Journal of Clinical Orthopaedics and Trauma最新文献

{"title":"\"Inching closer to native anatomy: A CT scan based morphometric analysis of tunnels in all-inside ACL reconstruction\"","authors":"Imroz Jindal ,&nbsp;Kamparsh Thakur ,&nbsp;Chander Mohan Singh ,&nbsp;Chetan Sood ,&nbsp;Saurabh Mahajan ,&nbsp;Mohini Agrawal","doi":"10.1016/j.jcot.2025.103072","DOIUrl":"10.1016/j.jcot.2025.103072","url":null,"abstract":"<div><h3>Background</h3><div>Placement of ACL tunnels closer to native ACL footprint is of utmost importance. Thus, study was designed to analyze radiomorphometric parameters of tunnels in All-inside technique (AI) and compare them to Antero-medial portal with full Tibial tunnel technique (AMP).</div></div><div><h3>Methods</h3><div>Observational study was conducted from January 2019 to December 2021. Participants were divided into two groups for single bundle ACL reconstruction: AI and AMP. Radiomorphometric analysis of tunnels was done on CT-scan. Paired <em>t</em>-test was used for comparison, with p &lt; 0.05 considered to be significant.</div></div><div><h3>Results</h3><div>60 patients were included in the study, with one female and 29 males, with no significant differences in demographic parameters (p = 0.0554). For femoral tunnels, t% was 22.27 ± 3.677 and 22.506 ± 2.481; h% was 29.92 ± 3.255 and 27.654 ± 2.938 for AMP and AI respectively, with no significant differences. For tibial tunnels, ap% was 45.658 ± 3.33 and 46.008 ± 3.448; ml% was 51.247 ± 1.91 and 52.035 ± 2.533 for AMP and AI, respectively. There was no significant differences for t% (p = 0.84), h% (p = 0.0551), ap% (p = 0.7794), and ml% (p = 0.3443). Mean diameter of femoral tunnels was 9.43 ± 0.75 mm and 9.16 ± 0.58 mm, and tibial tunnels were 9.43 ± 0.70 mm and 9.06 ± 0.70 mm for AMP and AI, respectively, with no statistical difference. The length of femoral tunnels was 20.146 ± 3.256 mm and 21.64 ± 2.011 mm, and tibial tunnels were 39.16 ± 5.447 mm and 20.72 ± 3.68 mm for AMP and AI respectively, showing a significant difference in tibial tunnel length (p &lt; 0.00001). No significant difference was noted in sagittal orientation in two techniques. However, a significant difference was noted in coronal alignment for femoral tunnels (p &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>There is no significant differences in femoral and tibial tunnel placement, length, diameter, and sagittal orientation. However, significant difference was noted in femoral tunnels' coronal orientation and tibial tunnels’ length. Drilling femoral tunnel at 90° enhances ease of placement for femoral-jig but does not affect tunnel placement.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103072"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144185195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in a neglected case of traumatic anterior dislocation after total knee replacement: A case report","authors":"Aashay Sonkusale ,&nbsp;Vijay Kishore Kondreddy ,&nbsp;Kunal Patel","doi":"10.1016/j.jcot.2025.103073","DOIUrl":"10.1016/j.jcot.2025.103073","url":null,"abstract":"<div><div>Anterior tibio-femoral dislocation following total knee replacement (TKR) is a dreaded complication. We present a case of a 43-year-old lady who presented to us 3 months after a domestic ground level fall with pain, deformity and, inability to bear weight on her right knee. She had undergone a successful TKR 3 years ago with no complaints up until the fall. On examination, the limb was well perfused with no neurologic damage. A vascular surgery opinion was taken and arterial doppler showed good flow at and below the level of the knee. Radiologic assessment revealed a complete anterior dislocation of the prosthetic knee and a bone avulsion of medial epicondyle (ME). With an aim to add to current literature, we focus on the challenges faced intra-operatively and have described excision of the ME with excellent functional outcome at six months in such long-standing cases of dislocation. The patient was revised to constraint hinge knee with a rotating platform. At a 6-month follow-up, patient made a good functional recovery and had a stable knee with an Oxford knee score of 41. Informed consent has been taken from the patient as per CARE guidelines.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103073"},"PeriodicalIF":0.0,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BROAD SCORE: A tool for assessing reduction quality and predicting functional outcomes in paediatric diaphyseal both-bone forearm fractures","authors":"Binoti Sheth,&nbsp;Kamal Jain,&nbsp;Pankaj Pawar","doi":"10.1016/j.jcot.2025.103071","DOIUrl":"10.1016/j.jcot.2025.103071","url":null,"abstract":"<div><h3>Background</h3><div>Conservative management is the gold standard in the treatment of both bone forearm fractures in children. However, the guidelines for the same remain unclear. Acceptability of reduction and its maintenance in a cast are both important aspects of this management. Various casting indices have been described for the latter but no acceptability criterion has been considered as a standard. This study aimed to create a simple scoring system that would guide orthopaedicians in accepting a reduction, making informed decisions and explaining the outcomes to the patient and the caregivers.</div></div><div><h3>Methods</h3><div>40 children with both bone forearm fractures under the age of 9 were selected according to inclusion and exclusion criteria, closed reduction and above elbow casting was done and the patients prospectively followed up over a period of 1 year. Forearm radiographs were taken and range of motion (Flexion – Extension and Pronation - Supination) was documented at every visit. The BROAD Score (Bowing, Rotation, Overlap, Angulation, Displacement) was calculated at every visit and correlated with the range of motion and functional outcome grade as per Price criteria.</div></div><div><h3>Results</h3><div>57.5 % of the study population were aged 6–8 years (Male: Female = 5:3). Diaphyseal midshaft fractures were the most common (55 %). In patients with acceptable functional outcome (82.5 %, n = 33), the mean BROAD score immediately post reduction was 4.061 (±0.609), while in those with a fair/poor functional outcome (17.5 %, n = 7), the mean score was 2.643 (±0.626).</div></div><div><h3>Conclusion</h3><div>A BROAD score of at least 3.5 immediate post reduction, with a good casting technique and a meticulous follow up with radiographic evaluation would suffice to result in an acceptable functional outcome, provided there is enough time till skeletal maturity for remodeling. A score less than 3 should encourage the treating orthopaedician to consider re-manipulation in order to achieve a better outcome.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103071"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteochondroma of the iliac crest as a mimicker of prolapsed intervertebral disc- A case report and review of literature","authors":"Jeevan Kumar Sharma ,&nbsp;Anuj Gupta ,&nbsp;Md Neshar Ansari","doi":"10.1016/j.jcot.2025.103068","DOIUrl":"10.1016/j.jcot.2025.103068","url":null,"abstract":"<div><div>Osteochondromas of the pelvis are benign bone tumors. They might be accidently discovered during imaging studies and can stay inactive without causing any symptoms. However, as they grow larger, they may cause compressive symptoms in adjacent areas. A 17-year-old male presented with a history of back strain sustained while participating in sports. He experienced shooting pain radiating down his left leg, following the L4 dermatome pattern. Nerve irritation tests, such as the straight leg raise test and reported paresthesia in the L4 dermatome, were positive. The classic symptoms and clinical findings lead to an initial tentative diagnosis of a prolapsed intervertebral disc with no “red flags” symptoms. He was prescribed conservative treatment. However, there was no alleviation of pain over the next six weeks, at which point an MRI (Magnetic Resonance Imaging) identified an osteochondroma of Iliac crest. Following the excision of the lesion, the patient made a complete recovery without recurrence of lesion. Osteochondromas continue to perplex healthcare professionals as they can arise in isolated form at various location of bones. Pelvic osteochondroma leading to radicular symptom is very unusual. The primary treatment approach for symptomatic cases are to surgically remove the lesion.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103068"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144116941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight bearing after fractures; time to weigh in!","authors":"Nirmal C. Tejwani MD, MPA, FRCS, FAAOS","doi":"10.1016/j.jcot.2025.103070","DOIUrl":"10.1016/j.jcot.2025.103070","url":null,"abstract":"","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103070"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted total knee arthroplasty in the USA: Nationwide adoption trends towards 70 % by 2030","authors":"Shujaa T. Khan ,&nbsp;Ahmed K. Emara ,&nbsp;Guangjin Zhou ,&nbsp;Siran M. Koroukian ,&nbsp;Cleveland Clinic Adult Reconstruction Research,&nbsp;Nicolas S. Piuzzi ,&nbsp;Cleveland Clinic Adult Reconstruction Research consists of,&nbsp;Ignacio Pasqualini ,&nbsp;Alvaro Ibaseta ,&nbsp;Benjamin E. Jevnikar ,&nbsp;Nicholas K. Schiltz ,&nbsp;Matthew Deren","doi":"10.1016/j.jcot.2025.103069","DOIUrl":"10.1016/j.jcot.2025.103069","url":null,"abstract":"<div><h3>Background</h3><div>Robotic-assistance is becoming more prevalent in total knee arthroplasty (TKA). This study aims to (1) project the volume and percentage of manual (M-TKA) and robotic-assisted TKA (RA-TKA) in the United States through 2030, and (2) compare healthcare utilization and postoperative complications between RA-TKA and M-TKA.</div></div><div><h3>Methods</h3><div>Two national databases (Nationwide Inpatient Database and National Ambulatory Surgery Service Database) from 2012 to 2020 were queried for manual and robotic TKAs using ICD-10 and CPT codes. Future RA-TKA utilization was estimated using log-binomial regression modeling. The predicted probabilities from the regression models were multiplied by the projected population of each age-sex-hospital region subgroup per year through 2030.</div></div><div><h3>Results</h3><div>RA-TKA utilization increased from 0.01 % in 2008 to 8.5 % in 2020. Projections indicate that by 2030, RA-TKA is expected to represent 70.1 % (95 % CI:65.5–74.5) of the 2,631,972 TKAs performed. M-TKA exhibited higher incidences of mechanical, non-mechanical, and infective complications compared to RA-TKA (1.8 % vs. 0.7 %; 30.1 % vs. 24.9 %; 1.8 % vs. 0.7 % respectively, p &lt; 0.0001). A greater proportion of RA-TKA patients were discharged to home health care (88.7 % vs. 73 %, p &lt; 0.0001), and they had shorter hospital stays (1.9 vs. 2.8 days, p &lt; 0.0001).</div></div><div><h3>Conclusion</h3><div>RA-TKA is anticipated to make up more than 70 % of all TKAs performed in the United States by 2030. The increasing integration of robotic technology raises the need for deeper explorations into value based on training, cost efficiency and long-term outcomes to understand the ramifications of widespread adoption of RA-TKA as a routine procedure. However, this study is limited by its retrospective design, reliance on administrative coding which may lead to misclassification, and the unavailability of outpatient data prior to 2018.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103069"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144194633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative dexamethasone: Effects on length of stay, perioperative outcomes, and safety in isolated lower extremity long bone fracture fixation","authors":"Tanios Dagher ,&nbsp;Lohith Vatti ,&nbsp;Diana Sosa ,&nbsp;Jason Strelzow","doi":"10.1016/j.jcot.2025.103067","DOIUrl":"10.1016/j.jcot.2025.103067","url":null,"abstract":"<div><h3>Background</h3><div>Corticosteroids are frequently administered perioperatively during arthroplasty procedures with reported reductions in length of stay (LOS), postoperative pain &amp; nausea, and opioid consumption. This investigation aims to evaluate the effects of perioperative dexamethasone on LOS, post-operative outcomes, and adverse event rates for trauma patients undergoing femoral/tibial intramedullary nailing (IMN).</div></div><div><h3>Methods</h3><div>A retrospective cohort study was conducted at an urban Level 1 Trauma center between May 2018 and May 2022. 201 patients aged 16–65 with isolated femur or tibia fractures treated with antegrade or retrograde femoral or tibial IMN underwent chart review. Those with mental or physical disability, GFR &lt;30, liver disease, poorly controlled diabetes (HbA1C ≥ 8), or steroid use within 3 months were excluded. Patients with both open and closed fractures were included in the study. LOS postoperatively was compared between patients who received dexamethasone perioperatively (Dex, n = 88) and those who did not (No Dex, n = 113). Secondary outcomes pertained to inpatient admission (e.g. average pain score), time to union, incidence of nonunion by 6 months, and 90-day surgical site infection rate. Categorical outcomes were analyzed using Wilcoxon rank-sum analysis and dichotomous data using chi-square testing.</div></div><div><h3>Results</h3><div>There was no difference in LOS between groups (Dex 2.0 ± 1.6 days, No Dex 2.1 ± 1.3 days). While the Dex group had lower rates of superficial infection (Dex 0 % [0/43], No Dex 13.5 % [5/37]), opioid consumption (morphine milligram equivalent [MME]) on postoperative day 0 (Dex 16.7 ± 16.1, No Dex 21.1 ± 17.4), and MME POD0-3 average (Dex 24.5 ± 16.5, No Dex 30.5 ± 18.3), these results were not statistically significant. There were no differences in other secondary outcomes, including time to union, pain scores, average blood glucose, and complication rates.</div></div><div><h3>Conclusion</h3><div>Despite previous literature supporting a reduction in LOS associated with perioperative dexamethasone administration, the current study demonstrated no difference in trauma patients undergoing tibial or femoral IMN. However, perioperative administration may provide short-term benefits without increasing adverse event rate.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103067"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144108234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends, complications, and comorbidity risk in total elbow arthroplasty versus open reduction and internal fixation for distal humerus fractures","authors":"David H. Jung ,&nbsp;Senthooran Kalidoss ,&nbsp;Douglas Zhang ,&nbsp;Sahil Sethi ,&nbsp;Daniel A. Hu ,&nbsp;Jason A. Strelzow","doi":"10.1016/j.jcot.2025.103062","DOIUrl":"10.1016/j.jcot.2025.103062","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of distal humerus fractures (DHF) in older patients presents challenges due to high complication rates. Total elbow arthroplasty (TEA) has emerged as an alternative to open reduction and internal fixation (ORIF). This study investigates trends, outcomes, and risk factors associated with TEA and ORIF for the treatment of DHF.</div></div><div><h3>Methods</h3><div>Using the PearlDiver Mariner database, patients aged 55 years and older treated with either TEA or ORIF for DHF between 2010 and 2021 were identified. Trends in procedure volume, 90-day complications (postoperative bleeding, wound disruption, thromboembolic events, infection), and 12-month revision rates were analyzed. Risk factors (age, gender, diabetes, tobacco use, obesity, chronic kidney disease) were assessed using exact matching (1:4 ratio) and multivariable logistic regression.</div></div><div><h3>Results</h3><div>A total of 16,572 patients were reviewed, including 1825 treated with TEA and 14,747 with ORIF. TEA utilization peaked in 2014 but declined thereafter. Both TEA and ORIF showed decreased complication and revision rates over time. After exact matching (n = 8989; 1800 TEA, 7189 ORIF), TEA was associated with significantly higher 90-day postoperative bleeding (OR: 2.51, <em>p</em> &lt; 0.001) and infection rates (OR: 1.83, <em>p</em> &lt; 0.0001). Multivariable logistic regression showed that tobacco use increased wound disruption (OR: 1.71, <em>p</em> = 0.002), while chronic kidney disease was a predictor of infection (OR: 1.62, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>TEA utilization for DHF has declined, possibly due to its association with a 2.5-fold higher risk of postoperative bleeding and 1.8-fold higher risk of infection compared to ORIF. Further assessment of treatment trends and their impact on clinical practice is needed.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103062"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144123844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted ilio-sacral screws in vertically-unstable sacral fractures","authors":"Madhava Pai ,&nbsp;S. Vidyadhara ,&nbsp;T. Balamurugan","doi":"10.1016/j.jcot.2025.103063","DOIUrl":"10.1016/j.jcot.2025.103063","url":null,"abstract":"<div><div>Posterior pelvic stabilization with the iliosacral screw has long been a challenge due to the complex anatomy, proximity to vessels and nerves and narrow safe bony corridor for screw placement. Conventionally these screws were placed under fluoroscopic guidance, however the safe bony corridors are poorly represented on 2D imaging. The current generation of spine robots allow accurate drilling of trajectories while visualizing the 3D bony anatomy using intraoperatively acquired computed tomographic scans. The TiRobot (TINAVI Medical Technologies, Beijing, China) has been used to place percutaneous iliosacral screws in pelvic fractures, but no such workflow exists for the MazorX stealth edition (MXSE) (Medtronic, Dublin, Ireland).</div><div>Two patients who underwent iliosacral screw fixation for vertically unstable sacral fractures using robotic assistance were included. The challenges faced and lessons learned were described in detail in this technical note.</div><div>In each patient, two 6.5mm cannulated cancellous ilio-sacral screws were placed percutaneously through the ilium-S1/S2 bony corridor, using robotic assistance. The patients were allowed to sit with the leg hanging down on the first post operative day.</div><div>Robotic assistance in surgery offers unique solutions to challenges, improves surgeon's understanding of the problem, and increases confidence in treating them unconventionally.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"68 ","pages":"Article 103063"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple-rod fixation with laminar screws for three-column cervical spine injury in ankylosing spondylitis: A case report","authors":"Saurabh Rawall,&nbsp;Sean Taylor,&nbsp;Sakthivel Rajaram","doi":"10.1016/j.jcot.2025.103066","DOIUrl":"10.1016/j.jcot.2025.103066","url":null,"abstract":"<div><div>A 74-year-old male with ankylosing spondylitis sustained a C6–7 three-column injury from a fall. He underwent triple-rod fixation with laminar screws, which resulted in slight neurological recovery and independent ambulation with a walker. Triple-rod constructs with laminar screws enhance stability, modularity, and fixation options in complex cervical cases, including ankylosing spondylitis, cervical deformities, multilevel corpectomy, and tumor reconstructions.</div></div>","PeriodicalId":53594,"journal":{"name":"Journal of Clinical Orthopaedics and Trauma","volume":"67 ","pages":"Article 103066"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144099838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}