{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:32:00Z","timestamp":1783607520723,"version":"3.55.0"},"reference-count":58,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Technology of Taiwan, ROC","award":["MOST 110-2622-B-A49-001"],"award-info":[{"award-number":["MOST 110-2622-B-A49-001"]}]},{"name":"Ministry of Science and Technology of Taiwan, ROC","award":["MOST 110-2221-E-A49A-505"],"award-info":[{"award-number":["MOST 110-2221-E-A49A-505"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Symptomatic osteoporotic compression fractures are commonly addressed through vertebroplasty and kyphoplasty. However, cement leakage poses a significant risk of neurological damage. We introduced \u201caspiration percutaneous kyphoplasty\u201d, also known as \u201cdecompressed kyphoplasty\u201d, as a method to mitigate cement leakage and conducted a comparative analysis with high viscosity cement vertebroplasty. We conducted a retrospective study that included 136 patients with single-level osteoporotic compression fractures. Among them, 70 patients underwent high viscosity cement vertebroplasty, while 66 patients received decompressed percutaneous kyphoplasty with low-viscosity cement. Comparison parameters included cement leakage rates, kyphotic angle alterations, and the occurrence of adjacent segment fractures. The overall cement leakage rate favored the decompressed kyphoplasty group (9.1% vs. 18.6%), although statistical significance was not achieved (p = 0.111). Nonetheless, the risk of intradiscal leakage significantly reduced in the decompressed kyphoplasty cohort (p = 0.011), which was particularly evident in cases lacking the preoperative cleft sign on X-rays. Kyphotic angle changes and the risk of adjacent segment collapse exhibited similar outcomes (p = 0.739 and 0.522, respectively). We concluded that decompressed kyphoplasty demonstrates efficacy in reducing intradiscal cement leakage, particularly benefiting patients without the preoperative cleft sign on X-rays by preventing intradiscal leakage.<\/jats:p>","DOI":"10.3390\/jcm13020345","type":"journal-article","created":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T05:21:38Z","timestamp":1704691298000},"page":"345","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Assessment of Cement Leakage in Decompressed Percutaneous Kyphoplasty"],"prefix":"10.3390","volume":"13","author":[{"given":"Shih-Hao","family":"Cheng","sequence":"first","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"},{"name":"Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Hsiang","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Chuan","family":"Tsuei","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"},{"name":"Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Chu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"},{"name":"Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan"},{"name":"School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woei-Chyn","family":"Chu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1016\/8756-3282(92)90193-Z","article-title":"The clinical consequences of vertebral compression fracture","volume":"13","author":"Silverman","year":"1992","journal-title":"Bone"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.spinee.2006.04.013","article-title":"Osteoporotic compression fractures of the spine; current options and considerations for treatment","volume":"6","author":"Kim","year":"2006","journal-title":"Spine J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S89","DOI":"10.1016\/8756-3282(93)90358-H","article-title":"The epidemiology of vertebral fractures. European Vertebral Osteoporosis Study Group","volume":"14","author":"Cooper","year":"1993","journal-title":"Bone"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1007\/s00264-004-0619-1","article-title":"Conservative treatment of fractures of the thoracolumbar spine","volume":"29","author":"Tezer","year":"2005","journal-title":"Int. Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/j.spinee.2012.08.024","article-title":"Comparative analysis of clinical outcomes in patients with osteoporotic vertebral compression fractures (OVCFs): Conservative treatment versus balloon kyphoplasty","volume":"12","author":"Lee","year":"2012","journal-title":"Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1097\/00007632-200004150-00005","article-title":"Percutaneous vertebroplasty for pain relief and spinal stabilization","volume":"25","author":"Barr","year":"2000","journal-title":"Spine"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"11S","DOI":"10.1016\/S8756-3282(99)00126-X","article-title":"Vertebroplasty: Clinical experience and follow-up results","volume":"25","author":"Martin","year":"1999","journal-title":"Bone"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.1097\/01.brs.0000229254.89952.6b","article-title":"Vertebroplasty and kyphoplasty: A systematic review of 69 clinical studies","volume":"31","author":"Hulme","year":"2006","journal-title":"Spine"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kuo, Y.R., Cheng, T.A., Chou, P.H., Liu, Y.F., Chang, C.J., Chuang, C.F., Su, P.F., Lin, R.M., and Lin, C.L. (2022). Healing of Vertebral Compression Fractures in the Elderly after Percutaneous Vertebroplasty\u2014An Analysis of New Bone Formation and Sagittal Alignment in a 3-Year Follow-Up. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030708"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1007\/s00586-004-0839-5","article-title":"Cement leakage during vertebroplasty: An underestimated problem?","volume":"14","author":"Schmidt","year":"2005","journal-title":"Eur. Spine J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3411","DOI":"10.1007\/s00586-015-3923-0","article-title":"Risk factors for predicting cement leakage following percutaneous vertebroplasty for osteoporotic vertebral compression fractures","volume":"25","author":"Ding","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1097\/01.RVI.0000144757.14780.E0","article-title":"A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site","volume":"15","author":"Nussbaum","year":"2004","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"27","DOI":"10.3171\/spi.2005.2.1.0027","article-title":"Calcium phosphate cement leakage after percutaneous vertebroplasty for osteoporotic vertebral fractures: Risk factor analysis for cement leakage","volume":"2","author":"Nakano","year":"2005","journal-title":"J. Neurosurg. Spine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/j.spinee.2011.07.027","article-title":"Cement leakage in percutaneous vertebroplasty for osteoporotic vertebral compression fractures: Identification of risk factors","volume":"11","author":"Nieuwenhuijse","year":"2011","journal-title":"Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1302\/0301-620X.85B1.13026","article-title":"Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures","volume":"85","author":"Yeom","year":"2003","journal-title":"J. Bone Joint Surg. Br."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e828","DOI":"10.1016\/j.wneu.2022.12.117","article-title":"Systematic Retrospective Analysis of Risk Factors and Preventive Measures of Bone Cement Leakage in Percutaneous Kyphoplasty","volume":"171","author":"Li","year":"2023","journal-title":"World. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2562","DOI":"10.1097\/01.brs.0000240695.58651.62","article-title":"High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: An experimental model and study on cement leakage","volume":"31","author":"Baroud","year":"2006","journal-title":"Spine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.clineuro.2014.11.018","article-title":"A comparison of high viscosity bone cement and low viscosity bone cement vertebroplasty for severe osteoporotic vertebral compression fractures","volume":"129","author":"Zhang","year":"2015","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_19","first-page":"E187","article-title":"Comparison of high-viscosity cement vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures","volume":"18","author":"Wang","year":"2015","journal-title":"Pain. Physician."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"4602","DOI":"10.1038\/s41598-021-84314-6","article-title":"Role of percutaneous vertebroplasty with high-viscosity cement in the treatment of severe osteoporotic vertebral compression fractures","volume":"11","author":"Li","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1054\/arth.2000.5266","article-title":"A comparison of 2 modern femoral cementing techniques: Analysis by cement-bone interface pressure measurements, computerized image analysis, and static mechanical testing","volume":"15","author":"Reading","year":"2000","journal-title":"J. Arthroplasty"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1097\/00003086-198702000-00039","article-title":"A study of intrusion characteristics of low viscosity cement Simplex-P and Palacos cements in a bovine cancellous bone model","volume":"215","author":"Rey","year":"1987","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1016\/j.jbiomech.2004.07.023","article-title":"Biomechanical assessment of stability in the metastatic spine following percutaneous vertebroplasty: Effects of cement distribution patterns and volume","volume":"38","author":"Tschirhart","year":"2005","journal-title":"J. Biomech."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.jss.2014.12.053","article-title":"Biomechanical effects of cement distribution in the fractured area on osteoporotic vertebral compression fractures: A three-dimensional finite element analysis","volume":"195","author":"Liang","year":"2015","journal-title":"J. Surg. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1007\/s00586-011-1744-3","article-title":"Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae","volume":"20","author":"Chen","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"10184","DOI":"10.1038\/s41598-021-89412-z","article-title":"Cement bridging phenomenon in percutaneous vertebroplasty for adjacent vertebral compression fracture","volume":"11","author":"Li","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.injury.2012.10.017","article-title":"Decompressed percutaneous vertebroplasty: A secured bone cement delivery procedure for vertebral augmentation in osteoporotic compression fractures","volume":"44","author":"Chu","year":"2013","journal-title":"Injury"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lu, H.T., Lin, J.Y., Tsuei, Y.C., Hsu, Y.F., Chen, C.Y., Cheng, S.H., Chu, W., Li, C., and Chu, W.C. (2023). Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution-An Ex Vivo Study in Goat Vertebrae. Bioengineering, 10.","DOI":"10.3390\/bioengineering10070795"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1148\/radiol.2213991129","article-title":"The intravertebral vacuum cleft sign","volume":"221","author":"Theodorou","year":"2001","journal-title":"Radiology."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1016\/j.anclin.2007.07.011","article-title":"Vertebroplasty and kyphoplasty","volume":"25","author":"Lavelle","year":"2007","journal-title":"Anesthesiol. Clin."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"504","DOI":"10.3174\/ajnr.A1861","article-title":"Clinical experience with high-viscosity cements for percutaneous vertebral body augmentation: Occurrence, degree, and location of cement leakage compared with kyphoplasty","volume":"31","author":"Georgy","year":"2010","journal-title":"AJNR. Am. J. Neuroradiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2721","DOI":"10.1016\/S0142-9612(03)00086-3","article-title":"Theoretical and experimental model to describe the injection of a polymethylmethacrylate cement into a porous structure","volume":"24","author":"Bohner","year":"2003","journal-title":"Biomaterials"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.neurad.2013.07.004","article-title":"Analysis of intradiscal cement leakage during percutaneous vertebroplasty: Multivariate study of risk factors emphasizing preoperative MR findings","volume":"41","author":"Hong","year":"2014","journal-title":"J. Neuroradiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1002\/jor.1100060416","article-title":"Sustained pressurization of polymethylmethacrylate: A comparison of low- and moderate-viscosity bone cements","volume":"6","author":"Bean","year":"1988","journal-title":"J. Orthop. Res."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Qi, J., Hu, Y., Yang, Z., Dong, Y., Zhang, X., Hou, G., Lv, Y., Guo, Y., Zhou, F., and Liu, B. (2022). Incidence, Risk Factors, and Outcomes of Symptomatic Bone Cement Displacement following Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fracture: A Single Center Study. J. Clin. Med., 11.","DOI":"10.3390\/jcm11247530"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2248","DOI":"10.1007\/s00330-007-0684-0","article-title":"The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: Results from a radiological and histological study","volume":"17","author":"Libicher","year":"2007","journal-title":"Eur. Radiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1227\/01.NEU.0000204313.36531.79","article-title":"Efficacy of postural reduction in osteoporotic vertebral compression fractures followed by percutaneous vertebroplasty","volume":"58","author":"Chin","year":"2006","journal-title":"Neurosurgery"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"W442","DOI":"10.2214\/AJR.09.2774","article-title":"Cement leakage in percutaneous vertebroplasty for osteoporotic compression fractures with or without intravertebral clefts","volume":"193","author":"Tanigawa","year":"2009","journal-title":"AJR. Am. J. Roentgenol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1097\/00004728-200605000-00025","article-title":"Leakage of polymethylmethacrylate in percutaneous vertebroplasty: Comparison of osteoporotic vertebral compression fractures with and without an intravertebral vacuum cleft","volume":"30","author":"Jung","year":"2006","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1007\/s00330-005-0056-6","article-title":"Kyphosis reduction and the rate of cement leaks after vertebroplasty of intravertebral clefts","volume":"16","author":"Krauss","year":"2006","journal-title":"Eur. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.2214\/AJR.06.0903","article-title":"Cement leakage during vertebroplasty can be predicted on preoperative MRI","volume":"188","author":"Hiwatashi","year":"2007","journal-title":"AJR. Am. J. Roentgenol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1302\/0301-620X.88B5.17345","article-title":"Percutaneous vertebroplasty for vertebral compression fractures with and without intravertebral clefts","volume":"88","author":"Ha","year":"2006","journal-title":"J. Bone. Joint Surg. Br."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.wneu.2017.01.124","article-title":"Risk Factors for Cement Leakage after Vertebroplasty or Kyphoplasty: A Meta-Analysis of Published Evidence","volume":"101","author":"Zhan","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1007\/s00132-015-3092-1","article-title":"Experiences with PMMA cement as a stand-alone intervertebral spacer. Percutaneous cement discoplasty in the case of vacuum phenomenon within lumbar intervertebral discs","volume":"44","author":"Varga","year":"2015","journal-title":"Orthopade"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"180","DOI":"10.4184\/asj.2011.5.3.180","article-title":"Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty","volume":"5","author":"Kim","year":"2011","journal-title":"Asian Spine J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1007\/s00256-011-1139-x","article-title":"Analysis of adjacent fracture after percutaneous vertebroplasty: Does intradiscal cement leakage really increase the risk of adjacent vertebral fracture?","volume":"40","author":"Lee","year":"2011","journal-title":"Skeletal. Radiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s00330-007-0694-y","article-title":"CT-guided vertebroplasty in osteoprotic vertebral fractures: Incidence of secondary fractures and impact of intradiscal cement leakages during follow-up","volume":"18","author":"Pitton","year":"2008","journal-title":"Eur. Radiol."},{"key":"ref_48","first-page":"175","article-title":"Vertebroplasty: Cement leakage into the disc increases the risk of new fracture of adjacent vertebral body","volume":"25","author":"Lin","year":"2004","journal-title":"AJNR. Am. J. Neuroradiol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1308\/rcsann.2017.0083","article-title":"Impact of the quantity of intradiscal cement leak on the progression of intervertebral disc degeneration","volume":"99","author":"Jamjoom","year":"2017","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"34","DOI":"10.14444\/3034","article-title":"Adjacent disc height reduction and clinical outcome after intradiscal cement leakage","volume":"10","author":"Shen","year":"2016","journal-title":"Int. J. Spine Surg."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"3059","DOI":"10.1016\/j.actbio.2014.03.008","article-title":"Intervertebral disc degeneration induced by intradiscal poly(methyl methacrylate) leakage after spine augmentation in an in vivo rabbit model","volume":"10","author":"Mao","year":"2014","journal-title":"Acta. Biomater."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Szabelski, J., Karpinski, R., Krakowski, P., Jojczuk, M., Jonak, J., and Nogalski, A. (2022). Analysis of the Effect of Component Ratio Imbalances on Selected Mechanical Properties of Seasoned, Medium Viscosity Bone Cements. Materials, 15.","DOI":"10.3390\/ma15165577"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Karpinski, R., Szabelski, J., Krakowski, P., Jojczuk, M., Jonak, J., and Nogalski, A. (2022). Evaluation of the Effect of Selected Physiological Fluid Contaminants on the Mechanical Properties of Selected Medium-Viscosity PMMA Bone Cements. Materials, 15.","DOI":"10.3390\/ma15062197"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Szabelski, J., Karpinski, R., Krakowski, P., and Jonak, J. (2021). The Impact of Contaminating Poly (Methyl Methacrylate) (PMMA) Bone Cements on Their Compressive Strength. Materials, 14.","DOI":"10.3390\/ma14102555"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Takahara, K., Kamimura, M., Moriya, H., Ashizawa, R., Koike, T., Hidai, Y., Ikegami, S., Nakamura, Y., and Kato, H. (2016). Risk factors of adjacent vertebral collapse after percutaneous vertebroplasty for osteoporotic vertebral fracture in postmenopausal women. BMC. Musculoskelet. Disord., 17.","DOI":"10.1186\/s12891-016-0887-0"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s00586-011-2099-5","article-title":"Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty","volume":"21","author":"Rho","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_57","first-page":"217","article-title":"New fractures after vertebroplasty: Adjacent fractures occur significantly sooner","volume":"27","author":"Trout","year":"2006","journal-title":"AJNR. Am. J. Neuroradiol."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Moldovan, F. (2023). Bone Cement Implantation Syndrome: A Rare Disaster Following Cemented Hip Arthroplasties-Clinical Considerations Supported by Case Studies. J. Pers. Med., 13.","DOI":"10.3390\/jpm13091381"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/2\/345\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:41:52Z","timestamp":1760103712000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/2\/345"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,8]]},"references-count":58,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["jcm13020345"],"URL":"https:\/\/doi.org\/10.3390\/jcm13020345","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,8]]}}}