HAND最新文献

{"title":"Teardrop Alignment Changes After Volar Locking Plate Fixation of Distal Radius Fractures With Volar Ulnar Fragments.","authors":"Justin C McCarty, Rachel E Cross, Charlotte L E Laane, Yannick Albert J Hoftiezer, Aquiles Gavagnin, Pietro Regazzoni, Alberto Fernandez Dell'Oca, Jesse B Jupiter, Abhiram R Bhashyam","doi":"10.1177/15589447241233762","DOIUrl":"10.1177/15589447241233762","url":null,"abstract":"<p><strong>Background: </strong>We assessed factors associated with change in radiographic teardrop angle following volar locking plate (VLP) fixation of volarly displaced intra-articular distal radius fractures with volar ulnar fragments (VUF) within the ICUC database. The primary outcome was change in radiographic alignment on follow-up imaging, defined as a change in teardrop angle from intra-operative fluoroscopy greater than 5°.</p><p><strong>Methods: </strong>Patients with distal radius fractures treated with a VLP within the ICUC database, an international collaborative and publicly available dataset, were identified. The primary outcome was volar rim loss of reduction on follow-up imaging, defined as a change in radiographic alignment from intra-operative fluoroscopy, teardrop angle less than 50°, or loss of normal radiocarpal alignment. Secondary outcomes were final range of motion (ROM) of the affected extremity. Radiographic Soong classification was used to grade plate position. Descriptive statistics were used to assess variables' distributions. A Random Forest supervised machine learning algorithm was used to classify variable importance for predicting the primary outcome. Traditional descriptive statistics were used to compare patient, fracture, and treatment characteristics with volar rim loss of reduction. Volar rim loss of reduction and final ROM in degrees and as compared with contralateral unaffected limb were also assessed.</p><p><strong>Results: </strong>Fifty patients with volarly displaced, intra-articular distal radius fractures treated with a VLP were identified. Six patients were observed to have a volar rim loss of reduction, but none required reoperation. Volar ulnar fragment size, Soong grade 0, and postfixation axial plate position in relation to the sigmoid notch were significantly associated (<i>P</i> < .05) with volar rim loss of reduction. All cases of volar rim loss of reduction occurred when VUF was 10.8 mm or less.</p><p><strong>Conclusions: </strong>The size of the VUF was the most important variable for predicting volar rim loss of reduction followed by postfixation plate position in an axial position to the sigmoid notch and the number of volar fragments in the Random Forest machine learning algorithm. There were no significant differences in ROM between patients with volar ulnar escape and those without.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"748-754"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140027931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Injury Mechanism in Hamate Hook Fractures by Investigating Fracture Morphologies: A Case Series Study.","authors":"Ayumi Suzuki, Toshihiro Kanda","doi":"10.1177/15589447241232096","DOIUrl":"10.1177/15589447241232096","url":null,"abstract":"<p><strong>Background: </strong>Many studies have described hamate hook fractures resulting from direct force from sporting tools. However, several authors have reported fractures that did not occur during swing-related activities. This study aimed to understand the injury mechanism of fractures by investigating their morphologies.</p><p><strong>Methods: </strong>We selected patients with hamate hook fractures and collected data on computed tomography scans, injury causes, and how athletes handled sporting tools.</p><p><strong>Results: </strong>We investigated 50 patients, and the study cohort included 32 patients who sustained injuries during sports: 24 during baseball (group A) and 8 during other sports (group B). Sixteen patients sustained injuries from falls (group C), and 2 had their hands crushed while using an industrial press machine (group D). In group A, most patients had a fracture line starting from the middle section of the radial side, accompanied by osteosclerotic changes in their lower hand. In group B, most patients had fracture morphologies similar to those of most patients in group A. The main morphology of fractures in group C was a transverse fracture at the base. Two patients in group D had minimal fragments at the tip of the hooks.</p><p><strong>Conclusions: </strong>Our results question the theory that most hamate hook fractures in athletes are caused by direct force exerted on the palm because the fracture morphology was different from that of patients injured by acute trauma from direct force. Instead, these fractures likely stem from an indirect mechanism involving repetitive force generated by the tendons and muscles acting on the hook.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"711-719"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139989807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison Between Intramedullary Nail and Percutaneous Pin Fixation in Proximal Phalanx Fractures.","authors":"Andrew W Hollins, Kristina Dunworth, Suhail K Mithani, Tyler S Pidgeon, Christopher S Klifto, David S Ruch, Marc J Richard","doi":"10.1177/15589447241232009","DOIUrl":"10.1177/15589447241232009","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous pinning has been the predominant technique for fixation of proximal phalanx fractures, but stiffness is a reported complication. The introduction of intramedullary (IM) nail fixation of proximal phalanx fractures provides a stronger biomechanical fixation for amenable fracture patterns with the added benefit of not tethering the soft tissue. The goal of this study was to compare the surgical outcomes of IM nail and percutaneous pin fixation in isolated proximal phalanx fractures.</p><p><strong>Methods: </strong>A retrospective review was performed at our institution between the years 2018 and 2022 for patients treated for proximal phalanx fractures. Patients that underwent fixation with IM nails or percutaneous fixation for isolated extraarticular proximal phalanx fractures were included. Patients were excluded if they had concomitant hand fractures, tendon injury, or intraarticular extension.</p><p><strong>Results: </strong>A total of 50 patients were included in this study. Twenty-eight patients received percutaneous pin fixation, and 22 patients underwent IM nail or screw fixation. There was no significant difference in injury patterns or demographics between these two groups. Patients that underwent IM nail fixation had a significantly quicker return to active motion, shorter duration of orthosis treatment, and fewer occupational therapy visits. In addition, patients in the IM fixation group had significantly improved range of motion (ROM) at 6 weeks postoperatively.</p><p><strong>Conclusions: </strong>This study demonstrates that patients receiving percutaneous pin or IM nail fixation have equivocal union and complication rates. The IM nail fixation group was able to have quicker return to mobilization, fewer required occupational therapy visits, and improved early ROM.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"675-683"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Adding Shoulder Stabilization Exercises to the Rehabilitation of Postoperative Hand Injuries in Young Adult Patients.","authors":"Ehab A Abdallah, Mohamed T Eldesoky, Joseph W Saweres, Mahmoud D Abdelhaleem","doi":"10.1177/15589447241232017","DOIUrl":"10.1177/15589447241232017","url":null,"abstract":"<p><strong>Background: </strong>Hand injuries are common and could have an impact on all upper limb functions. Engaging shoulder muscle training during the rehabilitation protocol postoperatively could have a significant impact on regaining all upper limb function. The purpose of this study was to assess the effect of adding shoulder stabilization exercise to hand rehabilitation postoperatively.</p><p><strong>Methods: </strong>Forty patients were randomly assigned to 2 equal groups. Group A received a standard physical therapy program plus shoulder exercise protocol and group B received only a standard physical therapy protocol for hand rehabilitation. Outcome measures were pain intensity; grip strength; Arabic modified Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire; and range of motion (ROM). All outcome measures were assessed before and after treatment.</p><p><strong>Results: </strong>Statistical analysis revealed that both groups, the experimental and control, showed significant improvement in all outcome measures, but experimental group A showed significant improvement than the control group B posttreatment for hand grip strength, ROM, and QuickDASH questioners (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>Adding shoulder stabilizer muscle training to the hand rehabilitation protocol postoperatively has a significant impact on hand function outcomes.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"778-784"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571716/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139735053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Review of 1228 In-Office Hand Surgery Procedures With Wide Awake Local Anesthesia No Tourniquet (WALANT) at a Single Private Practice.","authors":"Jason R Coffman, Jeffrey A Dela Cruz, Brandon A Stein, Mark R Bagg, David W Person, Kunj K Desai, Ramesh C Srinivasan","doi":"10.1177/15589447241235251","DOIUrl":"10.1177/15589447241235251","url":null,"abstract":"<p><strong>Background: </strong>This study examined the complication rate of Wide Awake Local Anesthesia No Tourniquet (WALANT) technique in the clinic setting with field sterility at a single private practice. We hypothesized that WALANT is safe and effective with a low complication rate.</p><p><strong>Methods: </strong>This retrospective chart review included 1228 patients who underwent in-office WALANT hand procedures at a single private practice between 2015 and 2022. Patients were divided into groups based on type of procedure: carpal tunnel release, A1 pulley release, first dorsal compartment release, extensor tendon repair, mass excision, foreign body removal, and needle aponeurotomy. Patient demographics and complications were recorded; statistical comparisons of cohort demographics and risk factors for complications were completed, and <i>P</i> < .05 was considered significant for all statistical comparisons.</p><p><strong>Results: </strong>The overall complication rate for all procedures was 2.77% for 1228 patients including A1 pulley release (n = 962, 2.7%), mass excision (n = 137, 3.7%), extensor tendon repair (n = 23, 4.3%), and first dorsal compartment release (n = 22, 8.3%). Carpal tunnel release, foreign body removal, and needle aponeurotomy groups experienced no complications. No adverse events (e.g. vasovagal reactions, digital ischemia, local anesthetic toxicity, inadequate vasoconstriction) were observed in any group. Patients with known autoimmune disorders and those who were currently smoking had a statistically significant higher complication rate.</p><p><strong>Conclusions: </strong>Office-based WALANT procedures with field sterility are safe and effective for treating common hand maladies and have a similar complication profile when compared to historical controls from the standard operating room in an ambulatory center or hospital.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"785-789"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experimenting With the New Frontier: Artificial Intelligence-Powered Chat Bots in Hand Surgery.","authors":"Zayd M Al Rawi, Benjamin J Kirby, Peter A Albrecht, Julia A V Nuelle, Daniel A London","doi":"10.1177/15589447241238372","DOIUrl":"10.1177/15589447241238372","url":null,"abstract":"<p><p><b>Background:</b> Increased utilization of artificial intelligence (AI)-driven search and large language models by the lay and medical community requires us to evaluate the accuracy of AI responses to common hand surgery questions. We hypothesized that the answers to most hand surgery questions posed to an AI large language model would be correct. <b>Methods:</b> Using the topics covered in Green's <i>Operative Hand Surgery</i> 8^th Edition as a guide, 56 hand surgery questions were compiled and posed to ChatGPT (OpenAI, San Francisco, CA). Two attending hand surgeons then independently reviewed ChatGPT's answers for response accuracy, completeness, and usefulness. A Cohen's kappa analysis was performed to assess interrater agreement. <b>Results:</b> An average of 45 of the 56 questions posed to ChatGPT were deemed correct (80%), 39 responses were deemed useful (70%), and 32 responses were deemed complete (57%) by the reviewers. Kappa analysis demonstrated \"fair to moderate\" agreement between the two raters. Reviewers disagreed on 11 questions regarding correctness, 16 questions regarding usefulness, and 19 questions regarding completeness. <b>Conclusions:</b> Large language models have the potential to both positively and negatively impact patient perceptions and guide referral patterns based on the accuracy, completeness, and usefulness of their responses. While most responses fit these criteria, more precise responses are needed to ensure patient safety and avoid misinformation. Individual hand surgeons and surgical societies must understand these technologies and interface with the companies developing them to provide our patients with the best possible care.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"795-800"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cause of Extensor Pollicis Longus Ruptures After Distal Radius Fracture Fixation Using a Volar Plate.","authors":"Charlotte L E Laane, Anjuli L Dijkmans, Chelsea J Messinger, Mathieu M E Wijffels, Abhiram R Bhashyam, Neal C Chen","doi":"10.1177/15589447241233763","DOIUrl":"10.1177/15589447241233763","url":null,"abstract":"<p><strong>Background: </strong>This research sought to analyze a cohort of patients with extensor pollicis longus (EPL) ruptures after volar locked plating of a distal radius fracture (DRF) to characterize the incidence of ruptures that are unlikely to be related to dorsal screw prominence.</p><p><strong>Methods: </strong>This is a retrospective, observational, descriptive cohort study of adults with operative fixation of a closed DRF and an EPL rupture between 2002 and 2022. Eighteen patients with operative fixation using a volar plate of a closed DRF had an EPL rupture. The cohort consisted of 66% women with an average age of 57.5 years. Median follow-up was 14.5 months.</p><p><strong>Results: </strong>The incidence of EPL rupture was 0.4% (18/4768). The average time from DRF and DRF fixation to EPL rupture was 3.7 and 3.4 months, respectively. Based on the operative record, in 2 of the 18 patients (11%), the rupture was directly attributable to prominent hardware; however, in 4 of the 18 patients (22%), the rupture was not related to prominent hardware, and the cause was indeterminate in 12 patients (67%). Radiologic analysis of those in the indeterminate group demonstrated that 5 of the 12 patients had screws that had a high probability of being prominent.</p><p><strong>Conclusions: </strong>The incidence of EPL rupture after volar plating of DRF is between 0% and 1% and usually occurs about 3 months after fixation. Approximately 50% of EPL ruptures are attributable to prominent dorsal screws. Although screw prominence is an important cause of EPL rupture, it is not the sole cause of rupture.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"770-777"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139989803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Social Determinants of Health on the Treatment of Distal Radius Fracture.","authors":"Graham Grogan, Kristen L Stephens, Jesse Chou, Jasmina Abdalla, Ryan Wagner, Kacy J Peek, Aaron M Freilich, Brent R DeGeorge","doi":"10.1177/15589447241233369","DOIUrl":"10.1177/15589447241233369","url":null,"abstract":"<p><strong>Background: </strong>Disparities in social determinants of health (SDH) have been shown to play an increasingly important role in the equitable delivery of health care. Distal radius fractures (DRFs) are among the most common upper-extremity injuries encountered. This study aims to examine the influence of economic, educational, social, environmental, and healthcare disparities on management of these injuries.</p><p><strong>Methods: </strong>PearlDiver Mariner insurance claims database was analyzed for treatment patterns of DRF in patients aged 18 to 65 years based on the presence or absence of social determinants of health disparities (SDHDs). Outcome variables included the primary mode of management of DRF, including operative versus non-operative, as well as concomitant procedures. Multivariate logistic regression was used to compare fracture management modality in patients with and without SDHDs.</p><p><strong>Results: </strong>Of 161 704 patients identified with DRF, 38.3% had at least 1 reported SDHD. The majority of SDHDs were economic. Patients identified with 1 or more SDHDs had a higher medical comorbidity index. Patients with environmental SDHD were more likely to receive non-operative management. Within any SDHD and economic subgroups, odds of operative management were higher. No relationship was identified between SDHD and concomitant procedures.</p><p><strong>Conclusions: </strong>The presence of environmental disparities in SDH may predispose patients disproportionately to non-operative management. The presence of SDHDs may influence medical decision-making in favor of open reduction and internal fixation in patients with DRF treated operatively. In treating at-risk populations, providers should be aware of the potential for implicit bias associated with SDHDs and prioritize shared decision-making between patients and physicians.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"740-747"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139971699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Variations in the Management of Displaced Distal Radius Fractures With Satisfactory Reduction.","authors":"Jomar N A Aryee, Giulia C Frias, Daniel K Haddad, Kevin D Guerrero, Vivian Chen, Fan Ling, David Kirschenbaum, James T Monica, Brian M Katt","doi":"10.1177/15589447241233709","DOIUrl":"10.1177/15589447241233709","url":null,"abstract":"<p><strong>Background: </strong>The American Academy of Orthopaedic Surgeons has set forth Clinical Practice Guidelines (CPGs) to help guide management of closed, displaced distal radius fractures (DRFs). There still exists variation in practice regarding operative vs nonoperative decision-making. This study aims to identify which factors influence the decision to treat DRFs not indicated for surgery by the CPGs after initial closed reduction.</p><p><strong>Methods: </strong>Fifteen sets of DRFs and clinical vignettes were distributed via email to over 75 orthopedic residency programs, Orthopaedic Trauma Association, and New York Society for Surgery of the Hand membership. A Qualtrics survey collected respondent demographics, choice of treatment, and rationale.</p><p><strong>Results: </strong>Responses were received from 106 surgeons and resident trainees. The odds of selecting operative management for fractures with 5 or more radiographic instability signs versus 3 or 4 was 3.11 (<i>P</i> < .05). Age over 65, higher patient activity level, and dominant-hand injury were associated with greater odds of operative management (3.4, 30.28, and 2.54, respectively). In addition, surgeons with more years in practice and high-volume surgeons had greater odds of selecting operative management (2.43 and 2.11, respectively).</p><p><strong>Conclusions: </strong>Assessment of instability at the time of injury, patient age and activity level, as well as surgeon volume and time in practice independently affect the decision to manage well-reduced DRF with surgical or nonsurgical treatment. The source of heterogeneity in the treatment of these fractures is borne at least in part from a lack of formal direction on the importance of prereduction instability from the CPGs.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"762-769"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140059217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical Variation of the Recurrent Motor Branch of the Median Nerve.","authors":"Kowsar A Ahmed, Sami H Tuffaha","doi":"10.1177/15589447241284411","DOIUrl":"10.1177/15589447241284411","url":null,"abstract":"<p><p>The recurrent motor branch (RMB) of the median nerve has commonly thought to originate proximal to the terminal digital branches, although its anatomical course and number may vary. We report a rare variation of the RMB that arose from the second common palmar digital nerve. The median nerve bifurcated into the first and second common palmar digital nerves distal to the transverse carpal ligament, with the RMB dividing from the second common palmar digital nerve and traveling retrograde to enter the abductor pollicis brevis muscle. This high origin variation may be at increased risk of injury during procedures of the hand.</p>","PeriodicalId":12902,"journal":{"name":"HAND","volume":" ","pages":"NP1-NP4"},"PeriodicalIF":1.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142463903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}