Journal of Childrens Orthopaedics最新文献

{"title":"Operative and non-operative treatment of congenital radio-ulnar synostosis in children: Results from a multicenter study.","authors":"Paola Zarantonello, Giovanni Trisolino, Filippo Maria Senes, Giovanni Luigi Di Gennaro, Diego Antonioli, Nunzio Catena, Annalisa Culmone, Alexandra Stauffer, Laetitia Sophie Chiarella, Sebastian Farr","doi":"10.1177/18632521251322677","DOIUrl":"10.1177/18632521251322677","url":null,"abstract":"<p><strong>Purpose: </strong>Congenital radioulnar synostosis is a congenital disorder affecting the elbow. We aimed to investigate the baseline characteristics and the clinical and functional outcome of a cohort of children with congenital radioulnar synostosis undergoing operative and non-operative treatment.</p><p><strong>Methods: </strong>This multicenter retrospective study evaluated children with congenital radioulnar synostosis admitted to three European pediatric orthopedic centers from January 1998 to April 2021. Baseline characteristics were extracted from medical records. Operative cases treated with rotational osteotomy were further analyzed. Outcomes were assessed using the Mayo Elbow Performance Score and the Quick-DASH questionnaire.</p><p><strong>Results: </strong>Ninety-seven patients (122 forearms) were included. Forearm positions were predominantly neutral or excessively pronated. Type 3 Congenital radioulnar synostosis was the most common radiographic finding. A total of 52 patients (66 forearms) underwent proximal derotational osteotomy, achieving a neutral forearm position in 61.9% of cases. Six complications were reported. The mean follow-up was 4.5 ± 3.4 years. MEPS averaged 90.6 points and Quick-DASH 18.5 points. No significant differences were found between operated and non-operated cases. MEPS results were good or excellent in 77.9% of patients, while only 31% reported a Quick-DASH ≤ 7points.</p><p><strong>Conclusion: </strong>We present the largest case series of pediatric congenital radioulnar synostosis to date. Mild deformities caused minimal disability and required no surgery. For severe malrotation, proximal derotational osteotomy was safe, with low complication rates, restoring a neutral forearm position and yielding outcomes comparable to non-surgical management of mild cases.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251322677"},"PeriodicalIF":1.3,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12149165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric knee fractures: A current concept review.","authors":"Marco Turati, Franck Accadbled, Stéphane Tercier, Monika Thüsing, Luca Rigamonti, Jaakko Sinikumpu, Benjamin Tschopp, Nicolas Nicolaou","doi":"10.1177/18632521251327129","DOIUrl":"10.1177/18632521251327129","url":null,"abstract":"<p><p>Knee periarticular and intra-articular fractures in children and adolescents have specific features and should be carefully detected. Typical non-contact and contact mechanisms that may lead to an anterior cruciate ligament injury in a skeletally immature patient can cause a tibial eminence fracture. During patellar dislocation or other traumatic events, pure chondral fractures can occur and should be excluded. During sports, traumatic events leading to a forceful quadriceps contraction can cause specific paediatric fracture patterns such as patella sleeve and tibial apophyseal fractures. This review will highlight controversies and innovative aspects of non-operative and operative treatment, basic science, new evidence and unanswered questions for these fractures. <b>Level of evidence:</b> level V.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251327129"},"PeriodicalIF":1.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of body weight and age on plantar pressure in typically developing children: Normative data and methodological considerations.","authors":"Anika Behrendt, Tobias Siebert, Sonia D'Souza","doi":"10.1177/18632521251335875","DOIUrl":"10.1177/18632521251335875","url":null,"abstract":"<p><strong>Purpose: </strong>Pedobarography is frequently employed for the identification and characterisation of foot pathologies in paediatrics. However, the lack of standardised normalisation methods presents a challenge for cross-age comparisons. This cross-sectional study provides normative plantar pressure data for typically developing children aged 4-17 years and compares normalisations and explanatory powers of parameters measuring peak and total load.</p><p><strong>Methods: </strong>Dynamic foot pressure of 101 typically developing children aged 4-17 years was measured at self-selected speed using the mid-gait protocol. They were divided into five age groups: 4-6, 7-8, 9-11, 12-14 and 15-17 years old. Force and pressure variables measuring peak and total load were normalised by body weight or scaled by maximum value and the foot region where the peak pressure occurred was identified.</p><p><strong>Results: </strong>The absolute values demonstrated an increase in load with advancing age. In contrast, when normalised to body weight, peak pressure and pressure time integrals decreased. The scaled peak pressure showed a load shift to the forefoot. The results indicate that the normalised parameters exhibit superior qualitative significance, suggesting a more dynamic gait pattern and improved morphology of the foot in relation to body weight with increasing age.</p><p><strong>Conclusions: </strong>This study shows that standardisation of the measurement protocol is imperative because results in typically developing children can vary depending up parameter selection and normalisation technique.</p><p><strong>Level of evidence: </strong>3.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251335875"},"PeriodicalIF":1.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severity of elbow mobility limitation in pediatric patients with a displaced supracondylar humerus fracture requiring surgical treatment: A monocentric retrospective clinical study.","authors":"Tomáš Merkl, David Astapenko, Radek Štichhauer, Pavel Navrátil, Antonín Šafus, Zuzana Burešová, Petr Lochman","doi":"10.1177/18632521251341140","DOIUrl":"10.1177/18632521251341140","url":null,"abstract":"<p><strong>Purpose: </strong>It was aimed to determine whether there is a statistically significant difference between various types of displaced supracondylar fractures of the humerus in children with movement impairment according to Flynn's classification.</p><p><strong>Methods: </strong>Clinical results of 263 patients who were operated on with closed reduction and percutaneous pinning for displaced supracondylar fracture of the humerus were evaluated. Flynn's classification was used to compare movement impairment.</p><p><strong>Results: </strong>One year after the procedure, only one patient in the category of extension fractures of type II displacement, and only in elbow flexion, had an unsatisfactory treatment outcome according to Flynn. All other patients achieved a satisfactory treatment outcome, with the vast majority, 252 patients (96%), in the excellent category. Four patients were in the good category, one patient in the fair category, and the aforementioned one patient in the poor category.</p><p><strong>Conclusion: </strong>In 1 year after the surgery, the limitation of elbow mobility is usually insignificant regardless of the grade of displacement or type of supracondylar fracture of the humerus.</p><p><strong>Level of evidence: </strong>Level III-retrospective comparative study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251341140"},"PeriodicalIF":1.3,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12126471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three radiographic parameters correlate with computed tomography displacement in transitional ankle fractures.","authors":"Luke Sang, Steven M Garcia, Alex Youn, Katherine Bach, Ishaan Swarup","doi":"10.1177/18632521251338537","DOIUrl":"10.1177/18632521251338537","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess the ability of radiographic measures to predict displacement on computed tomography (CT) for transitional ankle fractures.</p><p><strong>Methods: </strong>This study is a retrospective review of pediatric patients who presented with Tillaux (Salter-Harris III) and triplane (Salter-Harris IV) fractures at a single institution. Radiographs and CT measurements were performed by three independent evaluators. Intraclass correlation coefficients (ICCs) were calculated to determine interrater reliability. Spearman correlations were performed to assess the correlations between each radiographic parameter and CT measurements.</p><p><strong>Results: </strong>A total of 61 patients were included in this study. The average age of patients was 12.3, and 65.6% of patients were male. There was an almost even split of triplane (55.7%) and Tillaux (44.3%) fractures. Overall, measurements showed at least good interobserver agreement (ICC >0.6). Radiographic anteroposterior view showed the least reliable measurements compared to the mortise and lateral views. There was significant correlation between CT displacement and the following measures on radiographs: tibiofibular clear space on the mortise view (ρ = 0.27, <i>p</i> < 0.05), articular displacement on the mortise view (ρ = 0.35, <i>p</i> < 0.01), articular displacement on the lateral view (ρ = 0.28, <i>p</i> < 0.05), and epiphyseal displacement on the lateral view (ρ = 0.55, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>There are several radiographic parameters that significantly correlate with increased displacement of transitional ankle fractures on CT. Increased articular displacement on the mortise and lateral view, as well as increased tibiofibular clear space on the mortise view, correlates with increased displacement. These radiographic parameters may be good indicators for the selective use of CT scans for transitional ankle fractures.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251338537"},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Test-retest reliability of clinical measurements of lower extremity joint motion and alignment in the pediatric population.","authors":"Thea Saabye, Thomas Colding-Rasmussen, Andreas Balslev-Clausen, Søren Bødtker, Christian Wong, Steen Harsted","doi":"10.1177/18632521251322639","DOIUrl":"10.1177/18632521251322639","url":null,"abstract":"<p><strong>Purpose: </strong>Manual anthropometric evaluations of pediatric lower extremities are essential in orthopedic pediatric practice due to their noninvasive and time-feasible nature. Therefore, this study aims to assess the test-retest reliability of clinical measurements obtained on children to examine measurement stability over time.</p><p><strong>Methods: </strong>In a test-retest design, data were collected from 50 Danish school children with 5-to 6 weeks between sessions. Measurements encompassed the joint range of motion (ROM), rotational profile, and angular alignment of lower extremities for a representative sample of school children. Reliability was assessed using intraclass correlations (ICC), and agreement was assessed using limits of agreement (LoA) and precision.</p><p><strong>Results: </strong>Reliability analysis revealed excellent results for foot length (ICC > 0.9), good results for foot width (ICC < 0.9), and poor to moderate results for all other measurements (ICC < 0.5, ICC < 0.75). Agreement results for hallux valgus were acceptable (within established reference) and the remaining variables were not acceptable (outside established reference).</p><p><strong>Conclusions: </strong>The majority of the manual assessment procedures were found to have poor reliability. This study highlights the need for reliable and time-efficient tools to assist clinicians in assessing manual clinical measurements and future research should explore this.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251322639"},"PeriodicalIF":1.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12081435/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plates for the treatment of long bone metaphyseal and diaphyseal fracture and deformity in osteogenesis imperfecta: A scoping review.","authors":"Yacine Louni, Reggie Hamdy","doi":"10.1177/18632521251332498","DOIUrl":"https://doi.org/10.1177/18632521251332498","url":null,"abstract":"<p><strong>Purpose: </strong>Osteogenesis imperfecta is a rare disorder characterized by bone fragility. The current gold standard treatment for long bone fractures and deformities is telescopic intramedullary rods. Although the use of plates as a standalone implant has been discouraged, recent research has investigated their use as an adjunct to intramedullary fixation. This scoping review aims to assess the current literature on plates for the treatment of long bone metaphyseal and diaphyseal fractures and deformities in osteogenesis imperfecta.</p><p><strong>Methods: </strong>The MEDLINE, Embase, CENTRAL, and CDSR databases were searched via PubMed, Ovid, and Cochrane. Titles and abstracts of studies were screened, followed by full assessment of selected articles. Studies included were peer-reviewed, published in English in the last 20 years, and investigated plating alone or combined with other implants for the treatment of metaphyseal or diaphyseal long bone fractures and deformities in osteogenesis imperfecta.</p><p><strong>Results: </strong>Eleven articles were included: four investigated plating alone, two compared different implants, and five assessed plating as an adjunct to intramedullary fixation.</p><p><strong>Conclusions: </strong>Using plates alone is not recommended due to the high rate of complications, implant-related complications, and revision surgeries. However, they can be used when deemed appropriate by the surgeon or in narrow canals. Overall, the use of plates as an adjunct to intramedullary nails shows promising results, although further research is required to determine the indications for additional plating and the best timing of plate removal.</p><p><strong>Level of evidence: </strong>Level III (scoping review).</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251332498"},"PeriodicalIF":1.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12031734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General anesthesia versus locoregional anesthesia in pediatric forearm fractures.","authors":"Alessandro Aprato, Alessia Fierro, Chiara Arrigoni, Mattia Cravino, Nathalie Bini, Carlo Origo","doi":"10.1177/18632521251325066","DOIUrl":"https://doi.org/10.1177/18632521251325066","url":null,"abstract":"<p><strong>Aim of the study: </strong>Aim is to define whether the type of anesthesia during the reduction and fixation of a pediatric forearm fracture, can influence the fracture reduction technique.</p><p><strong>Materials and methods: </strong>All surgically treated forearm fractures were enrolled: patients underwent a different anesthesiology protocol depending on the on-call anesthesiologist: deep sedation in which the patient is still able to breathe with limited external support and nerve block (group A) and general anesthesia with curare (group B). Demographic data, type of fracture, surgical timing and technique, anesthesia type and timing, and clinical outcomes were recorded.</p><p><strong>Outcomes: </strong>Of the total 326 patients considered, 228 children were treated by closed reduction (70%), and 98 children were treated by open reduction (30%). Of the latter, 75% of the fractures reduced open were of group A and 25% were of group B. In more detail, in group A, of the 162 patients, 73 (45%) required an open reduction, while 89 (55%) did not. In group B, of the 164 patients, 25 (15%) required an open reduction, while 139 (85%) did not. This resulted in being statistically significant (<i>p</i> = 0.001). No statistically significant results emerged from the data related to complication and range of motion apart from the pronation movement (<i>p</i> = 0.153).</p><p><strong>Conclusion: </strong>According to our data, the use of curare, in a pediatric forearm fracture reduction and stabilization surgery, leads to a reduction in the number of open treatments. If deep sedation and nerve block are preferred to improve postoperative pain control, the technique and timing should be improved to facilitate reduction.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251325066"},"PeriodicalIF":1.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12012494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preliminary assessment of large language models' performance in answering questions on developmental dysplasia of the hip.","authors":"Shiwei Li, Jun Jiang, Xiaodong Yang","doi":"10.1177/18632521251331772","DOIUrl":"https://doi.org/10.1177/18632521251331772","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the performance of three large language models in answering questions regarding pediatric developmental dysplasia of the hip.</p><p><strong>Methods: </strong>We formulated 18 open-ended clinical questions in both Chinese and English and established a gold standard set of answers to benchmark the responses of the large language models. These questions were presented to ChatGPT-4o, Gemini, and Claude 3.5 Sonnet. The responses were evaluated by two independent reviewers using a 5-point scale. The average score, rounded to the nearest whole number, was taken as the final score. A final score of 4 or 5 indicated an accurate response, whereas a final score of 1, 2, or 3 indicated an inaccurate response.</p><p><strong>Results: </strong>The raters demonstrated a high level of agreement in scoring the answers, with weighted Kappa coefficients of 0.865 for Chinese responses (<i>p</i> < 0.001) and 0.875 for English responses (<i>p</i> < 0.001). No significant differences were observed among the three large language models in terms of accuracy when answering questions, with rates of 83.3%, 77.8%, and 77.8% for Claude 3.5 Sonnet, ChatGPT-4o, and Gemini in the Chinese responses (<i>p</i> = 1), and 83.3%, 83.3%, and 72.2% for ChatGPT-4o, Claude 3.5 Sonnet, and Gemini in the English responses (<i>p</i> = 0.761). In addition, there was no significant difference in the performance of the same large language model between the Chinese and English settings.</p><p><strong>Conclusions: </strong>Large language models demonstrate high accuracy in delivering information on dysplasia of the hip, maintaining consistent performance across both Chinese and English, which suggests their potential utility as medical support tools.</p><p><strong>Level of evidence: </strong>Level II.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251331772"},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knee surveillance for ambulant children with cerebral palsy.","authors":"Pam Thomason, Kerr Graham, Ken Ye, Annette O'Donnell, Vedant Kulkarni, Jon R Davids, Erich Rutz","doi":"10.1177/18632521251330448","DOIUrl":"https://doi.org/10.1177/18632521251330448","url":null,"abstract":"<p><strong>Purpose: </strong>A majority of ambulant children with cerebral palsy (CP) develop progressive musculoskeletal pathology (MSP) during growth. Fixed flexion deformity at the knee joint (FFDKn) contributes to flexed knee gait and is prone to relapse after index multi-level surgery. This perspective introduces the concept of \"knee surveillance\" (KS), defined as a repeated systematic assessment of gait and knee range of motion until skeletal maturity. KS aims to detect early FFDKn, allowing for early intervention with minimally invasive techniques such as anterior distal femur hemiepiphysiodesis (ADFH), and reduce the need for higher-risk surgery such as distal femoral extension osteotomy (DFEO) and patellar tendon shortening (PTS).</p><p><strong>Methods: </strong>Recent literature on the assessment of ambulant children with CP, consensus statements on indications for dose-based knee surgery, and the indications for ADFH have been reviewed and synthesized. These provide a preliminary evidence base for the concept of KS in ambulant children with CP.</p><p><strong>Conclusion: </strong>We propose the concept of KS for ambulant children with CP. The goals of KS are early detection of knee flexion deformity, early intervention, less invasive surgery, and better long-term outcomes. There is preliminary evidence to suggest that soft-tissue surgery, in combination with ADFH, can reduce, or perhaps replace, the need for more invasive surgery such as DFEO and PTS.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":56060,"journal":{"name":"Journal of Childrens Orthopaedics","volume":" ","pages":"18632521251330448"},"PeriodicalIF":1.3,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11999989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}