Journal of Hand and Microsurgery最新文献

{"title":"Hand reconstruction with multi-pedicled anterolateral thigh flap.","authors":"Trần Thiết Sơn, Phan Tuấn Nghĩa, Phạm Thị Việt Dung, Tạ Thị Hồng Thuý, Đặng Phương Nam, Tahsin Oğuz Acartürk","doi":"10.1016/j.jham.2025.100336","DOIUrl":"10.1016/j.jham.2025.100336","url":null,"abstract":"<p><p>Complex hand defects that involve multiple components present significant challenges for reconstructive surgery. The Anterolateral Thigh (ALT) flap is one of the most versatile options in reconstructive microsurgery, offering numerous advantages. Variations in ALT anatomy enable the creation of different types of multi-pedicle flaps, which aid in addressing complex injuries. This study involved 116 patients treated with the ALT flap for hand lesions, with a focus on 20 patients who received multipedicle flaps for complex hand defects. Among these, ten patients were treated with adipocutaneous multi-pedicled flaps for the coverage of defects, while the remaining ten patients received a combination of adipocutaneous and FL multi-pedicled flaps, which enabled both the covering of the skin and the reconstruction of the extensor tendon. Prior to thinning, the average thickness of the flaps was measured at 21 mm, which was subsequently reduced to an average of 6.5 mm following the thinning procedure. The overall survival rate of the flaps was 97.5 %, and two patients required defatting after one year. Patient satisfaction regarding both functional and aesthetic outcomes was reported to be high. Multi-pedicle flaps that incorporate two skin islands or combinations of skin islands and FL flaps have proven to be highly effective for complex, multi-unit hand reconstruction. The success of this technique is influenced by various factors, including the types and number of perforators, the composition of the flap, the methods used for thinning, and the specific arrangement of flaps tailored to each defect.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100336"},"PeriodicalIF":0.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12391788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973528","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":"Challenges and complications of trans-osseous carpal tenodesis for scapholunate ligament tears.","authors":"Mikko P Räisänen, Nicholas C Smith, Fransisco Del Piñal","doi":"10.1016/j.jham.2025.100338","DOIUrl":"10.1016/j.jham.2025.100338","url":null,"abstract":"<p><p>Scapholunate (SL) instability remains a challenging condition with significant possibility of implications for wrist function and long-term outcomes. This review explores the limitations and complications of current trans-osseous scapholunate ligament (SLL) reconstruction techniques, focusing on isometric reconstruction challenges and complications, for example osteonecrosis, tunnel fractures, graft failure, and iatrogenic extrinsic ligament injuries. Through biomechanical analysis and clinical case reviews, we demonstrate that the conventional three-ligament tenodesis (3LT) scaphoid tunnel has high risk of resulting in a non-isometric volar scapho-trapezial (vST) ligament reconstruction, potentially exacerbating carpal instability. Additionally, trans-osseous techniques have risk of osteonecrosis and fracture, which can accelerate degenerative changes and necessitating salvage procedures. This paper will additionally highlight concerns regarding tendon graft viability, anchor failure, and the critical role of extrinsic ligaments in SL stability. It will also be shown that modular arthroscopic approaches, which focus on selective ligament repair, may provide better outcomes with fewer complications and lower morbidity compared to traditional reconstructions. Future advancements probably should prioritise preserving bone vascularity and minimising iatrogenic injury, guiding surgeons toward safer and more effective treatment strategies.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100338"},"PeriodicalIF":0.5,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12390943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973468","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 osteocutaneous superficial circumflex iliac artery (SCIP) flap in extremity reconstruction.","authors":"Cédric Zubler, Mihai A Constantinescu, Ioana Lese, Radu Olariu","doi":"10.1016/j.jham.2025.100337","DOIUrl":"10.1016/j.jham.2025.100337","url":null,"abstract":"<p><strong>Introduction: </strong>Reconstruction of composite defects involving both soft tissue and bone in the extremities remains a complex challenge in reconstructive surgery. The osteocutaneous superficial circumflex iliac artery perforator (SCIP) flap combines a pliable skin island with vascularized iliac bone, offering a potential solution. However, reports on its application in reconstruction of the upper and lower limb remain limited. This study evaluates our clinical experience using osteocutaneous SCIP flaps for extremity reconstruction, with particular attention to surgical details, bony union and long-term outcomes.</p><p><strong>Methods: </strong>A retrospective review was conducted of all patients who underwent upper or lower extremity reconstruction with an osteocutaneous SCIP flap between September 2019 and April 2024 at a single tertiary trauma centre. Clinical data, surgical details, complications, and follow-up outcomes were collected. Bone union was assessed radiographically, and functional outcomes were evaluated using the Lower Extremity Functional Scale (LEFS) where applicable.</p><p><strong>Results: </strong>Nine patients (eight male, one female; mean age 48 years) underwent reconstruction using the osteocutaneous SCIP flap - six in the lower limb and three in the upper extremity. All flaps survived, providing successful soft tissue coverage. Full-thickness iliac bone segments (mean 5 × 3.2 cm) were harvested. Bony union was achieved in 8 of 9 cases (89 %) after a mean of 8.25 months. One case of pseudoarthrosis required secondary bone grafting. Two early postoperative hematomas were surgically drained, and one patient developed a donor-site iliac wing fracture, managed conservatively. Functional outcomes were favourable: all lower limb patients achieved full weight-bearing ambulation (mean LEFS score 59.4), and upper extremity patients regained useful hand function. Mean postoperative follow-up was 26.3 months.</p><p><strong>Conclusion: </strong>The osteocutaneous SCIP flap is a reliable option for reconstruction of composite defects in the extremities, offering stable soft tissue coverage and vascularized bone suitable for structural support and osseous integration. In our opinion, this flap represents a valuable addition to the reconstructive toolbox, particularly in cases requiring a moderately sized segment of bone and thin, customizable soft tissue coverage.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100337"},"PeriodicalIF":0.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12355524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875832","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":"Robotic-assisted technique in plastic and reconstructive surgery: Experience in Taiwan.","authors":"Yi-Chia Chen, Ming-Hsien Chung, Chieh-Kai Chang, Cheng-Yeu Wu, Yi-Ling Lin, Yueh-Chi Tsai, Chen-Te Lu, I-Chen Chen, Chih-Sheng Lai","doi":"10.1016/j.jham.2025.100332","DOIUrl":"10.1016/j.jham.2025.100332","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted surgery (RAS) has increasingly been applied in the field of plastic and reconstructive surgery, offering enhanced precision, reduced invasiveness, and improved patient outcomes. This review summarizes Taiwan's pioneering experience with robotic-assisted techniques in this specialty, with an emphasis on clinical applications, educational models, and future directions.</p><p><strong>Methods: </strong>A narrative literature review was conducted focusing on robotic-assisted plastic and reconstructive surgery with relevance to Taiwanese clinical practice. Articles published between January 2000 and April 2024 were considered. Searches were performed in PubMed, Google Scholar, and Cochrane Library using the keywords: \"robotic surgery,\" \"plastic surgery,\" \"reconstructive surgery,\" \"Taiwan,\" and \"microsurgery.\" Inclusion criteria were: (1) studies involving robotic-assisted surgical techniques, (2) relevance to plastic and reconstructive surgery, (3) Taiwanese institutional or clinical context, and (4) availability of clinical or technical outcome data. Articles not published in English, lacking original data, or unrelated to the Taiwan context were excluded.</p><p><strong>Results: </strong>Robotic-assisted techniques were successfully applied in various reconstructive domains, notably in microsurgical anastomosis for free flap procedures, nerve transfers, and minimally invasive mastectomies. These approaches demonstrated favorable outcomes in terms of operative precision, reduced complications, and patient satisfaction. Taiwan's major medical centers, including Chang Gung Memorial Hospital and Taichung Veterans General Hospital, have been instrumental in driving these innovations. Furthermore, robotic training models facilitated the learning curve for microsurgeons and supported the integration of robotic platforms into surgical education.</p><p><strong>Conclusions: </strong>Taiwan's experience underscores the feasibility and clinical value of robotic-assisted techniques in plastic and reconstructive surgery. Robotic platforms not only improve surgical outcomes but also expand the scope of reconstructive options. Ongoing research and educational efforts are crucial to optimizing technique standardization and surgeon training in this rapidly evolving field.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 6","pages":"100332"},"PeriodicalIF":0.5,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12337664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838146","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":"Managing complex hand, wrist, and forearm injuries with WALANT: A case-based technical report.","authors":"Mikko P Räisänen, Mikael S Hytönen, Yrjänä A Nietosvaara, Matti T Juntunen","doi":"10.1016/j.jham.2025.100295","DOIUrl":"10.1016/j.jham.2025.100295","url":null,"abstract":"<p><p>Wide-Awake Local Anaesthesia No Tourniquet (WALANT) is an effective and increasingly utilised method of anaesthesia for the surgical treatment of injuries to the hand, wrist, and forearm. Despite its proven safety, efficacy, and cost-effectiveness, the adoption of WALANT has been limited, particularly in Western healthcare systems where general and regional anaesthesia predominate, especially in complex injuries. We report the application of WALANT in a variety of hand surgical procedures for the treatment of complex injuries ranging from complex fractures to multiple soft tissue injuries in adult patients. WALANT's benefits includes active intraoperative testing of the strength of tendon repairs and osteosynthesis which applies also to complex injuries. Additionally, nerve repairs can also be actively tested under WALANT, leading to more effective and safer postoperative rehabilitation. We anticipate that WALANT will soon see broader application even in more complex surgeries, extending to the surgical treatment of complex injuries around and above elbow.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 5","pages":"100295"},"PeriodicalIF":0.5,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12268562/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676084","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":"Anatomical morphometry of the proximal humerus in the Vietnamese population: A comparative study using multiplanar computed tomography and cadaveric dissection.","authors":"Thy Gia Anh Le, Nguyen Tri Phan, Phi Duong Nguyen","doi":"10.1016/j.jham.2025.100294","DOIUrl":"10.1016/j.jham.2025.100294","url":null,"abstract":"<p><strong>Background: </strong>Fractures of the proximal humerus are prevalent among the elderly, often posing challenges in anatomical reconstruction and internal fixation. Precise anatomical knowledge tailored to specific populations is essential for optimal surgical outcomes. This study aims to quantitatively evaluate the anatomical characteristics of the proximal humerus in the Vietnamese population through multiplanar computed tomography (CT) and cadaveric measurements, and to determine the consistency between the two modalities.</p><p><strong>Methods: </strong>A prospective descriptive study was conducted on 75 CT scans and 30 shoulder specimens from 15 fresh cadavers. Parameters measured included the neck-shaft angle, diameters of the humeral head (superior-inferior and anterior-posterior), width of the greater tuberosity, deltoid tuberosity index, and distances from the greater tuberosity to anatomical landmarks such as the lesser tuberosity, bicipital groove, and pectoralis major insertion.</p><p><strong>Results: </strong>The average neck-shaft angle was 132.36° ± 2.44°, with most values within 130°-140°. The deltoid tuberosity index averaged 1.76 ± 0.20, exceeding thresholds reported in previous studies. No statistically significant differences were found between CT and cadaveric measurements across most parameters (p > 0.05). The anatomical measurements were found to be smaller than those reported in Western populations but comparable to other Asian populations.</p><p><strong>Conclusion: </strong>The study confirms that CT imaging provides reliable and accurate morphometric data comparable to cadaveric dissection. Key anatomical landmarks such as the pectoralis major insertion, lesser tuberosity, and bicipital groove can serve as consistent intraoperative references for implant positioning in Vietnamese patients.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100294"},"PeriodicalIF":0.3,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555294","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":"National trends in bone supplement use and vitamin D deficiency - implications for upper extremity surgery.","authors":"Rishub K Das, Brian C Drolet, Wesley P Thayer, Izabela A Galdyn","doi":"10.1016/j.jham.2025.100298","DOIUrl":"10.1016/j.jham.2025.100298","url":null,"abstract":"","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100298"},"PeriodicalIF":0.3,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12209920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555296","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":"Development of a novel artificial intelligence clinical decision support tool for hand surgery: HandRAG.","authors":"Berk B Ozmen, Nishant Singh, Kavach Shah, Ibrahim Berber, Damanjit Singh, Eugene Pinsky, Antonio Rampazzo, Graham S Schwarz","doi":"10.1016/j.jham.2025.100293","DOIUrl":"10.1016/j.jham.2025.100293","url":null,"abstract":"<p><strong>Purpose: </strong>Hand surgery decision-making requires integration of complex anatomical understanding, diverse patient-specific factors, and nuanced operative techniques. While artificial intelligence (AI), large language models (LLMs), and retrieval-augmented generation (RAG) models have advanced significantly in various fields, no AI-driven clinical decision support systems currently exist for hand surgery. A novel retrieval-enhanced AI large language model specifically tailored for hand surgery was developed, capable of effectively utilizing peer-reviewed published hand surgery literature for clinical decision support in real-time at point of care.</p><p><strong>Methods: </strong>An AI clinical decision support system was developed integrating all available open-access 4510 peer-reviewed hand surgery publications from 2000 to 2024 identified through hand surgery-relevant keywords. Documents were processed using a hierarchical pipeline based on the RAPTOR methodology, which breaks down large texts into smaller segments to enhance accurate retrieval. The system was evaluated using 15 standardized clinical queries assessed using automated computational metrics for correctness and semantic similarity to source documents.</p><p><strong>Results: </strong>The AI system demonstrated consistent performance with an average G-Eval correctness score of 0.79, SEM with an average similarity score of 0.75 (range: 0.54-0.86) and average maximum similarity score of 0.80 (range: 0.56-0.91), predominantly at moderate confidence levels. Generated recommendations were contextually appropriate and reliably linked to relevant hand surgery literature, providing accurate and clinically meaningful guidance.</p><p><strong>Conclusion: </strong>The AI system, HandRAG, incorporating RAG and LLM approach offers potential benefits for evidence-based clinical decision support and education in hand surgery.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100293"},"PeriodicalIF":0.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144555295","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":"Reliability and validity of Camry dynamometer for isometric hand grip strength measurement in healthy Indian adults.","authors":"Vrushali Panhale, Raveena Kini, Shreya Kothale","doi":"10.1016/j.jham.2025.100291","DOIUrl":"10.1016/j.jham.2025.100291","url":null,"abstract":"<p><strong>Background: </strong>The Jamar dynamometer is the gold standard to assess hand grip strength, but is expensive. The Camry dynamometer is relatively cost-effective. There is a dearth of literature on Camry's validation in healthy Indian adults, which is important to establish as hand grip is known to vary with age, gender and race.</p><p><strong>Objectives: </strong>To establish the reliability and validity of the Camry dynamometer in comparison to the Jamar handheld dynamometer among healthy Indian adults in the age group of 20-59 years.</p><p><strong>Methods: </strong>Following basic demographics, occupation and hand dominance, three trials of each dynamometer were performed in standardised positions for the non-dominant and dominant hand of each participant and the best value was recorded. A gap of 10 min was provided between the 2 dynamometers. Data was then recorded and analyzed.</p><p><strong>Results: </strong>120 participants were recruited, with an equal males and females. The mean isometric hand grip strength for the non-dominant hand was 26.71 ± 9.29 kgf, and for the dominant hand was 27.66 ± 9.12 kgf using the Camry hand-held dynamometer, while it was 26.43 ± 9.07 kgf for the non-dominant and 27.37 ± 9.26 kgf for the dominant side using the Jamar Hand Held dynamometer. Data was further analyzed with age and gender stratification. The Camry hand-held device had excellent reliability (ICC>0.97) and good validity with Pearson's correlation index of 0.97 (p < 0.05) for the dominant hand and 0.99 (p < 0.05) for the nondominant hand, and Bland-Altman's graphics showing more than 90 % of measures within confidence limits.</p><p><strong>Conclusion: </strong>Camry digital dynamometer is a reliable and valid device to measure isometric handgrip strength in healthy Indian adults compared to the Jamar hydraulic handgrip dynamometer.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100291"},"PeriodicalIF":0.3,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12206103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530303","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":"Older age is a predictor for hardware failure in open lower extremity fractures requiring free flap coverage.","authors":"Ramin Shekouhi, Syeda Hoorulain Ahmed, Harvey Chim","doi":"10.1016/j.jham.2025.100287","DOIUrl":"10.1016/j.jham.2025.100287","url":null,"abstract":"<p><strong>Background: </strong>The primary objective of this study was to investigate incidence and factors associated with hardware failure in a cohort of patients with open tibial and ankle fractures who underwent free flap coverage in conjunction with open reduction and internal fixation (ORIF) and hardware placement. Secondary objectives were to determine incidence of fracture union and limb salvage. Finally, we sought to identify flap-related factors that might impact rates of infection, flap failure, and nonunion.</p><p><strong>Methods: </strong>A consecutive single-surgeon series was studied. Baseline patient characteristics, flap-related factors, incidence of hardware failure, amputation, and non-union were extracted and analyzed.</p><p><strong>Results: </strong>A total of 37 consecutive patients with a mean age of 38.9 ± 16.4 years were included, with a mean postoperative follow-up of 703.4 ± 459.6 days. There were 9 patients (24.3 %) with hardware failure and deep tissue infection. Time from injury to flap and time from last ORIF to flap were not significantly different between patients with hardware failure and those without. Flap type (muscle versus fasciocutaneous), smoking status, diabetes and body mass index were not associated with hardware failure. Multivariate regression analysis controlling for potential confounders showed that older age in patients was the only significant factor predicting hardware failure. Bone union was achieved in 29 (78.4 %) patients. Mean time from surgery to radiological signs of union was 329.3 ± 425.3 days.</p><p><strong>Conclusion: </strong>In patients requiring free flap reconstruction and ORIF for open tibial and ankle fractures, age was the only significant non-modifiable risk factor for hardware failure.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"17 4","pages":"100287"},"PeriodicalIF":0.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318350","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}