Plastic and Reconstructive Surgery Global Open最新文献

{"title":"Gull-wing Stacked Profunda Artery Perforator Flap for Unilateral Breast Reconstruction.","authors":"Hajime Matsumine, Yosuke Niimi, Hiroyuki Sakurai","doi":"10.1097/GOX.0000000000006933","DOIUrl":"10.1097/GOX.0000000000006933","url":null,"abstract":"<p><p>The profunda artery perforator (PAP) flap, harvested from the medial aspect of the thigh, is increasingly used for breast reconstruction because of its low donor-site morbidity and ease of harvest. However, the PAP flap has a limited fat volume, which makes it difficult to use in women with larger breasts. To overcome this limitation, we have developed the \"gull-wing stacked\" PAP flap, which combines 2 PAP flaps with the aim of achieving adequate volume, projection, and aesthetic outcomes. We performed skin-sparing mastectomy followed by immediate reconstruction using 2 PAP flaps in 3 patients (aged 47-50 y) with unilateral breast cancer. Both thighs were used as donor sites. The flaps were sutured proximally and rotated in opposing directions, mimicking a gull-wing door motion, to create a rounded breast. The internal mammary vessels were chosen as the recipient vessels, with vascular anastomoses performed in an antegrade or retrograde manner. All flaps survived without vascular complications or the need for reoperation. The transferred tissue provided adequate volume and projection, eliminating the need for additional fat grafting. Aesthetic outcomes were deemed excellent in all cases. The gull-wing stacked PAP flap is a promising option for patients who are ineligible for an abdominal flap because of previous surgery or other factors. This method effectively replicates the shape of the breast using a unique flap configuration but requires an extended operation time and significant surgical staffing. Further studies are necessary to optimize the procedure and evaluate long-term outcomes.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6933"},"PeriodicalIF":1.5,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12200228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144507512","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":"Utilizing Computer-assisted Planning for Split Calvarial Bone Cranioplasty of an Infant With Occipital Langerhans Cell Histiocytosis.","authors":"Jordan R Whittles, William Cobb, Chenue Abongwa, Mohga Ali, Keyne Johnson, Joseph Lopez","doi":"10.1097/GOX.0000000000006908","DOIUrl":"10.1097/GOX.0000000000006908","url":null,"abstract":"<p><p>Langerhans cell histiocytosis is frequently characterized by lytic calvarial lesions, periodically necessitating cranioplasty in infant patients. Split calvarial bone graft cranioplasty is a feasible, though technically challenging option, which may be augmented with computer-assisted planning. Our case concerns a 14-month-old boy who presented with rapid evolution of soft calvarial masses of the subocciput. Lesional aspiration was pathologically indeterminate, and lesional resection with histopathologic diagnosis and cranioplasty was planned. Virtual surgical planning allowed for identification of the most ideal harvest graft site for successful calvarial splitting. After successful lesional excision, the graft was harvested using custom manufactured osteotomy guides, split, and secured at both donor and lesion sites. The patient did well after surgery and subsequently began oncological chemotherapy. This report represents the unique description of computer-assisted planning applied to split calvarial bone grafting for the treatment of an infantile patient with calvarial Langerhans cell histiocytosis.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6908"},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497633","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 Novel Method of Chest Wall Reconstruction Succeeding Pediatric Heart Transplantation Donor-recipient Size Mismatch: 25-year Follow-up.","authors":"Malcolm Lesavoy, Jade March, Ian Roy, Hillel Laks, Nandini Parmar","doi":"10.1097/GOX.0000000000006916","DOIUrl":"10.1097/GOX.0000000000006916","url":null,"abstract":"<p><p>Pediatric heart transplantation can present with many obstacles, including size mismatch of the donor heart with the thoracic cavity of the recipient. For the patient to have vitality, they may need to have surgical interventions to address these conditions. We investigate the case of a 23-month-old infant who underwent orthotopic heart transplantation for nonischemic dilated cardiomyopathy. Given the large size of the donor heart relative to the infant, a subsequent modified thoracoplasty was performed to allow for chest wall closure. This report provides potential surgical techniques that can be taken and follows the patient for a 25-year time span.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6916"},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497628","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":"Establishing a Standard Method for Screening Lymphatic Ultrasound in Lymphedema Patients.","authors":"Hisako Hara, Makoto Mihara","doi":"10.1097/GOX.0000000000006922","DOIUrl":"10.1097/GOX.0000000000006922","url":null,"abstract":"<p><strong>Background: </strong>Lymphatic ultrasound (LU) is a valuable tool for treating lymphedema, but no detailed protocol exists. This study aimed to establish a standardized method for screening LU.</p><p><strong>Methods: </strong>We analyzed LU images from 70 limbs of 35 patients with lower extremity lymphedema (1 man, 34 women; mean age 66.5 y). An 18-MHz linear probe was used, and the D-CUPS (Doppler, crossing, uncollapsible, parallel, superficial fascia) index identified lymphatic vessels. Images were taken at 5 cm (T5) and 10 cm (T10) distal to the saphenofemoral junction and at 5 cm (C5) and 10 cm (C10) distal to the popliteal fossa. Distances between the great saphenous vein (GSV) and lymphatic vessels were measured. Vessel diameters were assessed, and a receiver operating characteristic curve determined the cutoff value for distinguishing normal from dilated lymphatic vessels.</p><p><strong>Results: </strong>At T5 and T10, lymphatic vessels were identified in 62 limbs (88.6%), with average distances of 17.3 and 15.5 mm lateral to the GSV, respectively. At C5 and C10, vessels were identified in 53 limbs (75.7%), with distances of 12.6 and 13.9 mm medial to the GSV. The receiver operating characteristic curve yielded an area under the curve of 0.83, with a cutoff of 0.25 mm for differentiating normal and dilated vessels.</p><p><strong>Conclusions: </strong>Lymphatic vessels are generally lateral to the GSV in the thigh and medial to the GSV in the calf. These findings simplify vessel identification, enabling broader use of LU for assessing lymphatic function.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6922"},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12189971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497629","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 Discrepancy Between White Blood Cell and C-reactive Protein Levels in Group A Streptococcal Necrotizing Soft-tissue Infections.","authors":"Yusaku Saijo, Shimpei Ono, Goh Akiyama, Masataka Sugii, Yoshihiro Kodama, Sawako Nukaga, Shoji Yokobori, Rei Ogawa","doi":"10.1097/GOX.0000000000006917","DOIUrl":"10.1097/GOX.0000000000006917","url":null,"abstract":"<p><strong>Background: </strong>Group A streptococcal necrotizing soft tissue infection (GAS-NSTI) is a severe condition that can be complicated by streptococcal toxic shock syndrome. Management necessitates multidisciplinary care, including emergency medicine, surgery, plastic surgery, and infectious diseases. Early diagnosis and appropriate therapeutic intervention are essential for GAS-NSTI, as effective prevention strategies have not been established. However, it is often misdiagnosed as cellulitis, resulting in delayed treatment.</p><p><strong>Methods: </strong>In a single-center retrospective study, 25 patients with GAS-NSTI were analyzed for initial symptoms, vital signs, quick sequential organ failure assessment (qSOFA), and blood test results, comparing those with early-stage (≤3 d) and later-stage (≥4 d) GAS-NSTI.</p><p><strong>Results: </strong>Twelve patients had their first blood test done 3 days or less (early) after first symptom awareness. The remaining13 patients had their first blood test done at 4 or more days (later) after symptom onset. Early-stage GAS-NSTI showed elevated C-reactive protein (CRP) levels (34.0 ± 11.2 mg/dL) but normal white blood cell (WBC) counts (6.7 ± 4.9/μL), whereas later-stage cases had elevated CRP (29.7 ± 9.0 mg/dL) and WBCs (18.6 ± 10.1/μL, <i>P</i> < 0.001). Seven patients (28%) had a laboratory risk indicator for necrotizing fasciitis (LRINEC) score of 5 or more points (4 from the early-stage group and 3 from the late-stage group). Nineteen patients (76%) had a negative qSOFA score at the initial outpatient visit.</p><p><strong>Conclusions: </strong>In addition to soft tissue symptoms, elevated creatinine and blood urea nitrogen levels, and thrombocytopenia, high CRP levels with normal WBCs should raise suspicion of early GAS-NSTI, even when laboratory risk indicator for necrotizing fasciitis and qSOFA scores are negative.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6917"},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12189988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497632","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":"Evaluation of Biodegradable Temporizing Matrix for Functional and Aesthetic Outcomes in Hand Soft-tissue Defect: A 3-year Retrospective Study.","authors":"Usama Farghaly Omar, Vinnie Eleanor Lim, Shirong Huang, Ee Xion Tan, Vaikunthan Rajaratnam","doi":"10.1097/GOX.0000000000006909","DOIUrl":"10.1097/GOX.0000000000006909","url":null,"abstract":"<p><strong>Background: </strong>Hand soft-tissue defects compromise both function and aesthetics, significantly impacting quality of life. Traditional reconstructive techniques frequently lead to complications, such as donor-site morbidity and suboptimal aesthetic outcomes. The NovoSorb biodegradable temporizing matrix (BTM) may address these challenges by promoting tissue ingrowth. This study evaluates BTM's effectiveness in managing hand soft-tissue defects.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted on 67 patients who underwent BTM placement for hand soft-tissue defects from July 2020 to May 2024. Data were collected on patients' demographics, wound size, cause of injury, time to tissue integration, postoperative complications, and clinical outcomes. Functional outcomes were assessed using range of motion and grip strength, whereas aesthetic outcomes were evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Descriptive and correlational analyses explored the relationship between wound size, return to work, and outcomes.</p><p><strong>Results: </strong>Among the 67 patients (58 men, 9 women; mean age 43.3 y), 97% achieved successful BTM integration, with only 2 cases of failure due to poor vascularity. The mean range of motion for metacarpophalangeal joints was 76.17 degrees, and grip strength averaged 21.3 kg. Functional outcomes, based on the Finger Injury Outcome Score, were good to excellent in 58.2% of cases. Aesthetic outcomes were generally favorable, with a mean POSAS observer score of 3.58. The correlation between wound size and return to work was weak (r = 0.132).</p><p><strong>Conclusions: </strong>NovoSorb BTM appears to be a promising alternative for managing complex hand injuries, providing both functional and aesthetic benefits with minimal complications.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6909"},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12189986/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497630","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":"Moving the Needle: Program Directors' Views on the Recruitment of Diverse Trainees to Plastic Surgery Residency.","authors":"Natalie B Baxter, Timothy C Guetterman, Noelle Thompson, Mary L Byrnes, Gurjit Sandhu, Rachel C Hooper","doi":"10.1097/GOX.0000000000006915","DOIUrl":"10.1097/GOX.0000000000006915","url":null,"abstract":"<p><strong>Background: </strong>The plastic surgery workforce lacks racial and ethnic diversity. Traditionally, United States Medical Licensing Examination scores have been used as the initial screening tool for most residency programs; however, this can lead to interview selection bias against underrepresented in medicine (URiM) applicants. Understanding the barriers and facilitators to diversifying the specialty from the perspectives of program directors (PDs) may reveal strategies for improvement.</p><p><strong>Methods: </strong>In this mixed methods study, we invited integrated plastic surgery PDs to participate in an online survey and one-on-one semistructured interviews to understand their perspectives on the application process, interview day, and strategies to improve recruitment and retention of URiM trainees. Descriptive statistics were used to analyze the survey data. Interviews were deidentified, transcribed, and analyzed inductively to generate themes based on patterns observed across narratives.</p><p><strong>Results: </strong>Of 108 PDs and assistant PDs, 29 (26.9%) responded to the survey and 8 participated in semistructured interviews. We identified 3 broad themes: (1) resident diversity is important for patient care and education, (2) lack of exposure and longitudinal mentorship are barriers to matriculation, and (3) program culture change can shift trends in the recruitment of URiM trainees.</p><p><strong>Conclusions: </strong>PDs value the racial and ethnic diversity of trainees and are in favor of efforts to increase representation in the field. Improving mentorship and reducing bias in the application process are necessary strategies to increase representation in plastic surgery.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6915"},"PeriodicalIF":1.5,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12190121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497631","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":"An Assessment of the Longitudinal Impact of Gender-affirming Care in an Adolescent and Young Adult Transmasculine and Nonbinary Patient Population.","authors":"Emily Ewing, Gabriela Sendek, Miriam Becker, Edna Montes, RocNeil Nguyen, Rachel Jenkins, Clara Lee, Andrew Richardson, Bixby Marino-Kibbee, David Inwards-Breland, Amanda Gosman","doi":"10.1097/GOX.0000000000006911","DOIUrl":"10.1097/GOX.0000000000006911","url":null,"abstract":"<p><strong>Background: </strong>Gender-affirming care (GAC) during adolescence is associated with decreased adverse gender dysphoria-related outcomes and steadily improved psychological functioning into young adulthood. This single-institution, longitudinal study examined the impact of GAC on various treatment outcomes for transgender and nonbinary adolescents and young adults. Participants included 110 transmasculine and nonbinary adolescents and young adults who were referred for gender-affirming top surgery through the Center for Gender-Affirming Care and Plastic Surgery multidisciplinary clinic at Rady Children's Hospital, San Diego.</p><p><strong>Methods: </strong>Outcomes were assessed via the Patient Health Questionnaire-2, chest and gender dysphoria scales, and surgical satisfaction scales, which were administered at various time points throughout treatment. Multilevel modeling was used to evaluate the impact of GAC on depressive symptoms, chest and gender dysphoria, and surgical satisfaction over time.</p><p><strong>Results: </strong>Significant reductions were observed in patient-reported depressive symptoms, gender dysphoria, and chest dysphoria before and after surgery. On average, survey results indicated that patients reported positive perceptions of their surgical experience, were satisfied with their surgical outcome, and had a positive recovery experience.</p><p><strong>Conclusions: </strong>Results suggest that GAC appears to have a measurable and beneficial impact on patients' mental health.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6911"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485560","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":"Analysis of Penetrating Injuries to the Sciatic Nerve, Highlighting Insights From Sudan.","authors":"Albra Kamal, Momen M Mohamed, Amin M Yassin, Hozifa Mohamed, Mohamed Dirar","doi":"10.1097/GOX.0000000000006901","DOIUrl":"10.1097/GOX.0000000000006901","url":null,"abstract":"<p><strong>Background: </strong>Sciatic nerves extend a considerable distance through the thigh and are near bone, which increases their risk of injury. This vulnerability can result in long-lasting morbidity and disability. Injuries caused by high-energy weapons can affect neural tissue through multiple pathways, and the effectiveness of subsequent interventions is often unpredictable.</p><p><strong>Methods: </strong>This is a descriptive retrospective analysis of a multicenter, cross-sectional hospital-based study focused on the evaluation and reconstruction of sciatic nerve injuries in Sudan from January 2022 to January 2024. The study encompassed all patients who had sciatic nerve injuries due to penetrating mechanisms and subsequently received reconstructive surgery. Patients with severe injuries leading to death and those with traumatic limb amputations have been excluded from the analysis.</p><p><strong>Results: </strong>Among the 34 patients studied, a significant majority, 85.3%, were men, whereas women constituted 14.7%. The highest representation was the 20- to 30-year-old group, which accounts for 50%. The primary cause of the injuries was gunshot wounds. Sciatic nerve injuries were associated with femoral fractures in 26.5%. The predominant surgical approach used was neurolysis (41.2%), with primary repair (35.3%) and nerve graft repair (23.5%). Deep sensation was restored within 6 months following surgery, except in 2.9% who did not recover sensation.</p><p><strong>Conclusions: </strong>The sciatic nerve is frequently injured due to penetrating wounds in the lower limbs, leading to potentially severe disabilities. Although surgical options can be beneficial, particularly for sensory restoration and managing neuropathic pain, it is vital to engage in rehabilitation as muscle recovery progresses.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6901"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485561","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":"First Russian Experience of Pediatric Subtotal Facial Tissue Replantation.","authors":"Alexey S Dikarev, Seyran A Vartanyan, Alexander A Martirosyan, Ivan A Zemlin, Kazbek U Kudzaev, Igor S Sergeev, Robert S Vartanyan, Daniel U Dryga, Irina O Vlasova, Elen V Gorgoma, Anna V Bilyak, Spartak S Anthoniadis, Daniel U Rudenok, Elena I Kletshenko","doi":"10.1097/GOX.0000000000006906","DOIUrl":"10.1097/GOX.0000000000006906","url":null,"abstract":"<p><p>Treatment and rehabilitation of patients with posttraumatic, contaminated, lacerated wounds present a complex challenge. The concept of delayed, multistage treatment, as well as the rehabilitation protocols for pediatric patients is associated with a series of reconstructive procedures, one of which is face transplantation; however, it remains an unresolved issue to date due to the development of immunologic tissue intolerance by the recipient, as well as various psychosocial rehabilitation challenges. The challenge of successful pediatric replantation creates interest in the global medical community to develop generalized algorithms for managing patients with posttraumatic subtotal facial defects. This case report demonstrated the experience of the first posttraumatic subtotal facial replantation less than 12 hours after injury in a pediatric patient in Russia. The goal of this work was to show the algorithm used in the case of a pediatric posttraumatic subtotal facial defect in hopes of aiding the future development of such guidelines.</p>","PeriodicalId":20149,"journal":{"name":"Plastic and Reconstructive Surgery Global Open","volume":"13 6","pages":"e6906"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144485562","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}