General Thoracic and Cardiovascular Surgery最新文献

{"title":"Pulsatile cardiopulmonary bypass using a centrifugal pump reduces acute kidney injury after cardiac surgery: a propensity score-matched analysis.","authors":"Ryoma Ueda, Hideki Tsubota, Masanori Honda, Masafumi Kudo, Hitoshi Okabayashi","doi":"10.1007/s11748-025-02146-x","DOIUrl":"https://doi.org/10.1007/s11748-025-02146-x","url":null,"abstract":"<p><strong>Objective: </strong>Acute kidney injury (AKI) affects approximately 30% of patients undergoing cardiac surgery with conventional non-pulsatile cardiopulmonary bypass (CPB). Pulsatile flow has long been proposed for mitigating this complication. While the 2019 EACTS guidelines recommend pulsatile perfusion for high-risk renal patients, most evidence is based on intra-aortic balloon pump (IABP) studies, with limited evidence for centrifugal pumps. We aimed to evaluate whether pulsatile CPB using a centrifugal pump reduces postoperative AKI in patients undergoing cardiac surgery.</p><p><strong>Methods: </strong>This retrospective study analyzed 824 patients who underwent cardiac surgery between December 2008 and December 2023. The patients were divided into pulsatile perfusion (PP) and non-pulsatile perfusion (NP) groups. Propensity score matching was adjusted for the baseline characteristics, resulting in 265 matched pairs. The primary endpoint was postoperative AKI, defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Subgroup analyses were performed based on estimated glomerular filtration rate (eGFR).</p><p><strong>Results: </strong>In the matched cohort, the PP group had a significantly lower incidence of AKI than the NP group (20.8 vs. 34.3%; odds ratio, 0.5; 95% confidence interval, 0.33-0.75; P < 0.001). A subgroup analysis showed that patients with a preoperative eGFR of 15-60 had a significantly lower incidence of AKI in the PP group (28.3 vs. 47.1%; P = 0.005). No significant differences were observed in secondary outcomes, including hemodialysis, cerebrovascular events, and in-hospital mortality.</p><p><strong>Conclusions: </strong>Pulsatile CPB using a centrifugal pump significantly reduced the incidence of postoperative AKI in cardiac surgery patients, particularly in those with preoperative renal impairment.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pretreatment platelet level is associated with tumor proliferation and prognosis in malignant pleural mesothelioma.","authors":"Ryota Sumitomo, Kentaro Tsuji, Hiroyuki Katsuragawa, Tetsuya Fukui, Toshi Menju, Masashi Kobayashi, Hiroaki Sakai, Hiroshi Date","doi":"10.1007/s11748-025-02148-9","DOIUrl":"https://doi.org/10.1007/s11748-025-02148-9","url":null,"abstract":"<p><strong>Objective: </strong>The present study aimed to investigate the relationship between serum-based inflammatory biomarkers and MPM tumor biology and prognosis.</p><p><strong>Methods: </strong>A total of 83 patients with MPM who were diagnosed and started treatment between January 1998 and December 2010 were studied. Clinicopathological variables were evaluated, including age, sex, clinical stage, histology, surgical resection, and chemotherapy. The cut-off values for pretreatment levels of white blood cell count, neutrophil count, lymphocyte count, platelet count, C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index were determined using receiver operating characteristic curve analysis for predicting 5-year survival. Univariate and multivariate Cox regression analyses were performed to estimate the prognostic impact on 5-year overall survival.</p><p><strong>Results: </strong>The mean Ki-67 proliferation index in MPM cells was 35.1 ± 29.5% and the median overall survival of patients was 15.0 months. The Ki-67 proliferation index in MPM cells was significantly higher in the platelet-high group compared with that in the platelet-low group (42.1 ± 31.9 vs. 27.7 ± 25.1%; P = 0.027). Multivariate Cox regression analyses identified platelet count (hazard ratio = 1.929; P = 0.022) and PLR (hazard ratio = 1.776; P = 0.040) as significant prognostic factors.</p><p><strong>Conclusion: </strong>Pretreatment platelet level may be a useful prognostic marker for 5-year overall survival related to tumor proliferation in patients with MPM.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143987573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot study of autologous multilayered fibroblast sheet transplantation for reinforcing bronchial stump healing after pulmonary lobectomy in a canine model.","authors":"Junichi Murakami, Toshiki Tanaka, Kenji Tani, Koji Ueno, Naohiro Yamamoto, Sota Yoshimine, Melpa Susanti Purba, Hiroshi Sunahara, Yoshinobu Hoshii, Kimikazu Hamano","doi":"10.1007/s11748-025-02145-y","DOIUrl":"https://doi.org/10.1007/s11748-025-02145-y","url":null,"abstract":"<p><strong>Objective: </strong>Bronchopleural fistula (BPF) is a serious complication that can occur after lung resection. This pilot study aimed to evaluate the effectiveness of autologous multilayered fibroblast sheet transplantation in reinforcing bronchial stump healing after lung resection in a canine model.</p><p><strong>Methods: </strong>Four beagles underwent left caudal lobe excision. Two dogs received autologous multilayered fibroblast sheet transplantation on the stapled bronchial stump, while two served as controls. Fibroblast sheets generated from autologous oral mucosal fibroblasts were optimized for growth factor secretion. Fourteen days after lobectomy, the bronchial stumps were histologically and immunohistochemically analyzed to assess connective tissue formation, blood vessel formation, and inflammation.</p><p><strong>Results: </strong>Fibroblast sheets secreted high levels of pro-healing and pro-angiogenic factors in vitro. No adverse events or serious postoperative complications associated with the fibroblast sheet transplantation were observed. The cell sheet-transplanted group exhibited a layered structure of newly formed tissue around the bronchial stump. This was associated with enhanced blood vessel formation, as indicated by increased CD31-positive cells and high VEGF levels. The untreated control group showed a localized nodule of inflammation near the bronchial stump, which lacked evidence of blood vessel formation.</p><p><strong>Conclusion: </strong>Autologous multilayered fibroblast sheet transplantation promoted connective tissue formation and blood vessel growth around the bronchial stump after lobectomy in a canine model. These findings suggest that fibroblast sheet transplantation is a promising therapeutic approach for preventing BPF after lung resection.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world observation of pain scores using patient-reported outcome measures in lung cancer surgery.","authors":"Hideo Ichimura, Keisuke Kobayashi, Masahiko Gosho, Tomoyuki Kawamura, Shuntaro Kawabata, Hisashi Suzuki, Shinsuke Kitazawa, Naohiro Kobayashi, Yukinobu Goto, Yukio Sato","doi":"10.1007/s11748-025-02143-0","DOIUrl":"https://doi.org/10.1007/s11748-025-02143-0","url":null,"abstract":"<p><strong>Objective: </strong>Although preoperative pain has been reported to affect postoperative quality of life and physical function in lung cancer surgery patients, its impact on postoperative pain remains unclear. This study aimed to describe the frequency and locations of preoperative pain and evaluate its impact on postoperative pain trajectories and chronic pain occurrence in a real-world setting.</p><p><strong>Methods: </strong>A prospective patient-reported outcome survey was conducted at Hitachi General Hospital. QOL was assessed using EORTC QLQ-C30 and LC13 at three time points: preoperatively (Pre), 1 month postoperatively (M1), and 1 year postoperatively (Y1). Among 184 patients with complete data, chronic pain was defined as an increase of ≥ 10 points in the pain score from Pre to Y1.</p><p><strong>Results: </strong>Fifty-five (30%) of the 184 patients reported experiencing pain at Pre. The pain scores (Pre:M1:Y1) of the patients without and with preoperative pain (the no-pain and pain groups, respectively) were 0: 26.4 ± 18.8:7.9 ± 10.6 and 29.1 ± 12.1:35.8 ± 20.1:20.6 ± 20.0, respectively. Chronic pain incidence was higher in the no-pain group (39.5%) than in the pain group (20%). Predictors of chronic pain included age, living alone, and open surgical approach in the no-pain group, and heavy smoking and having work in the pain group.</p><p><strong>Conclusion: </strong>Preoperative pain influences postoperative pain trajectories and chronic pain risk. Identifying preoperative pain may enhance understanding and management of postoperative pain in lung cancer surgery patients.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative pneumothorax occurrence in patients with Marfan syndrome.","authors":"Masahiro Yanagiya, Jun Nakajima, Chihiro Konoeda, Masaaki Sato","doi":"10.1007/s11748-025-02142-1","DOIUrl":"https://doi.org/10.1007/s11748-025-02142-1","url":null,"abstract":"<p><strong>Objectives: </strong>Marfan syndrome is a congenital connective tissue disorder frequently complicated by pneumothorax. However, the long-term efficacy of surgical intervention in these cases remains underreported. This study aimed to assess the surgical outcomes of pneumothorax associated with Marfan syndrome.</p><p><strong>Methods: </strong>A retrospective review was conducted at a single center, including patients diagnosed with secondary pneumothorax associated with Marfan syndrome who underwent surgery between 2004 and 2019. Postoperative pneumothorax recurrence rates and potential predictors of postoperative recurrence were assessed. The incidence of ipsilateral pneumothorax after surgery was analyzed and compared with that before surgery.</p><p><strong>Results: </strong>Overall, 20 patients (60% male, 40% female) with a median age of 18.5 years (range 13-40 years) were included in the analysis. Seventeen patients underwent bullectomy, while the remainder received pulmorrhaphy. The cumulative incidence of postoperative pneumothorax at 5 and 10 years was 25% and 44%, respectively. Notably, patients with pectus excavatum had a 5-year cumulative recurrence rate of 25%, and those with a flat chest had a rate of 60%, compared with 9.1% for patients without chest deformities (P = 0.017). Chest deformity emerged as a significant predictor of postoperative pneumothorax recurrence (hazard ratio 7.63; 95% confidence interval 1.29-45.1; P = 0.025). The frequency of ipsilateral pneumothorax significantly decreased postoperatively, from 1.09 ± 0.66 episodes/year (mean ± SD) pre-surgery to 0.04 ± 0.10 episodes/year post-surgery (P < 0.001).</p><p><strong>Conclusions: </strong>Surgical intervention is an effective treatment for pneumothorax in patients with Marfan syndrome. Chest deformity may serve as a predictor of postoperative pneumothorax recurrence in this patient population.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144005967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative imaging assessment of neurogenic tumors at the thoracic apex to determine suitability for robotic surgery.","authors":"Mariko Fukui, Takeshi Matsunaga, Aritoshi Hattori, Kazuya Takamochi, Kenji Suzuki","doi":"10.1007/s11748-025-02140-3","DOIUrl":"https://doi.org/10.1007/s11748-025-02140-3","url":null,"abstract":"<p><strong>Objective: </strong>To predict suitability for robotic surgery from preoperative images in patients with neurogenic tumors at the thoracic apex.</p><p><strong>Methods: </strong>This retrospective cohort study included patients who underwent robot-assisted thoracic surgery for tumors at the thoracic apex located cranial to the first rib. Patient characteristics, preoperative computed tomography findings, operative time, operative bleeding, rate of conversion to thoracotomy, and surgical outcomes were reviewed. We examined the image characteristics of converted cases and cases with an operative time exceeding 2 h.</p><p><strong>Results: </strong>Twenty-five patients underwent robot-assisted thoracic surgery for apical neurogenic tumors, and 64% of these tumors were schwannomas. Ninety-day mortality was 0%; however, postoperative neurological complications were common (Horner's syndrome: 56%, bronchial plexus disorder: 36%) even after enucleation. However, almost all symptoms disappeared within 1 year. Persistent nerve complications were observed in two patients (8%). Tumors < 3 cm did not interfere with vessel visualization and were resected within 2 h. Patients with an unconfirmed boundary with the vessels were considered for an anterior transcervical thoracic approach for safety reasons.</p><p><strong>Conclusions: </strong>Robot-assisted thoracic surgery for apical neurogenic tumors is feasible; however, postoperative neurological symptoms are common within 1 year after surgery. Thoracotomy should be considered for patients with tumors in contact with the subclavian vessels. Preparations for a transmanubrial approach may be necessary for such cases.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transmanubrial approach for en bloc resection of oligometastatic extranodal extension positive lymph nodes with partial common carotid artery and trachea resection after esophagectomy.","authors":"Naoya Okada, Hiroaki Kato, Syuichi Naraoka, Takeshi Yokoyama, Yasushi Furuta, Yoshihiro Kinoshita","doi":"10.1007/s11748-025-02135-0","DOIUrl":"https://doi.org/10.1007/s11748-025-02135-0","url":null,"abstract":"<p><strong>Background and aims: </strong>The transmanubrial approach (TMA) provides excellent exposure of the cervical-thoracic border area, allowing for the resection of thoracic outlet structures while preserving the clavicle, avoiding muscle sacrifice, and maintaining full shoulder mobility.</p><p><strong>Methods: </strong>This report presents the first instance of TMA being utilized for oligometastatic, extranodal extension-positive lymph node dissection en bloc with partial resection of the common carotid artery and trachea following esophagectomy.</p><p><strong>Surgical technique: </strong>We describe the surgical technique with illustrated explanations.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Importance of confounding risk factors for newly occurring atrial fibrillation after coronary artery bypass grafting.","authors":"Mesut Engin, Bişar Amaç","doi":"10.1007/s11748-025-02118-1","DOIUrl":"10.1007/s11748-025-02118-1","url":null,"abstract":"","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"295-296"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive factors for size change of aorta in patients with acute blunt traumatic aortic injury.","authors":"Soojin Lee, Seunghwan Song, Seon Hee Kim, Chang Won Kim, Hoon Kwon, Dongman Ryu, Na Hyeon Lee, Eunji Kim","doi":"10.1007/s11748-024-02054-6","DOIUrl":"10.1007/s11748-024-02054-6","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to investigate the changes in aorta size, the factors affecting size changes in patients with acute blunt traumatic aortic injury and to evaluate the adequacy of the current 120% thoracic endovascular aortic repair graft oversizing policy.</p><p><strong>Design and methods: </strong>This retrospective review study was conducted using the prospectively collected medical records of 45 patients (mean age: 53.5 years, male: 39 patients) with blunt traumatic aortic injury treated at a level 1 trauma center between 2012 and 2021. Aortic diameter was measured by computed tomography angiographic images at four different levels [ascending aorta (A), isthmus (B), descending thoracic aorta (C), and infrarenal aorta (D)] on arrival and follow-up (median time interval, 13 days). Associated factors including patient characteristics and hemodynamic parameters on arrival and follow-up were collected to determine their influence on changes in the aorta.</p><p><strong>Results: </strong>The mean diameter of all four aortic levels increased on follow-up computed tomography compared to initial computed tomography (A: + 11.77%, B: + 10.19%, C: + 7.71%, D: + 12.04%). Patient age and injury severity score influenced changes in the diameter of the ascending aorta (P < 0.05). Patient age and blunt traumatic aortic injury grade were significantly associated with changes in the infrarenal aortic diameter (P < 0.05). Three cases of type 1 endoleak were observed at follow-up but all were spontaneously resolved without further intervention at next computed tomography follow-up.</p><p><strong>Conclusions: </strong>In patients with acute blunt traumatic aortic injury, aortic diameter is significantly smaller by about 10% under shock and is not considered a basis for oversizing the currently implemented 120% thoracic endovascular aortic repair graft sizing. However, in young patients under the age of 40, the change is significantly large and subsequent computed tomography follow-up is required.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"209-217"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Off-pump versus on-pump coronary artery bypass grafting in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis.","authors":"Anelise Poluboiarinov Cappellaro, Luiz F Costa de Almeida, Manoela Lenzi Pinto, Marcelo Albuquerque Barbosa Martins, Augusto Graziani E Sousa, Júlia Gonçalves Gadelha, Ana Carolina Putini Vieira, Luís Fernando Rosati Rocha, Myat Soe Thet","doi":"10.1007/s11748-025-02116-3","DOIUrl":"10.1007/s11748-025-02116-3","url":null,"abstract":"<p><strong>Introduction: </strong>Off-pump coronary artery bypass graft surgery (OPCAB) has been suggested as superior to on-pump coronary artery bypass graft surgery (ONCAB) in certain high-risk subgroups, but its benefit in patients with chronic obstructive pulmonary disease (COPD) remains controversial. This meta-analysis aimed to evaluate OPCAB versus ONCAB outcomes in COPD patients.</p><p><strong>Methods: </strong>We followed PRISMA guidelines and searched PubMed, Embase, and the Cochrane Library in August 2024 for studies comparing OPCAB and ONCAB in COPD patients. Statistical analysis was conducted using Review Manager 5.4.1 and Rstudio with a fixed or random effects model.</p><p><strong>Results: </strong>Six studies with a total of 1,687 patients were included, of which 1,062 (62.95%) underwent OPCAB. The mean patient age was 63.6 years. OPCAB did not significantly affect all-cause mortality compared to ONCAB (OR 1.14; 95% CI 0.65-1.99). There were no significant differences in reintubation (OR 0.81; 95% CI 0.53-1.23), prolonged ventilation (OR 0.54; 95% CI 0.24-1.22), post-operative atrial fibrillation (OR 0.90; 95% CI 0.70-1.15), or ARDS (OR 0.43; 95% CI 0.14-1.33). However, ventilation time was significantly shorter in the OPCAB group (MD - 5.30 h; 95% CI - 7.22 to - 3.38).</p><p><strong>Conclusion: </strong>OPCAB is associated with reduced ventilation time in COPD patients though it shows no significant difference in all-cause mortality or other post-operative complications compared to ONCAB.</p>","PeriodicalId":12585,"journal":{"name":"General Thoracic and Cardiovascular Surgery","volume":" ","pages":"201-208"},"PeriodicalIF":1.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11914329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}