Asian Spine Journal最新文献

{"title":"Evaluation of fusion status after spine fusion surgery: a comprehensive review.","authors":"Wook-Tae Park, Yusuke Dodo, Takahiro Hirano, Ryo Yamamura, Ichiro Okano, Yoshifumi Kudo, Gun Woo Lee","doi":"10.31616/asj.2025.0465","DOIUrl":"10.31616/asj.2025.0465","url":null,"abstract":"<p><p>Accurate assessment of fusion status following spinal fusion surgery is paramount, as it closely relates to patient outcomes and quality of life. Multiple imaging modalities have been developed to evaluate fusion, each with distinct advantages and limitations. Plain radiography remains the most accessible and practical method, with dynamic flexion-extension radiographs providing reasonably reliable information on segmental motion and stability. Computed tomography offers superior spatial resolution and enables direct visualization of trabecular bone bridging between vertebral segments, making it the most accurate modality for confirming fusion. Magnetic resonance imaging and radionuclide imaging can serve as complementary techniques, particularly when conventional methods are inconclusive or contraindicated. This review summarizes the strengths and limitations of each imaging modality used for assessing spinal fusion. It also highlights recent technological advances and emerging diagnostic approaches that may enhance the objectivity, reliability, and accuracy of fusion assessment in the future.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"604-614"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343386","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":"Letter to the editor: Effect of mechanical bowel preparation with antibiotics and probiotics on postoperative ileus in patients undergoing posterior lumbar spine surgeries.","authors":"Akanksha Sharma, Vaishali Gupta","doi":"10.31616/asj.2026.0051.r1","DOIUrl":"10.31616/asj.2026.0051.r1","url":null,"abstract":"","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":"20 3","pages":"615-616"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374333","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":"Recurrent lumbar disc herniation: a systematic review and meta-analysis of risk factors, surgical timing, and outcomes of revision discectomy versus fusion.","authors":"Sydney Rucker, Aidan Gillespie, Robert J Ferdon, Warren Roth, Jason Silvestre, Charles Reitman, James Lawrence, Robert A Ravinsky","doi":"10.31616/asj.2025.0353","DOIUrl":"10.31616/asj.2025.0353","url":null,"abstract":"<p><p>Recurrent lumbar disc herniation (RLDH) occurs in up to 15% of patients after primary discectomy and poses challenges in surgical decision-making. Both revision discectomy (RD) and spinal fusion (SF) is utilized for reoperation, but the optimal treatment strategy remains a topic of debate. Additionally, data on the ideal timing for reoperation are limited. This study systematically reviewed risk factors for RLDH, evaluated surgical timing, and compared outcomes between RD and SF. A systematic review and meta-analysis were conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines (PROSPERO-registered). The PubMed, Scopus, and CINAHL databases were searched through December 2024. Eligible studies included patients undergoing revision surgery for RLDH, with data on surgical technique, timing, and outcomes. The risk of bias was assessed using ROB-2 for randomized controlled trials and the Newcastle-Ottawa Scale for observational studies. Random-effects meta-analysis was employed to pool 12-month improvements in Visual Analog Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) scores. Additional outcomes included perioperative metrics, complications, recurrence rates, and patient satisfaction. Ten studies (including 939 patients) met the inclusion criteria. Reported risk factors included male sex, obesity, smoking, diabetes, and large annular defects. Surgical timing was inconsistently reported, which limited the pooled analysis. SF was associated with significantly greater intraoperative blood loss ((p=0.039), while operative time and hospitalization duration did not differ significantly. Recurrence rates did not significantly differ ((p=0.262), although open fusion showed a trend toward reduced recurrence. No significant differences in 12-month VAS or ODI scores were found between the groups (p>0.3). Minimally invasive techniques (minimally invasive transforaminal lumbar interbody fusion and percutaneous endoscopic lumbar discectomy) were associated with fewer complications and greater patient satisfaction. Both RD and SF are viable options for RLDH, each presenting distinct risk-benefit profiles. Importantly, this study highlights the inconsistent reporting of surgical timing as a persistent knowledge gap. Further high-quality research utilizing standardized definitions of recurrence and reoperation timeframes, with long-term follow-up, is necessary to clarify optimal surgical timing and guide treatment selection (PROSPERO CRD42024570791).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"585-603"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147462546","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":"Can intraoperative T1 tilt predict postoperative shoulder imbalance in patients with Lenke 2 adolescent idiopathic scoliosis?: a retrospective study in Japan.","authors":"Yuki Kinoshita, Yusuke Hori, Masaki Kawamura, Takashi Namikawa, Masatoshi Hoshino, Akira Matsumura","doi":"10.31616/asj.2025.0420","DOIUrl":"10.31616/asj.2025.0420","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Purpose: </strong>To evaluate whether intraoperative changes in T1 tilt can predict the development of postoperative shoulder imbalance (PSI) in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS).</p><p><strong>Overview of literature: </strong>Multiple factors have been associated with PSI, but few studies have specifically investigated intraoperative radiographic predictors, such as changes in T1 tilt, in patients with Lenke type 2 AIS.</p><p><strong>Methods: </strong>Fifty patients (45 females, five males) who underwent posterior corrective fusion surgery for Lenke type 2 AIS with at least 2 years of follow-up were included. Radiographic parameters and health-related quality of life were evaluated preoperatively, 1 week postoperatively, and at final follow-up. Intraoperative T1 tilt and upper instrumented vertebra (UIV) tilt were measured in the prone position before and after correction. PSI was defined as radiographic shoulder height (RSH) greater than 15 mm at 1 week postoperatively. Patients were classified into PSI and non-PSI groups. Intergroup comparisons were conducted using the Mann-Whitney U test or chisquare test. Correlations of intraoperative changes in T1 tilt (ΔT1) and UIV tilt (ΔUIV) with changes in RSH (ΔRSH) and clavicle angle (ΔCA) were analyzed.</p><p><strong>Results: </strong>Twelve patients (24.0%) had PSI at 1 week postoperatively, which persisted in five patients (10.0%) at final follow-up. Intraoperative ΔT1 and ΔUIV were significantly correlated with ΔRSH (R =0.613, p <0.001; R =0.435, p =0.002) and ΔCA (R =0.453, p =0.002; R =0.383, p =0.007). In the PSI group, ΔRSH was strongly correlated with ΔT1 (R =0.678, p =0.015).</p><p><strong>Conclusions: </strong>Minimizing intraoperative changes in T1 tilt may help reduce the risk of PSI in Lenke type 2 AIS.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"466-474"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329253/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145766925","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":"Single-slice computed tomography-derived pedicle screw trajectory Hounsfield unit values predict screw loosening after lumbar fusion: a retrospective study in Japan.","authors":"Shuji Yamamoto, Satoshi Komatsubara, Takaaki Fujiki, Katsuya Mitamura, Masakazu Ishikawa","doi":"10.31616/asj.2025.0306","DOIUrl":"10.31616/asj.2025.0306","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective observational study.</p><p><strong>Purpose: </strong>This study aimed to determine the predictive utility of Hounsfield unit (HU) values, derived from single-slice computed tomography (CT) images, for identifying postoperative pedicle screw (PS) loosening in patients undergoing lumbar interbody fusion. The HU values were specifically measured along the planned PS trajectory.</p><p><strong>Overview of literature: </strong>PS loosening is a frequent complication following spinal fusion surgery, particularly in individuals with compromised bone quality. Although prior research has explored the correlation between screw loosening and general vertebral HU values or bone mineral density, the specific predictive capability of a simple, single-slice measurement along the screw path remains a gap in the literature.</p><p><strong>Methods: </strong>We retrospectively reviewed data from 47 patients (212 screws) who underwent lumbar interbody fusion between November 2020 and September 2022. Preoperative CT images were used to measure HU values in both the vertebral body and along the PS trajectories. Patients were then stratified into two groups based on the presence (L group, n=9) or absence (no-loosening [NL] group, n=38) of screw loosening identified on 1-year follow-up CT. Comparative analyses were conducted, followed by a receiver operating characteristic curve analysis to establish the optimal predictive HU cutoff.</p><p><strong>Results: </strong>The incidence of postoperative screw loosening was 11.8% (25/212). While no significant inter-group differences were observed regarding age, bone mineral density, or vertebral body HU values, the PS trajectory HU was significantly lower in the L group (111±40) compared to the NL group (157±74) (p <0.001). Receiver operating characteristic curve analysis identified an optimal HU cutoff of 123. The area under the curve was 0.7106, with an odds ratio of 3.18, sensitivity of 0.31, and specificity of 0.41.</p><p><strong>Conclusions: </strong>Lower HU values measured along the PS trajectory using single-slice CT images were significantly associated with a higher risk of screw loosening. This straightforward method may serve as a valuable tool for identifying high-risk patients during the preoperative planning phase of spinal fusion surgery.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"498-505"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145548132","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":"Surgical management protocol for anterior-only reduction and fixation for acute, delayed and old subaxial cervical facet dislocation: a retrospective study of 87 consecutive cases in China.","authors":"Zhengfeng Zhang","doi":"10.31616/asj.2025.0324","DOIUrl":"10.31616/asj.2025.0324","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective study.</p><p><strong>Purpose: </strong>To evaluate the efficacy of a surgical protocol utilizing novel anterior-only reduction and fixation techniques for acute, delayed, and old subaxial cervical facet dislocations.</p><p><strong>Overview of literature: </strong>There is no clear consensus on the optimal surgical approach (anterior, posterior, or combined) for cervical facet dislocation.</p><p><strong>Methods: </strong>Over a 10-year period, 87 consecutive patients with subaxial cervical facet dislocations were treated using an anterior-only approach. Patients were classified into three groups: (1) those indicated for urgent surgery; (2) those contraindicated for urgent surgery; and (3) those with old dislocations. Closed reduction was used in patients contraindicated for urgent surgery. Open reduction involved two anterior-only reduction techniques: modified Caspar pin kyphotic paramedian distraction and anterior facetectomy if required. Fixation was performed with anterior vertebral screw plates for C3/4, C4/5, and selected C5/6 cases, or pedicle screw plates for C6/7, C7/ T1, and C5/6 cases with severe vertebral or articular process fractures.</p><p><strong>Results: </strong>Reduction success rates were 67% for closed reduction, 81% for the modified Caspar pin kyphotic paramedian distraction, and 100% for anterior facetectomy. No supplemental posterior surgery was required. At a minimum follow-up of 12 months, all patients achieved satisfactory fusion without implant failure. Neurological improvement of at least one American Spinal Injury Association grade was observed in 29 patients (43.9%), and no neurological deterioration occurred.</p><p><strong>Conclusions: </strong>The anterior-only protocol, incorporating modified kyphotic paramedian distraction with Caspar pins, anterior facetectomy, and anterior pedicle screw plate fixation, is safe and effective for managing acute, delayed, and old subaxial cervical facet dislocations.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"515-524"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905534","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":"Radiographic and clinical effects of core stabilization on cervical pain and sagittal balance in forward head posture: a randomized controlled trial.","authors":"Ahmed Mahmoud Mohamed Shabana, Reda Sayed Ashour, Ahmad Salamah Yamany, Abeer Farag Hanafy","doi":"10.31616/asj.2025.0297","DOIUrl":"10.31616/asj.2025.0297","url":null,"abstract":"<p><strong>Study design: </strong>Randomized controlled trial with a pretest-posttest control group design.</p><p><strong>Purpose: </strong>To investigate the radiographic and clinical effects of core stabilization exercises (CSEs) on cervical sagittal alignment and pain in individuals with forward head posture (FHP).</p><p><strong>Overview of literature: </strong>FHP is a common postural disorder increasingly linked to prolonged screen use. Conventional rehabilitation primarily targets cervical musculature, whereas the role of core stabilization in influencing cervical alignment remains underexplored.</p><p><strong>Methods: </strong>Forty patients (aged 20-40 years) with FHP (craniovertebral angle ≤50°) were randomly assigned to two groups: group A received CSEs combined with postural correction exercises (PCEs), and group B received PCEs alone. Interventions were delivered 3 times per week for 6 weeks. The primary outcomes were T1 slope (T1S), spino-cranial angle (SCA), and pain intensity measured using the Pain Rating Scale (PRS).</p><p><strong>Results: </strong>Thirty-six participants completed the intervention. A two-way mixed-design multivariate analysis of variance revealed a significant main effect of time (F =19.461, p <0.001) and a significant time×group interaction (F =9.726, p <0.001), indicating superior improvements in group A. Group A demonstrated significantly greater gains in SCA and PRS scores compared to group B (p <0.05). Both groups showed significant improvements in T1S.</p><p><strong>Conclusions: </strong>CSEs are effective in improving cervical sagittal alignment and reducing cervical pain in individuals with FHP. These findings support the integration of core-focused interventions into clinical rehabilitation programs for postural dysfunction (ClinicalTrial.gov registration number: NCT06160245).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"431-441"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329235/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145905495","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":"Interlaminar endoscopic contralateral decompression: redefining technique through standardized maneuvers and nomenclature.","authors":"Prasad Patgaonkar, Tanmay Avhad, Vidit Pathak","doi":"10.31616/asj.2025.0434","DOIUrl":"10.31616/asj.2025.0434","url":null,"abstract":"<p><p>Lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) is a minimally invasive procedure designed to treat lumbar spinal stenosis. While traditional uniportal endoscopic decompression already reduces tissue damage and promotes faster recovery compared to open surgery, this work introduces standardized terminology and specific endoscope-camera maneuvers to improve visualization and precision during both ipsilateral and contralateral decompression. By describing endoscope (\"shaft\") and camera head (\"optic\") rotations in a degree-degree format (e.g., 0-0, 90-0, 135-135, 180-180), the technique allows reproducible, targeted access to key anatomical areas while minimizing unnecessary bone removal. This systematic approach addresses the steep learning curve and technical intricacies of lumbar endoscopy, aiding intraoperative communication and potentially decreasing complications from inadequate decompression or poor visualization. The method aims to improve training, safety, and consistency of outcomes in endoscopic lumbar decompression procedures stenosis.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"525-532"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112058","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":"Impact of sarcopenia on outcomes of percutaneous vertebroplasty and kyphoplasty: a comprehensive meta-analysis.","authors":"Pablo Palacios, Isabel Palacios, Pablo Arauz de Robles, Alejandro Lorente, Gonzalo Mariscal, María Benlloch, Juan Carlos Gutiérrez, Ana Palacios","doi":"10.31616/asj.2025.0265","DOIUrl":"10.31616/asj.2025.0265","url":null,"abstract":"<p><strong>Purpose: </strong>This meta-analysis evaluated the impact of sarcopenia on the efficacy and safety of percutaneous vertebroplasty and kyphoplasty in patients with osteoporotic vertebral compression fractures.</p><p><strong>Methods: </strong>Following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, a systematic literature search was conducted to identify studies comparing outcomes between patients with and without sarcopenia undergoing vertebroplasty or kyphoplasty. Twelve studies involving 1,786 patients were included. The primary outcomes were pain (measured using the Visual Analog Scale), refractures, disability (using the Oswestry Disability Index), length of hospital stay, and mortality rates. Heterogeneity was assessed using the I2 statistic. Mean differences (MDs) and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, applying a random-effects model when heterogeneity was present.</p><p><strong>Results: </strong>Patients with sarcopenia experienced significantly higher pain (MD, 0.82; 95% CI, 0.47-1.17; p<0.00001), greater disability (MD, 5.70; 95% CI, 4.54-6.87; p<0.00001), and increased refracture risk (OR, 2.58; 95% CI, 1.13-5.89; p=0.02) compared with those without sarcopenia. Length of hospital stay was also longer, and mortality rates were significantly higher in the sarcopenia group.</p><p><strong>Conclusions: </strong>Sarcopenia is an important risk factor for adverse outcomes after vertebroplasty and kyphoplasty. A systematic assessment of sarcopenia and the development of tailored perioperative strategies may help mitigate these risks and improve patient outcomes (PROSPERO registration no., CRD42024628263).</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"572-584"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008644","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":"Computer-navigated transfacet uniportal endoscopic lumbar interbody fusion: a novel technique and illustrative case series.","authors":"Xian Jun Ngoh, Jia Yi Loh, Dickson Hong Him Chau, Lei Jiang","doi":"10.31616/asj.2025.0519","DOIUrl":"10.31616/asj.2025.0519","url":null,"abstract":"<p><p>Minimally invasive lumbar interbody fusion continues to evolve with advancements in navigation and endoscopic technologies aimed at reducing tissue trauma and improving safety. Conventional endoscopic fusion approaches, such as the interlaminar and trans-Kambin techniques, have inherent limitations regarding neural safety and implant positioning. We describe a novel computer-navigated transfacet uniportal endoscopic lumbar interbody fusion technique that leverages advanced navigation and endoscopic visualization to safely access the disc space via a transfacet corridor. We present an initial case series to demonstrate the clinical feasibility, safety, and effectiveness of this technique.</p>","PeriodicalId":8555,"journal":{"name":"Asian Spine Journal","volume":" ","pages":"533-540"},"PeriodicalIF":2.7,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343459","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}