World Journal of Gastrointestinal Endoscopy最新文献

{"title":"Endoscopic ultrasound training: Current state, challenges, and the path to proficiency.","authors":"Hanane Delsa, Wafaa Khannoussi, Elsayed Ghoneem, Hussein Hassan Okasha","doi":"10.4253/wjge.v17.i8.107458","DOIUrl":"10.4253/wjge.v17.i8.107458","url":null,"abstract":"<p><p>Endoscopic ultrasound (EUS) is an indispensable tool for the diagnosis and management of various diseases, particularly biliopancreatic disorders, as it provides detailed visualization of the gastrointestinal tract and surrounding structures. As the demand for diagnostic and interventional EUS procedures increases, ensuring high-quality training for endoscopists is essential to improve patient outcomes. This mini-review provides an overview of the current state of EUS training and emphasizes the importance of a structured approach that integrates theoretical knowledge and hands-on experience. We discuss different training methods, focusing on the main courses available worldwide, and highlight their advantages and limitations. In addition, we examine the challenges of training for diagnostic and interventional EUS, such as limited access to training centers and the need for personalized feedback. Overall, improving EUS training programs is essential to enhance physician skills and ensure this advanced technique is used safely and efficiently in clinical practice.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"107458"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic treatment modalities for colonic diverticular bleeding: A systematic review with direct and network meta-analyses.","authors":"Zahid Ijaz Tarar, Mustafa Gandhi, Faisal Inayat, Umer Farooq, Baltej Singh, Ahtshamullah Chaudhry, Aun Muhammad, Ahmad Zain, Faisal Kamal","doi":"10.4253/wjge.v17.i8.109313","DOIUrl":"10.4253/wjge.v17.i8.109313","url":null,"abstract":"<p><strong>Background: </strong>Colonic diverticular bleeding (CDB) is a leading cause of lower gastrointestinal hemorrhage that has a high risk of recurrence. The endoscopic clipping and endoscopic band ligation (EBL) methods are widely used for hemostasis in patients with CDB. Endoscopic detachable snare ligation (EDSL) has also become an increasingly common treatment option. The data remain inconsistent regarding the comparative efficacy of these endoscopic therapies in achieving initial hemostasis and reduction of early and late rebleeding rates.</p><p><strong>Aim: </strong>To study the effectiveness and complications of endoscopic clipping, EBL, and EDSL for CDB.</p><p><strong>Methods: </strong>We conducted a systematic search of PubMed/MEDLINE, Scopus, Web of Science, Embase, Google Scholar, and the Cochrane database for clinical trials to find studies that reported CDB and endoscopic clipping, EBL, or EDSL as treatment methods. The pooled estimates of initial hemostasis, early and late rebleeding, and the need for transarterial embolization or surgery between these groups were calculated.</p><p><strong>Results: </strong>We analyzed 28 studies with 5224 patients. Of these, 4526 had active CDB and required one of the three endoscopic interventions. The pooled prevalence of early rebleeding was 23.5%, 10.7%, and 10.6% in the endoscopic clipping, EBL, and EDSL groups, respectively. Patients who underwent endoscopic clipping had a significantly higher rate of early rebleeding compared to those who received EBL [odds ratio (OR) = 3.76 (95%CI: 2.13-6.63)] and EDSL (OR = 3.30, 95%CI: 1.28-8.53). There was no difference in the initial hemostasis between the three groups. The pooled prevalence of late rebleeding was 27.2% in the clipping, followed by 13.8% in the EBL and 2.7% in the EDSL group. Compared to 2.6% in the EBL group, 4.0% of patients who received endoscopic clipping subsequently underwent surgery or transarterial embolization. These results were consistent in the network meta-analysis. Based on the ranking of the indirect comparison of modalities, the snare technique was better at achieving initial hemostasis and had a lower late rebleeding rate.</p><p><strong>Conclusion: </strong>The findings of this direct and indirect pairwise comparison suggest that EDSL is superior to endoscopic clipping and EBL in achieving initial hemostasis and lowering the rate of late rebleeding in patients with CDB.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"109313"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative endoscopic alternatives for the conservative management of recurrent/refractory esophageal strictures in children: A case series.","authors":"Chiara Imondi, Maria Elisabetta Bartoli, Filippo Torroni, Simona Faraci, Tamara Caldaro, Paola De Angelis, Valerio Balassone","doi":"10.4253/wjge.v17.i8.104238","DOIUrl":"10.4253/wjge.v17.i8.104238","url":null,"abstract":"<p><strong>Background: </strong>Refractory esophageal strictures (ES) are defined an anatomical restriction without an active endoscopic inflammation resulting in dysphagia after a minimum of five seriated dilatations in a 4-weeks interval. Recurrent ES (REES) refer to the inability to maintain a satisfactory luminal diameter for four weeks once an age-appropriate feeding diameter was achieved. Seriated endoscopic dilations are the reference maintenance for ES in pediatric age. Iterative dilations increase the risk of complications and may cause significant organic and psychological consequences in children and excessive costs for families and health systems. Furthermore, fibrotic modifications can make the surgery even more challenging. The surgical approach is burdened by high morbidity, with prolonged hospitalization and delayed oral refeeding in fragile patients with comorbidities.</p><p><strong>Aim: </strong>To evaluate the efficacy and safety of the most recent adjuvant treatments, with the aim of avoiding or, at least, postponing surgery.</p><p><strong>Methods: </strong>Intralesional steroids or mitomycin C injections with antiproliferative and anti-fibroblastic properties have been attempted, but have been abandoned because of systemic adsorption, local complications, or lack of efficacy. Self-expanding metal stents are generally designed for the palliation of neoplastic strictures in adults and rarely employed in pediatrics because of the high risk of complications, in terms of stent migration, local pain and perforation. Our group developed a customized dynamic esophageal stent to stabilize esophageal patency and promote continuous dilatation determined by the food passage between the stent and the REES wall, but it requires an appropriate diameter for placement.</p><p><strong>Results: </strong>Recently peroral endoscopic tunneling for restoration of the esophagus has been employed to treat esophageal obstructions exploiting the submucosal space. Re-absorbable self-expanding stents (like SX-ELLA Stent Esophageal Degradable BD-BD stent) and energy-delivering surgical devices (HARMONIC ACE^™ + 7 Laparoscope) have also been proposed.</p><p><strong>Conclusion: </strong>After an overview about the historically applied adjuvant therapies, we aim to update the common knowledge with our recent experience of these new minimally invasive options for pediatric REES and refractory ES in three exemplary cases, focusing on their mid-term effectiveness and safety for the purpose of maintain the patency after standard endoscopic dilations and avoiding or, at least, postponing an invasive replacement surgery.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"104238"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detachable over-the-scope clip for colon defects in the trans intestinal natural orifice transluminal endoscopic cholecystolithotomy: A case report.","authors":"Pei Li, Rong-Rong Ding, Jiang Liu, Ming-Qing Zhang, Yan Liu","doi":"10.4253/wjge.v17.i8.109399","DOIUrl":"10.4253/wjge.v17.i8.109399","url":null,"abstract":"<p><strong>Background: </strong>Secure transluminal closure remains a fundamental barrier to endoscopic surgery. It has been reported that through-the-scope clips were used to secure the incision of the gallbladder during natural orifice transluminal endoscopic cholecystolithotomy and were left in the body post-operation. The over-the-scope clip (OTSC) is favored for its rapid deployment and strong anchoring capabilities. Nevertheless, OTSCs are difficult to remove once implanted. The Senscure Biotechnology in China has developed a detachable over-the-scope clip (D-OTSC) for this purpose. Here, we utilized the D-OTSC to successfully close a full-thickness sigmoid defect exceeding 1 cm in diameter. Subsequently, the clip was completely removed postoperatively, yielding favorable clinical outcomes.</p><p><strong>Case summary: </strong>We present the case of a 51-year-old female patient who underwent natural orifice transluminal endoscopic cholecystolithotomy. The sigmoid incision was closed using a D-OTSC. Postoperative recovery was uneventful, with no abdominal infection or bleeding. The D-OTSC was subsequently removed <i>via</i> enteroscopy in the outpatient department one month later.</p><p><strong>Conclusion: </strong>The utilization of D-OTSC presents a viable option for closing colonic mucosal incisions ranging from 1 cm to 2 cm.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"109399"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removal of gastrointestinal foreign body.","authors":"Dusan Dj Popovic","doi":"10.4253/wjge.v17.i8.110863","DOIUrl":"10.4253/wjge.v17.i8.110863","url":null,"abstract":"<p><p>The minireview titled \"Modern endoscopist's toolbox: Innovations in foreign body removal\" by Shahid and published in the <i>World Journal of Gastrointestinal Endoscopy</i> provided a clear and comprehensive overview of endoscopic management of gastrointestinal foreign bodies. It will serve as a valuable resource for endoscopists involved in the diagnosis and treatment of such cases. Several key and controversial aspects of patient management were highlighted in a meaningful way, including the importance of thorough medical history-taking, appropriate use of radiological imaging, and the selection of suitable endoscopic extraction techniques. An individualized, multidisciplinary approach is essential for diagnosis and treatment. While current guidelines offer significant support, they cannot replace the judgment of an experienced endoscopist working with a well-trained team.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"110863"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motorized spiral enteroscopy assisted endoscopic retrograde cholangiography in patients with Roux-en-Y-anatomy.","authors":"Simon Nennstiel, Ron Fried, Alexander Herner, Christoph Schlag","doi":"10.4253/wjge.v17.i8.102787","DOIUrl":"10.4253/wjge.v17.i8.102787","url":null,"abstract":"<p><strong>Background: </strong>In postsurgical upper gastrointestinal anatomy, motorized spiral enteroscopy (MSE) assisted endoscopic retrograde cholangiopancreaticography (ERCP) was shown feasible and has the advantage that standard ERCP instruments can be used. Therefore, MSE-ERCP appears to be the optimal solution for postsurgical patients, especially with Roux-en-Y anatomy.</p><p><strong>Aim: </strong>To show feasibility and safety of MSE-ERCP in patients with Roux-en-Y anatomy.</p><p><strong>Methods: </strong>We retrospectively analyzed all consecutive MSE-ERCP procedures in patients with Roux-en-Y anatomy between September 2021 and May 2023 in an endoscopic tertiary referral center.</p><p><strong>Results: </strong>We identified 26 MSE-ERCPs: (1) 18 MSE-ERCPs in 13 patients with Roux-en-Y anatomy after liver transplantation (<i>n</i> = 11) or gastrectomy (<i>n</i> = 2); and (2) Another 8 MSE-ERCP interventions in 5 patients with very long Roux-en-Y situation after gastric bypass. Overall success of reaching the biliary entry was 88% and further interventions were successful in 83% of patients. In very long alimentary limb situations, success of reaching the biliary entry was not-significantly lower compared to \"standard\" Roux-en-Y (75% <i>vs</i> 94%, <i>P</i> = 0.215). ERCP-interventions were not-significantly less successful in patients with native papilla compared to hepaticojejunostomy (63% <i>vs</i> 93%, <i>P</i> = 0.103). Mean intervention time was 105 minutes. Intervention times were longer in very long limb situations (133 minutes <i>vs</i> 91 minutes; <i>P</i> = 0.032). Overall, we observed three adverse events (<i>n</i> = 1 caused by enteroscopy, <i>n</i> = 1 caused by the biliary intervention, <i>n</i> = 1 unrelated to the procedure). In 15/26 cases (58%) MSE-ERCP was carried out on an outpatient basis.</p><p><strong>Conclusion: </strong>MSE-ERCP has been a promising technique for patients with Roux-en-Y reconstruction requiring biliary interventions. However, MSE was recently withdrawn from the market due to severe safety concerns, which were not observed in this study.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"102787"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive approaches to obesity: Evaluating the efficacy and safety of endoscopic gastroplasty.","authors":"Yue-Zhan Shan, Yu Qin, Hong-Yang Liu, Yuan-Hang Zhou, Qun Cao, Yan Jiao","doi":"10.4253/wjge.v17.i8.110335","DOIUrl":"10.4253/wjge.v17.i8.110335","url":null,"abstract":"<p><p>Obesity is a major global health issue, contributing to numerous comorbidities such as type 2 diabetes mellitus, hypertension, and cardiovascular diseases. While bariatric surgery remains the gold standard for treating severe obesity, its invasive nature has led to the development of minimally invasive alternatives. Endoscopic sleeve gastroplasty (ESG) is a promising, minimally invasive procedure for weight loss, offering significant weight reduction without the need for surgical incisions. This editorial evaluates the efficacy and safety of ESG, highlighting its weight loss outcomes, safety profile, and comparison with other bariatric procedures, including intragastric balloon, laparoscopic sleeve gastrectomy, and robotic sleeve gastrectomy. ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03% to 17.51% at 12 months and sustained weight reduction over 36 months. The safety profile is favorable, with low rates of serious adverse events and minimal complications compared to surgical alternatives. ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options. However, further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"110335"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362559/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combining techniques and technologies increases adenoma detection rates in colonoscopy: More is more.","authors":"Ioannis Stasinos, Theodoros A Voulgaris, Theodoros Alexopoulos, Georgios P Karamanolis","doi":"10.4253/wjge.v17.i8.107734","DOIUrl":"10.4253/wjge.v17.i8.107734","url":null,"abstract":"<p><p>Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer (CRC) incidence. Nevertheless, it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists. Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate (ADR), which is the most important quality indicator for colonoscopy. Increasing ADR unquestionably decreases carcinoma miss rate. Simple measures to improve ADR include among others slower withdrawal time and position change. The introduction of optical imaging innovations has improved mucosal visualization. Moreover, auxiliary devices attached to the colonoscope tip have been introduced, aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots, thereby increasing ADR. Digital image analysis using artificial intelligence is the latest approach to polyp detection. All of the above approaches have been separately evaluated concerning their effect in ADR; however, it has not been thoroughly investigated whether any benefit exists from their combined use. We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"107734"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in multibending endoscope: A paradigm shift in minimally invasive diagnostics and therapeutics.","authors":"Xiang Song, Tao Mao, Xiao-Kai Chen, Lin-Lin Ren","doi":"10.4253/wjge.v17.i8.106087","DOIUrl":"10.4253/wjge.v17.i8.106087","url":null,"abstract":"<p><p>Digestive endoscopy has been widely used in the diagnosis and treatment of digestive diseases. However, the anatomical complexity of specific lesions increases the difficulty of these operations, resulting in complications or treatment failure. Although various strategies, such as floss traction and the application of transparent caps, have been explored, their effectiveness remains limited due to individual differences in patients' anatomical characteristics. The multibending (MB) endoscope represents a significant innovation as it is a conventional endoscope with an additional bending section and dual channels. Currently, this technology has been applied in gastroscopy, duodenoscopy and peroral cholangioscopy. The bending part of the endoscope facilitates its passage into difficult-to-reach anatomical regions and improves operating angles, thereby enhancing surgical precision and efficiency while reducing complication rates. Furthermore, the dual-channel design accelerates procedural workflows and increases operational versatility. This innovation is poised to transform endoscopic diagnosis and treatment of digestive system diseases. Since the MB endoscope is relatively new, further research is needed to comprehensively explore its benefits for and potential in endoscopic diagnosis and treatment. The aim of this review is to summarize the current research, indications, and future directions of MB endoscope.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"106087"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Malignant gastric outlet obstruction: The emerging role of endoscopic ultrasound-guided gastroenterostomy.","authors":"Filippo Antonini, Giacomo Emanuele Maria Rizzo, Lorenzo Fuccio, Ilaria Tarantino","doi":"10.4253/wjge.v17.i8.110301","DOIUrl":"10.4253/wjge.v17.i8.110301","url":null,"abstract":"<p><p>Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) is emerging as a preferred approach for managing malignant gastric outlet obstruction. This technique offers a balance between the durability of surgical gastrojejunostomy (SGJ) and the minimally invasive nature of endoscopic methods. Compared to enteral stenting, EUS-GE shows superior outcomes, including higher long-term patency, lower symptom recurrence, and fewer reinterventions. It also demonstrates comparable or better efficacy than SGJ, with faster oral intake, shorter hospital stays, and reduced complications. However, EUS-GE requires specialized expertise, and long-term outcome data remain limited, so further research is needed to refine protocols and optimize patient selection.</p>","PeriodicalId":23953,"journal":{"name":"World Journal of Gastrointestinal Endoscopy","volume":"17 8","pages":"110301"},"PeriodicalIF":1.8,"publicationDate":"2025-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12362568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144971817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}