Facts Views and Vision in ObGyn最新文献

{"title":"Complications, recurrence, and survival rates for endometrial and cervical cancer treated by minimally invasive surgery: a systematic review and meta-analysis of randomised controlled trials.","authors":"Theodoros D Theodoridis, Christos-Georgios Kontovazainitis, Ramon Rovira Negre, Istvan Argay, Gabriele Centini, Stavros Karampelas, Marcus Wallwiener, Federica Campolo, Susana Maia, Ursula Catena, Helder Ferreira","doi":"10.52054/FVVO.2026.220","DOIUrl":"https://doi.org/10.52054/FVVO.2026.220","url":null,"abstract":"<p><strong>Background: </strong>Consensus is lacking regarding the relative safety and oncological outcomes of minimally invasive compared to abdominal hysterectomy.</p><p><strong>Objectives: </strong>To estimate complications and survival rates of minimally invasive hysterectomy (i.e., laparoscopic or robotic assisted) compared to total abdominal hysterectomy for endometrial and cervical cancer.</p><p><strong>Methods: </strong>A systematic quantitative review of randomised controlled trials (RCTs) comparing minimally invasive hysterectomy with total abdominal hysterectomy (TAH) for the treatment of endometrial or cervical cancer. Medline-PubMed, Cochrane Library, Scopus, ongoing clinical trials and the grey literature were searched until December 1, 2024.</p><p><strong>Main outcome measures: </strong>Complications, overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates.</p><p><strong>Results: </strong>Twenty-nine RCTs enrolling 6127 patients were included. The risk of bladder injury was higher in the minimally invasive hysterectomy group [risk ratio (RR): 1.84, 95% confidence interval: (CI): 1.03-3.29, I²: 0%), as was the risk of vaginal injury (RR: 12.39, 95% CI: 1.61-95.29, <i>P</i>=0.02, I²: 0%) but the risk of wound dehiscence was lower (RR: 0.32, 95% CI: 0.13-0.83, <i>P</i>=0.02, I²: 13%) compared to abdominal hysterectomy. Among cervical cancer patients, the risk for blood transfusion was significantly lower with the minimally invasive hysterectomy (RR: 0.42, 95% CI: 0.21-0.84, <i>P</i>=0.01, I²: 0%). Among endometrial cancer patients, the OS, DFS, and DSS were comparable between routes of hysterectomy. In contrast, the overall the OS and DFS rates were lower for minimally invasive compared to abdominal hysterectomy (0.94, 95% CI: 0.90-0.98, <i>P</i>=0.005, I²:0 %) and (0.89, 95% CI: 0.84-0.94, <i>P</i><0.001, I²: 0%) respectively.</p><p><strong>Conclusions: </strong>Bladder and vaginal injuries are higher with minimally invasive compared to abdominal hysterectomy. Survival rates for endometrial cancer are comparable but for cervical cancer, minimally invasive hysterectomy is associated with poorer survival outcomes and this should be taken into account when counselling patients and deciding upon the route of hysterectomy.</p><p><strong>What is new?: </strong>TAH has superior survival outcomes compared to minimally invasive hysterectomy.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867171","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-guided TVT placement after prior colpo-suspension.","authors":"Anna Pitsillidi, Laura Vona, Günter Karl Noé","doi":"10.52054/FVVO.2026.462","DOIUrl":"https://doi.org/10.52054/FVVO.2026.462","url":null,"abstract":"<p><strong>Background: </strong>Previous retropubic surgery, such as laparoscopic Burch colpo-suspension, can significantly alter the anatomy of the space of Retzius due to fibrosis and scarring. These changes increase the technical difficulty and risk of complications during subsequent retropubic procedures, particularly midurethral sling placement.</p><p><strong>Objectives: </strong>To demonstrate the feasibility and safety of laparoscopic-assisted tension-free vaginal tape (TVT) placement in a patient with recurrent stress urinary incontinence (SUI) following prior colpo-suspension.</p><p><strong>Participant: </strong>A 74-year-old woman with recurrent stress urinary incontinence following laparoscopic Burch colpo-suspension performed five years previously.</p><p><strong>Intervention: </strong>Retropubic TVT placement was performed under simultaneous laparoscopic guidance at a tertiary gynaecological centre. Intraoperative laparoscopy enabled visualisation of the retropubic space, revealing significant fibrosis and distorted anatomy. Needle passage and sling positioning were performed under direct visualisation. Because extensive retropubic dissection reduced the usual tissue support of the tape, it was temporarily secured with a rapidly absorbable suture to maintain its position without increasing suburethral tension.</p><p><strong>Conclusions: </strong>Laparoscopic-assisted TVT placement is a feasible and safe approach in patients with prior retropubic surgery. Direct visualisation allows identification of altered anatomical planes, facilitating controlled needle passage and potentially reducing the risk of complications.</p><p><strong>What is new?: </strong>This video demonstrates the importance of avoiding blind needle insertion in patients with prior colposuspension and highlights laparoscopic guidance as a valuable strategy to improve safety during retropubic sling procedures.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867208","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":"Proposals for the #Enzian addendum and update: an international expert survey for item generation.","authors":"Milena Petrovic, Jörg Keckstein, Mohamed Mabrouk, Ertan Saridogan, Mario Malzoni, Gernot Hudelist","doi":"10.52054/FVVO.2026.359","DOIUrl":"https://doi.org/10.52054/FVVO.2026.359","url":null,"abstract":"<p><strong>Background: </strong>Accurate and standardised characterisation of endometriosis extent is essential for patient counselling regarding pain and fertility outcomes, surgical planning, multidisciplinary communication, and clinical research. The Enzian classification has been applied in Central Europe for over two decades, while the updated #Enzian classification, published in 2021, has subsequently gained broader international acceptance.</p><p><strong>Objectives: </strong>To evaluate international expert perspectives and generate potential items informing updates to selected compartments of the #Enzian classification.</p><p><strong>Methods: </strong>Twenty-six internationally recognised experts in endometriosis surgery, imaging, and reproductive medicine were invited to participate in a structured survey. The electronic questionnaire comprised 29 single-choice and open-ended items addressing five #Enzian compartments: T (tuboovarian condition), B (sacrouterine ligaments, cardinal ligaments, pelvic sidewall), C (rectum), FB (bladder), and FA (adenomyosis). Responses were collected anonymously, analysed descriptively, and thematically grouped. Consensus thresholds followed established criteria.</p><p><strong>Main outcome measures: </strong>Expert perspectives regarding the need for revision of selected #Enzian compartments and proposed modifications.</p><p><strong>Results: </strong>Twenty-three experts responded (88.5%). Strong agreement for revision was observed for compartments B, C, and FB (>80%). Moderate agreement (>60%) supported updates to compartments T and FA. Specific suggested refinements included adding the suffix d within compartment T to reflect tubal dilatation (73.9% in favour) and the suffix P within compartment B to denote pelvic sidewall/parametrial involvement (78.3% in favour). For colorectal disease (compartment C), respondents supported reporting lesion-anal verge distance and multifocality. A graded FA1-FA3 system for adenomyosis was favoured (73.9%). Opinions regarding descriptors of bladder endometriosis were heterogeneous.</p><p><strong>Conclusions: </strong>Experts identified clear priorities for refining the #Enzian classification, particularly regarding parametrial involvement, colorectal deep endometriosis and adenomyosis extent. These findings could provide a structured framework to inform subsequent Delphi consensus rounds.</p><p><strong>What is new?: </strong>The study identifies international expert-agreed priorities for refinement of selected #Enzian classification compartments.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632282","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":"Robotic ureteral reimplantation for endometriosis: the Lich-Gregoir technique. A step-by-step approach.","authors":"Diego Raimondo, Gabriele Centini, Daniele Neola, Matteo Giorgi, Roberto Palermo, Enrico Pazzaglia, Errico Zupi, Renato Seracchioli","doi":"10.52054/FVVO.2026.334","DOIUrl":"10.52054/FVVO.2026.334","url":null,"abstract":"<p><strong>Background: </strong>Urinary tract endometriosis affects fewer than 6% of patients with endometriosis, with ureteral involvement representing the second most common site of disease (9-23%). The condition is often asymptomatic, which may result in silent loss of renal function. Surgical intervention is required in cases of ureteral obstruction. Ureteroneocystostomy is indicated for distal ureteral disease, particularly when ureterolysis is insufficient or vascular compromise is present. The Lich-Gregoir technique is an extravesical approach to ureteral reimplantation into the bladder.</p><p><strong>Objectives: </strong>To present a step-by-step demonstration of robot-assisted ureteral reimplantation using the Lich-Gregoir technique following excision of a parametrial and vaginal endometriosis nodule.</p><p><strong>Participant: </strong>A 47-year-old nulliparous woman presented with dysuria, deep dyspareunia, and dyschezia. Imaging revealed a left parametrial endometriosis nodule extending to the vagina, causing distal ureteral obstruction and grade III hydronephrosis.</p><p><strong>Intervention: </strong>This narrated video demonstrates the surgical management of severe ureteral endometriosis, including ureterolysis, safe nodule excision, and ureteral reimplantation using the Lich-Gregoir technique. Reimplantation was preferred to segmental resection or ureterolysis due to distal stenosis, proximity to the bladder, and the depth of disease infiltration. The patient remained asymptomatic at follow-up visits at 1 and 6 months. Retrograde cystography performed 3 weeks postoperatively showed no leakage.</p><p><strong>Conclusions: </strong>Robot-assisted Lich-Gregoir ureteral reimplantation represents a feasible and reproducible option for distal ureteral endometriosis. The robotic platform may facilitate precise and complex reconstructive procedures.</p><p><strong>What is new?: </strong>The case illustrates the role of robotic surgery in complex pelvic endometriosis, demonstrates the feasibility of integrating ureteroneocystostomy with simultaneous excision of parametrial and vaginal endometriosis.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":"151-152"},"PeriodicalIF":1.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Buddy operating in gynaecological endoscopy: what should this model of surgical practice look like?","authors":"Lina Antoun, T Justin Clark","doi":"10.52054/FVVO.2026.414","DOIUrl":"10.52054/FVVO.2026.414","url":null,"abstract":"<p><p>\"Buddy operating\" is a subtype of dual operating described in the Clark model, where two surgeons of comparable proficiency collaborate during complex procedures. Potential benefits include improved surgical efficacy and safety, shared intraoperative decision making, enhanced skill development, and improved surgeon wellbeing. However, implementation must be justified given resource constraints and potential impacts on surgical training. We propose that buddy operating should be selectively applied to clearly defined complex cases, supported by governance frameworks, structured protocols, and outcome monitoring. Importantly, buddy operating must be distinguished from supervisory training. Future research should evaluate its effects on clinical outcomes, cost-effectiveness, surgeon health, and access to training opportunities.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":"81-84"},"PeriodicalIF":1.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate volume reduction following transvaginal ultrasound-guided thermal ablation (interstitial myolysis) of a symptomatic uterine fibroid.","authors":"Antonio La Marca, Christian Battipaglia, Nunzia Del Villano, Sara Verra, Maria Longo","doi":"10.52054/FVVO.2026.361","DOIUrl":"10.52054/FVVO.2026.361","url":null,"abstract":"<p><strong>Background: </strong>Interstitial thermal ablation represents a uterine-sparing alternative for symptomatic fibroid management. Transvaginal ultrasound-guided myolysis enables precise targeting and real-time monitoring of the ablation zone.</p><p><strong>Objectives: </strong>To illustrate the feasibility and immediate intraoperative response of transvaginal ultrasound-guided interstitial myolysis for the treatment of uterine fibroids.</p><p><strong>Participant: </strong>A 36-year-old multiparous woman with persistent abnormal uterine bleeding and pelvic pain related to a known uterine fibroid seeking a uterus-preserving treatment. Previous treatments, including levonorgestrel-releasing intrauterine system and oral therapy with relugolix, estradiol, and norethisterone had failed.</p><p><strong>Intervention: </strong>Transvaginal ultrasound revealed a retroverted, enlarged uterus with a posterior type 2-5 fibroid measuring 45×37×49 mm (volume: 42.4 cm³). Under conscious sedation, a 16G-27 cm microwave antenna was transvaginally inserted and repositioned within the fibroid under continuous ultrasound guidance. Ablation was delivered in four cycles at 20 W for a total duration of 194 seconds, with a cumulative net energy delivered of 3.3 kJ calculated by the device, while continuously assessing safety margins and tissue response. Immediate ultrasound evaluation showed a 42.7% volume reduction (from 42.4 to 24.3 cm³), loss of fibroid definition, and partial collapse, consistent with effective devascularisation. No complications occurred, and the patient was discharged the same day. At 4-month follow-up, fibroid volume reduction was sustained (41.7%), with complete symptom control under the previously ineffective hormonal therapy.</p><p><strong>Conclusions: </strong>Transvaginal interstitial myolysis offers a minimally invasive, uterine-sparing treatment option for selected patients with symptomatic fibroids. Real-time ultrasound monitoring enables precise ablation and immediate confirmation of treatment efficacy.</p><p><strong>What is new?: </strong>This video documents the immediate volumetric response of a uterine fibroid following transvaginal ultrasound-guided myolysis.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 2","pages":"153-154"},"PeriodicalIF":1.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retained intrauterine devices and abdominal actinomycosis, diagnostic challenges from a case series.","authors":"Nadica Nakev Nikolova, Guldzhan Vorona, Ismail El-Kharbotly, Chetan Parmar, Manikandan Kathirvel","doi":"10.52054/FVVO.2026.329","DOIUrl":"10.52054/FVVO.2026.329","url":null,"abstract":"<p><p>Abdominal actinomycosis is an uncommon infection that may mimic malignancy or inflammatory bowel disease, leading to delayed diagnosis. Retained intrauterine devices (IUDs) have been associated with pelvic and abdominal actinomycosis. We report four women with prolonged IUD use presenting with non-specific abdominal symptoms and varied radiological findings, including abdominal wall, pelvic and hepatic abscesses. Diagnosis was supported by microbiological and/or histopathological findings. Management included IUD removal, prolonged antibiotic therapy and, in one case, surgery. These cases highlight the diagnostic challenges of abdominal actinomycosis and the importance of considering the diagnosis in women with long-term IUD use.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 2","pages":"135-140"},"PeriodicalIF":1.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Pocket sign\" on hysterosalpingography: an adjunctive imaging finding suggestive of caesarean isthmocele.","authors":"Emre Göksan Pabuccu","doi":"10.52054/FVVO.2026.374","DOIUrl":"10.52054/FVVO.2026.374","url":null,"abstract":"<p><p>Caesarean scar defects, known as isthmocele, are increasingly recognized in women with secondary infertility, yet hysterosalpingographic (HSG) criteria remain poorly defined. We describe a reproducible HSG feature, the \"pocket sign,\" observed in seven women with prior caesarean delivery. This finding appears as contrast pooling in the anterior lower uterine segment near the internal cervical os. In all cases, it correlated with transvaginal ultrasound and hysteroscopic findings. Although non-specific and not diagnostic, the pocket sign may serve as an adjunctive indicator prompting further evaluation. Given anatomical variability and intrinsic limitations of HSG, multimodal imaging remains essential.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":"18 2","pages":"122-124"},"PeriodicalIF":1.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148296733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-uterine use of a Foley balloon catheter to tamponade an actively bleeding post-traumatic uterine arteriovenous shunt.","authors":"Kobe Dewilde, Brenda Somers, Judit Decoene, Thierry Van den Bosch","doi":"10.52054/FVVO.2026.357","DOIUrl":"10.52054/FVVO.2026.357","url":null,"abstract":"<p><p>Arteriovenous shunts (AV-shunts) whilst rare, can complicate intrauterine surgical procedures leading to severe vaginal bleeding. We present the case of a 29-year-old woman who experienced sudden, torrential vaginal bleeding 10 days following a hysteroscopic resection and curettage of a placental remnant after vaginal delivery. Ultrasonographic evaluation with power doppler demonstrated a post-traumatic AV-shunt. Tamponading the shunt for 36 hours utilising an intra-uterine inflated Foley catheter successfully controlled the bleeding and led to complete resolution of the AV-shunt. Accurately differentiating an AV-shunt from other hyper vascular entities, such as enhanced myometrial vascularity or arteriovenous malformations, is essential, due to the important differences in therapeutic management strategies.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":"141-146"},"PeriodicalIF":1.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148165078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Four-Clamp Technique for primary laparoscopic access in morbidly obese patients: a retrospective cohort study.","authors":"Murat Api, Esra Keles, Uğur Kemal Öztürk, Damlanur Yücel, Fatih Şanlıkan, Özge Nur Gülen, Ümmügülsüm Kuyucu, İsmail Bağlar","doi":"10.52054/FVVO.2026.312","DOIUrl":"10.52054/FVVO.2026.312","url":null,"abstract":"<p><p>This retrospective, single-centre cohort study evaluated the Four-Clamp Technique for primary laparoscopic access in 45 morbidly obese women (body mass index ≥40 kg/m2) undergoing gynaecological procedures at a tertiary centre between January 2015 and August 2025. The technique utilised four symmetrically positioned towel clamps to allow omnidirectional traction to achieve stable abdominal wall elevation before direct trocar insertion. First-attempt success was achieved in 39 (86.7%) of patients, with overall success in 42 (93.3%) women. No major vascular or visceral injuries occurred. Ten (22.2%) minor complications occurred: trocar-site or clamp-site bleeding (4, 8.9%), minor omental injury (3, 6.6%), subcutaneous emphysema (2, 4.4%), and extraperitoneal insufflation (1, 2.2%). Mean time to intraperitoneal access was 74±18 seconds. Target intra-abdominal pressure was maintained at 12-14 mmHg. The Four-Clamp Technique may represent a feasible and reproducible method for primary laparoscopic access in morbidly obese patients in this single-centre cohort; however, prospective comparative studies are warranted to confirm these preliminary findings.</p>","PeriodicalId":46400,"journal":{"name":"Facts Views and Vision in ObGyn","volume":" ","pages":"125-134"},"PeriodicalIF":1.5,"publicationDate":"2026-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13285351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147976381","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}