World Neurosurgery: X最新文献

{"title":"Early surgical intervention in pediatric trauma patients with GCS 3 – Results of 8 Years experience","authors":"Merve Boyraz ,&nbsp;Servet Yüce ,&nbsp;Abdulrahman Özel ,&nbsp;Mehmet Tolgahan Örmeci ,&nbsp;Hasan Özen ,&nbsp;Süleyman Akkaya ,&nbsp;Edin Botan","doi":"10.1016/j.wnsx.2025.100476","DOIUrl":"10.1016/j.wnsx.2025.100476","url":null,"abstract":"<div><h3>Objectives</h3><div>Traumatic brain injury (TBI) is the leading cause of death and disability in children. Mortality and morbidity increase dramatically in patients with severe brain injury and a Glasgow Coma Scale (GCS) score of 3. This study evaluates the impact of early surgery (within 0–6 h) on mortality and morbidity in this patient group, often considered \"hopeless cases.\"</div></div><div><h3>Methods</h3><div>Children with TBI and a GCS score of 3 admitted to the Pediatric Intensive Care Unit of Van Training and Research Hospital between 2016 and 2024 were retrospectively analyzed. Medical records, imaging studies, and outcomes were reviewed. Mortality and neurological sequelae were assessed within one year using the Glasgow Outcome Scale (GOS).</div></div><div><h3>Results</h3><div>Among 514 children admitted with isolated head trauma, 11.3 % (n = 58) had a GCS score of 3. Twelve patients (20.7 %) died within the first 4 h due to hemodynamic instability and were excluded. Of the remaining 46 patients, 14 (30.4 %) underwent cranial surgery, while 32 (69.6 %) received medical treatment. Mortality rates were 50 % (7/14) in the surgical group and 71.8 % (23/32) in the medical group (p = 0.137). Neurological sequelae were significantly lower in the surgical group (14.3 % vs. 77.8 %, p = 0.020). Early surgery (within 6 h) resulted in lower mortality (25 % vs. 83.3 %, p = 0.005) and better neurological outcomes, with all survivors discharged neurologically intact. In contrast, the only survivor operated on after 6 h had neurological sequelae.</div></div><div><h3>Conclusion</h3><div>Early decompressive craniectomy (within 6 h) significantly reduces mortality and neurological sequelae in pediatric patients with severe TBI (GCS: 3). These patients should not be dismissed as \"hopeless\" but given the opportunity for surgical intervention.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100476"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923868","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":"Outpatient transforaminal lumbar interbody fusion demonstrated favorable safety in comparison to the inpatient setting: analysis of 10,595 NSQIP patients and systematic review","authors":"Simon G. Ammanuel ,&nbsp;Kaissa Sylla ,&nbsp;Cuong P. Luu ,&nbsp;Momin M. Mohis ,&nbsp;Bradley Schmidt","doi":"10.1016/j.wnsx.2025.100478","DOIUrl":"10.1016/j.wnsx.2025.100478","url":null,"abstract":"<div><h3>Objective</h3><div>To determine nationally how outpatient surgery affects transforaminal lumbar interbody fusion (TLIF) outcomes versus the inpatient setting.</div></div><div><h3>Methods</h3><div>TLIF patients were identified from the National Surgical Quality Improvement database for the years 2015–2020 and stratified into inpatient and outpatient groups. Univariate and multivariate analyses, adjusting for differing patient characteristics, were performed to delineate outcome differences. A review of PubMed following PRISMA guidelines summarized prior level 3 evidence on how outpatient TLIF had affected outcomes.</div></div><div><h3>Results</h3><div>Contrasting the characteristics of the 10,237 inpatient to 358 outpatient TLIF cases, the outpatient group fared younger (57.1 vs. 59.9 years old, p &lt; 0.001) and lower in ASA &gt;2 (42.2 % vs. 51.1 % p = 0.001). The outpatient group experienced shorter operations (183.86 vs. 214.29 min, p &lt; 0.001), shorter stays (1.97 vs. 3.40 days, p &lt; 0.001), and more home discharges (94.1 % vs. 87.1 %, p &lt; 0.001). The outpatient group experienced fewer minor complications (4.7 % vs 10.7 %, p &lt; 0.001), particularly perioperative blood transfusion (0.8 % vs 6.0 %, p &lt; 0.001). Multivariate analysis showed outpatient group did not differ in major complications (OR 0.92, CI 0.45–1.88, p = 0.82) or readmissions (OR 1.06, CI 0.64–1.77, p = 0.82). A review of 7 smaller retrospective cohort studies revealed that complications rates (6 of 7 studies, p ≥ 0.05), the visual analog scale, and the Oswestry Disability Index (3 of 4 studies, p ≥ 0.05) did not differ between settings.</div></div><div><h3>Conclusions</h3><div>TLIF can be performed safely in the outpatient setting with comparable outcomes to inpatient TLIF with prudent patient selection. It is also likely to have similar long-term functional outcomes, which therefore supports its expanded coverage under Medicare.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100478"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143923869","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":"Bridging the gap: Enhancing AI capabilities in visual interpretation for neurosurgical education","authors":"Mila Yunita ,&nbsp;Palasara Brahmani Laras ,&nbsp;Fiki Prayogi ,&nbsp;Inas Afifah Zahra ,&nbsp;Ilham Khairi Siregar","doi":"10.1016/j.wnsx.2025.100477","DOIUrl":"10.1016/j.wnsx.2025.100477","url":null,"abstract":"","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100477"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143916733","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":"Initial clinical presentations and morphological characteristics of cerebral AVM in a tertiary health center – Does gender matter?","authors":"Jovian Philip Swatan ,&nbsp;Wardah Rahmatul Islamiyah ,&nbsp;Achmad Firdaus Sani ,&nbsp;Dedy Kurniawan ,&nbsp;Shakir Husain","doi":"10.1016/j.wnsx.2025.100475","DOIUrl":"10.1016/j.wnsx.2025.100475","url":null,"abstract":"<div><h3>Purpose</h3><div>Comparative studies on the initial clinical presentation and morphological characteristics of cerebral arteriovenous malformation (AVM) between genders are limited. This study aims to analyze the influence of gender on these aspects.</div></div><div><h3>Materials and methods</h3><div>We retrospectively analyzed our 8-year cerebral AVM database, covering the period from January 2016 to December 2023. The study included all patients diagnosed with cerebral AVM, who had no other vascular abnormalities and underwent a 3-dimensional cerebral digital subtraction angiography evaluation. We used bivariate analysis to compare the initial clinical presentations and morphological characteristics of cerebral AVM between genders.</div></div><div><h3>Results</h3><div>The study included a total of 92 patients, comprising 53 males and 39 females. Male patients were more likely to present with seizures (<em>p</em> = 0.035, OR 2.52, 95 % CI 1.06–6.00), but less likely to present with headaches (<em>p</em> = 0.008, OR 0.32, 95 % CI 0.13–0.76). In terms of morphology, being male was significantly associated with a larger mean cerebral AVM size (<em>p</em> &lt; 0.001), cerebral AVMs located in eloquent areas (<em>p</em> = 0.039; OR 2.81, 95 % CI 1.03–7.70), and a higher mean Spetzler-Martin grade (<em>p</em> = 0.015).</div></div><div><h3>Conclusion</h3><div>This study highlights the influence of gender on the initial clinical presentation and morphological characteristics of cerebral AVM.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100475"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895840","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":"Are lumbar drains necessary in endoscopic trans-sellar surgery with an intraoperative high-flow leak? A systematic review and meta-analysis","authors":"Hei Yi Vivian Pak ,&nbsp;Peter Taylor ,&nbsp;Dhruv Parikh ,&nbsp;Caroline Hayhurst","doi":"10.1016/j.wnsx.2025.100467","DOIUrl":"10.1016/j.wnsx.2025.100467","url":null,"abstract":"<div><h3>Background</h3><div>Cerebrospinal fluid (CSF) leaks are a serious complication of endoscopic trans-sphenoidal surgeries that can lead to meningitis, pneumocephalus and a risk to life. Neurosurgeons have used perioperative lumbar drains to facilitate the healing of the dura and prevent postoperative CSF leaks. However, the use of lumbar drains is controversial and has primarily been left to individual surgeon preference. Sellar and suprasellar lesions form most pathologies treated by skull base surgeons using the endoscopic trans-nasal approach. Through meta-analysis, we aim to determine whether lumbar drains effectively reduce the risk of postoperative CSF leak in the context of a high-flow intraoperative leak in trans-sellar and trans-tuberculum approaches.</div></div><div><h3>Method</h3><div>A systematic review using PRISMA guidelines was conducted. Databases used in literature searching include PubMed, Ovid (including Embase and Medline), Scopus and Cochrane Library. De-duplication, title and abstract screening were performed on the Rayyan platform. Studies were selected according to the inclusion and exclusion criteria. The random-effects model was used in statistical analysis.</div></div><div><h3>Results</h3><div>A total of 2623 non-duplicated articles were identified. After screening and full-text reviews, 21 studies were included. Lumbar drains did not significantly lower the rates of postoperative CSF leaks (<em>p</em> = 0.65; 95 % CI 1.24–0.78).</div></div><div><h3>Conclusion</h3><div>Lumbar drains are not proven to be beneficial for patients who undergo endoscopic endonasal trans-sellar surgery with a concurrent intraoperative high-flow leak. For trans-sellar pathologies, a meticulous repair is sufficient. As repair techniques continue to improve, the role of the lumbar drain is likely to be further diminished.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100467"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143895839","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":"Mechanical thrombectomy with the non-attaching remote thrombus-aspiration (NARA) technique: a technical note","authors":"Masashi Kotsugi,&nbsp;Ai Okamoto,&nbsp;Yudai Morisaki,&nbsp;Ryosuke Maeoka,&nbsp;Shohei Yokoyama,&nbsp;Shuichi Yamada,&nbsp;Ichiro Nakagawa","doi":"10.1016/j.wnsx.2025.100471","DOIUrl":"10.1016/j.wnsx.2025.100471","url":null,"abstract":"<div><h3>Background</h3><div>A direct aspiration, first-pass thrombectomy (ADAPT) has become the standard technique for thrombus removal and involves contact aspiration with a large-bore suction catheter. However, thrombus retrieval can prove difficult in cases where the thrombus volume is large and occlusion extends across branches. Further, access to the thrombus is frequently complicated by the age of the affected population.</div></div><div><h3>Methods</h3><div>We present two cases in which the thrombus was remotely retrieved with the non-attaching remote thrombus-aspiration (NARA) technique to indirectly apply pressure to the thrombus by maintaining negative pressure through a suction catheter while completely blocking antegrade blood flow.</div></div><div><h3>Results</h3><div>Although the aspiration catheter was not guided to the thrombus, aspiration was started under proximal flow control with inflation of the guiding balloon. When aspiration pressure reached the thrombus, the aspirating catheter showed no retrograde blood flow. Both thrombi were retrieved in a single procedure, and blood flow (Thrombolysis in Cerebral Infarction grade 3) was restored in each case.</div></div><div><h3>Conclusions</h3><div>We achieved remote thrombus retrieval using the NARA technique in two cases. Remote thrombus retrieval is feasible even if the tip of the suction catheter cannot reach the thrombus. This technique may be useful in difficult-to-access cases.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100471"},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143887924","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":"Letter to the Editor Regarding “Virtual reality as a digital premed to alleviate preoperative anxiety and postoperative pain in patients undergoing spine surgery: A randomised controlled clinical trial”","authors":"Redwan Jabbar,&nbsp;Agnieszka Pawelczyk,&nbsp;Maciej Radek","doi":"10.1016/j.wnsx.2025.100474","DOIUrl":"10.1016/j.wnsx.2025.100474","url":null,"abstract":"","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100474"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898913","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":"Real estate for fusion: An anatomical comparison of surface area between cervical facet joints and the intervertebral disc space","authors":"Christopher Seidel ,&nbsp;Clifford Pierre ,&nbsp;Luke Jouppi ,&nbsp;Luke DiPasquale ,&nbsp;Chelsea Bush ,&nbsp;Anna Anderson ,&nbsp;Amit R. Patel","doi":"10.1016/j.wnsx.2025.100473","DOIUrl":"10.1016/j.wnsx.2025.100473","url":null,"abstract":"<div><h3>Introduction</h3><div>Cervical stenosis may be treated surgically with anterior or posterior decompression with or without fixation. Recently, facet fusion using implantable devices using a posterior approach has been described as an alternative to anterior cervical discectomy and fusion (ACDF). To our knowledge, no anatomic studies have compared the surface area of the cervical facet joints to the intervertebral space. This study sought to provide a better understanding of the potential surface areas for arthrodesis.</div></div><div><h3>Methods</h3><div>We performed a cross-sectional retrospective review using CT scans of the cervical spine in patients who had undergone imaging between 2014 and 2017. Using our institution's imaging software, we measured the area contained within the intervertebral space and the facet joints bilaterally. All surface area values for each intervertebral space were then compared using a paired <em>t</em>-test to the cumulative surface area of the facet joints calculated at each level.</div></div><div><h3>Results</h3><div>Two hundred twelve patients (120 male, 92 female) were eligible for the analysis based on the inclusion and exclusion criteria. The mean age was 33 ± 6.0 years (range 18–55). The mean BMI was 29 ± 7.2 (range 19–58). In each of the comparisons, the combined intra-facet joint surface area (IFSA) was significantly greater than the intervertebral surface area (IVSA) of the corresponding interbody space.</div></div><div><h3>Conclusion</h3><div>The surface area between the combined facet joints was almost two times greater than the intervertebral space. This may help establish an anatomic basis for comparable fusion results between the traditional ACDF and posterior fusion.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100473"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143882684","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":"Is fixation beneficial in Kümmell's disease? A metaanalysis of clinical and radiological outcomes","authors":"Marven Aoun ,&nbsp;Mohammad Daher ,&nbsp;Gaby Kreichati ,&nbsp;Khalil Kharrat ,&nbsp;Amer Sebaaly","doi":"10.1016/j.wnsx.2025.100472","DOIUrl":"10.1016/j.wnsx.2025.100472","url":null,"abstract":"<div><h3>Background</h3><div>The standard surgical management of Kummell's disease consists of kyphosis reduction and augmentation of the affected vertebrae. This can be achieved by vertebral augmentation alone or vertebral augmentation in addition to instrumentation. This meta-analysis was conducted to compare vertebral augmentation alone or vertebral augmentation in addition to instrumentation in terms of post-operative complications, improvement in radiographic parameters, and patient-reported outcomes in Kummell's disease.</div></div><div><h3>Methods</h3><div>PubMed, Cochrane, and Google Scholar (page 1–20) were searched till August 2024. The studied outcomes were the complications, intra-operative bleeding, operating time, anterior vertebral height, kyphotic Cobb angle and the improvement in back pain with the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI).</div></div><div><h3>Results</h3><div>Four studies were included in this meta-analysis. Operative time and Intra-operative bleeding were significantly higher in vertebral augmentation with fixation (p &lt; 0.00001). No difference was seen in the remaining outcomes between both surgeries.</div></div><div><h3>Conclusion</h3><div>Vertebral augmentation, either in combination with fixation or as a standalone procedure, has demonstrated remarkable efficacy in treating Kummell's disease. Both approaches have shown comparable rates of complications, achieved similar radiographic outcomes, and effectively reduced post-operative pain. However, it is important to note that vertebral augmentation combined with instrumentation and fixation does come with some drawbacks, as it requires more operative time and is associated with higher blood loss.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100472"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143868508","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":"A new risk factor? Diagonal earlobe crease (Frank's sign) associated with intracranial aneurysms: a case–control study","authors":"Victor Ramzes Chavez-Herrera ,&nbsp;Bayron A. Sandoval-Bonilla ,&nbsp;Joel Abraham Velazquez-Castillo ,&nbsp;Pedro Adrian Gonzalez-Zavala ,&nbsp;Flavio Hernandez-Gonzalez ,&nbsp;Felix Adrian Vergara-Martinez ,&nbsp;Anabel Saldaña-Gonzalez ,&nbsp;Miguel Abdo-Toro ,&nbsp;Blas Ezequiel Lopez-Felix ,&nbsp;Ivan Tellez-Medina ,&nbsp;Martin Paredes-Cruz ,&nbsp;Rabindranath Garcia-Lopez","doi":"10.1016/j.wnsx.2025.100469","DOIUrl":"10.1016/j.wnsx.2025.100469","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the association of diagonal earlobe crease (DELC, Frank's sign), laterality, and type of DELC with the presence of intracranial arterial aneurysms (IAA).</div></div><div><h3>Methods</h3><div>The authors conducted a hospital-based case–control study involving 130 patients diagnosed with IAA and 130 age-grouped and sex-matched controls who had no arterial intracranial aneurysms. This study aimed to evaluate a potential association between IAA and DELC, the laterality of DELC, and the type of DELC. Multivariable logistic regression models were applied to identify correlations between cases and controls.</div></div><div><h3>Results</h3><div>DELC was identified in 96 patients of the IAA group (73.8 %) and 45 in the control group (34.6 %). There was a significant association between IAA and DELC (OR 7.92, 95 % CI 3.96–15.83, <em>p</em> &lt; 0.001), unilateral and bilateral DELC (OR 7.36, 95 % CI 2.96–18.31, <em>p</em> &lt; 0.001, and OR 8.17, 95 % CI 3.90–17.14, <em>p</em> &lt; 0.001, respectively), and type 2, type 3, and type 4 DELC (OR 5.66, 95 % CI 2.17–14.77, <em>p</em> &lt; 0.001, OR 5.73, 95 % CI 1.95–16.83, p 0.001, and OR 39.45, 95 % CI 12.40–125.50, <em>p</em> &lt; 0.001, respectively). Type 1 DELC was not associated with IAA (p 0.079).</div></div><div><h3>Conclusions</h3><div>This study demonstrates a significant association between DELC and the presence of IAA. Laterality was not a limiting factor. Complete and deep features in DELC are associated with IAA, whereas superficial incomplete DELC is not. Hypertension also showed an association with IAA. DELC should be considered a risk factor for IAA. DELC could serve as a crucial candidate risk factor for determining prognosis and screening protocols for patients with IAA; this may enable timely interventions to improve outcomes.</div></div>","PeriodicalId":37134,"journal":{"name":"World Neurosurgery: X","volume":"27 ","pages":"Article 100469"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876970","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}