Spine Surgery and Related Research最新文献

{"title":"Separation Surgery and Adjuvant Carbon Ion Radiotherapy for a Recurrent Solitary Fibrous Tumor/Hemangiopericytoma: A Case Report.","authors":"Yusuke Tomomatsu, Eiji Takasawa, Shintaro Shiba, Masahiko Okamoto, Hayato Ikota, Kazuhiro Inomata, Akira Honda, Sho Ishiwata, Tokue Mieda, Yoichi Iizuka, Tatsuya Ohno, Hirotaka Chikuda","doi":"10.22603/ssrr.2022-0177","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0177","url":null,"abstract":"The treatment of solitary fibrous tumor/hemangiopericytoma (SFT/HPC) remains challenging because gross total resection is difficult for vertebral lesions located near the spinal cord. Adjuvant chemotherapy and radiotherapy can be considered for cases of recurrence or malignant change. We herein report our experience of performing separation surgery and adjuvant carbon ion radiotherapy (CIRT) for a rare case of recurrent spinal SFT/HPC. Ten years ago, a 74-year-old woman visited a public hospital with a 2-month history of chest pain, muscle weakness, and hypesthesia in her lower extremities. Magnetic resonance imaging (MRI) revealed an extradural, extramedullary dumbbell-shaped tumor at the T4-T5 level (Fig. 1-A). She underwent subtotal tumor resection combined with T2-T7 fusion. Pathological examination of the resected specimen revealed SFT/HPC grade 3. Seven years after the initial surgery, she was referred to our university hospital because of unsteady gait due to progressive thoracic myelopathy. Imaging studies showed local recurrence of the tumor. We performed partial resection of the tumor surrounding the dural sac because total resection was considered to have a high risk of spinal cord injury. Postoperatively, she was able to walk without support. Two years after her second operation, she gradually became bedridden due to progressive gait disturbance with dysesthesia below the T5 level. MRI showed spinal cord compression due to the regrowth of the recurrent tumor with vertebral invasion (Fig. 1-B). We planned separation surgery and adjuvant CIRT. Following additional laminectomy, the tumor was observed as a nodular, tan to reddish-brown mass, which surrounded the dura mater. An ultrasonic scalpel was used to remove the tumor adjacent to the dural sac. Gelfoam of 1-cm thickness wrapped with Goa-Tex membrane (Fig. 2-A) was placed between the ventral dura mater and the residual tumor as a spacer (Fig. 2-B). We then applied 5.5-mm Ti-alloy rods medially to allow for the optimal trajectory of irradiation (Fig. 2-C). After separation surgery, adjuvant CIRT was performed once a day, 4 days per week, in a total of 16 fractions over 4 weeks with the respiratory-gated plan (Fig. 3-B) for a total dose of 64.0 Gy. Two years after separation surgery and adjuvant CIRT, the tumor size had decreased, and local control was maintained (Fig. 3-C, 3-D). The patient was able to walk with a cane without CIRT-related adverse events. Histopathological examination revealed spindle cells proliferating with staghorn-like shaped vessels (Fig. 4-A, 4-B). According to immunohistochemistry, the intervening blood vessels expressed biomarkers CD34, and tumor cells were positive for the nuclear marker STAT6, indicating SFT (Fig. 4-C, 4-D). The final diagnosis was SFT/HPC grade 3. The local control rates of SFT/HPC treated with gross total and subtotal resection are reported to be 84% and 30%, respectively, with a time to recurrence of approximately 5 years. Although CIRT i","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"402-405"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cb/00/2432-261X-7-0402.PMC10447192.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10099808","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 Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 4. Surgical Treatment.","authors":"Gen Inoue","doi":"10.22603/ssrr.2022-0209","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0209","url":null,"abstract":"・Surgical procedures should be selected with patient consent based on comprehensive evaluations, including short-term and long-term clinical outcomes, risk of complications, and cost-effectiveness. Surgical treatment is indicated when conservative treatments are less effective or severe neurological symptoms in the cauda equina, such as bladder and bowel dysfunction, are noted. ・Several reports have indicated that decompression for lumbar spinal stenosis (LSS) produces better clinical outcomes than conservative treatment. It is suggested to perform decompression for patients with LSS without spinal segmental instability diagnosed by physical findings and imaging, in whom conservative treatment is ineffective. ・While decompression with fusion is useful for patients with spinal instability and the improvement of Quality of Life (QOL)/Activities of Daily Living (ADL) is expected, the cost is higher than that of decompression alone, and the return-to-work rate is slightly poorer. The rates of complications and reoperation are also higher than those of decompression alone. So, fully considering pathological conditions and surgical procedures to examine indications is necessary, such as instability and the need for long-segment fusion. ・The bone union state may affect clinical outcomes, but a clear recommendation cannot currently be presented. ・It is suggested to use local bone and to combine the use of artificial bone, demineralized bone matrix, and allogenic bone as the bone graft material for spinal fusion. ・A clear recommendation cannot be made as to whether surgical treatment using Interspinous Process Devices (IPDs) or dynamic stabilization using pedicle screws is more useful than conservative treatment, decompression, or fusion surgery for LSS. ・For patients with LSS, minimally invasive spine surgery may be more useful for preventing the occurrence of iatrogenic instability, alleviating low back pain, and reducing the bleeding volume than conventional surgery, and it is suggested to perform it. ・Even in the very elderly aged 80 years (octagenarian and over), surgical treatment for LSS improves their clinical symptoms.","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"308-313"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/14/06/2432-261X-7-0308.PMC10447186.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108266","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":"Clinical Outcomes of Condoliase Injection Therapy for Lateral Lumbar Disc Herniation.","authors":"Yujiro Kagami,&nbsp;Hiroaki Nakashima,&nbsp;Naoki Segi,&nbsp;Ryuichi Shinjo,&nbsp;Shiro Imagama","doi":"10.22603/ssrr.2022-0189","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0189","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the efficacy of condoliase injection therapy (CIT) for lateral lumbar disc herniation (LLDH).</p><p><strong>Methods: </strong>This retrospective study included 157 of 180 enrolled patients (70 males, 87 females; mean age: 52.6±16.9 years). These patients were divided into two groups (group L: LLDH, group M: medial LDH [subligamentous and transligamentous]). From baseline to 1 year after injection (final follow-up), leg pain was assessed using the visual analog scale (VAS) and the Japanese Orthopedic Association (JOA) scoring for CIT's clinical efficacy of CIT. Radiography and magnetic resonance imaging conducted before and 3 months after the injection were assessed. Patients with a VAS improvement of ≥50% at the final follow-up were defined as responders. The responder and nonresponder LLDH groups were also compared.</p><p><strong>Results: </strong>Groups L and M showed comparable responder rates (75.0% and 77.4%, respectively) (<i>P</i>=0.80). VAS and JOA scores at 1 year showed no significant differences between the groups (<i>P</i>=0.82 and 0.80, respectively). VAS score at 1 month after injection reduced considerably in the responder group compared with that in the nonresponder group (19.7 vs. 66.0, <i>P</i><0.01) and continued to decrease at the last follow-up (3.5 vs. 52.0, <i>P</i><0.001). Nonresponders had significantly lower disc heights after 3 months. However, intervertebral instability, alignment, and disc degeneration did not differ between the responders and nonresponders.</p><p><strong>Conclusions: </strong>The response rate of CIT for LLDH was comparable to that for medial LDH. Therefore, CIT is an effective treatment for LLDH.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"363-370"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3e/24/2432-261X-7-0363.PMC10447184.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10108279","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":"Thoracic Dislocation Fracture Complicated by a Serious Electric Shock Injury: A Case Report.","authors":"Ryosuke Hirota,&nbsp;Atsushi Teramoto,&nbsp;Mitsumasa Chiba,&nbsp;Masahiro Onuma,&nbsp;Hidetomo Narimatsu,&nbsp;Takatoshi Yotsuyanagi,&nbsp;Toshihiko Yamashita","doi":"10.22603/ssrr.2023-0007","DOIUrl":"https://doi.org/10.22603/ssrr.2023-0007","url":null,"abstract":"The patient, a 14-year-old boy, was injured after he collided with a high-voltage power line, which led to his loss of consciousness and caused him to fall from a 20-meterhigh steel tower. After being taken to a nearby hospital, he was flown by helicopter to our hospital for multidisciplinary treatment, where he was administered light sedation for pain relief. His initial measurements were 112/68-mmHg blood pressure, 118-beats/min heartbeat, respiratory rate of 15 breaths/ min, SpO2 of 100%, and body temperature of 38.0°C. His posterior neck, chest, and back were all severely burned (Fig. 1), and he had lost all motor and sensory function caudally from the Th10 level. He was diagnosed with an electric shock injury, a Th 10/11 dislocation fracture (AO type classification; type C), and a complete thoracic spinal cord injury. Concomitant injuries included Th 7.8.9.12 fractures, right hemothorax, left hemothorax, and multiple rib fractures (Fig. 2A-D). MRI revealed a complete spinal cord tear at the Th10/11 level (Fig. 2E). The paraspinal muscles showed high signals on MRI T2 weighted imaging, respectively (Fig. 2F-G). After confirming partial dislocation repair by manual traction under fluoroscopic guidance, we performed percutaneous posterior stabilization (Th5-L2) with percutaneous pedicle screws (PPS) without bone fusion. Relatively good realignment was achieved by intraoperative compression of the injured area in the supine position (Fig. 3A-D). On day 20 after injury, Th7-12 anterior intervertebral body fusion was performed via the extraperitoneal approach to reconstruct the anterior column (Fig. 3E-H). Debridement of burned skin was performed on the 5th, and skin grafting on the back was performed on the 35th day after the injury, respectively. The grafted skin survived well, and the wound healed completely on day 47 (Fig. 4). Rehabilitation, including wheelchair mobility training, could be started after two-stage spine surgery. On the 70th day after the injury, the wound was well-healed, and the patient was transferred to a nearby hospital. Electric shock injuries may be accompanied by deep tissue injury to the nerves, blood vessels, muscles, and bones. To our knowledge, this is the first report of severe electroshock injury combined with spinal cord injury. Recently, the concept of spine damage control has been reported in the field of spine trauma injuries, often accompanied by complications caused by high-energy trauma, such as iliac and pelvic ring fractures. Early stabilization of the spinal column promotes hemodynamic stability, respiratory failure, and systemic management and prevents complications. Initial stabilization with PPS and two-stage anterior strut reconstruction may be helpful in cases of high spinal instability and soft tissue damage. In this case, early surgery allowed good alignment without direct visual repair of the injured area. Electroshock wounds generally result in deep tissue damage, resulting in deep tissue necros","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"410-413"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e3/ab/2432-261X-7-0410.PMC10447183.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10163405","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 Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 2. Diagnosis and Evaluation.","authors":"Miho Sekiguchi","doi":"10.22603/ssrr.2022-0080","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0080","url":null,"abstract":"•In the middle-aged and elderly, if pain and numbness are experienced from the buttocks to the lower limbs and the symptoms are exacerbated when walking and standing but alleviated when in the sitting and flexed positions, lumbar spinal stenosis (LSS) is very likely. Intermittent claudication is a characteristic symptom of LSS, but it is important to differentiate it from vascular intermittent claudication. •The “Diagnostic Support Tool for Lumbar Spinal Stenosis” is a convenient and useful tool for screening patients.","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"300-305"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d2/c6/2432-261X-7-0300.PMC10447202.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10109060","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":"Impact of Brace-Related Stress on Brace Compliance in Adolescent Idiopathic Scoliosis: A Single-Center Comparative Study Using Objective Compliance Measurement and Brace-Related Stress.","authors":"Tomoyuki Asada,&nbsp;Toshiaki Kotani,&nbsp;Tsuyoshi Sakuma,&nbsp;Yasushi Iijima,&nbsp;Keita Nakayama,&nbsp;Kazuhide Inage,&nbsp;Yasuhiro Shiga,&nbsp;Tsutomu Akazawa,&nbsp;Shohei Minami,&nbsp;Seiji Ohtori,&nbsp;Masao Koda,&nbsp;Masashi Yamazaki","doi":"10.22603/ssrr.2022-0246","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0246","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to investigate the brace compliance and clinical background of patients with adolescent idiopathic scoliosis (AIS) who demonstrate different degrees of psychological brace-related stress.</p><p><strong>Methods: </strong>Forty-five patients initiating brace treatment with a Cobb angle between 25° and 45° were included. Patients receiving brace treatment for AIS were administered a questionnaire for brace-related stress (i.e., the Japanese version of the Bad Sobernheim Stress Questionnaire-Brace [JBSSQ-brace]). Based on their scores, we allocated the patients into two stress groups: mild-stress (≥16 points) and below-moderate-stress (<16 points). We investigated the character of brace compliance and brace-related psychological stress in all patients and compared the demographics and brace compliance between both groups.</p><p><strong>Results: </strong>Forty-one of 45 patients completed the study. The mean JBSSQ-brace scores were 18.7±5.1, 19.1±5.2, and 18.7±5.0 points at the 1-month, 4-month, and 1-year follow-ups, respectively. There was no significant change in JBSSQ-brace scores over one year after the brace prescription (<i>P</i>=0.332). There was no difference in-brace compliance between seasons during the first month of brace prescription (<i>P</i>=0.252). Both groups' overall brace compliance was comparable (below-moderate: 17.1±7.1 h/day vs. mild: 20.4±3.0 h/day; <i>P</i>=0.078). The mild-stress group showed better compliance than the below-moderate-stress group on weekdays (below-moderate: 17.0±6.9 h/day vs. mild: 20.5±2.8 h/day; <i>P</i>=0.048) and at nighttime (below-moderate: 82.3%±27.0%/nighttime vs. mild: 93.8%±12.4%/nighttime; <i>P</i>=0.008).</p><p><strong>Conclusions: </strong>Overall, brace compliance was comparable among patients with different brace-related stress, but brace compliance during weekdays and nighttime was significantly better in the mild-stress group.</p>","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"377-384"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/74/5a/2432-261X-7-0377.PMC10447194.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10109064","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 Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 5. Postoperative Prognosis.","authors":"Miho Sekiguchi","doi":"10.22603/ssrr.2022-0082","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0082","url":null,"abstract":"Preoperative numbness at rest (OR 85.6) was associated with residual leg pain/numbness, and preoperative numbness at rest (OR 4.5) and foot drop (OR 11.6, 95% CI 2.5-59.1) were associated with residual gait disturbance. The degree of symptoms after surgery was stronger in the DM group than in the non-DM group. It is necessary to explain that leg numbness and pain tend to remain when performing surgery on LSS patients with DM. The mechanism of leg cramps is complex and remains inconclusive. Therefore, it cannot be confirmed whether leg cramps are a symptom of LSS or a comorbidity. Poor Prognostic Factors for Surgical Outcomes of LSS","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"314-318"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/9b/2432-261X-7-0314.PMC10447196.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10109065","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 Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 1. Definition, Epidemiology, and Natural History.","authors":"Miho Sekiguchi","doi":"10.22603/ssrr.2022-0079","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0079","url":null,"abstract":"Based on a historical background, LSS is not a single disease but a combination of various symptoms. At present, there is no uniform view on the definition of LSS. Disorders of the nervous and/or vascular elements are caused by the lumbar spinal canal or intervertebral foramen (anatomically not included in the spinal canal), and they induce symptoms in patients with LSS. In this edition, the diagnostic criteria (draft) of the 1 edition were revised, and the diagnostic criteria for LSS are proposed as follows: 1) presence of pain and numbness from the buttocks to the lower limbs, 2) symptoms from the buttocks to the lower limbs that appear or are exacerbated by continuous standing or walking and are alleviated with the maintenance of a forward flexion or sitting position, 3) either with or without low back pain, and 4) presence of findings of degenerative stenosis in imaging results, such as MRI, that can explain clinical findings. There is no consensus on the LSS definition as the etiology and pathological changes have not been completely elucidated.","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"298-299"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7e/cb/2432-261X-7-0298.PMC10447198.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10464077","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 Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021: 3. Conservative Treatment.","authors":"Katsushi Takeshita","doi":"10.22603/ssrr.2022-0081","DOIUrl":"https://doi.org/10.22603/ssrr.2022-0081","url":null,"abstract":"The","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"306-307"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/94/66/2432-261X-7-0306.PMC10447185.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10111109","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":"Introduction to the Essence of Clinical Practice Guidelines for Lumbar Spinal Stenosis, 2021.","authors":"","doi":"10.22603/ssrr.2023-0109","DOIUrl":"https://doi.org/10.22603/ssrr.2023-0109","url":null,"abstract":"","PeriodicalId":22253,"journal":{"name":"Spine Surgery and Related Research","volume":"7 4","pages":"297"},"PeriodicalIF":1.2,"publicationDate":"2023-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10447188/pdf/2432-261X-7-0297.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10084473","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}