Indian Journal of Surgical Oncology最新文献

{"title":"Can Intraoperative Analysis of Sentinel Lymph Nodes be Abandoned in Early-stage Breast Cancer?","authors":"Ogün Aydoğan, Erdem Barış Cartı, Muhammed Çağrı Coşkun, Ulaş Utku Şekerci, Akay Edizsoy","doi":"10.1007/s13193-025-02520-4","DOIUrl":"10.1007/s13193-025-02520-4","url":null,"abstract":"<p><p>After the ACOSOG Z0011 study, the rate of axillary dissection(AD) decreased in patients undergoing breast-conserving surgery(BCS). With the expansion of AD criteria in patients undergoing mastectomy in the NCCN 2025 guideline, intraoperative frozen section(iFS) analysis in early-stage breast cancer has become controversial. This study aims to evaluate the feasibility of iFS analysis in patients with early-stage breast cancer and the adequacy of only permanent section analysis. iFS analysis was performed on 187 patients with node-negative early-stage breast cancer between March 2022 and December 2024. Clinically and radiologically node-negative T1-2 tumors with sentinel lymph node biopsy were included. Clinicopathological data of patients who underwent mastectomy and BCS were analyzed. Sentinel lymph node involvement rates and reoperation rates prevented by iFS analysis were reported. Of 187 patients with early-stage breast cancer, 64 underwent mastectomy and 123 underwent BCS with sentinel lymph node biopsy. Sentinel lymph node metastases were detected in 18.7% of the patients. More than two nodal metastases were detected in two of 187 patients (1.1%). More than two nodal metastases were not detected in patients who underwent mastectomy. Intraoperative frozen section analysis prevented reoperation for AD in 1.1% of all patients. The false-negative rate of iFS was 2.1%. No significant difference was detected between the AD rates between the two groups (<i>p</i> = 0.547). In early-stage breast cancer patients with clinically negative axillary nodes, the benefit of iFS appears limited, selective rather than routine use of iFS may be appropriate and permanent section evaluation alone may be sufficient in most cases. Our findings may help avoid iFS analysis.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2086-2091"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082254","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":"Retrosternal Goitre with Retrotracheal Extension.","authors":"Richa Todi, Thaufeeq Ali Ahmed, Rakesh Kumar, M Sarthak Swarup","doi":"10.1007/s13193-026-02558-y","DOIUrl":"10.1007/s13193-026-02558-y","url":null,"abstract":"<p><p>Although retrosternal extension of goitre is reported in approximately 5-20% of patients with thyroid enlargement, true retrotracheal extension is extremely rare and seldom reported. Awareness of this configuration is essential for preoperative planning and safe surgical management. We describe a 52-year-old woman with recurrent multinodular goitre showing posterior extension behind the trachea, causing airway displacement and compression of adjacent vascular structures. Although benign, such extensive retrotracheal goitres may simulate invasive thyroid carcinoma clinically and radiologically, necessitating comparable preoperative evaluation and surgical precision. The lesion was well delineated on cross-sectional imaging and was completely excised through a transcervical approach without sternotomy. This case underscores the importance of detailed imaging and multidisciplinary coordination in achieving safe resection of thyroid enlargements with atypical posterior extensions.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2234-2237"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082335","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":"GLOBOCAN 2024 and Cancer in India: Implications for Surgical Oncology.","authors":"Pankaj Kumar Garg, Snita Sinukumar, Caleb Harris, S P Somashekhar","doi":"10.1007/s13193-026-02700-w","DOIUrl":"10.1007/s13193-026-02700-w","url":null,"abstract":"","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2009-2011"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082371","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":"Jejunal Metastasis from Sarcomatoid Lung Carcinoma: a Rare Metastatic Site for an Uncommon Tumour.","authors":"José Luis Maestro de Castro, Fernando Labarga Rodríguez, Enrique Asensio Díaz, David Pacheco Sánchez","doi":"10.1007/s13193-026-02568-w","DOIUrl":"10.1007/s13193-026-02568-w","url":null,"abstract":"","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2232-2233"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082418","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":"A Short-Term Longitudinal Study on Arm/Shoulder Functions Following Breast Cancer Surgery and Its Implications on Shoulder Physiotherapy.","authors":"Khriethonuo Kesiezie, Navneet Kaur","doi":"10.1007/s13193-026-02548-0","DOIUrl":"10.1007/s13193-026-02548-0","url":null,"abstract":"<p><strong>Background: </strong>Enhanced survival following breast cancer diagnosis has brought into focus various long term sequelae of treatment, one of the most common of which are arm/shoulder problems (ASPs).</p><p><strong>Objectives: </strong>To study arm and shoulder functions in the post operative period and early follow up to elucidate the role of surgery in the etiopathogenesis of ASPs and to develop a pragmatic plan for shoulder physiotherapy.</p><p><strong>Methods: </strong>This prospective longitudinal study was conducted on (<i>n</i> = 53) patients, who underwent surgery for operable breast cancer. Evaluation of shoulder function was done at 2, 4, and 12 weeks after surgery. Main outcome measures were: (1) Restriction in range of shoulder movement (ROM) assessed using Goniometer; (2) Arm strength measurement using Hand grip dynamometer; (3) Arm/shoulder function assessment using Kwan's Arm Problem scale (KAPS).</p><p><strong>Results: </strong>At 2 weeks, 66% patients showed a significant restriction in flexion and 53% in abduction of shoulder, which had reduced to 7.5% and 9.4% respectively by 12 weeks. Arm strength was significantly reduced at all the three assessments. At 2 weeks, 72% patients had significant arm/shoulder dysfunction (KAPS score > 21.5), while none at 12 weeks. Arm and shoulder pain and use of arm were the items with highest mean scores.</p><p><strong>Conclusion: </strong>Early initiation of structured physiotherapy and an emphasis on both mobility and strength restoration can achieve near complete functional recovery within three months.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at https://doi.org/10.1007/s13193-026-02548-0.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2174-2179"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082299","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":"ERAS Compliance and Postoperative Outcome in Patients Undergoing Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).","authors":"Vishnu K S, Vishnu Kumar Tumma, Syam Vikram, Deepak Damodaran, Deepa Chandramohan, Dileep Damodaran","doi":"10.1007/s13193-026-02545-3","DOIUrl":"10.1007/s13193-026-02545-3","url":null,"abstract":"<p><p>Background Cytoreductive surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), which is now recognised worldwide as the standard treatment for primary and secondary peritoneal surface malignancies, is associated with significant physiological stress, morbidity, and prolonged recovery. Enhanced Recovery After Surgery (ERAS) protocols aim to optimise perioperative care and attenuate surgical stress responses. This study evaluated ERAS compliance (primary objective) and its impact on postoperative outcomes (secondary objective) in CRS-HIPEC patients at a high-volume Indian tertiary centre. Methods A prospective observational study of CRS-HIPEC patients managed using ERAS (1st July 2021- 31st December 2022) was compared with a retrospectively collected pre-ERAS cohort (1st January 2019- 30th June 2020). Compliance with 27 ERAS parameters across four perioperative phases was recorded. Postoperative complications, ICU stay, and hospital stay were compared. Multivariable linear and logistic regression analyses were performed to assess predictors of outcomes. Results Eighty-five ERAS and 78 pre-ERAS patients were analysed. Demographics, PCI score and tumour distribution were comparable. Complete adherence (100%) was achieved in 59% of ERAS parameters, while 26% had 85-94% compliance. The overall compliance to ERAS protocol per patient was 94.76% with the. highest noted for the prehabilitative and preoperative domains, with the mean rates of 99.71% and 99.33%, respectively, while the lowest compliance was in the postoperative domain, with a mean of 94.38%. ERAS implementation significantly reduced Intensive Care Unit(ICU) stay (3.01 vs. 1.15 days; <i>p</i> < 0.001) and hospital stay (9.67 vs. 7.52 days; <i>p</i> < 0.001). Overall immediate postoperative complications declined from 33.3% to 12.9% (<i>p</i> = 0.003), mainly due to reductions in Clavien-Dindo grade I-II complications. Major morbidity, readmission and mortality rates were similar. Regression analysis showed ERAS implementation was independently associated with reduced ICU and hospital stay, and lower early complications. Conclusion ERAS implementation in CRS-HIPEC is feasible in the Indian setting, demonstrates high protocol adherence, and significantly improves perioperative outcomes without increasing readmissions or mortality.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at https://doi.org/10.1007/s13193-026-02545-3.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 9","pages":"2125-2132"},"PeriodicalIF":0.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13620022/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082394","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":"Thyroid Malignancy - Our Experience.","authors":"Aman Bansal, Midhun Mohandas, A Swathi, Neelam Naik, Ashwin Ashok Jaiswal, Girish Umredkar, Prachi Mene, Neeta Sharma, Praveer Kumar Banerjee, Amrish Kumar Garg, Sweta Verma, M Ravindranath, Danteshwar Chandra Prasad, Priya Sahu, Vineeta Dwivedi, Jayita Sarkar, Kumudini Tigga, Dhiraj Gupta, Pratibha Issar","doi":"10.1007/s13193-025-02508-0","DOIUrl":"10.1007/s13193-025-02508-0","url":null,"abstract":"<p><p>Thyroid carcinoma is the most common endocrine cancer, with increasing detection due to advances in imaging and cytology. Differentiated types generally have good prognosis, while aggressive variants present treatment challenges. Resource-limited settings require tailored management protocols. This study reports a 10-year experience from a tertiary center in India, focusing on clinical presentation, management, surgical findings, complications, and outcomes. This retrospective study included 118 patients with histologically confirmed thyroid carcinoma who underwent thyroidectomy from January 2013 to December 2022. Data on clinical features, imaging (ultrasonography, contrast-enhanced CT), FNAC (Bethesda classification), intraoperative findings, surgical approach, histopathology, adjuvant therapy, and follow-up were analyzed. Patients with benign thyroid disease were excluded. The cohort comprised predominantly females (74.6%) with a mean age of 39.4 years; the most common presenting complaint was neck swelling (92%). Papillary thyroid carcinoma accounted for 79.7% of cases, followed by medullary (10.2%) and follicular carcinoma (8.5%). Most nodules were solitary (52%) and classified as TIRADS IV or V (90%), with Bethesda V/VI cytology in 50%. Stage I disease predominated (71.2%), and total thyroidectomy (with or without neck dissection) was performed in 81% of patients. Zuckerkandl's tubercle was identified in 75% of lobes, and anatomical variations of the recurrent and superior laryngeal nerves were carefully documented. Postoperative complications were limited to 4.2%, including one case each of permanent hypocalcemia and transient recurrent laryngeal nerve palsy. Kaplan-Meier analysis showed 10-year recurrence-free survival rates exceeding 90% for Stage I patients. Statistically significant associations were found between FNAC Bethesda category and final histopathology (<i>p</i> = 0.0019), and with TNM stage (<i>p</i> = 0.0436). This study highlights distinct demographic and pathological features of thyroid malignancies in a resource-constrained Indian center, including younger age and diverse histologies. Strong FNAC-pathology concordance supports cytology's diagnostic value when combined with imaging. Standardized surgical protocols with careful anatomical dissection resulted in excellent functional outcomes and low complication rates. Favorable long-term survival underscores the effectiveness of individualized, risk-adapted management. These findings stress the importance of early diagnosis, precise surgery, and context-specific care to optimize outcomes.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1820-1830"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841576","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":"Validation of CPS+EG Staging System in a Cohort of Eastern Indian Breast Cancer Patients.","authors":"Sravya Deepika Ganti, Priyansh Jain, Priyanka Saha, Ephraim Rebba, Vigneshwaran B, Imaduddin Mohammed, Saroj Kumar Das Majumdar, Sandip Barik, Deepak Das, Ilavarasi V, Sourav K Misra, Mukund N Sable, Pritinanda Misra, Biswajit Sahoo, Mahesh Sultania, Sudhakar G, Phanindra K Swain, Madhabananda Kar, Dillip Kumar Muduly","doi":"10.1007/s13193-025-02502-6","DOIUrl":"10.1007/s13193-025-02502-6","url":null,"abstract":"<p><p>Neoadjuvant chemotherapy (NACT) has become standard for locally advanced breast cancer (LABC), offering opportunities for tailored treatment and improved survival. However, current staging systems fail to incorporate treatment response into prognosis. The CPS+EG staging system presents a novel approach, integrating clinical and pathological stages with ER status and nuclear grade. While validated in Western cohorts, its applicability in Indian patients remains unexplored. This study aimed to validate CPS+EG in an Eastern Indian cohort (<i>n</i>=208) treated with NACT. A retrospective analysis of data from 2016 to 2023 was done. The CPS+EG scores for all the eligible patients were calculated. Clinicopathologic characteristics and patient outcomes were assessed. The discrimination of CPS+EG and CS was assessed using the area under the curve (AUC) for survival data, calculated using Receiver operating time (ROC) curves. CPS+EG effectively stratified patients, with higher scores correlating with poorer outcomes. Median follow-up was 24 months, with 22.1% recurrence and 16.3% mortality. Five-year overall survival (OS) was 67%, and disease-free survival (DFS) 39.3%. The 5-year DFS for CPS+EG scores 1-5 was 50%, 75%, 58.3%, 44.3%, and 37.9%, respectively. None of the patients with a score of 6 survived for 5 years. CPS+EG outperformed CS alone, with AUCs of 0.75 (OS) and 0.73 (DFS) versus 0.57 and 0.58, respectively. This study fills a literature gap by validating CPS+EG in Eastern Indian patients, highlighting its utility in the prognostication of post-NACT patients. CPS+EG offers a simple yet effective, promising tool for personalized prognosis, warranting further investigation and clinical integration.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1861-1868"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841589","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":"Achieving Textbook Outcomes in Pancreatic Cancer Surgeries: A Case for Balancing Centralization and Access in Low-Resource Settings.","authors":"Nawaz Usman, Menaita M Lala, Sanath Patil, Akhil Palod, Preethi S Shetty, Naveena An Kumar","doi":"10.1007/s13193-025-02479-2","DOIUrl":"10.1007/s13193-025-02479-2","url":null,"abstract":"<p><p>Centralization is associated with improved outcomes in pancreatic surgery. However, its feasibility in low- and middle-income countries (LMICs) is uncertain due to logistic and infrastructural constraints. This study evaluates outcomes from a tier-II, low-volume centre using textbook outcome (TO) as a composite quality metric. A retrospective analysis of a prospectively maintained database (2019-2024) was performed. Textbook outcome was defined according to van Roessel et al. All perioperative outcomes were reported descriptively. Eighty patients underwent pancreatic resections during the study period. Clinically relevant postoperative pancreatic fistula occurred in 10%, delayed gastric emptying in 16.3%, post-pancreatectomy haemorrhage (B/C) in 3.7%, and major morbidity (Clavien-Dindo ≥ III) in 17.5%. In-hospital mortality was 6.3%. Textbook outcome was achieved in 73.8% of patients. Pancreatic surgery can be performed with acceptable outcomes in a lower-volume centre when standardized techniques and structured perioperative protocols are followed. However, the higher mortality and failure-to-rescue rates underscore the need for strengthening critical-care systems and early-escalation pathways. Expanding surgical capacity beyond metropolitan centres must be accompanied by corresponding investments in postoperative support infrastructure.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1765-1770"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841732","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":"Beyond Treatment: Impact of Multimodal Prehabilitation on Colorectal Cancer Patients.","authors":"Yamin Manzoor, Kainaat Salaria, Mohd Fazl Ul Haq, Fazl Qadir Parray, Gowhar Aziz Bhat, Rauf Ahmad Wani","doi":"10.1007/s13193-025-02507-1","DOIUrl":"10.1007/s13193-025-02507-1","url":null,"abstract":"<p><p>Colorectal cancer surgery is a complex and invasive procedure associated with significant post-operative morbidity and mortality. In recent years, prehabilitation has emerged as a promising strategy to improve post-operative outcomes in patients undergoing colorectal cancer surgery. Prehabilitation, a multidisciplinary approach that combines physical exercise, nutritional counselling, and psychological support, aims to optimise patients' physical and mental condition before surgery. This prospective study analysed data from 134 patients who underwent colorectal cancer surgery, comparing outcomes between patients who received prehabilitation (<i>n</i> = 73) and those who did not (<i>n</i> = 61). Primary outcomes included post-operative complications, hospital stay, 6-minute walk test scores, anastomotic leak rates, and readmission rates. The results demonstrated significant benefits of prehabilitation in reducing post-operative complications (21.91% vs. 54.09%, <i>p</i> < 0.001), shortening hospital stays (7.49 days vs. 9.54 days, <i>p</i> = 0.0001), and improving 6-minute walk test scores (pre-operative / postoperative: 580.82 m / 492.73 m vs. 516.06 m / 289.34 m, <i>p</i> = 0.00001 ). Anastomotic leak rates and readmission rates were also lower in the prehabilitation group. In conclusion, this study provides evidence supporting the role of prehabilitation in improving outcomes in patients undergoing colorectal cancer surgery. Prehabilitation reduces post-operative complications, shortens hospital stays, and improves physical function. These findings are consistent with existing literature and highlight the importance of incorporating prehabilitation into standard care for patients undergoing colorectal cancer surgery.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1886-1891"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841742","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}