Medical Journal of Malaysia最新文献

{"title":"Assessing male involvement in family planning: A scoping review of prevalence and its associated factors.","authors":"A Alias, K Mokti, N Azhar, W H N Wan Mohamad Lotfi, A Hidrus, Z N Sidek Ahmad, S M I R Mohd Zali, M Y Ibrahim","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Family planning (FP) is a key component of the Safe Motherhood Program, aimed at reducing maternal mortality and morbidity. Male involvement in FP is increasingly recognized as essential for improving reproductive health outcomes through shared decisionmaking and spousal collaboration. This scoping review aimed to assess the prevalence of male involvement in family planning and identify the factors that influence their participation.</p><p><strong>Materials and methods: </strong>A literature search was conducted in ProQuest, PubMed, and Scopus for peer-reviewed articles published between 2014 and 2024. Eligible studies reported on the prevalence and determinants of male involvement in FP. Two reviewers independently screened articles and extracted data. Findings were synthesised descriptively and thematically.</p><p><strong>Results: </strong>Eight studies met the inclusion criteria. Reported male involvement in FP varied widely, ranging from 8.4% to 80%. Key influencing factors included education level, access to FP information, number of children, spousal communication, and attitudes towards contraception. Barriers included cultural norms, limited male-targeted services, and misconceptions about FP.</p><p><strong>Conclusion: </strong>Male involvement in family planning remains inconsistent across regions. Targeted educational and community-based interventions are essential to enhance men's engagement in reproductive health and improve FP outcomes.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 5","pages":"642-648"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187098","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":"Unmasking nasal basal cell carcinoma: Strategies for defect coverage.","authors":"A S Halim, M C Lim, H N R Shawaltul","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Many reconstruction methods have been introduced for the reconstruction of basal cell carcinoma (BCC) post excision however no study has described the preferred reconstruction method in the Malaysia setting. Variations in resource availability and surgical training between regions may affect reconstructive choices. This study intends to find out our preferred method for reconstruction in nasal BCC patients post excision in our centre.</p><p><strong>Materials and methods: </strong>We conducted a retrospective chart review of patients undergoing different reconstruction methods and assessing outcomes for a series of patients with BCC post-resection, conducted in Hospital Universiti Sains Malaysia (HUSM) and Hospital Raja Perempuan Zainab II, Kelantan, from 2012 to 2024.</p><p><strong>Results: </strong>A total of seven patients were identified in this retrospective study, comprising five females and two males. The ages of these seven patients range from 60 to 77 years old. All seven patients who underwent excision postoperatively underwent immediate soft tissue reconstruction with either a local or regional flap, a free flap, or a combination of flaps. Among those seven patients, only one developed flap-related complications. All patients were followed up for at least 3 months, with a range of 3-38 months. Functional and cosmetic assessments over the resected area post-reconstruction were good.</p><p><strong>Conclusion: </strong>Local flaps remain the preferred option for small and medium nasal BCC defects, while forehead flaps and free flaps are reserved for larger or complex defects. In Asian patients, thicker skin and pigmentation influence flap design and thinning to optimize outcomes.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 5","pages":"550-554"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187085","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":"Velopharyngeal function and nasalance score in post-radiation nasopharyngeal carcinoma patients.","authors":"T Handayani, T J Airlangga, S Zizlavsky, E Z K Rachmawati, I D Mayangsari, H Kodrat, J Prihartono","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Voice production and speech impairment in head and neck cancer patients can be experienced due to tumors or therapy such as radiotherapy. Velopharyngeal fibrosis in post-radiation nasopharyngeal carcinoma (NPC) patients can disrupt the velopharyngeal closure during speech, causing hypernasality. This study aims to determine the characteristics and proportions of the nasalance score in post-radiation NPC patients with or without resonance disorder.</p><p><strong>Materials and methods: </strong>This research is a descriptive study using cross-sectional techniques, followed by retrospective data collection of post-radiation NPC patients at Dr. Cipto Mangunkusumo General Hospital for the period July-August 2023. The parameter assessed is the nasalance score using a nasometer, the velopharyngeal dysfunction assessed with flexible laryngoscopy, and the hypernasality assessed by a 15 years' experienced speech therapist.</p><p><strong>Results: </strong>The nasalance score in the Gajah 1 test obtained a median of 14 (7-22), for the mean value of Hantu 1 test was 39.8% ± 4.5, and for the mean value of Sengau test was 62.2 ± 6.9, with a nasalance score cut point in Gajah 1 test between normal resonance and hypernasal was 15.5% and in Hantu 1 test was 42.5%. Gender and radiation dose to the pharyngeal constrictor muscle tend to have a significant relationship with resonance disorder in post-radiation NPC patients.</p><p><strong>Conclusion: </strong>A prospective study is needed in NPC patients with pre- and post-radiation assessment and follow-up evaluation to assess the effects of radiation which includes all relevant functional aspects of voice and speech.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 5","pages":"544-549"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187024","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":"Changes in fundus by optical coherence tomography in patients with chronic obstructive pulmonary disease: A systematic review.","authors":"A Kim, C Erb, G Kapanova","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic obstructive pulmonary disease (COPD) exerts a negative impact on various tissues and organs throughout the body due to chronic hypoxia. The retina and choroid are implicated in this process, and the application of optical coherence tomography (OCT) enables the detection of potential changes in the fundus. This study aims to explore and discuss OCT-assisted fundus alterations in individuals with COPD by undertaking a systematic review.</p><p><strong>Materials and methods: </strong>A systematic review of the literature was conducted in adherence to the PRISMA checklist. Exclusion criteria encompassed articles published in non- peer-reviewed journals or unpublished literature. Consistent criteria were applied during both the title-and-abstract screening and full-text screening phases. Inclusion criteria comprised research conducted in the English language and published after 1993. Selection criteria were articulated in accordance with PICOS. Articles falling within the purview of meta-analyses, systematic reviews, guidelines, case reports, pilot studies, and non-human studies (e.g., laboratory research) were excluded from consideration.</p><p><strong>Results: </strong>A total of 68 articles were initially identified, 10 reports met inclusion criteria and were included in qualitative analysis. In Turkey were conducted 8 studies and 2 studies in Egypt. All the studies included are case-control designed. Above-mentioned changes in retina were studied in 10 cases and found in 8 of them. In the same time changes in choroid were studied in 9 cases and found in 6 of them.</p><p><strong>Conclusions: </strong>The findings of this systematic review indicate that, as observed through OCT, chronic hypoxia and systemic inflammation resulting from COPD predominantly impact the retina and choroid.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 5","pages":"635-641"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187046","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":"Evaluating the efficacy of transrectal povidone-iodine application for infection prevention in transrectal ultrasound-guided prostate biopsy: A single-center retrospective study.","authors":"M H Azizi, M H Mohd Hashim, L Y Lim, H C Khoo, Z Md Zainuddin, N S Che Razali","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate cancer diagnosis via transrectal ultrasound-guided (TRUS) biopsy carries a significant risk of infectious complications due to potential contamination from the rectal microbiome. This study aimed to evaluate the efficacy of transrectal 10% povidone-iodine application, in combination with antibiotic prophylaxis, in reducing infectious complications following TRUS biopsy.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on 643 patients who underwent TRUS biopsy at a single center in a tertiary hospital in Kuala Lumpur between January 2017 and December 2023. Patient records were reviewed for demographic data, biopsy indications, type of antibiotic prophylaxis, and post-biopsy complications. Patients were categorized into two groups: those who received antibiotic prophylaxis alone and those who received both antibiotic prophylaxis and transrectal povidone-iodine. Statistical analyses, including chi-square tests and logistic regression, were performed to compare outcomes and assess the impact of povidone-iodine on infection rates.</p><p><strong>Results: </strong>Of the 643 patients, 285 received antibiotic prophylaxis combined with transrectal povidone-iodine, was associated with a significantly lower infection rate from 2.23% to 0.7% (P < 0.05). There were no significant differences between the povidone-iodine and non- povidone-iodine groups in terms of patient demographics, including age, prostate volume, Prostate Specific Antigen (PSA) levels, and histopathological findings. Logistic regression analysis further confirmed the significant effect of povidone-iodine in reducing post-biopsy infections presenting as fever >37.5 within 30 days after TRUS biopsy.</p><p><strong>Conclusion: </strong>The results indicate that the use of transrectal 10% povidone-iodine alongside antibiotic prophylaxis is an effective approach for reducing infectious complications following TRUS biopsy.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 5","pages":"589-593"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187079","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":"Patient satisfaction and experience for virtual consultation services in the Malaysian government health clinics: A review.","authors":"A K Nasim, I Khalid, M R Isa","doi":"","DOIUrl":"","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Virtual consultation (VC) has emerged as a vital mode of healthcare delivery, particularly accelerated by the COVID-19 pandemic. The Ministry of Health (MOH) has progressively implemented VC services across government health clinics in Malaysia, guided by national digital health strategies. As VC becomes integral to primary care, evaluating patient satisfaction and experience becomes essential to ensure service quality. Despite the global availability of various tools, a lack of validated instruments remains in the context of Malaysian primary care, particularly in Malay. This narrative review aims to identify existing instruments used to assess patient satisfaction and experience with VC, evaluate their relevance and psychometric robustness, and highlight gaps in measurement, particularly for public primary care in Malaysia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A systematic search was conducted using PubMed, employing a comprehensive search strategy combining MeSH terms and text words related to \"patient satisfaction,\" \"patient experience,\" \"surveys and questionnaires,\" and \"telemedicine.\" The search was restricted to English-language publications involving adult populations and returned 876 articles. After applying the free full-text filter, 397 articles were screened. Title and abstract screening yielded 83 potentially eligible studies, from which only eight were found to involve original development or adaptation of relevant instruments and were included for further analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the seven included studies, most questionnaires were focused primarily on domains related to usability and acceptability, such as interface ease, access, and convenience. However, few instruments addressed core components of clinical care quality, including communication, diagnostic confidence, care continuity, and coordination. Furthermore, none of the reviewed questionnaires underwent complete validation and reliability assessment within the context of Malaysian primary care. Four studies were conducted in Malaysia; however, these either lacked robust validation processes or focused solely on acceptability. Additionally, no tools were validated in Malay or tailored specifically to the cultural and healthcare delivery context of Malaysia's government clinics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The findings reveal a significant methodological gap in assessing patient satisfaction and experience with VC in Malaysian primary care. Existing tools largely derive from models focused on technology usability or service acceptability, with limited attention to the clinical dimensions of virtual care. Instruments such as the Telemedicine Satisfaction Questionnaire (TSQ), the Telemedicine Usability Survey (TUS) and the Service User Technology Acceptability Questionnaire (SUTAQ) offer partial frameworks but lack comprehensive validation or contextual adaptation. In Malaysia, while efforts have been mad","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 5","pages":"627-634"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187092","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":"Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios can only predict the severity of COVID-19 if the criteria for a biomarker are met.","authors":"J Finsterer","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 5","pages":"649"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187059","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":"Artificial Intelligence (AI) in a Singaporean Emergency Department: Detecting fractures and reducing recalls.","authors":"H Y Chan, Y P Tang, Z Y Wong, S H Koh, O Nickalls, W Steven, M O Tan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>There has been rapid increase in the number of artificial intelligence and machine learning (ML) algorithms in recent years. In our local emergency department (ED), after-hours, radiographs are read by the ED doctor, with formal reporting by the radiology department performed on the subsequent day. Discrepant diagnoses between the ED doctor and radiologist potentially result in recalls of discharged patients for additional treatment, leading to greater monetary and manpower costs. To the authors' knowledge, no Singapore based study has utilized local data to analyse the performance of an AI fracture detection solution in the Singapore ED. The objective of this study is to evaluate the diagnostic performance of an AI radiograph fracture tool compared to ED doctors.</p><p><strong>Materials and methods: </strong>A retrospective study was conducted on 42 discrepant radiographic studies. In these studies, the final radiology report by the radiology department (the \"ground truth\") had a different diagnosis from bedside radiographic assessment by an ED Doctor.</p><p><strong>Results: </strong>There were 20 studies with fractures and 22 studies with no fractures. The AI solution correctly diagnosed 15 fractures (75.0% of cases with fracture) (Figure 1), missed 5 fractures (25.0% of cases with fracture) and overcalled 1 fracture (4.5% of cases with no fracture) (Figure 2). The AI solution sensitivity is 75.0%, specificity is 95.5%, positive predictive value (PPV) is 93.8% and the negative predictive value (NPV) is 80.8%.</p><p><strong>Conclusion: </strong>Having a fracture detection AI solution has the potential of reducing discrepant cases by up to 73.7% in the ED setting. Further large-scale studies should be performed to quantify the economic, manpower and healthcare outcome benefits of such an AI solution.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 4","pages":"462-465"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754726","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":"Comparing the effectiveness of retina funduscopy using direct ophthalmoscope and handheld non-mydriatic digital retina fundus camera in medical practice.","authors":"S H Hussein, M Abdul Muna'aim, A Mokhtar, N Zainol, T A M Tengku Mohd","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Retinal examination plays an essential role in ocular assessment and serves as a key tool for diagnosing various eye conditions. The traditional direct ophthalmoscope (DO) remains widely used due to its affordability, accessibility, and rapid application. However, it presents several limitations, including a steep learning curve, narrow field of view, and strong dependence on user expertise. In contrast, the handheld fundus camera (HFC) is a newer innovation that provides high-resolution digital imaging and is more user-friendly. This study compared the usability, diagnostic confidence, and user preference between the DO and HFC among medical students and practitioners.</p><p><strong>Materials and methods: </strong>This quasi-experimental study was conducted among 70 participants comprising medical students and practitioners. All participants had prior exposure to the DO and were recruited through convenience sampling. The study took place at the Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia (USIM), Negeri Sembilan and USIM's mobile eye screening sites. Participants received a 15-minute hands-on training with both the DO (Welch Allyn) and HFC (New Eyes) before performing non-mydriatic retinal examinations on separate patients. A structured questionnaire was used to assess device usability, comfort, diagnostic confidence, ability to identify retinal structures, and System Usability Scale (SUS) scores. Data were analysed using paired t-tests, Fisher's exact test, and chi-square tests.</p><p><strong>Results: </strong>Among the participants, 70% were female and 62.9% were medical students. The mean(SD) time to identify retinal structures was significantly shorter with the HFC (2.8(1.84) minutes) compared to the DO (6.4(5.77) minutes; p<0.001). While red reflex detection was higher with the DO (97.1%), the HFC significantly outperformed in locating key structures: optic nerve (88.6% vs. 42.9%, p<0.001) and fovea (82.9% vs. 41.4%, p<0.001). No significant difference was found in identifying retinal vessels. Confidence in findings (92.9% vs. 32.9%) and image clarity (94.3% vs. 45.7%) favoured the HFC, with both differences being statistically significant (p<0.001). The HFC scored higher in usability with a mean SUS score of 64.0(9.37) versus 58.6(9.91) for the DO (p<0.001). Notably, 97.1% of participants preferred the HFC over the DO.</p><p><strong>Conclusion: </strong>Our findings show that the HFC offers clear advantages over the traditional DO, especially in ease of use, diagnostic confidence, and user experience. These strengths make it a more effective tool in clinical practice and medical education.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 4","pages":"448-453"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754730","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":"Vitamin D status and its association with asthma control and severity in children.","authors":"W M W N Fatin, D Mariana, A L Hasniah","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Vitamin D has an immunomodulatory effect on innate and adaptive immunity within the body, which partially explains its links to inflammation-induced epithelial changes seen in asthma. Various evidence suggest a potential link between vitamin D deficiency and asthma control and severity. This study aimed to determine the vitamin D levels in asthmatic children and their association with asthma severity and control.</p><p><strong>Materials and methods: </strong>A cross-sectional prospective study was conducted on 72 children with persistent asthma aged 5 to 18 years old in a tertiary hospital in Kelantan. Asthma severity was assessed using the Global Initiative for Asthma (GINA) guidelines based on treatment given. Asthma control was evaluated using both parent/patient self-administered Asthma Control Test (ACT) or Children's Asthma Control Test (c-ACT) scores accordingly to their age and asthma control GINA classification. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured, with <52 nmol/L defined as deficient and 52-73 nmol/L as insufficient.</p><p><strong>Results: </strong>Of the 72 children with persistent asthma, 40.3% had vitamin D deficient and 38.9% had vitamin D insufficient with a mean 25(OH)D level of 58.74 nmol/L. Being female, older age group and higher body mass index (BMI) were associated with vitamin D deficiency (p =<0.05). Lower vitamin D levels were significantly associated with increased asthma severity (p =0.020). There was no significant association between vitamin D levels and asthma control based on GINA classification (p =0.470) and c-ACT/ACT scores (p =0.052).</p><p><strong>Conclusion: </strong>High prevalence of vitamin D deficient and insufficient was found among children with persistent asthma. Vitamin D deficiency was significantly associated with increased asthma severity. This group of children needs further evaluation for intervention. We recommend routine assessments of vitamin D levels among children with moderate to severe asthma.</p>","PeriodicalId":39388,"journal":{"name":"Medical Journal of Malaysia","volume":"80 4","pages":"454-461"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754743","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}