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

{"title":"2024 international trauma care forum guest nation symposium: gunshot injuries.","authors":"Jaime A Leal, Roman Hayda, Volodymyr Biliavskyi, Yurii Klapchuk, Amparo Gomez, Paul Whiting","doi":"10.1097/OI9.0000000000000444","DOIUrl":"10.1097/OI9.0000000000000444","url":null,"abstract":"<p><p>The Orthopaedic Trauma Association (OTA/AO) 2024 International Trauma Care Forum held in Montreal focused on the management of gunshot-related extremity trauma in both conventional and irregular warfare. Key presentations addressed the full-scale Russo-Ukrainian war and Colombia's enduring internal conflict, emphasizing the disproportionate burden of complex civilian injuries. In Ukraine, since the 2022 invasion, high-velocity ballistic and explosive trauma has resulted in injuries with extensive skeletal and soft tissue damage, often necessitating staged surgical debridement, external fixation, limb reconstruction, or amputation. Innovative techniques, including 3D-printed implants and regional or free flap coverage, have been incorporated into multidisciplinary protocols, despite significant limitations in subspecialty access and surgical resources. Conversely, Colombia's conflict-ongoing for over 7 decades-has resulted in over 2 million registered victims who have sustained physical injuries caused by bullets, explosions, or other war-related trauma, including both combatants and civilians. Urban areas primarily see low-energy gunshot wounds, whereas rural zones are affected by higher-energy injuries caused by improvised landmines and other unconventional weapons. Treatment is complicated by delayed evacuation, lack of trauma system infrastructure, and biologically contaminated injuries leading to high infection rates. The forum highlighted the importance of adaptable, evidence-based protocols, antimicrobial stewardship, and long-term rehabilitation strategies. The consensus of the expert panel was that the persistent burden of extremity trauma in conflict settings demands coordinated global trauma systems and equitable access to limb preservation and reconstructive care.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e444"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304940","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":"Unstable pelvic fractures in patients with hemodynamic instability: global treatment controversies.","authors":"Zsolt J Balogh, Kornelis J Ponsen, Katherine R Miclau, Rafael Amadei, Alessandro Casiraghi, Stefano Cattaneo, Leo M G Geeraedts, Vincenzo Giordano, Mahmoud Jammal, Jaime Andres Leal Camacho, Yoram Weil, Theodore Miclau","doi":"10.1097/OI9.0000000000000436","DOIUrl":"10.1097/OI9.0000000000000436","url":null,"abstract":"<p><p>Pelvic fractures associated with hemodynamic instability present a major challenge in trauma care, carrying mortality rates up to 30%. Successful management requires a multidisciplinary approach focused on resuscitation, mechanical stabilization, and hemorrhage control. Based on the 2024 International Orthopaedic Trauma Association (IOTA) Annual Meeting Pelvic Symposium, this review summarizes current recommendations for the management of hemodynamically unstable patients with pelvic fractures. Initial skeletal stabilization typically involves noninvasive pelvic binding devices, such as sheets or commercially available binders, employed in both pre-hospital and hospital settings. Subsequent resuscitation strategies include hypotensive resuscitation-restricting fluid administration to maintain lower blood pressure until bleeding is controlled-and damage control resuscitation-consisting of rapid surgical interventions aimed at achieving hemostasis. Current best practice also includes early empirical administration of balanced transfusion products guided by massive transfusion protocols, with targeted adjustments based on point-of-care testing results. Hemorrhage control methods vary depending on available resources: angioembolization effectively manages arterial bleeding in well-resourced facilities, whereas preperitoneal pelvic packing offers a quick, accessible solution for venous and bone-related hemorrhage, particularly in low-resource environments. Although the timing of pelvic binder removal and definitive invasive skeletal stabilization remains controversial, recent evidence supports early definitive internal fixation within 24 hours post-injury.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 6 Suppl","pages":"e436"},"PeriodicalIF":0.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304943","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":"Fracture nonunions.","authors":"Vu Le, Clifford Jones, Zachary M Working, Georg Duda, Christopher Evans, Andrew Evans","doi":"10.1097/OI9.0000000000000441","DOIUrl":"10.1097/OI9.0000000000000441","url":null,"abstract":"<p><p>The Fracture Nonunion Symposium presented at the 2024 Orthopaedic Trauma Association Basic Science Focus Forum featured invited speakers who discussed current perspectives on this topic. Clinical approaches, diagnostic advancements, basic science perspectives, and novel treatment strategies were discussed. This symposium was curated to highlight this common and challenging clinical problem faced by orthopaedic and musculoskeletal practitioners from around the globe.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 5 Suppl","pages":"e441"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240582","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":"Physiologic impact of inflammation in the polytrauma patient.","authors":"Chukwuebuka Achebe, Arun Aneja, Melanie Haffner-Lutzner, Gareth Ryan, Prism Schneider, Michel P J Teuben, Hans-Cristoph Pape, Justin Haller","doi":"10.1097/OI9.0000000000000442","DOIUrl":"10.1097/OI9.0000000000000442","url":null,"abstract":"<p><p>Polytrauma represents one of the most challenging scenarios in modern trauma care, with fracture healing outcomes that defy conventional expectations. Although isolated fractures typically follow predictable healing patterns, the presence of multiple injuries creates complex interactions that can either accelerate or severely impair bone regeneration. Remarkably, patients with traumatic brain injury often demonstrate enhanced fracture healing with rapid callus formation and shorter time to union, whereas those with systemic inflammatory burden from thoracic or multiorgan trauma frequently experience delayed healing and complications. These paradoxical outcomes reflect distinct biological pathways that are only beginning to be understood. Malnutrition, affecting up to one-third of hospitalized orthopaedic patients, further complicates recovery by impairing both soft tissue and bone healing. Emerging research has identified key molecular mediators including complement factors, inflammatory cytokines, and potentially leptin as critical determinants of healing trajectories. However, translating these laboratory findings into clinical practice remains challenging because of the heterogeneous nature of polytrauma populations and the complexity of coordinating multicenter research. The purpose of this review is to synthesize current understanding of nutritional optimization strategies in polytrauma, delineate the molecular mechanisms underlying both accelerated and delayed fracture healing, explore the unique effects of traumatic brain injury on bone regeneration, and describe the development of collaborative research infrastructure necessary to advance the field.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 5 Suppl","pages":"e442"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240580","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":"Basic science and current management for fracture-related infections.","authors":"Justin Haller, Lucas Marchand, John Scolaro, Peter V Giannoudis, Joseph Wenke, Hans-Cristoph Pape","doi":"10.1097/OI9.0000000000000431","DOIUrl":"10.1097/OI9.0000000000000431","url":null,"abstract":"<p><p>Fracture-related infections (FRIs) play a significant role in poor clinical outcomes and patient morbidity for patients with orthopaedic trauma. FRI diagnosis has become more standardized, which will strengthen research efforts to identify prognostic factors and improve clinical management. Biofilm research continues to advance our understanding of how FRIs develop and improve FRI prevention. Antibiotic bead pouches are a useful technique to locally administer high antibiotic concentrations for open fractures that are at high risk for FRI. There are a variety of techniques for managing critical sized bone defects in the setting of infection including serial bone grafting, induced membrane, distraction osteogenesis, and vascularized bone transfer. Management of acute and chronic FRI relies on successful debridement of necrotic tissue with infection eradication and bony reconstruction.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 5 Suppl","pages":"e431"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240564","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":"Emerging basic science concepts in geriatric fracture fixation and patient recovery.","authors":"Makoa Mau, Philipp Leucht, Frede Frihagen, Gustavo Duque, Richard Yoon, Emil Schemitsch, Justin Haller","doi":"10.1097/OI9.0000000000000433","DOIUrl":"10.1097/OI9.0000000000000433","url":null,"abstract":"<p><p>In recent history, human life expectancy has increased significantly, resulting in a high burden of late-life morbidity and geriatric fractures. Changes to the body as a result of aging, such as degeneration of the bone marrow, osteoblast apoptosis, and a decline in hormone production, coupled with sarcopenia, are only a few factors that predispose the elderly to fractures. In addition, these factors further complicate surgical management, as they increase the risk of fixation failure, nonunion, malunion, and wound complications. As a result, the standards of geriatric fracture fixation must account for variables that are rarely included when planning for surgery in the younger population. Operative fixation should provide a stable limb to allow for early mobilization and weight bearing, lowering the risk of medical complications. Therefore, early mobility is of the utmost importance in the setting of most fragility fractures. However, early mobility in some, such as the pelvic fragility fracture, may lead to an increased risk for bleeding and death. Geriatric fractures carry significant morbidity, mortality, and financial risk, which indicates that there should be a continuing review and understanding of the multifactorial process leading toward and treatment strategies employed after geriatric fractures. The purpose of this review is to summarize the biology of aging, the causes, effects, and treatments of sarcopenia, the current fixation strategies of geriatric fractures, and the importance of mobility in the geriatric patient.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 5 Suppl","pages":"e433"},"PeriodicalIF":0.0,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12494311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145240606","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":"Exploring the generalizability of wire navigation skills attained through simulator training.","authors":"Steven Long, Jared J Hill, Donald D Anderson, Geb W Thomas, Matthew D Karam","doi":"10.1097/OI9.0000000000000424","DOIUrl":"10.1097/OI9.0000000000000424","url":null,"abstract":"<p><strong>Background: </strong>Wire navigation is a common skill used in a variety of core orthopaedic procedures. Our team previously developed a simulator to train residents on this skill and have shown that skills developed on the simulator transfer to the operating room for a given procedural task. However, it has not yet been determined if skill attained through simulator training on one procedural task generalizes to others. To explore this question, we tested if training on a femoral neck fracture simulation improves performance in placing a center-center wire for an intertrochanteric fracture.</p><p><strong>Methods: </strong>This study was conducted at 2 2019 OTA/AO Comprehensive Fracture Courses for Residents. A total of 160 residents (80 working pairs) participated. Residents first performed a baseline assessment, placing a guide wire in the center-center position, aiming to minimize tip-apex distance, fluoroscopy use, total time, and decision-making errors. The simulator then provided training on wire placement for pinning femoral neck fractures using a three-wire configuration. Residents then repeated the center-center wire placement assessment on a different simulated intertrochanteric fracture case. The results were evaluated using a composite score that incorporates the tip-apex distance, decision-making errors, and the magnitude of these errors.</p><p><strong>Results: </strong>A total of 129 residents completed the full protocol in the allotted time. Residents improved significantly between baseline and post-training assessments on all performance measures (paired T-test, <i>P</i> < 0.05). Among residents with a baseline score less than zero (i.e., below acceptable performance levels), 91% improved their score with an average improvement of 0.9.</p><p><strong>Conclusions: </strong>This study demonstrates that training on a 3-wire configuration for pinning femoral neck fractures helps residents improve their skills in placing a center-center guide wire. The ability to generalize wire navigation skills led to fewer decision errors, reduced tip-apex distance, less fluoroscopy use, and better overall performance. Notably, residents who needed the training the most showed the greatest improvement.</p><p><strong>Clinical relevance: </strong>Residents and programs do not have the time or financial capacity to train on every single procedure in the orthopaedic spectrum. Better understanding how skills generalize between procedures will help focus training efforts and resources while still achieving the goal of producing technically skilled orthopaedic surgeons.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 4","pages":"e424"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066685","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":"Are orthopaedic trauma surgeons at risk of occupational noise-induced hearing loss?","authors":"Vincent W Lau, Stephanie A Kwan, Jack Graham, Gregory K Deirmengian","doi":"10.1097/OI9.0000000000000422","DOIUrl":"10.1097/OI9.0000000000000422","url":null,"abstract":"<p><strong>Objectives: </strong>Orthopaedic surgeons are at risk of occupational, noise-induced hearing loss due to exposure to instruments in the operating room. The primary objective of this study was to determine whether orthopaedic trauma procedures exceed recommended decibel (dB) limits. The secondary objective was to demonstrate which actions during a case create the highest sound levels.</p><p><strong>Methods: </strong>Intraoperative recordings were taken during orthopaedic trauma surgeries and classified into open reduction internal fixation (ORIF), intramedullary nailing, closed reduction percutaneous pinning, external fixation, soft tissue procedures, or a combination thereof. Recordings were taken of drilling, screw insertion, suctioning, saw use, and mallet striking. Decibel levels were reported as maximum dB level (MDL), LAeq, LCpeak, and time weighted average (TWA). Percentage of allowable daily noise was reported as dose, while the dose predicted for an 8-hour period was reported as projected dose.</p><p><strong>Results: </strong>A total of 89 recordings were collected, comprising 46 baseline and 43 trauma case recordings. All procedures had significantly higher dB levels compared with controls for all variables (<i>P</i> < 0.001). In all cases, the MDL was greater than 85 dB. ORIF had the highest average MDL (108.4 dB) and TWA (70.3 dB). Overall, no procedures exceeded the maximum allowable daily noise dose. However, the soft tissue group had the highest projected dose (18.8%). Suctioning against soft tissue had the highest dose and projected dose.</p><p><strong>Conclusion: </strong>Orthopaedic trauma procedures stayed within noise limits, but average MDL exceeded 85 dB. ORIF and suctioning produced some of the highest sound levels among procedures and recorded steps.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3","pages":"e422"},"PeriodicalIF":0.0,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12377292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981600","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":"Residual radiographic fracture displacement in healed tibial plateau fractures: comparison after treatment with suprapatellar nailing versus lateral plating.","authors":"Ivan Bandovic, Adrian Olson, Austin Smith, Ryan Centanni, Usher Khan, Virginia Leadbetter, Alan Afsari, Benjamin Best","doi":"10.1097/OI9.0000000000000418","DOIUrl":"10.1097/OI9.0000000000000418","url":null,"abstract":"<p><strong>Objectives: </strong>Compare maintenance of articular reduction and alignment in bicondylar tibial plateau fractures (OTA/AO 41-C2/C3) treated with suprapatellar intramedullary nailing (IMN) versus dual-plate open reduction and internal fixation (ORIF).</p><p><strong>Design: </strong>Retrospective Cohort Study.</p><p><strong>Setting: </strong>Single Level I academic trauma center.</p><p><strong>Patients/participants: </strong>Fifty-eight adults treated between July 2012 and July 2022 (28 IMN, 30 ORIF); groups were matched for age, body mass index, and fracture pattern.</p><p><strong>Intervention: </strong>Semiextended suprapatellar IMN with ≥1 independent lag screw compared with dual-plate ORIF performed through standard open approaches.</p><p><strong>Main outcome measurements: </strong>Joint-line depression, condylar widening, medial proximal tibial angle (MPTA), and posterior proximal tibial angle (PPTA) at union (12 months).</p><p><strong>Results: </strong>Initial displacement was greater in the ORIF cohort (joint-line 8.2 mm vs. 5.6 mm, <i>P</i> = 0.014; widening 7.2 mm vs. 5.8 mm, <i>P</i> = 0.150). At 12 months, healed widening (0.6 mm IMN vs. 1.0 mm ORIF, <i>P</i> = 0.856), healed depression (2.0 mm vs. 1.1 mm, <i>P</i> = 0.991), MPTA (89.9° vs. 89.6°, <i>P</i> = 0.699), and PPTA (11.3° vs. 9.8°, <i>P</i> = 0.078) did not differ. No secondary loss of reduction requiring revision occurred.</p><p><strong>Conclusion: </strong>Suprapatellar IMN maintained healed joint line displacement, condylar widening, MPTA, and PPTA in OTA/AO C1, C2, and certain C3 fractures. The MPTA and PPTA were surgically restored and maintained. This technique may be useful in certain circumstances where ORIF of the tibial plateau fractures places the soft tissue envelope at risk or where an intramedullary implant is otherwise preferred.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3","pages":"e418"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981585","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":"Osseous union after antibiotic cement application with retention of stable orthopaedic hardware in fracture-related infections without union.","authors":"Devone Mansour, Hunter Ross, Tannor Court, Daniel Cavazos, Trey D VanAken, Rahul Vaidya","doi":"10.1097/OI9.0000000000000415","DOIUrl":"10.1097/OI9.0000000000000415","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate treatment outcomes of patients treated with antibiotic impregnated cement applied over implanted orthopaedic hardware, in the setting of fracture-related infection, without osseous union, after open reduction internal fixation.</p><p><strong>Design: </strong>Retrospective observational case series.</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Patients/participants: </strong>Retrospective review of 15 patients who underwent antibiotic cement application to their retained plate for the treatment of acute fracture-related infections (12) and acutely infected nonunion (3) status after open reduction internal fixation (ORIF).</p><p><strong>Outcomes: </strong>Suppression of infection and radiographic union by final follow-up.</p><p><strong>Results: </strong>Antibiotic plate application successfully led to fracture union in all 15 patients (100%). Three of these patients (20%) required removal of hardware. Of these 3 patients, all 3 achieved fracture union before hardware removal. However, 2 of these patients developed a chronic infection and were placed on long term PO antibiotics for chronic infection suppression, thus making them ineligible for classification as free of infection.</p><p><strong>Conclusions: </strong>The results of this study suggest that application of antibiotic cement to retained plates/screws for ORIF during treatment of both acute fracture infections and acutely infected nonunions is a viable technique to achieve osseous union. Hardware removal may be required in some cases. Use of this technique supports fracture healing and local infection control, while maintaining construct stability long enough to achieve fracture union.</p>","PeriodicalId":74381,"journal":{"name":"OTA international : the open access journal of orthopaedic trauma","volume":"8 3","pages":"e415"},"PeriodicalIF":0.0,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12356638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877179","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}