World Journal of Surgery最新文献

{"title":"Transforming Surgical Training: The Evolution of the COSECSA eLogbook Through a Theory of Change Framework.","authors":"Lawa Shaban, Lucia Brocato, Eric O'Flynn, Abebe Bekele, Eric Borgstein, Laston Chikoya, Amani Pascal Uiso, James Geraghty, Juan Carlos Puyana","doi":"10.1002/wjs.70573","DOIUrl":"10.1002/wjs.70573","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical training logbooks are vital for tracking trainee experience and training quality. As the College of Surgeons of East, Central and Southern Africa (COSECSA) expanded across 24 countries, its paper-based system outgrew the capacity of paper logbooks. In partnership with the Royal College of Surgeons in Ireland, COSECSA developed an electronic logbook (eLogbook) to enhance data collection, trainee monitoring, and quality assessment. This study reviews its evolution using a theory of change framework to inform future surgical training needs in sub-Saharan Africa and beyond.</p><p><strong>Methods: </strong>We applied a retrospective theory of change (ToC) framework to analyze the development, implementation, and impact of the COSECSA eLogbook. Data sources included archived project records, eLogbook data, and published articles utilizing logbook data. Descriptive summaries were generated to analyze the logged surgical procedures.</p><p><strong>Results: </strong>Phased rollout began in 2015 with full adoption in 2017. By the end of 2025, 1806 trainees had logged 712,118 procedures. The eLogbook facilitated training standardization across multiple countries and improved monitoring. Studies utilizing logbook data have identified disparities in procedural exposure, training gaps, and speciality-specific challenges. The logbook also supported quality assurance and program improvement.</p><p><strong>Discussion: </strong>Key challenges include limited internet access, necessitating offline functionality, and initial resistance to digital adoption mitigated through training and iterative refinements. Lessons from COSECSA informed the development of a similar logbook for the College of Anesthesiologists in East, Central, and Southern Africa (CANECSA).</p><p><strong>Conclusion: </strong>The COSECSA eLogbook has revolutionized surgical training documentation, enabling data-driven evaluation and standardization across programs. It showcases how digital tools and long-term international collaboration can strengthen surgical education in low-resource settings.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2937-2945"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002431","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":"Serum Beta-Hydroxybutyrate as a Biomarker for Predicting Major Adverse Cardiovascular Events After Type a Aortic Dissection Surgery.","authors":"Jian Zhou, Liuyan Xu, Taoran Yang, Menglin He, Rurong Wang, Bowen Ke, Xuehan Li","doi":"10.1002/wjs.70520","DOIUrl":"10.1002/wjs.70520","url":null,"abstract":"<p><strong>Background: </strong>Acute type A aortic dissection (ATAAD) is a life-threatening cardiovascular emergency, and major adverse cardiovascular events (MACE) are common postoperative complications. However, reliable biomarkers for predicting MACE remain lacking. This study evaluated the prognostic value of serum beta-hydroxybutyrate (β-OHB) in predicting MACE after ATAAD surgery.</p><p><strong>Methods: </strong>A retrospective observational study analyzed 728 surgically treated ATAAD patients from West China Hospital (2020-2024). Patients were stratified by preoperative β-OHB levels. The primary endpoint was in-hospital MACE (all-cause mortality, myocardial infarction, heart failure, repeat surgery, or stroke); secondary endpoints included 30-day mortality and ICU/hospital stay duration.</p><p><strong>Results: </strong>Elevated β-OHB levels independently predicted higher MACE risk (adjusted OR: 8.314, 95% CI: 4.149-16.659, p < 0.001) and 30-day mortality (adjusted HR: 2.316, 95% CI: 1.522-3.524, p < 0.001). ROC analysis showed β-OHB (AUC: 0.781) was not inferior to conventional biomarkers (BNP, D-dimer) in predicting the occurrence of MACE. High β-OHB (≥ 0.30 mmol/L) correlated with increased MACE incidence (5.2% vs. 9.0% vs. 31.9%, p < 0.001) and lower 30-day survival (100% vs. 96.2% vs. 89.0%, log-rank p < 0.001) when patients were divided into three groups based on serum β-OHB levels: low β-OHB group (< 0.15 mmol/L, n = 287), intermediate β-OHB group (0.15-0.30 mmol/L, n = 212), and high β-OHB group (≥ 0.30 mmol/L, n = 229).</p><p><strong>Conclusions: </strong>β-OHB is a novel metabolic biomarker for postoperative risk stratification in ATAAD, with potential clinical utility in guiding decision-making.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2828-2837"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760436","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":"The Aging Shock Index in Colorectal Cancer Surgery: Unresolved Questions on Exposure-Outcome Overlap, Component Redundancy, and Mediation by Molecular Residual Disease.","authors":"Imen Ben Ismail, Mariem Marzouki","doi":"10.1002/wjs.70527","DOIUrl":"10.1002/wjs.70527","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3140-3141"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148798570","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":"Tried and True: The Supraclavicular Approach to Management of Thoracic Outlet Syndrome.","authors":"Brooks V Udelsman","doi":"10.1002/wjs.70568","DOIUrl":"10.1002/wjs.70568","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2780-2781"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012560","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":"Witzel Versus Stamm-Like Technique in Laparoscopic Feeding Jejunostomy: A Comparative Analysis of Complications.","authors":"L N Miraglia, F Saba Zotto, F Badaloni, D Solinas, M G Ramírez, A Nieponice","doi":"10.1002/wjs.70556","DOIUrl":"10.1002/wjs.70556","url":null,"abstract":"<p><strong>Background: </strong>Feeding jejunostomy (FJ) is a key procedure to ensure proper nutrition in complex gastrointestinal surgeries and upper gastrointestinal (GI) obstruction. Over time, many techniques have been employed. In our unit, the preferred technique was Stamm's. Following an observed increase in jejunostomy-related complications, a Witzel-type approach was adopted. The aim of this article is to compare jejunostomy-related complications between both techniques.</p><p><strong>Methods: </strong>This retrospective study includes all laparoscopic feeding jejunostomies performed from January 2023 until October 2025. Patients were divided into two groups according to the technique that was used for the laparoscopic jejunostomy. Variables registered were demographics and complications related specifically to jejunostomy at 30-day follow-up.</p><p><strong>Results: </strong>There were a total of 96 patients, 40 performed using Stamm's technique and 56 with Witzel's. In the Stamm-like group, 8 patients (20%) developed adverse events related to the jejunostomy. In the Witzel group, 2 patients had a jejunostomy related complication (3.6%) (p = 0.009).</p><p><strong>Conclusions: </strong>Even when part of a more complex procedure, feeding jejunostomy should not be overlooked. Patients' nutritional support often depends on it. When adverse events occur, they may prolong hospitalization and delay oncological treatment. In our cohort, Witzel's technique presented significantly fewer complications.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2900-2905"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978144","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":"Anticipated Resection Ratio (ARR) Based Flap Selection for Volume-Replacement Oncoplastic Breast-Conserving Surgery: 130 Breast Cancer Patients Cohort From a South Asian Tertiary Cancer Center.","authors":"Ashutosh Mishra, Gajendra Pandit, Anik Rathee, Ekta Dhamija, Ajay Gogia, Amit Kumar, Atul Batra, Jyoutishman Saikia, Sachidanand J Bharati, Babul Bansal, Surendra Saini, Sandeep Mathur, Sunil Kumar","doi":"10.1002/wjs.70569","DOIUrl":"10.1002/wjs.70569","url":null,"abstract":"<p><strong>Background: </strong>Volume-replacement oncoplastic breast-conserving surgery (VR-OBCS) reconstructs the lumpectomy cavity with autologous tissue and spares the contralateral breast. Chest-wall perforator flaps (CWPFs)-lateral, anterior, and medial intercostal artery perforator (LICAP, AICAP, MICAP) flaps-together with a pedicled latissimus dorsi (LD) flap form the usual toolkit, but most programs depend on hand-held color Doppler for perforator mapping and indocyanine-green (ICG) angiography for perfusion assessment, neither of which is widely available in resource-limited oncology units. We evaluated whether a structured radiological assessment using ARR, BEV, and aORV could facilitate preoperative planning for volume replacement oncoplastic breast-conserving surgery (VR-OBCS).</p><p><strong>Methods: </strong>Consecutive women undergoing VR-OBCS at an Indian tertiary cancer center (January 2023-March 2025) were reviewed retrospectively. Eligibility required an anticipated resection ratio (ARR) ≥ 0.15 or expected poor cosmesis after standard BCS; an ARR of 0.20-0.40 was the usual planning range for perforator-based volume replacement. Flap choice followed a quadrant-based map; the pedicled LD flap was reserved for defined indications. Perforator zones were identified by intercostal-space counting; color Doppler and ICG were never used. The primary endpoint was primary R0 resection (SSO-ASTRO 2014 \"no ink on tumor\"); secondary endpoints included flap loss, Clavien-Dindo morbidity, oncological events, and 12-month BREAST-Q satisfaction.</p><p><strong>Results: </strong>One hundred thirty women (mean age 47.7 ± 5.5 years) were treated: LICAP in 68 (52.3%), MICAP in 29 (22.3%), AICAP in 21 (16.2%), and pedicled LD in 12 (9.2%); 42.3% received neoadjuvant chemotherapy. Primary R0 was 95.4%, with all six margin-positive women achieving R0 at re-excision (final R0 100%). No total or partial flap loss occurred. Thirty-day morbidity was 25.4% (maximum Clavien-Dindo IIIa) and late morbidity 16.9%. At a median follow-up of 15.9 months (IQR 12.3-22.6), no locoregional or distant recurrence and no disease-related death were recorded. The median BREAST-Q Satisfaction-with-Breasts score was 86 (IQR 78-92); none preferred mastectomy.</p><p><strong>Conclusions: </strong>Simple preoperative calculation of BEV, aORV, and ARR can guide selection between standard or type I oncoplastic BCS, perforator-flap volume replacement, and muscle-based reconstruction. This approach achieved reliable margin clearance, preserved flap viability, and high patient satisfaction without Doppler or ICG, making it a practical planning tool for resource-limited centers.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2796-2808"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978183","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":"Comment on: \"Comparative Study of Myocutaneous Latissimus Dorsi Flap Breast Reconstruction With Implant Versus Lipofilling: Complication Rates and Risk Factors\".","authors":"Fabio Santanelli di Pompeo, Theodor Mareş, Michail Sorotos","doi":"10.1002/wjs.70578","DOIUrl":"10.1002/wjs.70578","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3146-3147"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149008908","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":"Lesion Diameter Versus Inflammatory Biomarkers and Clinical Severity in Predicting Treatment Selection in Idiopathic Granulomatous Mastitis.","authors":"Muhammet Fatih Keyif, Sabahattin Destek","doi":"10.1002/wjs.70554","DOIUrl":"10.1002/wjs.70554","url":null,"abstract":"<p><strong>Background: </strong>Idiopathic granulomatous mastitis (IGM) is a rare chronic inflammatory breast disease with no established predictor to guide medical versus surgical treatment. Neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) have been proposed, but prior reports rarely adjusted for lesion morphology or other markers of disease severity. We evaluated whether NLR, CRP, lesion diameter and clinical severity variables independently predict treatment selection in IGM.</p><p><strong>Methods: </strong>Single-center retrospective cohort of 71 women with biopsy-proven IGM (2015-2019). An age-matched control group (n = 42) was selected from 74 healthy women. Pretreatment leukocyte, NLR, CRP and ultrasonographic lesion diameter were analyzed together with clinical severity variables (fistula/ulcer, multi-quadrant involvement and axillary lymphadenopathy). Primary outcome was treatment modality (any surgery vs. medical only). Univariable and multivariable logistic regression were performed with an a priori biomarker-focused model and an extended model incorporating severity variables. Sensitivity analyses assessed drainage-only and excisional-only subgroups. ROC analysis used bootstrap confidence intervals with pairwise DeLong tests.</p><p><strong>Results: </strong>Surgical treatment was performed in 38 patients (53.5%; 30 drainage, 8 excisional); 33 (46.5%) received medical treatment only. After age matching, leukocyte, NLR and CRP were higher in patients than controls (all p < 0.001; large effect sizes). On univariable analysis, only lesion diameter predicted surgical treatment (OR 1.21 per mm; p < 0.001). In the biomarker-focused multivariable model, only lesion diameter remained independent (aOR 1.23; 95% CI 1.11-1.36; p < 0.001). In the extended model, lesion diameter retained independence (aOR 1.25; 95% CI 1.13-1.40; p < 0.001), whereas severity variables and biomarkers did not contribute; axillary lymphadenopathy showed an inverse association (aOR 0.08; p = 0.046), likely reflecting confounding with lesion size. Sensitivity analyses confirmed the predictive value of lesion diameter. Lesion diameter discriminated treatment selection with high accuracy (AUC 0.914; 22 mm cut-off: sensitivity 92.1%, specificity 84.8%); the extended model did not improve on this (AUC 0.918; ΔAUC +0.004; DeLong p = 0.89).</p><p><strong>Conclusion: </strong>Inflammatory biomarkers and standard severity variables did not add independent predictive value beyond ultrasonographic lesion diameter for the medical-versus-surgical decision in IGM. NLR and CRP nonetheless correlated with lesion burden and may retain a role as markers of inflammatory activity rather than as independent selectors of treatment. These findings should be interpreted as predictors of treatment selection under the studied decision-making pattern rather than as intrinsic markers of disease severity.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2817-2827"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866899","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":"Explosive Weapons Trauma Care Collective (EXTRACCT) Blast Injury Clinical Practice Guideline: Traumatic Brain Injury From Blast and Penetrating Mechanisms in Settings With Variable Resource Availability.","authors":"Andres M Rubiano, Laura M Loaiza-Cardona, Ali Msheik, Andrés Salazar Restrepo, Santiago Cardona-Collazos, Andrii Sirko, Ruben Peralta","doi":"10.1002/wjs.70522","DOIUrl":"10.1002/wjs.70522","url":null,"abstract":"<p><strong>Introduction: </strong>Blast- and penetrating-mechanism traumatic brain injury (TBI) is increasingly prevalent in settings affected by conflict and explosive violence, including among local casualties in environments where neurosurgical infrastructure, advanced imaging, and critical care resources may be limited or absent. No protocols or guidelines comprehensively address the full spectrum of TBI from blast and penetrating mechanisms across variable resource levels.</p><p><strong>Methods: </strong>The Explosive Weapons Trauma Care Collective (EXTRACCT) conducted a targeted narrative literature review across key clinical domains, including initial assessment, hemodynamic and airway management, medical treatment of intracranial hypertension, noninvasive neuromonitoring, surgical decision-making, and interfacility transport. Searches were performed in PubMed and supplemented by military, penetrating and trauma system clinical practice guidelines (Joint Trauma System, Brain Trauma Foundation, TCCC). Evidence was synthesized by a multidisciplinary authorship team and consensus was achieved through iterative expert review, following the AGREE II framework.</p><p><strong>Results: </strong>This document provides stratified recommendations across variable resource contexts. Key recommendations include: early physiological stabilization with avoidance of hypotension and hypoxia; structured neurological assessment using postresuscitation GCS and pupillometry; noncontrast head CT as the primary imaging modality, with CT angiography for penetrating TBI and high-risk blunt mechanisms; hyperosmolar therapy as first-line treatment for intracranial hypertension; evidence-based sedation, analgesia, and neuromuscular blockade protocols; noninvasive multimodal neuromonitoring when invasive ICP monitoring is unavailable; surgical thresholds for decompressive craniectomy and craniotomy; and standardized transport protocols to minimize secondary brain injury during interfacility transfer.</p><p><strong>Conclusions: </strong>This document addresses a critical gap in context-appropriate blast-TBI management for settings with variable resource availability. Strict control of basic physiological parameters, structured clinical decision-making, and early transfer to neurosurgical care remain the primary determinants of outcome in resource-limited environments.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"3074-3091"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866837","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":"Video-Assisted Versus Conventional Surgical Informed Consent in Visceral Surgery-A Cluster Quasi-Randomized Clinical Trial.","authors":"Svenja G P D Leicht, Leon Schuetze, Johan F Lock, Christoph-Thomas Germer, Johanna C Wagner","doi":"10.1002/wjs.70561","DOIUrl":"10.1002/wjs.70561","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive informed consent is a core surgical responsibility but is increasingly challenged by rising patient volumes and limited personnel resources. Digital solutions in healthcare offer opportunities to optimize patient education. Video-assisted informed consent may reduce time expenditure without compromising informational quality. The objective was to compare video-assisted with conventional informed consent regarding duration, patient understanding, patient, and physician satisfaction.</p><p><strong>Methods: </strong>In this prospective, cluster quasi-randomized clinical trial at the University Hospital Wuerzburg, Germany (September 2023-March 2025), 153 of 330 screened patients scheduled for elective cholecystectomy or colon resection were enrolled. The intervention group received a video developed by medudoc education GmbH, while the control group received physician-led informed consent according to the hospital's standard. Consultation duration was recorded using a stopwatch. Patients completed questionnaires on satisfaction and understanding immediately after consent and postoperatively, physicians rated satisfaction at study completion. The primary outcome was time reduction for the physician consultation time. Secondary outcomes included patient understanding, patient satisfaction, physician satisfaction, and postoperative pain.</p><p><strong>Results: </strong>Of 153 participants, 84 (55%) received video-assisted and 69 (45%) conventional consent. Median physician consultation time was significantly reduced with video assistance for cholecystectomy (1.5 vs. 8.1 min) and colon resection (3.3 vs. 11.9 min). Patient understanding, satisfaction, and postoperative pain outcomes were high in both groups. Physician satisfaction with the video-assisted process was consistently high.</p><p><strong>Conclusions: </strong>Video-assisted surgical informed consent serves as a valuable adjunct in preoperative patient education and represents a promising approach to digital innovation in clinical practice.</p><p><strong>Trial registration: </strong>ISRCTN registry ISRCTN26680260 (https://www.isrctn.com/search?q=ISRCTN26680260).</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":"2866-2876"},"PeriodicalIF":2.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897594","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}