Chirurgia最新文献

{"title":"Artificial Intelligence in Colon Cancer: Advances, Challenges, and Future Perspectives.","authors":"Ovidiu Adrian Bitere, Corina-Elena Minciuna, Catalin Andras, Florina Almarii, Iulia Andrei-Bitere, Teodora Manuc, Aurel Tonea, Simona Olimpia Dima, Adina Croitoru, Vlad Herlea, Catalin Vasilescu","doi":"10.21614/chirurgia.3240","DOIUrl":"10.21614/chirurgia.3240","url":null,"abstract":"<p><p>Colorectal cancer (CRC) remains a significant global health challenge, with rising incidence in younger populations and high mortality. Artificial intelligence (AI) is transforming CRC care, enhancing accuracy and efficiency across diagnostic, therapeutic, and follow-up stages. In endoscopy, computer-aided detection (CADe) systems increase adenoma detection rates by 25â?\"50%, while computer-aided diagnosis (CADx) supports real-time lesion characterization. In pathology, AI applied to whole-slide imaging enables automated triage, in silico microsatellite instability prediction, and prognostic risk stratification, often outperforming TNM staging. Radiology benefits from AI-driven lesion detection, staging, and radiomic â??virtual biopsyâ? for molecular profiling (e.g., KRAS, MSI). AI-based treatment planning integrates histopathology, imaging, and multi-omics to refine chemotherapy indications, predict neoadjuvant response, and identify novel therapeutic targets. In surgery, AI-enhanced robotic platforms enable real-time anatomical recognition, perfusion assessment, and complication risk prediction, improving intraoperative safety. Prognostic modeling using multimodal datasets offers superior survival and recurrence predictions, while AI-driven quality-of-life forecasting and patient-reported outcome monitoring facilitate personalized survivorship care. Challenges to widespread adoption include data heterogeneity, external validation gaps, interpretability, and regulatory compliance. Advances in multimodal AI and federated learning may overcome these barriers. With rigorous evaluation, AI is poised to become a cornerstone of precision oncology in CRC, improving outcomes and optimizing care delivery.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 1","pages":"13-26"},"PeriodicalIF":1.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147364121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing ERAS in a Crisis-Stricken Healthcare System: Outcomes from Laparoscopic Colorectal Surgery in Lebanon.","authors":"Michael Osseis, Farid Abi Habib, Maria Al Rachid, Christopher El Hadi, Jean Jul Sarrouf, Christian Mouawad, Ghassan Chakhtoura, Roger Noun","doi":"10.21614/chirurgia.3213","DOIUrl":"10.21614/chirurgia.3213","url":null,"abstract":"<p><p><b>Introduction:</b> Lebanon's healthcare system has faced significant challenges due to prolonged political and economic crises. In this context, cost-effective surgical care is essential. Enhanced Recovery After Surgery (ERAS) protocols, widely adopted globally, have been shown to improve postoperative recovery, reduce complications, and shorten hospital stays. In 2023, our tertiary care center implemented ERAS protocols for colorectal surgery. <b>Materials and Methods:</b> We prospectively analyzed outcomes for 72 patients who underwent elective laparoscopic colorectal surgery between 2023 and 2024. The ERAS pathway included standardized preoperative education, intraoperative minimally invasive techniques with optimized anesthesia and fluid management, and postoperative early mobilization and feeding with multimodal, opioid-sparing analgesia. Primary outcomes were length of hospital stay, complication rates, and readmissions. <b>Results:</b> The median hospital stay was 4 days. Readmission and ICU admission rates were low at 1.39% and 2.7%, respectively. Only 16% of patients required postoperative morphine. Early ambulation and oral intake were achieved in nearly all cases, with minimal need for blood transfusion (4.17%). Conclusion: ERAS implementation in laparoscopic colorectal surgery demonstrated feasibility and showed promising perioperative outcomes, even within the constraints of Lebanon's strained healthcare system. Given the observational design and absence of a control group, causal inferences cannot be drawn. Nevertheless, the protocol was associated with short hospital stay, low complication rates, and limited opioid use, supporting its applicability in resource-limited settings.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 1","pages":"62-69"},"PeriodicalIF":1.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147364368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to - Surgical Management of Rectal Cancer: Does Robotic Surgery Emerge as the Best Alternative A Narrative Review.","authors":"","doi":"10.21614/chirurgia.3276","DOIUrl":"https://doi.org/10.21614/chirurgia.3276","url":null,"abstract":"<p><p>In the originally published version of the article, the author MariaManuela Ravas omitted the affiliation for the Clinical Department No 10, General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. Below is the updated list of authors and corresponding affiliations: Maria-Manuela Ravas, Virgiliu-Mihail Prunoiu1,2, Eugen Braucu1,2, Marian Marincas 1,2, Laurentiu Simion1,2, Laura-Maria Manea3 and Mircea-Nicolae Bratucu2,4 \u00001Department of Surgery, Prof. Dr. Al.Trestioreanu Oncological Institute, Bucharest, Romania \u00002Clinical Department No 10, General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania \u00003Department of Internal Medicine, Coltea Clinical Hospital, Bucharest, Romania \u00004Carol Davila Nephrology Clinical Hospital, Bucharest, Romania.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 Ahead of print","pages":"1"},"PeriodicalIF":0.8,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of HER2-Positive Invasive Micropapillary Breast Cancer: Focus on Chemotherapy Toxicities and Surgical Implications of Typhlitis.","authors":"Stefania Chipuc, Diana Troncota, Cristian Pavel, Nicolae Bacalbasa, Roxana Rahnea-Nita, Anca Zgura, Gabriela Rahnea-Nita, Anghel Rodica","doi":"10.21614/chirurgia.3221","DOIUrl":"10.21614/chirurgia.3221","url":null,"abstract":"<p><p><b>Background:</b> Breast cancer remains the most prevalent malignancy in women worldwide and a leading cause of cancer-related mortality. Invasive micropapillary carcinoma (IMPC), though relatively uncommon, exhibits aggressive biological behavior, characterized by lymphovascular invasion and a marked propensity for nodal metastasis. The HER2-positive subtype of IMPC poses particular therapeutic challenges, necessitating targeted biological therapy but also conferring an increased risk of treatment-related adverse events. Objective: This review aims to synthesize current evidence on the clinicopathological features and treatment of HER2-positive IMPC, with a special emphasis on the emerging complication of typhlitis in the context of taxane-based chemotherapy. <b>Methods:</b> A narrative review of the literature was conducted to summarize data regarding pathogenic mechanisms, clinical presentation, diagnostic considerations, and management strategies related to HER2-positive IMPC and chemotherapy-associated typhlitis. <b>Results:</b> Existing evidence highlights the aggressive course of IMPC, the therapeutic relevance of HER2-directed regimens, and the rare but potentially life-threatening occurrence of neutropenic enterocolitis in patients receiving taxanes. Although data remain limited, reported cases underscore the importance of early recognition and multidisciplinary management. <b>Conclusions:</b> HER2-positive invasive micropapillary carcinoma is a rare but aggressive breast cancer subtype requiring multimodal therapy. While dual HER2 blockade with taxane-based chemotherapy improves survival, it also increases the risk of severe complications such as typhlitis. Early recognition and timely surgical intervention are essential to reduce morbidity and mortality. With appropriate therapeutic adjustments, systemic treatment can be safely continued, emphasizing the need for better risk stratification and preventive strategies.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"625-631"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bowel Ischaemia was Associated with Elevated Lactate and Pyruvate in Peritoneal fluid: A Prospective Observational Pilot Study.","authors":"LongHai Jin, Rong Xian Chia, Miho Mugino, Krishanth Naidu, Eleni Baird-Gunning, Alice Richardson, Soon-Ngee Lau, Sivakumar Gananadha","doi":"10.21614/chirurgia.3074","DOIUrl":"10.21614/chirurgia.3074","url":null,"abstract":"<p><strong>Purpose: </strong>Diagnosing bowel ischaemia (BI) can be challenging with non-specific clinical, biochemical and radiological findings. We aimed to identify biomarkers in peritoneal fluid that could be utilised to enhance the diagnosis of BI. <b>Methods:</b> A prospective single-centre observational study was conducted with adult patients undergoing laparotomy for suspected BI. Samples of preoperative serum and intraoperative peritoneal fluid were analysed. Patients with bowel perforation were excluded. <b>Results:</b> Sixty-nine patients were identified; 5 were excluded for bowel perforation and 6 for incomplete data. Thirty-four patients had BI intraoperatively and were allocated to the ischaemia group; 24 did not have features of BI intraoperatively and were allocated to the control group. The ischaemia group had significantly higher median peritoneal fluid lactate (3.9 vs 1.2 mmol/L; p = 0.002) and pyruvate (190 vs 114 ümol/L; p = 0.003); as well as significantly higher mean serum white cell count (16.23 x 109/L vs 9.77 x 109/L; p = 0.001), neutrophils (13.97 x 109/L vs 7.03 x 109/L; p 0.001) and C-reactive protein (95.56 vs 53.42 mg/L; p = 0.039). The area under the curve (AUC) was the greatest for peritoneal fluid lactate (0.770), followed by pyruvate (0.751); the composite AUC for these peritoneal fluid and serum biomarkers was 0.901.</p><p><strong>Conclusion: </strong>BI was associated with elevated peritoneal fluid lactate and pyruvate. Introducing a composite analysis of these peritoneal fluid and serum biomarkers could improve the diagnosis of BI in surgical practice.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"650-656"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and Clinical Implications of Prostate Cancer Mimickers. A Study Conducted at a Tertiary Center.","authors":"Mihai-Cătălin Roşu, Daniela Luminiţa Zob, Cristina Anita Ionescu, Bogdan Cîmpineanu, Mihaela Pundiche, Georgeta-Camelia Cozaru, Ionuţ Iorga, Gabriela-Izabela Bălţătescu, Antonela-Anca Nicolau, Ionuţ Burlacu, Oana Cojocaru, Sabina Elena Vlad, Miruna-Gabriela Vizireanu, Sînziana-Andra Ghiţoi, Lucian Cristian Petcu","doi":"10.21614/chirurgia.3237","DOIUrl":"10.21614/chirurgia.3237","url":null,"abstract":"<p><p><b>Introduction:</b> The accuracy of histopathological diagnosis is crucial in the management of prostate cancer. Benign entities such as atypical adenomatous hyperplasia (AAH) and atypical small acinar proliferation (ASAP), referred to as \"lesions that mimic prostate cancer\", represent a major diagnostic pitfall, placing the surgeon in a therapeutic dilemma. Thus, this study aimed to quantify the incidence of these entities in a tertiary center in Romania. <b>Materials and Methods:</b> Retrospective study on a cohort of 900 patients who underwent ultrasound-guided prostate biopsy/TURP between January 2020 and March 2025. Histopathological diagnoses were established according to the International Society of Urological Pathology (ISUP) criteria. <b>Results:</b> Of the 900 biopsies, the most common primary diagnoses were benign prostatic hyperplasia (BPH) (62%, n = 558) and prostatic adenocarcinoma (ADK) (27.6%, n = 248). The potentially major confounding entities, AAH and ASAP, together accounted for 6.6% (n = 59) of all biopsies. AAH (6%) was three times more common than Gleason 6 ADK (2%). The mean age of patients with AAH (69.2 years) was similar to that of patients with ADK (71.5 years). Multivariate analysis showed that age 70 years was an independent predictor of ADK (OR=1.9, p 0.01), and PSA values showed significant overlap between groups. <b>Conclusions:</b> In total, 6.6% (n=59) of the biopsies analyzed presented entities that can mimic prostate cancer and that require careful interpretation to avoid errors and to establish the most appropriate surgical conduct. Histopathological correlation with imaging and rebiopsy, within a multidisciplinary approach, are essential steps in the management of these cases.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"685-695"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney Anatomy, Stone Type: Is There a Link?","authors":"Ștefan Raşcu, Ovidiu-Cătălin Nechita, Tudor Marian Proca, Daniel Liviu Bădescu, Cosmin-George Radu, Viorel Jinga","doi":"10.21614/chirurgia.3162","DOIUrl":"10.21614/chirurgia.3162","url":null,"abstract":"<p><p><b>Background:</b> Renal anatomical anomalies are associated with altered urinary drainage and pH, which may influence urinary stone formation and composition. However, limited studies have assessed the stone composition differences in patients with abnormal versus normal renal anatomy. <b>Methods:</b> This observational study included 100 patients treated between September 2023 and August 2024 in a tertiary academic center in southern Romania. Stone composition was assessed using Fourier-transform infrared spectroscopy and categorized into five major types. Comparative and multivariate analyses were performed to assess associations between renal morphology, comorbidities, and stone type. <b>Results:</b> Uric acid (39%) and calcium oxalate (32%) were the most common stone types. Patients with horseshoe kidney and ectopic kidneys showed higher proportions of calcium phosphate stones. Diabetes and hyperuricemia were significant predictors of calcium phosphate and uric acid stones, respectively. No statistically significant association was found between renal anatomy and stone composition, though descriptive differences were observed. <b>Conclusions:</b> While anatomical anomalies did not show statistically significant differences in stone composition, metabolic factors such as diabetes and hyperuricemia strongly influenced stone type. Spectroscopic analysis remains essential in guiding individualized nephrolithiasis management.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"677-684"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Quality of Life in Gastric Cancer Patients Undergoing Different Surgical Reconstruction Methods. A Comparative Study using the EORTC QLQ-STO22 Questionnaire.","authors":"Cătălin Cosma, Vlad Olimpiu Butiurca, Cosmin Nicolescu, Paul Cristian Russu, Marian Botoncea, Călin Molnar","doi":"10.21614/chirurgia.3203","DOIUrl":"10.21614/chirurgia.3203","url":null,"abstract":"<p><p><b>Background:</b> Gastric cancer remains a major global health burden. Beyond oncologic outcomes, health-related quality of life (HRQoL) is increasingly recognized as a critical endpoint influenced by the reconstruction method after gastrectomy. <b>Methods:</b> A prospective observational study was conducted between December 2021 and December 2024 at the Emergency County Hospital of Targu Mures, Romania, including 150 patients undergoing curative-intent gastrectomy. Patients were divided into two groups: gastroduodenal anastomosis (Billroth I, n=72) and gastrojejunal anastomosis (Billroth II/Roux-en-Y, n = 78). HRQoL was assessed using the EORTC QLQ-STO22 preoperatively and at 3 and 6 months postoperatively. Scores were linearly transformed to a 0 100 scale. Statistical analysis was performed with EasyMedStat <b>Results:</b> The mean age was 61 years, with similar baseline characteristics. Postoperative complications occurred in 32.0% of patients, mostly grade I II. Both groups showed deterioration in dysphagia, pain, reflux, and anxiety at 3 months, followed by partial recovery at 6 months. Reflux scores were consistently higher in the gastrojejunal group at all timepoints (baseline 26.1 vs. 17.6; 3 months 36.5 vs. 24.5; 6 months 27.2 vs. 14.7; p 0.001). Eating restrictions were also greater at 3 and 6 months. <b>Conclusions:</b> Both reconstruction methods impair short-term HRQoL, with partial recovery by 6 months. Gastrojejunal reconstruction is associated with higher reflux and eating restrictions, whereas gastroduodenal reconstruction shows more favorable functional outcomes.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"632-642"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transoral Thyroidectomy (TOETVA) - Experience of the First 6 Months.","authors":"Cosmin Giulea, Tiberiu Bîrcă, Mădălina Tartalea, Raluca Elena Hanganu, Flavinia Ţipă, Adrian Miron","doi":"10.21614/chirurgia.3189","DOIUrl":"10.21614/chirurgia.3189","url":null,"abstract":"<p><p>Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is an emerging minimally invasive technique of performing thyroidectomy with no scarring, less dissection and less laryngeal nerve manipulation. This article presents in detail the TOETVA technique and includes the first Romanian series of 23 patients enrolled in a study between December 2024 and June 2025 who underwent TOETVA. All procedures were carried out by a single surgical team using standard laparoscopic equipment. Surgeon experience in both endocrine surgery and laparoscopy is necessary. For a selected group of patients, this technique proved to be safe, with no laryngeal or mental nerve injury, few cases of transient hypocalcaemia and good aesthetic results, the most common complication being anterior cervical ecchymosis. These preliminary results support TOETVA as an effective alternative to the conventional open thyroidectomy, especially for patients seeking scarless outcomes.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"707-713"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hippocratic Hands, Sacred Boundaries: Surgery and its Dilemmas in Ancient Greece.","authors":"Vasileios Leivaditis, Dritan Todhe, Georgios Mavroudes, Francesk Mulita, Nikolaos G Baikoussis, Sofoklis Mitsos, Athanasios Papatriantafyllou, Elias Liolis, Konstantinos Tasios, Andreas Antzoulas, Dimitrios Litsas, Panagiotis Dimitrios Papadopoulos, Panagiotis Leventis, Nikolaos Kornaros, Ioannis Boucharas, Chrysa Andrikopoulou, Violetta Papadimitriou, Vasiliki Karakoida, Konstantinos Nikolakopoulos, Spyros Papadoulas, Manfred Dahm","doi":"10.21614/chirurgia.3169","DOIUrl":"10.21614/chirurgia.3169","url":null,"abstract":"<p><p><b>Background:</b> This article offers a comprehensive exploration of surgical techniques practiced in ancient Greece, tracing their development from prehistoric times through the Classical, Hellenistic, and Byzantine periods. <b>Methods:</b> Drawing on literary, archaeological, and anatomical evidence, this examination explores procedures such as trepanation, fracture management, nasal and facial reconstruction, and early interventions in the abdominal and thoracic regions. Particular attention is given to the contributions of Hippocrates, Galen, and Paul of Aegina, whose systematic approaches to trauma, wound care, and operative techniques laid the foundation for later surgical traditions. The study also highlights the use of specialized instruments, pharmacological treatments, and ethical considerations rooted in mythological and philosophical thought. <b>Results:</b> By highlighting the scientific sophistication and enduring influence of ancient Greek surgical practices, this work underscores their pivotal role in the development of Western medicine. <b>Conclusions:</b> Ancient Greek surgery stands as a complex intersection of empirical skill, ethical reflection, and cultural meaning - a practice shaped as much by philosophical restraint as by technical ingenuity.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 eCollection","pages":"1-20"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}