OTA international : the open access journal of orthopaedic trauma最新文献

{"title":"Intramedullary nailing with absorbable antibiotic-eluting ceramic for fracture-related infection prophylaxis in high-risk open fractures: a case series and technique.","authors":"Scott M Sandilands, Akshay V Daji","doi":"10.1097/OI9.0000000000000478","DOIUrl":"10.1097/OI9.0000000000000478","url":null,"abstract":"<p><strong>Objectives: </strong>Fracture-related infection (FRI) is a devastating complication of open fractures and remains common even with ideal open fracture care including prompt systemic antibiotics and thorough surgical debridement. There is growing interest in the use of adjuvant local antibiotics; however, traditional carriers like polymethylmethacrylate (PMMA) are limited by subtherapeutic elution, biofilm formation, and the need for secondary removal. We describe a technique of in vivo augmentation of intramedullary nailing with Cerament G, a resorbable gentamicin-eluting calcium sulfate/hydroxyapatite ceramic, delivered through the 2-CAN device for targeted antibiotic prophylaxis.</p><p><strong>Methods: </strong>Nine patients (mean age 44 years; 22% female) with Gustilo-Anderson Type II (n = 3), IIIA (n = 4), IIIB (n = 1), and IIIC (n = 1) open fractures of the tibia, femur, or humerus underwent this technique at a Level 1 trauma center by a single fellowship-trained orthopaedic traumatologist. Postoperative outcomes included FRI incidence, fracture union, complications, and functional recovery.</p><p><strong>Results: </strong>At a mean follow-up of 9.1 months (2.6-17.1 months), all fractures achieved union with no cases of FRI. Two GA IIIB/C cases required flap coverage, including one flap failure successfully revised. Self-limiting serous drainage (n = 3) resolved within 1 week. No secondary procedures for infection, implant removal, or amputations occurred.</p><p><strong>Conclusion: </strong>Intramedullary nailing and intraoperative augmentation with Cerament G using the 2-CAN device offer a technically simple, time-efficient strategy for FRI prophylaxis in high-risk open fractures. The technique provides sustained local antibiotic delivery, avoids PMMA-related complications, and maximizes biomechanical stability by eliminating nail downsizing. Early results demonstrate promising infection prophylaxis, warranting further prospective trials to validate long-term efficacy and cost-effectiveness.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e478"},"PeriodicalIF":0.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147379375","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":"Lower extremity osseointegration for amputees with diabetes mellitus and vascular disease.","authors":"Jason S Hoellwarth, LaYow C Yu, Tyler D DeSena, Jidapa Wongcharoenwatana, Taylor J Reif, S Robert Rozbruch","doi":"10.1097/OI9.0000000000000472","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000472","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to describe outcomes of osseointegration in amputees with diabetes mellitus (DM) and/or peripheral vascular disease (PVD).</p><p><strong>Design: </strong>This was a case series.</p><p><strong>Setting: </strong>The study was conducted at an urban tertiary referral academic medical center.</p><p><strong>Patients/participants: </strong>Five patients (1 with DM, 3 with PVD, 1 with both; 4 transtibial, 1 transfemoral) with a follow-up duration of 4.1 ± 0.3 (3.6-4.3) years were included.</p><p><strong>Intervention: </strong>Revision amputation with press-fit osseointegration implant insertion was performed.</p><p><strong>Main outcome measurements: </strong>Primary outcomes included adverse events requiring nonsurgical or surgical intervention. Secondary outcomes included patient-reported outcome measures (PROMs) and mobility performance.</p><p><strong>Results: </strong>No patients experienced implant loosening, periprosthetic fracture, procedure-related systemic complications, or death. Three patients received additional surgery: one had osteomyelitis, prompting debridement after 9 months; 2 underwent refashioning to reduce redundant skin around the portal site at 4 years. All PROMs improved significantly. All patients improved by at least one K-level.</p><p><strong>Conclusion: </strong>Osseointegration appears safe to consider for appropriately selected patients with DM and/or PVD. Only one patient had an infection, requiring surgical debridement. The 2 refashioning cases were not infected and may have been avoidable with more aggressive tissue reduction at index surgery. No deaths or systemic complications occurred. Conscientious use and study of osseointegration may help optimize rehabilitation for amputees with DM and/or PVD.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e472"},"PeriodicalIF":0.0,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12956232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357939","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":"Treatment of high-energy lower extremity trauma is explained by the Orthopaedic Trauma Association Open Fracture Classification.","authors":"Julie Agel, Lisa Reider, Saam Morshed, Anthony R Carlini, Renan C Castillo, Raymond A Pensy, Jason J Yoo, Michael J Bosse","doi":"10.1097/OI9.0000000000000469","DOIUrl":"https://doi.org/10.1097/OI9.0000000000000469","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the association of Orthopaedic Trauma Association Open Fracture Classification (AO FC-OFC) designation for a specific high-energy lower extremity fracture with the need for 3 or more surgeries, soft -tissue closure with a flap, or amputation.</p><p><strong>Design: </strong>Secondary analysis of multicenter prospective observational study.</p><p><strong>Setting: </strong>Thirty-two Level 1 trauma centers.</p><p><strong>Patient/participants: </strong>Adult patients admitted from July 2012 to October 2015 with open pilon, ankle, talus, calcaneus, foot crush, or blast injuries.</p><p><strong>Main outcome measurements: </strong>Multivariable regression analyses examined the association between the OTA-FC (contamination, bone loss, muscle, skin and arterial injury) with 3 or more trips to the OR before definitive fixation, soft-tissue closure with a flap, and amputation within 18 months of injury.</p><p><strong>Results: </strong>A total of 447 patients comprised the study population. In adjusted models, embedded contamination [odds ratio (OR) = 3.0, 95% confidence interval (CI): 1.54-5.99], functional muscle loss (OR = 2.6, 95% CI: 1.60-4.23), skin that cannot be approximated (OR = 10.0, 95% CI: 5.02-19.79), and degloving (OR = 5.9, 95% CI: 2.94-11.61) were significantly associated with 3+ OR trips. Embedded contamination (OR = 2.2, 95% CI: 1.00-4.86), skin that cannot be approximated (OR = 23.8, 95% CI: 11.73-48.12), and degloving (OR = 12.4, 95% CI: 5.87-26.05) were significantly associated with soft tissue closure with a flap. Dead muscle (OR = 12.9, 95% CI: 4.78-34.89), arterial injury with ischemia (OR = 12.0, 95% CI: 3.22-44.27), skin that cannot be approximated (OR = 2.4, 95% CI: 1.03-5.37), and degloving (OR = 3.0, 95% CI: 1.25-6.98) were significantly associated with amputation.</p><p><strong>Conclusions: </strong>The OTA-FC variables that were most important for predicting treatment intervention varied. The severity of skin injury was associated with all outcomes.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e469"},"PeriodicalIF":0.0,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12956240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357983","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":"Intramedullary nailing with an absorbable antibiotic bone graft substitute in fracture-related infections and osteomyelitis: a case series.","authors":"Scott M Sandilands, Akshay V Daji","doi":"10.1097/OI9.0000000000000470","DOIUrl":"10.1097/OI9.0000000000000470","url":null,"abstract":"<p><strong>Objectives: </strong>Fracture-related infections (FRI), infected nonunions, and osteomyelitis with bony instability require aggressive treatment involving systemic antibiotics and surgical debridement. Adjuvant local antibiotic therapy delivers higher and sustained concentrations directly to the site of infection while minimizing systemic toxicity. Antibiotic-loaded poly-methyl methacrylate remains a standard option but presents significant limitations, including nonbiodegradability, reduced antibiotic elution over time, and the need for subsequent removal. Cerament G is a bioabsorbable bone void filler composed of calcium sulfate, hydroxyapatite, and gentamicin sulfate. It provides sustained high-dose antibiotic release, promotes osteoconduction, and remodels into bone within 6 to 12 months, eliminating the need for removal. This makes Cerament G a compelling option for the treatment of FRI and osteomyelitis.</p><p><strong>Methods: </strong>We describe a technique and case series using the Reamer-Irrigator-Aspirator (RIA) system, Cerament G injection via the 2Can device, and, when necessary, intramedullary nailing for the treatment of FRI and osteomyelitis. The technique was applied to 7 patients at a single Level-1 Trauma Center from 2022 to 2024 with FRI or osteomyelitis. Intramedullary nailing was performed in cases of nonunion or bony instability.</p><p><strong>Results: </strong>The mean age of patients was 35 years, with a mean body mass index of 29.2. Three patients required adjuvant intramedullary nailing for stabilization. All patients were weight bearing as tolerated after surgery. At a mean follow-up of 14.4 months (6-21 months), there were no recurrence of infection, major complications, or amputations.</p><p><strong>Conclusion: </strong>The combination of Cerament G and the RIA system represents a viable solution for FRI and osteomyelitis providing effective infection control and sustained antibiotic elution. This technique presents a promising alternative to traditional methods, although larger and longer-term studies are needed to confirm its efficacy.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"9 1","pages":"e470"},"PeriodicalIF":0.0,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12935411/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147313309","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":"Musculoskeletal trauma rehabilitation: a global comparison.","authors":"Brian Bernstein, Douglas W Lundy, Theodore A Miclau, Zsolt J Balogh, Shimpei Kitada, Ross Leighton, Guy Putzeys, Luis G Padilla Rojas, Inger Schipper, Linda Vallejo, Jonathan Tamayo-Cosio, Dario E Garin Zertuche, Cristian A Rojas Herrera, José Octavio Soarez Hungria, Jaime A Leal Camacho, Marcelo T Caiero, Horacio Tabares Neyra, Vincenzo Giordano, Hans-Christoph Pape, Theodore Miclau","doi":"10.1097/OI9.0000000000000437","DOIUrl":"10.1097/OI9.0000000000000437","url":null,"abstract":"<p><p>Rehabilitation after musculoskeletal trauma is globally acknowledged as essential for restoring function and improving quality of life; however, significant variation exists in rehabilitation frameworks and services worldwide. Although certain principles-such as early intervention, structured care pathways, and multidisciplinary approaches-are universally recognized as important determinants of outcomes in trauma patients, their implementation and effectiveness vary considerably due to differences in health care infrastructure, economic resources, policy frameworks, and cultural contexts. Drawing on comparative analyses of rehabilitation frameworks across regions, including North America, Latin America, Europe, Asia-Pacific, and Africa, this paper identifies structural variations, systemic challenges, and innovations that can inform global rehabilitation efforts. Strategic international collaboration focusing on shared learning, standardized protocols, technology integration, and targeted investments is key to creating equitable and sustainable rehabilitation models, especially in resource-limited settings and aging populations.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e437"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304909","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":"Guest nation symposium: management of musculoskeletal war injuries.","authors":"Roman Hayda, Oleksandr Rikhter, Oleksii Horehliad, Petro Nikitin, Kostiantyn Romanenko, Vasyl Makhovskyi, Serhiy Hariyan, Oleksandr Tsybulskyi","doi":"10.1097/OI9.0000000000000443","DOIUrl":"10.1097/OI9.0000000000000443","url":null,"abstract":"<p><p>For the last 2.5 years, Ukrainian surgeons have faced a vast number of war casualties generated by the Russian full-scale invasion in 2022. Despite being a middle-income country with limited medical resources, both the military and civilian Ukrainian health care systems were forced to respond to save lives and limbs of those injured by the destructive battlefield munitions. Development of educational resources to include on-line platforms were used on an unprecedented scale to educate civilian surgeons in the principles of war injury care, which differ from most civilian care practices. War trauma care principles of initial stabilization, debridement, external fixation with conversion to internal fixation where appropriate with bone and soft tissue defect management principles were implemented. Infection control measures were also important in mitigating infections associated with these severe injuries. These models and lessons can be useful in other conflict zones across the globe.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e443"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519551/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304898","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 bigger picture: unconventional open fractures in Colombia.","authors":"Diego Luis Carvajal Lievano, Jaime Andres Leal, Cristian Alberto Rojas, Fredy Santisteban, Miguel S Daccarett","doi":"10.1097/OI9.0000000000000440","DOIUrl":"10.1097/OI9.0000000000000440","url":null,"abstract":"<p><p>The management of open fractures in Colombia is influenced by special conditions shaped by the unique medical, social, and infrastructural environment that exists within the many varied regions of the country. These factors make the treatment of open fractures and associated injuries particularly complex.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e440"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304900","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":"Navigation and intraoperative imaging in pelvic and acetabular trauma.","authors":"Lynn Hutchings, Douglas Haase, Sven Meylaerts, Frank Ijpma, Ashraf El Naga, Kornelis J Ponsen","doi":"10.1097/OI9.0000000000000432","DOIUrl":"10.1097/OI9.0000000000000432","url":null,"abstract":"<p><p>The introduction of 3D technology in pelvic and acetabular surgery has the potential to change preoperative and intraoperative management. This technology is being developed in a number of areas, including improved preoperative planning and the development of patient-specific implants, and intraoperative visualization and assistance in traditionally technically challenging procedures. This expanding field holds exciting avenues for future changes in practice but requires knowledge of its limitations for appropriate application.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e432"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304941","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":"Soft tissue coverage before 12 days prevents fracture-related infection in IIIB open tibial fractures in young and healthy patients.","authors":"Álvaro I Zamorano, Matías A Vaccia, Rodrigo I Parra, Tomás Turner, Ignacio Rivera, Tomás Errázuriz, Andrés Oyarzún, Luis A Bahamonde","doi":"10.1097/OI9.0000000000000435","DOIUrl":"10.1097/OI9.0000000000000435","url":null,"abstract":"<p><strong>Introduction: </strong>Gustilo-Anderson type IIIB open tibial fractures carry a high risk of fracture-related infection (FRI) due to extensive soft tissue damage and frequent delays in coverage. Although early orthoplastic intervention lowers infection rates, many trauma centers lack the resources for same-day or early flap coverage. This study aimed to assess the relationship between timing of flap coverage and FRI risk in a young, healthy population, and to define a clinically relevant therapeutic window.</p><p><strong>Materials and methods: </strong>A retrospective cohort study was conducted at a single Level I trauma center (2012-2023). Patients with GA IIIB tibial fractures were treated under a standardized protocol with strict inclusion criteria. Timing of flap coverage was analyzed using Levene test, Student <i>t</i> test, and ROC curve analysis with the Youden index to determine the optimal infection-risk threshold.</p><p><strong>Results: </strong>Out of 332 open tibial fractures, 41 patients with GA IIIB injuries met inclusion criteria. Mean time to coverage was 24.6 days. FRI occurred in 15 patients (36.6%). Delayed coverage was significantly associated with FRI (<i>P</i> < 0.001). ROC analysis showed an AUC of 0.83; the Youden index identified <12 days as the optimal cutoff (100% sensitivity, 34.6% specificity). None of the 10 patients treated within 12 days developed FRI, versus 56.6% in those treated later (<i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>Coverage within 12 days minimizes infection risk in GA IIIB tibial fractures. Although immediate coverage remains ideal, a defined 12-day window offers practical guidance, especially where early orthoplastic care is not feasible.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e435"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304910","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":"Outcomes of intramedullary nailing for traumatic adult femoral shaft fractures in low-and-middle-income countries; a systematic review.","authors":"Marcella F D Ryan-Coker, Rekha Batura, Hilary Kubai, Martha Y E Forde, Juan C Perdomo-Lizarraga, Kebba Marenah, Hassan Haghparast-Bidgoli","doi":"10.1097/OI9.0000000000000434","DOIUrl":"10.1097/OI9.0000000000000434","url":null,"abstract":"<p><strong>Objective: </strong>This review reports on the radiologic and functional outcomes and complications of managing adult traumatic femur shaft fractures (FSFs) with intramedullary nailing (IMN) in Low-and-Middle-Income Countries (LMICs) and evaluates the quality of existing evidence.</p><p><strong>Methodology: </strong>A thorough literature search was conducted across several databases, including reference lists of selected articles. Screening was done per the PRISMA guidelines. Peer-reviewed articles published in English between January 2011 and December 2022 that reported radiologic or functional outcomes in adults with isolated traumatic FSFs managed with IMN in LMICs were included for review. The quality and level of evidence were assessed using modified Critical Appraisal Skills Program checklists and the modified Oxford Centre for Evidence-Based Medicine criteria.</p><p><strong>Findings: </strong>Forty studies from 13 LMICs were included in this review. The mean time to union was 15.4 weeks, with a mean union rate of 88.1%. Functional outcomes scores showed >70% excellent outcomes. The Radiographic Union Scale in Tibia score and Thoresen criteria were the most used assessment tools. Mean infection rates were 4.8%, and limb shortening (of varying amounts) occurred in 3.5% of patients. The findings revealed variability in measuring and reporting IMN outcomes in FSFs, but overall, the existing evidence was of satisfactory quality.</p><p><strong>Conclusion: </strong>Despite the data limitations, methodological differences, and outcome discrepancies, this review demonstrates a trend favoring IMN for FSFs, with low failure rates in low-resources settings. However, more robust studies using standardized radiographic and functional outcomes measures in LMICs are needed.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e434"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304899","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}