Abstract
Objective
To investigate the combining ropivacaine paravertebral nerve block with dexmedetomidine in prolongation of operative analgesia time in thoracic orthopaedic patients.
Methods
30 patients with thoracic orthopedic surgery (including chicken breast, funnel chest and forked rib) who were treated in the thoracic department of our hospital from May 2021 to November 2022 were recruited as the study objects. The patients ranged in age from 8 to 18 years old, with an average age of 10.94 ± 3.66 years old. All patients underwent corrective surgery. 15 patients were divided into control group (receiving conventional analgesia) and the experimental group (combining ropivacaine paravertebral nerve block with dexmedetomidine analgesia) according to intraoperative analgesia, respectively. All patients were informed of the protocol when they signed up for the study.
Results
There was no difference in the general data between the two groups (P > 0.05). The duration of sensory block and analgesia in the experimental group was longer than that in the control group (P < 0.05). The analgesia time of the experimental group was longer than that of the control group (P < 0.05), the pain score was lower than that of the control group (P < 0.05), and the postoperative recovery score was relatively high (P < 0.05). The incidence of adverse reactions in the experimental group was lower than that in the control group (P < 0.05).
Conclusion
Combining Ropivacaine paravertebral nerve block with dexmedetomidine is superior to conventional analgesia in thoracic orthopaedic surgery.
Keywords: Ropivacaine, Paravertebral nerve block, Dexmedetomidine, Chicken breast, Funnel chest, Forked rib
Background
Postoperative pain management is an important topic in modern medicine, especially in thoracic surgery. Effective pain control is not only related to the comfort of patients, but also directly affects their postoperative recovery and rehabilitation quality. Pectus Carinatum, forked ribs, and infundibular chest are common chest wall malformations that often require surgical correction [1–3]. Since this type of surgery involves the bones and soft tissues of the chest, postoperative pain management becomes an integral part of the treatment process. Traditional pain management methods as systematic administration of opioids, while effective in pain control, are often associated with side effects such as nausea, vomiting, constipation, and respiratory depression. These effects not only increase patient discomfort, but may also prolong hospital stays and increase medical costs. In recent years, visual nerve block technique has been widely used in postoperative pain control. Ropivacaine, as an effective local anesthetic, reduces nerve excitability by blocking the sodium channel in nerve conduction pathway, thus achieving pain relief. Parathoracic nerve block using ropivacaine to create local anesthesia in the parathoracic region has been proven to be highly effective in reducing pain after chest surgery [4, 5].
Dexmedetomidine, which acts as a centrally acting sedative and analgesic adjunct, reduces pain perception by stimulating alpha2-adrenergic receptors. The dexmedetomidine in postoperative pain management has been shown to reduce the need for opioids and mitigate their associated side effects [6]. Although ropivacaine and dexmedetomidine have positive impacts on postoperative pain management, the efficacy of their combination has not been fully explored. Especially in the thoracic surgery of chicken breast, funnel chest, forked rib and other patients, the patients have higher requirements for postoperative pain management due to its special physiological and psychological needs. In theory, the local analgesic effect of ropivacaine may be synergistic with the central analgesic effect of dexmedetomidine.
The combined use may reduce pain while reducing drug-related effects and speeding up post-operative recovery. Therefore, this study is to investigate the effect of combining ropivacaine paravertebral nerve block with dexmedetomidine on postoperative analgesia in patients with chicken breast, infundibular chest, forked rib and other skeletal malformations in the chest.
Materials and methods
General information
30 patients with thoracic orthopedic surgery (including chicken breast, funnel chest and forked rib) who received treatment in the Department of Thoracic Surgery of a hospital from May 2021 to November 2022 were recruited as the study objects. The patients ranged in age from 8 to 18 years old, with an average age of 10.94 ± 3.66 years old. All patients underwent corrective surgery. The subjects were grouped using a random number table method. Random numbers from 1 to 30 were generated from the table, with odd numbers assigned to the control group (n = 15) and even numbers to the experimental group (n = 15). The grouping process was performed by statisticians independent of the clinical procedures to ensure assignment concealment. A double-blind design was adopted to ensure that patients were not aware of their grouping, the operating physician did not participate in prognostic assessment, and medication preparation was performed by an independent pharmacist. The nerve block medications used in both groups appeared identical. The control group received routine analgesia, while the experimental group received ropivacaine paravertebral nerve block combined with dexmedetomidine for analgesia. All patients were informed of the protocol when they signed up for the study.
Inclusion criteria
Children aged 6 to 18 years; They were diagnosed by professional doctors as breast bone malformation chicken breast, funnel chest, forked rib, etc.; All patients required sternal correction surgery; Preoperative comprehensive physical examination showed no serious dysfunction of heart, lung, kidney, liver and other vital organs; Patients and their legal guardians have fully understood the study and signed informed consent forms.
Exclusion criteria
Children have a known history of allergy to ropivacaine, dexmedetomidine, or other drug ingredients in the study; They suffer from major cardiovascular disease, severe liver and kidney dysfunction, severe asthma or other serious systemic disease; They are receiving medication that may affect pain perception or analgesia (e.g. antidepressants, antipsychotics, etc.); Children suffer from coagulation dysfunction or are taking anticoagulant drugs; Children or their legal guardians fail to provide informed consent or refuse to participate in the study.
Methods
Analgesic interventions
Both groups of patients underwent a standardized total intravenous anesthesia protocol during the perioperative period. During induction, propofol 2–3 mg/kg, fentanyl 3–5 µg/kg, and vecuronium bromide 0.1–0.15 mg/kg were administered intravenously sequentially. After complete muscle relaxation, endotracheal intubation or laryngeal mask airway was inserted, and mechanical ventilation was initiated. During maintenance, propofol 4–12 mg/(kg·h) + remifentanil 0.1–0.2 µg/(kg·min) were continuously infused intravenously. Drug dosages were adjusted according to the intensity of surgical stimulation and the patient’s vital signs to ensure consistent depth of anesthesia throughout the operation. No additional opioid analgesics were used in either group during the operation. Acetaminophen 15 mg/kg was routinely administered intravenously 30 min before the end of the operation and continued postoperatively every 6 h for 48 h. The control group received no regional analgesia techniques and no nerve blocks, only routine analgesia. Sufentanil was administered intravenously immediately postoperatively at a rate of 1 µg/kg in 100 mL of 0.9% sodium chloride solution at a rate of 2 mL/h. The experimental group received ropivacaine paravertebral nerve block combined with dexmedetomidine for analgesia. Thirty minutes preoperatively, thoracic paravertebral nerve blocks were performed under ultrasound guidance at the intervertebral spaces corresponding to the surgical incision. A total of 20 mL of 0.5% ropivacaine was injected into each intervertebral space, while simultaneously dexmedetomidine was administered via intravenous pump at a rate of 0.2–0.4 µg/(kg·h).
ELISA detection of cytokine
Serum concentrations of cortisol, C-reactive protein, TNF-α and IL-6 were detected by ELISA. Serum samples were collected by intravenous blood collection on 3rd, 24th, and 48th hour after surgery. The blood sample is centrifuged to separate the serum and the serum is diluted to a suitable concentration. According to the ELISA kit (Thermo Fisher Technologies), the above cytokine levels are tested.
Pain scores
Postoperative pain is assessed by the Visual Analog Scale (VAS). A straight line or scale is used to indicate the level of pain. One represents no pain and the other stands for the most intense pain. 0 shows no pain and 10 explains the most intense pain. All patients received standardized training from professionals one day prior to surgery. Standardized explanations and illustrated examples were used. Patients completed multiple simulated scoring exercises until they could clearly articulate the key points of the surgery. For patients aged 8–10, pain levels were explained in more accessible language. VAS assessments for all age groups were conducted by the same trained medical staff using the same scoring criteria. The VAS scores of both groups were tracked and recorded on the 3rd, 24th, and 48th hour after surgery.
Nerve block time and duration of analgesia
The pain degree of patients was evaluated by VAS scale. Patients need to mark how much pain they feel on a scale. Each patient was scored immediately, on the 1st, 2nd, 4th, 6th, 12th hour. One day after surgery, and the scores were recorded by another uninformed health care provider to maintain the objectivity of the scores. The block duration should be recorded, which records the point at which the patient first requested additional analgesic medication, and the time from the completion of the block until the patient subjectively reported an increase in pain was considered the effective duration of the nerve block.
Postoperative recovery and adverse reactions
An activity score system and a dietary recovery score system are developed to compare postoperative recovery. The range of activity recovery score is 0 to 10, with 0 indicating bedridden and 10 indicating complete inability to move. The dietary recovery scores range from 0 to10, 0 indicating inability to eat, and 10 suggesting normal eating. At a specific time point after surgery, two days after surgery, the patient’s mobility and dietary recovery were assessed by the medical staff through the above system. Any adverse reactions within 48 h were recorded.
Statistical analysis
Data analysis is performed using SPSS 15.0 software (SPSS Inc., Chicago, IL). Continuous variables such as age, weight, biochemical indicators, VAS score, and duration were analyzed using the Shapiro-Wilk test. Data conforming to a normal distribution are expressed as mean ± Standard Deviation (SD), and independent samples t-tests are used for comparisons between groups. The number of households not conforming to a normal distribution is expressed as the median, and Mann-Whitney U tests are used for comparisons between groups. Categorical variables such as gender and incidences of adverse reactions are expressed as percentage of cases and compared between groups using the chi-square test. A significance level of 0.05 is set, and P < 0.05 is considered statistically significant.
Experimental results
General data
General data of the two groups were analyzed. The male to female ratio in the control group was 9:6, the average age was 10.38 ± 3.11 years old, the average weight was 38.75 ± 5.28 kg, the average height was 149.36 ± 7.25 cm, and the average BMI was 16.26 ± 4.18 kg/m2. The ratio of male to female in the experimental group was 8:7, the average age was 11.12 ± 3.85 years old, the average weight was 37.13 ± 5.39 kg, the average height was 147.87 ± 8.34 cm, and the average BMI was 16.55 ± 5.56 kg/m2. There was no difference in the general data between the two groups (P > 0.05). (Table 1)
Table 1.
General data statistics
| Items | Control group (n = 15) | Experimental group (n = 15) | t value/χ2 value | P value |
|---|---|---|---|---|
| Sex (Male: Female) | 9:6 | 8:7 | 3.017 | 0.562 |
| Age (years) | 10.38 ± 3.11 | 11.12 ± 3.85 | 5.529 | 0.176 |
| Weight (kg) | 38.75 ± 5.28 | 37.13 ± 5.39 | 2.146 | 0.344 |
| Height (cm) | 149.36 ± 7.25 | 147.87 ± 8.34 | 4.558 | 0.605 |
| BMI (kg/m2) | 16.26 ± 4.18 | 16.55 ± 5.56 | 3.119 | 0.219 |
Analysis of serum biochemical indexes
The concentrations of serum cortisol, C-reactive protein, T-NF-α and IL-6 were measured by EILSA on 3 rd, 1 st day and 2 nd day after surgery. The concentrations of serum cortisol, C-reactive protein, T-NF-α and IL-6 in the experimental group were lower than those in the control group on 3rd, 1st day and 2nd day after surgery (P < 0.05). The effect size of Cohen’s d ranged from 1.25 to 1.92. These differences between the two groups were statistically significant. (Table 2)
Table 2.
Analysis of serum biochemical indexes
| Indexes | Control group (n = 15) | Experimental group (n = 15) | t value | P value | Cohen’s d |
|---|---|---|---|---|---|
| After Three Hours of Surgery | |||||
| Cortisol (nmol/l) | 119.35 ± 15.34 | 82.56 ± 10.24 | 11.508 | 0.023 | 1.53 |
| C-Reactive Protein (mg/l) | 97.22 ± 8.35 | 78.31 ± 6.45 | 16.425 | 0.019 | 1.72 |
| TNF-α (pg/ml) | 118.45 ± 12.62 | 90.36 ± 8.13 | 19.501 | 0.006 | 1.85 |
| IL-6 (pg/ml) | 83.14 ± 9.57 | 65.26 ± 6.41 | 21.744 | 0.032 | 1.92 |
| After One Day of Surgery | |||||
| Cortisol (nmol/l) | 85.55 ± 10.44 | 68.28 ± 7.31 | 10.558 | 0.006 | 1.42 |
| C-Reactive Protein (mg/l) | 80.22 ± 6.51 | 71.49 ± 5.48 | 9.216 | 0.016 | 1.25 |
| TNF-α (pg/ml) | 92.36 ± 8.12 | 74.51 ± 6.25 | 13.028 | 0.024 | 1.63 |
| IL-6 (pg/ml) | 77.32 ± 7.61 | 65.45 ± 6.53 | 9.562 | 0.037 | 1.25 |
| After Two Days of Surgery | |||||
| Cortisol (nmol/l) | 73.22 ± 8.66 | 60.19 ± 6.45 | 18.426 | 0.014 | 1.68 |
| C-Reactive Protein (mg/l) | 64.27 ± 5.42 | 50.36 ± 4.17 | 23.008 | 0.005 | 1.81 |
| TNF-α (pg/ml) | 75.43 ± 6.29 | 64.93 ± 5.21 | 17.453 | 0.008 | 1.57 |
| IL-6 (pg/ml) | 65.39 ± 5.44 | 50.21 ± 4.56 | 11.207 | 0.022 | 1.39 |
Comparison of VAS pain scores
VAS scores on 3rd, 24th and 48th hour after operation were compared. VAS scores in the experimental group were lower than those in the control group (P < 0.05). The effect size of Cohen’s d was 1.85, 1.32, and 1.56, respectively, indicating that the differences between the experimental group and the control group were statistically significant. (Fig. 1; Table 3)
Fig. 1.
VAS pain scores after surgery
Table 3.
Comparison of VAS pain scores
| Groups | After three hours of surgery | After one day of surgery | After two days of surgery |
|---|---|---|---|
| Control Group (n = 15) | 6.24 ± 1.33 | 4.56 ± 0.85 | 3.37 ± 0.44 |
| Experimental Group (n = 15) | 4.17 ± 1.02 | 3.21 ± 0.64 | 2.15 ± 0.30 |
| t value | 15.204 | 11.663 | 9.542 |
| P value | 0.004 | 0.015 | 0.002 |
| Cohen’s d | 1.85 | 1.32 | 1.56 |
Comparison of duration of block and analgesia
The duration of nerve block and analgesia in the experimental group were longer than those in the control group (P < 0.05). (Fig. 2; Table 4)
Fig. 2.
Nerve block time and analgesia time
Table 4.
Comparison of nerve block and analgesia time
| Groups | Duration of nerve block (h) | Duration of analgesia (h) |
|---|---|---|
| Control Group (n = 15) | 13.56 ± 2.19 | 18.65 ± 3.45 |
| Experimental Group (n = 15) | 17.34 ± 3.54 | 23.17 ± 3.76 |
| T Value | 18.336 | 11.219 |
| P value | 0.024 | 0.003 |
Comparison of postoperative recovery scores
The postoperative activity recovery and dietary recovery of the patients were compared. The scores of activity recovery and dietary recovery in the experimental group were higher than those in the control group (P < 0.05). (Table 5)
Table 5.
Comparison of postoperative recovery scores
| Groups | Activity recovery | Dietary recovery |
|---|---|---|
| Control Group (n = 15) | 6.61 ± 0.47 | 7.0 ± 0.42 |
| Experimental Group (n = 15) | 8.35 ± 0.66 | 9.24 ± 0.68 |
| t value | 10.563 | 8.114 |
| P value | 0.017 | 0.036 |
Comparison of the incidence of adverse reactions
The incidences of adverse reactions to analgesia could be compared. In the control group, there were two cases of nausea, one case of dizziness, one case of allergy, with a total incidence of adverse reactions of 26.66%. There was only 1 case of nausea in the experimental group, with a total incidence of adverse reactions was 6.66%. The incidence of adverse reactions in the experimental group was lower than that in the control group (P < 0.05). (Table 6)
Table 6.
Comparison of incidence of adverse reactions
| Groups | Nausea (%) | Dizziness (%) | Allergy (%) | Total (%) |
|---|---|---|---|---|
| Control Group (n = 15) | 2 (13.33%) | 1 (6.66%) | 1 (6.66%) | 4 (26.66%) |
| Experimental Group (n = 15) | 1 (6.66%) | 0 (0%) | 0 (0%) | 1 (6.66%) |
| χ2 | 11.449 | 5.439 | 2.016 | 3.588 |
| P value | 0.003 | 0.135 | 0.624 | 0.001 |
Discussion
This study aims to evaluate the effect of combing ropivacaine paravertebral nerve block with dexmedetomidine in improving postoperative analgesia in patients with breast bone malformations such as chicken breast, funnel chest, and furciform rib. Previous studies have confirmed that the combination of ropivacaine and dexmedetomidine has significant analgesic advantages in adult thoracic surgery. However, the effect of this combination in pediatric patients undergoing thoracic correction surgery remains unclear. This study extended this approach to this group, providing a targeted strategy for postoperative pain management in this specific subgroup. The results showed that the experimental group outperformed the control group in both postoperative pain control and overall recovery, further validating the applicability and effectiveness of this strategy in the pediatric population.
Postoperative pain control is a key factor affecting patients’ postoperative recovery. In this study, the combination of ropivacaine and dexmedetomidine showed significant advantages in postoperative pain management. This finding is consistent with existing studies, which suggests that this drug strategy may interact with different mechanisms of action to achieve better analgesia. As a local anesthetic, Ropivacaine has effects primarily by blocking sodium channels in nerve cells. This blocking reduces the excitability of nerve cells, which decreases the transmission of pain signals. In thoracic paravertebral nerve block, ropivacaine is injected directly into the thoracic paravertebral region, so as to effectively block pain signal transmission in the surgical area, which helps to reduce patients’ perception of pain in the early postoperative period [7–9]. Dexmedetomidine is an α2-adrenergic agonist with a different mechanism of action from ropivacaine. Dexmedetomidine mainly produces sedative and analgesic effects by stimulating α2-adrenergic receptors and reducing the release of norepinephrine. This effect not only reduces the patient’s perception of pain, but also has an anti-anxiety and sedative effect, which is very important for postoperative recovery. In addition, dexmedetomidine has also been shown to reduce the need for other analgesics (especially opioids), thereby reducing the risk of side effects associated with opioids [10, 11]. When ropivacaine and dexmedetomidine are used to combing, the different mechanisms of action of the two drugs may produce synergistic effects. Ropivacaine provides direct pain signal blocking, while dexmedetomidine reduces pain perception and anxiety through central action, the combination that makes postoperative pain management more effective. This approach is also applicable to pediatric patients aged 8–18, because the differences in pain perception and analgesia response in this age group are more likely to be attributed to factors such as psychosocial status, pain cognition level, and environmental adaptability. These factors make the sedative and analgesic synergistic effect of combined medication more likely to be manifested, thereby improving the analgesic effect. This strategy not only helps to control acute postoperative pain, but may also have a positive effect on reducing the development of chronic postoperative pain.
In the recovery process after surgery, the level of inflammatory markers is an important indicator to evaluate the stress and inflammatory response in the body [12, 13]. In this study, the levels of serum cortisol, C-reactive protein, TNF-α, and IL-6 in the experimental group were significantly lower than those in the control group, suggesting that the combination of ropivcaine and dexmedetomidine may effectively inhibit postoperative inflammatory response. Serum cortisol, a biomarker of stress response, is often elevated after surgery, reflecting the body’s response to surgical trauma. The lower cortisol levels in the experimental group may indicate lower stress level and an improved inflammatory state. C-reactive protein is another indicator of inflammation, and the improvement after surgery is a natural response to tissue damage. The low level of C-reactive protein in the experimental group in this study indicated that the inflammatory response was effectively controlled. In addition, TNF-α and IL-6, as key inflammatory cytokines, are usually elevated after surgery and are involved in inflammation and tissue repair [14, 15]. The reduce of these cytokines in the experimental group may reflect the inhibitory effect of the combination of ropivacaine and dexmedetomidine on the inflammatory response. These results indicate that the local anesthetic effect of ropivacaine combined with the central effects of dexmedetomidine not only has a synergistic effect in postoperative pain control, but also reduces the inflammatory response by regulating the release of inflammatory mediators. For pediatric patients who are more sensitive to inflammatory stress, the synergistic effect of the two can accelerate the postoperative recovery process, which has important clinical significance.
The extended duration of nerve block and analgesia in the experimental group in this study emphasizes the synergistic effect of ropivacaine and dexmedetomidine in postoperative analgesic management. The mechanism of action of ropivacaine is involved in blocking channels in nerve pathways, thereby extending the duration of the analgesic effect. This long-lasting nerve blocking effect is key to reducing early postoperative pain and reducing the need for analgesic drugs [16–18]. Besides, Dexmedetomidine acts as a centrally acting analgesic drug that reduces pain perception and central nervous system excitability through α2-adrenergic receptor excitability. When ropivacaine is made a combination with dexmedetomidine, they interact to create a synergistic effect that extends the duration of analgesia and reduces the overall need for postoperative analgesics. This combination provides a more comprehensive and long-lasting analgesic effect through the mutual complement of local nerve block and central analgesic effects. In addition, this strategy reduces dependence on a single drug and lessens the risk of drug-related side effects, especially dependence on opioids.
The quality of postoperative recovery directly affects the overall well-being of patients and the cost of healthcare. In this study, patients in the experimental group had significantly higher mobility and diet recovery scores than those in the control group, the finding that highlights the importance of effective pain management to accelerate post-operative recovery. Pain is not only an uncomfortable feeling after surgery, but it can also limit the patient’s mobility, delay the recovery process, and even increase the risk of postoperative complications. Therefore, reducing pain allows patients to engage in physical activity earlier and return to a normal diet, which is crucial for preventing postoperative complications such as deep vein thrombosis and pulmonary complications [19, 20]. Reducing the occurrence of adverse reactions is an important consideration in postoperative pain management. The decrease of incidence of adverse reactions in the experimental group in this study may be related to the well-tolerated and lower risk of side effects of ropivacaine and dexmedetomidine. This combination offers a safer alternative to other pain relief methods, especially opioids. Although opioids are effective, they are often accompanied by such effects as respiratory depression, nausea, vomiting, constipation, and drug dependence [21, 22]. The combination reduces these associated side effects by providing effective pain control so as to reduce dependence on opioids. In this study, no central or systemic reactions such as dizziness or allergies occurred in the experimental group, with only one case of mild nausea. This provides a safer alternative to avoid opioid abuse after pediatric surgery and further verifies the safety of the combined regimen of ropivacaine and dexmedetomidine. In addition, ropivacaine, as a local anesthetic, has relatively low side effects and is mainly limited to the site of application. Dexmedetomidine is widely used for its sedative and anti-anxiety effects, and its side effects are usually mild and manageable [23, 24]. The low risk of adverse reactions from this combination is critical to improve patients’ postoperative comfort and reduce potential complications.
Conclusion
In summary, it is shown that combining ropivacaine thoracic paravertebral nerve block with dexmedetomidine significantly improved the pain control effect in postoperative analgesia in patients with thoracic skeletal malformations such as chicken breast, funnel chest, and forked rib. It decreased inflammatory response and prolonged the pain relief time, so as to expedite postoperative recovery, and reduce the incidence of adverse reactions. This study extends the combination of ropivacaine and dexmedetomidine to pediatric patients undergoing thoracic surgery, providing a new approach to postoperative analgesia in pediatric thoracic surgeons. However, this study is a single-center design, which limits the extrapolation of its conclusions. Future research will involve multi-center studies to further validate the generalizability and reliability of the combined regimen. Simultaneously, the postoperative follow-up period will be extended to monitor long-term efficacy, providing more comprehensive clinical evidence for pain management in patients undergoing thoracic orthopedic surgery.
Acknowledgements
Not applicable.
Author contributions
H.J. wrote the main manuscript text; T.Q. and S.L. prepared figures and tables; J.X. and Y.L. revised this paper critically. All authors reviewed the manuscript.
Funding
The research is supported by: Baoding Science and Technology Plan Project, Efficacy and Safety of Extrapleural Block for Post thoracoscopic Surgery Treatment of Coronary Heart Disease Patients, (No. 2341ZF038).
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the Ethics Committee of the Baoding Hospital, Beijing Children’s Hospital Affiliated to Capital Medical University (Approval No. 2024-20). All experiments in this study were conducted in accordance with the relevant guidelines and regulations, or in accordance with the Declaration of Helsinki. Informed consent to participate was obtained from the parents or legal guardians of all of the participants.
Consent for publication
Not Applicable.
Clinical trial number
Not Applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Tianfang Qu, Email: qu520twin@163.com.
Yi Lin, Email: linyi20240122@163.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.