Shoulder and Elbow最新文献

{"title":"A UK-based consensus exercise to determine the most acceptable method of suprascapular nerve block injection for people consulting with rotator cuff disorders.","authors":"Neil Smith, Dr Caroline Miller, Dr Steve Gwilym, Emma L Healey","doi":"10.1177/17585732251350116","DOIUrl":"10.1177/17585732251350116","url":null,"abstract":"<p><strong>Introduction: </strong>Suprascapular nerve block (SSNB) injections are used to treat shoulder pain in clinical practice. Its effectiveness compared to other shoulder pain relieving injections requires evaluation in high quality clinical trials. A range of different methods are used for SSNB injections. This study aimed to gain expert consensus on the most acceptable method of delivering SSNB injection in a future comparative clinical trial.</p><p><strong>Methods: </strong>Between October 2023 and May 2024, we conducted a three stage, online, modified Delphi survey with NHS clinicians who currently perform SSNB injections in the United Kingdom.</p><p><strong>Results: </strong>Thirty-eight NHS registered healthcare professionals completed Stage 1, 34 completed Stage 2 and 25 completed Stage 3. Anatomical land-marked and ultrasound guided SSNB injection methods reached consensus as acceptable to use in a multi-centre clinical trial. Targeting the supraspinatus fossa (SSF) or the suprascapular notch (SSN) reached consensus as acceptable. Finally, Kenalog (40 mg) or Depo-medrone (40 mg) combined with either Bupivacaine 0.25% (5-10 ml), Bupivacaine 0.5% (5 ml to10 ml), Lidocaine 1% (5-10 ml) all reached consensus as acceptable injectates.</p><p><strong>Conclusions: </strong>This consensus study has provided valuable information from expert NHS clinicians to help determine the method of SSNB injection delivery in the conduct of a future clinical trial.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251350116"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508696","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":"Management of acute septic native elbow arthritis - a systematic review.","authors":"Dylan Mistry, Chetan Khatri, Madeleine Bickley, Gunaratnam Shyamalan, Shahbaz Malik, Robert Jordan","doi":"10.1177/17585732251351944","DOIUrl":"10.1177/17585732251351944","url":null,"abstract":"<p><strong>Background: </strong>Elbow septic arthritis makes up about 6-9% of all septic arthritis cases. Optimum management and outcomes are extrapolated from other large joints and there is very scarce literature specifically for the elbow joint. This systematic review aims to analyse the available evidence on the management and outcomes of native septic arthritis of the elbow.</p><p><strong>Methods: </strong>A review using PRISMA guidelines was conducted of three databases. Adult patients suffering from native elbow septic arthritis were included. Outcomes of interest included functional outcomes and complications.</p><p><strong>Results: </strong>About 11 studies with 47 patients were included. The most common causative organism was staphylococcus aureus. About 46 patients were managed with surgery, either arthroscopic or open. About 17 patients, across three studies, had a Mayo Elbow Performance Score reported ranging from 70.0-100.0 and 77% of patients regained range of motion. About 12.9% of patients returned to theatre during their initial infection, 5% of patients developed a repeat infection and there was a 7% mortality rate.</p><p><strong>Discussions: </strong>This review shows good outcomes for this group of patients, however there is a group who are at risk of significant morbidity and mortality. Further evidence is needed to identify how to optimise treatment in this subset.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251351944"},"PeriodicalIF":1.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12187696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508697","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":"Proximal ulna fracture dislocation: Review of current concepts and surgical management.","authors":"Fiona Ashton, Joideep Phadnis","doi":"10.1177/17585732251348668","DOIUrl":"10.1177/17585732251348668","url":null,"abstract":"<p><p>Proximal ulna fracture dislocations (PUFDs) encompass a wide spectrum of injuries from relatively benign isolated ulna fractures to highly complex fractures with multiple osseous and ligamentous components. Classification of these injuries is challenging with few validated systems which generally focus on only one aspect of the injury. Surgical management of these injuries remains fraught with high rates of complications and poor long-term outcomes, and any subsequent salvage surgery is often extremely challenging. The aim of this review is to provide a framework for the evaluation and surgical management of these injuries using simple pathoanatomical principles where each key component of a PUFD is considered in turn, along with suggested surgical strategies and tips and tricks gleaned from the authors' clinical experience and available literature.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251348668"},"PeriodicalIF":1.5,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12181187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477142","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":"Epidemiology and time trends of isolated greater tuberosity fractures from 1944 to 2020 - A cohort study in Malmö, Sweden.","authors":"Anton Cederwall, Björn E Rosengren, Henrik G Ahlborg","doi":"10.1177/17585732251344547","DOIUrl":"10.1177/17585732251344547","url":null,"abstract":"<p><strong>Background: </strong>Although up to 25% of proximal humeral fractures are isolated greater tuberosity fractures (IGTFs), comprehensive epidemiological data are lacking.</p><p><strong>Objectives: </strong>Describe the epidemiology and time trends of IGTF in Malmö, Sweden, 1944-2020.</p><p><strong>Methods: </strong>We identified IGTF in Malmö residents (≥18 years) by reviewing relevant radiology examinations during 17 sample years from 1944 to 2020. Fractures were classified according to the Mutch classification.</p><p><strong>Results: </strong>In total, 614 IGTF (60% women) were identified (mean age women 60 (SD 16), men 48 (SD 16)). Among individuals <50 years, the incidence was lower in women than men (9 95% confidence interval (CI) 7-10] vs 15 [95% CI 13-18] per 100,000 persons years) whereas the reverse was found in individuals ≥50 years (36 [95% CI 30-42] vs 19 [16-23]). No statistically significant time trends in the incidence rate were observed from year 1944 to 2020. We identified 45% avulsion-, 44% split- and 11% depression-fractures.</p><p><strong>Conclusions: </strong>IGTF is more common in men than women in age-group <50 years, while the opposite is found in age-group ≥50 years. No statistically significant time trend was observed in IGTF incidence from 1944 to 2020 in Malmö, Sweden.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251344547"},"PeriodicalIF":1.5,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209805","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":"Measurement properties of core outcomes in patients with tennis elbow.","authors":"Håkon Sveinall, Jens Ivar Brox, Kaia B Engebretsen, Aasne Fenne Hoksrud, Cecilie Røe, Marianne Bakke Johnsen","doi":"10.1177/17585732251344264","DOIUrl":"10.1177/17585732251344264","url":null,"abstract":"<p><strong>Background: </strong>The Patient-Rated Tennis Elbow Evaluation (PRTEE), pain on gripping, pain-free, and maximum grip strength are widely used outcomes for tennis elbow. This study tested the measurement properties with a prospective test-retest study design.</p><p><strong>Methods: </strong>100 participants with tennis elbow were included. The reliability, internal consistency, validity, responsiveness, and the Minimal Important Change (MIC) were evaluated.</p><p><strong>Results: </strong>The reliability of all measures was acceptable. 8/15 PRTEE items were below the criteria for content validity. For PRTEE total score (0-100), the smallest detectable change 95% (SDC_95%) was 17 points, and for the pain and function subscales (0-50) 8 and 12. For pain on gripping (0-10), the SDC_95% was 4, and 6.4 kg for pain-free grip strength and 8.4 kg for maximum grip strength. The MIC for PRTEE total score was 9 points, 11 for pain and 4 for function. The MIC was 3.5 for pain on gripping, and 6.5 kg and 1 kg for pain-free and maximum grip strength. Construct validity was confirmed for PRTEE, pain-free grip strength, and pain on gripping. PRTEE pain and pain-free grip strength were responsive.</p><p><strong>Conclusion: </strong>All measurements were reliable. PRTEE had questionable content validity. The interpretation of MIC is challenging due to large measurement errors.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251344264"},"PeriodicalIF":1.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200338","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":"Partial repair versus superior capsule reconstruction in managing massive rotator cuff tears. A meta-analysis of the current evidence.","authors":"Mohamed A Khalafallah, Mohamed I Mohamed, Mohamed M Farrag, Hazem A Bishara, Duncan Muir, Ali Narvani, Emilio Calvo, Mohamed A Imam","doi":"10.1177/17585732251345137","DOIUrl":"10.1177/17585732251345137","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff tear (RCT) is a common musculoskeletal condition. Managing RCTs can be challenging. Initial treatments typically involve conservative approaches such as physical therapy and corticosteroid injections. This meta-analysis compared the functional and clinical outcomes of two surgical techniques, Partial Repair (PR) and Superior Capsular Reconstruction (SCR), for managing rotator cuff tears.</p><p><strong>Methods: </strong>The search included studies published in PubMed, Scopus, Web of Science, and Cochrane Library databases from 2013 to 2023. Studies comparing SCR with PR techniques in rotator cuff tear patients were included. Primary outcome was Constant shoulder score.</p><p><strong>Results: </strong>Four cohort studies, totaling 235 patients, were included and analysed. There were no statistically significant differences between SCR and PR groups in constant shoulder score (<i>P</i> = 0.12), disabilities of the arm, shoulder, and hand (<i>P</i> = 0.42), acromiohumeral distance (<i>P</i> = 0.61), re-operation rate (<i>P</i> = 0.33), forward flexion (<i>P</i> = 0.73), and Visual Analog Score (VAS) score (<i>P</i> = 0.69). Heterogeneity was observed in some outcomes.</p><p><strong>Discussion: </strong>Based on the available low level of evidence and observed heterogeneity, this meta-analysis did not identify significant disparities in functional and clinical outcomes between SCR and PR. Further high-quality clinical trials with larger sample sizes are warranted to confirm these findings.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251345137"},"PeriodicalIF":1.5,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200339","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":"Return to sport after shoulder arthroplasty: The role of fast-track rehabilitation in reverse shoulder arthroplasty.","authors":"Francesco Franceschi, Luca Saccone, Edoardo Giovannetti de Sanctis, Angelo Baldari, Gian Mauro De Angelis d'Ossat, Luca La Verde, Alessio Palumbo, Pier Paolo Ciampa, Antonio Caldaria","doi":"10.1177/17585732251345323","DOIUrl":"10.1177/17585732251345323","url":null,"abstract":"<p><strong>Introduction: </strong>Shoulder arthroplasty, encompassing Total Shoulder Arthroplasty (TSA) and Reverse Shoulder Arthroplasty (RSA), has become an essential treatment for severe glenohumeral arthritis and complex rotator cuff pathologies. This study evaluated and compared clinical outcomes and return-to-sport rates in TSA patients following standard rehabilitation protocol and RSA patients following fast rehabilitation protocol.</p><p><strong>Material and methods: </strong>This retrospective study analyzed 44 patients (TSA: 13; RSA: 31) treated between 2020 and 2023 with at least 12 months of follow-up. Participants engaged in regular upper-extremity sports preoperatively. Patients in the TSA group followed a standard rehabilitation protocol, whereas those in the RSA group were assigned a new standardized fast rehabilitation protocol. Clinical outcomes were assessed using the Constant-Murley Score (CS), Visual Analogue Scale (VAS) for pain, and return-to-sport rates.</p><p><strong>Results: </strong>TSA patients showed a 100% return-to-sport rate, significantly higher than the 54.84% rate for RSA patients (p < 0.05). Functional outcomes were better in TSA (CS: 81 ± 13.18) compared to RSA (CS: 76.54 ± 8.3, p > 0.05). Within the RSA group, those who resumed sports had significantly higher CS scores (79.59 ± 7.41) than non-returners (73.21 ± 8.64, p < 0.05). Postoperative VAS was similarly low in both groups.</p><p><strong>Conclusion: </strong>TSA patients exhibited superior return-to-sport rates and functional outcomes compared to RSA patients, highlighting TSA's biomechanical advantages.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251345323"},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144182475","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 use of pyrocarbon as a bearing surface in shoulder arthroplasty: A systematic review and meta-analysis.","authors":"Geoffrey W Schemitsch, Patrick Carroll, Patrick Henry, Diane Nam, Ujash Sheth","doi":"10.1177/17585732251345077","DOIUrl":"10.1177/17585732251345077","url":null,"abstract":"<p><strong>Background: </strong>Pyrocarbon has been trialed as an alternative bearing surface to metal for young active patients with glenohumeral joint arthritis. The aim of this study was to systematically review and summarize the available evidence on reported outcomes of pyrocarbon implants in shoulder arthroplasty.</p><p><strong>Methods: </strong>A systematic review was conducted according and reported according to standardized guidelines. Patient demographics, complications, implant survivorship and patient-reported outcome measures were extracted and included in the quantitative analysis. Outcome data was summarized with weighted mean differences and proportions.</p><p><strong>Results: </strong>Fifteen studies were included with 904 patients and a median follow-up of 38 months. The pooled mean range of motion improvement was 43.9 degrees (95% confidence interval [95% CI] 36.7-51.2) in forward elevation and 24.1 degrees (95% CI 18.4-29.9) in external rotation. Pooled mean Constant Score improvement was 34.7 (95% CI 29.4-40.1) and Subjective Shoulder Value improvement was 40.6 (95% CI 33.4-47.8). The overall pooled re-operation rate was 8.03% (95% CI 5%-12.7%).</p><p><strong>Discussion: </strong>Pyrocarbon shoulder implants demonstrated improvements in functional outcomes with low revision rates at early- to mid-term follow-up. Further well-designed prospective studies with long-term follow-up are required to verify the safety and efficacy of pyrocarbon implants in shoulder arthroplasty.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251345077"},"PeriodicalIF":1.5,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12116484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144181290","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":"Predictors of operating room time in shoulder arthroplasty for glenohumeral osteoarthritis.","authors":"William E Harkin, Jay M Levin, Tyler Williams, Zeeshan A Khan, Alexander Hornung, Gregory P Nicholson, Christopher S Klifto, Grant E Garrigues","doi":"10.1177/17585732251343859","DOIUrl":"10.1177/17585732251343859","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to identify risk factors for prolonged operative duration in anatomic total shoulder arthroplasty (ATSA) and reverse total shoulder arthroplasty (RTSA) for patients with glenohumeral osteoarthritis (GHOA).</p><p><strong>Methods: </strong>A retrospective chart review of electronic medical records was conducted to identify patients who underwent shoulder arthroplasty for GHOA by one of six surgeons across two academic institutions between 2017 and 2023. Multivariate linear regression was used to identify factors associated with operative duration.</p><p><strong>Results: </strong>In total, 513 patients underwent primary ATSA, and 528 underwent primary RTSA. The mean operating room (OR) time was significantly longer in patients undergoing ATSA (183.5 ± 39.5 minutes) compared to those undergoing RTSA (150.5 ± 33.4 minutes). For ATSA, older patient age, male sex, increased body mass index, lower Charlson comorbidity index (CCI), increased preoperative retroversion, increased preoperative inclination, and a glenoid Walch classification of B2 or B3 were significant predictors of OR time. For RTSA, younger patient age, lower CCI, and increased preoperative retroversion were significant predictors of OR time.</p><p><strong>Conclusion: </strong>ATSA has a significantly longer mean OR time than RTSA for the treatment of isolated GHOA. Preoperative demographic and radiographic data can be used to predict operative duration.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251343859"},"PeriodicalIF":1.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143876","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":"Shortened length of stay and its impact on total shoulder arthroplasty expenses.","authors":"William ElNemer, Arman Kishan, Henry M Fox, Sarah Nelson, Gergo B Merkely, Nicholas A Alfonso, Nikolaos K Paschos, Matthew J Best, Uma Srikumaran","doi":"10.1177/17585732251344159","DOIUrl":"10.1177/17585732251344159","url":null,"abstract":"<p><strong>Background: </strong>The volume of both anatomic and reverse total shoulder arthroplasty (TSA) has increased in the United States over the last decade. A reduction in length of stay (LOS) postoperatively is a clear way to reduce hospital costs and labor burden. This study aimed to quantify how the LOS reduction has impacted inpatient TSA costs.</p><p><strong>Methods: </strong>The study queried the National Inpatient Sample (NIS) database to identify individuals undergoing inpatient elective TSA for osteoarthritis from 2012 to 2020. Total costs were determined by multiplying the hospital's cost-to-charge ratio from NIS by the total charges, inflation-adjusted to 2020. Bivariate linear regression assessed the LOS trend, and multivariate gamma regression with log link modeled TSA total cost and charge, adjusting for patient variables and operational year. Predicted total cost and charge were plotted postmodel fitting. Additionally, LOS was standardized to the 2012 mean for model predictions.</p><p><strong>Results: </strong>Numbers are reported as national estimates. In all, 527,300 patients were identified with an average age of 69 years, and 47% were male. The average LOS in 2012 was two days and had a decreasing trend to 1.2 days in 2020 (ß = -0.01, <i>p</i> < .001). Multivariate analysis revealed that increased LOS postoperatively was an independent predictor of increased total charges and costs of surgery after adjustment for covariates including overall health of the patient. Between 2012 and 2020, there was an observed increase in total costs despite accounting for the decrease in LOS. The total costs of surgery would have increased 11.8% ($18,597.03 to $20,792.84) from 2012 to 2020 if surgeons maintained the 2012 LOS; total costs would have increased 5.5% ($18,597.03 to $19,628.92) from 2012 to 2020.</p><p><strong>Conclusion: </strong>Total hospital costs for total shoulder replacement increased by 23% from 2012 to 2020. This increase in total cost was simultaneously dampened by the concurrent reduction in LOS, from 2 days to 1.2 days. By recognizing the tangible link between shorter lengths of stay and economic savings, healthcare institutions can make informed decisions that promote both fiscal responsibility and quality patient care.<b>Level of Evidence::</b> 3.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732251344159"},"PeriodicalIF":1.5,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12102086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143880","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}