1 Introduction

The rotator cuff is a complex structure composed of ligaments and tendons that surround the shoulder joint, facilitating stable and flexible movement.¹ Unfortunately, various factors, including trauma, repetitive activities, aging, and chronic degeneration, frequently lead to rotator cuff injuries, which are becoming increasingly prevalent among the aging population.^2,3 Rotator cuff injuries often result in shoulder pain, dysfunction, and decreased performance, significantly impacting daily activities and overall quality of life.⁴

Multiple surgical treatment methods have been proposed, with positive outcomes reported.⁵ However, the limited self-healing capacity of tendons, their avascular nature, and cellular scarcity contribute to the high failure rates associated with traditional surgical repair, with retear rates ranging from 20 % to 90 %.⁶ Additionally, the healing process of the rotator cuff scar further diminishes tendon flexibility and strength.⁷ Consequently, innovative therapeutic strategies are necessary to restore injured rotator cuff tendons and minimize scar formation.

Stem cell therapy, with its potential for unlimited proliferation, differentiation, and tissue regeneration, offers a promising solution for various medical conditions.⁸ Stem cells can differentiate into resident cells to replace damaged tissues, regulate adjacent cells, and enhance tissue repair capabilities through their potent immunomodulatory properties.⁹ This regenerative approach holds significant promise for treating rotator cuff injuries.¹⁰ However, a comprehensive understanding of its developmental trends, hotspots, and future directions of the current research landscape is still lacking. Most studies tend to focus on specific aspects, resulting in a gap in knowledge regarding the broader research landscape.¹¹

Bibliometric analysis primarily evaluates the knowledge carriers of published articles using mathematical and statistical methods. It is widely employed to quantitatively analyze scientific research activities through knowledge maps.¹² It enables beginners and researchers to intuitively, systematically, and comprehensively understand the development processes, structural relationships, and emerging trends within a certain field.¹³ VOSviewer and CiteSpace are the two primary software applications that visualize information to present and identify emerging trends, providing evidence for the development of clinical guidelines.^14,15 They are widely utilized in bibliometric analysis across information science, orthopaedics, respiratory diseases, cancer, and other disciplines, due to their accessibility, ease of use, and high readability. Chen et al. conducted a bibliometric analysis of stem cell therapy for knee osteoarthritis, revealing the current research hotspots, future focuses, and clinical application research of stem cell therapy.⁹ Another bibliometric analysis of stem cell therapy for spinal cord injury has demonstrated that molecular mechanisms, exosomes, scaffolds, hydrogels, and inflammatory responses are potential therapeutic methods and emerging frontiers.¹⁶ Relevant systematic reviews and research on stem cell therapy for rotator cuff injuries provide only a general overview of stem cell applications, basic mechanistic research, repair effects, and clinical prognosis observations. To date, no bibliometric study has been performed to summarize the existing literature to elucidate the structural characteristics and developmental trends of stem cell therapy for rotator cuff injuries.

Therefore, our study aims to bridge this information gap for researchers by conducting a bibliometric and visual analysis of stem cell therapy for rotator cuff injuries. We hypothesize that our analysis will provide valuable insights into the current state of stem cell therapy in this context, highlighting the emerging research hotspots and frontiers. Furthermore, we believe this study will serve as a vital resource for researchers, clinicians, and policymakers, guiding future research directions and fostering collaborative efforts to advance this promising therapeutic strategy.

2 Materials and methods

2.1

2.1 Data acquisition

We conducted a comprehensive literature search utilizing the Web of Science Core Collection (WoSCC) database, encompassing the period from January 1, 2003, to December 31, 2024. The search employed the following key terms: (“stem cells” OR “stem cell” OR “Progenitor Cells” OR “Progenitor Cell” OR “Mother Cells” OR “Mother Cell”) AND (“Cuff Injury” OR “Rotator cuff” OR “Tear, Rotator Cuff” OR “Rotator Cuff Tear” OR “Tears, Rotator Cuff” OR “Rotator Cuff Disease” OR “Rotator Cuff Disorder”). To ensure the accuracy and comprehensiveness of the search results, we implemented a rigorous strategy that included only original research articles and review articles. We excluded editorial material, book chapters, proceeding papers, meeting abstracts, early access articles, retracted publications, letters, corrections, reprints, retractions, and non-English documents. This process yielded a final dataset of 927 valid documents, as illustrated in Fig. 1. The selected documents were exported in plain text format, including full records and cited references for further analysis.

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Fig. 1 Flowchart for retrieved literature.

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3 Results

3.1

3.1 Global publication and growth trend

Analyzing the publication timeline and trends can provide valuable insights into the evolving interest and developments. From January 1, 2003 to December 31, 2024, our search identified 927 publications (689 articles and 238 reviews). The research output showcases a significant upward trajectory, reflecting an increased attention and interest in this promising therapeutic modality (Fig. 2). Upon closer examination, three distinct stages can be identified within the research timeline.

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Fig. 2 Annual publication and annual cumulation publication.

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Exploration Phase (2003–2009): During this initial phase, the number of published papers remained relatively low and stable, with annual publications generally not exceeding 10. Growth Phase (2010–2015): This period was characterized by a steady increase in publications, with the number of papers rising from 11 in 2010 to 56 in 2015, indicating a growing interest and research activity. Rapid Expansion Phase (2016–2024): The most recent phase has witnessed a dramatic surge in publications, peaking at 107 papers in 2024. This upward trend demonstrates the accelerated pace of research and the growing recognition of the potential of stem cell therapy for rotator cuff injuries. Notably, from 2021 to 2023, the trend was a slight slowly in publications, likely attributed to the disruptions caused by the COVID-19 pandemic. Nevertheless, the overall trajectory continues to follow a clear upward path, signaling sustained momentum and interest in this field.

3.2

3.2 Contributions of countries

The research landscape of stem cell therapy for rotator cuff injuries spans 50 countries, yielding a total of 927 articles. The top 10 most productive countries, based on the number of publications, are presented in Fig. 3A and Table 1. The United States leads the field with 359 publications, accounting for 31.7 % of the total output, closely followed by China at 30.3 %. South Korea and Germany also make significant contributions, accounting for 7.3 % and 7.2 %, respectively. Other countries each have fewer than 60 publications. Among them, China is the only developing country, underscoring its growing research capabilities and commitment to advancing stem cell therapy. The United States leads in both publication volume and citation count, with 13,377 citations, nearly twice as many as China's 6873 citations. This demonstrates the substantial influence and impact of the United States' research. Switzerland and France exhibit the highest average citation counts, indicating high-quality research with considerable influence. Fig. 4A illustrates the complex web of international collaborations, particularly among developed countries. The United States represents the most extensive network, collaborating with numerous countries. Followed by Germany, China, and the United Kingdom, which also demonstrate strong collaborative efforts.

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Fig. 3 Literature publication information on countries, institutions, journals, and authors. (A) The top 10 countries by publication volume. (B) The top 10 institutions by publication volume. (C) The Bradford's Law for journals. (D) The top 10 authors by publication volume.

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Table 1 Publications in the top 10 most productive countries and institutions.

Rank	Country	Documents	Citations	aACs	Rank	Institutions	Counts	Citations	aACs
1	USA	359	13377	37.26	1	Shanghai Jiao Tong University	46	1181	25.67
2	China	281	6873	24.46	2	University of Connecticut	40	1037	25.93
3	South Korea	68	1685	24.78	3	Zhejiang University	37	1320	35.68
4	Germany	67	2350	35.07	4	Hospital Special Surgery	30	1671	55.70
5	Italy	55	1687	30.67	5	Seoul Natl University	26	723	27.81
6	England	54	1769	32.76	6	Mayo Clinic	25	1133	45.32
7	Japan	44	1613	36.66	7	Cent South University	23	357	15.52
8	Switzerland	28	2221	79.32	8	Chinese University of Hong Kong	21	719	34.24
9	Australia	18	812	45.11	9	Sichuan University	21	359	17.10
10	France	15	1072	71.47	10	University Pittsburgh	20	1439	71.95

a Acs: average citations.

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Fig. 4 The cooperative network of countries, institutions, journals, and authors of stem cell therapy for rotator cuff injury (A) The cooperative network map of countries. (B) The co-network visualized map of institutions; (C) The co-network visualized map of journals. (D) The co-network visualized a map of authors.

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3.7

3.7 Analysis of funding organizations

Fig. 5 illustrates the ten most prominent funding organizations that support research in stem cell therapy for rotator cuff injuries. Among the leading funding organizations, four are located in the United States, three in China, two in Japan, and one in South Korea. The National Natural Science Foundation of China (NSFC) has emerged as the primary funder, supporting 147 research studies. Following closely, the National Institutes of Health (NIH) and the United States Department of Health and Human Services rank as the second most active funders, each having funded 110 studies. The remaining funding organizations have each contributed to fewer than 35 studies, thereby underscoring the substantial role played by these three entities in advancing research in this domain.

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Fig. 5 The top 10 funding organizations.

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3.8

3.8 Visual analysis of reference co-citation, clustering network, and burst value

The co-citation relationship refers to multiple publications being cited together in subsequent literature. Fig. 6A illustrates the temporal distribution of reference co-citations along with the corresponding first authors. Fig. 6B demonstrates the emergence of eight distinct clusters from a dataset of 3,0078 articles, with the “umbilical cord-derived mesenchymal stem cell” cluster being the most prominent. Citation burst analysis is utilized to predict emerging relevant research directions. A surge in the frequency of citations over a specific period is considered an indicator of academic focus and can illuminate developing trends. Fig. 6C presents the top 25 references, exhibiting the strongest citation bursts. The dark blue bars indicate years with a slight increase in citations, whereas the red bars illustrate a notable increase in citations.

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Fig. 6 Bibliometric analysis of references (A) Co-cited references. (B) Clustering of co-cited references. (C) Top 25 cited journal with the strongest citation bursts of publications related to stem cell therapy for rotator cuff injury.

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To gain further insight into these references, this study focuses on articles with high link strength. The most frequently co-cited references originate from the journal “International Orthopaedics”, with notable citation bursts occurring since 2016. Among these, the publication by Hernigou P (2015) in “International Orthopaedics” (strength: 27.62) exhibits the highest burst strength, followed as the publication by Gulotta LV in 2009 and 2011 in the “American Journal of Sports Medicine” (strength:19.65 and 19.39, respectively), Kim YS (2017) in the “American Journal of Sports Medicine” (strength:18.34), and Yokoya S (2012) in the “American Journal of Sports Medicine” (strength:12.46). The average duration of a citation burst in this field is observed to range between three to four years, underscoring the sustained interest and impact of these key publications.

3.9

3.9 Visual analysis of keyword co-occurrence, clustering network, burst value, and timeline evolution

In the scientific landscape, keyword and co-occurrence analyses are reliable for identifying and capturing research hotspot trends. Keywords from 927 papers were extracted, identifying 24 keywords that appeared more than 60 times. The top ten keywords are presented in Table 4, with “mesenchymal stem cells” identified as the most significant, having 444 co-occurrences and a total link strength of 1890. Subsequently, the most frequently co-occurring keywords included “rotator cuff repair,” “rotator cuff,” and “platelet-rich plasma.” Fig. 7A illustrates a visual map of keyword co-occurrence. Keyword bursts are instrumental in identifying terms that have captured the academic community's interest, signifying areas of cutting-edge research. A high burst value of keywords during a specific period indicates intense focus and relevance within the field. The keywords clustering analysis yielded seven distinct clusters (Fig. 7B), primarily concentrated on two aspects: restoration (“tendon-bone healing (#1)”, “rotator cuff (#2)”, “retear rate (#3)” and “rotator cuff tendon repair (#6)”) and regeneration medicine (“tendon tissue engineer (#0),” “fibro adipogenic progenitor (#4),” and “regenerative potential (#5).”)

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Fig. 7 Bibliometric analysis of keywords (A) The co-occurrence analysis map of keywords. (B) The co-occurrence cluster map of keywords. (C) The top 25 keywords with the strongest citation bursts.

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The analysis of keyword emergence and frequency surges is crucial for forecasting the future development of research direction. We identified and presented the top 25 keywords with the highest emergence intensity (Fig. 7C). The top five keywords with the highest emergence intensity were “supraspinatus tendon” (8.45), “marrow stromal cells” (7.87), “degeneration” (7.15), “rabbit model” (6.68), and “endothelial growth factor” (5.73). This suggests that the current research on rotator cuff injuries focuses on degeneration, stem cell therapy, and regeneration. Keywords such as scaffolds, tendon stem cells, tenogenic differentiation, and stem/progenitor cells have experienced bursts in recent years, indicating that current research priorities are likely to remain at the forefront of the field in the foreseeable future. Furthermore, the keyword timeline plot (Fig. 8) demonstrates significant variations in the frequency of keyword appearances over time, indicating a clear change in research focus and direction.

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Fig. 8 Keywords timeline visualization related to stem cell therapy for rotator cuff injury.

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4 Discussion

The incidence of rotator cuff injuries has gradually increased due to the aging population and the diversification of contemporary lifestyles. It is a common cause of shoulder pain and dysfunction, severely impairing physical activity and quality of life, and increasingly represents a significant health burden on society.¹⁷ Traditional surgical treatments are incomplete in repairing the tendon and susceptible to re-tears.¹⁸ Therefore, novel regenerative medicine, such as stem cell therapy, has garnered increasing attention from the clinical community. Stem cell therapy has been successfully utilized in osteoarthritis, meniscal injuries, and spinal cord injuries due to its unlimited potential for proliferation, differentiation, and tissue regeneration.¹⁹ However, the trends and hotspots associated with stem cell therapy for rotator cuff injuries have not been delineated. To address this gap, a bibliometric analysis was conducted to gain insights into the research hotspots, developmental trends, and future frontiers.

Our analysis encompassed 927 studies retrieved from the WoSCC database. Single-digit annual publications occurred in the first seven years, and subsequently transitioned to double-digit publications. The development trajectory can be delineated into three distinct phases: the exploration stage of slow development from 2003 to 2009, the steady growth stage from 2010 to 2015, and the rapid promotion stage from 2016 to 2024. Notably, a slight decline in the growth rate of publications from 2021 to 2023 is attributable to the disruptions caused by the COVID-19 pandemic. Following the end of the pandemic and the resumption of research activities, in-depth investigations in this field have experienced a resurgence. The global publication trend indicates an increased emphasis on the application of stem cell therapy for rotator cuff injuries, suggesting substantial potential for future exploration.

Among the top ten countries with the highest publication output, five are European (Germany, England, Italy, Switzerland, and France), three are Asian (China, South Korea, and Japan), and two are from North America and Oceania (the United States and Australia). The United States and China lead the cohort with 359 and 281 publications, respectively. The top ten most productive institutions have collectively published 289 articles, accounting for 31.2 % of the total publications, with Shanghai Jiao Tong University and the University of Connecticut leading the field. The prominence of Asia and North American institutions is evident, with five from Chinese institutions, four from the US, and one from South Korea among the top ten. Additionally, financial support is crucial for sustaining research endeavors. Among the top ten funding agencies, four are based in the United States, three are based in China, and the remaining three are based in Japan and South Korea. The United States and China are the leaders, comprising the most productive countries and institutions. The United States, recognized as a superpower, boasts the highest number of publications, citations, robust scientific research, and a relatively extensive network of collaborations. Developed countries possess advanced technology, equipment, sufficient funding, and dedicated research teams, enabling them to deepen research in related fields. Notably, China, classified as a developing country, has gradually emerged as a dominant research force. However, research collaboration in China is predominantly intra-national, which limits the quality, flexibility, and global interactivity of research. Therefore, developing countries need more technology, funding, resources, and international cooperation to bridge the gap with the United States.

Reviewing these 281 journals that have published articles on stem cell therapy for rotator cuff injuries, we find that the top ten journals belong to the core journals, collectively contributing 296 papers, which account for 31.9 % of the total. These journals are classified within the Q1 and Q2 quartiles of the Journal Citation Reports (JCR), signifying their high academic quality. The American Journal of Sports Medicine stands out with the highest number of publications (82) and boasts an impressive impact factor (IF) of 4.4, reflecting its significant international influence in rotator cuff injuries treated with stem cells. The citation counts serve as a testament to the journal's authority and leadership. The American Journal of Sports Medicine recorded the highest citation count, while Acta Biomaterialia exhibited the highest average citation times. The composition of the leading journals reflects a balance between basic and clinical research. Half of these journals focus on translational, molecular, and material sciences, indicating a promising application potential of basic stem cell research in this domain. The other half is more practical and clinically oriented, showcasing the efficacy of stem cell applications. Additionally, the collaboration network among journals has formed two main clusters, with themes centered around surgery, materials, and regenerative medicine. This diversity provides scholars with a broader selection of professional journals, facilitating the dissemination of research findings and promoting the advancement of the discipline.

The visualized results of the top ten authors reveal that Mazzocca, Augustus D., is the most productive author, with 31 publications and an average citation count of 21.00. Following closely is Rodeo, Scott A., the second-most productive author, with 21 publications and the highest total (1487) and average citation count (70.81). The number of publications and citations reflects the high quality of their work, indicating that their research in this field is worthy of further exploration. Mazzocca, Augustus D., and colleagues have made a significant discovery regarding the osteogenic potential of connective tissue progenitor cells aspirated from the proximal humerus during arthroscopic rotator cuff surgery. Their findings suggest that these cells play a crucial role in cell-based therapies for rotator cuff repair.²⁰ Similarly, Rodeo, Scott A., has demonstrated that osteoinductive growth factors and BMP-12 promote tendon-to-bone healing and enhance load-to-failure properties. They have also explored other regeneration therapies, such as platelet-rich plasma, stem cells, and transcription factors, to facilitate the formation of the native tendon-bone insertion site following rotator cuff injury repair surgery.²¹ Their study introduces a novel cell therapy and highlights new focal points for treating rotator cuff injuries, providing an alternative to traditional surgical methods. Among the 14 clusters of co-authorship, Zhao Jinzhong, Mazzocca, Augustus D., and Tuan, Rocky S., have emerged as a notably more collaborative research team compared to other groups. However, the top three authors in terms of total link strength do not align with the aforementioned leading teams. This suggests that deeper collaborations among different teams and authors could result in higher-quality publications, advance the discipline, and contribute to the standardization of practices within the field.

By summarizing and analyzing existing research findings, review articles can help readers understand the current state of research and potential future research directions. In contrast, original articles emphasize the latest research trends and hotspots through basic or clinical experimental investigations. Of the top ten most cited publications, seven are review articles, and three are original articles. The review article “Biologics for tendon repair” by Docheva et al. (2015) has the highest citation count (478) and the highest average annual citations.²² This landmark study provides a comprehensive evaluation of tendon biology and treatment strategies, particularly in the context of regenerative medicine. Gulotta et al. published an original research article titled “Application of Bone Marrow-Derived Mesenchymal Stem Cells in a Rotator Cuff Repair Model” in 2009.²³ Their findings indicate that the application of mesenchymal stem cells (MSCs) to the damaged rotator cuff insertion site did not improve the structure, composition, or strength of the attachment site. The pursuit of a definitive biological solution to the challenge of tendon-to-bone healing in rotator cuff injuries may be influenced by factors such as the purification method of MSCs, the administered dose, the duration of observation, and the limitations of experimental conditions and technology. Additionally, the absence of cellular or molecular signaling simulations may present a significant challenge. However, their work provides valuable insights and serves as a reference point for determining future research directions and priorities.

The visual analysis of the reference co-citation map serves as an invaluable tool for scholars to identify the most influential publications. Each circle on the map represents a reference, with the diameter indicative of the citation frequency. The interconnections between circles signify the shared citations among related articles. Notably, the article authored by Hernigou P. in 2014 in the Journal of International Orthopaedics emerged as the most frequently cited reference 24. This study revealed that the injection of MSCs as an adjunct to rotator cuff injury repair significantly enhanced the healing rate, improved the integrity of the repaired tendon, and reduced the incidence of re-tears. Furthermore, cluster analysis offers a clear snapshot of the knowledge structure and framework within the research field, encapsulating the thematic focus of specific domains. The largest reference co-citation cluster is “umbilical cord-derived mesenchymal stem cell (#0)”, followed by “tendon injury (#1)” and “to-bone interface regeneration (#2)”. Examination of these clusters indicates a collective emphasis on regeneration, biology, mechanics, and bioactive materials in treating rotator cuff injuries.^19,25,26 Current research emphasizes more advanced regenerative therapeutic modalities, whereas earlier studies primarily concentrated on “tendon engineering modality (#4)”. The publication “Tissue engineered biological augmentation for tendon healing: a systematic review” summarizes advancements in tissue engineering techniques that facilitate tendon augmentation and repair, emphasizing the necessity for rigorous scientific evaluation of these emerging methods.²⁷ In the citation bursts map, the top five references with the strongest bursts are identified as Hernigou P, 2014 (Bursts: 27.62), Gulotta LV 2009 and 2011 (Bursts: 19.65 and 19.39), Kim YS 2017 (Bursts: 18.34), and Yokoya S 2012 (Bursts: 13.77). These citation bursts reflect the most frequently cited articles, suggesting that they represent prominent topics within their respective fields.^{23,24,28–30}

The evolution and variety of keywords over time reflect the complexity of the disease mechanisms and provide profound insights into the direction and focus of the research endeavors. Among the top ten keywords, “mesenchymal stem cells,” “rotator cuff repair,” “rotator cuff,” “platelet rich plasma,” and “repair” were identified as particularly salient, representing frontier research domains. Based on the patterns of the keywords within each cluster, we categorized them into two distinct categories. The first cluster type pertains to rotator cuff repair, platelet-rich plasma, differentiation, stem cells, and tear. This cluster includes “tendon-bone healing (#1),” “rotator cuff (#2),” “retear rate (#3),” and “rotator cuff tendon repair (#6).” This cluster primarily focuses on rotator cuff injury features and restoration. The second type of cluster pertains to mesenchymal stem cells, rotator cuff, regeneration, and transplantation, which includes “tendon tissue engineer (#0),” “fibro adipogenic progenitor (#4),” and “regenerative potential (#5).” Increasing research emphasizes regenerative medicine for rotator cuff injuries, as regenerative medicine possesses the potential for in-situ repair of torn tendons, prevention of retears, and alleviation of chronic pain and dysfunction following surgical repair.^5,6,31,32

In the list of keywords with the strongest citation bursts, the “supraspinatus tendon (Bursts: 8.45),” “marrow stromal cells (Bursts: 7.87),” “degeneration (Bursts: 7.15),” “rabbit model (Bursts: 6.68),” and “endothelial growth factor (Bursts: 5.73)” exhibit high burst intensity and top rankings, suggesting they represent research hotspots in this field over time. Additionally, a significant shift in research orientation and contraction is evident from the analysis of keyword frequency and the timeline plot. In recent years, the keywords “scaffolds,” “tendon stem cells,” and “tenogenic differentiation” have gradually garnered increasing attention. Scaffolds, composed of various inorganic, natural, and bioactive materials, exhibit excellent biocompatibility, biodegradability, and the ability to induce differentiation.³³ Incorporating physical and biochemical cues into scaffold design to mimic the structure and composition of native enthesis can guide specific differentiation of seeded cells and facilitate tendon-bone interface regeneration.³⁴ Among these, hydrogel scaffolds can enhance the healing of rotator cuff injuries through the effective delivery of bioactive materials; however, most studies are limited to laboratory and animal experiments.³⁵ Therefore, the construction, active components, application methods, and devices of hydrogel scaffolds require further exploration and research. Furthermore, tendon stem cells and tenogenic differentiation have garnered increased attention, as they can promote regenerative repair of rotator cuff tendon injury via the transforming growth factor-β (TGF-β), mitogen-activated protein kinase (MAPK) pathway, or transcription factors.^36–38 This reflects the current priorities and research focus for the forthcoming year.

5 Conclusions

Stem cell therapy for the treatment of rotator cuff injuries has garnered significant interest within the scientific community. Bibliometric and visual analyses reveal that the United States and China are at the forefront of this burgeoning field of research. Nonetheless, there is a clear need for enhanced collaboration and exchange among authors, institutions, and countries to further advance this domain of research. Bibliometric research provides scholars a novel lens through which to swiftly acquire foundational knowledge, identify research hotspots, and comprehend the direction of the field. To date, stem cells, rotator cuff pathologies, degeneration, and regeneration remain central themes in research endeavors. As biomaterials and cell therapy evolve, scaffolds, tendon stem cells, and tenogenic differentiation processes are prone to becoming research hotspots in the future.

CRediT authorship contribution statement

Xiong Wang: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Validation, Visualization, Writing – original draft, Writing – review & editing. Zhi Zhang: Data curation, Formal analysis, Investigation, Methodology, Writing – original draft. Biao Cheng: Conceptualization, Investigation, Writing – original draft, Writing – review & editing. Yonghu Xu: Conceptualization, Data curation, Investigation, Writing – original draft, Writing – review & editing. Shuming Zi: Conceptualization, Data curation, Formal analysis, Investigation, Supervision, Writing – original draft, Writing – review & editing.

Guardian Patient's consent

All authors agreed to the publication of the article.

Ethical statement

The content of this article does not deal with the content of ethical review.

Funding

This work is supported by the Science and Technology Commission of Baoshan District, Shanghai, China (2024-E−43), Funded by the Baoshan District Health Commission Excellent Youth (Yucai) Program (BSWSYC-2024-17), and the National Natural Science Foundation Of China (82272529).