled trials. Irrelevant studies were excluded. Then, the ROB-2 taken was used to assess bias. The result was constructed with PICOS criteria table. MRI score, VAS score, Lysholm score, Cartilage volume, size of cartilage defect, Knee Society Clinical Rating System Score (KSS), and WOMAC index to evaluate treatment’s effication outcomes were analyzed by Revman 5.4. This systematic review followed the PRISMA guidelines. Result nine studies were included in the final screening. The meta-analysis showed a significant (P < 0.00001) elevation of Lysholm score with a pooled mean difference (MD) of (17.89) (95% CI: 16.01, 19.77; I2 = 0%, P = 0.56); a significant reduction (P < 0.00001) of VAS score with a pooled MD of (-2.62) (95% CI: -2.83, -2.41; I2 = 99%, P <0.00001); Knee society clinical rating system score (KSS) evaluation also showed significant elevation (P< 0.00001) with mean polled (29.59) (95% CI: 27.66, 31.52; I2= 95%, P< 0.0001); and significantly reduction (P< 0.00001) of WOMAC score occurred as pooled MD of (-12.38) (95% CI: -13.75, -11.01; I2= 99%, P< 0.0001). Conclusions Arthroscopic guided high-dose subchondral application of primary cultured synovial mesenchymal stem cells in popliteal platelet-rich plasma media combined with hyaluronic acid effectively regenerate cartilage defect and increase clinical outcomes in the early stage of osteoarthritis.
{"title":"A New Advanced Osteoarthritis Treatment Utilizing Modified Mesenchymal Stem Cells: Arthroscopic Guided Intra-Articular Intervention Approach a Systematic Review and Meta-Analysis","authors":"Kevin Christian Tjandra, Robin Novriansyah, I Nyoman Sebastian Sudiasa, Ardiyana Ar, Nurul Azizah Dian Rahmawati, Ismail Hadisoebroto Dilogo","doi":"10.1101/2023.12.18.23299488","DOIUrl":"https://doi.org/10.1101/2023.12.18.23299488","url":null,"abstract":"Background Mesenchymal stem cells (MSCs) can help repair damaged cartilage in osteoarthritis (OA) and prevent disability. Combining MSCs with platelet-rich plasma (PRP) and hyaluronic acid (HA) might make this treatment more effective. This study aims to find out how well MSCs, PRP, and different HA doses work together, what's the best source of MSCs, and how many MSCs to use for treating osteoarthritis and regenerating cartilage. Method The sources included were original articles published from 2013 until 2023 from 4 databases. Studies included were original research of clinical trials or randomized controlled trials. Irrelevant studies were excluded. Then, the ROB-2 taken was used to assess bias. The result was constructed with PICOS criteria table. MRI score, VAS score, Lysholm score, Cartilage volume, size of cartilage defect, Knee Society Clinical Rating System Score (KSS), and WOMAC index to evaluate treatment’s effication outcomes were analyzed by Revman 5.4. This systematic review followed the PRISMA guidelines. Result nine studies were included in the final screening. The meta-analysis showed a significant (P < 0.00001) elevation of Lysholm score with a pooled mean difference (MD) of (17.89) (95% CI: 16.01, 19.77; I2 = 0%, P = 0.56); a significant reduction (P < 0.00001) of VAS score with a pooled MD of (-2.62) (95% CI: -2.83, -2.41; I2 = 99%, P <0.00001); Knee society clinical rating system score (KSS) evaluation also showed significant elevation (P< 0.00001) with mean polled (29.59) (95% CI: 27.66, 31.52; I2= 95%, P< 0.0001); and significantly reduction (P< 0.00001) of WOMAC score occurred as pooled MD of (-12.38) (95% CI: -13.75, -11.01; I2= 99%, P< 0.0001). Conclusions Arthroscopic guided high-dose subchondral application of primary cultured synovial mesenchymal stem cells in popliteal platelet-rich plasma media combined with hyaluronic acid effectively regenerate cartilage defect and increase clinical outcomes in the early stage of osteoarthritis.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138823924","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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