Journal of Orthopaedic Science最新文献

{"title":"Clinical outcomes and return to sports following medial malleolar stress fractures in adolescent athletes.","authors":"Ryoto Kura, Yuka Kimura, Kyota Ishibashi, Hikaru K Ishibashi, Eiji Sasaki, Eiichi Tsuda, Yasuyuki Ishibashi","doi":"10.1016/j.jos.2026.04.005","DOIUrl":"https://doi.org/10.1016/j.jos.2026.04.005","url":null,"abstract":"<p><strong>Purpose: </strong>Medial malleolar stress fractures (MMSF) are relatively rare and classified as a high-risk fracture progressing to a complete fracture. The purpose of this study was to describe the clinical outcome of conservative and surgical treatments for MMSF in adolescent athletes.</p><p><strong>Methods: </strong>Twenty MMSF in 19 athletes (mean age 15.6 ± 2.0 years) were analyzed retrospectively. MMSF were categorized into four stages (I) no visible fracture lines based on radiograph and only confirmed high signal intensity on MRI (II) incomplete fracture on radiograph (III) complete and non-displacement fracture on radiograph, and (IV) displaced fracture on radiograph. The time required for radiographic bone union and return to sports (RTS) was evaluated.</p><p><strong>Results: </strong>Seven fractures were categorized as stage I, 5 were stage II, 2 were stage III, and 6 were stage IV. Radiographic union (Stage II-IV) did not differ among stages (p = 0.696). RTS differed significantly according to stage (p < 0.010), with Stage I achieving earlier RTS than Stage II (p = 0.018). Stage I lesions were successfully treated conservatively, whereas 76.9% of Stage II or higher lesions ultimately required surgical fixation.</p><p><strong>Conclusion: </strong>In adolescent athletes with MMSF, clinical outcomes were strongly associated with fracture stage. Stage I responded well to conservative treatment and achieved early RTS, whereas Stage II or higher frequently required surgical treatment. Early MRI evaluation may facilitate timely diagnosis and help guide stage-based treatment decisions in this population.</p>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient acceptable symptom state for New Knee Society Score after primary total knee arthroplasty","authors":"Kohei Nishitani ,&nbsp;Yosuke Yamamoto ,&nbsp;Daisuke Hamada ,&nbsp;Hiromu Ito ,&nbsp;Shinichiro Nakamura ,&nbsp;Shinichi Kuriyama ,&nbsp;Shuichi Matsuda","doi":"10.1016/j.jos.2025.10.004","DOIUrl":"10.1016/j.jos.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Patient-reported outcome measures (PROMs) play a crucial role in evaluating surgical success by incorporating patient perspectives in total knee arthroplasty (TKA). While the Patient Acceptable Symptom State (PASS) has been established for various PROMs, its threshold for the new Knee Society Score (2011KSS) remains undetermined. This study aimed to determine PASS thresholds for the 2011KSS.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted on patients with knee osteoarthritis who underwent TKA and voluntarily completed satisfaction questionnaires and the 2011KSS at one or two years postoperatively. Patients were included regardless of age sex, severity of osteoarthritis, degree of deformity, or implant type. The 2011KSS Symptoms, Satisfaction, and Functional Activities domains were analyzed. PASS was evaluated based on a single question asking whether patients were satisfied or unsatisfied with the postoperative condition. PASS thresholds were determined using receiver operating characteristic (ROC) curve analysis with area under the curve (AUC). The Youden index identified optimal cutoff values.</div></div><div><h3>Results</h3><div>A total of 135 and 87 patients were included in the one- and two-year analyses, respectively. ROC analysis demonstrated significant discriminatory ability, with AUC values of 0.73 (95 % confidence interval: 0.60 to 0.87), 0.76 (0.63–0.88), and 0.77 (0.67–0.88) for the one-year, and 0.97 (0.94–1.00), 0.91 (0.83–0.98), and 0.75 (0.59–0.90) for the two-year 2011KSS Symptoms, Satisfaction, and Functional Activities domains. The PASS thresholds for 2011KSS Symptoms, Satisfaction, and Functional Activities were 17, 22, and 49 at one year, and 21, 30, and 55 at two years, respectively.</div></div><div><h3>Conclusions</h3><div>This study established clinically meaningful PASS thresholds for the 2011KSS at one and two years post-TKA. These thresholds enhance the applicability of the 2011KSS by providing benchmarks for patient satisfaction, supporting clinical decision-making, and facilitating outcome comparisons in research and clinical practice.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 609-613"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145390578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for the progression of hallux valgus angle on radiography in Japanese adults","authors":"Akinobu Nishimura ,&nbsp;Yoshiyuki Senga ,&nbsp;Yuki Fujikawa ,&nbsp;Chihiro Konno ,&nbsp;Akihiro Sudo ,&nbsp;Masahiro Hasegawa","doi":"10.1016/j.jos.2025.11.004","DOIUrl":"10.1016/j.jos.2025.11.004","url":null,"abstract":"<div><h3>Objectives</h3><div>Hallux valgus (HV) is common in middle-aged and older adults. However, previous studies that linked HV to factors such as sex, knee osteoarthritis, footwear, and aging were mostly cross-sectional. This longitudinal study aimed to investigate HV risk factors and progression.</div></div><div><h3>Materials and methods</h3><div>Serial radiographs were assessed in Japanese mountain villagers aged ≥50 years who underwent at least two health checkups within an interval of 4 or more years. Demographic data, medical history, and radiographic measurements were collected.</div></div><div><h3>Results</h3><div>We included 271 participants (542 feet; mean age: 69.6 years); the mean follow-up period was 6.7 years. The average annual change in the HV angle (HVA) was 0.19°. In 16.1 % of the feet, the HVA increased by ≥ 1°/year. Lateral tibial sesamoid bone positioning was a significant risk factor for HV.</div></div><div><h3>Conclusions</h3><div>HVA progression was less likely in adults aged ≥50 years without tibial sesamoid bone malposition.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 664-670"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145635114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A transformative perspective in orthopaedic oncology for patients’ futures","authors":"Yoshihiro Nishida","doi":"10.1016/j.jos.2026.02.001","DOIUrl":"10.1016/j.jos.2026.02.001","url":null,"abstract":"","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 499-500"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a fully automated multiplex PCR panel for the microbiological diagnosis of joint infections","authors":"Narumi Ueda ,&nbsp;Yasushi Nakamori ,&nbsp;Kazuyuki Okuda ,&nbsp;Hirokazu Iida ,&nbsp;Tetsuro Sugiura ,&nbsp;Takanori Saito","doi":"10.1016/j.jos.2025.12.004","DOIUrl":"10.1016/j.jos.2025.12.004","url":null,"abstract":"<div><h3>Aims</h3><div>Rapid identification of the causative microorganisms of osteoarticular infections is essential for successful treatment. BIOFIRE® FilmArray® Joint Infection Panel (JI panel), a fully automated multiplex PCR panel, can rapidly detect pathogens and antimicrobial resistance genes in the synovial joints in patients with acute osteoarticular infections. Accordingly, this study aimed to evaluate the diagnostic method of the JI panel in patients with osteoarticular infections.</div></div><div><h3>Methods</h3><div>Synovial fluid samples were collected from patients with suspected osteoarticular infections. Fifty-five samples from 49 patients were analysed. The JI panel results were compared with those obtained using conventional culture methods.</div></div><div><h3>Results</h3><div>The sensitivities of the JI panel and culture for detecting microorganisms were 55 and 61 %, respectively, while the specificities were both 100 %. For patients with osteoarticular infections (n = 23) and positive culture or JI panel, the agreement rate between the JI panel and culture was 65 %. In five samples (22 %), the culture was positive, but the JI panel was negative. In three of the five JI panel-negative specimens (13 %), the bacteria identified in the culture were not included in the panel design. Three culture-negative specimens were JI panel-positive<em>.</em> Significantly higher sensitivity (70 % vs. 55 %; P = 0.008) was observed with the combined JI panel and culture than with the JI panel alone.</div></div><div><h3>Conclusion</h3><div>The JI panel is a useful technique to identify causative bacteria rapidly and automatically, but the combination of the JI panel and culture methods is recommended because some pathogens are not included in the JI panel.</div></div><div><h3>Level of evidence</h3><div>Diagnostic level III.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 731-741"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The requirement of allogeneic transfusion and risk of perioperative systemic complications in elderly patients undergoing total knee arthroplasty with contemporary blood conservation strategies","authors":"Sachiyuki Tsukada,&nbsp;Masayoshi Saito,&nbsp;Hiroyuki Ogawa,&nbsp;Masahiro Nishino,&nbsp;Takuya Kusakabe,&nbsp;Naoyuki Hirasawa","doi":"10.1016/j.jos.2025.10.003","DOIUrl":"10.1016/j.jos.2025.10.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Improvements in perioperative management may have mitigated complications in elderly patients who underwent total knee arthroplasty (TKA). The purpose of this study was to compare the rates of allogeneic blood transfusion and perioperative complication rates in the elderly patients who underwent primary TKA with contemporary blood conservation strategies with those in the younger patients.</div></div><div><h3>Methods</h3><div>We assessed 800 patients who underwent unilateral primary TKA, with 235 patients aged 80 or older (Elderly group) and 565 patients aged 79 or younger (Control group). All TKAs followed a standardized blood conservation protocol including combined intravenous and intra-articular tranexamic acid administration, and no use of a pneumatic tourniquet. For patients on chronic antithrombotic therapy, the medication was continued throughout the perioperative period. The primary outcome was the requirement for allogeneic blood transfusion. Propensity score matching (1:2 matching ratio) was used to balance the study groups.</div></div><div><h3>Results</h3><div>The propensity score-matched population comprised 190 patients in the Elderly group and 380 patients in the Control group. Allogeneic blood transfusion was required in 1 of 190 patients in the Elderly group (0.5 %) versus 2 of 380 patients in the Control group (0.5 %), respectively (p &gt; 0.99). There were no differences between two groups in the systemic event within one year after TKA (5.3 % versus 6.3 %; p = 0.71), the total number of the death within one year after TKA (1.1 % versus 0.3 %; p = 0.26), and requirement of the revision TKA (1.1 % versus 0 %; p = 0.11).</div></div><div><h3>Conclusions</h3><div>We found no significant differences between elderly patients and younger patients in the requirement of the allogeneic transfusion in the cohort underwent primary TKA with contemporary blood conservation strategies.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 603-608"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145400977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased postoperative complication risk in elderly hip fracture patients with cerebrovascular disorders: A propensity score-matched nationwide cohort study","authors":"Yu Mori ,&nbsp;Kunio Tarasawa ,&nbsp;Hidetatsu Tanaka ,&nbsp;Naoko Mori ,&nbsp;Kiyohide Fushimi ,&nbsp;Toshimi Aizawa ,&nbsp;Kenji Fujimori","doi":"10.1016/j.jos.2025.10.012","DOIUrl":"10.1016/j.jos.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Cerebrovascular disorders are known risk factors for hip fractures in the elderly. However, their impact on postoperative complications following hip fracture surgery remains insufficiently studied.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the Japanese Diagnosis Procedure Combination (DPC) database from April 2016 to March 2022. Patients aged ≥65 years who underwent surgical treatment for hip fractures were included. Individuals with cerebrovascular disorders were identified via ICD-10 codes (I60–I64). Propensity score matching (1:1) was performed based on age, sex, BMI, Charlson Comorbidity Index, anesthesia type, fracture classification, and surgical procedure. Outcomes included venous thromboembolism, urinary tract infection, pneumonia, postoperative cognitive dysfunction, and in-hospital mortality. Secondary outcomes were length of hospital stay, blood transfusion volume, and use of anti-osteoporotic agents.</div></div><div><h3>Results</h3><div>Out of 474,293 eligible patients, 46,158 matched pairs were analyzed. Multivariate logistic regression showed cerebrovascular disorders were independently associated with higher risks of pneumonia (adjusted OR: 1.515; 95 % CI: 1.418–1.619), urinary tract infection (adjusted OR: 1.336; 95 % CI: 1.245–1.433), and cognitive dysfunction (adjusted OR: 1.237; 95 % CI: 1.117–1.371). No significant difference in in-hospital mortality was observed. Patients with cerebrovascular disorders had longer hospital stays (38.2 vs. 35.6 days).</div></div><div><h3>Conclusions</h3><div>Cerebrovascular disorders are associated with increased postoperative infectious and cognitive complications in elderly hip fracture patients. These findings underscore the importance of incorporating cerebrovascular history into perioperative risk assessment and optimizing multidisciplinary care strategies.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 589-595"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145513074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone marrow lesions and serum NTx predict varus change in medial proximal tibial angle in early knee osteoarthritis","authors":"Kyota Ishibashi ,&nbsp;Eiji Sasaki ,&nbsp;Tetsushi Oyama ,&nbsp;Gentaro Kumagai ,&nbsp;Eiichi Tsuda ,&nbsp;Yasuyuki Ishibashi","doi":"10.1016/j.jos.2025.11.003","DOIUrl":"10.1016/j.jos.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>We investigated the influence of abnormal magnetic resonance imaging findings and serum bone metabolism on varus deformity progression in the proximal tibia of women without radiographic abnormalities.</div></div><div><h3>Methods</h3><div>A hundred and forty-six participants without radiographic knee osteoarthritis were assessed using a 5-year longitudinal analysis of the Iwaki cohort. Participants were classified into a normal or an early radiographic knee osteoarthritis group based on the Knee Injury and Osteoarthritis Outcome Score, clinical examinations, and bilateral radiographs. The medial proximal tibial angle was measured on knee radiographs. Abnormal imaging findings were assessed using the whole-organ magnetic resonance imaging scoring method. Serum bone metabolic markers were also measured.</div></div><div><h3>Results</h3><div>Thirty-eight of the participants (26 %) were classified into the early radiographic knee osteoarthritis group. Variation in the medial proximal tibial angle was greater in participants with early radiographic knee osteoarthritis and bone marrow lesions than in those without either of them (p &lt; 0.001). Varus deformity in the proximal tibia negatively correlated with tartrate-resistant acid phosphatase-5b (r = −0.192, p = 0.022) and N-telopeptide of type I collagen (r = −0.031, p &lt; 0.001). Linear regression revealed that varus deformity was associated with bone marrow lesions (β = −0.252, p = 0.002), N-telopeptide of type I collagen (β = −0.249, p = 0.002), and early radiographic knee osteoarthritis (β = −0.163, p = 0.037).</div></div><div><h3>Conclusions</h3><div>Early radiographic knee osteoarthritis with bone marrow lesions and a high bone absorption metabolism are potential risk factors for the progression of varus deformity in the proximal tibia.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 629-636"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145635102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on “Circumferential parallel ligation for debulking of very large neurofibromas in patients with neurofibromatosis type 1”","authors":"Bhumesh Tyagi,&nbsp;Leelabati Toppo,&nbsp;Aishwarya Biradar","doi":"10.1016/j.jos.2025.12.018","DOIUrl":"10.1016/j.jos.2025.12.018","url":null,"abstract":"","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 760-761"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147321863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vivo kinematics of mobile-bearing posterior-stabilized total knee arthroplasty developed from three dimensional computed tomography system measurements of Japanese knee joints","authors":"Kengo Sakakura ,&nbsp;Shigeru Sasaki ,&nbsp;Yukinori Sato ,&nbsp;Keiji Suzuki ,&nbsp;Akihiro Kotani ,&nbsp;Tetsuya Tomita ,&nbsp;Kazuomi Sugamoto ,&nbsp;Takaharu Yamazaki ,&nbsp;Takeshi Morii ,&nbsp;Shoichi Ichimura ,&nbsp;Naobumi Hosogane","doi":"10.1016/j.jos.2025.10.002","DOIUrl":"10.1016/j.jos.2025.10.002","url":null,"abstract":"<div><h3>Background</h3><div>The mobile-bearing posterior-stabilized (PS) total knee arthroplasty (TKA) tailored to the bone morphology of Japanese patients has the kinematic features such as medial pivot motion (MP), external femoral rotation relative to the tibia during knee flexion, and bicondylar rollback, the backward movement of the femur relative to the tibia, both resembling those of a normal knee. However, these concepts have not been confirmed <em>in vivo</em>. This study aimed to analyze the in vivo kinematics of this TKA and confirm the reproducibility of the concepts.</div></div><div><h3>Methods</h3><div>A two dimensional to three dimensional (2D/3D) registration technique was used to analyzed the <em>in vivo</em> kinematics of mobile-bearing PS TKA designed based on morphological characteristics of Japanese patients. We also investigated the relationship between the setting position of implants and <em>in vivo</em> kinematics. The setting position of the implants was evaluated using the hip-knee-ankle angle and the alpha, beta, gamma, and delta angles.</div></div><div><h3>Results</h3><div>Analysis was performed on 17 knees in 11 patients with a mean age of 73.0 ± 6.7 years. Loaded flexion caused 8.39 ± 3.4° of external rotation of the femoral component relative to the tibial component. Regarding kinematics, an MP pattern was observed during the initial flexion, and bicondylar rollback was observed beyond approximately 80° of flexion. Patients were subdivided into two groups according to the presence of the MP pattern (MP and non-MP groups). No evident relationship between the setting position of the implants and in vivo kinematics was observed, except for γ angle.</div></div><div><h3>Conclusion</h3><div>This study verified the <em>in vivo</em> kinematics of the PS-mobile-type implant and demonstrated that it reproduced its intended design in most cases. Although a significant difference was found in the γ angle, no consistent relationship was observed between the presence of the MP pattern and other implant positioning parameters. Therefore, the factors contributing to the absence of medial pivot motion in some cases remain unclear. Despite this limitation, our findings suggest that the design principles of the implant were found to be reproducible to a certain extent, suggesting potential applicability in replicating natural knee motion in clinical settings.</div></div>","PeriodicalId":16939,"journal":{"name":"Journal of Orthopaedic Science","volume":"31 3","pages":"Pages 596-602"},"PeriodicalIF":1.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145426878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}