Thoracic and Cardiovascular Surgeon最新文献

{"title":"Accuracy of Preoperative Positron Emission Tomography - Computed Tomography for Mediastinal Lymph Node Staging in Non-Small Cell Lung Cancer.","authors":"Sarah Häufglöckner, Peter Kleine, André Althoff, Neelam Lingwal","doi":"10.1055/a-2855-2535","DOIUrl":"10.1055/a-2855-2535","url":null,"abstract":"<p><strong>Background: </strong>Accurate mediastinal lymph node staging is essential in non-small cell lung cancer (NSCLC) treatment. While 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is widely used for noninvasive staging, its diagnostic reliability, particularly for nodal assessment, remains debated.</p><p><strong>Methods: </strong>A retrospective multicenter analysis included 278 patients with histologically confirmed NSCLC who underwent FDG-PET/CT followed by surgery with systematic lymphadenectomy between 2015 and 2021. PET/CT-based nodal staging was compared with histopathology. Diagnostic performance was evaluated using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and Cohen's κ. Logistic regression was performed to identify predictors of correct N staging. Patients receiving neoadjuvant therapy were excluded from subgroup analyses (<i>n</i> = 252).</p><p><strong>Results: </strong>Histopathology revealed nodal metastases in 112 patients (40.3%). PET/CT detected nodal involvement with sensitivity of 66.8% and specificity of 85.2%. PPV was 50.7% and NPV 85.5%, with an overall concordance of 43.3%. Sensitivity for N1 disease was 38.2%, whereas N2 and N3 metastases were detected with sensitivities of 55.3% and 100.0%. The false-negative rate was 25.2%, with intrapulmonary nodes (station 11) most frequently missed. False-positive findings occurred in 20.1%, predominantly in hilar nodes. Multivariable analysis identified lymph node involvement and tumor stage as independent predictors of staging accuracy, whereas extracapsular extension showed a non-significant trend.</p><p><strong>Conclusion: </strong>FDG-PET/CT demonstrates high specificity and NPV but limited sensitivity for mediastinal nodal staging in NSCLC under real-world conditions. These findings are primarily driven by disease characteristics rather than methodological factors. A multimodal approach remains essential, with histopathological confirmation of PET-positive findings and selective invasive staging in PET-negative patients to ensure accurate treatment allocation.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717493","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":"Radiographic Lung Volume Recovery and Clinical Outcomes of Video-Assisted Thoracoscopic Surgery for Early-Stage Empyema.","authors":"Zhenhua Yue, Yifei Wang, Yiling Huang, Guozhan Xia, Fangzheng Hong, Wen Cheng, Kun Wang, Xuewei Zhao, Mingdong Wang","doi":"10.1055/a-2855-2595","DOIUrl":"10.1055/a-2855-2595","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the clinical and radiographic outcomes of video-assisted thoracoscopic surgery (VATS) for early-stage empyema, emphasizing the restoration of lung volume as a crucial indicator of treatment success.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients with early-stage empyema who underwent VATS between January 2020 and June 2025. Data regarding inflammatory markers, coagulation parameters, and clinical recovery were systematically collected. A key radiographic outcome, specifically the affected lung volume, was quantitatively assessed using computed tomography (CT) volumetry both preoperatively and postoperatively to objectively evaluate lung re-expansion.</p><p><strong>Results: </strong>Thirty patients were included in the study. VATS resulted in significant reductions in postoperative inflammatory markers, including white blood cell, neutrophil percentage, C-reactive protein, interleukin-6, and D-dimer (<i>p</i> < 0.05). CT-based lung volume increased significantly from 1,278.81 cm³ (interquartile range [IQR]: 1,021.9-1,677.56) preoperatively to 1,587.81 cm³ (IQR: 1,320.51-1,978.91) at 3 months postoperatively, representing a median absolute increase of 309.0 cm³ (+24.2%, <i>p</i> = 0.002). The mean duration of chest tube drainage was 7.47 ± 3.96 days, and the mean length of hospital stay was 19.70 ± 8.35 days. The 30-day readmission rate was 23.33%.</p><p><strong>Conclusion: </strong>VATS is a highly effective intervention for early-stage empyema, resulting in significant resolution of systemic inflammation and, importantly, a substantial increase in lung volume. The restoration of lung volume substantiates the procedural efficacy of VATS in facilitating mechanical lung liberation and promoting functional recovery, thereby highlighting its essential role in the management of this condition.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147717825","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":"Letter to the Editor: HTK Solution Cardioplegia in Pediatric Patients: A Meta-Analysis.","authors":"Syed Muhammad Momin, Said Umair Shah, Haris Akbar, Syed Hatim Hussain","doi":"10.1055/a-2858-4226","DOIUrl":"https://doi.org/10.1055/a-2858-4226","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147821017","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":"Heart Transplantation on Temporary Mechanical Circulatory Support: A Single-Center Study (2010-2024).","authors":"Raphael Phinicarides, Freya Sophie Jenkins, Vincent Hendrik Hettlich, Charlotte Boettger, Fabian Voß, Tobias Zeus, Nikolaos Kalampokas, Bedri Ramadani, Hug Aubin, Artur Lichtenberg, Udo Boeken","doi":"10.1055/a-2858-4481","DOIUrl":"https://doi.org/10.1055/a-2858-4481","url":null,"abstract":"<p><strong>Background: </strong>Temporary mechanical circulatory support (tMCS) is increasingly used to stabilize patients in cardiogenic shock as a bridge-to-transplant. While this strategy facilitates listing and organ allocation in critically ill patients, its effect on post-transplant outcomes remains incompletely defined.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study including all adult patients undergoing orthotopic heart transplantation (HTX) between September 2010 and December 2024. Patients were stratified by presence or absence of tMCS at the time of transplant. Primary endpoints were resternotomy, perioperative extracorporeal life support (ECLS), in-hospital mortality, and 1-year mortality. Student's <i>t</i>-test and chi-square tests were used for comparisons.</p><p><strong>Results: </strong>Among 296 patients (mean age: 55.2 ± 10.8 years; 70.6% male), 15 (5.1%) received tMCS at the time of HTX. Compared with controls, tMCS patients had significantly higher inflammatory markers and lower platelet and hemoglobin levels preoperatively. They were more often listed with high urgency (78.6 vs. 39.4%, <i>p</i> < 0.01), required perioperative ECLS more frequently (64.3 vs. 26.9%, <i>p</i> < 0.01), and exhibited higher in-hospital (21.4 vs. 7.6%, <i>p</i> < 0.01) and 1-year mortality (54.5 vs. 16.7%, <i>p</i> < 0.01). Resternotomy rates were similar. Patients bridged with Impella or transitioned from extracorporeal membrane oxygenation to right ventricular-assist device (RVAD) had better outcomes than those transplanted directly from ECLS.</p><p><strong>Conclusion: </strong>HTX in tMCS-supported patients is feasible but associated with significantly higher early and mid-term mortality. The type of preoperative support and transition strategy may impact outcomes. Tailored bridging concepts and early conversion to durable or RVAD-based support warrant further investigation.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147782003","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":"Risk-Reduction by direct thrombin antagonism during ECMO therapy.","authors":"Susanne Rohrbach, Maurice Himmel, Melanie Spaenig, Andreas Böning, Florian Brenck, Michael Sander, Joern Pons-Kuehnemann, Thomas Walther, Bernd Bernd Niemann","doi":"10.1055/a-2851-6221","DOIUrl":"https://doi.org/10.1055/a-2851-6221","url":null,"abstract":"<p><strong>Background: </strong>ECMO-patients can develop heparin (Hep)-induced-thrombocytopenia Type II (HITII). Approval for direct thrombin-antagonism is lacking. We analyze if direct thrombin antagoism feasible, save and not inferior to heparin.</p><p><strong>Methods: </strong>254 multicenter prospective patients (vv- or va-ECMO) were analyzed in 4 different cardiothoracic, pulmonary, or anesthesiological intensive care units at university hospitals in XXXXXXX from 2020 to 2022.</p><p><strong>Results: </strong>153 va-ECMO / 101 vv-ECMO patients always received heparin (95/43), only DTA (8/6) or a switch (50/52) from heparin to direct thrombin antagonism (DTA) in cases of suspected HITII and reduced platelet count (reduction: p =0.017). ICU morbidity, survival, therapeutic stability of anticoagulation, bleeding, thrombosis and technical integrity was analyzed regarding non inferiority and superiority of DTA versus heparin. Patients who changed anticoagulation showed increased infection levels before the change. Before switching from heparin to DTA, there was only a moderate increase in the INR, a decrease in the Quick and no therapeutic increase in the PTT with heparin. With regard to thrombosis and system occlusions, there is no difference between heparin and DTA. Weaning rates from extracorporal support and survival analysis did show non-inferiority of DTA. After switching a clear superiority of DTA in terms of (A) overall complication rate CI((0.6479/0.7871/0.9546)) (defined as bleeding from any cause, stroke, amputation, thrombosis and device-occlusion) and (B) bleeding from any cause alone CI((0.6432/0.7829/0.9513)) and a NON inferiority in terms of preventing strokes exists.</p><p><strong>Conclusions: </strong>DTA is not inferior to heparin in ECLS/ECMO therapy. Regarding all complications, stroke, thromboembolism, amputation DTA is superior.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147781994","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":"Fluoroscopic Pericardiocentesis by Cardiac Surgeons: Hybrid Setup Outcomes.","authors":"Erturk Karaagac, Nuri Utkan Tunca, Serkan Yazman, Hasan Iner, Yuksel Besir, Levent Yilik, Ali Gurbuz","doi":"10.1055/a-2849-6543","DOIUrl":"10.1055/a-2849-6543","url":null,"abstract":"<p><p>Pericardiocentesis is a life-saving intervention in the treatment of cardiac tamponade. This study aims to evaluate the safety, efficacy, and short-term outcomes of fluoroscopy-guided pericardiocentesis performed by cardiovascular surgeons in a hybrid operating room setting.Data from 64 patients who underwent fluoroscopy-guided percutaneous drainage for symptomatic pericardial effusion in a hybrid operating room between January 2020 and December 2024 were analyzed retrospectively. Procedures were performed using a standard subxiphoid approach and a pigtail catheter.The etiology was malignancy in 31.2% (<i>n</i> = 20) of the patients. The median maximum effusion diameter measured on preoperative echocardiography was 24 mm (interquartile range [IQR]: 20-28 mm), which decreased significantly to 7 mm (IQR: 5-9 mm) on postoperative evaluation (<i>p</i> < 0.001). The minor complication rate was 1.5% (<i>n</i> = 1, pneumothorax). No surgical conversion (sternotomy) was required during the procedures. Reintervention was required in only two patients (3.1%) during the 3-month follow-up.Fluoroscopy-guided pericardiocentesis performed under hybrid operating room conditions represents a safe option with low complication and recurrence rates, even in high-risk groups such as malignancy. The real-time anatomical visualization provided by fluoroscopy, combined with the surgical infrastructure of the hybrid environment, provides a feasible workflow for cardiac surgeons. However, these findings need to be supported by more extensive and comparative studies.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640059","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":"Physician Assistants in Cardiac Surgery: Insights from a German University Hospital.","authors":"Freya S Jenkins, Anna Kathrin Assmann, Giuseppina P Pellegrino, Artur Lichtenberg, Alexander Assmann","doi":"10.1055/a-2836-2282","DOIUrl":"https://doi.org/10.1055/a-2836-2282","url":null,"abstract":"<p><p>The rising complexity of cardiac surgery patients, coupled with new regulations reducing working hours for surgical residents, and increased healthcare costs, has led to the growing introduction of physician assistants (PAs) into cardiacsurgery teams in German hospitals. This study aims to systematically explore the experience of introducing PAs into the cardiac surgery workforce in a tertiary university hospital in Germany, identifying what is working well and areas for improvement, as well as offering suggestions for appropriate measures.The study was of an observational nature and comprised both quantitative assessments and qualitative interviews. For the quantitative component, a survey was distributed internally to employees of the cardiovascular surgery department. The survey was first distributed within 1 month of the first PAs starting in our department (\"baseline\") and again 1 year later (\"follow-up\" [FU]).Forty-one healthcare professionals completed the baseline, and 37 completed the FU survey. Overall satisfaction with PAs was high across all professional groups. Among residents,73.3% reported being satisfied at baseline and 70% at FU. All cardiovascular surgeons (6/6) and PAs (10/10) reported high satisfaction at both time points, and 90% of nursing staff reported being satisfied or very satisfied at baseline, with no dissatisfaction reported at baseline or FU. All PAs reported providing workload relief and feeling fully integrated into the team, while two-thirds of residents reported workload relief due to PAs assuming ward-based clinical and administrative tasks. PAs were consistently perceived as improving continuity of care as a stable point of contact for patients and nursing staff.PAs substantially strengthen cardiac surgery teams in the German healthcare system. To successfully establish the implementation of PAs, the challenges of long-term retention incentives and clear delineation of responsibilities have to be addressed.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147676947","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":"Introduction of Patient-Reported Outcome Measures in a Cardiac Surgery Center.","authors":"Selina Bilger, Luca Koechlin, Brigitta Gahl, Jules Miazza, Luise Vöhringer, Denis Berdajs, Florian Rüter, Oliver Reuthebuch","doi":"10.1055/a-2509-0430","DOIUrl":"10.1055/a-2509-0430","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"210-219"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053671","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":"Myocardial Recovery, Metabolism, and Structure after Cardiac Arrest with Cardioplexol.","authors":"Carina Hemmerich, Martina Heep, Ulrich Gärtner, Zulfugar Timur Taghiyev, Matthias Schneider, Andreas Böning","doi":"10.1055/s-0043-1772210","DOIUrl":"10.1055/s-0043-1772210","url":null,"abstract":"<p><p>Clinical studies indicate encouraging cardioprotective potential for Cardioplexol. Its cardioprotective capacities during 45 minutes of ischemia compared with pure no-flow ischemia or during 90 minutes of ischemia compared with Calafiore cardioplegia were investigated experimentally.Forty-four rat hearts were isolated and inserted into a blood-perfused pressure-controlled Langendorff apparatus. In a first step, cardiac arrest was induced by Cardioplexol or pure no-flow ischemia lasting 45 minutes. In a second step, cardiac arrest was induced by Cardioplexol or Calafiore cardioplegia lasting 90 minutes. For both experimental steps, cardiac function, metabolic parameters, and troponin I levels were evaluated during 90 minutes of reperfusion. At the end of reperfusion, hearts were fixed, and ultrastructural integrity was examined by electron microscopy.Step 1: after 90 minutes of reperfusion, hearts exposed to Cardioplexol had significantly higher left ventricular developed pressure (CP-45': 74%BL vs. no-flow-45': 45%BL; <i>p</i> = 0.046) and significantly better maximal left ventricular relaxation (CP-45': 84%BL vs. no-flow-45': 51%BL; <i>p</i> = 0.012). Oxygen consumption, lactate production, and troponin levels were similar in both groups. Step 2: left ventricular developed pressure was lower (22 vs. 48% of BL; <i>p</i> = 0.001) and coronary flow was lower (24 vs. 53% of BL; <i>p</i> = 0.002) when Cardioplexol was used compared with Calafiore cardioplegia. Troponin I levels were significantly higher under Cardioplexol (358.9 vs. 106.1 ng/mL; <i>p</i> = 0.016).Cardioplexol significantly improves functional recovery after 45 minutes of ischemia compared with pure ischemia. However, Cardioplexol protects the myocardium from ischemia/reperfusion-related damage after 90 minutes of ischemia worse than Calafiore cardioplegia.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"253-263"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9976785","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":"Impact of SGLT2 Inhibitor Therapy on Patients Undergoing Cardiac Surgery.","authors":"Zulfugar T Taghiyev, Lili-Marie Beier, Carina Leweling, Sophia Gunkel, Kevin Mike Sadowski, Birgit Assmus, Andreas Boening","doi":"10.1055/a-2616-4962","DOIUrl":"10.1055/a-2616-4962","url":null,"abstract":"<p><p>Sodium-glucose cotransporter-2 (SGLT2) inhibitors (SGLT2i) are nephroprotective in patients with recompensated acute and chronic heart failure (HF) and chronic kidney disease, but their potential influence during cardiac surgery is unclear. Currently, discontinuation of SGLT2i at least 2 days before surgery is recommended.Between March 2022 and December 2023, 53 cardiac surgical patients on SGLT2i therapy in addition to standard medical treatment for HF were compared with 447 other HF patients from the same period. After 1:1 covariate adjustment, 33 patients with SGLT2i treatment were matched with 33 controls. The primary endpoint was a change in estimated glomerular filtration rate (eGFR) 36 hours after surgery. Secondary endpoints were changes in eGFR, cumulative urine output, diuretic efficacy, and albuminuria over seven postoperative days.Mean baseline eGFR was similar between the groups (<i>p</i> = 0.973). Thirty-six hours postoperatively, eGFR was significantly higher in the SGLT2i group by a mean difference (MD) of 11.8 mL/min (95% CI [3.12-20.44]; <i>p</i> = 0.009) compared with the control group. The mean urinary albumin level was 18.1 mg/mL lower in the SGLT2i group (95% CI [-42.5-6.33]; <i>p</i> = 0.143). There were numerically positive changes in urine output and diuretic efficacy in the SGLT2i group without significant difference: MD 131.4 mL/24 hours (95% CI [-366.7-629.5]; <i>p</i> = 0.600) and MD 11.3 mL/mg (95% CI [-12.2-34.7]; <i>p</i> = 0.301), respectively, although the dosage of diuretics was higher in controls (30.6 ± 43.7 vs. 51.3 ± 130.1 mg/24 hours; <i>p</i> = 0.268, respectively).SGLT2i may have nephroprotective effects in patients undergoing heart surgery with extracorporeal circulation. More evidence is needed to determine whether SGTL2i needs to be discontinued before surgery.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"220-231"},"PeriodicalIF":1.4,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144111994","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}