Spine deformity最新文献

{"title":"Previously fused, sagittally malaligned patients undergoing a pedicle subtraction osteotomy: early neurologic deficit recovery kinetics and their impact on patient-reported outcomes.","authors":"Julio J Jauregui, Sapan Patel, Hershil Patel, Maksim A Shlykov, Michael Kelly, Rohit K Bhan, Camilo Molina, Tomas Ries, Laviel A Fernandez, Taryn E LeRoy, Keith H Bridwell, Munish C Gupta","doi":"10.1007/s43390-026-01529-1","DOIUrl":"https://doi.org/10.1007/s43390-026-01529-1","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the incidence and recovery of motor weakness after pedicle subtraction osteotomy (PSO) for fixed sagittal imbalance and determine whether early postoperative weakness is associated with patient-reported outcomes (PROs) at latest available follow-up.</p><p><strong>Methods: </strong>We retrospectively reviewed consecutive adults undergoing revision posterior fusion with PSO (Schwab grade 3-4) for fixed sagittal imbalance from December 2015 to June 2022. Lower-extremity strength was graded 0-5, and weakness was defined as 3/5 or less in any distribution. PROs (SRS-22r, ODI, VAS back, and leg pain) were collected preoperatively through latest follow-up. Latest outcomes were compared by weakness status on postoperative day 5, 6 weeks, and 3 months.</p><p><strong>Results: </strong>Forty-nine patients (67% female; mean age 63 years) were included. Weakness was present in 4% preoperatively, increased to 27% on postoperative day 5, and declined to 12% at 6 weeks and 10% at 3 months; no patient had persistent weakness at latest follow-up. Weakness at 6 weeks was associated with worse latest SRS-22r Function, Self-Image, Mental Health, and Satisfaction (all p ≤ 0.033). At 3 months, weakness was associated with lower SRS Satisfaction (p = 0.004) and higher VAS leg pain (p = 0.009).</p><p><strong>Conclusion: </strong>Motor weakness after revision PSO is common early and typically resolves. However, weakness persisting at 6 weeks or 3 months is associated with lower satisfaction and higher leg pain at latest available follow-up.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sagittal alignment following a modified Jackson technique in the surgical management of high-grade spondylolisthesis.","authors":"Karim Aboelmagd, Emma Nadler, Reinhard Zeller, Mark Camp, David Lebel","doi":"10.1007/s43390-026-01547-z","DOIUrl":"https://doi.org/10.1007/s43390-026-01547-z","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal surgical management of paediatric high-grade spondylolisthesis (HGS) remains controversial. Instrumented fusion in situ (IFIS) is considered low risk for neurological complications at the expense of limited correction of spinopelvic imbalance. This study evaluated radiographic outcomes of IFIS using a modified Jackson technique, with a focus on sagittal alignment and the evolution of spinopelvic balance over time.</p><p><strong>Methods: </strong>A retrospective review of 19 patients (< 18 years, mean age 13.7) with ≥ grade 3 HGS treated with IFIS using a modified Jackson technique between 2006 and 2022. Radiographic parameters including slip percentage, pelvic incidence, sacral slope, pelvic tilt, lumbosacral angle, and balance classification were analysed at baseline, 6 months, and 2 years post-operatively. Subgroup analysis was performed for patients with vertical versus non-vertical sacrum morphology. Mixed-measures ANOVA determined changes across time points.</p><p><strong>Results: </strong>Improvements in sagittal parameters were progressive, with more substantial changes observed at 2 years than at 6 months, suggesting gradual improvement over time. Significant improvements were observed in slip percentage (p < 0.001), sacral slope (p = 0.005), pelvic tilt (p = 0.016), lumbosacral angle (p < 0.001), and L5 incidence (p = 0.019). Patients presenting with a vertical sacrum showed greater increases in sacral slope and reduction in pelvic retroversion.</p><p><strong>Conclusion: </strong>The results of IFIS using a modified Jackson technique for paediatric HGS suggests significant partial improvements in key sagittal alignment parameters, including SS, PT, and LSA at 2-year follow-up. Whilst pelvic balance often remained incomplete at 2 years, ongoing radiographic improvement suggests a potential for further adaptation with longer follow-up.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implant migration in growth-friendly constructs for early-onset scoliosis: a systematic review of reported patterns, associated factors, and clinical consequences.","authors":"Suhani Sharma, Ally Cheung, Khyber Afridi Rabbi, Ellie Smith, Shreya Sankar, Michael O'Connor, George-Paul O'Byrne, Oliver Boughton, Patrick Kiely","doi":"10.1007/s43390-026-01574-w","DOIUrl":"https://doi.org/10.1007/s43390-026-01574-w","url":null,"abstract":"<p><strong>Purpose: </strong>Implant migration is an incompletely characterised complication of growth-friendly treatment for early-onset scoliosis (EOS), with inconsistent terminology across the literature. This systematic review aimed to characterise reported patterns, study-specific frequency, associated factors, detection, and clinical consequences of implant migration and migration-related fixation failure in growth-friendly EOS constructs.</p><p><strong>Methods: </strong>PubMed, Embase, and CINAHL were searched from database inception to 27th November 2025 in accordance with PRISMA guidelines. Studies reporting implant migration or migration-related fixation failure in children with EOS treated with growth-friendly constructs were included. Findings were synthesised descriptively because migration definitions, constructs, outcome ascertainment, and reporting were heterogeneous. Risk of bias was assessed using Joanna Briggs Institute critical appraisal tools, and certainty of evidence was evaluated using GRADE.</p><p><strong>Results: </strong>Nineteen studies were included, predominantly retrospective cohorts and case series. Migration terminology was inconsistent and frequently overlapped with pull-out, dislodgement, loosening, and loss of fixation. For descriptive synthesis, reported events were organised into three recurring anatomical patterns: apical/ventral rod migration, proximal anchor migration/fixation failure, and distal or pelvic anchor migration/fixation failure. Ventral rod migration was represented by two publications, including one cohort in which CT-defined migration occurred in 3/90 patients (3.3%) and one case report. Proximal anchor-related events were represented across a greater number of studies. Candidate associated factors included deformity severity, repeated lengthening, patient morphology or bone quality, and construct characteristics; however, the available evidence did not permit identification of independent predictors.</p><p><strong>Conclusion: </strong>Implant migration and migration-related fixation failure in growth-friendly EOS constructs are inconsistently defined and reported. The available evidence supports a proposed descriptive anatomical framework but does not permit reliable pooled incidence estimation or prediction of individual patient risk. Standardised definitions and prospective multicentre reporting are required to determine frequency, predictors, and clinically meaningful surveillance strategies.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Achieving \"ideal\" sagittal alignment does not influence HRQoL outcomes 5 years following PSF for lenke 1 AIS.","authors":"K Aaron Shaw, Michael P Kelly, Tracey Bryan, A Noelle Larson, Stefan Parent, Nicholas D Fletcher","doi":"10.1007/s43390-026-01571-z","DOIUrl":"https://doi.org/10.1007/s43390-026-01571-z","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies have emphasized the importance of thoracic kyphosis (TK) restoration and sagittal alignment for long-term outcomes following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Although various equations have been introduced to predict the ideal regional alignment of the thoracic or lumbar spine, no study has validated these equations or investigated the influence of achieving these patient-specific ideal regional parameters on patient-reported health-related quality of life (HRQoL) outcomes following PSF for AIS.</p><p><strong>Methods: </strong>A retrospective cohort study of a multicenter AIS database identifying patients with PSF with 5-year follow-up was performed. Patients with Lenke 1 curves with complete radiographic records, focusing on sagittal alignment parameters for lumbar lordosis (LL), TK (T2-12), sagittal vertical alignment (SVA), and patient-reported outcomes scores (SRS-22) at preoperative and 5-year follow-up timepoints were included for analysis. \"Ideal\" TK was calculated using pelvic incidence (PI) and \"ideal\" lumbar alignment was defined using two criteria. Patients were then subdivided based on whether ideal regional alignment was achieved at 5 years follow-up. SRS-22 total scores were subdivided into quintiles with the lowest 40% of patients (score ≤ 4.3) used to define less optimal outcome (LOO).</p><p><strong>Results: </strong>A total of 991 patients were identified, with 192 patients meeting inclusion criteria (mean 14.5 ± 2.1 years, 88.5% female). The mean \"ideal\" TK was calculated at 37.6 ± 5.7° (range 23.9°-51.8°) with a mean measured preoperative TK of 27.0 ± 11.8°). Following surgery, there was a significant increase in TK (P < 0.001) with 62 patients (32.3%) achieving \"ideal\" TK (Table 1). Nonetheless, achieving ideal TK demonstrated no significant impact on SRS-22 domain scores. Additionally, there was no association between achieving ideal TK and the development of LOO (33.9 vs 42.3%; P = 0.16), nor were other sagittal radiographic parameters. Preoperative SRS-22 scores primarily impacted 5-year SRS domain scores and change in score from preoperative values.</p><p><strong>Conclusion: </strong>In a cohort of patients undergoing PSF for Lenke 1 AIS, the pursuit of ideal region-specific alignment parameters did not influence patient-reported outcome measures 5 years following surgery. While this may indicate that younger patients are unaffected by less than \"ideal\" sagittal alignment, it is also possible that the current definition of \"ideal\" needs reconsideration. This may indicate the need for an updated sagittal plane assessment in AIS, searching beyond regional measures of sagittal curvature magnitude to better understand the sagittal plane distribution and shape as it relates to longer term outcomes.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dr. John Emmett Hall: a legacy in spine surgery.","authors":"Richard M Schwend, Richard E McCarthy","doi":"10.1007/s43390-026-01568-8","DOIUrl":"https://doi.org/10.1007/s43390-026-01568-8","url":null,"abstract":"<p><p>The study of biography is important to understand the principles of our profession and the intersections of the lives of the key figures in our spine deformity history. We hope that by telling these stories this history will come alive. The surgeons who came before us, as exemplified by Dr. John Emmett Hall, understood the importance of unwavering principles, developing close professional relationships, the value of travel, and the power of collaboration. The legacy of his full life is summed up by the plaque placed by the nurses in his operating room, at Boston Children's Hospital: \"The Dr. John E. Hall Room: Dedicated to Compassion, Respect, and Excellence\".</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Algorithmic fairness reporting in artificial intelligence for spinal deformity: a systematic review.","authors":"Ritvik R Jillala, Shivam Singh, Vikas N Vattipally, Daniel Lubelski, Amit Jain, Sang H Lee, Ali Bydon, Khaled M Kebaish, Christopher P Ames, Tej D Azad","doi":"10.1007/s43390-026-01573-x","DOIUrl":"https://doi.org/10.1007/s43390-026-01573-x","url":null,"abstract":"<p><strong>Purpose: </strong>Artificial intelligence (AI) and machine learning (ML) are increasingly studied for diagnosis, surgical planning, risk stratification, and outcome prediction in spinal deformity. However, these models may reproduce inequities when datasets, outcome definitions, or validation strategies incompletely represent diverse populations. Given the rapid growth of AI in spinal deformity, there is a need to evaluate how algorithmic fairness is reported and assessed.</p><p><strong>Methods: </strong>A systematic review was performed in accordance with PRISMA guidelines. PubMed, Embase, Cochrane, Scopus, and Web of Science were searched in May 2026 for studies applying AI or ML to spinal deformity care. Studies were evaluated for application domain, population, data modality, model type, validation strategy, demographic reporting, subgroup performance, calibration, and fairness audit or mitigation.</p><p><strong>Results: </strong>Fifty-eight studies were included: 33 image-based diagnosis or measurement studies (57%) and 25 clinical prediction or decision-support studies (43%). Age and sex or gender were commonly reported but rarely used for subgroup evaluation. Race, ethnicity, or skin tone were reported in 8 studies (14%), and socioeconomic or insurance-related variables in 1 study (2%). Fairness-aware evaluation was uncommon: 2 studies (3%) reported subgroup performance analyses, none evaluated subgroup calibration, and 2 studies (3%) described formal fairness audit or mitigation. Despite increasing technical sophistication, evaluation of demographic representativeness, subgroup reliability, and algorithmic equity remained limited.</p><p><strong>Conclusions: </strong>AI applications in spinal deformity show promise across diagnosis, measurement, surgical planning, prognosis, and postoperative prediction. Before clinical implementation, studies should improve demographic reporting, test subgroup performance and calibration, and evaluate whether model outputs perform equitably across clinically relevant populations.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Less opioid at no extra cost: charge-code decomposition of an ERAS pathway for adolescent scoliosis surgery.","authors":"Mark Gamadia, Jonathan Marshall, Anne Stuedemann, Liz Edmundson, Michael Benvenuti, Richard M Schwend, John T Anderson, K Aaron Shaw","doi":"10.1007/s43390-026-01565-x","DOIUrl":"https://doi.org/10.1007/s43390-026-01565-x","url":null,"abstract":"<p><strong>Purpose: </strong>Enhanced recovery after surgery (ERAS) pathways using dexamethasone and liposomal bupivacaine (Dex/LB) have been shown to reduce opioid use after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), but their economic impact is unknown. This study examined whether the Dex/LB pathway increases hospital cost, analyzing charge lines rather than encounter-level totals.</p><p><strong>Methods: </strong>Retrospective sequential implementation study at a single pediatric center. Of 140 consecutive AIS patients undergoing PSF (2019-2025), a transitional cohort (n = 20) was excluded, leaving 120 for primary analysis: traditional (n = 87) versus Dex/LB (n = 33). Charge lines were classified a priori as protocol-sensitive (medication, hospital stay, anesthesia/recovery) or protocol-independent (implant cost, imaging, laboratory studies, etc.).</p><p><strong>Results: </strong>The Dex/LB group had lower inpatient opioid use (median 30.0 vs. 150.0 MME; adjusted - 133.7, 95% CI - 177.1 to - 90.3, P < 0.001) and shorter length of hospital stay (LOS) (2.1 vs. 2.8 days, P < 0.001; adjusted P = 0.46). Total Direct Cost was higher in the DEX/LB cohort ($57,288 vs. $50,780, P = 0.006), but protocol-sensitive Direct Cost did not differ ($5873 vs. $6324; adjusted +$326, 95% CI - $679 to $1330, P = 0.52), with decrease LOS offsetting increased LB cost. The total cost increase traced to implant charges (+ $7034, P < 0.001) from concurrent billing changes. When implants were excluded, total Direct Cost did not differ (- $880, P = 0.58). Cost equivalence was sensitive to payer composition (Medicaid exclusion: +$596, P = 0.035).</p><p><strong>Conclusion: </strong>Protocol-sensitive Direct Cost did not differ significantly between the Dex/LB and traditional pathways. The apparent total cost increase was attributable to concurrent changes in implant charge capture unrelated to the analgesic protocol.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Walter Putnam Blount, MD (1900-1992) pioneer of modern scoliosis bracing and spine deformity care.","authors":"Richard M Schwend","doi":"10.1007/s43390-026-01569-7","DOIUrl":"https://doi.org/10.1007/s43390-026-01569-7","url":null,"abstract":"<p><p>Walter Putnam Blount was a thoughtful clinician, inventive surgeon, and careful observer of growth and deformity in children. His work ranged widely, from the mechanics of osteotomy and internal fixation to the nonoperative management of scoliosis. He combined an intense curiosity with intellectual honesty. Through innovations such as epiphyseal stapling for guided growth and the development of the Milwaukee brace for scoliosis, Blount helped reshape the treatment of deformity in growing children. At the same time, his teaching, writing, and international collaborations placed him among the early leaders of modern pediatric orthopaedics and spine deformity surgery.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Setting the future of SRS: the strategic plan.","authors":"Suken A Shah","doi":"10.1007/s43390-026-01567-9","DOIUrl":"https://doi.org/10.1007/s43390-026-01567-9","url":null,"abstract":"","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating reasoning-tuned large language models for clinical decision-making in spine surgery.","authors":"Chuck H Lam, Conor T Boylan, Adit Ravishankar, Alex Bulloso, George McKay, David L Skaggs, Morgan Jones","doi":"10.1007/s43390-026-01557-x","DOIUrl":"https://doi.org/10.1007/s43390-026-01557-x","url":null,"abstract":"<p><strong>Purpose: </strong>Most clinical evaluations of large language models assess factual recall rather than the multi-step reasoning behind operative plans. Reasoning-tuned models, post-trained to generate explicit intermediate reasoning before answering, may better approximate surgical decision-making. We compared two such models from different development ecosystems, OpenAI o1 and DeepSeek R1, on complex spine cases.</p><p><strong>Methods: </strong>Ten synthetic vignettes spanning deformity, degenerative, urgent, and cervical pathology were analysed; an eleventh was excluded owing to a survey error. Both models received identical prompts. Outputs were anonymised and randomised. Eight fellowship-trained spine surgeons (five consultants, three fellows) scored diagnostic accuracy, reasoning and thoroughness, surgical plan appropriateness, and clarity on 5-point Likert scales, giving 78 paired evaluations. Analysis used linear mixed-effects models with crossed random intercepts for rater and vignette (Bonferroni-adjusted alpha 0.0125); reliability was assessed by intraclass correlation.</p><p><strong>Results: </strong>o1 scored higher in all four domains, significantly for diagnostic accuracy (4.6 vs. 4.3; mean difference 0.24, 95% CI 0.11-0.38) and clarity (4.4 vs. 4.2; 0.26, 0.07-0.44); reasoning and thoroughness (0.21, 0.03-0.38), and surgical plan appropriateness (0.17, - 0.03 to 0.36) did not meet the adjusted threshold. Inter-rater reliability was poor (ICC 0.03-0.07). Clarity correlated strongly with the clinical domains (rho 0.74-0.79); adjusting for clarity attenuated the o1 advantage by 55% to over 100%, leaving no detectable clinical-domain difference.</p><p><strong>Conclusion: </strong>Both models produced plans surgeons usually rated good or excellent. o1 was rated higher, significantly only for diagnostic accuracy and clarity, most of it reflecting presentation rather than clinical content. Surgeon oversight and format-normalised evaluation designs remain essential.</p>","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}