Shoulder and Elbow最新文献

{"title":"Clinical outcomes of a novel 'all-suture' fixation for valgus-impacted proximal humeral fractures.","authors":"Chad Brooker-Thompson, Hariharan Mohan, Neil Chotai, Toby Baring","doi":"10.1177/17585732231184208","DOIUrl":"10.1177/17585732231184208","url":null,"abstract":"<p><strong>Background: </strong>Conventional techniques for the fixation of displaced proximal humeral fractures include the use of locking plates, intramedullary nailing, hemiarthroplasty and reverse shoulder replacement. Valgus-impacted fractures are a common subtype of proximal humeral fracture, but there are few publications concerning the outcomes of treatment. This study aims to review outcomes following an 'all-suture' technique for this fracture subtype without the use of transosseous sutures.</p><p><strong>Methods: </strong>All patients over the age of 18 who presented with 3- or 4-part valgus-impacted proximal humeral fractures and who underwent 'all-suture' repair at our centre were included. We reviewed their post-operative imaging and collected data on post-operative complications and patient-reported outcome measures.</p><p><strong>Results: </strong>We identified 15 patients who had undergone all-suture fixation. The cohort's mean age was 56. Eleven patients were female. Eight patients had 3-part fractures and seven patients had 4-part fractures. There were no major post-operative complications. All fractures united. The mean Oxford Shoulder Score was 43.7 and the mean Single Assessment Numerical Evaluation score was 85.9 at the final follow-up.</p><p><strong>Discussion: </strong>Our results suggest that all-suture fixation of proximal humeral fractures presents an attractive alternative to conventional techniques, whilst avoiding complications relating to metalwork implantation.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":"28 1","pages":"605-610"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81383694","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":"Chest wall soft tissue thickness is associated with humeral shaft non-union: A radiographic study.","authors":"Alex Chowdhury, Kizzie A Peters, Henry B Colaço, Iain Ar MacLeod","doi":"10.1177/17585732231190325","DOIUrl":"10.1177/17585732231190325","url":null,"abstract":"<p><strong>Background: </strong>Anecdotally, upper truncal obesity and large breasts have often been associated with inferior outcomes from non-operative management of diaphyseal humerus fractures. However, this assertion is without basis in the literature.</p><p><strong>Aims: </strong>To produce radiographic measurements of chest wall soft tissue thickness (STT) and determine association with non-union in diaphyseal humerus fractures.</p><p><strong>Methods: </strong>Two hundred and seventeen consecutive non-operative humeral shaft fractures were included. Radiographic STT measurements were taken at three standardised points (upper, middle and lower) using a simple reproducible method, with ratios derived (dividing these figures by the mid-humerus diameter). Bivariate and multivariable analyses were used to assess association with non-union.</p><p><strong>Results: </strong>There were 58 (26.7%) cases of non-union. On multivariable analysis, the middle (odds ratio (OR) 1.39, p <  0.001) and lower (OR 1.23, p = 0.009) STT measurements were independently associated with non-union. Additionally, the middle (OR 1.85, p < 0.001) and lower (OR 1.47, p < 0.001) STT ratios were independently associated with non-union. A receiver operating characteristic curve determined a threshold value of a middle STT ratio of ≥ 3 (OR 3.73, p < 0.001, sensitivity 69.0%, specificity 62.3%), which was independently associated with non-union.</p><p><strong>Conclusion: </strong>Chest wall STT is independently associated with humeral shaft non-union. Threshold values can assist in decision making for these fractures.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":"29 1","pages":"611-620"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91241754","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":"Photodynamic therapy for <i>Cutibacterium acnes</i> decolonization of the shoulder dermis.","authors":"John G Horneff, Alayna Vaughan, Manan Patel, Thema Nicholson, Serge Tzeuton, Mark Lazarus, Surena Namdari, Joseph A Abboud","doi":"10.1177/17585732231192856","DOIUrl":"10.1177/17585732231192856","url":null,"abstract":"<p><strong>Introduction: </strong><i>Cutibacterium acnes (C. acnes)</i> is a common source of infection in shoulder surgery. 5-Aminolevulinic acid (5-ALA) is a naturally occurring metabolite of <i>C. acnes</i> that creates an exothermic reaction when activated by blue light. The purpose of this study was to evaluate the efficacy of preoperative photodynamic therapy using topical 5-ALA to decrease <i>C. acnes</i> colonization.</p><p><strong>Methods: </strong>Patients were randomized to receive topical 5-ALA skin solution activated by blue light photodynamic therapy or standard of care preoperative skin preparation. Prior to skin incision, two punch biopsy specimens were taken from the portal sites and were incubated for 13 days. Culture positivity rate, days until positive, and semiquantitative growth classification were analyzed.</p><p><strong>Results: </strong>Fifty patients undergoing arthroscopic shoulder surgery were randomized. The overall positive culture rate was 54%. All cultures were positive for <i>C. acnes</i> except for one. Sixty-four percent of standard preparation patients and 44% of investigational group patients had at least one positive culture for <i>C. acnes</i>. There was no significant difference between groups in patients with at least one positive <i>C. acnes</i> culture (<i>p</i> = 0.49).</p><p><strong>Conclusion: </strong>The use of photodynamic therapy undergoing arthroscopic shoulder surgery did not significantly reduce colonization of <i>C. acnes</i> as compared to standard preparation.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":"98 1","pages":"635-640"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77227226","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":"Isometric shoulder strength: Normative Australian population data and associated factors.","authors":"Phillip Fr Duke, Darcy Bennett, Ruby Strauss, Susan E Peters, Mark Ross","doi":"10.1177/17585732231190577","DOIUrl":"10.1177/17585732231190577","url":null,"abstract":"<p><strong>Background: </strong>Age and sex are known predictors of isometric shoulder strength and therefore must be accounted for when noting strength values or administering assessments such as the Constant Score. Given the popularity of the Constant Score, it is important to ensure protocols and values remain clinically relevant and are representative of the intended population.</p><p><strong>Method: </strong>Isometric shoulder strength was recorded for 511 participants without shoulder pathology using the Chatillon^TM hand-held dynamometer. Data were stratified by age and sex for comparison with published normative strength series. Other demographic variables were evaluated using linear regression models.</p><p><strong>Results: </strong>Normative values for shoulder strength were generated. Age (<i>p</i> = .003, <math><msup><mi>r</mi> <mn>2</mn></msup> <mo>=</mo> <mn>.010</mn></math> ) and sex (<i>p</i> < .001, <math><msup><mi>r</mi> <mn>2</mn></msup> <mo>=</mo> <mn>.026</mn></math> ) were significant predictors of shoulder strength. Height (<i>p</i> = .03, <math><msup><mi>r</mi> <mn>2</mn></msup> <mo>=</mo> <mn>.010</mn> <mo>)</mo></math> was a significant predictor of strength in females and weight was a significant predictor of strength in males (<i>p</i> < .001, <math><mspace></mspace> <msup><mi>r</mi> <mn>2</mn></msup> <mo>=</mo> <mn>.017</mn></math> ). Hand dominance was also significant, with non-dominant shoulder strength associated with higher strength in females (<i>p</i> < .001, <math><mspace></mspace> <msup><mi>r</mi> <mn>2</mn></msup> <mo>=</mo> <mn>.081</mn></math> ) and lower strength in males (<i>p</i> < .001, <math><mspace></mspace> <msup><mi>r</mi> <mn>2</mn></msup> <mo>=</mo> <mn>.154</mn></math> ).</p><p><strong>Conclusion: </strong>This study generated normative shoulder strength values for a sample of the Australian population and provided a comparison between other normative scores. Significant demographic predictors in addition to age and sex were identified.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":"46 1","pages":"621-627"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74188252","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":"Lifting limitations following elbow arthroplasty: A survey of British Elbow and Shoulder Society members.","authors":"Eleanor G Burden, Jonathan P Evans, Christopher D Smith","doi":"10.1177/17585732231170292","DOIUrl":"10.1177/17585732231170292","url":null,"abstract":"<p><p>The primary aim of this survey was to capture current practice with regard to lifting limitations following elbow arthroplasty. An online survey was emailed to all members of the British Elbow and Shoulder Society. All consultant respondents who reported performing elbow arthroplasty were asked about their advice for post-operative lifting limitations. In total, 115 surveys were completed: 55 consultants reported performing linked total elbow arthroplasty, 18 reported performing unlinked total elbow arthroplasty and 44 reported performing distal humeral hemiarthroplasty. The majority of elbow consultants advise a lifelong lifting limitation following linked and unlinked total elbow arthroplasty (78% and 61% respectively). There was variation in the weight specified for lifelong lifting limitations, the median weight restriction in linked total elbow arthroplasty was 5 lb, and in unlinked total elbow arthroplasty was 10 lb (range 1-20 lb). In total, 13% of consultants performing linked total elbow arthroplasty and 33% of consultants performing unlinked total elbow arthroplasty do not advise any lifelong lifting limitations post-operatively. In a perceived attempt to prolong implant longevity, most surgeons recommend lifelong lifting limitations following total elbow arthroplasty. There is variation in the weight restriction advised by consultant elbow surgeons. Currently the optimal weight restriction to maximise implant longevity is not known and further work needs to be done to understand the true relationship between activity, loading and implant failure.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":"105 1","pages":"641-645"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79215749","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 precise location of \"Midshaft\" clavicle fractures: Scrimmaging from the 42 yard-line.","authors":"Kofi D Agyeman, Joseph A Abboud, Steven P Kalandiak, Jonathan C Levy, Anand M Murthi, Grant Jamgochian, Mohamad Y Fares, Peter M Govey","doi":"10.1177/17585732231191204","DOIUrl":"10.1177/17585732231191204","url":null,"abstract":"<p><strong>Background: </strong>The realities of midshaft clavicle fracture distribution have not been described accurately. Consequently, a topographical depiction of midshaft clavicle fractures may help design implants that are more anatomically concordant with the fractured clavicle, leading to better outcomes and fewer complications.</p><p><strong>Methods: </strong>This is a retrospective cohort study. One-hundred sixty-six surgically treated midshaft clavicle fractures of four fellowship-trained shoulder surgeons were evaluated to determine the precise \"location\" of the fracture on standard radiographs. This location was determined by noting the lateral, central, and medial endpoint of each fracture, expressed as a percentage (0%-100%) of the distance from the lateral to the medial end of the clavicle.</p><p><strong>Results: </strong>Fractures on average began at the 36% line (SD = 6%), were centered at the 42% line (SD = 6%), and ended at the 48% line (SD = 7%). Ninety percent of fractures were centered lateral to the midpoint, and 64% were completely lateral to the midpoint. Thirty-two percent of midshaft fractures extended into the lateral third of the clavicle, but no fractures extended into the medial third.</p><p><strong>Conclusion: </strong>Midshaft clavicle fractures in skeletally mature individuals appear to occur predominantly within the lateral metadiaphyseal half of the clavicle, and rarely extend into the medial third. Industry professionals and surgeons alike should consider this when designing and selecting implants. To note, our study relied on two-dimensional radiographs, and future studies should work on fully capturing the complex three-dimensional anatomy of the clavicle.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":"31 1","pages":"628-634"},"PeriodicalIF":1.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11622320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83794217","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 'vulnerable nerve'; surgically acquired neuropathy in distal humeral surgery patients and the role of a tourniquet.","authors":"Mark G Williams, Sophie J Donoghue, Ellen Thomas, Jonathan P Evans, William Thomas, Christopher Smith","doi":"10.1177/17585732241284255","DOIUrl":"10.1177/17585732241284255","url":null,"abstract":"<p><strong>Background: </strong>The complication of neuropathy is high in patients undergoing distal humerus surgery. Tourniquets (TQs) are typically used but can lead to nerve injury.</p><p><strong>Methods: </strong>We present a comparative study of a pre-intervention group (<i>n</i> = 38) and a post-intervention group (<i>n</i> = 38) undergoing distal humerus surgery between November 2020 and July 2023. The intervention included TQ discontinuation and the introduction of intravenous tranexamic acid at induction. Our analysis encompasses patient, anaesthetic, and surgical variables, as well as the rates and severity of neuropathy.</p><p><strong>Results: </strong>Post-intervention, the rate of surgically acquired or deterioration in nerve injury improved from 15.8% (<i>n</i> = 6) to 2.6% (<i>n</i> = 1). Pre-intervention, the mean TQ duration was significantly longer for patients with post-operative neuropathy versus those without (120 min, SD = 29 vs. 88 min, SD = 38, <i>p</i> = 0.032). Surgery duration was not significantly longer without a TQ but was associated with a greater reduction in haemoglobin (12.7 g/L, SD = 10.9 vs. 25.2 g/L, SD = 15.5, <i>p</i> = 0.03).</p><p><strong>Discussion: </strong>Trauma patients have a high risk of acquiring a nerve injury following elbow surgery or deterioration of a pre-surgical nerve injury, which emphasises the concept of vulnerable nerves. The cessation of using a TQ was associated with a lower nerve injury rate, with no cases of major nerve injury and no significant increase in surgical time.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241284255"},"PeriodicalIF":1.5,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629973","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":"ChatGPT provides acceptable responses to patient questions regarding common shoulder pathology.","authors":"Umar Ghilzai, Benjamin Fiedler, Abdullah Ghali, Aaron Singh, Benjamin Cass, Allan Young, Adil Shahzad Ahmed","doi":"10.1177/17585732241283971","DOIUrl":"10.1177/17585732241283971","url":null,"abstract":"<p><strong>Background: </strong>ChatGPT is rapidly becoming a source of medical knowledge for patients. This study aims to assess the completeness and accuracy of ChatGPT's answers to the most frequently asked patients' questions about shoulder pathology.</p><p><strong>Methods: </strong>ChatGPT (version 3.5) was queried to produce the five most common shoulder pathologies: biceps tendonitis, rotator cuff tears, shoulder arthritis, shoulder dislocation and adhesive capsulitis. Subsequently, it generated the five most common patient questions regarding these pathologies and was queried to respond. Responses were evaluated by three shoulder and elbow fellowship-trained orthopedic surgeons with a mean of 9 years of independent practice, on Likert scales for accuracy (1-6) and completeness (rated 1-3).</p><p><strong>Results: </strong>For all questions, responses were deemed acceptable, rated at least \"nearly all correct,\" indicated by a score of 5 or greater for accuracy, and \"adequately complete,\" indicated by a minimum of 2 for completeness. The mean scores for accuracy and completeness, respectively, were 5.5 and 2.6 for rotator cuff tears, 5.8 and 2.7 for shoulder arthritis, 5.5 and 2.3 for shoulder dislocations, 5.1 and 2.4 for adhesive capsulitis, 5.8 and 2.9 for biceps tendonitis.</p><p><strong>Conclusion: </strong>ChatGPT provides both accurate and complete responses to the most common patients' questions about shoulder pathology. These findings suggest that Large Language Models might play a role as a patient resource; however, patients should always verify online information with their physician.</p><p><strong>Level of evidence: </strong>Level V Expert Opinion.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241283971"},"PeriodicalIF":1.5,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629945","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":"Lateralization and inclination angle in reverse arthroplasty-what do we know?","authors":"Anders L Ekelund, Didier Poncet","doi":"10.1177/17585732241281910","DOIUrl":"10.1177/17585732241281910","url":null,"abstract":"<p><p>Since the original Grammont design of a reverse shoulder arthroplasty there has been a trend to decrease inclination angle from 155° to 145 or 135°. Furthermore, lateralization on the glenoid side has been advocated. These changes decrease the risk for impingement between humerus and the inferior part of the glenoid (notching). These changes were also made to improve restoration of rotation. However, there is very little evidence that rotation has improved due to these changes. A negative effect of lateralization is that it increases the risk for glenoid loosening. Furthermore, the stress on acromion increases which may lead to more acromion or scapula spine fractures. More randomized studies are needed to define optimal design of a reverse shoulder arthroplasty.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241281910"},"PeriodicalIF":1.5,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629955","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":"Is revision to anatomic shoulder arthroplasty still an option? A systematic review.","authors":"Musab Gulzar, Kathryn M Welp, Michelle J Chang, Jarret M Woodmass, Jacob A Worden, Hayden L Cooke, Krishna N Chopra, Michael B Gottschalk, Eric R Wagner","doi":"10.1177/17585732241284512","DOIUrl":"10.1177/17585732241284512","url":null,"abstract":"<p><strong>Background: </strong>With the historical complications when using total shoulder arthroplasty (TSA) to revise failed arthroplasties, and the success of the reverse prosthesis in the revision setting, the question arises whether revision to TSA is still a reasonable option? This systematic review examines revision to TSA and the factors associated with outcomes.</p><p><strong>Methods: </strong>A systematic review was performed for studies of TSA used to revise a failed hemiarthroplasty or TSA. The primary outcome was implant failure leading to a repeat revision arthroplasty. Secondary outcomes included visual analog scale (VAS) pain scores, shoulder motion and other clinical outcomes of shoulder function. Data were pooled to generate representative frequency-weighted means.</p><p><strong>Results: </strong>Thirteen studies were included, totaling 312 shoulders. Etiologies for revision included glenoid arthrosis (62%), glenoid component failure (36%), and other (2%). Of which, 39% of cases experienced complications and 12% required another arthroplasty revision. Secondary outcomes such as VAS pain, Constant, ASES and UCLA score improved, but none were statistically significant. Unsatisfactory outcomes were higher among patients with glenoid bone loss, instability, and soft tissue deficiencies.</p><p><strong>Discussion: </strong>Revision to anatomic TSA can be an acceptable option in certain patients. However, the high rate of complications and glenoid loosening, makes this a limited approach for a revision to anatomic TSA procedure.</p>","PeriodicalId":36705,"journal":{"name":"Shoulder and Elbow","volume":" ","pages":"17585732241284512"},"PeriodicalIF":1.5,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629953","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}