Spine Surgery and Related Research最新文献

{"title":"Letter to the Editor: Evaluating the Clinical Readiness of General-Purpose Large Language Models in Evidence Synthesis.","authors":"Muhammad Kamran Khan","doi":"10.22603/ssrr.2026-0205","DOIUrl":"10.22603/ssrr.2026-0205","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"827-828"},"PeriodicalIF":1.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216739","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":"Association between Perioperative Blood Glucose Levels and Wound Complications in Diabetic Patients Undergoing Adult Spinal Deformity Surgery: A Retrospective Cohort Study.","authors":"Tomohiro Yamada, Yu Yamato, Tomohiko Hasegawa, Go Yoshida, Tomohiro Banno, Hideyuki Arima, Shin Oe, Hiroki Ushirozako, Koihiro Ide, Yusuke Murakami, Yukihiro Matsuyama","doi":"10.22603/ssrr.2025-0377","DOIUrl":"10.22603/ssrr.2025-0377","url":null,"abstract":"<p><strong>Introduction: </strong>Adult spinal deformity (ASD) surgery is highly invasive and carries a substantial risk of postoperative wound complications, particularly in patients with type 2 diabetes mellitus (DM). Perioperative hyperglycemia is a known risk factor for surgical-site infection, but glucose thresholds specific to patients with diabetes and ASD remain unclear.</p><p><strong>Methods: </strong>We retrospectively reviewed 437 adults who underwent ASD correction between 2010 and 2020, of whom 50 (11.4%) had type 2 DM. Capillary blood glucose was measured at standardized intervals from the day of surgery through postoperative day 3 and at least once daily thereafter until discharge. For each diabetic patient, we calculated an overall mean perioperative glucose value (mean of all in-hospital measurements from postoperative day 0 to discharge) and maximum/mean glucose during postoperative days 0-3. These patient-level indices were compared between patients with and without wound complications, and receiver operating characteristic (ROC) analysis based on overall mean glucose was used to explore thresholds associated with wound morbidity.</p><p><strong>Results: </strong>Wound complications occurred more often in patients with DM than those without DM (18.0% vs 3.1%, p<0.001). Among the patients with diabetes, overall mean perioperative glucose was higher in the wound-complication group than in the non-wound group (184.8±35.1 vs 156.1±26.6 mg/dL; p=0.020). ROC analysis of overall mean glucose yielded an area under the curve of 0.75 and suggested an exploratory threshold around 185 mg/dL. Patients with diabetes also had higher rates of systemic complications.</p><p><strong>Conclusions: </strong>Type 2 DM was associated with substantially increased wound morbidity and systemic complications after ASD surgery. Higher overall mean perioperative glucose in patients with diabetes was linked to wound complications, and an exploratory threshold near 185 mg/dL showed moderate discriminatory ability. These findings support the concept that tighter perioperative glycemic control may reduce wound morbidity, although the proposed threshold should be regarded as hypothesis-generating and should be confirmed in larger prospective studies.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"710-717"},"PeriodicalIF":1.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216837","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":"Full-Endoscopic Spine Surgery Enables High Rates of Pathogen Identification after Short-Term Antibiotic Therapy in Pyogenic Spondylitis.","authors":"Takafumi Ohshima, Masatoshi Morimoto, Kosaku Higashino, Kazuya Kishima, Seiji Yamaya, Kiyoshi Yagi, Ryota Mio, Naoto Ono, Takayuki Kitahara, Yuji Nagao, Seiya Watanabe, Saori Soeda, Daiki Nakajima, Hiroshi Kageyama, Hiroaki Manabe, Fumitake Tezuka, Junzo Fujitani, Koichi Sairyo","doi":"10.22603/ssrr.2026-0027","DOIUrl":"10.22603/ssrr.2026-0027","url":null,"abstract":"<p><strong>Introduction: </strong>Prompt and accurate identification of pathogens is essential for effective treatment of pyogenic spondylitis. However, conventional non-surgical methods, such as blood culture and percutaneous needle biopsy, have limited sensitivity and reliability. This multicenter study investigated whether specimen collection during full-endoscopic spine surgery (FESS) is more useful than the conventional diagnostic modalities.</p><p><strong>Methods: </strong>We retrospectively analyzed data for 53 patients diagnosed with pyogenic spondylitis across three participating institutions between January 2021 and April 2025. Pathogen identification rates were compared between FESS, percutaneous needle biopsy, and blood culture. The patients were stratified into three groups based on duration of pre-procedural antibiotic therapy (0 days, 1-13 days, or ≥14 days) to determine the influence of antibiotic exposure on diagnostic yield. Multivariate analysis was performed to adjust for inflammatory markers and clinical factors.</p><p><strong>Results: </strong>The overall pathogen identification rate was 79.2%, with <i>Escherichia coli</i> (20.8%) and Staphylococcus aureus (17.0%) being the most frequent isolates. FESS achieved the highest identification rate (59.2%), followed by needle biopsy (45.2%) and blood culture (38.6%). Although detection rates were similar among the three methods in antibiotic-naïve patients, FESS demonstrated a significantly higher detection rate in the 1-13-day antibiotic group than blood culture (87.5% vs 16.7%, p=0.026), whereas the difference between FESS and needle biopsy (57.1%) was not statistically significant. FESS yielded positive results in 15.6% of patients, identifying pathogens despite negative findings on both blood culture and needle biopsy.</p><p><strong>Conclusions: </strong>FESS enables direct targeted sampling of infected tissues, resulting in pathogen identification rates that are higher than those with conventional diagnostic methods, particularly in patients with short-term antibiotic exposure. Unlike needle biopsy, FESS allows for the retrieval of adequate samples under direct vision. These findings indicate that FESS is a valuable diagnostic tool that complements its therapeutic role, potentially facilitating earlier optimization of antimicrobial therapy.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"718-725"},"PeriodicalIF":1.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676372/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216703","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":"Temporal Observations of Multifidus Muscle Injury and Degeneration Following Posterior Thoracolumbar Spine Surgery: A Clinical Histological Study over a Three-Year Time Period.","authors":"Can Liu, Pan Deng, Xiao-Bo Li, De-Jian Xiang, Yu-Lin He, Xiao-Jun Huang","doi":"10.22603/ssrr.2025-0430","DOIUrl":"10.22603/ssrr.2025-0430","url":null,"abstract":"<p><strong>Introduction: </strong>To determine the consequences and potential mechanisms of injury to the multifidus muscle associated with surgery using the conventional thoracolumbar posterior approach.</p><p><strong>Methods: </strong>Patients were categorized into three groups based on the duration of time since their initial thoracolumbar fracture surgery: a 1-year postoperative group, a 2-year postoperative group, and a 3-year postoperative group. All patients required removal of internal fixation between May 2023 and June 2024. For each group, we performed morphometric analysis of the multifidus muscle using digital images, and muscle samples were subjected to histological analysis.</p><p><strong>Results: </strong>Digital photography indicated a significant temporal reduction in the proportion of muscle within the multifidus muscle, exhibiting a significant change over time (p<0.0001). Hematoxylin and eosin staining of histological samples revealed varying degrees of steatosis in the postoperative multifidus muscles; prolonged intervals following internal fixation surgery were associated with more pronounced fat infiltration. Analysis of the multifidus fibrosis using Masson's staining demonstrated that muscle fibers subjected to paravertebral muscle dissection surgery exhibited a tendency towards fibrosis, which increased over time. Reduced vessel density, defined by CD31 expression, was observed at all follow-up times, and the number of nerve fibers decreased significantly with increasing time post-surgery.</p><p><strong>Conclusions: </strong>Over time, the multifidus muscle exhibited obvious fibrosis and steatosis following traditional posterior thoracolumbar surgery. Our analyses suggest that the mechanism involved could be related to reduced angiogenesis and denervation.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"761-770"},"PeriodicalIF":1.6,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216819","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":"Delayed versus Same-Day Second-Stage Cervical Spine Surgery.","authors":"James F Bathon, Omar Zakieh, Claudia Davidson, Alicia M Hymel, Jacquelyn S Pennings, Mason W Young, Mitchell Bowers, Julian G Lugo-Pico, Raymond J Gardocki, Scott L Zuckerman, Byron F Stephens, Amir M Abtahi","doi":"10.22603/ssrr.2025-0335","DOIUrl":"10.22603/ssrr.2025-0335","url":null,"abstract":"<p><strong>Background: </strong>Two-stage, anterior and posterior, cervical spine surgery is often utilized for complex spinal pathologies. The second stage may be performed on the same day or delayed to a separate day. A variety of considerations influence this decision, yet comprehensive and broad analyses examining predictors and outcomes of same-day versus delayed staging remain limited.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to investigate the effects of same-day versus delayed staging on complications and surgical outcomes. Adults undergoing two-stage cervical procedures were identified using the Quality Outcomes Database. The primary exposure was delaying the second-stage surgery to a separate day, termed the delayed second stage. Demographic, clinical, and preoperative data were analyzed. Outcomes included patient-reported outcome measures (PROMs) and reoperation rates at 3, 12, and 24 months, as well as the 30-day complication rate.</p><p><strong>Results: </strong>Among 394 patients (mean age 60.8±10.7, 52.0% male), 27.9% had delayed second-stage surgery, the majority had an anterior approach as the first stage (87.8%), and patients who had delayed second-stage surgery were less likely to have American Society of Anesthesiologists scores ≥3 (43.6% vs. 64.5%, p<0.001). Patients with delayed second-stage surgery had longer operative times (326±37.0 vs. 293±34.0 minutes, p=0.022) and longer hospital stays (4.4±0.79 vs. 3.1±0.54 days, p<0.001), with no significant differences in blood loss, reoperation rates, PROMs at 3, 12, and 24 months, or 30-day complication rates (all p>0.05).</p><p><strong>Conclusions: </strong>These results suggest that delaying the second stage may be more a question of resource utilization rather than concern for a negative impact on patient outcomes. Surgeons should acknowledge that either staging strategy, same-day or delayed, results in equivalent clinical outcomes with some differences in perioperative outcomes. The choice to delay second-stage surgery should be patient-centered and consider institutional factors.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 4","pages":"558-566"},"PeriodicalIF":1.6,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13477760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763794","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":"Reply to: \"Evaluating the Clinical Readiness of General-Purpose Large Language Models in Evidence Synthesis\".","authors":"Masaki Sakamoto, Shintaro Honda, Bungo Otsuki, Koichi Murata, Takayoshi Shimizu, Takashi Sono, Koichiro Shima, Takaki Yoshiyama, Ryohei Saito, Kosei Ono, Atsushi Tanaka, Shuichi Matsuda","doi":"10.22603/ssrr.2026-0258","DOIUrl":"10.22603/ssrr.2026-0258","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"829-830"},"PeriodicalIF":1.6,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216806","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":"Occult Proximal Femur Fractures Mimicking Lumbar Spinal Stenosis.","authors":"Masahiro Kawanishi, Naokado Ikeda, Hidekazu Tanaka, Kunio Yokoyama, Yutaka Ito","doi":"10.22603/ssrr.2026-0034","DOIUrl":"10.22603/ssrr.2026-0034","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"824-826"},"PeriodicalIF":1.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216682","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":"Neurological Recovery Trajectories in Older Patients with Cervical Spinal Cord Injury: A Multicenter Longitudinal Study.","authors":"Ryosuke Hirota, Yoshinori Terashima, Makoto Emori, Atsushi Teramoto, Noriaki Yokogawa, Takeshi Sasagawa, Hiroaki Nakashima, Naoki Segi, Sadayuki Ito, Toru Funayama, Fumihiko Eto, Akihiro Yamaji, Kota Watanabe, Satoshi Nori, Kazuki Takeda, Takeo Furuya, Atsushi Yunde, Hideaki Nakajima, Tomohiro Yamada, Tomohiko Hasegawa, Hidenori Suzuki, Yasuaki Imajo, Shota Ikegami, Masashi Uehara, Hitoshi Tonomura, Munehiro Sakata, Ko Hashimoto, Yoshito Onoda, Nobuyuki Suzuki, Kenji Kato, Hiroshi Uei, Hirokatsu Sawada, Kazuo Nakanishi, Kosuke Misaki, Hidetomi Terai, Koji Tamai, Akiyoshi Kuroda, Gen Inoue, Yoichi Iizuka, Eiji Takasawa, Koji Akeda, Norihiko Takegami, Haruki Funao, Yasushi Oshima, Takashi Kaito, Daisuke Sakai, Toshitaka Yoshii, Shoji Seki, Seiji Okada, Shiro Imagama, Satoshi Kato","doi":"10.22603/ssrr.2026-0064","DOIUrl":"10.22603/ssrr.2026-0064","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to characterize neurological recovery trajectories in patients with cervical spinal cord injury, aged ≥65 years.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study used registry data from the Japan Association of Spine Surgeons with Ambition. Patients aged ≥65 years with traumatic cervical spinal cord injury and complete International Standards for Neurological Classification of Spinal Cord Injury motor score data at baseline, 6 weeks, and 6 months post-injury, were included (n=222). Neurological assessments included total, upper extremity, and lower extremity motor scores; the American Spinal Injury Association Impairment Scale (AIS) and motor zone of partial preservation. Motor recovery and AIS conversion were analyzed based on baseline and 6-week AIS grades.</p><p><strong>Results: </strong>Motor recovery occurred predominantly within the first 6 weeks after injury. From baseline to 6 weeks, patients with baseline AIS B and C exhibited significantly greater improvement in total motor score than those with AIS A and D. From 6 weeks to 6 months, measurable recovery persisted in patients with AIS C at 6 weeks, whereas those with AIS A or B demonstrated minimal additional gains. AIS conversion followed a similar pattern: 38.5%, 63.6%, and 82.7% among patients with baseline AIS A, B, and C, respectively, which improved by 6 weeks, whereas conversions beyond 6 weeks were uncommon. Among patients who remained AIS A or B at 6 months, motor zone of partial preservation extension occurred almost exclusively within the first 6 weeks.</p><p><strong>Conclusions: </strong>In older patients with cervical spinal cord injury, most neurological recovery under routine clinical practice occurs within the first 6 weeks after injury. The magnitude of motor recovery and AIS conversion in this cohort was comparable to outcomes reported in age-unrestricted populations, suggesting that meaningful early neurological recovery can be observed even in older patients and highlighting the importance of early neurological assessment.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"693-701"},"PeriodicalIF":1.6,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216687","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":"Sagittal Alignment-Dependent Mechanical Interference during Robotic-Assisted S2 Alar-Iliac Screw Insertion.","authors":"Hiroaki Manabe, Yutaka Kinoshita, Takayuki Kitahara, Kazuta Yamashita, Saori Soeda, Takafumi Ohshima, Hiroshi Kageyama, Seiya Watanabe, Junzo Fujitani, Daiki Nakajima, Makoto Takeuchi, Masatoshi Morimoto, Fumitake Tezuka, Koichi Sairyo","doi":"10.22603/ssrr.2026-0099","DOIUrl":"10.22603/ssrr.2026-0099","url":null,"abstract":"<p><strong>Introduction: </strong>Although robotic-assisted spinal instrumentation enables highly accurate screw placement, mechanical feasibility constraints remain underrecognized. During sacral instrumentation, a collision between the robotic arm and the patient's body may prevent completion of S2 alar-iliac (S2AI) screw placement as planned. Alignment-related factors associated with failure of this procedure have not been clearly defined. The aim of this study was to identify spinopelvic alignment factors associated with mechanical interference during robotic-assisted S2 alar-iliac (S2AI) screw insertion.</p><p><strong>Methods: </strong>This retrospective observational study included 17 consecutive patients who underwent planned robotic-assisted S2AI screw insertion using the Cirq robotic alignment system (Brainlab) between July 2022 and January 2026. Patients were categorized into a success group (robotic guidance completed as planned) and an interference group (robotic guidance abandoned because of mechanical collision requiring conversion to a conventional technique). Supine spinopelvic parameters, including lumbar lordosis, sacral slope, pelvic tilt, and pelvic incidence, were evaluated preoperatively. Continuous variables were compared between groups using the Mann-Whitney <i>U</i> test.</p><p><strong>Results: </strong>Robotic guidance was successfully completed in 13 patients (76%) and discontinued because of mechanical interference in 4 (24%). Supine lumbar lordosis was significantly greater in the interference group (median 58.5° vs. 27.6°, p=0.0008). All cases in the interference group demonstrated lumbar lordosis >50°, whereas none in the successful group exceeded this value (p<0.001). Pelvic tilt demonstrated complete separation between groups, with negative values in all interference cases and positive values in all successful cases (p=0.0008). Sacral slope was significantly higher in the interference group (p=0.0055), whereas pelvic incidence and skin-to-bone distance were not associated with interference.</p><p><strong>Conclusions: </strong>Mechanical interference during robotic-assisted S2AI screw insertion was associated with a sagittal alignment profile characterized by increased lumbar lordosis and anterior pelvic orientation. Recognition of alignment-dependent spatial constraints may improve preoperative assessment and help predict technical difficulty.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"802-808"},"PeriodicalIF":1.6,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216789","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 Rare Case of Distant Intradural Extramedullary Thoracic Metastasis from an Intracranial Solitary Fibrous Tumor.","authors":"Naoki Nishimura, Toshiki Okubo, Narihito Nagoshi, Yuji Nakayama, Ryota Tamura, Takahito Iga, Kazuki Takeda, Masahiro Ozaki, Satoshi Suzuki, Kota Watanabe, Masaya Nakamura","doi":"10.22603/ssrr.2026-0148","DOIUrl":"10.22603/ssrr.2026-0148","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"10 5","pages":"820-823"},"PeriodicalIF":1.6,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13676364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216828","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}