Patient Safety in Surgery最新文献

{"title":"Perforated meckel's diverticulum misdiagnosed as a urinary tract infection in an 11-year-old adolescent: case report of a rare differential diagnosis.","authors":"Mohamed Ali, Hisham Hazem Warda, Ahmed Elghrieb","doi":"10.1186/s13037-025-00443-1","DOIUrl":"10.1186/s13037-025-00443-1","url":null,"abstract":"<p><strong>Background: </strong>Meckel's diverticulum, a congenital anomaly of the gastrointestinal tract, is often asymptomatic but can present with complications such as inflammation, perforation, or obstruction. Misdiagnosis is common owing to its varied presentations, particularly when symptoms mimic other conditions such as urinary tract infections (UTI).</p><p><strong>Case presentation: </strong>An 11-year-old boy presented with persistent suprapubic pain and dysuria for one week. Initial urine analysis revealed turbid urine with high numbers of red blood cells, leading to a diagnosis of urinary tract infection (UTI), and antibiotic treatment was initiated. However, the patient's symptoms persisted, with worsening clinical signs. A complete blood count revealed leukocytosis with neutrophilia, suggesting the need for further evaluation. A non contrast computed tomography (CT) scan revealed a thickened, blind-ended structure in the midline lower abdomen with gas, extensive fat stranding, and associated mesenteric lymphadenopathy, suggestive of perforated Meckel's diverticulum. The patient underwent laparoscopic exploration, which revealed an abscess caused by perforated Meckel's diverticulum adherent to the urinary bladder. Diverticulectomy and incidental appendectomy were performed via a stapling device. Pathology confirmed a perforation of Meckel's diverticulum with serofibrinous peritonitis and follicular appendicitis. The postoperative course was uneventful, with the patient resuming full oral intake by the fifth day and being discharged in stable condition.</p><p><strong>Conclusion: </strong>This case emphasizes how Meckel's diverticulum can mimic a urinary tract infection, especially in pediatric patients with overlapping symptoms like suprapubic pain and dysuria. The delayed diagnosis highlights the importance of reconsidering rare causes when symptoms persist. Timely imaging was crucial in guiding effective treatment.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"20"},"PeriodicalIF":2.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12231995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561477","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":"Risk factors for 30-day unplanned readmissions after surgical procedures in the elderly population.","authors":"Gino Sartor, Marco Fusco, Marzio Milana, Leonardo Rigon, Giorgio Arcara, Pierfranco Conte, Alessandra Buja","doi":"10.1186/s13037-025-00442-2","DOIUrl":"10.1186/s13037-025-00442-2","url":null,"abstract":"<p><strong>Introduction: </strong>Urgent hospital readmissions within 30 days of discharge after surgery are a measure of the quality of health and social care. This study aims to identify the characteristics of patients at higher risk of readmission and the main reasons for readmission, stratified by type of surgery.</p><p><strong>Methods: </strong>This cross-sectional study analysed the medical records of patients over 60 years of age in 2022 who had undergone surgery. Records came from hospitals covering an area of 890,000 inhabitants in Northern Italy (ULSS Marca Trevigiana). Risk factors for readmission included demographic characteristics, hospitalisation details, comorbidities, and procedures. Readmission rates and 95% CI were calculated by risk factor, type of intervention and reason for readmission. A logistic model was used to estimate the OR of readmission, adjusting for potential confounders.</p><p><strong>Results: </strong>The overall 30-day readmission rate was 3.8% (3.5-4.3), with the highest rates after gastrointestinal surgery (49.7 per 1,000 admissions) and the lowest after skin-soft tissue surgeries (15.5 per 1,000 admissions). Multivariate analysis identified dementia (OR = 3.19), end-stage kidney disease or dialysis (OR = 2.84), and metastatic cancer (OR = 2.65) as strong predictors of readmission. Advanced age (75+), male gender, primary cancer, and anemia were also independent predictors. Infection was the main reason for readmission. Other significant causes were hemorrhage, thrombosis/embolism, and intestinal obstruction.</p><p><strong>Conclusions: </strong>The study highlights the importance of identifying risk factors for readmission to improve transitions of care. Targeted interventions for high-risk populations, particularly those with dementia, renal disease, or cancer, are essential to improve postoperative outcomes and alleviate the burden of unplanned readmissions on healthcare systems.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"19"},"PeriodicalIF":2.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12210902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545458","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":"Prevalence and root causes of operating room fires in the United States 2014-2024.","authors":"Monica M Attia","doi":"10.1186/s13037-025-00441-3","DOIUrl":"10.1186/s13037-025-00441-3","url":null,"abstract":"<p><strong>Background: </strong>Operating room fires, though rare, pose serious risks to patient and operator safety. Among the known ignition sources, light-emitting surgical devices-including fiberoptic cables, headlamps, and light boxes-are increasingly recognized contributors. However, the true prevalence and underlying causes remain under-characterized in national surveillance data. This study hypothesized that operator error is a leading cause of light-source-related fires and sought to identify specific device types, procedural timing, and preventable risk factors involved in these adverse events.</p><p><strong>Methods: </strong>Reports from the U.S. FDA's MAUDE database were analyzed for light source-related operating room fires from January 1, 2014, to January 1, 2024. Events were categorized by device type, procedural timing, root cause, and resultant injury.</p><p><strong>Results: </strong>A total of 45 adverse events were analyzed. Most fires were associated with light sources (33.3%), light headlamps (31.1%), and fiberoptic cables (20%). Intraoperative fires comprised the majority (35.6%). Operator error accounted for 37.8% of cases, with common errors including device mishandling (35.2%) and failure to detect damage (17.6%). Only 13.3% required intra-procedural interventions; injuries included one patient burn and two operator injuries.</p><p><strong>Conclusions: </strong>Most operating room fires involving light sources were linked to modifiable operator errors. These findings underscore the urgent need for preventive strategies-including mandatory training, regular equipment checks, and improved design standards-to reduce intraoperative fire risk and enhance surgical safety.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"18"},"PeriodicalIF":2.6,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144209864","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":"\"One family, one patient\": a human-centered approach to safety in the operating room.","authors":"Saeid Amini Rarani","doi":"10.1186/s13037-025-00436-0","DOIUrl":"10.1186/s13037-025-00436-0","url":null,"abstract":"","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"17"},"PeriodicalIF":2.6,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129146","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":"From error to prevention of wrong-level spine surgery: a review.","authors":"Parisa Javadnia, Hasti Gohari, Nila Salimi, Ehsan Alimohammadi","doi":"10.1186/s13037-025-00440-4","DOIUrl":"10.1186/s13037-025-00440-4","url":null,"abstract":"<p><p>Wrong-level spine surgery remains a significant concern in spine surgery, leading to devastating consequences for patients and healthcare systems alike. This comprehensive review aims to analyze the existing literature on wrong-level spine surgery in spine procedures, identifying key factors that contribute to these errors and exploring advanced strategies and technologies designed to prevent them. A systematic literature search was conducted across multiple databases, including PubMed, Scopus, EMBASE, and CINAHL. The selection criteria focused on preclinical and clinical studies that specifically addressed wrong site and wrong level surgeries in the context of spine surgery. The findings reveal a range of contributing factors to wrong-level spine surgeries, including communication failures, inadequate preoperative planning, and insufficient surgical protocols. The review emphasizes the critical role of innovative technologies-such as artificial intelligence, advanced imaging techniques, and surgical navigation systems-alongside established safety protocols like digital checklists and simulation training in enhancing surgical accuracy and preventing errors. In conclusion, integrating advanced technologies and systematic safety protocols is instrumental in reducing the incidence of wrong-level spine surgeries. This review underscores the importance of continuous education and the adoption of innovative solutions to foster a culture of safety and improve surgical outcomes. By addressing the multifaceted challenges associated with these errors, the field can work towards minimizing their occurrence and enhancing patient care.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"16"},"PeriodicalIF":2.6,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080630","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":"Gallbladder perforation as a rare complication of minor blunt abdominal trauma: a case report.","authors":"Haddis Birhanu W/Kiros, Ashenafi Amsalu Feleke, Kidanemariam Mulualem Alamir, Temesgen Agegnehu Abebe, Wudie Mekonen Alemu, Shimelis Seid Tegegne, Habtu Adane Aytolign","doi":"10.1186/s13037-025-00431-5","DOIUrl":"https://doi.org/10.1186/s13037-025-00431-5","url":null,"abstract":"<p><strong>Background: </strong>Blunt abdominal trauma leading to gallbladder injury is rare and presents a diagnostic challenge. Here, we present scenario of gallbladder perforation due a blow from a fist to the abdomen.</p><p><strong>Case presentation: </strong>A 30-years old male patient was admitted to University of Gondar comprehensive specialized hospital emergency department in Ethiopia due to blow from a fist on the right upper abdomen with a presumptive diagnosis of generalized peritonitis and underwent emergency laparotomy. The operative finding showed that, gallbladder was perforated at the fundus and a cholecystectomy was done. Postoperative time was uneventful and discharged on the 5th postoperative day.</p><p><strong>Conclusion: </strong>Isolated gallbladder injury from a fist fight is rare, however, should be considered in the differential diagnosis of patients presenting with abdominal pain following minor blunt abdominal trauma.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"15"},"PeriodicalIF":2.6,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040101","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":"Patient perspectives on surgical handover quality: a mixed-methods survey.","authors":"Jessica M Ryan, Philip Tomlinson, Anastasija Simiceva, Dara O Kavanagh, Walter Eppich, Ailbhe O'Driscoll Collins, Bevin Arthurs, Catherine Timon, Luke McGarry, Clothilde Dunleavy, Sandra Stewart, Annabella Stewart-Miller, Adam Fairhurst, Simon Roe, William Murray, Deborah A McNamara","doi":"10.1186/s13037-025-00437-z","DOIUrl":"https://doi.org/10.1186/s13037-025-00437-z","url":null,"abstract":"<p><strong>Background: </strong>In-hospital handover of patient care is an essential but high-risk professional activity that often lacks transparency for patients. The purpose of this survey was to gain insight into surgical patients' perceptions of handover communications between doctors, incorporating patient and public involvement to enhance accessibility and understanding.</p><p><strong>Methods: </strong>A cross-sectional, mixed-methods survey was developed with patient and public involvement and distributed to general surgery patients in two University Teaching Hospitals between 24 October 2023 and 21 July 2024. Comparative analyses of quantitative data were performed using McNemar's test for paired nominal data and Wilcoxon rank-sum test for continuous data. Free-text responses underwent thematic analysis to validate and expand on quantitative findings. Patient and public involvement partners contributed to study design, methodology, and the final manuscript.</p><p><strong>Results: </strong>In total, 208 responses were received (52.3%). Significantly more patients reported having prior knowledge of nursing handovers (73.1%) compared to doctors' handovers (63.9%; x² = 14.53, p = 0.0002). Patient perceptions of the handover process were generally positive; although satisfaction declined significantly with weekend handovers (p < 0.05). Thematic analysis identified four themes: (1) the impact of poor inter-professional communication, (2) the importance of teamwork, (3) external factors influencing handover effectiveness, and (4) patient nonchalance about their care. The use of patient and public involvement in this study improved survey accessibility and understanding of the concept and importance of handover.</p><p><strong>Conclusions: </strong>This study shows limited prior awareness of handover between doctors among surgical patients, especially the potential hazards that can arise if performed poorly. Patient and public involvement improved accessibility and understanding of the topic; however, challenges such as adequate training for meaningful engagement remain.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"14"},"PeriodicalIF":2.6,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12049061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990199","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":"Predictive value of the American college of surgeons \"surgical risk calculator\" (ACS-NSQIP SRC) for plastic and reconstructive surgery: a validation study from an academic tertiary referral center in Germany.","authors":"Florian Bucher, Martynas Tamulevicius, Nadjib Dastagir, Catherine Fuentes Alvarado, Doha Obed, Khaled Dastagir, Peter M Vogt","doi":"10.1186/s13037-025-00438-y","DOIUrl":"https://doi.org/10.1186/s13037-025-00438-y","url":null,"abstract":"<p><strong>Aims: </strong>The American College of Surgeons Surgical Risk Calculator (ACS-NSQIP SRC) was designed to predict morbidity and mortality in order to help providing informed consent. This study evaluated its performance in the field of plastic and reconstructive surgery for patients undergoing body contouring and breast reconstruction procedures.</p><p><strong>Methods: </strong>A retrospective analysis of patients undergoing body contouring and breast reconstruction procedures from January 1, 2022 to November 1, 2024 was performed.</p><p><strong>Results: </strong>The ACS-NSQIP SRC showed good prediction only for severe complications in patients undergoing breast reconstruction with DIEP flap (AUC = 0.727); overall prediction and calibration for the remaining 15 subgroups was poor. The incidence of overall and general complications, as well as length of hospital stay was underestimated.</p><p><strong>Conclusions: </strong>The overall performance of the ACS-NSQIP SRC was poor, a finding that underlines the importance of individual decision-making, also considering the surgeon's expertise and patient-specific characteristics.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"13"},"PeriodicalIF":2.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12044890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144017668","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":"Lytic bone lesion of the skull as a rare manifestation of hepatocellular carcinoma: a case report.","authors":"Sherif Wael, Omar Hamdy, Mohamed Yasser, Sara Elmandrawi, Mai Mostafa, Nouran Mohammed, Ahmed Elghrieb","doi":"10.1186/s13037-025-00434-2","DOIUrl":"https://doi.org/10.1186/s13037-025-00434-2","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) ranks among the leading causes of cancer-related deaths worldwide, with metastatic spread to bones being alarmingly frequent. However, HCC metastases to the skull are notably rare, accounting for only 0.4-1.6% of all bone metastases. Typically, metastases are found in the spine, pelvis, and ribs. The occurrence of solitary skull metastases, especially in the absence of active primary liver cancer, is extremely uncommon.</p><p><strong>Case description: </strong>We present the clinical case of a 57-year-old male patient with a documented history of hepatitis C virus infection but without prior evidence of active hepatocellular carcinoma. Over the course of several months, he developed a non-tender, progressively enlarging mass located in the occipital region of the skull. A computed tomography (CT) scan identified a lytic lesion with intracranial compression, although no midline shift was noted. Histopathological examination confirmed the lesion as metastatic HCC, further supported by immunohistochemical markers Hepatari- 1 and Cytokeratin- 19. Subsequent diagnostic procedures revealed hepatic lesions, including a positron emission tomography (PET)-CT scan. Further examination through CT imaging of the abdomen with contrast highlighted a well-defined focal lesion in hepatic segment 4a, measuring 4.3 × 4.3 cm, predominantly enhancing with HCC characteristics. The skull lesion was surgically removed en bloc, and the patient underwent adjunct radiotherapy and systemic therapy, with palliative therapy till his death in May 2024. To better understand and manage this atypical presentation, we conducted a review for the discussion of clinical manifestations, imaging findings, pathological features, and patient outcomes associated with HCC skull metastases.</p><p><strong>Conclusion: </strong>This case emphasizes the critical importance of considering hepatocellular carcinoma in the differential diagnosis of solitary skull lesions, especially in patients with risk factors for liver disease. Prompt identification of the primary malignancy remains essential for ensuring optimal management and improving patient prognosis.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"12"},"PeriodicalIF":2.6,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034302","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":"Wrong-site, wrong-procedure, and retained foreign object events in out-of-hospital settings: analysis of closed medico-legal complaints in Canada (2012-2021).","authors":"Omar I Hajjaj, Joanna Zaslow, Reem El Sherif, Diane L Héroux, Richard E Mimeault, Jacqueline H Fortier, Gary E Garber","doi":"10.1186/s13037-025-00432-4","DOIUrl":"https://doi.org/10.1186/s13037-025-00432-4","url":null,"abstract":"<p><strong>Background: </strong>Surgical sentinel events (SSEs) are serious safety incidents associated with significant patient harm and medico-legal consequences for healthcare teams and institutions. SSEs include wrong-site surgeries, wrong procedures, and unintentional retention of foreign objects. SSEs occur in hospitals and out-of-hospital operating spaces (physician offices or ambulatory surgical centres). It is unclear how the resource constraints and workflow differences of an out-of-hospital setting contribute to SSEs.</p><p><strong>Methods: </strong>We conducted a retrospective review and descriptive content analysis of all out-of-hospital SSEs reported to the Canadian Medical Protective Association (CMPA) between 2012 and 2021. Medico-legal files, medical records, and peer expert opinions were analyzed to identify the contributing factors to out-of-hospital wrong-site, wrong-procedure, and retained-object SSEs.</p><p><strong>Results: </strong>A total of 276 medico-legal complaints involved a wrong-site, wrong-procedure or retained-object SSE, of which 24 (24/276; 9%) occurred out of hospital. Only twenty of these out-of-hospital complaints were included in the qualitative content analysis. We identified five main contributing factor categories to out-of-hospital SSEs. These categories included (1) incomplete preoperative verification, (2) inadequate intraoperative surgical counts, (3) insufficient review of patient medical records, (4) surgery performed without the necessary resources, and (5) administrative errors or office disorganization. Half of the complaints were assigned more than one contributing factor. The majority of out-of-hospital SSEs (19/20; 95%) resulted in an unfavourable outcome for the operating physician and most (18/20; 90%) required additional healthcare resources to resolve or mitigate the consequences of the SSE.</p><p><strong>Conclusions: </strong>Recognizing the contributing factors to an out-of-hospital SSE enables targeted improvements in facility protocols to support patient safety. Some factors identified in this dataset overlap with hospital-based contributing factors previously identified in literature (incomplete preoperative verification and inadequate surgical counts), whereas other novel factors are associated with the practice environment of an out-of-hospital setting (resource constraints, office disorganization). Addressing the identified contributing factors may mitigate the risk of SSEs in all facilities.</p>","PeriodicalId":46782,"journal":{"name":"Patient Safety in Surgery","volume":"19 1","pages":"11"},"PeriodicalIF":2.6,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11987446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015294","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}