Orthopedics最新文献

{"title":"Factors Affecting Operating Room Scheduling Accuracy for Primary and Revision Total Knee Arthroplasty: A Retrospective Study.","authors":"Casey Cardillo, Conor Garry, Jonathan L Katzman, Morteza Meftah, Joshua C Rozell, Ran Schwarzkopf, Claudette Lajam","doi":"10.3928/01477447-20240702-01","DOIUrl":"10.3928/01477447-20240702-01","url":null,"abstract":"<p><strong>Background: </strong>Optimizing operating room (OR) scheduling accuracy is important for improving OR efficiency and maximizing value of total knee arthroplasty (TKA). However, data on factors that may impact TKA OR scheduling accuracy are limited.</p><p><strong>Materials and methods: </strong>A retrospective review of 7655 knee arthroplasties (6999 primary TKAs and 656 revision TKAs) performed between January 2020 and May 2023 was conducted. Patient baseline characteristics, surgeon experience (years in practice), as well as actual vs scheduled OR times were collected. Actual OR times that were at least 15% shorter or longer than scheduled OR times were considered to be clinically important. Logistic regression analyses were employed to assess the influence of specific patient and surgeon factors on OR scheduling inaccuracies.</p><p><strong>Results: </strong>Using adjusted odds ratio, patients with primary TKA who had a lower body mass index (<i>P</i><.001) were independently associated with overestimation of scheduled surgical time. Conversely, younger age (<i>P</i><.001), afternoon procedure start time (<i>P</i><.001), surgeons with less than 10 years of experience (<i>P</i>=.037), and higher patient body mass index (<i>P</i><.001) were associated with underestimation of scheduled surgical time. For revision TKA, female sex (<i>P</i>=.021) and morning procedure start time (<i>P</i>=.038) were associated with overestimation of scheduled surgical time, while surgeons with less than 10 years of experience (<i>P</i>=.014) and patients who underwent spinal/epidural/block anesthesia (<i>P</i>=.038) were associated with underestimation of scheduled surgical time.</p><p><strong>Conclusion: </strong>This study highlights patient, surgeon, and intraoperative variables that impact the accuracy of scheduling for TKA procedures. Health systems should take these variables into consideration when creating OR schedules to fully optimize resources and available space. [<i>Orthopedics</i>. 2024;47(5):313-319.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"313-319"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559440","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":"Effect of Insulin Dependence on Perioperative Risk in Patients With Diabetes Undergoing Total Shoulder Arthroplasty.","authors":"Sam Razaeian, Dafang Zhang","doi":"10.3928/01477447-20240718-03","DOIUrl":"10.3928/01477447-20240718-03","url":null,"abstract":"<p><strong>Background: </strong>Approximately 15% of patients who undergo total shoulder arthroplasty (TSA) have diabetes mellitus, and this group is particularly at risk for perioperative complications. The objective of this study was to quantify the effects of insulin dependence on the risk of 30-day perioperative adverse events after TSA in patients with diabetes mellitus using a large national database.</p><p><strong>Materials and methods: </strong>We retrospectively identified patients with diabetes mellitus who underwent TSA in the National Surgical Quality Improvement Program (NSQIP) database from 2011 to 2020. Patients were grouped as having insulin-dependent or non-insulin-dependent diabetes mellitus. The primary outcome was 30-day complication, and secondary outcome variables included 30-day readmission, reoperation, and death. Multivariable logistic regression analyses adjusted for baseline differences were performed. The cohort included 5888 patients with diabetes mellitus who underwent TSA, with 1705 patients in the insulin-dependent group and 4183 patients in the non-insulin-dependent group.</p><p><strong>Results: </strong>The 30-day postoperative complication rate was higher in patients with insulin-dependent diabetes mellitus (8.7%) than in patients with non-insulin-dependent diabetes mellitus (5.6%). The 30-day hospital readmission rate was higher in patients with insulin-dependent diabetes mellitus (4.8%) than in patients with non-insulin-dependent diabetes mellitus (3.3%). These significant differences in complication and readmission rates persisted in the multivariable logistic regression analyses after adjusting for baseline differences between the two groups. Reoperation and death were not associated with insulin dependence.</p><p><strong>Conclusion: </strong>Patients with insulin-dependent diabetes mellitus have higher odds of episode-of-care complication and readmission compared with patients with non-insulin-dependent diabetes mellitus, even after adjusting for between-group baseline differences. [<i>Orthopedics</i>. 2024;47(5):295-300.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"295-300"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788790","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":"Diagnosing the Severity of Knee Osteoarthritis Using Regression Scores From Artificial Intelligence Convolution Neural Networks.","authors":"Michael Fei, Sarah Lu, Jun Ho Chung, Sherif Hassan, Joseph Elsissy, Brian A Schneiderman","doi":"10.3928/01477447-20240718-02","DOIUrl":"10.3928/01477447-20240718-02","url":null,"abstract":"<p><strong>Background: </strong>This study focused on using deep learning neural networks to classify the severity of osteoarthritis in the knee. A continuous regression score of osteoarthritis severity has yet to be explored using artificial intelligence machine learning, which could offer a more nuanced assessment of osteoarthritis.</p><p><strong>Materials and methods: </strong>This study used 8260 radiographic images from The Osteoarthritis Initiative to develop and assess four neural network models (VGG16, EfficientNetV2 small, ResNet34, and DenseNet196). Each model generated a regressor score of the osteoarthritis severity based on Kellgren-Lawrence grading scale criteria. Primary performance outcomes assessed were area under the curve (AUC), accuracy, and mean absolute error (MAE) for each model. Secondary outcomes evaluated were precision, recall, and F-1 score.</p><p><strong>Results: </strong>The EfficientNet model architecture yielded the strongest AUC (0.83), accuracy (71%), and MAE (0.42) compared with VGG16 (AUC: 0.74; accuracy: 57%; MAE: 0.54), ResNet34 (AUC: 0.76; accuracy: 60%; MAE: 0.53), and DenseNet196 (AUC: 0.78; accuracy: 62%; MAE: 0.49).</p><p><strong>Conclusion: </strong>Convolutional neural networks offer an automated and accurate way to quickly assess and diagnose knee radiographs for osteoarthritis. The regression score models evaluated in this study demonstrated superior AUC, accuracy, and MAE compared with standard convolutional neural network models. The EfficientNet model exhibited the best overall performance, including the highest AUC (0.83) noted in the literature. The artificial intelligence-generated regressor exhibits a finer progression of knee osteoarthritis by quantifying severity of various hallmark features. Potential applications for this technology include its use as a screening tool in determining patient suitability for orthopedic referral. [<i>Orthopedics</i>. 2024;47(5):e247-e254.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e247-e254"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141788788","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":"Outcomes and Risks Associated With Subsequent Contralateral Hip Fractures.","authors":"Paige N Chapman, Gregory M Georgiadis, Sara Seegert, Benjamin Russell, Kristin O'Mara-Gardner, Jeffrey M Bair, Jason C Tank","doi":"10.3928/01477447-20240520-05","DOIUrl":"10.3928/01477447-20240520-05","url":null,"abstract":"<p><strong>Background: </strong>Hip fractures constitute a major public health problem for older individuals. They are associated with functional deterioration, limited mobility, and increased mortality, while contributing to economic and social hardships that are compounded by a second hip fracture. With the aging US population and increasing rates of hip fractures, it is essential to understand factors surrounding subsequent contralateral hip fractures.</p><p><strong>Materials and methods: </strong>This descriptive study was a retrospective review of patients 60 years and older who were identified in the institutional geriatric hip fracture database as having had an initial and subsequent contralateral hip fracture, with the second treated at our tertiary referral center.</p><p><strong>Results: </strong>The incidence of subsequent hip fracture was 13.2%. The mean time to second hip fracture was 3.5 years after the initial injury. The first fracture tended to be a femoral neck fracture, whereas the second injury was more likely to have an intertrochanteric pattern. There was a higher complication rate after a subsequent hip fracture. Patients taking osteoporosis and adjuvant medication prior to admission for the second fracture tended to have a lower 90-day mortality rate. Patients with a history of any fracture prior to the first hip fracture, with cancer, and with osteopenia had shorter intervals to the subsequent event.</p><p><strong>Conclusion: </strong>Subsequent hip fractures carry high morbidity and mortality rates. Steps should be taken after the initial injury to optimize outcomes in the case of a subsequent event. Patients discharged after initial hip fracture should be maintained with osteoporosis medication. [<i>Orthopedics</i>. 2024;47(5):264-269.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"264-269"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176067","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":"Re-revision Extensor Mechanism Reconstruction Because of Nonunion and Tendon Failure After Total Knee Arthroplasty.","authors":"Brandi Krieg, Michael Dayton, Nicholas Alfonso","doi":"10.3928/01477447-20240809-14","DOIUrl":"10.3928/01477447-20240809-14","url":null,"abstract":"<p><p>Extensor mechanism (EM) disruption after total knee arthroplasty (TKA) is devastating, especially in cases of re-rupture. A 67-year-old man with diabetes had patellar tendon rupture after revision TKA and then had migration of the bone block after Achilles tendon allograft with bone block (ATBB) augmentation with cerclage. A third reconstruction was performed with open reduction and internal fixation and high-strength braided suture augmentation. Five months postoperatively, the patient had regained full range of motion with intact EM and hardware. The risk of re-rupture is high in ATBB, and the primary issues in this case were nonunion and tendinous compromise. A construct that encompasses compression and buttressing of the bone block with tendon augmentation potentially addresses the risks of recurrent EM rupture in more complex cases. [<i>Orthopedics.</i> 2024;47(5):e273-e276.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e273-e276"},"PeriodicalIF":1.1,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009112","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":"Therapeutic Interventions for Prevention of Musculoskeletal Pain Among Orthopedic Surgeons.","authors":"Chenée Armando, Morgan Voulo, Dean Plafcan, Paul Herickhoff","doi":"10.3928/01477447-20240609-02","DOIUrl":"https://doi.org/10.3928/01477447-20240609-02","url":null,"abstract":"<p><p>Orthopedic surgery is a physically demanding specialty. The factors contributing to musculoskeletal injury among surgeons often stem from positioning the patient, using non-ergonomic instruments, maintaining static postures, and performing repetitive movements. This article focuses on exercise techniques intended to combat the most common problematic static postures held during procedures. Each exercise explained in this article is organized into \"preop,\" \"intraop,\" and \"postop\" components. Preop includes strengthening movements, intraop provides postural recommendations, and postop focuses on mobilization and recovery. This article aims for efficient body conditioning, targeting the muscular posterior chain and supporting elements. [<i>Orthopedics</i>. 2024;47(4):e214-e216.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"47 4","pages":"e214-e216"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748822","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":"<i>Cutibacterium acnes</i> Infection as a Cause of Nonunion After Ulnar-Shortening Osteotomy.","authors":"Logan M Hansen, Alex C Lindahl, Erik B Eller, Charles S Day","doi":"10.3928/01477447-20240609-01","DOIUrl":"10.3928/01477447-20240609-01","url":null,"abstract":"<p><p>Ulnar-shortening osteotomy is a reliable solution to treat ulnar impaction syndrome, but it has a significant rate of nonunion as a known complication. Generally nonunion after the procedure is attributed to noninfectious causes. When infections happen, they follow the microbiological trends of nonunions elsewhere in the body. We present a case of ulnar-shortening osteotomy using an oblique-cut osteotomy system that resulted in septic nonunion. At the time of revision surgery, <i>Cutibacterium acnes</i> and <i>Staphylococcus hominis</i> were isolated from the osteotomy site. The patient was successfully treated using intravenous antibiotics and the two-stage Masquelet technique and eventually went on to bony union. As <i>C acnes</i> is rarely encountered in this context, this report highlights the need to consider all possible pathogens in the workup of a potentially septic nonunion. Surgeons should consider bacteria such as <i>C acnes</i> that require prolonged incubation for isolation from cultures, which may not be part of many institutions' usual protocol. [<i>Orthopedics</i>. 2024;47(4):e211-e213.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":"47 4","pages":"e211-e213"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141748821","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 Morbidity of Greater Trochanteric Pain Syndrome Versus That of Patients Awaiting Total Hip Replacement.","authors":"Sonia Wadekar, John M Gaddis, Emily Middleton, Yin Xi, Ed Mulligan, Ryan Bialaszewski, Bretton Laboret, Joel Wells","doi":"10.3928/01477447-20240520-03","DOIUrl":"10.3928/01477447-20240520-03","url":null,"abstract":"<p><strong>Background: </strong>Greater trochanteric pain syndrome (GTPS) is a commonly diagnosed medical issue, yet there are little data assessing the relative morbidity of GTPS. We sought to characterize the morbidity on presentation of GTPS and compare it to that of patients with end-stage hip osteoarthritis awaiting total hip arthroplasty. We hypothesized that patients with GTPS would have morbidity similar to or worse than that of patients with osteoarthritis.</p><p><strong>Materials and methods: </strong>This retrospective case-control study examined patient-reported outcome measures of 156 patients with GTPS (193 hips) and 300 patients with hip osteoarthritis before total hip arthroplasty (326 hips). Patients with secondary hip conditions or previous hip surgeries were excluded from the study. Patient-reported outcome measures were analyzed using an equivalence test and two one-sided <i>t</i> tests.</p><p><strong>Results: </strong>Equivalence in mean visual analog scale pain scores between GTPS and osteoarthritis was established with a tolerance margin of ±10. The difference in mean visual analog scale pain scores was 0.35 (95% CI, -0.86 to 0.16; <i>P</i>=.02). The Hip disability and Osteoarthritis Outcome Score Quality of Life was much worse for patients with GTPS, placed well outside of the ±10 tolerance margin, and the difference in mean scores was 1.72 (95% Cl, -2.17 to -1.26; <i>P</i>=.99). Equivalence in mean UCLA Activity scores between GTPS and osteoarthritis was established with a tolerance margin of ±5. The difference in mean UCLA Activity scores was 0.002 (95% CI, -0.45 to 0.43; <i>P</i><.01).</p><p><strong>Conclusion: </strong>The morbidity and functional limitations of patients with GTPS were similar to those of patients undergoing total hip arthroplasty. GTPS remains a functional problem for patients, and clinicians and researchers should consider GTPS as seriously as hip osteoarthritis. [<i>Orthopedics</i>. 2024;47(4):205-210.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"205-210"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176120","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":"Pain Self-Efficacy Can Improve During a Visit With an Orthopedic Surgeon.","authors":"Jacie L Lemos, Giselle I Gomez, Pariswi Tewari, Derek F Amanatullah, Loretta Chou, Michael J Gardner, Serena Hu, Marc Safran, Robin N Kamal","doi":"10.3928/01477447-20240605-01","DOIUrl":"10.3928/01477447-20240605-01","url":null,"abstract":"<p><strong>Background: </strong>Greater pain self-efficacy (PSE) is associated with reduced pain, fewer limitations, and increased quality of life after treatment for orthopedic conditions. The aims of this study were to (1) assess if PSE improves during a visit with an orthopedic surgeon and (2) identify modifiable visit factors that are associated with an increase in PSE.</p><p><strong>Materials and methods: </strong>We performed a prospective observational study of orthopedic clinic visits at a multispecialty clinic from February to May 2022. New patients who presented to one of six orthopedic surgeons were approached for the study. Patients who provided consent completed a pre-visit questionnaire including the Pain Self-Efficacy Questionnaire (PSEQ) and demographic questions. A trained research member recorded the five-item Observing Patient Involvement in Decision Making Instrument (OPTION-5) score, number of questions asked, and visit duration. Immediately after the visit, patients completed a post-visit questionnaire consisting of the PSEQ and Perceived Involvement in Care Scale (PICS).</p><p><strong>Results: </strong>Of 132 patients enrolled, 61 (46%) had improved PSE after the orthopedic visit, with 38 (29%) having improvement above a clinically significant threshold. There were no significant differences between patients with increased PSE and those without increased PSE when comparing the PICS, OPTION-5, questions asked, or visit duration.</p><p><strong>Conclusion: </strong>Almost half of the patients had improvement in PSE during an orthopedic visit. The causal pathway to how to improve PSE and the durability of the improved PSE have implications in strategies to improve patient outcomes in orthopedic surgery, such as communication methods and shared decision-making. Future research can focus on studying different interventions that facilitate improving PSE. [<i>Orthopedics</i>. 2024;47(4):e197-e203.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"e197-e203"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141306521","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 the Safety of Uninterrupted Warfarin Anticoagulation With Tranexamic Acid in Total Joint Arthroplasty.","authors":"Michael G Johnston, Matthew A Porter, Kade E Eppich, Celeste G Gray, David F Scott","doi":"10.3928/01477447-20240304-04","DOIUrl":"10.3928/01477447-20240304-04","url":null,"abstract":"<p><strong>Background: </strong>The continuation of long-term warfarin therapy is gaining acceptance in minor surgeries but maintaining therapeutic international normalized ratio (INR) values among patients during major orthopedic procedures raises concern. While bridging therapy with low-molecular-weight heparin is currently recommended for patients receiving anticoagulation, few studies have evaluated the safety of continuing warfarin during total joint arthroplasty. This study evaluated the safety and efficacy of continuous warfarin anticoagulation through total joint arthroplasty with and without prophylactic tranexamic acid (TXA).</p><p><strong>Materials and methods: </strong>We conducted a retrospective, matched-pair analysis of two experimental groups of patients who underwent primary total hip arthroplasty or total knee arthroplasty performed by a single surgeon. Our first experimental group, warfarin plus TXA (warfarin+TXA), consisted of 21 patients who underwent arthroplasty while receiving therapeutic anticoagulation with warfarin (INR, 2.0-3.0) and who received prophylactic TXA. Our second experimental group, warfarin without TXA (warfarin-TXA), consisted of 40 patients who underwent arthroplasty while receiving therapeutic anticoagulation with warfarin (INR, 2.0-3.0) without prophylactic TXA.</p><p><strong>Results: </strong>The percent change in hemoglobin value after surgery, red blood cells transfused, surgical site infections, bleeding complications, and thrombotic complications were similar between both experimental and control groups. When comparing the historical group with the warfarin+TXA group, the addition of TXA resulted in a statistical decrease in mean red blood cells transfused and estimated blood loss, with no statistically significant increase in complications.</p><p><strong>Conclusion: </strong>Many factors must be considered when choosing perioperative thromboembolic prophylaxis for arthroplasty candidates with medical comorbidities requiring long-term anticoagulation. This study presents data indicating that it could be safe and effective to continue therapeutic warfarin while using prophylactic TXA. [<i>Orthopedics</i>. 2024;47(4):211-216.].</p>","PeriodicalId":19631,"journal":{"name":"Orthopedics","volume":" ","pages":"211-216"},"PeriodicalIF":1.1,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102089","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}