{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T06:20:15Z","timestamp":1788070815224,"version":"build-2784847793"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004543","name":"China Scholarship Council","doi-asserted-by":"crossref","award":["201808080126"],"award-info":[{"award-number":["201808080126"]}],"id":[{"id":"10.13039\/501100004543","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100010874","name":"Shandong Provincial Finance Department","doi-asserted-by":"publisher","award":["2020FY019"],"award-info":[{"award-number":["2020FY019"]}],"id":[{"id":"10.13039\/501100010874","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","award":["ZR2021QH307"],"award-info":[{"award-number":["ZR2021QH307"]}],"id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Orthop Surg Res"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The treatment of complex 3- and 4-part proximal humeral fractures has been controversial due to numerous postoperative complications. With the further study of medial support and blood supply of humeral head, new techniques and conception are developing. The study aims to illustrate the medial approach of the proximal humeral fracture through cadaver autopsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>Upper limbs from 19 cadavers have been dissected to expose the shoulder joint. We selected the coracoid process as the bony reference. Vernier caliper will be used to measure the following data, including distance from coracoid process to circumflex brachial artery, distance between anterior humeral circumflex artery (ACHA) and posterior circumflex brachial artery (PCHA) and their diameters. Assessment included the characteristics of the vascular supply around the humeral head, identification of the structures at risk, quality of exposure of the bony structures, and feasibility of fixation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The medial approach is appropriate in 86.84% anatomical patterns. Between the lower part of the shoulder capsule and the insertion of conjoined tendon, the bony surface exposed was limited by the interval between ACHA and PCHA. An interval of 2 to 3\u00a0cm (24.29\u2009\u00b1\u20093.42\u00a0mm) was available for medial plate. ACHA (49.35\u2009\u00b1\u20098.13\u00a0mm, 35.14\u201368.53\u00a0mm) and PCHA (49.62\u2009\u00b1\u20097.82\u00a0mm, 37.67\u201366.76\u00a0mm) were about 5\u00a0cm away from the coracoid process. Risk structures including ACHA and PCHA originate in common, PCHA originated from the deep brachial artery (DBA), the presence of perforator vessels, musculocutaneous nerve intersects with ACHA, the diameter of PCHA: ACHA\u2009&lt;\u20091.5. In 13.15% anatomical patterns, this risk structure should be taken seriously.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The medial approach opens a new perspective in the optimal management of complex fractures of proximal humerus. Anatomical research proves that the medial approach is feasible. The interval between ACHA and PCHA is suitable for placement. Anatomical pattern and indication have been discussed, and we hypothesized that ACHA has been destroyed in complex PHFs. With further studies on the anatomy and mechanism of injury, the development of more clinical cases will be an important work of our institution in the future.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13018-021-02897-2","type":"journal-article","created":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T10:03:57Z","timestamp":1642413837000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Anatomical study for the treatment of proximal humeral fracture through the medial approach"],"prefix":"10.1186","volume":"17","author":[{"given":"Hao","family":"Xiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongliang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanxiao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingsen","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingpeng","family":"Kong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingzhen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7641-3475","authenticated-orcid":false,"given":"Fu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"issue":"8","key":"2897_CR1","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.injury.2006.04.130","volume":"37","author":"CM Court-Brown","year":"2006","unstructured":"Court-Brown CM, Caesar B. Epidemiology of adult fractures: a review. Injury. 2006;37(8):691\u20137.","journal-title":"Injury"},{"issue":"12","key":"2897_CR2","doi-asserted-by":"publisher","first-page":"2117","DOI":"10.1016\/j.jse.2017.05.029","volume":"26","author":"D Passaretti","year":"2017","unstructured":"Passaretti D, et al. Epidemiology of proximal humeral fractures: a detailed survey of 711 patients in a metropolitan area. J Shoulder Elbow Surg. 2017;26(12):2117\u201324.","journal-title":"J Shoulder Elbow Surg"},{"issue":"1","key":"2897_CR3","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1186\/s13018-021-02551-x","volume":"16","author":"S Iglesias-Rodriguez","year":"2021","unstructured":"Iglesias-Rodriguez S, et al. Epidemiology of proximal humerus fractures. J Orthop Surg Res. 2021;16(1):402.","journal-title":"J Orthop Surg Res"},{"issue":"6","key":"2897_CR4","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1016\/j.otsr.2012.05.013","volume":"98","author":"A Roux","year":"2012","unstructured":"Roux A, et al. Epidemiology of proximal humerus fractures managed in a trauma center. Orthop Traumatol Surg Res. 2012;98(6):715\u20139.","journal-title":"Orthop Traumatol Surg Res"},{"key":"2897_CR5","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1097\/01.blo.0000194672.79634.78","volume":"442","author":"M Palvanen","year":"2006","unstructured":"Palvanen M, et al. Update in the epidemiology of proximal humeral fractures. Clin Orthop Relat Res. 2006;442:87\u201392.","journal-title":"Clin Orthop Relat Res"},{"issue":"8","key":"2897_CR6","doi-asserted-by":"publisher","first-page":"1697","DOI":"10.1007\/s00264-014-2362-6","volume":"38","author":"C Bahrs","year":"2014","unstructured":"Bahrs C, et al. Trends in epidemiology and patho-anatomical pattern of proximal humeral fractures. Int Orthop. 2014;38(8):1697\u2013704.","journal-title":"Int Orthop"},{"issue":"12","key":"2897_CR7","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1007\/s00402-019-03252-1","volume":"139","author":"A Klug","year":"2019","unstructured":"Klug A, et al. Trends in surgical management of proximal humeral fractures in adults: a nationwide study of records in Germany from 2007 to 2016. Arch Orthop Trauma Surg. 2019;139(12):1713\u201321.","journal-title":"Arch Orthop Trauma Surg"},{"issue":"2","key":"2897_CR8","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2106\/JBJS.J.00155","volume":"93","author":"Y Zhu","year":"2011","unstructured":"Zhu Y, et al. Locking intramedullary nails and locking plates in the treatment of two-part proximal humeral surgical neck fractures: a prospective randomized trial with a minimum of three years of follow-up. J Bone Joint Surg Am. 2011;93(2):159\u201368.","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"2897_CR9","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s10195-015-0384-5","volume":"17","author":"J Wong","year":"2016","unstructured":"Wong J, Newman JM, Gruson KI. Outcomes of intramedullary nailing for acute proximal humerus fractures: a systematic review. J Orthop Traumatol. 2016;17(2):113\u201322.","journal-title":"J Orthop Traumatol"},{"issue":"2","key":"2897_CR10","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1007\/s12306-019-00610-5","volume":"104","author":"S Congia","year":"2020","unstructured":"Congia S, et al. Is antegrade nailing a proper option in 2- and 3-part proximal humeral fractures? Musculoskelet Surg. 2020;104(2):179\u201385.","journal-title":"Musculoskelet Surg"},{"issue":"1","key":"2897_CR11","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.jse.2007.03.016","volume":"17","author":"B Lanting","year":"2008","unstructured":"Lanting B, et al. Proximal humeral fractures: a systematic review of treatment modalities. J Shoulder Elbow Surg. 2008;17(1):42\u201354.","journal-title":"J Shoulder Elbow Surg"},{"issue":"1","key":"2897_CR12","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1097\/BOT.0000000000000229","volume":"29","author":"AK Gupta","year":"2015","unstructured":"Gupta AK, et al. Surgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma. 2015;29(1):54\u20139.","journal-title":"J Orthop Trauma"},{"issue":"Suppl 3","key":"2897_CR13","doi-asserted-by":"publisher","first-page":"S59","DOI":"10.1016\/j.injury.2007.08.013","volume":"38","author":"D Ring","year":"2007","unstructured":"Ring D. Current concepts in plate and screw fixation of osteoporotic proximal humerus fractures. Injury. 2007;38(Suppl 3):S59-68.","journal-title":"Injury"},{"issue":"6","key":"2897_CR14","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1302\/0301-620X.86B6.14577","volume":"86","author":"C Gerber","year":"2004","unstructured":"Gerber C, Werner CM, Vienne P. Internal fixation of complex fractures of the proximal humerus. J Bone Joint Surg Br. 2004;86(6):848\u201355.","journal-title":"J Bone Joint Surg Br"},{"key":"2897_CR15","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1097\/01.blo.0000194674.56764.c0","volume":"442","author":"N Helmy","year":"2006","unstructured":"Helmy N, Hintermann B. New trends in the treatment of proximal humerus fractures. Clin Orthop Relat Res. 2006;442:100\u20138.","journal-title":"Clin Orthop Relat Res"},{"issue":"5","key":"2897_CR16","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1007\/s00776-009-1382-3","volume":"14","author":"ID Micic","year":"2009","unstructured":"Micic ID, et al. Analysis of early failure of the locking compression plate in osteoporotic proximal humerus fractures. J Orthop Sci. 2009;14(5):596\u2013601.","journal-title":"J Orthop Sci"},{"issue":"8","key":"2897_CR17","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.1016\/j.jse.2019.11.026","volume":"29","author":"JD Barlow","year":"2020","unstructured":"Barlow JD, et al. Locking plate fixation of proximal humerus fractures in patients older than 60 years continues to be associated with a high complication rate. J Shoulder Elbow Surg. 2020;29(8):1689\u201394.","journal-title":"J Shoulder Elbow Surg"},{"issue":"4","key":"2897_CR18","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1016\/j.injury.2010.11.058","volume":"42","author":"RC Sproul","year":"2011","unstructured":"Sproul RC, et al. A systematic review of locking plate fixation of proximal humerus fractures. Injury. 2011;42(4):408\u201313.","journal-title":"Injury"},{"issue":"6","key":"2897_CR19","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1097\/BOT.0000000000000252","volume":"29","author":"SW Jung","year":"2015","unstructured":"Jung SW, et al. Factors that influence reduction loss in proximal humerus fracture surgery. J Orthop Trauma. 2015;29(6):276\u201382.","journal-title":"J Orthop Trauma"},{"issue":"3","key":"2897_CR20","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1097\/BOT.0b013e3180333094","volume":"21","author":"MJ Gardner","year":"2007","unstructured":"Gardner MJ, et al. The importance of medial support in locked plating of proximal humerus fractures. J Orthop Trauma. 2007;21(3):185\u201391.","journal-title":"J Orthop Trauma"},{"issue":"1","key":"2897_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13018-018-1031-7","volume":"14","author":"X Zhang","year":"2019","unstructured":"Zhang X, et al. Inferomedial cortical bone contact and fixation with calcar screws on the dynamic and static mechanical stability of proximal humerus fractures. J Orthop Surg Res. 2019;14(1):1.","journal-title":"J Orthop Surg Res"},{"issue":"9","key":"2897_CR22","doi-asserted-by":"publisher","first-page":"e352","DOI":"10.1097\/BOT.0000000000001515","volume":"33","author":"SG Park","year":"2019","unstructured":"Park SG, Ko YJ. Medial buttress plating for humerus fractures with unstable medial column. J Orthop Trauma. 2019;33(9):e352\u20139.","journal-title":"J Orthop Trauma"},{"issue":"1","key":"2897_CR23","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1186\/s13018-017-0573-4","volume":"12","author":"Y He","year":"2017","unstructured":"He Y, et al. Biomechanical evaluation of a novel dualplate fixation method for proximal humeral fractures without medial support. J Orthop Surg Res. 2017;12(1):72.","journal-title":"J Orthop Surg Res"},{"issue":"1","key":"2897_CR24","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s13018-020-02094-7","volume":"16","author":"F Wang","year":"2021","unstructured":"Wang F, et al. A novel surgical approach and technique and short-term clinical efficacy for the treatment of proximal humerus fractures with the combined use of medial anatomical locking plate fixation and minimally invasive lateral locking plate fixation. J Orthop Surg Res. 2021;16(1):29.","journal-title":"J Orthop Surg Res"},{"key":"2897_CR25","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/1471-2482-14-39","volume":"14","author":"YX Chen","year":"2014","unstructured":"Chen YX, et al. Anatomical study of simple landmarks for guiding the quick access to humeral circumflex arteries. BMC Surg. 2014;14:39.","journal-title":"BMC Surg"},{"issue":"1","key":"2897_CR26","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1186\/s13018-020-01776-6","volume":"15","author":"Y Yongliang","year":"2020","unstructured":"Yongliang Y, et al. Intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture. J Orthop Surg Res. 2020;15(1):258.","journal-title":"J Orthop Surg Res"},{"issue":"4","key":"2897_CR27","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1002\/ca.20958","volume":"23","author":"A Olinger","year":"2010","unstructured":"Olinger A, Benninger B. Branching patterns of the lateral thoracic, subscapular, and posterior circumflex humeral arteries and their relationship to the posterior cord of the brachial plexus. Clin Anat. 2010;23(4):407\u201312.","journal-title":"Clin Anat"},{"issue":"1","key":"2897_CR28","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1302\/0301-620X.75B1.8421010","volume":"75","author":"CH Brooks","year":"1993","unstructured":"Brooks CH, Revell WJ, Heatley FW. Vascularity of the humeral head after proximal humeral fractures. An anatomical cadaver study. J Bone Joint Surg Br. 1993;75(1):132\u20136.","journal-title":"J Bone Joint Surg Br"},{"issue":"3","key":"2897_CR29","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s00276-001-0185-9","volume":"23","author":"F Duparc","year":"2001","unstructured":"Duparc F, Muller JM, Freger P. Arterial blood supply of the proximal humeral epiphysis. Surg Radiol Anat. 2001;23(3):185\u201390.","journal-title":"Surg Radiol Anat"},{"issue":"10","key":"2897_CR30","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.2106\/00004623-199072100-00009","volume":"72","author":"C Gerber","year":"1990","unstructured":"Gerber C, Schneeberger AG, Vinh TS. The arterial vascularization of the humeral head. An anatomical study. J Bone Joint Surg Am. 1990;72(10):1486\u201394.","journal-title":"J Bone Joint Surg Am"},{"issue":"4","key":"2897_CR31","doi-asserted-by":"publisher","first-page":"943","DOI":"10.2106\/JBJS.H.01144","volume":"92","author":"CM Hettrich","year":"2010","unstructured":"Hettrich CM, et al. Quantitative assessment of the vascularity of the proximal part of the humerus. J Bone Jt Surg Am. 2010;92(4):943\u20138.","journal-title":"J Bone Jt Surg Am"},{"issue":"4","key":"2897_CR32","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/j.jses.2019.09.002","volume":"3","author":"N Keough","year":"2019","unstructured":"Keough N, et al. An anatomical investigation into the blood supply of the proximal humerus: surgical considerations for rotator cuff repair. JSES Open Access. 2019;3(4):320\u20137.","journal-title":"JSES Open Access"},{"issue":"5","key":"2897_CR33","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.1007\/s00167-013-2823-2","volume":"23","author":"Y Hagiwara","year":"2015","unstructured":"Hagiwara Y, et al. Blood flow changes of the anterior humeral circumflex artery decrease with the scapula in internal rotation. Knee Surg Sports Traumatol Arthrosc. 2015;23(5):1467\u201372.","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"3","key":"2897_CR34","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1007\/s00276-019-02356-y","volume":"42","author":"A Sergent","year":"2020","unstructured":"Sergent A, et al. Quantitative localization of the entry point of the lateral ascending branch of the anterior circumflex humeral artery: a high definition CT-scan radiological study. Surg Radiol Anat. 2020;42(3):233\u20137.","journal-title":"Surg Radiol Anat"},{"issue":"1","key":"2897_CR35","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1177\/1758573218825476","volume":"12","author":"S Gates","year":"2020","unstructured":"Gates S, et al. Surgically relevant anatomy of the axillary and radial nerves in relation to the latissimus dorsi tendon in variable shoulder positions: a cadaveric study. Shoulder Elbow. 2020;12(1):24\u201330.","journal-title":"Shoulder Elbow"},{"issue":"1","key":"2897_CR36","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s10877-015-9807-3","volume":"31","author":"T Kjelstrup","year":"2017","unstructured":"Kjelstrup T, Sauter AR, Hol PK. The relationship of the musculocutaneous nerve to the brachial plexus evaluated by MRI. J Clin Monit Comput. 2017;31(1):111\u20135.","journal-title":"J Clin Monit Comput"},{"issue":"3","key":"2897_CR37","doi-asserted-by":"publisher","first-page":"499","DOI":"10.1016\/j.jse.2017.07.008","volume":"27","author":"P Boileau","year":"2018","unstructured":"Boileau P, et al. Isolated loss of active external rotation: a distinct entity and results of L\u2019Episcopo tendon transfer. J Shoulder Elbow Surg. 2018;27(3):499\u2013509.","journal-title":"J Shoulder Elbow Surg"},{"issue":"4","key":"2897_CR38","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1016\/j.jse.2004.01.034","volume":"13","author":"R Hertel","year":"2004","unstructured":"Hertel R, et al. Predictors of humeral head ischemia after intracapsular fracture of the proximal humerus. J Shoulder Elbow Surg. 2004;13(4):427\u201333.","journal-title":"J Shoulder Elbow Surg"},{"issue":"4","key":"2897_CR39","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1016\/j.injury.2020.11.022","volume":"52","author":"N Sirisreetreerux","year":"2021","unstructured":"Sirisreetreerux N, Pengrung N, Apivatthakakul T. Proximal humerus exposure with the inverted-L anterolateral deltoid flip approach, anterolateral deltoid splitting approach, and deltopectoral approach: a comparative cadaveric study. Injury. 2021;52(4):738\u201346.","journal-title":"Injury"}],"container-title":["Journal of Orthopaedic Surgery and Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-021-02897-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13018-021-02897-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13018-021-02897-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T10:05:48Z","timestamp":1642413948000},"score":1,"resource":{"primary":{"URL":"https:\/\/josr-online.biomedcentral.com\/articles\/10.1186\/s13018-021-02897-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,17]]},"references-count":39,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["2897"],"URL":"https:\/\/doi.org\/10.1186\/s13018-021-02897-2","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-955263\/v1","asserted-by":"object"}]},"ISSN":["1749-799X"],"issn-type":[{"value":"1749-799X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,17]]},"assertion":[{"value":"5 October 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the medical ethics committee of Shandong Provincial Hospital Affiliated to Shandong University.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All participants signed informed consent forms for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"35"}}