Indian Journal of Surgical Oncology最新文献

{"title":"ICG-based Tracheobronchial Fluorescence during Esophagectomy: the Right Questions that Matter.","authors":"Nivedita Sharma, Atul Anand, Dharma Ram Poonia, Jeewan Ram Vishnoi","doi":"10.1007/s13193-025-02522-2","DOIUrl":"10.1007/s13193-025-02522-2","url":null,"abstract":"","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2012-2015"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082353","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":"Outcomes of Rectal Cancer in Young Patients: A Comprehensive Analysis from a Tertiary Cancer Centre in North-East India.","authors":"Jyotiman Nath, Mouchumee Bhattacharyya, Giridharan S, Joydeep Nath, Gaurav Das, Partha Sarathi Roy, Lopamudra Kakoti, Yanpothung Yanthan, Rahul Thakuria, Tapashi Das, Abhinandan Das, Ratnadeep Sharma","doi":"10.1007/s13193-025-02518-y","DOIUrl":"10.1007/s13193-025-02518-y","url":null,"abstract":"<p><p>Rectal cancer in young patients [YRC] is emerging as a significant health concern, especially in low-resource settings like India, where molecular profiling and targeted therapies are not widely accessible. This study aims to evaluate the baseline demographics, clinicopathological characteristics, treatment patterns, survival outcomes, failure patterns, and treatment compliance among rectal cancer patients aged ≤ 40 years. A retrospective analysis was conducted using electronic medical records of YRC patients registered at a tertiary cancer center in Northeast India from January 2020 to December 2022. Of the 214 patients aged ≤ 40 years, 118 with complete clinical data were included. Treatment compliance was assessed, and patients lost to follow-up were contacted telephonically. Those unreachable [<i>n</i> = 4] were excluded from survival analysis. YRC accounted for 26.9% of all rectal cancer cases. Most patients were aged 31-40 years [55.9%], with a male-to-female ratio of 1.8:1. Upfront metastases were seen in 27%, and 31% had poor histological subtypes [signet-ring, mucinous, papillary]. Curative intent therapy was initiated in 70%, but only 44% completed treatment. Non-compliance [39%] was primarily due to disease progression during neoadjuvant therapy. For those completing treatment, median PFS was 46.6 months and median OS was 53.6 months. Palliative therapy yielded a median OS of 11.6 months. The incidence of YRC in our region is notably higher than global estimates. High rates of non-compliance and poor histology underscore the urgent need for resource-adapted, age-specific treatment guidelines and prospective studies focused on this younger population.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at https://doi.org/10.1007/s13193-025-02518-y.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2143-2150"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082359","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":"Robotic versus Thoracoscopic-Assisted Esophagectomy for Esophageal Cancer: Initial Experience Comparing Perioperative Outcomes and CUSUM Learning Curve Analysis.","authors":"Azhar Perwaiz, Archit Gupta, Yashoda Yadav, Meet Desai, Amanjeet Singh, Adarsh Chaudhary","doi":"10.1007/s13193-026-02564-0","DOIUrl":"10.1007/s13193-026-02564-0","url":null,"abstract":"<p><p>Robotic-assisted thoracoscopic surgery (RATS) offers enhanced precision and ergonomics in esophageal cancer surgery compared to video-assisted thoracoscopic surgery (VATS). However, its clinical advantage remains debated, and adoption is limited by financial and learning curve challenges. We conducted a retrospective analysis of 68 patients undergoing transthoracic radical esophagectomy between July 2022 and October 2024 at a high-volume centre. Patients were allocated to RATS (<i>n</i> = 31) or VATS (<i>n</i> = 37) based on preference following informed consent. Demographics, perioperative outcomes, and lymph node yield were compared. The learning curve for RATS was assessed by cumulative sum (CUSUM) analysis of operation time and lymph node yield. Baseline characteristics were similar between groups. The RATS group had a longer operative time (314.8 ± 7.8 min vs. 298.5 ± 15.4 min; <i>p</i> < 0.001) but higher lymph node yield (20.7 ± 7.9 vs. 18.3 ± 6.5; <i>p</i> = 0.038). Postoperative complication rates, readmissions, and mortality were comparable. CUSUM analysis showed proficiency in RATS was achieved at case 16 for operative time and case 14 for lymph node yield. RATS and VATS offer comparable short-term outcomes in transthoracic esophagectomy. RATS enables superior lymphadenectomy with an acceptable learning curve plateauing within 16 cases. Broader adoption remains constrained by financial and accessibility barriers. Further studies evaluating long-term outcomes and cost-effectiveness are warranted.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2210-2216"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13619992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082364","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":"Clinical Characteristics of Prostate Cancer in India: Insights from Hospital-Based Cancer Registries.","authors":"Gunaseelan Karunanidhi, Pooja Sethi, Anita Nath, Kondalli Lakshminarayan Sudarshan, Thilagavathi Ramamoorthy, Abhishek David George, Prashant Mathur","doi":"10.1007/s13193-026-02551-5","DOIUrl":"10.1007/s13193-026-02551-5","url":null,"abstract":"<p><p>To analyse the clinicopathological characteristics of prostate cancer using data from Hospital Based Cancer Registries (HBCRs) under India's National Cancer Registry Programme (NCRP), providing real-world insights into its management across health care institutions despite existing standardised treatment guidelines. We conducted a descriptive analysis of prostate cancer, examining key parameters such as age, diagnostic techniques, primary histological classification (categorised using the ICD -O3), disease stage at presentation(localised, loco regional, or distant metastasis), treatment intent modalities and the time interval between diagnosis and treatment initiation, utilising the data from Hospital Based Cancer Registries(HBCRs). 75.6% of total prostate cancer cases occurred in the age group of 60-80 years. Adenocarcinoma was the most common pathology, constituting 77% of cases. At the time of presentation, 57% of cases were diagnosed with localised (29.9%) or locoregional (27%) cancer, while 43% of patients presented with distant metastasis. Thirty per cent underwent surgical treatment, and 22% received radiation therapy. Systemic therapy was the most common single modality treatment. Our study indicates that over 80% of patients commence treatment within two months of diagnosis, but referral systems and delays in care persist. To address these challenges, the healthcare system must prioritise improving referral efficiency, reducing administrative bottlenecks, enhancing coordination through digital health records, and multidisciplinary tumour boards.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2203-2209"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082265","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 Role of Indocyanine Green Fluorescence Angiography in Reducing Anastomotic Leaks after Esophagectomy - A Comprehensive Meta-Analysis of Comparative Studies.","authors":"Syed Nusrath, Dharma Ram Poonia, Sujith Chyau Patnaik, Subramanyeshwar Rao Thammineedi, Yogesh Vashist","doi":"10.1007/s13193-025-02506-2","DOIUrl":"10.1007/s13193-025-02506-2","url":null,"abstract":"<p><p>Anastomotic leaks (AL) after esophagectomy contribute to significant morbidity (up to 30%) and mortality (5-10%). Indocyanine green (ICG) fluorescence angiography offers real-time perfusion assessment, potentially reducing AL compared to conventional methods. This meta-analysis evaluates ICG's efficacy in reducing AL after esophagectomy with gastric pull-up, focusing on cervical versus intrathoracic anastomoses. This systematic review and meta-analysis followed PRISMA guidelines. A comprehensive search of PubMed and Google Scholar from 2005 to the present was performed using MeSH terms to identify comparative studies of esophagectomy with gastric conduit reconstruction. Study quality was evaluated using the MINORS criteria. Statistical analyses included forest plots, random-effects models, leave-one-out sensitivity analysis, and Trial Sequential Analysis (TSA) to assess robustness. Harbord's test evaluated publication bias of binary outcomes. Fifteen studies (2,263 patients) were included. Overall, ICG significantly reduced odds of AL by 58% (9% vs. 15.5%; OR 0.42, 95% CI: 0.26-0.70; I²=42%), with an absolute risk difference (ARD) of 6.5% (95% CI: 3.3-9.7) and a number needed to treat (NNT) of 15 (10-30). In McKeown esophagectomy (MKE) with cervical anastomosis (10 studies, 1,768 patients), ICG reduced odds of AL by 62% (9.5% vs. 17.0%; OR 0.38, 95% CI: 0.26-0.57; I²=0%), corresponding to an ARD of 7.5% (95% CI: 4.8-10.2) and NNT of 13 (10-21), with TSA and leave-one-out sensitivity analysis confirming robust evidence. In contrast, in Ivor Lewis esophagectomy (ILE) with intrathoracic anastomosis (3 studies, 302 patients), ICG showed no benefit (8.0% vs. 6.9%; OR 1.70, 95% CI: 0.12-25.01; I²=70.6%), with an ARD of - 1.1% (95% CI: -8.0 to + 5.8). ICG fluorescence angiography significantly reduces AL after esophagectomy, particularly in cervical anastomosis after MKE, with a 62% odds reduction. No significant benefit was observed in intrathoracic anastomosis after ILE. These findings support the use of ICG as a valuable tool in cervical anastomosis, while further studies are needed to clarify its role in intrathoracic anastomosis.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2055-2068"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082301","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":"Susceptibility Weighted and Perfusion Imaging for Differentiating Recurrence and Radiation Necrosis in Post-Operative Malignant Brain Tumors: A Retrospective Cohort Study.","authors":"Muhammad Saqlain Mustafa, Hussain Sohail Rangwala, Memoona Khan, Muhammad Ashir Shafique, Janta Devi, Aashish Kumar, Syed Taha Ahmed, Aisha Memon, Mina Shahid, Faiza Riaz, Fatima Mubarak","doi":"10.1007/s13193-025-02513-3","DOIUrl":"10.1007/s13193-025-02513-3","url":null,"abstract":"<p><strong>Background: </strong>Brain tumors present a challenge in oncology, necessitating comprehensive treatment strategies. Despite treatment, recurrence rates, especially in malignant tumors, remain high. Novel therapies have emerged, but treatment-related effects such as pseudo-progression (PsP) and radiation necrosis (RN) complicate diagnosis. Imaging techniques such as perfusion imaging and susceptibility-weighted imaging (SWI) show promise in distinguishing tumor progression from treatment effects. This retrospective study evaluated the effectiveness of these modalities in detecting brain tumours, their progression, and necrosis.</p><p><strong>Methods: </strong>This study was carried out at the Aga Khan University Hospital over a period of 11 years using non-probability retrospective sampling. The inclusion criteria were histopathologically proven brain tumours, complete imaging records, and available medical histories. Data were collected from the hospital's database. Statistical analyses were performed using SPSS v26, employing logistic regression models to assess accuracy.</p><p><strong>Results: </strong>The study included 37 patients with brain tumours, with a near-equal sex distribution. The most affected lobe was the parietal lobe, and glioblastoma was the most prevalent tumour type. Perfusion imaging identified radiation effects in 62.2% of the cases, while SWI showed radiation necrosis in 64.9%. Logistic regression models indicated significant accuracy for both modalities, with combined perfusion and SWI showing higher specificity.</p><p><strong>Conclusions: </strong>Our study highlights the effectiveness of novel MRI techniques, specifically perfusion MRI and SWI MRI, in distinguishing between tumour recurrence and therapy-induced remission in brain tumour patients. These imaging methods offer crucial insights for accurate diagnosis and treatment planning. Despite the study's limitations, including its single-centre design and small sample size, the findings underscore the need for further multi-centre research. Future studies should combine various imaging techniques with machine learning to improve diagnostic accuracy and include longitudinal analyses to assess long-term benefits. Future studies should integrate imaging techniques with machine learning and include longitudinal analyses.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2076-2085"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082115","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":"Awareness and Acceptability of Whole Breast Reconstruction After Mastectomy: A Cross-Sectional Survey Study.","authors":"Rahul Dholariya, Chidananda Murthy Giridhar","doi":"10.1007/s13193-025-02483-6","DOIUrl":"10.1007/s13193-025-02483-6","url":null,"abstract":"<p><p>Breast reconstruction following mastectomy offers significant psychosocial and aesthetic benefits, yet awareness and acceptability remain suboptimal in resource-limited settings. This study aimed to assess awareness, acceptability, and decision-making factors regarding breast reconstruction in women undergoing mastectomy. A descriptive cross-sectional survey was conducted among 148 women who had undergone mastectomy for breast cancer at a tertiary care center in South India. A structured, validated questionnaire assessed demographic data, awareness of reconstruction options, information sources, acceptability rates, decision-making influences, and barriers to reconstruction. Data were analyzed using descriptive statistics, Chi-square tests, and binary logistic regression to identify independent predictors of awareness and acceptability. Only 41.9% of participants were aware of breast reconstruction options before surgery. Awareness was particularly low for flap procedures (29.1%) and implant-based reconstruction (18.2%). Physicians were the primary information source (60%). While 52% were offered reconstruction, only 16% would have considered it. Multivariate analysis revealed that higher education (adjusted OR 2.8, 95% CI: 1.5-5.2, <i>p</i> = 0.001) and surgeon counseling (adjusted OR 4.1, 95% CI: 2.3-7.6, <i>p</i> < 0.001) were independent predictors of awareness. Primary barriers included lack of information (20%), low cosmetic priority (22%), and financial constraints (7%). Significant gaps persist in awareness and acceptability of breast reconstruction among mastectomy patients in resource-limited settings. Comprehensive preoperative counseling, family-inclusive decision-making, and survivor support programs are essential to improve informed decision-making and reconstruction uptake.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2092-2096"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082278","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":"Videofluoroscopic Swallow Study-Guided Management and Assessment of Neopharyngeal Integrity after Total Laryngectomy With or Without Partial Pharyngectomy: Diagnostic Accuracy and Risk Factor Analysis for Pharyngocutaneous Fistula.","authors":"Vikas Gupta, Parag Vasistha, Rajeev Chugh, Gunjan Dwivedi, Kamal Deep Joshi, Pankaj Kumar Sahu, Devendra Kumar Gupta, Himanshu Swami, Varun Jerath, Sanajeet Kumar Singh, Abha Kumari","doi":"10.1007/s13193-026-02535-5","DOIUrl":"10.1007/s13193-026-02535-5","url":null,"abstract":"<p><p>Pharyngocutaneous fistula (PCF) is the most frequent complication after total laryngectomy. Videofluoroscopic swallow study (VFSS) is often used to guide postoperative feeding, but its diagnostic reliability and the relative contribution of nutritional versus surgical risk factors remain uncertain. A prospective observational study was conducted on 30 patients undergoing total laryngectomy with or without partial pharyngectomy between August 2021 and July 2023 at a tertiary referral center. VFSS with Gastrografin was performed on postoperative day (POD) 7 and repeated on POD 14 or 21 if indicated. Diagnostic accuracy of VFSS was calculated against clinically evident PCF. Potential risk factors were analysed using logistic regression. Six patients (20%) developed PCF. VFSS demonstrated a sensitivity of 83.3% (95% CI: 44-97), specificity of 100% (95% CI: 86-100), positive predictive value of 100% (95% CI: 57-100), and negative predictive value of 96% (95% CI: 80-99). Five fistulas were identified on POD 7, while one clinically evident fistula was diagnosed on POD 12 despite a negative VFSS. On multivariable analysis, BMI < 18.5 (OR 12.5, <i>p</i> = 0.042) and serum albumin < 3.0 g/dL (OR 8.7, <i>p</i> = 0.049) independently predicted PCF. Flap reconstruction, margin status, prior treatment, extent of surgical resection and closure technique, though exhibited trend towards formation of PCF, however statistically were not significant predictors. VFSS is highly specific for PCF but insufficiently sensitive to exclude fistula on the basis of a single early study. Staged assessment improves detection of delayed leaks. Nutritional factors, particularly low BMI and hypoalbuminemia, are stronger predictors of PCF than surgical variables. Perioperative care should integrate nutritional optimization and structured VFSS protocols to reduce fistula risk and enable safer initiation of oral feeding.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2133-2142"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082289","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":"Comment on \"Intraoperative Stenting of Hepatic Ducts to Aid Dissection in An 8-Month-Old Child With Large Hepatoblastoma and Severe Porta Distortion\".","authors":"S Dhanya Dedeepya, Vaishali Goel, Nivedita Nikhil Desai","doi":"10.1007/s13193-026-02541-7","DOIUrl":"10.1007/s13193-026-02541-7","url":null,"abstract":"","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2238-2239"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082379","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 Fragility of Significance: Why P-values and the Fragility Index Are Not Enough.","authors":"Mufaddal Kazi","doi":"10.1007/s13193-026-02531-9","DOIUrl":"10.1007/s13193-026-02531-9","url":null,"abstract":"<p><p>The p-value has long been a cornerstone of evidence-based medicine, yet its misuse and misinterpretation are rampant. The Fragility Index (FI), developed to offer a more intuitive measure of statistical robustness, paradoxically penalizes well-designed, efficient clinical trials and remains tethered to the arbitrary <i>p</i> < 0.05 threshold. This commentary argues that both the p-value and the FI are insufficient as they operate within the flawed framework of Null Hypothesis Significance Testing. We propose that a shift towards a Bayesian framework is necessary. Bayesian methods, particularly the use of the Bayes Factor, align more closely with clinical reasoning by providing a direct measure of evidence for a hypothesis, allowing for a more nuanced, probabilistic approach to interpreting research findings and updating clinical beliefs.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2016-2018"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082321","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}