Journal of Gastrointestinal Cancer最新文献

{"title":"Impact of Prehabilitation in Major Gastrointestinal Oncological Surgery: a Systematic Review.","authors":"Reshma Ambulkar, Aditya Kunte, Sohan Lal Solanki, Veer Thakkar, Bhakti Deshmukh, Pankaj Singh Rana","doi":"10.1007/s12029-025-01196-x","DOIUrl":"10.1007/s12029-025-01196-x","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing major gastrointestinal oncologic surgeries often present with frailty, sarcopenia, anemia, and comorbidities that reduce physiological reserves and impair recovery. Prehabilitation is a proactive, multidisciplinary approach designed to optimize patient's health before surgery, thereby enhancing their capacity to tolerate surgical stress. Evidence indicates that prehabilitation can lead to shorter hospital stays, reduced intensive care admissions, a lower incidence of postoperative complications, and improved long-term quality of life.</p><p><strong>Methods: </strong>This systematic review is aimed at comprehensively evaluating the current evidence on prehabilitation in gastrointestinal and hepatopancreatobiliary (HPB) surgeries, examining its components, mechanisms of benefit, and barriers to implementation. It also explores the effectiveness of multimodal prehabilitation programs and highlights areas for future research. A systematic search of \"PubMed/MEDLINE,\" \"Google Scholar,\" \"Scopus,\" \"Cochrane Library,\" \"ClinicalTrials.gov,\" and \"POPLINE\" databases was conducted using a combination of Medical Subject Headings (MeSH) and keywords, including Prehabilitation, Anemia Correction, Nutrition Therapy, Physical Exercise, Gastrointestinal Cancer Surgeries, Hepato-Pancreato-Biliary Surgeries, Rehabilitation, and Postoperative Outcomes. Studies involving gastrointestinal cancer patients undergoing surgery, published between 1960 and June 2024, were included.  RESULTS: Multimodal prehabilitation programs demonstrated significant improvements in functional capacity, reductions in postoperative complications, shorter lengths of stay, and enhanced recovery. However, the strength of evidence varied by cancer type, with robust data supporting prehabilitation in colorectal surgeries and more limited evidence for HPB and upper gastrointestinal surgeries. Home-based programs showed mixed results, with adherence challenges potentially undermining their effectiveness. Inpatient supervised programs were more effective but associated with higher costs.</p><p><strong>Conclusion: </strong>Prehabilitation holds promise as a transformative strategy in the perioperative care of gastrointestinal cancer patients. While it improves functional and clinical outcomes, significant barriers such as implementation costs, patient adherence, and variability in program design must be addressed. Future research should focus on tailoring prehabilitation for different cancer types, developing cost-effective models, and conducting high-quality trials to establish standardized guidelines. Integrating prehabilitation into routine clinical practice can significantly enhance surgical outcomes and patient quality of life.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"133"},"PeriodicalIF":1.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehabilitation Reduces Occurrence of Anastomotic Leaks After Esophagectomy-A Retrospective Cohort Analysis and Meta-analysis.","authors":"Alissa Jell, Alexandra Dusi, Marcus Feith, Jeannine Bachmann, Dirk Wilhelm, Marc Martignoni, Ekin Ihsan Demir, Helmut Friess, Stephan Schorn","doi":"10.1007/s12029-025-01213-z","DOIUrl":"10.1007/s12029-025-01213-z","url":null,"abstract":"<p><strong>Background: </strong>Esophageal anastomotic leaks (EAL) after esophagectomy strongly increase postoperative mortality and morbidity. Identifying, addressing, and improving risk factors are pivotal. In this article, we conducted a systematic review with meta-analysis, comparing findings with our 13-year experience in a German high-volume esophageal surgery center.</p><p><strong>Methods: </strong>Databases of Pubmed, Scopus, and Cochrane were systematically screened for publications prior to 2025, and all patients undergoing esophageal resection surgery from 2010 to 2022 were analyzed for EAL occurrence, incorporating the review data into our analysis.</p><p><strong>Results: </strong>Among 14,163 studies screened, 202 were included, with 123 studies providing sufficient information on risk factors' impact on EAL. Our patient register revealed 144 out of 787 with EAL. Cardiopulmonary factors such as hypertension (RR 1.44; p = 0.0004), coronary artery disease (RR 1.28; p = 0.0004), heart insufficiency (RR 1.56; p = 0.05), peripheral artery disease (RR 1.65; p = 0.0009), pulmonary disease (RR 1.5; p = 0.01), COPD (RR 1.39; p = 0.13), renal insufficiency (RR 1.61; p = 0.03), diabetes mellitus (RR 1.51; p < 0.00001), obesity (BMI > 25; RR 1.31; p = 0.009; BMI > 30; RR 1.49; p = 0.006), smoking (former smoker: RR 1.54; p < 0.0001; active smoker: RR 1.25; p < 0.0001), and frequent alcohol intake (RR 1.7; p = 0.003) were all associated with an increased risk of EAL following esophagectomy. We show that preoperative management targeting these risk factors result in a significant reduction of EAL.</p><p><strong>Conclusion: </strong>Our extensive review underscores the critical role of cardiovascular, pulmonary, and renal conditions in EAL development, emphasizing the importance of prehabilitation to mitigate risks associated with EAL after esophagectomy.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"132"},"PeriodicalIF":1.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Yolk Sac Tumor: A Systematic Review of Presentation, Diagnosis, and Treatment.","authors":"Brittany Kwait, Awais Paracha, Umar Durrani, Michael Attanasi, Fahad Hussain, Jervon Wright, Amanda Lee, Anthony Papale, Veena John","doi":"10.1007/s12029-025-01250-8","DOIUrl":"10.1007/s12029-025-01250-8","url":null,"abstract":"<p><strong>Purpose: </strong>Primary hepatic yolk sac tumor (HYST) is a rare, extragonadal germ cell neoplasm that arises in hepatic tissue. This review aims to examine clinical features, diagnostic workup, and medical and surgical interventions in patients diagnosed with primary HYST.</p><p><strong>Methods: </strong>A literature search was performed using PubMed from 1950 to June 2024 using the filters English language and full text along with keywords \"Yolk sac tumor of the liver,\" \"Endodermal Sinus tumor of liver,\" \"Hepatic Yolk sac tumor,\" and \"Hepatic Endodermal sinus tumor.\"</p><p><strong>Results: </strong>Our results examined 20 patients ranging from age 15 months to 64 years. The cases included 14 female and 6 male patients. The most common presenting symptom was abdominal pain in adults and abdominal distention in children. Upon histologic evaluation, Schiller-Duval bodies were seen in the majority of examined tumors. Commonly noted markers included alpha fetal protein, cytokeratin AE1/AE3, alpha-1 anti-trypsin, placental alkaline phosphatase, SALL4, and periodic acid-Schiff. Treatment options included chemotherapy, surgery, transplant, and trans-arterial chemoembolization.</p><p><strong>Conclusions: </strong>In this review, we discuss clinical signs of primary HYST. We highlight the importance of Schiller-Duval bodies on histology, as well as new markers in an attempt to aid in making a diagnosis of HYST.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"131"},"PeriodicalIF":1.6,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266415","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":"The Essentials of Vitamin and Mineral Supplementation After Total Gastrectomy.","authors":"Rachael C Lopez, Amber F Gallanis, Jeremy L Davis","doi":"10.1007/s12029-025-01240-w","DOIUrl":"10.1007/s12029-025-01240-w","url":null,"abstract":"","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"130"},"PeriodicalIF":1.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12144039/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: The Association Between Health Literacy and Colorectal Cancer Screening: Findings Using a Three-Question Health Literacy Measure.","authors":"Alfonsus Adrian H Harsono, Rachel Ruiz, Meghna Katta, Hannah Ficarino Sheffer, Marshall Chandler McLeod, Smita Bhatia, Terry Davis, Daniel I Chu, Robert H Hollis","doi":"10.1007/s12029-025-01253-5","DOIUrl":"https://doi.org/10.1007/s12029-025-01253-5","url":null,"abstract":"","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"129"},"PeriodicalIF":1.6,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144234327","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":"Pancreatic Cancer Risk Assessment Tools in Primary Care: A Mixed Methods Systematic Review.","authors":"Hugh Claridge, Elizabeth A Cooke, Spencer A Thomas, Nan Greenwood, Agnieszka Lemanska","doi":"10.1007/s12029-025-01229-5","DOIUrl":"10.1007/s12029-025-01229-5","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancer is the twelfth most common cancer worldwide, but high mortality rates make it the sixth leading cause of cancer deaths. Diagnosis is frequently too late for curative intervention. Risk assessment tools incorporating diagnostic prediction models may assist early pancreatic cancer detection by primary care clinicians.</p><p><strong>Aim and methods: </strong>This mixed methods systematic review aims to identify risk assessment tools which can be used for the detection of pancreatic cancer and have been investigated in primary care. It also seeks to synthesise the qualitative and quantitative evidence relating to the patient and clinician perspectives and experiences with these tools.</p><p><strong>Results: </strong>Ten studies were included with five risk assessment tools identified: 'QCancer', 'eRATs' (electronic risk assessment tools), 'CaDet', 'Future Health Today' and 'C the Signs'. No tools were found for pancreatic cancer alone. Thematic synthesis of stakeholder perspectives resulted in three themes: impact on clinical decision-making, impact on patient consultations and implementation barriers and facilitators. Overall, experiences and impacts were positive, especially if used by less experienced clinicians.</p><p><strong>Conclusion: </strong>There is little evidence for the inclusion of many developed pancreatic cancer diagnostic prediction models in risk assessment tools in primary care, and limited research into stakeholder perceptions, especially patient perceptions. This review can inform future tool development, and further research should be undertaken assessing these tools' clinical validity to encourage uptake in clinical practice.</p><p><strong>Study registration: </strong>This study was registered prospectively as PROSPERO CRD42024488160.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"128"},"PeriodicalIF":1.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12141374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Oncological Outcomes After Complete Mesocolic Excision Versus Standard Resection for Right-Sided Colon Cancer: A Propensity Score Matching Analysis.","authors":"Federica Del Coco, Pietro Achilli, Pietro Carnevali, Irene Giusti, Alessandro Giani, Camillo Leonardo Bertoglio, Carmelo Magistro, Matteo Origi, Michele Mazzola, Giovanni Ferrari","doi":"10.1007/s12029-025-01248-2","DOIUrl":"10.1007/s12029-025-01248-2","url":null,"abstract":"<p><strong>Background: </strong>Complete mesocolic excision (CME) has not gained wide diffusion, mainly due to its technical complexity and unclear oncological benefits. We investigated the long-term outcomes of patients with right-sided colon cancer who underwent CME surgery compared to those treated with conventional surgery (NCME).</p><p><strong>Methods: </strong>Prospectively collected data of patients who underwent surgery between 2010 and 2018 were retrospectively analysed. Propensity score matching (PSM) was used to balance baseline characteristics of CME and NCME patients. The primary endpoints of the study were overall and disease-free survival (OS and DFS), distant and local recurrence-free survival (DRFS and LRFS).</p><p><strong>Results: </strong>Out of the 444 patients included in the study, 254 were correctly matched after PSM, 127 in each group. The median follow-up was 70 months (IQR 54-81). Conversion rate, complications, and 90-day mortality were comparable in both groups. Five-year LRFS rates for CME patients was 100% and 95% for NCME (log-rank p = 0.044). At 5 years, there were no differences between the two groups in terms of overall survival and disease-free survival.</p><p><strong>Conclusions: </strong>Laparoscopic CME for RCC is associated with a significant decrease in terms of LRFS. No benefit on long-term disease-free survival and overall survival was obtained.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"127"},"PeriodicalIF":1.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191890","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":"Melanoma and Colorectal Cancer as Second Primary Cancers: A Scoping Review of Their Association and the Underlying Biological, Lifestyle, and Genetic Factors.","authors":"Sasha Patil, Arunan Jeyakumar, Vinod Gopalan","doi":"10.1007/s12029-024-01114-7","DOIUrl":"10.1007/s12029-024-01114-7","url":null,"abstract":"<p><strong>Purpose: </strong>Second primary cancers (SPCs) are independent primary cancers that develop separately from pre-existing malignancies, distinct from metastasis or recurrence. This study aims to review the current literature and analyse the association between melanoma and colorectal cancer (CRC), as well as the factors contributing to the development of these SPCs.</p><p><strong>Methods: </strong>A scoping review was conducted, including 21 independent studies. Patient data from these studies were analysed and reviewed alongside relevant biological and lifestyle factors.</p><p><strong>Results: </strong>The studies reported standardised incidence ratios (SIRs) for a second primary colorectal cancer (CRC) following a melanoma diagnosis ranging from 0.62 to 1.55, while SIRs for a second primary melanoma following a CRC diagnosis ranged from 0.89 to 1.55. Males exhibited a higher risk of developing either CRC or melanoma as a second primary cancer (SPC). An inverse relationship between age and the development of CRC was observed, with younger individuals having a higher risk. African-American populations demonstrated a higher prevalence of melanoma and CRC as SPCs compared to Caucasian and other racial groups. Lifestyle factors such as alcohol consumption, sun exposure, and the intake of red and processed meats were associated with an increased risk of developing melanoma or CRC. Genetic mutations in KRAS, NRAS, and BRAF were commonly implicated in the development of both melanoma and CRC, while mutations in CDKN2A and BRCA2 were specifically significant in melanoma.</p><p><strong>Conclusion: </strong>The association between melanoma and CRC incidence was confirmed through analysis of current literature and is influenced by various biological, lifestyle, and genetic factors. Understanding these correlations is crucial for predicting the risk of SPCs and enhancing the follow-up care of melanoma and CRC survivors.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"125"},"PeriodicalIF":1.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12125029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Environmental Quality on Pancreatic Cancer Outcomes Post Pancreatoduodenectomy: A Retrospective Cohort Study.","authors":"Abdullah Khalid, Victoria Aveson, Shamsher A Pasha, Lyudmyla Demyan, Oliver Standring, Elliot Newman, Daniel A King, Danielle DePeralta, Sepideh Gholami, Matthew J Weiss, Marcovalerio Melis","doi":"10.1007/s12029-025-01254-4","DOIUrl":"10.1007/s12029-025-01254-4","url":null,"abstract":"<p><strong>Introduction: </strong>The Environmental Quality Index (EQI), a composite measure of county-level environmental burden, has been linked to cancer incidence and disease progression. We evaluated the association between EQI and clinical characteristics and outcomes among patients undergoing pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of PDAC patients who underwent PD between 2014 and 2023. Patients were stratified into low, moderate, or high EQI groups. Multinomial regression models were used to assess associations between EQI levels and clinical variables, using the low EQI group as the reference.</p><p><strong>Results: </strong>Among the 137 patients with PDAC who underwent PD, 37 (27.1%) were in the low, 42 (30.6%) in the moderate, and 58 (42.3%) in the high EQI groups. The study identified significant associations in high EQI groups: race (minority vs. white patients: RR 2.44, p = 0.044); diabetes mellitus prevalence (RR 3.12, 95% CI 1.30-7.49, p = 0.011), tumor size > 5 cm (RR 1.53, p = 0.048), history of other types of cancer (RR 1.64, p = 0.038), longer time-to-treatment (RR 1.96, p = 0.041), and ICU stay > 3 days (RR 1.95, p = 0.013), compared to the low EQI group. No significant differences were observed in severe post-operative complications, mortality rates, or median overall survival across groups (mOS: 20.2 months for low, 15.2 months for moderate, and 14.2 months for high EQI, respectively, p = 0.210).</p><p><strong>Conclusion: </strong>Patients residing in areas with poor environmental quality had higher comorbidity burden and delays in treatment, though EQI was not significantly associated with surgical or survival outcomes.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"126"},"PeriodicalIF":1.6,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191889","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":"Adherence to Multidisciplinary Tumor Board Recommendations and Its Association with Survival: A Retrospective Observational Study of Colorectal Cancer Patients.","authors":"Esin Aysel Kandemir, Julia Roeper, Heiner Zimmermann, Lena Ansmann, Petra Hülper, Maximilian Bockhorn, Claus-Henning Köhne, Frank Griesinger","doi":"10.1007/s12029-025-01246-4","DOIUrl":"10.1007/s12029-025-01246-4","url":null,"abstract":"<p><strong>Purpose: </strong>Multidisciplinary tumor boards (MTBs) intend to increase the quality of cancer care. Research on the association of adherence to MTB recommendations with survival is limited. This study aims to determine the impact of adherence to MTB recommendations on survival in colorectal cancer patients.</p><p><strong>Methods: </strong>This is a retrospective, observational study including patients diagnosed between 01.01.2014 and 31.12.2018. Electronic health records were reviewed to determine the adherence. Study endpoints were adherence rate, disease-free survival (DFS), and overall survival (OS). Follow-up was performed until 12.12.2023.</p><p><strong>Results: </strong>There was a significant difference in DFS (median DFS: 79 months [95% CI, 73-89] vs 22 months [95% CI, 17-87]) and OS (median OS: 78 months [95% CI, 75-86] vs 65 months [95% CI, 28-NR]) between the adherent group (n=406) versus the non-adherent group (n=52) (log-rank test, p<0.05). Performance status, stage and non-adherence were independent predictors of survival in the multivariate analysis (p<0.05 for all). The most common reason for non-adherence was patient preference (n=23).</p><p><strong>Conclusion: </strong>While MTBs have become an indispensable part of clinical practice, adherence to MTB recommendations was crucial to achieve survival benefit in this study. Patient preference should be prospectively analyzed from a patient and caregiver perspective in future studies.</p>","PeriodicalId":15895,"journal":{"name":"Journal of Gastrointestinal Cancer","volume":"56 1","pages":"124"},"PeriodicalIF":1.6,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12122649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}