Urology Practice最新文献

{"title":"Osteopathic Medicine Applicants in Urology: Evolving Pathways and Persistent Gaps Post-Merger.","authors":"Kimberly Toumazos, Christopher Svendsen, Katelyn A Spencer, Will Cranford, Christopher McLouth, Amanda F Buchanan","doi":"10.1097/UPJ.0000000000000887","DOIUrl":"10.1097/UPJ.0000000000000887","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000887"},"PeriodicalIF":1.7,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144776429","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":"Same-Day Hospital Discharge Is Feasible for a Variety of Urologic Surgeries When Using a Virtual Hybrid Care Hotel.","authors":"Sarah Hampton, Alan G Perry, Neal Kumar, Alex P Hochwald, Renny Ma, Gregory A Broderick, Chandler Dora, Timothy D Lyon, Raymond W Pak, Steven P Petrou, David D Thiel, Maura Nazario, Ryan Chadha, Ram A Pathak","doi":"10.1097/UPJ.0000000000000879","DOIUrl":"10.1097/UPJ.0000000000000879","url":null,"abstract":"<p><strong>Introduction: </strong>To determine postoperative outcomes of same-day discharge to a patient Care Hotel after select urologic surgeries.</p><p><strong>Methods: </strong>The Care Hotel is a hybrid-care model where patients, who historically would have been admitted, are discharged after surgery. In the Care Hotel, patients have access to an on-call nurse, paramedic team, and virtual access to the Command Center for medical questions or concerns. The primary outcome was 30-day hospital admission rates. Secondary outcomes included Clavien-Dindo complication rate, 48-hour Emergency Department (ED) visit, 30-day ED visit, and unplanned healthcare resource utilization. Other variables collected include demographics, American Society of Anesthesiologists class, procedure type, length of surgery, and patient calls while in the Care Hotel.</p><p><strong>Results: </strong>Of 556 patients who underwent surgery from August 2021 to August 2023, most underwent holmium laser enucleation of the prostate (52%) and robotic-assisted radical prostatectomy (31%). Thirty-day admission rate was 2% and 30-day complication rate was 11%, with a Clavien-Dindo Grade 3 or higher complication rate of 0.2%. Thirty-day ED visit rate was 9%. Admissions, complications, and ED visits were not correlated with patient demographics, American Society of Anesthesiologists class, procedure type, or length of surgery. Three hundred patients (54%) did not make a single phone call to the Command Center.</p><p><strong>Conclusions: </strong>Same-day discharge to the Care Hotel following certain urologic procedures was safe with favorable postoperative outcomes. Patients in the Care Hotel used fewer health resources compared with a hospital stay. The Care Hotel model is a feasible and effective alternative to hospital admission.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000879"},"PeriodicalIF":1.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709425","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":"Robot-Assisted Radical Prostatectomy: The Impact of Patient Positioning and Surgical Access on Intraoperative Anesthesiologic Parameters.","authors":"Matteo Pacini, Luca Lambertini, Nikki R Wilkinson, William B Fox, Ruben Sauer Calvo, Donato Cannoletta, Greta Pettenuzzo, Antony Pellegrino, Giulio Avesani, Juan R Torres Anguiano, Angelo Orsini, Francesco Lasorsa, Andrea Minervini, David B Glick, Petar Antonov, Alessandro Zucchi, Riccardo Bartoletti, Simone Crivellaro","doi":"10.1097/UPJ.0000000000000877","DOIUrl":"10.1097/UPJ.0000000000000877","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate the role of supine extraperitoneal single-port radical prostatectomy on intraoperative ventilatory and cardiovascular parameters and on surgical outcomes compared with a cohort of patients treated with the Trendelenburg-associated transperitoneal approach.</p><p><strong>Methods: </strong>Data from all consecutive patients who underwent radical prostatectomy between September 2019 and January 2024 were prospectively collected and retrospectively analyzed. Patients were divided into 2 groups based on the surgical approach: single-port supine extraperitoneal (SP-EP-RARP) and multi-port or single-port transperitoneal (MP-TP-RARP or SP-TP-RARP) radical prostatectomy. Intraoperative ventilatory and cardiovascular parameters were collected from anesthesia induction to the end of the procedure, and perioperative surgical outcomes were assessed.</p><p><strong>Results: </strong>A total of 211 patients who underwent robot-assisted radical prostatectomy were analyzed: 97 (46%) underwent MP-TP-RARP or SP-TP-RARP, whereas 114 (54%) underwent SP-EP-RARP. The median peak inspiratory pressure and end-tidal CO₂ were significantly lower throughout the surgery in the SP-EP-RARP group (<i>P</i> < .001 and <i>P</i> = .02). Similar results were found for median systolic and diastolic blood pressure. SP-EP-RARP was associated with lower postoperative pain, fewer narcotic administrations, shorter length of stay, and fewer postoperative complications. After adjusting for age, American Society of Anesthesiologists score, and Charlson Comorbidity Index, the TP approach was found to be an independent risk factor for complications.</p><p><strong>Conclusions: </strong>The supine SP-EP approach improved intraoperative ventilatory and cardiovascular outcomes, reducing postoperative pain, length of stay, and complications. This finding is constrained by the retrospective design and the involvement of 4 surgeons with differing experience. Notably, the surgeon with the highest volume was also the sole user of the SP-EP approach, introducing biases.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000877"},"PeriodicalIF":1.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709422","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":"Less Is More: Going Green in Urological Procedures.","authors":"Nicholas Choi, Danica May, Dane Stephens, Eugene Lee","doi":"10.1097/UPJ.0000000000000876","DOIUrl":"10.1097/UPJ.0000000000000876","url":null,"abstract":"<p><strong>Introduction: </strong>Operating rooms produce significant waste that is disproportionate compared with other departments within health care systems. In this pilot study, we aim to quantify the recyclable and nonrecyclable waste generated by urologic procedures at our institution, as well as survey other urologists' recycling practices.</p><p><strong>Methods: </strong>Data were collected from January 2022 to October 2024 for 5 urologic procedures: ureteral stent exchange, ureteroscopy and laser lithotripsy for stone removal, percutaneous nephrolithotomy, robotic-assisted radical prostatectomy, and radical cystectomy. Weight was collected before start of case and at completion and categorized into 2 groups: nonrecyclable solid waste and combined recyclable material. Each procedure had weights collected in 3 separate cases. To survey other hospital's recycling, a nonvalidated 11-question survey on recycling practices was sent to urologists within the 8 AUA sections.</p><p><strong>Results: </strong>The average total waste weight in kg (nonrecyclable solid waste/recyclable waste) included: stent exchange: 1.87/1.2, ureteroscopy and laser lithotripsy for stone removal: 3.7/1.0, percutaneous nephrolithotomy: 6.5/1.65, robotic-assisted radical prostatectomy: 11.3/2.97, and radical cystectomy: 11.69/2.67. We received 30 responses to our survey covering all 8 AUA sections. Fourteen of 34 (41.2%) academic hospitals had recycling in the OR vs 6 of 21 (28.6%) community hospitals; 38.8% felt knowledgeable of the items to recycle and 11.1% received proper training on recycling in the OR.</p><p><strong>Conclusions: </strong>This pilot study highlights the waste generated in urology operating rooms, with a significant proportion that is recyclable. This presents an opportunity for intervention with recycling initiatives in the operating room.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000876"},"PeriodicalIF":1.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709421","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":"Urologists Self-Report Rates of Postprostatectomy Incontinence and Referral Patterns for Treatment.","authors":"Annie Chen, Laura Oscar-Thompson, Kuemin Hwang, Austen Te, Raj Satkunasivam, Kathleen Kobashi, Ricardo R Gonzalez","doi":"10.1097/UPJ.0000000000000880","DOIUrl":"10.1097/UPJ.0000000000000880","url":null,"abstract":"<p><strong>Introduction: </strong>Rates of incontinence after prostate treatment, more specifically postprostatectomy incontinence (PPI), in patients who undergo radical prostatectomy (RP) are highly variable. Appropriate management is contingent on the surgeon's perception of necessity. There is no published literature regarding how surgeons perceive their own PPI rates.</p><p><strong>Methods: </strong>A 22-question survey hosted by Google Forms was developed to query RP surgeon perceptions, demographics, practice patterns, operative techniques, and outcomes and disseminated through social media, alumni mailing lists, and word-of-mouth.</p><p><strong>Results: </strong>Ninety-three responses were included. Most (74%) did not perform anti-incontinence procedures and refer < 6% for surgical evaluation. A greater proportion (62%) of RP surgeons refer at least 50% of their patients with bothersome PPI to pelvic floor physical therapy (PFPT). A higher perceived bothersome PPI rate correlated with lower rates of referral to other urologists and lower referral rates to PFPT. Many urologists referred to fellowship-trained PPI surgeons (83%). The most important factors associated with referral were number of pads (83%), perceived favorable outcomes (80%), and comfort with the other urologist (66%).</p><p><strong>Conclusions: </strong>RP surgeons contribute to the undertreatment of PPI and perceived their PPI rates at levels less than published literature. Most RP surgeons do not perform PPI procedures. They refer less than 10% of bothered patients for surgical evaluation and less than half of bothered patients for PFPT. Strategies to address surgeon-specific factors that contribute to this problem include surgeon recognition of the issue, education on guideline recommendations, standardizing reports of bother, access to trained surgeons who can perform anti-incontinence procedures, and access to PFPT.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000880"},"PeriodicalIF":1.7,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709426","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":"Engaging Black Women in Stress Urinary Incontinence Research Prioritization Through Intentional Recruitment and Alliance With Community Partners.","authors":"Rachel A Pozzar, Shazia Rangwala, Shenelle N Wilson, Donna Y Deng, Donna L Berry, Una J Lee","doi":"10.1097/UPJ.0000000000000857","DOIUrl":"https://doi.org/10.1097/UPJ.0000000000000857","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the disproportionate impact of stress urinary incontinence (SUI) on Black women and their underrepresentation in research, strategies for effectively engaging Black women remain underexplored. Here, we share insights gained from a Patient-Centered Outcomes Research Institute-funded patient engagement project on SUI in which increasing racial diversity of participants was prioritized and achieved.</p><p><strong>Methods: </strong>A multiphase patient and stakeholder engagement project, conducted from June 2021 to November 2023, sought to train SUI patient partners and identify patient-generated priorities for research. Collaborating with community partners, purposeful recruitment strategies targeting Black women were employed. Key activities included surveying patient experiences, educational video training, and research prioritization surveys, all facilitated virtually.</p><p><strong>Results: </strong>Initial crowdsourcing revealed low representation of Black women (6%). Collaboration with Black Health Matters increased representation in subsequent phases (ranging from 18% to 40%). Of the trained patient partners, 24% identified as Black. Ultimately, 16% of respondents to the research prioritization survey were Black. Collaborative efforts, including the dissemination of newsletter articles through Black Health Matters channels, significantly contributed to increased participation among Black women.</p><p><strong>Conclusions: </strong>Intentional and collaborative outreach efforts, emphasizing education, trust-building, and transparency, successfully increased representation of Black women in SUI-related patient engagement activities. The involvement of community organizations, clinicians, and patients was crucial in ensuring diverse representation and amplifying underrepresented voices in research prioritization efforts. This collaborative approach can serve as a model for enhancing racial diversity in patient engagement initiatives across health care research domains.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000857"},"PeriodicalIF":0.8,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709420","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":"Adverse Cardiovascular Outcomes of Individuals Treated With Androgen Deprivation Therapy.","authors":"Eric V Li, Austin Y Ho, Richard Bennett, Jonathan Aguiar, Clarissa Wong, Chalairat Suk-Ouichai, Sai Kaushik Shankar Ramesh Kumar, Zequn Sun, Clayton Neill, Yutai Li, Edward M Schaeffer, Alicia K Morgans, Hiten D Patel, Ashley E Ross","doi":"10.1097/UPJ.0000000000000878","DOIUrl":"10.1097/UPJ.0000000000000878","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular management of patients who receive androgen deprivation therapy (ADT) is evolving as new medications and practice patterns emerge. We sought to identify factors associated with treatment onset major adverse cardiovascular events (MACE) among patients undergoing ADT.</p><p><strong>Methods: </strong>This was a retrospective cohort of patients at a multicenter academic institution prescribed pharmacologic ADT from January 2018 to March 2024. Patients using leuprolide or degarelix were stratified into pre-relugolix (January 2018-November 2020) and post-relugolix (December 2020-March 2024) eras. MACE was defined as myocardial infarction, stroke, or cardiovascular-associated death.</p><p><strong>Results: </strong>One thousand one hundred twenty-eight and 1398 patients were prescribed leuprolide pre-relugolix and post-relugolix, respectively. Eighty patients were prescribed degarelix, and 367 patients were prescribed relugolix. The incidence of treatment onset MACE in the pre-relugolix era was 5.4% and 8.3% for leuprolide and degarelix, respectively. Incidence in the post-relugolix era was 2.3%, 3.6%, and 2.1% for leuprolide, degarelix, and relugolix, respectively. Higher Charlson Comorbidity Index (HR = 1.12, CI = 1.06-1.18, <i>P</i> < .001) and prior MACE (HR = 5.32, CI = 3.36-8.42, <i>P</i> < .001) were associated with increased risk of treatment onset MACE. While patients with a history of previous MACE were more likely to be managed by cardiology while receiving ADT (55% vs 23%, <i>P</i> < .001), 27% lacked care from cardiology or primary care during therapy and received cardioprotective therapies.</p><p><strong>Conclusions: </strong>A history of heart attack or stroke is significantly associated with increased risk of MACE after initiating ADT. Relugolix was not associated with lower risk of MACE in our analysis. Strategies to optimize the cardiovascular management of patients receiving ADT are needed.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000878"},"PeriodicalIF":1.7,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144664021","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":"Mortality and Causes of Death in Boys and Men Born With Hypospadias: A Swedish Population-Based Cohort Study.","authors":"Lottie Phillips, Giorgio Tettamanti, Ann Nordgren, Anna Skarin Nordenvall, Agneta Nordenskjöld","doi":"10.1097/UPJ.0000000000000860","DOIUrl":"10.1097/UPJ.0000000000000860","url":null,"abstract":"<p><strong>Introduction: </strong>Although hypospadias is not a life-threatening condition, studies have found perinatal factors and comorbidities which could increase mortality. We aimed to investigate mortality and causes of death in boys and men born with hypospadias.</p><p><strong>Methods: </strong>We created a cohort of almost 3 million individuals including 16,890 with hypospadias using Swedish registers. We used Cox regression analysis to measure associations between hypospadias and all-cause mortality in different age groups (maximum age 65 years) as well as cause-specific mortality in adolescents and adults.</p><p><strong>Results: </strong>We found associations between hypospadias and mortality in infancy (HR 2.07, 95% CI: 1.74-2.45), childhood (HR 1.77, CI: 1.34-2.33), and adolescence and adulthood (HR 1.31, CI: 1.11-1.56), with stronger associations for proximal hypospadias. Controlling for birth weight and congenital comorbidity significantly reduced the association in infancy. The association was lower in younger adults (HR 1.22, CI: 1.00-1.50) but increased again after age 35 years (HR 1.57, CI: 1.17-2.11). We found a significant association with death due to cardiovascular disease or diabetes (HR 3.20, CI: 1.93-5.32) and kidney or urological disease (HR 5.16, CI: 2.13-12.5), but not cancer overall, suicide, or accidents.</p><p><strong>Conclusions: </strong>While mortality overall was low, hypospadias is associated with relatively increased mortality from infancy to middle age. In early childhood, this is related to prenatal and perinatal factors. In adolescence and adulthood, the risk of death due to cardiovascular and urological disease was increased, providing further insight into long-term health in this patient group.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000860"},"PeriodicalIF":1.7,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477219","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":"Development and Utilization of a Novel Electronic Health Record-Based Care Pathway for Nonmuscle Invasive Bladder Cancer.","authors":"Shayan Smani, Soum D Lokeshwar, Michael Jalfon, Dylan Heckscher, Benjamin H Press, Daniel Heacock, Michael S Leapman, Patrick Kenney, Fady Ghali","doi":"10.1097/UPJ.0000000000000872","DOIUrl":"10.1097/UPJ.0000000000000872","url":null,"abstract":"<p><strong>Introduction: </strong>Adherence to clinical practice guidelines for NMIBC remains suboptimal. We aimed to develop an electronic health record (EHR)-integrated intervention to improve compliance with clinical guidelines for the management of NMIBC.</p><p><strong>Methods: </strong>We designed an EHR-integrated intervention within the Epic EHR (Epic Systems) based on the AUA NMIBC pathways. Our multidisciplinary group created 4 pathways for the clinical management of NMIBC: Evaluation and Staging, Low and Intermediate Risk, High and Very High Risk, and Persistent or Recurrent Disease. Adoption was encouraged through a communication strategy including newsletters, site visits, and CME-accredited meetings.</p><p><strong>Results: </strong>From October 2021 to May 2024, the Care Pathway was used 412 times across various encounter types, including procedural, office-based, and telemedicine visits, involving 253 patients (mean age: 70 years). Self-pay (84; 33.2%) and Medicare (66; 26.1%) were the most common payer type. Sixty-eight providers used the pathway, most commonly by MDs (38; 55.9%) and RNs (14; 20.6%). The pathway was used primarily in the urology specialty (28; 41.8%), but utilization also occurred in the primary care setting. The initial staging and treatment of low and intermediate risk pathway was the most used CarePathway (150; 36.4%).</p><p><strong>Conclusions: </strong>The EHR-integrated intervention was designed to improve adherence to AUA NMIBC guidelines across diverse clinical scenarios and was adopted by providers with varying expertise. This pathway could improve standardized care delivery and reduce practice variability in NMIBC management. Further evaluation of its long-term impact on clinical outcomes is warranted.</p>","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000872"},"PeriodicalIF":0.8,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601859","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":"Differences in the Use and Quality of Active Surveillance for Prostate Cancer Among Men Insured by Medicaid.","authors":"Arnav Srivastava, Stephanie Daignault-Newton, Sabir Meah, Kassem Faraj, Kevin Ginsburg, Firas Abdollah, Corinne Labardee, Anna Johnson, Alice Semerjian, Keow Mei Goh, Brent Hollenbeck, Vahakn Shahinian, Lindsey Herrel, Tudor Borza","doi":"10.1097/UPJ.0000000000000873","DOIUrl":"10.1097/UPJ.0000000000000873","url":null,"abstract":"","PeriodicalId":45220,"journal":{"name":"Urology Practice","volume":" ","pages":"101097UPJ0000000000000873"},"PeriodicalIF":1.7,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12324826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601860","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}