Pub Date : 2023-12-15DOI: 10.1101/2023.12.14.23299525
Zeyu Huang, Mary A. Bucklin, Weihua Guo, John T. Martin
The prevalence of knee osteoarthritis (OA) is widespread and the heterogeneous patient factors and clinical symptoms in OA patients impede developing personalized treatments for OA patients. In this study, we used unsupervised and supervised machine learning to organize the heterogeneity in knee OA patients and predict disease progression in individuals from the Osteoarthritis Initiative (OAI) dataset. We identified four distinct knee OA phenotypes using unsupervised learning that were defined by nutrition, disability, stiffness, and pain (knee and back) and were strongly related to disease fate. Interestingly, the absence of supplemental vitamins from an individual’s diet was protective from disease progression. Moreover, we established a phenotyping tool and prognostic model from 5 variables (WOMAC disability score of the right knee, WOMAC total score of the right knee, WOMAC total score of the left knee, supplemental vitamins and minerals frequency, and antioxidant combination multivitamins frequency) that can be utilized in clinical practice to determine the risk of knee OA progression in individual patients. We also developed a prognostic model to estimate the risk for total knee replacement and provide suggestions for modifiable variables to improve long-term knee health. This combination of unsupervised and supervised data-driven tools provides a framework to identify knee OA phenotype in a clinical scenario and personalize treatment strategies.
膝关节骨关节炎（OA）的发病率很高，OA患者的异质性因素和临床症状阻碍了为OA患者开发个性化治疗方法。在这项研究中，我们使用无监督和有监督机器学习来组织膝关节 OA 患者的异质性，并从骨关节炎倡议（OAI）数据集中预测个体的疾病进展。我们利用无监督学习确定了四种不同的膝关节 OA 表型，它们由营养、残疾、僵硬和疼痛（膝关节和背部）定义，并与疾病的命运密切相关。有趣的是，个人饮食中缺乏补充维生素对疾病进展具有保护作用。此外，我们还通过五个变量（右膝WOMAC残疾评分、右膝WOMAC总评分、左膝WOMAC总评分、补充维生素和矿物质的频率、抗氧化复合维生素的频率）建立了表型工具和预后模型，可用于临床实践，以确定个体患者的膝关节OA进展风险。我们还开发了一个预后模型，用于估算全膝关节置换术的风险，并为改善膝关节长期健康的可调节变量提供建议。这种将无监督和有监督数据驱动工具相结合的方法提供了一个框架，可用于在临床场景中识别膝关节 OA 表型并制定个性化治疗策略。
{"title":"Disease progression and clinical outcomes in latent osteoarthritis phenotypes: Data from the Osteoarthritis Initiative","authors":"Zeyu Huang, Mary A. Bucklin, Weihua Guo, John T. Martin","doi":"10.1101/2023.12.14.23299525","DOIUrl":"https://doi.org/10.1101/2023.12.14.23299525","url":null,"abstract":"The prevalence of knee osteoarthritis (OA) is widespread and the heterogeneous patient factors and clinical symptoms in OA patients impede developing personalized treatments for OA patients. In this study, we used unsupervised and supervised machine learning to organize the heterogeneity in knee OA patients and predict disease progression in individuals from the Osteoarthritis Initiative (OAI) dataset. We identified four distinct knee OA phenotypes using unsupervised learning that were defined by nutrition, disability, stiffness, and pain (knee and back) and were strongly related to disease fate. Interestingly, the absence of supplemental vitamins from an individual’s diet was protective from disease progression. Moreover, we established a phenotyping tool and prognostic model from 5 variables (WOMAC disability score of the right knee, WOMAC total score of the right knee, WOMAC total score of the left knee, supplemental vitamins and minerals frequency, and antioxidant combination multivitamins frequency) that can be utilized in clinical practice to determine the risk of knee OA progression in individual patients. We also developed a prognostic model to estimate the risk for total knee replacement and provide suggestions for modifiable variables to improve long-term knee health. This combination of unsupervised and supervised data-driven tools provides a framework to identify knee OA phenotype in a clinical scenario and personalize treatment strategies.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138717203","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 Low back pain (LBP) ranks as one of the top contributors to disability-adjusted life years worldwide. Social determinants of health (SDoH) encompass a range of factors that play a pivotal role in shaping healthcare outcomes. We aimed to examine the differences in SDoH between patients with acute and chronic non-specific low back pain (NSLBP).
{"title":"Correlation of Social Determinants of Health and Chronic Nonspecific Low Back Pain; A Brief Report","authors":"Alireza Ebrahimi, Hyunjoon Rhee, Atta Taseh, Hye Chang Rhim, Soheil Ashkani-Esfahani","doi":"10.1101/2023.12.06.23299619","DOIUrl":"https://doi.org/10.1101/2023.12.06.23299619","url":null,"abstract":"<strong>Background</strong> Low back pain (LBP) ranks as one of the top contributors to disability-adjusted life years worldwide. Social determinants of health (SDoH) encompass a range of factors that play a pivotal role in shaping healthcare outcomes. We aimed to examine the differences in SDoH between patients with acute and chronic non-specific low back pain (NSLBP).","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138575028","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 : 2023-12-07DOI: 10.1101/2023.12.06.23299599
Marie Germund Nielsen, Kristian Damgaard Lyng, Sinead Holden, Simon Kristoffer Johansen, Marinus Winters, Michael Skovdal Rathleff
Question: Which domains are important to develop a preliminary item bank for a new patient-reported outcome measure relating to adolescents with non-traumatic anterior knee pain? Design: Multiple methods: semi-structured interviews, Participants: Twenty-one adolescents with anterior knee pain participated in semi-structured interviews which explored their experience of living with knee pain. Following thematic analysis, we generated an item bank based on the domains which emerged from the impact their knee pain had on their daily life. Ten clinical experts provided input on the preliminary item bank via an online survey. Cognitive interviews were conducted using the think-aloud approach with ten adolescents to evaluate the comprehensibility and face validity of the items. Results: From the interviews we identified four overarching domains where adolescents were impacted by their knee pain: knee symptoms, limitations in physical activity/sport, limitations in social activities, and emotional impact of pain. Eighteen items was initially developed and expanded to 23 following clinical expert input. The cognitive interviews with adolescents demonstrated that the items were comprehensive, understandable, and relevant for adolescents. Conclusion: This study developed an item bank of 23 items. These spanned four domains of impact for adolescents with anterior knee pain. The items had good face validity and were deemed relevant and understandable for adolescents with knee pain. Further steps are needed to validate and reduce the items for the non-traumatic anterior knee pain (AKP)-YOUTH scale.
{"title":"Item generation for a new patient-reported outcome measure: The non-traumatic anterior knee pain (AKP)-YOUTH scale","authors":"Marie Germund Nielsen, Kristian Damgaard Lyng, Sinead Holden, Simon Kristoffer Johansen, Marinus Winters, Michael Skovdal Rathleff","doi":"10.1101/2023.12.06.23299599","DOIUrl":"https://doi.org/10.1101/2023.12.06.23299599","url":null,"abstract":"Question: Which domains are important to develop a preliminary item bank for a new patient-reported outcome measure relating to adolescents with non-traumatic anterior knee pain? Design: Multiple methods: semi-structured interviews, Participants: Twenty-one adolescents with anterior knee pain participated in semi-structured interviews which explored their experience of living with knee pain. Following thematic analysis, we generated an item bank based on the domains which emerged from the impact their knee pain had on their daily life. Ten clinical experts provided input on the preliminary item bank via an online survey. Cognitive interviews were conducted using the think-aloud approach with ten adolescents to evaluate the comprehensibility and face validity of the items. Results: From the interviews we identified four overarching domains where adolescents were impacted by their knee pain: knee symptoms, limitations in physical activity/sport, limitations in social activities, and emotional impact of pain. Eighteen items was initially developed and expanded to 23 following clinical expert input. The cognitive interviews with adolescents demonstrated that the items were comprehensive, understandable, and relevant for adolescents. Conclusion: This study developed an item bank of 23 items. These spanned four domains of impact for adolescents with anterior knee pain. The items had good face validity and were deemed relevant and understandable for adolescents with knee pain. Further steps are needed to validate and reduce the items for the non-traumatic anterior knee pain (AKP)-YOUTH scale.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138554409","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}
Prolonged immobilization of joints after distal radius fracture (DRF) leads to cerebral disuse-dependent plasticity (DDP) and deterioration of upper extremity function. Action observation therapy (AOT) can improve DDP. This nonrandomized controlled trial (UMIN 000039973) tested the hypothesis that AOT improves hand-use difficulties during activities of daily living in patients with DRF. Right-handed women with volar locking plate fixation for DRF were divided into AOT and Non-AOT groups for a 12-week intervention. The primary outcome was the difficulty in using the fractured hand, as examined by the Japanese version of the Patient-Related Wrist Evaluation (PRWE). Secondary outcomes were (1) range of motion (ROM) of the injured side and (2) difference between the measured and patient-estimated ROM. The survey was conducted immediately postoperatively and at 4, 8, and 12 weeks postoperatively. The AOT groups used a head-mounted display and three-dimensional video during ROM exercises, whereas the Non-AOT group used active ROM exercises alone. A generalized linear model (GLM) was used to confirm interactions and main effects by group and time period, and multiple comparisons were performed. In total, 35 patients were assigned to the AOT (n=18, median age 74 years) and Non-AOT (n=17, 70 years) groups. In the GLM, PRWE Total, PRWE Specific, and PRWE Usual scores showed interactions between groups and periods. A post-hoc test showed that the PRWE Specific (z=3.43, p=0.02) and PRWE Usual (z=7.53, p<0.01) scores w ere significantly lower in the AOT group than in the Non-AOT group at 4 weeks postoperatively, whereas PRWE Total s cores (z=3.29, p=0.04) were lower at 8 weeks postoperatively. These results suggest that AOT can improve hand-use difficulties in right-handed women after DRF surgery. AOT positively affects the motor imagery of patients with DRF and can reverse the patient’s perceived difficulty of using the fractured hand during rehabilitation.
桡骨远端骨折(DRF)后关节长时间固定导致脑废用依赖性可塑性(DDP)和上肢功能恶化。行动观察疗法(AOT)可改善DDP。这项非随机对照试验(UMIN 000039973)检验了AOT改善DRF患者日常生活活动中手部使用困难的假设。采用掌侧锁定钢板固定治疗DRF的右撇子女性分为AOT组和非AOT组，进行为期12周的干预。通过日本版患者相关腕关节评估(PRWE)的检查，主要结果是骨折手使用困难。次要结果是(1)受伤侧的活动范围(ROM)和(2)测量到的活动度与患者估计的活动度之间的差异。调查在术后立即进行，并在术后4周、8周和12周进行。AOT组在ROM练习中使用头戴式显示器和三维视频，而非AOT组仅使用主动ROM练习。采用广义线性模型(GLM)按组和时间段确定相互作用和主效应，并进行多重比较。共有35例患者被分为AOT组(n=18，中位年龄74岁)和非AOT组(n=17, 70岁)。在GLM中，PRWE Total、PRWE Specific和PRWE Usual得分显示了组与期之间的相互作用。事后检验显示，术后4周，AOT组PRWE Specific (z=3.43, p=0.02)和PRWE Usual (z=7.53, p= 0.01)评分明显低于非AOT组，而术后8周PRWE Total scores (z=3.29, p=0.04)评分明显低于非AOT组。这些结果表明辅助辅助治疗可以改善右利手女性DRF手术后的手部使用困难。AOT对DRF患者的运动意象有积极影响，可以逆转患者在康复过程中对骨折手的使用困难的感知。
{"title":"Action observation intervention using three - dimensional movies improves the usability of hands with distal radius fractures in daily life: a nonrandomized controlled trial in women","authors":"Kengo Usuki, Hiroaki Ueda, Toshiya Yamaguchi, Takako Suzuki, Toyohiro Hamaguchi","doi":"10.1101/2023.11.19.23297832","DOIUrl":"https://doi.org/10.1101/2023.11.19.23297832","url":null,"abstract":"Prolonged immobilization of joints after distal radius fracture (DRF) leads to cerebral disuse-dependent plasticity (DDP) and deterioration of upper extremity function. Action observation therapy (AOT) can improve DDP. This nonrandomized controlled trial (UMIN 000039973) tested the hypothesis that AOT improves hand-use difficulties during activities of daily living in patients with DRF. Right-handed women with volar locking plate fixation for DRF were divided into AOT and Non-AOT groups for a 12-week intervention. The primary outcome was the difficulty in using the fractured hand, as examined by the Japanese version of the Patient-Related Wrist Evaluation (PRWE). Secondary outcomes were (1) range of motion (ROM) of the injured side and (2) difference between the measured and patient-estimated ROM. The survey was conducted immediately postoperatively and at 4, 8, and 12 weeks postoperatively. The AOT groups used a head-mounted display and three-dimensional video during ROM exercises, whereas the Non-AOT group used active ROM exercises alone. A generalized linear model (GLM) was used to confirm interactions and main effects by group and time period, and multiple comparisons were performed. In total, 35 patients were assigned to the AOT (n=18, median age 74 years) and Non-AOT (n=17, 70 years) groups. In the GLM, PRWE Total, PRWE Specific, and PRWE Usual scores showed interactions between groups and periods. A post-hoc test showed that the PRWE Specific (z=3.43, p=0.02) and PRWE Usual (z=7.53, p<0.01) scores w ere significantly lower in the AOT group than in the Non-AOT group at 4 weeks postoperatively, whereas PRWE Total s cores (z=3.29, p=0.04) were lower at 8 weeks postoperatively. These results suggest that AOT can improve hand-use difficulties in right-handed women after DRF surgery. AOT positively affects the motor imagery of patients with DRF and can reverse the patient’s perceived difficulty of using the fractured hand during rehabilitation.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521979","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 : 2022-12-30DOI: 10.1101/2022.12.28.22284010
Cody R. Fisher, Kiran K. Mangalaparthi, Kerryl E. Greenwood-Quaintance, Matthew P. Abdel, Akhilesh Pandey, Robin Patel
Purpose This study aims to use proteomic profiling of sonicate fluid samples to compare host response during Staphylococcus aureus-associated periprosthetic joint infection (PJI) and non-infected arthroplasty failure (NIAF) and investigate novel biomarkers to increase diagnostic accuracy.
{"title":"Mass Spectrometry-Based Proteomic Profiling of Sonicate Fluid Differentiates Staphylococcus aureus Periprosthetic Joint Infection from Non-Infectious Failure: A pilot study","authors":"Cody R. Fisher, Kiran K. Mangalaparthi, Kerryl E. Greenwood-Quaintance, Matthew P. Abdel, Akhilesh Pandey, Robin Patel","doi":"10.1101/2022.12.28.22284010","DOIUrl":"https://doi.org/10.1101/2022.12.28.22284010","url":null,"abstract":"<strong>Purpose</strong> This study aims to use proteomic profiling of sonicate fluid samples to compare host response during <em>Staphylococcus aureus</em>-associated periprosthetic joint infection (PJI) and non-infected arthroplasty failure (NIAF) and investigate novel biomarkers to increase diagnostic accuracy.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138523384","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 : 2022-12-06DOI: 10.1101/2022.12.05.22283136
Maxwell Philip Omondi, Joseph Cege Mwangi, Fred Chuma Sitati, Herbert Onga’ngo’
Tertiary hospitals in resource-limited countries treat patients referred but in most cases are the first level of care for the vast majority of patients. As a result, the tertiary facility effectively functions as a primary health care facility. The urban phenomenon of widespread self-referral is associated with low rates of formal referral from peripheral health facilities. Study Objective: To determine the patterns of orthopaedic and trauma admissions to Kenyatta National Hospital. Methodology: This was descriptive study design. Sample size was 905 patient charts for 2021 Findings The mean age was 33.8 years (SD 16.5) with range of 1 - 93 years. Majority 66.3% were between 25 – 64 years with those above 65 years being 40 (4.4%). Children 0-14 years comprised 10.9% of the admissions. Of the 905 admissions, 80.7% were accident and trauma-related admissions while 17.1% were non-trauma related admissions. About 50.1% were facility referrals while 49.9% were walk-ins. Majority of admissions were through Accident and Emergency Department 78.1%, Corporate Outpatient Care 14.9% and Clinic 7.0%. About 78.7% were emergency admissions while 20.8% were elective admissions. Approximately admissions 48.5% were due to Road Traffic Accidents, 20.9% due to falls and non-trauma related conditions represented 17.1%. Close to 44.8% were casual workers and 20.2% unemployed. Education level was also reviewed with 34.0% having primary education and 35.0% having secondary education. A significant proportion of female admissions (33.2%) were due to non-trauma conditions as compared to male admissions (12.8%) (p<0.001). Aadmissions for those aged 25 – 64 years were 3.5 more likely to have emergency admission as compared to those aged 0 – 14 years. Male were 65.1% less likely to have elective admissions compared to female (p<0.001). Those unemployed were 3.9 more likely to have emergency admission compared to businessmen/women. Vast majority (89.2%) of admissions were within Nairobi Metropolitan region
{"title":"Patterns of orthopedic and trauma admissions to a tertiary teaching and referral health facility in Kenya: Chart review","authors":"Maxwell Philip Omondi, Joseph Cege Mwangi, Fred Chuma Sitati, Herbert Onga’ngo’","doi":"10.1101/2022.12.05.22283136","DOIUrl":"https://doi.org/10.1101/2022.12.05.22283136","url":null,"abstract":"Tertiary hospitals in resource-limited countries treat patients referred but in most cases are the first level of care for the vast majority of patients. As a result, the tertiary facility effectively functions as a primary health care facility. The urban phenomenon of widespread self-referral is associated with low rates of formal referral from peripheral health facilities. Study Objective: To determine the patterns of orthopaedic and trauma admissions to Kenyatta National Hospital. Methodology: This was descriptive study design. Sample size was 905 patient charts for 2021 Findings The mean age was 33.8 years (SD 16.5) with range of 1 - 93 years. Majority 66.3% were between 25 – 64 years with those above 65 years being 40 (4.4%). Children 0-14 years comprised 10.9% of the admissions. Of the 905 admissions, 80.7% were accident and trauma-related admissions while 17.1% were non-trauma related admissions. About 50.1% were facility referrals while 49.9% were walk-ins. Majority of admissions were through Accident and Emergency Department 78.1%, Corporate Outpatient Care 14.9% and Clinic 7.0%. About 78.7% were emergency admissions while 20.8% were elective admissions. Approximately admissions 48.5% were due to Road Traffic Accidents, 20.9% due to falls and non-trauma related conditions represented 17.1%. Close to 44.8% were casual workers and 20.2% unemployed. Education level was also reviewed with 34.0% having primary education and 35.0% having secondary education. A significant proportion of female admissions (33.2%) were due to non-trauma conditions as compared to male admissions (12.8%) (p<0.001). Aadmissions for those aged 25 – 64 years were 3.5 more likely to have emergency admission as compared to those aged 0 – 14 years. Male were 65.1% less likely to have elective admissions compared to female (p<0.001). Those unemployed were 3.9 more likely to have emergency admission compared to businessmen/women. Vast majority (89.2%) of admissions were within Nairobi Metropolitan region","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138542798","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 acetabular pathomorphology in patients with Crowe type II and III developmental dysplasia of the hip(DDH)often present complicated changes, which bring challenges to the anatomical reconstruction of acetabulum in total hip arthroplasty (THA). The objective of this study was to develope a novel 3D printed integral customized acetabular prosthesis, which provides a promising way to reconstruct the acetabulum with higher accuracy and efficiency by digital softwares, compared with previous 3D printing model method.
{"title":"How to Develope a Novel 3D Printed Integral Customized Anatomical Acetabular Prosthesis in Hip Arthroplasty for Crowe Type II and III Developmental Dysplasia of the Hip?","authors":"Heng Zhang, Xiaodong Ma, Zengjing Cheng, Xuanxuan Li, Jiansheng Zhou, Jianning Zhao","doi":"10.1101/2022.11.28.22282849","DOIUrl":"https://doi.org/10.1101/2022.11.28.22282849","url":null,"abstract":"<strong>Background</strong> The acetabular pathomorphology in patients with Crowe type II and III developmental dysplasia of the hip(DDH)often present complicated changes, which bring challenges to the anatomical reconstruction of acetabulum in total hip arthroplasty (THA). The objective of this study was to develope a novel 3D printed integral customized acetabular prosthesis, which provides a promising way to reconstruct the acetabulum with higher accuracy and efficiency by digital softwares, compared with previous 3D printing model method.","PeriodicalId":501263,"journal":{"name":"medRxiv - Orthopedics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138521980","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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