International Urogynecology Journal最新文献

{"title":"Infections in the Culture of Catheter Urine Specimens and Bladder Biopsies in Women Undergoing Cystoscopy.","authors":"Bernadette Lemmon, Vijaya Gopalan, Akshaya Mathialagan, Livia Khullar, Vik Khullar","doi":"10.1007/s00192-025-06086-1","DOIUrl":"10.1007/s00192-025-06086-1","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Urinary tract infections (UTIs) are one of the most common reasons for seeking medical review worldwide. Women are disproportionately affected, with a life-time incidence of 50%. Women presenting with clinical symptoms of UTI such as dysuria and urinary frequency can often have negative urine culture results, especially if they have been taking multiple courses of antibiotics. This can make the diagnosis and management of recurrent or chronic UTI challenging. In this study we compared the culture results of urine and bladder tissue in women undergoing rigid cystoscopy presenting with lower urinary tract symptoms. We hypothesise that a biopsy of the bladder wall might be more likely to reveal a causative uropathogen on culture than urine.</p><p><strong>Methods: </strong>Women had clean-catheter urine samples sent for urine culture and then bladder biopsies taken at cystoscopy cultured for uropathogens. Culture results from urine and bladder tissue were analysed and compared.</p><p><strong>Results: </strong>We found that under 10% of urine cultures were positive (n = 30), whereas 51% of bladder tissues cultures grew a uropathogen (n = 155). Analysis showed that the culture results of urine and bladder tissue did have a statistically significant relationship (p = 0.008). Culture of bladder tissue revealed a wider variety of uropathogens.</p><p><strong>Conclusions: </strong>This study proposes that cystoscopy with a bladder biopsy for culture might be a useful adjunctive tool in selected women with refractory symptoms of urine infection.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1237-1242"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaginal Erbium Laser Versus Pelvic Floor Muscle Training for Stress Urinary Incontinence: A Randomised Controlled Trial.","authors":"Ann-Sophie Page, Eline Borowski, Emma Bauters, Susanne Housmans, Frank Van der Aa, Jan Deprest","doi":"10.1007/s00192-025-06091-4","DOIUrl":"10.1007/s00192-025-06091-4","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Current studies on vaginal laser therapy for the management of stress urinary incontinence (SUI) are inconclusive, and many lack comparison with another conservative treatment. Therefore, we compared the efficacy of Er:YAG laser for SUI with that of pelvic floor muscle training (PFMT).</p><p><strong>Methods: </strong>Single-centre, randomised controlled trial comparing laser treatment (3-6 applications) with PFMT (9-18 sessions) in women with mild to moderate SUI. Main outcome measures included subjective change in urinary incontinence symptoms by change from baseline to 4 months after randomisation by Urogenital Distress Inventory-6 (UDI-6; primary), adverse events, and other subjective and objective outcomes up to 24 months. A priori sample size calculation for a non-inferiority study resulted in 28 patients per arm. Because of a higher than expected dropout early in the study, we increased our sample size from 56 to 60, without unblinding of the data.</p><p><strong>Results: </strong>Sixty women were enrolled. Two participants discontinued their allocated treatment (one in each group). At 4 months, mean difference in change in UDI-6 scores was -6.99 (95% CI = -22.34; 8.37), demonstrating non-inferiority of laser to PFMT (p = 0.023). Within groups, most patients improved, yet subjective cure was reached in only a minority (laser: 11% [3 out of 28]; PFMT: 8% [2 out of 26]). The mean number of treatment visits was 4.25 (SD 1.17) in the laser group and 10.04 (SD 6.36) in the PFMT group. There were no subjective or objective inter-group differences. At 24 months, the majority of patients requested additional, yet alternative treatment. There were no serious adverse events at any time point.</p><p><strong>Conclusions: </strong>Treatment effect of vaginal laser and PFMT in patients with mild and moderate SUI were comparable, limited and short lasting. No adverse events were reported.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1265-1272"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphometric Characterization of Levator Ani Subdivisions in Healthy Controls and Patients: An MRI Study Using 3D PICS.","authors":"Nina Jessica Gmür, Soleen Ghafoor, Klaus Steigmiller, Thomas Winklehner, Cäcilia S Reiner, Cornelia Betschart","doi":"10.1007/s00192-025-06082-5","DOIUrl":"10.1007/s00192-025-06082-5","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>To date, levator ani muscle (LAM) morphometry has been classified descriptively and semi-quantitatively. New MRI techniques enabling detailed visualization with the 3D pelvic inclination correction system (3D PICS) could offer a one-stop-shop diagnostic modality for quantitative assessment of LAM subdivisions. The aim of this controlled MRI study was to assess morphometric LAM subdivision characteristics in two distinct groups of premenopausal women, namely nulliparous asymptomatic controls and symptomatic patients (Pelvic Organ Prolapse Quantification [POP-Q] ≥ II).</p><p><strong>Methods: </strong>Magnetic resonance imaging scans of the 22 women in each group were analyzed applying the 3D PICS coordinate system. A second reading of MRI was used to calculate interrater reliability (IRR). Origins and insertions were expressed in the 3D-Cartesian coordinate system in relation to point 0/0/0 (inferior pubic point). Distances and angles between muscles and planes were described using mean and standard deviation or median with first and third quartiles for all LAM subdivisions.</p><p><strong>Results: </strong>Moderate to good IRR was reported except for points close to point 0/0/0. Origins showed no difference between groups. Insertions differed notably in the vertically oriented pubovaginal, puboperineal, and puboanal muscles, with patients exhibiting lower positions along the superior-inferior axis by 6.1-7.7, 8.8, and 8.0-8.2 mm respectively. In contrast, the insertions of the horizontally oriented puborectal muscle showed a smaller difference of 1.8 mm. Muscle lengths were also 4% to 24% longer in cases.</p><p><strong>Conclusions: </strong>This in vivo MRI study reveals first geometric 3D data on LAM morphology in 3D PICS for both cases and controls. Exact 3D coordinates of origin/insertion points, lengths, and angles could serve as a basis for future imaging-based POP diagnostics.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1281-1292"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telehealth vs Clinic Postoperative Visit After Hysterectomy: A Randomized Controlled Trial.","authors":"Susan D Wherley, David Sheyn, Leah H Hellerstein, Hope Bauer, Jeffrey Mangel, Sarah Sears, Linda-Dalal Shiber, Robert Pollard","doi":"10.1007/s00192-025-06070-9","DOIUrl":"10.1007/s00192-025-06070-9","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Telehealth is becoming more common, but there is a paucity of literature investigating the role of telehealth in perioperative gynecologic care. The authors hypothesized that patients evaluated via telehealth 4 weeks after minimally invasive hysterectomy would not have lower satisfaction than patients evaluated in clinic.</p><p><strong>Methods: </strong>This was a randomized controlled noninferiority trial of patients who underwent minimally invasive hysterectomy at a single academic medical center. Participants were randomized to postoperative clinic visit or telehealth visit 4 weeks after hysterectomy. After the 4-week postoperative visit, patients were sent a satisfaction questionnaire. The primary outcome was overall patient satisfaction on a 100 mm visual analog scale. Secondary outcomes were 90-day postoperative complications and unplanned events.</p><p><strong>Results: </strong>One hundred one patients who underwent minimally invasive hysterectomy were identified for inclusion. Complete data were collected for 47 in the clinic group and 45 in the telehealth group. Overall postoperative visit satisfaction did not differ between groups (94.3 clinic vs. 92.0 telehealth, p = 0.47). The clinic group was significantly more likely to contact the clinic two or more times (p = 0.02); both groups were similarly likely to contact the clinic at least once (57.4% vs. 51.1%). Postoperative complications did not differ between groups, nor did unplanned clinic visits or emergency department (ED) visits.</p><p><strong>Conclusions: </strong>Postoperative visit satisfaction of patients evaluated via telehealth was noninferior to the satisfaction of patients seen in the clinic 4 weeks after minimally invasive hysterectomy. Unplanned clinic visits and ED visits did not differ between groups, nor did 90-day postoperative complications.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1229-1236"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectocervical Fistula Repair After Laparoscopic Supracervical Hysterectomy and Laparoscopic Sacrocervicopexy.","authors":"Martin Havir, Khaled M Ismail, Martin Smazinka, Vladimir Kalis, Zdenek Rusavy","doi":"10.1007/s00192-025-06108-y","DOIUrl":"10.1007/s00192-025-06108-y","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Rectocervical fistula after a urogynecological surgery has never been described. In this video article, we present occurrence of this complication after laparoscopic supracervical hysterectomy and laparoscopic sacrocervicopexy (LSCH + LSC) and how it was treated.</p><p><strong>Methods: </strong>This was a case of a 47-year-old patient who had a laparoscopic supracervical hysterectomy and laparoscopic sacrocervicopexy (LSCH + LSC) for stage two pelvic organ prolapse. Within 3 months after the surgery, the patient complained of an odorous brownish vaginal discharge. On examination, this discharge was identified to be from the cervical canal. A provisional diagnosis of a rectocervical fistula was postulated and later confirmed by ultrasonography and colonoscopy. Consequently, a laparoscopic fistula repair with concomitant partial explantation of the mesh followed by removal of the cervix and transposition of an omental flap between the vaginal and rectal suture lines. The patient made an uneventful recovery. The resulting rectocele was repaired by a colpoperineorrhaphy 2 years after the surgery.</p><p><strong>Conclusion: </strong>Rectocervical fistula is a rare complication after laparoscopic sacrocervicopexy with concomitant supracervical hysterectomy. We demonstrated the feasibility of repairing this fistula laparoscopically. We opted for mesh explantation and removal of the cervix at the time of the fistula repair to mitigate the risk of recurrence.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1333-1335"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative and Postoperative Complications Rate Following Elective Pelvic Reconstructive Surgery in Women with Severe Obesity: A Retrospective Cohort Study.","authors":"Alireza Hadizadeh, Henry Chill, Angela Leffelman, Claudia Paya-Ten, Cecilia Chang, Jungeun Lee, Roger P Goldberg, Ghazaleh Rostaminia","doi":"10.1007/s00192-025-06124-y","DOIUrl":"10.1007/s00192-025-06124-y","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>To assess early intraoperative and postoperative complications and outcomes in patients with severe obesity undergoing apical prolapse repair compared with patients with normal weight.</p><p><strong>Methods: </strong>This retrospective cohort study included 315 patients who underwent apical prolapse repair at a tertiary medical center between 2009 and 2024. Fifty-six patients had a BMI greater than 40, and 259 had a normal BMI (18.5-30). Patients with class I and II obesity were excluded from the study. Preoperative data, surgical details, and 30-day postoperative complications were collected and analyzed.</p><p><strong>Results: </strong>The average age of the patients with severe obesity was significantly lower than that of patients with normal weight (56.6 vs 64.1 years, p < 0.001). Patients with severe obesity had a higher prevalence of diabetes (27.3% vs 9.0%, p < 0.001), hypertension (54.5% vs 25.1%, p < 0.001), and obstructive sleep apnea (21.8% vs 7.4%, p = 0.001). Intraoperatively, the group with severe obesity experienced greater estimated blood loss (233.6 ml vs 115.2 ml, p < 0.001) and were more likely to undergo concurrent incontinence procedures (76.4% vs 51.3%, p = 0.001). However, no significant difference in intraoperative complications was observed between the groups (5.4% vs 5.4%, p = 1.000). Hospitalization duration was longer in patients with morbid obesity. Total complication rate within 30 days was 7.3%, with no statistically significant difference between the groups with severe obesity and normal weight.</p><p><strong>Conclusion: </strong>Patients with severe obesity undergoing vaginal apical prolapse repair have similar rates of early postoperative complications and health care encounters to patients with normal weight. These findings support offering prolapse surgery to patients with morbid obesity when clinically indicated.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1301-1308"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Learning Curve in Urogynecology and Functional Urology: A Systematic Review.","authors":"Hanieh Salehi-Pourmehr, Fateme Tahmasbi, Shima Hosseinpour, Ozra Nouri, Behzad Lotfi, Pedram Iranmanesh, Fariba Pashazadeh, Sakineh Hajebrahimi","doi":"10.1007/s00192-024-06016-7","DOIUrl":"10.1007/s00192-024-06016-7","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>When adopting new methods, surgeons may experience a period of complexity and longer operation times because of their inexperience. This period is known as the \"learning curve.\" This study was aimed at systematically reviewing the current literature on functional urology learning curves.</p><p><strong>Methods: </strong>A comprehensive search was conducted across multiple databases from inception to July 2023 with no language restrictions. All original studies on urogynecological and functional urological procedures, including cross-sectional, cohort, and clinical trials, were eligible for inclusion. Relevant data were extracted, and methodological quality was appraised using standardized Joanna Briggs Institute critical appraisal tools. To quantitatively investigate learning curves, a mixed-effects generalized linear regression analysis was conducted on studies employing cumulative summation methods.</p><p><strong>Results: </strong>From the 7,104 records, 68 studies met the inclusion criteria. The majority of studies were observational and the most common outcome measures were surgical duration, blood loss, and hospital stay. The learning curves varied by procedure type-for incontinence surgeries, 15-80 cases were required; for pelvic organ prolapse surgeries, 18-47 cases; for laparoscopic procedures, 10-105 cases; and for robotic procedures, 5-84 cases. The analysis showed that the number of cases required to surpass the learning curve decreased over time, likely reflecting technological advancements and increased surgical experience.</p><p><strong>Conclusion: </strong>The learning curve for surgical procedures varies significantly. It varies between 5 cases for robotic supratrigonal cystectomy to 75 cases for robot-assisted ventral mesh rectopexy or robotic sacrocolpopexy surgery in 84 cases. These variable learning curves highlight the need for structured training programs and ongoing assessment.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1123-1148"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor: The Outcomes of the Manchester Procedure Versus Sacrospinous Ligament Hysteropexy for Uterine Prolapse: A Study of the British Society of Urogynaecology Database.","authors":"Hsin-Pei Lee, Kun-Ling Lin, Cheng-Yu Long","doi":"10.1007/s00192-024-05976-0","DOIUrl":"10.1007/s00192-024-05976-0","url":null,"abstract":"","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1337-1338"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educational and Resource Needs of Pelvic Health Physiotherapists: Context Matters.","authors":"Corlia Brandt","doi":"10.1007/s00192-024-06036-3","DOIUrl":"10.1007/s00192-024-06036-3","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Evidence on health system challenges mostly relate to high-income countries. Lack of context-specific knowledge, educational opportunities, and access to resources among pelvic health care providers could be barriers to effective implementation of pelvic health services in South Africa. The aim of this study was to determine the patient and therapist profile, and the educational and resource needs of pelvic health physiotherapists in South Africa.</p><p><strong>Methods: </strong>Ninety-five pelvic health physiotherapists, recruited over 6 months, participated in a cross-sectional study during 2022-2023. Participants completed a REDCap survey covering the stipulated domains. Frequencies, percentages, and Chi-squared tests were used for data analysis.</p><p><strong>Results: </strong>The majority were employed in the private sector (n = 72; 75.8%) and had undergraduate training in pelvic health (n = 86; 89.5%); mostly in pre- and postnatal care (n = 69; 72.6%). Urinary incontinence was the most frequently seen condition (n = 81; 85.3%). Conditions were seen very seldom (n = 46; 48.4%) and most participants treated < 5 patients per month (n = 75; 78.9%), did not have patient educational material available (n = 58; 61.1%), preferred hard-copy formats (63.8%, n = 60), whereas 94.7% (n = 90) felt that there is a lack of patient resources. Participants (n = 66; 69.5%) indicated a need for educational opportunities for clinicians.</p><p><strong>Conclusions: </strong>This study highlights the contextualising of educational and resource needs in mid- to low-income countries, such as South Africa, which might be contrary to common beliefs and practices.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1187-1195"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-Cultural Adaptation and Validation of the Portuguese Version of the \"Australian Pelvic Floor Questionnaire\".","authors":"Marina Mesquita, Luís Cavalheiro, Pedro Ferreira, Rui Soles Gonçalves, Sónia Vicente","doi":"10.1007/s00192-025-06087-0","DOIUrl":"10.1007/s00192-025-06087-0","url":null,"abstract":"<p><strong>Introduction and hypothesis: </strong>Pelvic floor dysfunction (PFD) is a common problem that occurs among women and increases with age and weight. This study was aimed at cross-culturally adapting and validating the original version of the Australian Pelvic Floor Questionnaire (APFQ) into Portuguese.</p><p><strong>Methods: </strong>The process of cultural and linguistic adaptation and validation followed the guidelines. The obtained Portuguese version was assessed by an expert panel of physiotherapists specialized in women's health. Women with pelvic floor dysfunction also participated in a cognitive pre-test (n = 9). A sample of 50 women with PFD completed the questionnaire to evaluate internal consistency, construct validity, reproducibility, floor/ceiling effects assessment, and standard error of measurement. Test-retest was assessed with a 2-week interval. The study was approved by the Ethics Commission and all participants signed an informed consent form.</p><p><strong>Results: </strong>Fifty women with a mean age of 53.90 (± 18.57) years, BMI of 27.5 (± 4.2), 55.6% with a bachelor's degree, and all with at least one child, participated in the study. The psychometric properties of the APFQ showed a high Cronbach's alpha for the four domains: bladder (0.837), bowel and sexual function (0.756), pelvic organ prolapse (0.840), and total score (0.714). In terms of reproducibility, intraclass coefficient domain values ranged from 0.934 to 0.976, with a total score of 0.948.</p><p><strong>Conclusions: </strong>The APFQ was cultural and linguistically adapted and validated for Portuguese. The Portuguese version of the APFQ (APFQ_P) showed acceptable values of validity and good reliability. It can be used in both clinical evaluation and in research on pelvic floor dysfunction.</p>","PeriodicalId":14355,"journal":{"name":"International Urogynecology Journal","volume":" ","pages":"1255-1263"},"PeriodicalIF":1.8,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}