Thoracic and Cardiovascular Surgeon最新文献

{"title":"Postoperative Recurrence of ROS1-Rearranged Lung Adenocarcinoma: A Case Series.","authors":"Ryo Miyata, Ryota Sumitomo, Ryo Nakanobo, Masatsugu Hamaji","doi":"10.1055/a-2768-2882","DOIUrl":"10.1055/a-2768-2882","url":null,"abstract":"<p><strong>Abstract: </strong>Postoperative recurrence of c-ros oncogene 1 (<i>ROS1</i>)-rearranged non-small cell lung cancer is rarely reported, and the role of tyrosine kinase inhibitors (TKIs) remains unclear. We retrospectively reviewed four patients with completely resected <i>ROS1</i>-positive lung adenocarcinoma who developed recurrence, three receiving crizotinib. The median disease-free interval was 33.4 months, and the median overall survival from postoperative recurrence and initial surgery was 40.7 and 71.2 months, respectively. Brain metastases were the most common initial recurrence site (75%). Crizotinib showed limited efficacy with a median progression-free survival of 3.5 months. These findings highlight indolent disease behavior but limited TKI benefit, supporting the need for adjuvant trials.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"430-432"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744206","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":"The Geometry of Survival: Left Ventricular Mass Index's Prognostic Value in Coronary Surgery.","authors":"Barış Timur, Rezan Aksoy, Zihni Mert Duman, Recep Çalışkan, Kandemir Baş, Cem Aydoğdu, Cevdet Ugur Kocogullari","doi":"10.1055/a-2637-0964","DOIUrl":"10.1055/a-2637-0964","url":null,"abstract":"<p><strong>Background: </strong>This study explores the impact of left ventricular mass and geometry on the prognosis of patients undergoing coronary artery bypass grafting. Left ventricular hypertrophy is a known risk factor for cardiovascular complications, yet its role in surgical outcomes remains underexplored.</p><p><strong>Methods: </strong>A retrospective cohort of 494 elective coronary artery bypass grafting patients treated between 2013 and 2018 was analyzed. Left ventricular mass was calculated using the Devereux formula, and patients were divided into normal and increased left ventricular mass index groups. Mortality rates, postoperative complications, and echocardiographic parameters were evaluated.</p><p><strong>Results: </strong>Patients with increased left ventricular mass exhibited significantly higher 5-year mortality rates (27.2 vs. 11.5%, <i>p</i> < 0.001), postoperative atrial fibrillation (24.8 vs. 16.0%, <i>p</i> = 0.018), and carotid stenosis (21.8 vs. 12.5%, <i>p</i> = 0.006). Elevated preoperative biomarkers, including creatinine and C-reactive protein, were observed in this group, with sustained impairment in postoperative kidney function. However, no significant differences in 30-day, 1-year, or 3-year mortality rates were detected.</p><p><strong>Conclusion: </strong>Left ventricular mass and geometry independently predict long-term outcomes in coronary artery bypass grafting patients. Targeted strategies to mitigate left ventricular remodeling may enhance postoperative outcomes. Future research should focus on therapeutic interventions to reverse adverse left ventricular changes and optimize patient survival and quality of life.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"349-354"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144544973","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":"Effectiveness of Gentamicin-Collagen Sponges in Preventing Sternal Wound Infections.","authors":"Roi Glam, Tom Ronai, Maged Makhoul, Tom Friedman, Mahli Raad, Zvi Adler, Oved Cohen, Benjamin Medalion, Gil Bolotin","doi":"10.1055/a-2635-3239","DOIUrl":"10.1055/a-2635-3239","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate whether the combined use of gentamicin-collagen sponges and topical vancomycin reduces the incidence of sternal wound infections (SWIs) in patients at high risk for infection following cardiac surgery.</p><p><strong>Methods: </strong>A single-center, retrospective study compared two groups of high-risk cardiac surgery patients from June 2018 to September 2021. High-risk patients, identified through departmental consensus, had multiple SWI risk factors. The study group (278 patients) received gentamicin-collagen sponges plus topical vancomycin, whereas the control group (309 patients) received only topical vancomycin. The primary outcome was SWI incidence.</p><p><strong>Results: </strong>The incidence of SWI was significantly lower in the study group, with 2.8% (8/278) compared with 9% (28/309) in the control group (<i>p</i> = 0.002). After adjusting for known risk factors, the odds of infection in the control group were 4.64 times higher (95% confidence interval [CI]: 1.63-13.21) than in the study group. The rate of deep sternal wound infections (DSWI) was 1.8% in the study group versus 4.2% in the control group (<i>p</i> = 0.09), with adjusted odds of DSWI being 4.1 times higher in the control group (95% CI: 0.99-16.86). Although the <i>p</i>-value was borderline (<i>p</i> = 0.05), no significant differences in mortality rates were observed between the two groups.</p><p><strong>Conclusion: </strong>The use of gentamicin-collagen sponges as part of a prophylactic regimen significantly reduces the incidence of SWI in high-risk cardiac surgery patients, suggesting its potential benefit as an adjunctive treatment in preventing postoperative infections.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"397-403"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310429","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":"Variables Associated with Treatment Failure after Negative Pressure Wound Therapy in Poststernotomy Mediastinitis: A Case-Control Study.","authors":"Christoph Schimmer, Christina Heinowski, Khaled Hamouda, Patrick Meybohm, Nodir Madrahimov, Gloria Färber, Dejan Radakovic","doi":"10.1055/a-2733-4361","DOIUrl":"10.1055/a-2733-4361","url":null,"abstract":"<p><strong>Background: </strong>This study investigated factors leading to treatment failure after negative pressure wound therapy (NPWT) in poststernotomy mediastinitis (PSM) patients.</p><p><strong>Methods: </strong>A single-center retrospective case-control study in 198 cardiac surgery patients with PSM and consecutive NPWT were retrospectively divided into two groups. Group I consisted of patients whose NPWT was successful (<i>n</i> = 117/198; 59.1%), while in Group II treatment, failure occurred (<i>n</i> = 81/198; 40.9%). The primary endpoint was treatment failure, defined as recurrence of wound infection requiring surgical treatment within 30 days after secondary wound closure.</p><p><strong>Results: </strong>Body mass index (BMI) >30 kg/m² (<i>p</i> = 0.04; odds ratio [OR] 1.07), diabetes mellitus (DM; <i>p</i> = 0.03; OR 1.94), and the number of sponge changes (<i>p</i> = 0.01; OR 1.57) showed an association with the occurrence of NPWT failure. During the study period, 10/198 (19.8%) patients died after secondary wound healing. In group I, 1/117 (0.9%) patient died versus group II with 9/81 (12.7%) patients. About 70% patients died from septic multiple organ failure.</p><p><strong>Conclusion: </strong>This study confirms that variables associated with treatment failure after NPWT in PSM are BMI >30 kg/m², diabetes mellitus (DM), and the \"number of sponge changes,\" respectively. However, this does not mean that sponge changes increase the risk; rather, sponge changes are associated with more resistant germs, incomplete wound healing, and more aggressive infection. This implies that management should be in the hands of cardiac surgeons with extensive experience in septic surgery and at centers with expertise in order to minimize the duration of NPWT and thus the number of sponge changes.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"404-409"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145410205","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":"Minimally Invasive Bypass in Obese Patients: Beyond Cosmesis.","authors":"Christos Voucharas, Angeliki Vouchara, Evangelia Tsigkraki","doi":"10.1055/a-2707-0772","DOIUrl":"10.1055/a-2707-0772","url":null,"abstract":"","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"361"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226009","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":"Surgical Aortic Valve Replacement in Patients Above the Guideline-endorsed Age Cut-off: Reasons for Surgery and Clinical Outcomes.","authors":"Johannes Petersen, Harun Sarwari, Till Demal, Oliver Bhadra, Simon Pecha, Hermann Reichenspurner, Andreas Schaefer","doi":"10.1055/a-2724-5108","DOIUrl":"10.1055/a-2724-5108","url":null,"abstract":"<p><strong>Objectives: </strong>The 2017 and 2021 ESC/EACTS guidelines for the management of valvular heart disease recommend transcatheter aortic valve implantation (TAVI) as a treatment option for severe symptomatic aortic valve stenosis (AS) in patients ≥75 years of age. However, surgical aortic valve replacement (SAVR) remains a viable option for elderly patients, particularly in specific anatomical or clinical subsets. The objective of this study was to analyze indications for SAVR and postoperative outcomes in patients ≥75 years of age.</p><p><strong>Methods: </strong>Heart team protocols were reviewed to determine indications for SAVR. The adjudication of acute procedural and early clinical outcomes was conducted in accordance with the standardized VARC-3 definitions. Furthermore, cardiovascular mortality and rate of aortic valve re-intervention were assessed at latest follow-up with a median duration of 5.5 years (1.9-7.1 years).</p><p><strong>Results: </strong>A total of 43 patients ≥75 years of age (51% male) underwent isolated SAVR at our center between 2017 and 2022. STS/EuroSCORE II was 1.7 ± 0.6%/1.7 ± 0.4%. The age distribution of patients was as follows: 75 to 76 years in 32.5% (14/43), 77 to 79 years in 46.5% (20/43), and 80 to 83 years in 21% (9/43) of patients. Indications for SAVR included low operative risk according to STS (1.6 ± 0.3%) and EuroSCORE II (1.4 ± 0.3%) in 51.2% (22/43), unicuspid/bicuspid aortic valve in 21% (9/43), patient preference in 13.9% (6/43), large aortic annulus in 9.3% (4/43), and massive calcification of the left ventricular outflow tract in 4.6% (2/43) of patients. Mean aortic cross clamp and cardiopulmonary bypass times were 67.1 ± 18.2 minutes and 98.6 ± 25.1 minutes. All-cause 30-day mortality was 0% (0/43). Technical success, device success, and early safety were 100% (43/43), 100% (43/43), and 81.4% (35/43). Bleeding complications and the need for permanent pacemaker implantation (PPM) were observed in 9.3% (4/43) and 4.6% (2/43) of patients. Mean ICU and hospital stay were 2.9 ± 2.1 days and 12.5 ± 3.6 days. Post-procedural echocardiography demonstrated absence of paravalvular leakage (PVL) in all but one patient, who exhibited moderate PVL. The mean transvalvular pressure gradient was 11.4 ± 4.5 mmHg. Latest follow-up was at median 5.5 years (1.9-7.1 years). Aortic valve re-intervention at follow-up was 2.3% (1/43) and cardiovascular mortality was 4.6% (2/43).</p><p><strong>Conclusion: </strong>In the current era, SAVR is rarely performed in patients ≥75 years of age. Despite the highly selective nature of the patient cohort studied, the results are excellent, with a 30-day mortality of 0% and a low cardiovascular mortality at 5 years. SAVR should still be considered a valid option in elderly patients, evaluated by a heart team, which considers each patient's unique clinical, anatomic, and procedural characteristics.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"384-389"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318676","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":"Embolisation of Contraceptive Implants to the Pulmonary Arterial System: A Series of Three Cases from a Tertiary Thoracic Surgery Unit.","authors":"Theo Hughes, Leo Gundle, Micayla Pather, Sara Khademi, Sophia Chan, Shuya Chen, Rebecca Weedle, Andrea Bille, Leanne Ashrafian, John Pilling","doi":"10.1055/a-2687-1182","DOIUrl":"10.1055/a-2687-1182","url":null,"abstract":"<p><strong>Abstract: </strong>Contraceptive implants are widely used for long-acting reversible contraception (LARC) due to their high efficacy and convenience. However, complications including migration and, rarely, embolisation to the pulmonary arterial system have been reported. This case series presents three cases of contraceptive implant embolisation to the pulmonary arterial system, managed at a tertiary thoracic surgery unit between 2021 and 2024. Different surgical management was performed in all three cases influenced by factors including: length of time since possible embolisation, implant location, and suspected degree of endothelialisation. The cases highlight challenges in surgical management of embolized contraceptive implants, focusing on arteriotomy and anatomical resection approaches. The importance of prompt diagnosis, multidisciplinary decision-making, and necessity for further research to establish guidelines for the management of embolized contraceptive implants is exemplified. Suppliers should be aware of this rare complication and consider methods to prevent its occurrence.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"410-413"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970124","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":"Totally Thoracoscopic Ablation for Atrial Fibrillation: All-Box Clamping.","authors":"Nicolas Doll, Antonia Doll, Geza Horvath, Gerold Mönnig, Christian Pott, Thorsten Hanke, Taoufik Ouarrak, Jochen Senges, Mahmoud Wehbe","doi":"10.1055/a-2625-9617","DOIUrl":"10.1055/a-2625-9617","url":null,"abstract":"<p><strong>Background: </strong>Epicardial surgical ablation is an effective strategy to treat non-paroxysmal forms of atrial fibrillation. Current thoracoscopic epicardial surgical strategies are complex, and are therefore often avoided. With slight modifications to the thoracoscopic maze procedure, totally thoracoscopic all-box clamping may facilitate the performance of epicardial thoracoscopic ablation, while maintaining good results.</p><p><strong>Methods: </strong>Between December 2023 and December 2024, 42 patients underwent thoracoscopic all-box clamping at a single center. All-box clamping uses commercially available bipolar radiofrequency clamps for isolation of the ipsilateral pulmonary veins and posterior left atrial wall through right and then left-sided thoracoscopic access. The left atrial appendage is occluded using a clip device, and the ligament of Marshall is transected. Assessment of a bidirectional block confirmed electrical isolation. Data from the CASE-AF registry were analyzed retrospectively. Short-term results pertaining to efficacy and safety are provided.</p><p><strong>Results: </strong>All-box clamping was successfully offered to all patients by three surgeons. There were no reported major or minor complications. The median hospital stay was 6 days (interquartile range 5-6). At discharge, a sinus rhythm was observed in 92.9%, and in 76.1% of patients off any class I/III antiarrhythmic drugs.</p><p><strong>Conclusion: </strong>Surgical ablation with a modified thoracoscopic technique is safe and feasible for the treatment of atrial fibrillation.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"390-395"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216945","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":"Long-Term Outcomes of Replica-Based Upsizing for Epic Supra Aortic Bioprosthesis.","authors":"Hristo Kirov, Murat Mukharyamov, Angelique Runkel, Tulio Caldonazo, Torsten Doenst","doi":"10.1055/a-2695-2575","DOIUrl":"10.1055/a-2695-2575","url":null,"abstract":"<p><strong>Background: </strong>Different techniques allow implantation of biological aortic valve prostheses larger than associated with classic annulus sizing. We described a replica-based technique (upsizing) before that utilizes the patient's root anatomy. We here evaluate the safety and efficacy of upsizing compared with standard sizing using the Epic Supra bioprosthesis.</p><p><strong>Methods: </strong>We assessed 958 patients undergoing aortic valve replacement with the Epic Supra bioprosthesis between 2010 and 2023. Upsizing was defined as implantation of a prosthesis larger than the measured annular size without enlarging the annulus. We assessed hemodynamic and standard outcome parameters. Mean follow-up was 44.5 ± 31.2 months. Propensity score matching was used to adjust for baseline differences.</p><p><strong>Results: </strong>Patient anatomy allowed upsizing in 62% of patients. Demographics and outcomes (perioperative mortality, reoperation, bleeding, and pacemaker implantation) were comparable between the matched groups. Immediate postoperative and long-term pressure gradients were consistently and significantly lower in the upsizing groups across all annular sizes (upsizing vs. control: 23 mm; 12.9 ± 8.2 vs. 14.0 ± 5.6 mm Hg, <i>p</i> = 0.029; 25 mm; 10.8 ± 4.0 vs. 13.0 ± 4.4 mm Hg, <i>p</i> < 0.001; 27 mm; 10.8 ± 4.0 vs. 13.0 ± 4.4 mm Hg, <i>p</i> < 0.001). Differences persisted at long-term follow-up but were less pronounced for the 25-mm annular size and greatest in the 27-mm group (8.5 ± 4.5 vs. 12.5 ± 5.5 mm Hg; <i>p</i> < 0.001). Long-term survival was numerically higher in the upsizing groups with statistical significance in annular size 25 mm.</p><p><strong>Conclusion: </strong>Implanting a larger Epic Supra prosthesis than classically recommended (\"upsizing\") is safe and associated with improved immediate- and long-term hemodynamics without increasing pacemaker, perioperative, or long-term mortality risks.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"362-368"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226053","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":"Surgical Repair of Pectus Arcuatum.","authors":"Tunc Lacin, Nezih Onur Ermerak, Haktan Uygar Onen, Aleyna Gultekin Aridas","doi":"10.1055/a-2642-1738","DOIUrl":"10.1055/a-2642-1738","url":null,"abstract":"<p><strong>Background: </strong>Pectus arcuatum, a very rare variant (chondromanubrial) of the carinatum chest wall deformity, occurs due to premature fusion of the sternal ossification centers causing obliteration of the manubrio-sternal joint. Typically, patients undergo surgical repair for cosmetic purposes. This study reviews the clinical experience using titanium plate systems for surgical repair of pectus arcuatum.</p><p><strong>Methods: </strong>The records of our prospective Chest Wall Deformities Clinical Database since September 2018 include 27 pectus arcuatum patients. The patients aged 17 and older were evaluated for corrective surgery (<i>n</i> = 24, 16 male, 8 female, mean age: 24.9 years). The hybrid surgical technique included wedge osteotomy of the most protruded part of the sternum, excision of the associated costochondral junctions followed by placement of two parallel titanium plates to secure the sternum, and insertion of an excavatum bar (<i>n</i> = 7) if there is a significant depression at the sternal body. Follow-up outpatient visits were every 3 to 6 months.</p><p><strong>Results: </strong>All of the patients tolerated the surgery very well. The mean length of the surgery was 118 minutes. The mean hospital length of stay was 5.6 days. One patient experienced pericardial and right pleural effusion 2 weeks after surgery, which was resolved by anti-inflammatory treatment. The mean time to return to daily activity was 12 days. The mean follow-up was 42 months. All patients indicated the postoperative results as very good or excellent.</p><p><strong>Conclusion: </strong>Repair of arcuatum deformity can be performed in adults with low morbidity, short hospital stay, and satisfactory cosmetic results even in complex cases.</p>","PeriodicalId":23057,"journal":{"name":"Thoracic and Cardiovascular Surgeon","volume":" ","pages":"420-429"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144508389","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}