Journal of the Pediatric Orthopaedic Society of North America最新文献

{"title":"Risk Factors for Loss to Follow Up in Pediatric Supracondylar Humerus Fractures.","authors":"Nathaniel Grey Loyd, David Hsiou, Armando Martinez, Pablo Coello, Lon Kai Pang, Muhammad Hamza Shamim, Jessica McGraw-Heinrich, Scott B Rosenfeld","doi":"10.1016/j.jposna.2024.100073","DOIUrl":"10.1016/j.jposna.2024.100073","url":null,"abstract":"<p><strong>Background: </strong>This study seeks to analyze risk factors associated with loss to follow up (LTF) after pin pull in pediatric patients with operatively treated supracondylar humerus fractures (SCHF).</p><p><strong>Methods: </strong>A retrospective cohort study of patients under 18 years with operative SCHF from 2010 to 2020 was conducted. Factors of interest included LTF, age, race, language, distance to the hospital, Gartland fracture type, and Social Deprivation Index (SDI) by ZIP code. Univariate logistic regression was performed for each independent variable and significant variables were additionally analyzed with multivariate logistic regression analysis.</p><p><strong>Results: </strong>Six hundred ninety-eight patients were included in the study. LTF was 27.8% (194/698). There was a significant difference in LTF between White and non-White (21.5% vs 31.8%, <i>P</i> = .003) patients. LTF patients had higher mean SDI scores by ZIP code (59.8 vs 45.7, <i>P</i> < .0001). When comparing the most deprived with the least deprived quartile, the odds ratio for LTF was 3.34 (95% CI 2.12-5.27). The patients lost to follow up were also younger (mean age of 6.9 years vs 7.8 years; <i>P</i> = .0004). After multivariate logistic regression, higher SDI and younger age remained significant.</p><p><strong>Conclusions: </strong>Higher social deprivation scores and younger age were associated with LTF in surgically treated pediatric SCHF at this institution.</p><p><strong>Key concepts: </strong>(1)Patients with higher Social Deprivation Index scores by ZIP code and younger age have higher rates of loss to follow up after pin pull for operatively managed supracondylar humerus fractures.(2)No differences in complications were seen in the loss to the follow-up group compared with those in the group that follow up.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"8 ","pages":"100073"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164728","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 Impact of Social Deprivation on Health Care Utilization Patterns Following Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures.","authors":"Elizabeth Cinquegrani, Matthew Van Boxtel, Sergey Tarima, Jessica Hanley","doi":"10.1016/j.jposna.2024.100071","DOIUrl":"10.1016/j.jposna.2024.100071","url":null,"abstract":"<p><strong>Background: </strong>Disparities in social determinants of health have been linked to worse patient-reported outcomes, higher postoperative pain, and increased risk of revision surgery following orthopaedic procedures. Identification of perioperative predictors of health care utilization is of particular interest to mitigate cost and improve patient outcomes. The aim of this study is to elucidate the effect of social deprivation levels, using the Area Deprivation Index (ADI), on health care utilization following the pinning of supracondylar humerus (SCH) fractures. Identifying risk factors for discrepancies in health care utilization following SCH fracture fixation can help mitigate unnecessary health care spending and improve the care of vulnerable patient populations.</p><p><strong>Methods: </strong>This is a retrospective review of a single institution's experience with SCH fracture pinning between 2010 and 2023. Demographic variables and health care utilization data were recorded within 90 days of surgery. The ADI was recorded, and patients were separated into terciles according to their relative level of social deprivation. Outcomes were then stratified based on ADI tercile and compared.</p><p><strong>Results: </strong>One thousand one hundred eighty-six patients from a single level one trauma center were included in this study. The upper, middle, and lower terciles of ADI consisted of 226, 458, and 502 patients, respectively. The most deprived tercile had greater emergency department (ED) visitation within 90 days of surgery relative to the least and intermediate-deprived terciles (incidence rate ratio [IRR] 1.85, 95% CI 1.10-3.08). Identifying as White was an independent risk factor for increased outpatient clinic utilization (IRR or 1.17, 95% CI 1.03-1.34). Higher levels of social deprivation were independent risk factors for increased ED visitation. There was no difference in 90-day inpatient readmission rates or telephone/telehealth calls made to the clinic between the least, intermediate, and most deprived patients.</p><p><strong>Conclusions: </strong>This study begins to shed light on how social determinants of health impact the postoperative care of the pediatric orthopaedic patient and which patient populations are the most at-risk for disproportionate resource utilization after pinning of SCH fractures. Understanding these differences may lead to improved patient outcomes while decreasing potentially unnecessary burdens on the health care system.</p><p><strong>Key concepts: </strong>(1)Social determinants of health impact the postoperative care of the pediatric patient in the setting of supracondylar humerus fractures.(2)More socially deprived patients are at higher risk of postoperative emergency department visits.(3)Patient race is shown to be a factor in postoperative clinic utilization.</p><p><strong>Level of evidence: </strong>III, Retrospective Comparative Study.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"8 ","pages":"100071"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164641","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":"Hemiepiphysiodesis Corrects Lower Extremity Coronal Plane Deformity in Children with Skeletal Dysplasia Irrespective of Intra-Articular Malalignment.","authors":"Deeptiman James, Prabjit Ajrawat, Andrew Howard, Maryse Bouchard","doi":"10.1016/j.jposna.2024.100068","DOIUrl":"10.1016/j.jposna.2024.100068","url":null,"abstract":"<p><strong>Background: </strong>Skeletal dysplasias (SkD) are a rare group of disorders characterized by abnormal growth and development of bone and cartilage, often causing limb deformity. Many patients also have ligamentous instability that can accentuate the malalignment. This ligamentous instability can present either a generalized ligamentous laxity or focal coronal plane intra-articular malalignment. Temporary hemiepiphysiodesis (HE) is a commonly employed minimally invasive surgical technique for correcting coronal plane limb deformities. This study evaluated the effectiveness of HE in the correction of knee coronal plane deformity in children with SkD and the correlation of concurrent joint laxity.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted to evaluate radiological outcomes of HE for coronal plane knee deformities in patients with SkD (aged <18 years) who had surgery between January 1, 2008 and December 31, 2020. Changes in distal femoral and proximal tibial mechanical angles, and knee joint line congruence angles (JLCA) prior to HE and at the final follow-up were analyzed. An increased JLCA of ≥±2° was considered a knee with ligamentous instability. Preoperative and postoperative patient-reported pain status was recorded.</p><p><strong>Results: </strong>Fifty-six tibial and 42 femoral HE procedures in 32 children (mean age at HE: 9.8 ± 2.8 years) were included. The deformity was fully corrected in 23/32 (72%) children, at an average annual rate of 6.3° at the distal femur and 3.3° at the proximal tibia, over 21.9 ± 12.6 months. The overall pre-HE JLCA improved by an average of 5.3° (<i>P</i> < .05). The improvement was more pronounced in varus knees (<i>n</i> = 45; <i>P</i> < .05) than valgus knees (<i>n</i> = 12; <i>P</i> = .11) but regardless of the severity of joint instability, pre-HE JLCA did not impede the rate of femoral (r = -0.22) or tibial (r = -0.21) corrections. Preoperative pain was reported by 78% of patients whereas only 25% of patients reported pain postoperatively at the final follow-up (mean follow-up: 26.4 ± 13.5 months).</p><p><strong>Conclusions: </strong>The presence of coronal plane intra-articular malalignment did not affect the rate and the magnitude of correction with HE in this cohort. Coronal plane deformities and JLCA improve with deformity correction by HE in children with SkD.</p><p><strong>Key concepts: </strong>(1)Intra-articular malalignment at the knee does not impede the success of hemiepiphysiodesis in children with skeletal dysplasia.(2)While all coronal plane knee deformities improved, a more significant improvement was noted in children with varus than valgus.(3)Joint line congruency angles improved with guided growth for coronal plane deformities.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"8 ","pages":"100068"},"PeriodicalIF":0.0,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164725","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":"Barriers to Health Care Communication: Patient Education Resource Readability and Spanish Translation for Slipped Capital Femoral Epiphysis.","authors":"Emma Danielle Grellinger, Ishaan Swarup","doi":"10.1016/j.jposna.2024.100076","DOIUrl":"10.1016/j.jposna.2024.100076","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The American Medical Association and the National Institutes of Health recommend that patient education resources be written at sixth- and eighth-grade reading levels, respectively. However, many existing resources are written above this level. In addition, the majority of patient education resources are only available in English, despite the significant Spanish-speaking population in the United States. The purpose of this study was to determine the availability and readability of online patient education resources for slipped capital femoral epiphysis (SCFE) provided by the top-ranked pediatric orthopaedic hospitals and major pediatric orthopaedic professional societies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a cross-sectional analysis to determine the availability of English and Spanish language resources for SCFE provided by the top pediatric orthopaedic hospitals and major professional societies. We then assessed the readability of available patient education materials via 3 measures of readability. Statistical analysis was performed using descriptive, univariate, and correlation analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 79.6% (39/49) of hospitals and 66.7% (2/3) of professional societies provided English language resources for SCFE. In contrast, Spanish language resources were provided by 34.7% (17/49) and 33% (1/3) hospitals and professional societies. English language resources scored significantly lower than Spanish language resources using the Flesch-Kincaid and Fernandez-Huerta reading ease scales, respectively (60.32 vs 65.89, &lt;i&gt;P&lt;/i&gt; &lt; .05). There was no difference in grade level calculated by Fry Graph/Gilliam-Peña-Mountain (9.5 vs 8.5, &lt;i&gt;P&lt;/i&gt; &gt; .05), but English language resources had a significantly higher grade level calculated by SMOG/SOL (11.9 vs 10.4, &lt;i&gt;P&lt;/i&gt; &lt; .01). There was greater availability of Spanish language resources in states with &gt;20% primary Spanish speakers (&lt;i&gt;P&lt;/i&gt; &lt; .05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The majority of top-ranked hospitals and professional societies provide online educational materials on SCFE in English; however, only a third provide similar materials in Spanish. Additionally, the average reading level of English and Spanish language resources is above the recommendations from the American Medical Association and National Institutes of Health. Additional effort and resources should be allocated toward improving SCFE patient education materials to increase accessibility to broader patient and caregiver populations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key concepts: &lt;/strong&gt;(1)Online patient education resources for slipped capital femoral epiphysis (SCFE) are written above the recommended reading grade level for both English and Spanish.(2)There is limited availability of Spanish-language patient education recourses for SCFE, despite the significant Spanish-speaking population in the United States.(3)There is greater availability of Spanish language resources fo","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"8 ","pages":"100076"},"PeriodicalIF":0.0,"publicationDate":"2024-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164719","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":"Biomechanical simulation of radial head subluxation in cadaveric pediatric elbows.","authors":"Molly Meadows, Brian Vuong, Hunter Storaci, Kaysie Tam, Kevin Shea","doi":"10.1016/j.jposna.2024.100036","DOIUrl":"10.1016/j.jposna.2024.100036","url":null,"abstract":"<p><strong>Background: </strong>Radial head subluxation, known as pulled elbow or nursemaid's elbow, is a common pediatric condition that occurs when a longitudinal traction force is applied to an extended elbow. The purpose of our study was to demonstrate and quantify the axial traction force required to produce a nursemaid's elbow in a pediatric cadaver specimen and to review the current relevant literature.</p><p><strong>Methods: </strong>We performed a literature search to identify relevant articles describing the nursemaid's elbow injury, as well as relevant biomechanical studies of the radiocapitellar joint. For the biomechanical model, 2 fresh-frozen cadaveric elbows from a single 3-year-old male donor were dissected by a fellowship-trained orthopedic surgeon. An Instron 5,944 testing machine with a 2 kN load cell was used to perform uniaxial testing. The radius and humerus were mounted to the Instron machine and loaded in the axial direction with the elbow in full extension. Loading occurred at a rate of 10 mm/second for 4 seconds, during which the force and actuator displacement were continuously recorded. The local instantaneous load and extension displacement at the time of subluxation were recorded.</p><p><strong>Results: </strong>The load to failure required to produce the nursemaid's elbow injury in our first specimen was 31 N, with a failure displacement of 4.6 mm. The second specimen demonstrated a load to failure of 26 N, with a failure displacement of 4.6 mm. After subluxation, we reduced the annular ligament from the first specimen. The elbow was then retested and demonstrated a load to failure of 20 N, with a failure displacement of 2.6 mm.</p><p><strong>Conclusions: </strong>Axial traction applied to a pediatric elbow results in subluxation of the annular ligament into the radiocapitellar joint, at relatively low loads. We demonstrated a mean load to failure in a pediatric cadaveric model of 28.5 N, and a lower load to failure was required to produce a recurrent subluxation in a previously injured specimen.</p><p><strong>Key concepts: </strong>(1)Radial head subluxation, known as pulled elbow or nursemaid's elbow, is a common pediatric condition that occurs when a longitudinal traction force is applied to an extended elbow.(2)This study is the first to demonstrate and quantify the axial traction force required to produce a nursemaid's elbow in a pediatric cadaver specimen.(3)Axial traction applied to a pediatric cadaver specimen results in subluxation of the annular ligament into the radiocapitellar joint.(4)The mean load to failure is 28.5 N, and a lower load to failure is required to produce a recurrent subluxation in a previously injured specimen.(5)Literature supports that the nursemaid's elbow injury is a result of subluxation of the annular ligament into the radiocapitellar joint, though this may involve a spectrum of injury to the annular ligament itself.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"7 ","pages":"100036"},"PeriodicalIF":0.0,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164717","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":"Effectiveness of various cast covers in the pediatric population.","authors":"Amit Parekh, John Moon, David Roberts, Verena M Schreiber","doi":"10.1016/j.jposna.2024.100028","DOIUrl":"10.1016/j.jposna.2024.100028","url":null,"abstract":"<p><strong>Background: </strong>Keeping casts dry is a challenge in pediatric Orthopaedics. A wet cast risks skin complications and generally requires a cast change resulting in unplanned visits and increased health care costs in patients undergoing cast immobilization. Previous research on the effectiveness of cast covers has only reviewed adult models. We evaluated the efficacy of different commercially available cast covers and do-it-yourself (DIY) methods for keeping casts dry in different-sized pediatric arm models and compared the relative costs of using each method.</p><p><strong>Methods: </strong>Short arm casts were applied to plastic mannequin arms representing pediatric patients ages 3, 6, and 12 years old. Different cast covers or DIY methods were applied over each cast and the limbs were then submerged in water for 1 minute. Water absorption was calculated by comparing the mass before and after submersion as measured with a digital scale. Each test group had 6 trials as determined by a power analysis. Statistical analysis was done using a nonparametric test with additional post-hoc analysis. Cost-effectiveness was estimated for typical materials needed for use over a 6-week period.</p><p><strong>Results: </strong>A plastic bag and duct tape were the most effective in keeping a cast dry. Other DIY methods (plastic bag and rubber bands, adhesive film) were not effective. There were several highly effective commercial cast covers across age groups, including Bloccs, Seal-Tight, and DryPro. Other commercial cast covers tested had inferior performance. Of the effective methods, a single plastic bag and duct tape were the most cost-effective.</p><p><strong>Discussion/conclusions: </strong>A plastic bag and duct tape was overall the most clinically and cost-effective method of avoiding a wet cast, with good to excellent results across arm size/age groups. Findings from this study may better inform patients about ways to keep casts dry, avoid unnecessary visits for cast changes, and decrease associated costs and risk of complications.</p><p><strong>Key concepts: </strong>(1)A plastic bag and duct tape were the most effective methods for keeping a cast dry across various arm sizes seen in pediatric Orthopaedics.(2)Other DIY methods (plastic bags and rubber bands, adhesive film) were ineffective, and should not be recommended.(3)Performance of commercial cast covers was variable. Several commercial cast covers (Bloccs, Seal-Tight, DryPro) were effective, but others (Walgreens, Curad) were not.(4)Amongst effective methods, a plastic bag and duct tape were also the least expensive.<i>Level of Evidence:</i> II, <i>prospective comparative study.</i></p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"7 ","pages":"100028"},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164718","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":"Plain Radiographs Have Limited Utility in the Evaluation of Discoid Lateral Meniscus.","authors":"Reid P Schlesinger, Sean M Rangwani, Neeraj M Patel","doi":"10.55275/JPOSNA-2023-756","DOIUrl":"10.55275/JPOSNA-2023-756","url":null,"abstract":"<p><p><b>Background:</b> Debate persists regarding the utility of plain film radiography in the diagnosis of discoid lateral meniscus, especially in children. The purpose of this study was to assess various radiographic measurements between healthy children and those with discoid lateral meniscus while controlling for other patient characteristics. <b>Methods:</b> Plain radiographs of 55 pediatric patients with discoid lateral meniscus were matched by age and sex to 55 controls with healthy knees as verified by magnetic resonance imaging. Each radiograph was evaluated for the following parameters: lateral joint space height (both in the central and medial portions of the compartment), medial joint space height, fibular head height, lateral tibial spine height, femoral inter-epicondylar distance, lateral tibial plateau obliquity, and chordal distance of the femoral condyle (medial and lateral). <b>Results:</b> In univariate analysis, children with discoid lateral meniscus had higher median lateral joint space heights (p<0.001) and lower fibular head height (p=0.001) than controls. No other radiographic measurements were significantly different. When adjusting for covariates in regression analysis, the presence of discoid lateral meniscus was predictive of higher lateral joint space heights and lower fibular head height, however, age was also significantly predictive in these models. <b>Conclusions:</b> On plain radiographs, lateral joint space heights and fibular head height are associated with discoid lateral meniscus. However, many previously reported measurements were not predictive. The practical utility of these parameters may be complicated by the impact of age. Advanced imaging is recommended to confirm the diagnosis of discoid lateral meniscus. <b>Level of Evidence:</b> III <b>Key Concepts</b>•Plain films may be used to rule out bony pathology but provide little benefit in ruling in a diagnosis of discoid lateral meniscus.•Many radiographic findings that were previously associated with discoid lateral meniscus are either inapplicable to skeletally immature X-rays or are confounded by age.</p>","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"5 4","pages":"756"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164716","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":"Editor's Note.","authors":"Ken Noonan","doi":"10.55275/JPOSNA-2023-815","DOIUrl":"https://doi.org/10.55275/JPOSNA-2023-815","url":null,"abstract":"","PeriodicalId":520850,"journal":{"name":"Journal of the Pediatric Orthopaedic Society of North America","volume":"5 4","pages":"815"},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12088079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164715","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}