World Journal of Surgery最新文献

{"title":"The Challenges of Predicting Rare Outcomes: A Critical Appraisal of Machine Learning Using the Pediatric Resuscitation and Trauma Outcome (PRESTO) Model in a Tanzanian Injury Registry.","authors":"Joao Vitor Perez de Souza, Elizabeth M Keating, William Nkenguye, Rosalia Njau, Happiness Kajoka, Pollyana Coelho Pessoa Santos, Edwin Joseph Shewiyo, Catherine A Staton, Blandina T Mmbaga, Joao Ricardo Nickenig Vissoci","doi":"10.1002/wjs.70553","DOIUrl":"10.1002/wjs.70553","url":null,"abstract":"<p><strong>Background: </strong>Injuries are responsible for 950,000 deaths per year among children and adolescents under 18 years old. Trauma prediction scores are useful in determining severity and prognosis of injury patients. The pediatric resuscitation and trauma outcome (PRESTO) score was developed as a simple score for short-term mortality prediction in pediatric populations in low- and middle-income countries (LMICs). Using variables available at the bedside in resource-limited settings, PRESTO has been validated in South Africa, Rwanda, and Tanzania. In Tanzania, our team found these variables were present for most pediatric injury patients and that the model performed well in predicting mortality. However, we faced challenges due to small sample size and mortality being a rare outcome.</p><p><strong>Objective: </strong>We sought to determine whether we could improve predictability of the PRESTO model for pediatric patients by increasing sample size through inclusion of adult trauma patients from the same population at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania.</p><p><strong>Design/methods: </strong>Data were collected between November 2020 and February 2024 from a pediatric registry, and between April 2018 and February 2024 from an adult injury registry at KCMC. Missing data were addressed using multiple imputation. The dataset was split into training and testing sets (75/25). Ten machine learning algorithms were trained to predict in-hospital mortality using clinical and demographic variables, with performance evaluated using cross-validation, ROC-AUC, sensitivity, and specificity.</p><p><strong>Results: </strong>A total of 5635 injury patients (911 pediatric and 4724 adults) were included. Pediatric in-hospital mortality was 6.8%, while adult mortality was 4.4%. Pediatric patients presented with worse GCS scores compared to adults (4% severe vs. 1.4% severe). The best-performing models were Random Forest (RF), C5, and Extreme Gradient Boosting (XGB), with ROC-AUCs of 0.92, 0.90, and 0.81. In the test set, ROC-AUC for pediatric patients was lower than for adults, with differences of 0.08, 0.06, and 0.05 for XGB, RF, and C5, respectively.</p><p><strong>Conclusions: </strong>Adding adult data did not improve predictability of the PRESTO model, possibly due to the fact that the lower mortality and injury severity in adults compared to children in our dataset statistically diluted the model. This supports the idea that children should be considered separately, especially for vital signs and mortality prediction. These findings highlight the challenge of predicting a rare outcome, and emphasize the need to increase pediatric registry sample sizes to develop more accurate models for mortality risk stratification in LMICs.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3103-3110"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148888694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing Minimally-Invasive and Open Approaches to Siewert II/III Gastro-Esophageal Junction Adenocarcinoma-A Systematic Review and Network Meta-Analysis.","authors":"Connor J Colson, Matthew G Davey, Noel E Donlon","doi":"10.1002/wjs.70528","DOIUrl":"10.1002/wjs.70528","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of adenocarcinoma of the esophagogastric junction has increased, likely driven by lifestyle factors such as obesity, gastro-esophageal reflux disease, and smoking. However, the long-term outcomes of different curative surgical approaches have yet to be comprehensively evaluated.</p><p><strong>Objectives: </strong>To perform a systematic review and meta-analysis evaluating the surgical approaches to resection of Siewert II/III Adenocarcinoma of the Esophagogastric junction.</p><p><strong>Setting: </strong>Integration of data from upper gastrointestinal surgical units across the world.</p><p><strong>Methods: </strong>A systematic review was performed as per PRISMA guidelines. Statistical analysis was performed with MetaInsight.</p><p><strong>Results: </strong>A total of 16 studies, comprising 4256 patients, were included in the meta-analysis. The findings suggest that robotic surgical approaches demonstrate equipoise to both laparoscopic and open techniques for resection, with comparable overall survival (OS) at both 3 and 5 years (3-year OS: OR 1.17, 95% CI [0.10-14.06]; 5-year OS: OR 0.66, 95% CI [0.39-1.12]). Additionally, a nonsignificant trend toward improved disease-free survival (DFS) was observed for robotic surgery at both 3 and 5 years (OR 1.17, 95% CI [0.10-14.06] for both time points).</p><p><strong>Conclusion: </strong>Laparoscopic approaches to surgical resection have proven to be as effective as open surgery for achieving R0 resection. Based on our meta-analysis results, we can conclude that robotic approaches to resection is equivalent to laparoscopic approaches.</p><p><strong>Prospective register: </strong>International Prospective Register of Systematic Reviews (PROSPERO): CRD42024590940.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3024-3031"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148901077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Subspecialization Matter? Institutional Outcomes Before and After Recruitment of Colorectal Surgeons.","authors":"Daniel C Steinemann","doi":"10.1002/wjs.70544","DOIUrl":"10.1002/wjs.70544","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2782-2783"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148832565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Textbook Outcomes and Survival in Gastric Cancer Surgery: Results of a French-Speaking Multicenter Study.","authors":"Ophélie Bacoeur-Ouzillou, Florian Martinet-Kosinski, Julie Veziant, Gilles Manceau, Jérome Guiramand, Thibault Voron, Johan Gagnière, Caroline Gronnier","doi":"10.1002/wjs.70577","DOIUrl":"10.1002/wjs.70577","url":null,"abstract":"<p><strong>Background: </strong>TO is a composite parameter used to assess surgical care quality. In oncologic gastric surgery, TO includes the following criteria: complete potentially curative resection during operation, no intraoperative complications, resection of at least 15 lymph nodes, absence of severe postoperative complications, no prolonged hospital stay, no reoperation, no postoperative mortality, and achievement of R0 resection. The objective of the study is to investigate the achievement of textbook outcome (TO) and its association with overall survival in patients treated for gastric cancer and to identify factors that contribute to the failure to meet TO criteria.</p><p><strong>Materials and methods: </strong>This multicenter French-speaking center retrospective study, based on data from the French Association of Surgery database, analyzed 2131 patients treated for gastric cancer between 2007 and 2017. Patients who met the TO criteria were compared with those who did not.</p><p><strong>Results: </strong>Among the 958 eligible patients, TO was achieved in 398 (41.5%) patients. TO achievement was significantly associated with improved overall survival (p < 0.01) and disease-free survival (p < 0.01). In the univariate analysis, factors associated with failure to achieve TO included age, body mass index, tumor location and stage, neoadjuvant treatment, and type of gastrectomy. In the multivariate analysis, only BMI > 30 and tumor of the lesser curvature treatment remained significantly associated with failure to achieve TO.</p><p><strong>Conclusion: </strong>TO is associated with improved overall and disease-free survival in patients undergoing surgery for gastric cancer. BMI < 30 and tumor of the lesser curvature were independently associated with a higher rate of TO.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3037-3046"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence for Predicting Length of Stay for General Surgery Patients: A Systematic Review.","authors":"Joshua Blum, Nomiki Glynatsis, Brieanna Hill, James Montgomery, Richard Turner","doi":"10.1002/wjs.70570","DOIUrl":"10.1002/wjs.70570","url":null,"abstract":"<p><strong>Background: </strong>Length of stay (LoS) prediction is vital for optimizing surgical patient flow and resource allocation. Artificial intelligence (AI) and machine learning (ML) models may enhance LoS prediction, yet their validity and clinical utility in General Surgery remain unclear.</p><p><strong>Methods: </strong>Embase, Medline, Scopus, and Web of Science were systematically searched to June 2025. Studies employing AI or ML to predict LoS or discharge timing in adult General Surgery cohorts were included. Data on model development, predictor and target variables, performance, and validation were extracted. Risk of bias was appraised using PROBAST + AI. A checklist was developed to guide future LoS-prediction research.</p><p><strong>Results: </strong>Nine of 4115 screened records met inclusion criteria. Classifier models with low overall risk of bias achieved moderate discrimination (AUROC 0.71-0.83), whereas regression models performed poorly (RMSE 4.6-12.7 days). Methodological weaknesses were frequent, including data leakage, temporally invalid predictors, biased patient selection, limited external validation, and incomplete performance reporting. Important predictors commonly included ASA score, age and operative duration; psychosocial and home-support features were rarely considered. Outcome definitions and intended applications varied substantially, limiting direct comparison of performance. Models predicting discharge within short, dynamically reassessed time horizons may achieve greater accuracy, but offer limited capacity for longer-term bed forecasting. No included study benchmarked ML or AI predictions against usual clinician LoS estimates. Low-bias models were retrospective and generally internally validated, so performance in prospective or external cohorts remains unknown. More complex neural network models did not consistently outperform simpler methods. This review identifies recurring barriers to prospective clinical application for routine real-world use.</p><p><strong>Conclusion: </strong>AI and ML models can moderately predict LoS for General Surgery patients, but generalizability is limited by methodological bias, incomplete reporting, and non-standard outcome definitions. Current models appear more suited to hospital-wide forecasting than bedside decision support. Future development should use prospectively available predictors, clinically meaningful outcomes, transparent performance reporting, and external validation. The proposed framework highlights strategies to avoid common methodological flaws in models published to date.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2906-2916"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Predictive Model for Patient Compliance in Enhanced Recovery After Surgery (ERAS) Programs for Colorectal Surgery.","authors":"Anas Taha, Bushra Mohandes, Michael Drew Honaker, Stephanie Taha-Mehlitz, Shantanu Roy, Vincent Ochs, Otto Kollmar, Robert Rosenberg, Philippe C Cattin","doi":"10.1002/wjs.70580","DOIUrl":"https://doi.org/10.1002/wjs.70580","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) programs optimize perioperative care to reduce surgical stress and improve recovery. Compliance with ERAS pathways is essential for achieving favorable outcomes, yet predictors of adherence remain poorly understood. Using demographic, clinical, and procedural factors, this study aims to develop and validate a predictive model for perioperative compliance within ERAS protocols for colorectal surgery.</p><p><strong>Methods: </strong>A retrospective analysis was performed, including all patients who were managed under the ERAS framework. The compliance model was built based on feature engineering, which involved scaling, polynomial interaction expansion, and Lasso-based variable selection. Three regression algorithms (CatBoost, XGBoost, and histogram-based gradient boosting) were compared using ten-fold cross-validation. Predictive performance was evaluated by root mean squared error (RMSE) and mean absolute error (MAE).</p><p><strong>Results: </strong>Analysis was performed on 1119 patients who had colorectal surgery under ERAS pathways. The average hospital stay was 9.2 days, and the average operating time was 221.5 minutes. The ERAS compliance rate was 78% overall, with minimally invasive procedures having a higher compliance rate (83%) than open surgery (67%). The CatBoost model had the best performance with good precision. The strongest predictors of compliance, according to feature importance analysis, were surgical approach, ASA class, and operative duration. These were followed by BMI, age, and ERAS process measures such as PONV prophylaxis.</p><p><strong>Conclusion: </strong>The newly developed compliance model will enable early identification of patients at risk of low adherence, thus supporting personalized perioperative management and improved recovery outcomes.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carbon Conscious Surgery: Environmental, Economic, and Clinical Outcomes of a Local Anaesthetic Hernia Repair Pathway.","authors":"David A Hamilton, Jad Zaghbour, Jared M Wohlgemut, Emma Clark, Jamie Ferry, Vivienne Gough","doi":"10.1002/wjs.70567","DOIUrl":"10.1002/wjs.70567","url":null,"abstract":"<p><p>Graphical abstract summarising the environmental and economic outcomes of a dedicated local anaesthetic hernia repair pathway, including total patient numbers, estimated carbon savings, and cost savings.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2897-2899"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Evaluating the Impact of Multi-Institutional Care in Early-Stage Hepatocellular Carcinoma: A Nationwide Analysis\".","authors":"","doi":"10.1002/wjs.70564","DOIUrl":"10.1002/wjs.70564","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3150"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extended D3 Mesenterectomy in Small Bowel Cancer Treatment: Feasibility and Importance for Staging. First Results of a Prospective Clinical Trial.","authors":"Erik Kjæstad, Espen Thiis-Evensen, Bjørn Edwin, Arne Olav Bakka, Anne Helene Lilleaas, Yngve Thorsen, Johannes Kurt Schultz","doi":"10.1002/wjs.70550","DOIUrl":"10.1002/wjs.70550","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on surgical techniques in small bowel cancer, particularly regarding the extent of lymph node dissection and strategic choices according to tumor localization and histological type. Clearance of central lymph node metastases can be challenging, especially when small intestinal neuroendocrine tumor (siNET) metastases give rise to fibrosis and desmoplasia around the cranial parts of the superior mesenteric vessels. The aim of this study was to assess the feasibility and staging implications of new techniques of central (D3) lymphadenectomy.</p><p><strong>Material and methods: </strong>The operative techniques in this prospective small bowel cancer cohort entailed central (D3) removal of all mesenteric tissue anterior and posterior to the superior mesenteric vessels up to the root of the mesentery. Preoperative 3D mapping of the vascular anatomy was performed to facilitate personalized surgery. A new resection classification was developed, based on bowel and mesentery involvement.</p><p><strong>Results: </strong>Among the 86 patients included, D3 lymphadenectomy was performed in 74 (86%). Small bowel resection was done in 40 (54%), and ileocecal or ileocolic resection in 34 (46%). There were five (7%) reoperations (two (3%) anastomotic leaks) and no 30-day mortality. At histopathology, 60 siNET (81%), 5 small bowel carcinomas, 3 metastases of other origin, 1 benign lesion, 3 lymphomas, and 2 gastrointestinal stromal tumors (GIST) were diagnosed. Lymph node count of 71 patients (one benign, two lymphomas not counted) showed mesenteric lymph node metastases in 62 (87%) (median lymph node yield 33). Metastases to the D3 volume were found in 31 (44%) (median D3 lymph node yield 13). In the siNET-group, 28/60 (47%) had D3 metastases, suggested in standard preoperative investigations in 12 (43%). Of all positive siNET lymph nodes, 173/509 (34%) were localized in the D3 volume. Upper/middle ileal siNET were D3 positive in 19/29 (66%) versus in 9/31 (29%) of terminal ileal siNET. All patients had mesenterial R0 resections.</p><p><strong>Conclusions: </strong>Central (D3) small bowel mesenterectomy can be performed with radicality and safety. The high proportion of central metastases that would remain in situ after traditional, less extensive (D2) surgery underlines the potential importance of D3 mesenterectomy for accurate staging and locoregional disease control. Subgroup analyses suggested differences in mesenteric dissemination between terminal ileal and more proximal small intestinal tumors.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2996-3007"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preservation Versus Routine Removal: Morbidity and Long-Term Outcomes Following Diagnostic Laparoscopy Versus Negative Appendectomy-A Regional Multicentre Observational Cohort Study.","authors":"Katrine Folmann Finne, Liv Hornnes, Anders Bang-Nielsen, Aya Nihad Abdulrahman Abdulrahman, Talha Malik, Peter Cornelius Helbo Jakobsen, Lars Nannestad Jørgensen, Jakob Kleif, Claus Anders Bertelsen","doi":"10.1002/wjs.70571","DOIUrl":"10.1002/wjs.70571","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend laparoscopic appendectomy (LA) for a macroscopically normal appendix when no pathology is identified during diagnostic laparoscopy (DL) for suspected acute appendicitis (AA). This approach may lead to increased hospitalization, higher costs, and greater morbidity. Whether these guidelines are justified remains debatable.</p><p><strong>Methods: </strong>This retrospective cohort study included all patients aged > 2 years undergoing DL for suspected AA at four Danish University hospitals from March 2017 to April 2021. Patients undergoing LA despite normal intraoperative findings were compared with patients with normal intraoperative findings undergoing DL only. Sensitivity analyses included patients with incidental intraoperative gynecological or histopathological findings not corresponding with the symptoms. The primary outcome was subsequent DL for suspected AA during follow-up, and the main secondary outcomes were complications within 30 days.</p><p><strong>Results: </strong>627 patients underwent DL and 518 underwent LA. Median follow-up was 5.2 years (IQR 4.1-6.1) and 5.7 years (IQR 4.5-6.6), respectively. At a median of 1.7 years (IQR 0.7-3.4), 3.5% (95% CI 2.0-4.9) of the DL group underwent a second DL for suspected AA, with a subsequent 0.96% risk of AA. In the main analyses, no significant differences between the groups were observed for subsequent intra-abdominal surgery, gastrointestinal endoscopy or surgical complications. In sensitivity analyses, surgical complications occurred significantly more frequently after LA (3.7% vs. 1.6% after DL, p = 0.02), mainly driven by a trend toward a higher risk of intra-abdominal bleeding (0.6% vs. 0%, p = 0.056) and intra-abdominal abscess.</p><p><strong>Conclusions: </strong>The risks of both subsequent DL and AA following initial DL are minimal. The risk of increased surgical complications after LA is low, and the clinical relevance is questionable.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2917-2926"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}