Khirurgiya最新文献

{"title":"[The role of early predictors in diagnosis of stapler suture and anastomotic failure in bariatric patients].","authors":"A G Khitaryan, A V Mezhunts, O V Voronova, M Yu Shtilman, A A Orekhov, D A Melnikov, O S Pen, D Yu Pukovsky","doi":"10.17116/hirurgia202503176","DOIUrl":"10.17116/hirurgia202503176","url":null,"abstract":"<p><strong>Objective: </strong>To study the role of early predictors in diagnosis of stapler suture and anastomotic failure in bariatric patients and to determine the indications for redo laparoscopy.</p><p><strong>Material and methods: </strong>A single-center retrospective study enrolled 2011 patients who underwent surgery. All patients were categorized into two groups: group 1 (1983 patients) - standard postoperative period; group 2 (28 patients) - major inflammatory complications with redo laparoscopy.</p><p><strong>Results: </strong>We found no significant differences in BMI, weight and age between patients with and without complications. Conversely, high serum glucose, duration of type 2 DM over 5 years, tachycardia > 100 bpm and high VAS score of abdominal pain significantly increased the risk of complications. Contrast-enhanced CT of the abdomen has the greatest informative value. To ascertain critical value of each factor for between-group differentiation, we performed ROC analysis and demonstrated specificity of these indicators.</p><p><strong>Conclusion: </strong>The challenge of early diagnosis of intra-abdominal inflammatory complications in bariatric patients is compounded by no typical symptoms and small informative value of laboratory and instrumental diagnostic methods. According to ROC analysis, combination of fever, hypotension, tachycardia and tachypnoea resulted AUC 0.80. Sensitivity 65% and specificity 82% indicated the need for immediate repeated surgery. However, availability of standardized surgical technique and clear algorithms for the entire team are essential for timely diagnosis and management of all potential complications in patients with serious postoperative bariatric complications.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"76-86"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endovascular treatment and selection criteria for acute mesenteric ischemia].","authors":"A B Mironkov, A D Pryamikov, S A Rautbart, A I Khripun","doi":"10.17116/hirurgia202502113","DOIUrl":"10.17116/hirurgia202502113","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the results of endovascular intervention in patients with acute arterial mesenteric ischemia, while observing the indications developed in the clinic.</p><p><strong>Material and methods: </strong>In total, endovascular approach in the treatment of acute mesenteric ischemia were used in 49 patients in the clinic. In compliance with the developed indications and criteria, endovascular intestinal revascularization was performed in 27 patients. Various endovascular intervention techniques were used (aspiration, balloon dilation, artery stenting and their combinations). Extracorporeal filtration techniques were used as a treatment for reperfusion syndrome after intestinal revascularization in 10 patients.</p><p><strong>Results: </strong>Angiographic success in the form of complete restoration of the main blood flow in the basin of the superior mesenteric artery and its large branches was obtained in 85% of cases. Intestinal viability was preserved in 15 (56%) patients. After successful endovascular surgery, intestinal necrosis was diagnosed on laparoscopy in the remaining 12 (44%) patients, which required extensive (<i>n</i>=2) or non-extensive (<i>n</i>=10) resection. Postoperative mortality was 48% (13 patients).</p><p><strong>Conclusion: </strong>Endovascular surgery in acute mesenteric ischemia is an effective method of intestinal revascularization. To optimize the indications for these interventions, it is necessary to gain experience and conduct large-scale studies.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 2","pages":"13-19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Hemorrhage after pancreaticoduodenectomy].","authors":"V A Solodky, A G Kriger, D S Gorin, A A Goev, A B Varava, V I Panteleev","doi":"10.17116/hirurgia202501114","DOIUrl":"10.17116/hirurgia202501114","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the incidence, clinical manifestations and treatment of post-pancreaticoduodenectomy hemorrhage in patients with pancreaticoduodenal tumors.</p><p><strong>Material and methods: </strong>There were 362 pancreaticoduodeneectomies for ductal adenocarcinoma of the pancreatic head and pancreatoduodenal tumors in 2016-2023. Post-pancreatectomy hemorrhage (PPH) occurred in 52 (14.4%) patients. Delayed post-pancreatectomy hemorrhage followed postoperative pancreatitis, pancreatic fistula or non-drained fluid collections. Bleeding was diagnosed considering clinical manifestations with verification through contrast-enhanced CT.</p><p><strong>Results: </strong>Emergency re-laparotomy was required in 15 (28.8%) patients with unstable hemodynamics; 9 (60%) people died. Thirty-seven patients with stable hemodynamics underwent emergency contrast-enhanced CT and subsequent endovascular hemostasis. Bleeding was stopped in 31 patients (89.2%). Endovascular hemostasis was ineffective in 1 patient who underwent re-laparotomy. We found no the cause of bleeding in 3 patients, and there was no hemorrhage recurrence. Six (18.7%) people died. The overall mortality among patients with PPH was 28.8% (15 out of 52 postoperative patients).</p><p><strong>Conclusion: </strong>PPH follows postoperative pancreatitis, pancreatic fistula or non-drained fluid collection. In case of stable hemodynamics, endovascular hemostasis is preferable for this complication.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"14-21"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ultrasound-guided core-needle biopsy for diagnosis of thyroid cancer].","authors":"D D Dolidze, S D Kovantsev, Z A Bagatelia, A V Bumbu, Yu V Barinov, G M Chechenin, N V Pichugina, D G Gogolashvili","doi":"10.17116/hirurgia202503187","DOIUrl":"10.17116/hirurgia202503187","url":null,"abstract":"<p><strong>Objective: </strong>To improve preoperative examination of patients with follicular thyroid tumors using ultrasound-guided core-needle biopsy.</p><p><strong>Material and methods: </strong>All patients with Bethesda IV (follicular tumor) underwent ultrasound-guided core-needle biopsy of thyroid neoplasm according to original technique (patent No. 2826474 RU). Preoperative histological specimen after core needle biopsy was compared with urgent and elective histological examination. Statistical analysis was carried out using Kolmogorov-Smirnov and Kruskal-Wallis tests. Differences were significant at <i>p</i><0.05.</p><p><strong>Results: </strong>Thyroid tumors were available for core needle biopsy in all 45 cases (100%). Repeated cytological analysis confirmed TI-RADS category 3 in 22 (48.89%), TI-RADS 4 in 15 (33.33%) and TI-RADS 5 in 8 (17.77%) patients. Histological examination revealed colloidal goiter in 13 patients (28.89%), adenomatous hyperplasia in 15 (33.33%), follicular adenoma in 9 (20%), and follicular neoplasia with undetermined malignant potential in 2 (4.44%) cases. The quality of histological material made it possible to assess morphological type of tumor, capsule vascularization and cell atypia, invasion into capsule or vessels. In case of colloidal goiter, we were able to assess dimensions of follicles, presence of colloid, cell polymorphism, mitosis and cytoplasm content.</p><p><strong>Conclusion: </strong>Ultrasound-guided core-needle biopsy can reduce the number of unjustified surgical interventions in patients with follicular tumors and optimize management of patients with nodular thyroid lesions.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"87-95"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vacuum-assisted laparostomy for diffuse postoperative peritonitis in patients with abdominal cancers].","authors":"I B Uvarov, A M Manuilov, D D Sichinava","doi":"10.17116/hirurgia202504153","DOIUrl":"https://doi.org/10.17116/hirurgia202504153","url":null,"abstract":"<p><strong>Objective: </strong>To improve the outcomes in patients with abdominal cancers complicated by diffuse postoperative peritonitis (DPP) using vacuum-assisted laparostomy (VAL) with elective staged peritoneal lavage.</p><p><strong>Material and methods: </strong>There were 141 patients with DPP: group I (63 patients) - VAL, group II (78 patients) - redo laparotomy on demand (RD). Negative pressure therapy was performed using commercial vacuum systems with vacuum dressing changes after 48 - 72 hours. We assessed mortality, morbidity, abdominal cavity status (Björck classification) and incidence of primary fascial closure of abdominal cavity.</p><p><strong>Results: </strong>There were 10 (15.9%) and 24 (30.8%) deaths, respectively (<i>p</i>=0.040). Complications Clavien-Dindo grade 3-5 were significantly more common in the 2^nd group. According to the Björck classification, grades 2A (39.7%) and 2B (41.3%) became more common after the 2^nd peritoneal lavage in the 1^st group. After the 3^rd and further staged peritoneal lavages, «frozen open abdomen» (grade 3A and 4) prevailed. This classification revealed significant correlations with abdominal index, intra-abdominal hypertension and C-reactive protein. Primary fascial closure of abdominal cavity was performed in 40 (63.5%) patients in the 1^st group.</p><p><strong>Conclusion: </strong>Vacuum-assisted laparostomy is effective for diffuse postoperative peritonitis compared to on-demand relaparotomy. This approach provides lower mortality and morbidity rates, as well as better control over local inflammatory process and intra-abdominal pressure.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 4","pages":"53-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Bilioduodenal stenting with fully covered self-expandable stent with anti-migration flaps in patients with benign obstructive jaundice].","authors":"Yu D Kulikov, Yu S Teterin, K R Brysyakina, B G Bembeev, P A Yartsev, S V Novikov","doi":"10.17116/hirurgia202505123","DOIUrl":"https://doi.org/10.17116/hirurgia202505123","url":null,"abstract":"<p><strong>Objective: </strong>To improve treatment outcomes in patients with mechanical jaundice by using fully covered self-expandable stents with anti-migration mechanism.</p><p><strong>Material and methods: </strong>The study included 100 patients who underwent endoscopic retrograde biliary duodenal stenting with fully covered self-expandable stent. All patients were divided into 2 groups: group 1 - fully covered self-expandable stent with anti-migration flap, group 2 - fully covered self-expandable stent.</p><p><strong>Results: </strong>Technical success was achieved in all patients of both groups. In group 1, fully covered self-expandable stent with anti-migration flap significantly reduced the incidence of stent dislocation (<i>p</i><0.05). There were no significant differences in the incidence of complications such as acute pancreatitis, purulent cholangitis, acute cholecystitis and sludge. There were no significant between-group differences in stent function (χ²=2.35; <i>p</i>=0.1250).</p><p><strong>Conclusion: </strong>Fully covered self-expandable stent with anti-migration flap reduces the incidence of stent dislocation without increase in the incidence of other complications and effect on duration of functioning.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 5","pages":"23-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Phage therapy analysis of effectiveness in comorbid patients with wounds and surgical infections of various etiology based on the results of a comparative clinical study].","authors":"Yu S Paskhalova, V A Mitish, G V Khamidulin, I A Chekmareva, R P Terekhova, V S Demidova, O V Paklina","doi":"10.17116/hirurgia2025031124","DOIUrl":"10.17116/hirurgia2025031124","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The continued importance of addressing the issue of treating purulent wounds and surgical infections of different origins and localization against the background of increased resistance of their main pathogens dictates the need to develop alternative protocols and search for new treatment strategies, the effectiveness of which is confirmed by objective diagnostic methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The aim of the study was to analyze the effectiveness of phage therapy in comparison with traditional methods of local drug and systemic treatment in comorbid patients with surgical infection of various etiologies and localization by studying the microbiological spectrum, cytology of wound impressions and morphological, including electron microscopic examination of tissue biopsies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;The results of the research are presented: a post-marketing, prospective, randomized, comparative clinical trial enrolling 70 adult patients with complicated skin, soft tissue, and bone infections of various etiologies and localizations, conducted at the Department of Wounds and Wound Infections, National Medical Research Center for Surgery named after A. Vishnevsky, Ministry of Health of the Russian Federation. During the study, clinical (edema, pain, the nature of wound discharge, the appearance of granulation tissue), laboratory (the presence and regression of signs of a systemic response to the presence of a surgical infection), microbiological (qualitative and quantitative), cytological and electron microscopic parameters were analyzed in all patients. Parametric data were evaluated based on the mean and standard deviation (SD) at 4 study points: point 1 (2±1 days), point 2 (4±1 days), point 3 (6±1 days) and point 4 (8±1 days). The key endpoint was the transition of the wound process into the regeneration phase.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;According to the study protocol, all the patients included in the analysis had purulent-necrotic wounds of soft tissues and bones different etiology and localization, requiring surgical debridement. To randomize patients into groups, upon admission or intraoperatively, material was collected for qualitative and quantitative microbiological, cytological, morphological and electron microscopic studies. Randomization into groups of bacteriophages was possible in the presence of sensitivity of isolated cultures to the \"Piobacteriophage complex\" liquid (Piofag, JSC NPO Microgen, Russia). In the postoperative period, patients of group 1 (&lt;i&gt;n&lt;/i&gt;=20) received systemic and local phage therapy (20 ml 3 times a day, according to the instructions), in group 2 (&lt;i&gt;n&lt;/i&gt;=20) - systemic and local phage therapy, combined with local negative pressure (-120 mmHg, constant mode), delivery of bacteriophages to the surgical infection site was carried out using VitMobil instillation (VitMedical, Russia), systemic (levofloxacin 500 mg twice a day) and local (multicompo","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 3","pages":"124-138"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143658843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Endoscopic treatment of patients with adenomas of the major duodenal papilla and familial adenomatous polyposis].","authors":"Yu G Starkov, A I Vagapov, R D Zamolodchikov, S V Dzhantukhanova","doi":"10.17116/hirurgia20250915","DOIUrl":"https://doi.org/10.17116/hirurgia20250915","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the effectiveness and safety of intraluminal endoscopic treatment of patients with adenomas of the major duodenal papilla and familial adenomatous polyposis.</p><p><strong>Material and methods: </strong>Over the past 4 years, 13 patients with adenomas of the major duodenal papilla and familial adenomatous polyposis underwent surgery in our hospital. Of these, 7 patients had exclusively extrapapillary adenomas without signs of spread to the ducts. Four patients had a mixed type of adenoma (type IV), i.e. a combination of extrapapillary component with intraductal one. In 2 cases, neoplasms had exclusively intraductal growth (type III). In 6 cases, adenoma spread to the common bile duct, in 3 cases - to the walls of the pancreatic duct.</p><p><strong>Results: </strong>Technical success was achieved in all cases. Postoperative complications occurred in 3 cases: moderate acute post-manipulation pancreatitis in 2 patients and delayed bleeding in 1 patient. Control examination revealed residual fragments of adenomatous tissue in 2 cases that required repeated endoscopic resection of residual tissues of the major duodenal papilla.</p><p><strong>Conclusion: </strong>Standardized criteria for choosing the optimal surgery for adenomas of the major duodenal papilla depending on characteristics of tumor growth, as well as its topographic and anatomical features made it possible to personalize optimal endoscopic removal of adenomas of the major duodenal papilla with minimal risk of postoperative complications.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","pages":"5-11"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical and laboratory aspects of ultrasound treatment for chronic wounds].","authors":"E L Stavchikov, I V Zinovkin, I Ya Savostenko, A V Marochkov","doi":"10.17116/hirurgia202509136","DOIUrl":"https://doi.org/10.17116/hirurgia202509136","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate clinical and laboratory effectiveness of ultrasound treatment for purulent wounds.</p><p><strong>Material and methods: </strong>The study enrolled 46 patients with purulent wounds divided into the main group (23 patients, ultrasonic treatment) and the control group (23 patients, traditional treatment). We assessed treatment effectiveness considering visual data, quality of granulation tissue, wound defect area and marginal epithelialization, complete blood count and C-reactive protein. Smear prints and acidity of wound discharge were analyzed.</p><p><strong>Results: </strong>In the main group, there was a faster completion of inflammatory phase and transition to proliferative one. This was accompanied by earlier granulations, reduced wound area and active marginal epithelialization with neutral pH of wound discharge. Neutrophil-lymphocytic and platelet-lymphocytic ratios significantly decreased after 3 days (2.56 and 118.23, respectively, <i>p</i><0.05) compared to the control group. This decrease persisted at all stages of the study. After 10 days, NLR and TLR in the main group were 1.88 and 96.12, in the control group - 2.48 and 118.87, respectively. Serum CRP significantly decreased after 3 days in the main group (67.45 mg/l). After 10 days, CRP in the main group was 20.01 mg/l, in the control group - 56.87 mg/l (<i>p</i><0.05).</p><p><strong>Conclusion: </strong>Ultrasonic treatment of purulent wounds significantly improves cytological picture of wounds, accelerates wound debridement from devitalized tissues and epithelization, as well as reduces inflammation. These findings indicate higher effectiveness of treatment.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","pages":"36-43"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Laparoscopic appendectomy in children: results of the all-Russian survey].","authors":"V P Gavrilyuk, I V Poddubny, D A Severinov, V V Sytkov, Yu A Zubkova, D A Baranov","doi":"10.17116/hirurgia202509154","DOIUrl":"https://doi.org/10.17116/hirurgia202509154","url":null,"abstract":"<p><strong>Objective: </strong>To study opinions of pediatric surgeons on technical aspects of laparoscopic appendectomy in children.</p><p><strong>Material and methods: </strong>An anonymous survey of surgeons was used as the main research method (Google Forms platform). Invitations were sent to specialized institutions (emergency pediatric surgery departments).</p><p><strong>Results: </strong>The study involved 110 pediatric surgeons. Of these, 69% of respondents noted an unspoken rule about the need for only laparoscopic appendectomy. Laparoscopic appendectomies are more common in federal centers compared to regional ones. About 94% of respondents use three-port laparoscopic appendectomy. About 50% of respondents prefer bipolar cauterization for treating the mesentery of the vermiform appendix. Raeder loop is used for vermiform appendix base closure by 97% of respondents.</p><p><strong>Conclusion: </strong>This survey revealed significant differences in the choice of surgical approach, treating the mesentery and the base of the appendix, material, equipment and other key tactical aspects among specialists. This requires further study of standardization of this intervention.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 9","pages":"54-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}