{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:04:08Z","timestamp":1792789448366,"version":"4.5.0"},"reference-count":53,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T00:00:00Z","timestamp":1686268800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"P.G."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The current method of treatment of spinal deformities would be almost impossible without pedicle screws (PS) placement. There are only a few studies evaluating the safety of PS placement and possible complications in children during growth. The present study was carried out to evaluate the safety and accuracy of PS placement in children with spinal deformities at any age using postoperative computed tomography (CT) scans. Methods: 318 patients (34 males and 284 females) who underwent 6358 PS fixations for pediatric spinal deformities were enrolled in this multi-center study. The patients were divided into three age groups: less than 10 years old, 11\u201313 years old, and 14\u201318 years old. These patients underwent postoperative CT scans and were analyzed for pedicle screw malposition (anterior, superior, inferior, medial, and lateral breaches). Results: The breach rate was 5.92% for all pedicles. There were 1.47% lateral and 3.12% medial breaches for all pedicles with tapping canals, and 2.66% lateral and 3.84% medial breaches for all pedicles without a tapping canal for the screw. Of the 6358 screws placed in the thoracic, lumbar, and sacral spine, 98% of the screws were accurately placed (grade 0, 1, and juxta pedicular). A total of 56 screws (0.88%) breached more than 4 mm (grade 3), and 17 (0.26%) screws were replaced. No new and permanent neurological, vascular, or visceral complications were encountered. Conclusions: The free-hand technique for pedicle screw placement in the acceptable and safety zone in pedicles and vertebral bodies was 98%. No complications associated with screw insertion in growth were noted. The free-hand technique for pedicle screw placement can be safely used in patients at any age. The screw accuracy does not depend on the child\u2019s age nor the size of the deformity curve. Segmental instrumentation with posterior fixation in children with spinal deformities can be performed with a very low complication rate. Navigation of the robot is only an auxiliary tool in the hands of the surgeons, and the result of the work ultimately depends on the surgeons.<\/jats:p>","DOI":"10.3390\/jcm12123954","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T08:37:33Z","timestamp":1686299853000},"page":"3954","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["The Child\u2019s Age and the Size of the Curvature Do Not Affect the Accuracy of Screw Placement with the Free-Hand Technique in Spinal Deformities in Children and Adolescents"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7059-2935","authenticated-orcid":false,"given":"Pawel","family":"Grabala","sequence":"first","affiliation":[{"name":"Department of Pediatric Orthopedic Surgery and Traumatology, University Children\u2019s Hospital, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland"},{"name":"Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5200-3279","authenticated-orcid":false,"given":"Ilkka J.","family":"Helenius","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Helsinki University Hospital, 00260 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Kowalski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Regional Specialized Hospital, Ul. Dekerta 1, 66-400 Gorzow Wielkopolski, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Grabala","sequence":"additional","affiliation":[{"name":"2nd Clinical Department of General and Gastroenterogical Surgery, Medical University of Bialystok, Ul. Marii Sk\u0142odowskiej-Curie 24a, 15-276 Bialystok, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Slawomir","family":"Zacha","sequence":"additional","affiliation":[{"name":"Department of Pediatric Orthopedics and Oncology of the Musculoskeletal System, Pomeranian Medical University in Szczecin, 71-252 Szczecin, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2227-147X","authenticated-orcid":false,"given":"Jaroslaw M.","family":"Deszczynski","sequence":"additional","affiliation":[{"name":"Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland"},{"name":"Department of Orthopedics and Rehabilitation, Warsaw Medical University, 02-091 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Albrewczynski","sequence":"additional","affiliation":[{"name":"Paley European Institute, Al. Rzeczypospolitej 1, 02-972 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael A.","family":"Galgano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob M.","family":"Buchowski","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University School of Medicine, 660 S Euclid Ave., St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3596-4825","authenticated-orcid":false,"given":"Kelly","family":"Chamberlin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of North Carolina, Chapel Hill, NC 27516, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suken A.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Nemours Children\u2019s Health, Delaware Valley,1600 Rockland Road, Wilmington, DE 19803, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1097\/00007632-200109150-00022","article-title":"Thoracic pedicle screw fixation in spinal deformities: Are they really safe?","volume":"26","author":"Suk","year":"2001","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1097\/01.BRS.0000109983.12113.9B","article-title":"Free hand pedicle screw placement in the thoracic spine: Is it safe?","volume":"29","author":"Kim","year":"2004","journal-title":"Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"512","DOI":"10.4103\/0028-3886.22622","article-title":"Thoracic pedicle screw placement: Free-hand technique","volume":"53","author":"Lenke","year":"2005","journal-title":"Neurol. India"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/01.brs.0000197865.20803.d4","article-title":"Comparative Analysis of Pedicle Screw Versus Hybrid Instrumentation in Posterior Spinal Fusion of Adolescent Idiopathic Scoliosis","volume":"31","author":"Kim","year":"2006","journal-title":"Spine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2084","DOI":"10.1097\/01.brs.0000178818.92105.ec","article-title":"Evaluation of Pedicle Screw Placement in the Deformed Spine Using Intraoperative Plain Radiographs: A Comparison with Computerized Tomography","volume":"30","author":"Kim","year":"2005","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.1097\/BRS.0b013e31816f2865","article-title":"Rationale Behind the Current State-of-the-Art Treatment of Scoliosis (in the Pedicle Screw Era)","volume":"33","author":"Lenke","year":"2008","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/01.brs.0000150482.26918.d8","article-title":"Accuracy and Efficacy of Thoracic Pedicle Screws in Curves More Than 90\u00b0","volume":"30","author":"Kuklo","year":"2005","journal-title":"Spine"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2679","DOI":"10.1097\/BRS.0b013e31815a7f13","article-title":"Computed tomography evaluation of pedicle screw placed in the pediatric deformed spine over an 8-year period","volume":"32","author":"Lehman","year":"2007","journal-title":"Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E1112","DOI":"10.1097\/BRS.0b013e3181ffeea2","article-title":"A Novel Method of Screw Placement for Extremely Small Thoracic Pedicles in Scoliosis","volume":"36","author":"Lee","year":"2011","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1007\/s00586-009-1065-y","article-title":"Evaluation of thoracic pedicle screw placement in adolescent idiopathic scoliosis","volume":"18","author":"Tosun","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s00264-008-0535-x","article-title":"Accuracy of thoracic pedicle screw placement in scoliosis using the ideal pedicle entry point during the freehand technique","volume":"33","author":"Modi","year":"2008","journal-title":"Int. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2759","DOI":"10.1097\/BRS.0b013e31815a5970","article-title":"Neural complications in the surgical treatment of adolescent idiopathic scoliosis","volume":"32","author":"Diab","year":"2007","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2040","DOI":"10.1007\/s00586-018-5611-3","article-title":"Esophageal perforation caused by a thoracic pedicle screw","volume":"30","author":"Marouby","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1519","DOI":"10.2106\/00004623-199911000-00003","article-title":"Complications Associated with Pedicle Screws","volume":"81","author":"Lonstein","year":"1999","journal-title":"J. Bone Jt. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/BPO.0b013e318279c31a","article-title":"Upper Thoracic Pedicle Screw Loss of Fixation Causing Spinal Cord Injury: A review of the literature and multicenter case series","volume":"33","author":"Skaggs","year":"2013","journal-title":"J. Pediatr. Orthop."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E1054","DOI":"10.1097\/BRS.0b013e3182600a7d","article-title":"The position of the aorta changes with altered body position in single right thoracic adolescent idiopathic scoliosis: A magnetic resonance imaging study","volume":"37","author":"Jiang","year":"2012","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/s00586-011-1986-0","article-title":"Pedicle screw instrumentation in adolescent idiopathic scoliosis (AIS)","volume":"21","author":"Suk","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Grabala, P., Helenius, I.J., Buchowski, J.M., and Shah, S.A. (2023). The Efficacy of a Posterior Approach to Surgical Correction for Neglected Idiopathic Scoliosis: A Comparative Analysis According to Health-Related Quality of Life, Pulmonary Function, Back Pain and Sexual Function. Children, 10.","DOI":"10.3390\/children10020299"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E920","DOI":"10.1097\/BRS.0000000000002000","article-title":"The azygous vein is at potential risk of injury from malpositioning of left thoracic pedicle screw in thoracic adolescent idiopathic scoliosis patients","volume":"42","author":"Jiang","year":"2017","journal-title":"Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"E103","DOI":"10.1097\/BSD.0b013e31824a7bc3","article-title":"The Position of the Aorta Relative to the Spine for Pedicle Screw Placement in the Correction of Idiopathic Scoliosis","volume":"25","author":"Liu","year":"2012","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_21","first-page":"61","article-title":"Accuracy and complications of pedicle screw insertion for lumbar and thoracolumbar fractures","volume":"1","author":"Azimi","year":"2014","journal-title":"Int. Clin. Neurosci. J."},{"key":"ref_22","first-page":"1","article-title":"Surgical technique: Power pedicle preparation and screw insertion in the treatment of pediatric spinal deformity","volume":"1","author":"Illingworth","year":"2019","journal-title":"J. Posna"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.jspd.2014.07.001","article-title":"Safety and Efficacy of Power-Assisted Pedicle Tract Preparation and Screw Placement","volume":"3","author":"Seehausen","year":"2015","journal-title":"Spine Deform."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1007\/s43390-021-00347-x","article-title":"Power versus manual pedicle tract preparation: A multi-center study of early adopters","volume":"9","author":"Skaggs","year":"2021","journal-title":"Spine Deform."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s11701-016-0587-7","article-title":"Accuracy of robot-assisted pedicle screw placement for adolescent idiopathic scoliosis in the pediatric population","volume":"10","author":"Macke","year":"2016","journal-title":"J. Robot. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1007\/s00586-022-07502-6","article-title":"Accuracy of computer-assisted pedicle screw placement for adolescent idiopathic scoliosis: A comparison between robotics and navigation","volume":"32","author":"Akazawa","year":"2022","journal-title":"Eur. Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Li, C., Su, J., Wang, Z., Li, D., Tian, Y., Yuan, S., Wang, L., and Liu, X. (2022). Comparison of the Accuracy of Pedicle Screw Placement Using a Fluoroscopy-Assisted Free-Hand Technique with Robotic-Assisted Navigation Using an O-Arm or 3D C-Arm in Scoliosis Surgery. Glob. Spine J., 21925682221143076.","DOI":"10.1177\/21925682221143076"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2309499017713938","article-title":"The accuracy and safety of fluoroscopic-guided percutaneous pedicle screws in the thoracic and lumbosacral spine in the Asian population: A CT scan analysis of 1002 screws","volume":"25","author":"Chiu","year":"2017","journal-title":"J. Orthop. Surg."},{"key":"ref_29","first-page":"e501","article-title":"Freehand Thoracic Pedicle Screw Placement: Review of Existing Strategies and a Step-by-Step Guide Using Uniform Landmarks for All Levels","volume":"8","author":"Avila","year":"2016","journal-title":"Cureus"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"E465","DOI":"10.1097\/BRS.0b013e3181d1021a","article-title":"Complications of Pedicle Screw Fixation in Scoliosis Surgery: A Systematic Review","volume":"35","author":"Hicks","year":"2010","journal-title":"Spine J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"104S","DOI":"10.1177\/2192568219859314","article-title":"The Use of Intraoperative Neurophysiological Monitoring in Spine Surgery","volume":"10","author":"Charalampidis","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_32","first-page":"55","article-title":"Management of juvenile idiopathic scoliosis","volume":"89","author":"Lenke","year":"2007","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/00007632-199001000-00004","article-title":"Accuracy of Pedicular Screw Placement In Vivo","volume":"15","author":"Gertzbein","year":"1990","journal-title":"Spine"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/01.bsd.0000211221.74307.57","article-title":"Stepwise Methodology for Plain Radiographic Assessment of Pedicle Screw Placement: A Comparison with Computed Tomography","volume":"19","author":"Choma","year":"2006","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1097\/BRS.0000000000001738","article-title":"Accuracy and safety of pedicle screw placement in adolescent idiopathic scoliosis patients: A review of 2020 screws using computed tomography assessment","volume":"42","author":"Kwan","year":"2017","journal-title":"Spine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"E188","DOI":"10.1097\/BRS.0b013e31822a2e0a","article-title":"Pediatric Pedicle Screw Placement Using Intraoperative Computed Tomography and 3-Dimensional Image-Guided Navigation","volume":"37","author":"Larson","year":"2012","journal-title":"Spine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1007\/s11999.0000000000000204","article-title":"Increased Radiation but No Benefits in Pedicle Screw Accuracy with Navigation versus a Freehand Technique in Scoliosis Surgery","volume":"476","author":"Urbanski","year":"2018","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2907","DOI":"10.1097\/BRS.0b013e3181b77af3","article-title":"Feasibility and Accuracy of Pedicle Screws in Children Younger Than Eight Years of Age","volume":"34","author":"Ranade","year":"2009","journal-title":"Spine"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1097\/00007632-200207150-00015","article-title":"Accuracy of Thoracic Pedicle Screws in Patients with and Without Coronal Plane Spinal Deformities","volume":"27","author":"Belmont","year":"2002","journal-title":"Spine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"319","DOI":"10.21037\/jss.2018.05.16","article-title":"Utilization of the 3D-printed spine model for freehand pedicle screw placement in complex spinal deformity correction","volume":"4","author":"Tan","year":"2018","journal-title":"J. Spine Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1007\/s43390-021-00434-z","article-title":"0.4% incidence of return to OR due to screw malposition in a large prospective adolescent idiopathic scoliosis database","volume":"10","author":"Swany","year":"2021","journal-title":"Spine Deform."},{"key":"ref_42","first-page":"382","article-title":"Morphometric analysis of thoracic and lumbar vertebrae in idiopathic scoliosis","volume":"88","author":"Liljenqvist","year":"2002","journal-title":"Stud. Health Technol. Inform."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"112","DOI":"10.5312\/wjo.v5.i2.112","article-title":"Techniques and accuracy of thoracolumbar pedicle screw placement","volume":"5","author":"Puvanesarajah","year":"2014","journal-title":"World J. Orthop."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.1097\/BRS.0b013e3181d3cfde","article-title":"A Novel Pedicle Channel Classification Describing Osseous Anatomy: How many thoracic scoliotic pedicles have cancellous channels?","volume":"35","author":"Watanabe","year":"2010","journal-title":"Spine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1097\/00007632-199309000-00018","article-title":"An Anatomic, Radiographic, and Biomechanical Assessment of Extrapedicular Screw Fixation in the Thoracic Spine","volume":"18","author":"Dvorak","year":"1993","journal-title":"Spine"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/01.BRS.0000105525.06564.56","article-title":"Volumetric spinal canal intrusion: A comparison between thoracic pedicle screws and thoracic hooks","volume":"29","author":"Polly","year":"2004","journal-title":"Spine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"E386","DOI":"10.1097\/BRS.0b013e318286be5d","article-title":"Complications of pedicle screws in children 10 years or younger: A case control study","volume":"38","author":"Baghdadi","year":"2013","journal-title":"Spine"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.2106\/JBJS.J.00678","article-title":"Pediatric pedicle screws: Comparative effectiveness and safety: A systematic literature review from the Scoliosis Research Society and the Pediatric Orthopaedic Society of North America task force","volume":"93","author":"Ledonio","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s00586-009-1203-6","article-title":"Radiological and clinical outcome of screw placement in adolescent idiopathic scoliosis: Evaluation with low-dose computed tomography","volume":"19","author":"Ohlin","year":"2010","journal-title":"Eur. Spine J."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"E473","DOI":"10.1097\/BRS.0b013e318238bbd9","article-title":"Computed tomography-guided navigation of thoracic pedicle screws for adoles- cent idiopathic scoliosis results in more accurate placement and less screw removal","volume":"37","author":"Ughwanogho","year":"2012","journal-title":"Spine"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Faldini, C., Barile, F., Viroli, G., Manzetti, M., Ialuna, M., Traversari, M., Paolucci, A., Rinaldi, A., D\u2019antonio, G., and Ruffilli, A. (2022). Freehand power-assisted pedicle screw placement in scoliotic patients: Results on 5522 consecutive pedicle screws. Musculoskelet. Surg., ahead of print.","DOI":"10.1007\/s12306-022-00754-x"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Du, S.-Y., Dai, J., Zhou, Z.-T., Shan, B.-C., Jiang, F.-X., Yang, J.-Y., Cao, L., and Zhou, X.-Z. (2022). Size selection and placement of pedicle screws using robot-assisted versus fluoroscopy-guided techniques for thoracolumbar fractures: Possible implications for the screw loosening rate. BMC Surg., 22.","DOI":"10.1186\/s12893-022-01814-6"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1227\/ons.0000000000000498","article-title":"A Retrospective Analysis of Pedicle Screw Placement Accuracy Using the ExcelsiusGPS Robotic Guidance System: Case Series","volume":"24","author":"Kanaly","year":"2023","journal-title":"Oper. Neurosurg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/12\/3954\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:51:43Z","timestamp":1760125903000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/12\/3954"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,9]]},"references-count":53,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,6]]}},"alternative-id":["jcm12123954"],"URL":"https:\/\/doi.org\/10.3390\/jcm12123954","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,9]]}}}