Journal of pediatric surgery最新文献

{"title":"Multisite veno venous extracorporeal support in children below 5 kg, experience from a referral center.","authors":"Erik Hervieux, Julie Starck, Garance Martin, Cyril Guillier, Sébastien Faraj, Pauline Leroux, Julia Guilbert, Yohan Soreze, Pauline Clermidi, Sabine Irtan, Sandrine Jean, Pierre-Louis Léger, Jérôme Rambaud","doi":"10.1016/j.jpedsurg.2026.163538","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163538","url":null,"abstract":"<p><strong>Introduction: </strong>Refractory respiratory failure is one of the leading indications for extracorporeal membrane oxygenation (ECMO) in neonates and children. Despite strong arguments supporting the use of veno-venous ECMO (VV ECMO), the international ELSO registry still reports a higher rate of veno-arterial ECMO (VA ECMO) in such situations. We report our experience with multisite V-V ECMO in children weighing less than 5 kg.</p><p><strong>Methods: </strong>We conducted a single-center retrospective study from January 2017 to December 2025. All patients weighing less than 5 kg who underwent multisite VV ECMO were included in the analysis.</p><p><strong>Results: </strong>During the study period, 52 patients weighing less than 5 kg underwent VV ECMO. Among these, 43 (83 %) received multisite VV ECMO. The median weight was 3.5 kg (2.9 - 4.3) and 12 patients (28 %) weighed less than 3 kg. Seventeen (39 %) patients were initially supported with VA ECMO and subsequently converted to VV ECMO. Percutaneous cannulation was performed using 21 femoral cannulas (48 %) and 17 jugular cannulas (39%). All vascular complications occurred during percutaneous femoral cannulation. Median blood flows on days 1, 3 and 7 were 106 ml/kg/min (92 - 117), 105 ml/kg/min (94 - 116) and 101 ml/kg/min (93 - 118), respectively. The median duration of ECMO support was 12 days (6 - 17). Twenty-six (60%) patients were successfully weaned from ECMO, and 25 were alive 6 months after ECMO support.</p><p><strong>Conclusion: </strong>Multisite VV ECMO is an effective cannulation strategy in children weighing less than 5 kg with refractory respiratory failure.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163538"},"PeriodicalIF":2.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Postoperative Antimicrobial Prophylaxis Practices: A Pediatric Surgery Quality Collaborative Effort.","authors":"Erin M Morris, Kerri McKie, Jeannette M Joly, Terry Fisher, Michael Chang, Grant Geissler, Tamar Levene, Tyler Morrissey, Tamara Thomas, Regan Williams, Lisa Wedel, Kevin P Lally, Shawn Rangel","doi":"10.1016/j.jpedsurg.2026.163527","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163527","url":null,"abstract":"<p><strong>Introduction: </strong>Inappropriate postoperative antibiotic exposure in children contributes to avoidable adverse events without reducing surgical site infections (SSI), yet postoperative surgical antimicrobial prophylaxis (SAP) use varies widely across children's hospitals and determinants of effective stewardship remain unclear. This study evaluated variation in prophylaxis use and outcomes, identified drivers of inappropriate use, and characterized strategies employed by high-performing institutions to promote antimicrobial stewardship.</p><p><strong>Methods: </strong>We conducted a mixed-methods project across 30 National Surgical Quality Improvement Program-Pediatric (NSQIP-Ped) hospitals participating in the Pediatric Surgery Quality Collaborative. Phase 1 analyzed NSQIP-Ped SAP Semiannual Reports to quantify variation in postoperative prophylaxis use (>24 hours), SSI rates, and identify outliers. Phase 2 surveyed surgical quality improvement (QI) leaders and Antimicrobial Stewardship Program representatives regarding data use, QI initiatives, and interdisciplinary collaboration. Phase 3 involved semi-structured interviews with high- and low-performing hospitals, guided by the Theoretical Domains Framework, to examine organizational, behavioral, and cultural determinants of stewardship performance and to identify barriers, facilitators, and effective practices.</p><p><strong>Results: </strong>Postoperative SAP use >24 hours varied 11.8-fold among hospitals (1.5-23.7%; case-mix-adjusted rate ratios: 0.32-3.78) with no correlation between prolonged prophylaxis and SSI rates (r = -0.086, p = 0.652). High- and low-performing hospitals reported similar perceived barriers. Determinants of success included supportive culture, standardized protocols, shared accountability, and multidisciplinary collaboration led by engaged QI champions.</p><p><strong>Conclusion: </strong>Substantial variation in postoperative antibiotic use exists without SSI benefit. High-performing centers achieved expected SSI rates without prolonged prophylaxis, highlighting an opportunity for targeted knowledge-sharing to strengthen pediatric surgical antimicrobial stewardship.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163527"},"PeriodicalIF":2.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LONG-TERM CLINICAL OUTCOMES OF ENDOSCOPIC TREATMENT OF VESICOURETERAL REFLUX WITH A NON-ABSORBABLE MATERIAL.","authors":"Ana Ramírez, Verónica Vargas, Álvaro Escassi, Rosa Paredes, Alberto Parente","doi":"10.1016/j.jpedsurg.2026.163531","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163531","url":null,"abstract":"<p><strong>Purpose: </strong>Absorbable and non-absorbable substances have been used for endoscopic treatment of vesicoureteral reflux (VUR). No material has been demonstrated superior over another. Our aim is to present the results of endoscopic treatment of VUR using polydimethylsiloxane.</p><p><strong>Methods: </strong>Retrospective study of patients with VUR who underwent polydimethylsiloxane subureteral transurethral injection between January 2015 and December 2024. Age, sex, hydronephrosis degree, VUR grade, and renal function before and after treatment were studied. Short and long-term complications of ureterorenal units (URUs) were analyzed.</p><p><strong>Results: </strong>148 URUs were treated endoscopically in 101 patients. 51.5% women, mean age 4.4±3.3 years (1-15 years). Before treatment, 15.5% URU had VUR grade II, 31.1% grade III, 33.8% grade IV and 19.6% grade V. Mean renal function was 46±15.7% (11-88%). Mean follow-up time was 59±36.3 months (13-128 months). The success rate, defined as complete resolution of VUR, was 93.9% after a maximum of two injections. Regarding the degree of hydronephrosis, improvement was observed in 66.3% at one year and in 87.1% at three years after treatment. Renal function improved or remained stable during follow-up in 26/40 URUs (65%). 16.2% and 6.4% experienced UTI during short and long-term follow-up respectively. Long-term obstruction secondary to endoscopic treatment occurred in 1.6%. 13 URU (8.8%) required surgical reimplantation.</p><p><strong>Conclusion: </strong>The use of polydimethylsiloxane in the endoscopic treatment of VUR is an effective therapeutic method with low morbidity, representing a valid alternative to surgical treatment.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163531"},"PeriodicalIF":2.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced Recovery After Surgery Pathways in Pediatric Thoracic Surgery: A Scoping Review.","authors":"Gamze Ataman Yıldız, Seçil Taylan, Fatma Eti Aslan","doi":"10.1016/j.jpedsurg.2026.163540","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163540","url":null,"abstract":"<p><strong>Background: </strong>Pediatric thoracic surgery is a field with a high risk of postoperative complications and a complex recovery process, requiring effective care models that support rapid and safe patient recovery.</p><p><strong>Objective: </strong>This study aims to systematically map the existing literature on ERAS (Enhanced Recovery After Surgery) protocols in pediatric thoracic surgery, to identify the reported protocol components and outcome measures, and to determine knowledge gaps for future research.</p><p><strong>Methods: </strong>A scoping review was conducted according to the six-stage framework of the Joanna Briggs Institute and reported in line with the PRISMA-ScR guidelines. A comprehensive literature search was performed in PubMed, Web of Science, and Scopus databases in February 2026. Studies examining ERAS protocols in pediatric thoracic surgery and reporting clinical and psychosocial outcomes were included. Two researchers independently extracted the data and synthesized them using thematic analysis.</p><p><strong>Results: </strong>A total of 7 studies were included in the scoping review. The most frequently evaluated components of ERAS protocols were early mobilization, multimodal analgesia, and early feeding, and these practices were important for shortening hospital length of stay, optimizing pain control, and supporting clinical efficiency without increasing complication rates. Although most studies were retrospective and single-center, ERAS was shown to be feasible when implemented through multidisciplinary teams and safe in terms of short-term clinical outcomes. However, patient-reported and long-term psychosocial outcomes remain limited.</p><p><strong>Conclusion: </strong>ERAS protocols in pediatric thoracic surgery are feasible and safe in terms of short-term clinical outcomes and can be effective with multidisciplinary team coordination. Future multicenter, prospective, and standardized studies are needed to evaluate patient-reported and long-term outcomes.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163540"},"PeriodicalIF":2.3,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing Urethral Meatal Location on the Glans Penis Using a Normalized Coordinate System.","authors":"Burak Ardicli, Idil Rana User, Saniye Ekinci","doi":"10.1016/j.jpedsurg.2026.163535","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163535","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163535"},"PeriodicalIF":2.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biliary Complications After High-Grade Blunt Liver Trauma in Children: Impact of Early Recognition on Management Burden.","authors":"Giulia Sollami, Lidia Rabiolo, Giuseppe Cristofalo, Davide Coppolino, Luigi Maruzzelli, Mariapina Milazzo, Giuseppe Mamone, Ilaria Tarantino, Nicolò Rizzitello, Roberto Miraglia, Jean de Ville de Goyet","doi":"10.1016/j.jpedsurg.2026.163539","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163539","url":null,"abstract":"<p><strong>Background/purpose: </strong>Biliary complications (BIC) are rare after high-grade blunt liver trauma in children, but a recognized source of morbidity. The main clinical issue is whether they are recognized in time to limit treatment burden. This study evaluated the incidence, presentation, and management of BIC after high-grade blunt liver trauma in a pediatric referral cohort.</p><p><strong>Methods: </strong>All consecutive children younger than 18 years referred to a quaternary pediatric hepatobiliary center between January 2006 and December 2025 for severe blunt liver injury were retrospectively reviewed. Demographic data, injury grade, timing of diagnosis, treatment, and clinical outcomes were analyzed. Length of hospital stay was used as a surrogate marker of management burden.</p><p><strong>Results: </strong>Eighteen BIC events were identified in 18 children, including 15 biliary fistulas and 3 bilomas. BIC occurred more often with increasing injury severity, affecting 20% of grade III, 50% of grade IV, and 67% of grade V injuries (P= 0.046). Median hospital stay was longer in children with BIC than in those without BIC (21 days [IQR, 16.5-33.5] vs 9.5 days [IQR, 7-13]; P = .007). In children who underwent planned second-look laparotomy after peri-hepatic packing, bile leak was recognized early, with trans-cystic drainage allowing single step cure; delayed diagnosis on the other hand was significantly associated with more complex and staged management, including percutaneous drainage, endoscopic or delayed interventions (P< 0.01).</p><p><strong>Conclusion: </strong>Timely recognition was associated with simpler management and shorter hospitalization, suggesting that structured surveillance of selected high-risk injuries should be incorporated into contemporary nonoperative management pathways.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163539"},"PeriodicalIF":2.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Therapeutic effect of colonic spring expansion and interposition into the small intestine on short bowel model in rats.","authors":"Jiaqi Shang, Li Yu, Hanfei Wang, Xintong Chen, Peng Wang, Han Wang, Anne-Laure Thomas, Weibing Tang, James C Y Dunn, Weiwei Jiang","doi":"10.1016/j.jpedsurg.2026.163526","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163526","url":null,"abstract":"<p><strong>Background: </strong>Short bowel syndrome (SBS) is a morbid disease with limited effective treatment modalities. Spring-mediated intestinal distraction has been successfully applied to lengthen the small intestine. This study investigates the therapeutic efficacy of spring-induced colonic lengthening followed by interposition into the small intestine in a rat SBS model.</p><p><strong>Methods: </strong>Twenty Sprague-Dawley rats matched for age and body weight were selected and randomly divided into four groups. Two groups underwent the implantation of nitinol spring-loaded capsules into the colon, while the other two groups underwent colonic resection and anastomosis only. After 3 weeks, 75% of the small intestine was resected, and three of the groups underwent colonic segment transplantation, while the other group did not. Four weeks later, tissue samples were collected and evaluated for histology and the expression of proliferation-related genes.</p><p><strong>Results: </strong>Compressed spring-implanted colonic segments elongated to 300%±50% of their initial length. One week after colonic interposition, the rate of weight loss slowed significantly (P < 0.01). Compared with the original colonic segments (127±45 μm), the circular muscle layers thickness of the elongated colonic segments (145±40 μm) in the compressed spring group increased (P < 0.01), but there was no significant change in crypt depth (P > 0.1). The interposed colonic segments exhibited higher PCNA expression than the native colon segments, with the highest expression levels (166±10 a.u.) observed in the compressed spring group.</p><p><strong>Conclusions: </strong>Spring-mediated colonic lengthening and interposition can improve intestinal absorption and survival in SBS rats, showing translational potential for SBS treatment.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163526"},"PeriodicalIF":2.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the Child: A Systematic Review of Parental Wellbeing and Family Functioning in Paediatric Colorectal Conditions.","authors":"Caryn Koo, Sadie Chiu, Sebastian K King, Frank Muscara, Misel Trajanovska","doi":"10.1016/j.jpedsurg.2026.163523","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163523","url":null,"abstract":"<p><strong>Introduction: </strong>Families of children with anorectal malformation (ARM) and Hirschsprung disease (HD) often experience ongoing caregiving demands extending beyond the child's medical management. This systematic review aimed to synthesise quantitative literature examining parental wellbeing and family functioning outcomes among families of children with ARM or HD.</p><p><strong>Methods: </strong>Using the PRISMA protocol, a systematic search was conducted across Ovid Medline, Embase, Web of Science, PsycINFO, and CINAHL. Eligible studies included quantitative studies evaluating psychosocial outcomes relating to parents or families of children (aged <18 years) surgically treated for ARM or HD. Data extraction and quality appraisal using the Joanna Briggs Institute tool were completed independently by two reviewers.</p><p><strong>Results: </strong>From 1205 records identified, nine studies met inclusion criteria and were synthesised without meta-analysis due to methodological heterogeneity. Across studies, families reported challenges relating to psychological wellbeing, parenting stress, caregiving burden, and family functioning, particularly in the context of ongoing bowel dysfunction and faecal incontinence. However, there was also considerable variability in resilience and adaptation among families.</p><p><strong>Discussion: </strong>Current evidence suggested that ARM and HD may have significant psychosocial impacts on the broader family unit. Future research should prioritise longitudinal and family-centred approaches to better inform integrated models of biopsychosocial care.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163523"},"PeriodicalIF":2.3,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Surgical Stress: A Global Cross-Sectional SURG-TLX Assessment in Pediatric Oncology Surgeons.","authors":"Albert Pasten, Raimon Ripoll, Anna Domenech Plana, Lucas Krauel","doi":"10.1016/j.jpedsurg.2026.163530","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163530","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163530"},"PeriodicalIF":2.3,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative of Robotic-Assisted versus Laparoscopic-Assisted Modified Soave Pull-Through with Short Muscular Cuff Anastomosis in Infants Under 3 Months with Classical Hirschsprung Disease.","authors":"Bo Wang, Chengyan Tang, Xinrong Xia, Yuan Gong, Qing Du, Daiwei Zhu, Zeping Li, Wangkan Zhou, Yuanli Wang, Shengying He, Yanyi Li, Zhu Jin, Yuanmei Liu, Zebing Zheng","doi":"10.1016/j.jpedsurg.2026.163453","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.163453","url":null,"abstract":"<p><strong>Objective: </strong>To compare the clinical efficacy of robotic-assisted versus laparoscopic-assisted modified Soave pull-through with short muscular cuff anastomosis in infants under 3 months of age with classical Hirschsprung's disease (HSCR).</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 35 infants under 3 months with classical HSCR who underwent radical surgery at our hospital from January 2020 to December 2024. Among them, 19 underwent robotic-assisted surgery (robotic group), and 16 underwent laparoscopic-assisted surgery (laparoscopic group). Baseline characteristics, perioperative outcomes, postoperative complications, and defecation function were compared between the two groups.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups (P > 0.05). Compared with the laparoscopic group, the robotic group had significantly shorter total operative time [(142.5±16.8) min vs. (171.3±24.6) min; P < 0.05], shorter anal dissection time [(20.8±5.2) min vs. (36.7±9.8) min; P < 0.05], less intraoperative blood loss [(6.5±2.4) ml vs. (11.0±5.6) ml; P < 0.05], and shorter postoperative hospital stays [(7.2±1.6) d vs. (8.9±2.4) d; P < 0.05]. The incidence of postoperative enterocolitis was significantly lower in the robotic group [0(0%) vs. 4(25.0%); P < 0.05]. Regarding defecation function, the robotic group showed fewer daily soiling episodes [(0.8±0.6) vs. (1.6±0.9); P < 0.05] and higher Kelly scores [(2.9±0.3) points vs. (2.4±0.7) points; P < 0.05]. No significant differences were observed between the two groups in terms of anastomotic complications, need for constipation intervention, daily bowel movement frequency, or excellent rate of defecation function (P > 0.05).</p><p><strong>Conclusion: </strong>In this non-randomized, retrospective comparison, robotic-assisted modified Soave pull-through with short muscular cuff anastomosis was found to be safe and feasible for infants under 3 months with classical HSCR. The robotic approach was associated with shorter operative time, reduced intraoperative blood loss, shorter hospital stays, and may be associated with improved mid-term defecation function compared with laparoscopic assistance.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163453"},"PeriodicalIF":2.3,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}