Annals of surgery open : perspectives of surgical history, education, and clinical approaches最新文献

{"title":"Surgeons' Perspectives on Liability for the Use of Artificial Intelligence Technologies in the United States and European Union: Results From a Focus Group Study.","authors":"Mindy Duffourc, Mathias Møllebæk, Louise C Druedahl, Timo Minssen, Sara Gerke","doi":"10.1097/AS9.0000000000000542","DOIUrl":"10.1097/AS9.0000000000000542","url":null,"abstract":"<p><strong>Objective: </strong>To examine surgeons' perspectives on liability for using artificial intelligence (AI)-driven technologies in surgery in the United States and the European Union.</p><p><strong>Background: </strong>The introduction of AI-driven technologies in surgery can improve surgical performance and patient outcomes. However, liability risks might inhibit their implementation in the operating room. We report here the results of a focus group study that explored surgeons' perspectives on liability for using AI-driven technologies in surgery in the United States and the European Union.</p><p><strong>Methods: </strong>Participants were identified through a call for participation disseminated through personal and professional networks. Inclusion criteria were: (1) adults (at least 18 years of age); (2) surgeons based in either the United States or in one of the European Union's Member States, with a preference for those specializing in gastrointestinal surgery to facilitate better discussions about the vignettes that involved a colorectal surgical procedure; (3) ability to comfortably read and communicate in English; (4) willingness to consent to participation, and (5) willingness to consent to keeping the focus group meeting content, participants, and discussions confidential.</p><p><strong>Results: </strong>We conducted 6 focus groups via Zoom with a total of 18 participants (11 EU surgeons and 7 US surgeons). The following main themes emerged: (1) acknowledgment of the potential benefits of using AI-driven technology in surgery, (2) acceptance of surgeon responsibility, (3) recognition that AI may impact the standard of care, (4) skepticism about potential liability for AI manufacturers, and (5) the importance of patient information and consent.</p><p><strong>Conclusions: </strong>Despite the potential future benefits of integrating AI into surgical practice, surgeons will benefit from (1) an increased understanding of how AI-driven technologies will deliver these benefits and (2) increased clarity surrounding how AI-driven technologies will be governed by both regulators and the surgical community. While our study focused on surgeons' perspectives, it could also provide valuable insights for other healthcare providers using AI to treat patients.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e542"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712329","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":"Bariatric Surgery Is Associated With Reduced Incidence of Mild Cognitive Impairment and Alzheimer Disease and Related Dementias: A Retrospective Cohort Study.","authors":"You Chen, Yubo Feng, Xinmeng Zhang, Katherine A Gifford, Yasser Elmanzalawi, Jason Samuels, Vance L Albaugh, Wayne J English, Charles R Flynn, Danxia Yu, Rui Zhang, Sayeed Ikramuddin","doi":"10.1097/AS9.0000000000000541","DOIUrl":"10.1097/AS9.0000000000000541","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association of bariatric surgery with reduced incidence and delayed development of mild cognitive impairment (MCI) and Alzheimer disease and related dementias (ADRD) in patients with obesity.</p><p><strong>Background: </strong>This retrospective longitudinal study utilized Electronic Health Records from Vanderbilt University Medical Center, covering 5303 patients who underwent bariatric surgery and 10,606 propensity score-matched obese patients who did not, from 2000 to 2023. Patients with prior MCI, ADRD, schizophrenia, alcoholism, gastric cancer, gastric ulcers, inflammatory bowel disease, coagulopathy, stroke, Parkinson disease, or brain cancer were excluded from both groups.</p><p><strong>Methods: </strong>Differences in time to MCI/ADRD between surgical and control groups were analyzed using linear regression, and adjusted for confounders: demographics, medical history, and socioeconomic status. Survival probability differences for MCI and ADRD between the 2 groups over time were assessed using Kaplan-Meier curves and log-rank tests. Incidence differences of MCI and ADRD between the groups were evaluated using Fine-Gray subdistribution hazard models, accounting for the competing risk of death and confounders.</p><p><strong>Results: </strong>Bariatric surgery was associated with a significantly reduced incidence of ADRD, evidenced by a subdistribution hazard ratio (SHR) of 0.37 (95% confidence interval [CI]: 0.15-0.89; <i>P</i> = 0.03). Similarly, the incidence of MCI was significantly lower in the surgical group, with an SHR of 0.57 (95% CI: 0.39-0.85; <i>P</i> = 0.01). Additionally, patients who underwent bariatric surgery experienced a delay of 2.01 years before developing MCI compared with the control group (95% CI: 0.70-3.50; <i>P</i> = 0.004).</p><p><strong>Conclusions: </strong>These findings suggest that bariatric surgery may serve as an effective strategy to delay the onset of MCI and reduce the risk of both MCI and ADRD in patients with obesity.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e541"},"PeriodicalIF":0.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712356","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":"Regenerative Peripheral Nerve Interface Surgery to Treat Chronic Postamputation Pain: A Prospective Study in Major Lower Limb Amputation Patients.","authors":"Jennifer C Lee, Carrie A Kubiak, Christine S W Best, Jennifer B Hamill, Jamie Ki, Hyungjin Myra Kim, Randy S Roth, Jeffrey H Kozlow, Melissa J Tinney, Michael E Geisser, Paul S Cederna, Stephen W P Kemp, Theodore A Kung","doi":"10.1097/AS9.0000000000000535","DOIUrl":"10.1097/AS9.0000000000000535","url":null,"abstract":"<p><strong>Objective: </strong>The objective was to assess the postsurgical outcomes of regenerative peripheral nerve interface (RPNI) surgery in a prospective cohort of major lower extremity amputation patients with chronic postamputation pain.</p><p><strong>Background: </strong>Chronic pain in lower limb amputation patients is commonly the result of neuroma formation after traumatic peripheral nerve injury. By implanting more proximal transected nerve ends into autologous free muscle grafts, RPNI surgery can treat postamputation pain by diminishing the development of neuromas. RPNI surgery in prior retrospective studies has been shown to mitigate postamputation pain.</p><p><strong>Methods: </strong>Twenty-two lower limb amputation patients with established chronic postamputation pain were recruited from 2 studies in this prospective study. All patients underwent RPNI surgery to treat identified symptomatic neuromas within the residual limb. Patient-reported outcome instruments were administered preoperatively and postoperatively at 1 week, 4 months, and 12 months to examine residual limb pain (McGill Pain Questionnaire, PROMIS Pain Intensity, and PROMIS Pain Interference), phantom limb pain (modified PROMIS Pain Intensity and Phantom Limb sensation questionnaire), psychosocial status (PHQ-9, GAD-7, and PCS), and functional (OPUS) outcomes.</p><p><strong>Results: </strong>RPNI surgery significantly improved residual limb pain. While phantom limb sensation improved significantly, phantom limb pain demonstrated a modest decrease. Psychosocial outcomes also improved significantly after RPNI surgery. Prosthetic use slightly increased, and patients did not experience loss of function.</p><p><strong>Conclusions: </strong>RPNI surgery leverages the processes of reinnervation to successfully treat residual limb pain and improve psychosocial outcomes in patients with chronic postamputation pain. Phantom limb pain may be more difficult to treat in chronic pain patients who have central sensitization at the time of surgery.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e535"},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712314","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":"Not Only Caseload but Also Patient Selection Is Predictive of Mortality After Pancreatic Resection.","authors":"Rene Mantke, Barbara Seliger, Shuji Ogino, Markus W Büchler, Richard Hunger","doi":"10.1097/AS9.0000000000000536","DOIUrl":"10.1097/AS9.0000000000000536","url":null,"abstract":"<p><strong>Background: </strong>Centralization of pancreatic surgery in high-volume centers is regarded as a key strategy in improving the outcome quality. However, the specific factors, in addition to higher case volumes, that influence inhospital mortality remain unclear.</p><p><strong>Methods: </strong>In this retrospective observational study, the German nationwide diagnostic-related groups statistics were analyzed for 86,073 patients with pancreatic resections. Hospitals performing at least 50 resections per year were identified as high-volume pancreatic centers (HVPCs). Statistical analyses compared crude and adjusted estimates of inhospital mortality for patients treated in HVPCs and non-HVPCs. A generalized mixed model was used for risk adjustment, considering various factors such as age group, sex, diagnosis, and comorbidities (ClinicalTrail.gov, NCT06390891).</p><p><strong>Results: </strong>A total of 24.2% (n = 20,798) of all pancreatic resections were performed in 23 HVPCs. The crude inhospital mortality for all patients undergoing resection was 9.0%. Crude inhospital mortality in HVPCs was 5.5% compared with 10.1% in non-HVPCs (<i>P</i> < 0.001). HVPCs performed more complex resections including more concomitant procedures. On the other hand, HVPCs treated younger patients and patients with less complicated comorbidities. Statistical adjustment of comorbidities and patient characteristics resulted in a significant increase of inhospital mortality from 5.5% to 8.7% in HVPCs.</p><p><strong>Conclusions: </strong>HVPCs have significantly lower inhospital mortality than the other hospitals. Nevertheless, the superior quality of outcome can be attributed not only to the enhanced expertise of the centers but also, at least in part, to a healthier patient population on average. However, the extent to which this patient selection is due to active selection by the practitioners or other causes remains unclear.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e536"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712287","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 Attempted Assassination of William H. Seward: Analysis of His Nonfatal Head and Neck Injuries.","authors":"Theodore N Pappas, Megan Llewellyn, Justin Barr","doi":"10.1097/AS9.0000000000000537","DOIUrl":"10.1097/AS9.0000000000000537","url":null,"abstract":"<p><p>On April 14, 1865, Abraham Lincoln was assassinated by John Wilkes Booth at Ford's Theatre in Washington DC. Booth's actions were part of a conspiracy by Confederate sympathizers to disrupt the US Government. The conspiracy also targeted Secretary of State William H. Seward, who was attacked in his home on the same evening by Lewis Powell. Seward, who was recuperating from a violent carriage accident, was brutally stabbed several times in the face and neck but survived his wounds. This article will review the assassination attempt before focusing on the details of Seward's wounds and his subsequent medical care. We will also analyze how Powell managed not to kill Seward despite having the opportunity to stab the defenseless, recumbent Secretary 5 times.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e537"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712349","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":"Erratum: Assessment of Racial Bias within the Risk Analysis Index of Frailty: Erratum.","authors":"","doi":"10.1097/AS9.0000000000000515","DOIUrl":"10.1097/AS9.0000000000000515","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1097/AS9.0000000000000490.].</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e515"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712163","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":"Ambulatory Surgery Ensemble: Predicting Adult and Pediatric Same-Day Surgery Cases Across Specialties.","authors":"Thomas Clark Howell, Hamed Zaribafzadeh, Maxwell D Sumner, Ursula Rogers, John Rollman, Daniel M Buckland, Michael Kent, Allan D Kirk, Peter J Allen, Bruce Rogers","doi":"10.1097/AS9.0000000000000534","DOIUrl":"10.1097/AS9.0000000000000534","url":null,"abstract":"<p><strong>Objective: </strong>To develop an ensemble model using case-posting data to predict which patients could be discharged on the day of surgery.</p><p><strong>Background: </strong>Few models have predicted which surgeries are appropriate for day cases. Increasing the ratio of ambulatory surgeries can decrease costs and inpatient bed utilization while improving resource utilization.</p><p><strong>Methods: </strong>Adult and pediatric patients undergoing elective surgery with any surgical specialty in a multisite academic health system from January 2021 to December 2023 were included in this retrospective study. We used surgical case data available at the time of case posting and created 3 gradient-boosting decision tree classification models to predict case length (CL) less than 6 hours, postoperative length of stay (LOS) less than 6 hours, and home discharge disposition (DD). The models were used to develop an ambulatory surgery ensemble (ASE) model to predict same-day surgery (SDS) cases.</p><p><strong>Results: </strong>The ASE achieved an area under the receiver operating characteristic curve of 0.95 and an average precision of 0.96. In total, 139,593 cases were included, 48,464 of which were in 2023 and were used for model validation. These methods identified that up to 20% of inpatient cases could be moved to SDS and identified which specialties, procedures, and surgeons had the most opportunity to transition cases.</p><p><strong>Conclusions: </strong>An ensemble model can predict CL, LOS, and DD for elective cases across multiple services and locations at the time of case posting. While limited in its inclusion of patient factors, this model can systematically facilitate clinical operations such as strategic planning, surgical block time, and case scheduling.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e534"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712354","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":"Using the Perspectives of Advanced Practice Providers to Design Strategies to Increase Engagement of Surgical Patients in Advance Care Planning.","authors":"Christopher L Johnson, Katherine E Barnes, Alexis Colley, Jeanette Broering, Alisa Yee, Tasce Bongiovanni, Sanziana Roman, Elizabeth C Wick","doi":"10.1097/AS9.0000000000000506","DOIUrl":"10.1097/AS9.0000000000000506","url":null,"abstract":"<p><strong>Objective: </strong>Advanced practice providers (APPs) are essential members of surgical teams. We sought to understand the barriers and facilitators they perceive when participating in advanced care planning (ACP) discussions with patients and use this knowledge to design strategies to promote interprofessional ACP uptake for surgical services and potentially extend ACP discussions and documentation to more patients.</p><p><strong>Background: </strong>ACP has been challenging to integrate into surgical practice despite being endorsed by national societies and payors as an essential aspect of caring for older adults.</p><p><strong>Methods: </strong>Using qualitative and quantitative methods, we surveyed and interviewed APPs at a single tertiary academic medical center. A previously validated Likert scale survey of clinician knowledge, attitudes, and experiences with ACP was adapted to include demographic information and details about practice experience.</p><p><strong>Results: </strong>Of the 88 APPs who were sent our surveys, 46 (52%) responded. Eighty-eight percent of respondents believed APPs play an important role in ACP discussions, 80% believed that ACP information was helpful in guiding clinical care discussions, 71% expressed comfort with discussing ACP with patients, and 59% endorsed comfort with communicating a prognosis to patients. Twelve interviews yielded 3 main themes: (1) clinical and professional benefits of ACP; (2) barriers to APP involvement in ACP; (3) proposed interventions to integrate APPs into ACP.</p><p><strong>Conclusions: </strong>To increase surgical ACP uptake by APPs, data on proposed ACP interventions must focus on establishing a multi-disciplinary team-based workflow, addressing competing clinical demands, opportunities for additional education, and clarifying the scope of work.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e506"},"PeriodicalIF":0.0,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712357","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 Obesity Paradox Revisited: Is Obesity Still a Protective Factor for Patients With High Comorbidity Burden or High-Complexity Procedures?","authors":"Hyo Jin Son, Denise W Gee, David Gomez, James J Jung","doi":"10.1097/AS9.0000000000000531","DOIUrl":"10.1097/AS9.0000000000000531","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the relationship between obesity and postoperative mortality in the context of high procedural complexity and comorbidity burden.</p><p><strong>Background: </strong>The \"obesity paradox\" suggests better postoperative outcomes in patients with higher body mass index (BMI), despite obesity's associated health risks. Research remains scarce on the influence of procedural complexity and comorbidities on the obesity-postoperative mortality relationship.</p><p><strong>Methods: </strong>We performed an observational study of adult patients undergoing major surgery using the 2016 to 2019 National Surgical Quality Improvement Program database. The outcome was 30-day mortality. We first estimated the risk-adjusted effects of BMI on mortality across the full cohort via multivariable regression and restricted cubic spline models. Then, we investigated the subgroups stratified by procedural complexity and comorbidity burden using a modified Charlson Comorbidity Index (mCCI) and mortality probability.</p><p><strong>Results: </strong>Among 3,085,582 patients, 47% had obesity. There was a reverse J-shaped relationship between BMI and mortality in the full cohort, consistent with the obesity paradox. However, no difference in odds of mortality was observed in patients with obesity who underwent high-complexity procedures compared with normal BMI counterparts (BMI 30-34.9: odds ratio, 0.93 [95% confidence interval: 0.86-1.01]; BMI 35-39.9: 0.92 [0.83-1.03]; BMI ≥ 40: 0.94 [0.83-1.07]), and in patients with obesity with high comorbidity burden (mCCI ≥ 8 [BMI 30-34.9: 0.95 (0.77-1.16); BMI 35-39.9: 0.78, (0.60-1.02); BMI ≥ 40: 0.84 (0.63-1.12)] and top 3% mortality probability [BMI 30-34.9: 0.96 (0.90-1.02); BMI ≥ 40: 0.94 (0.86-1.01)]).</p><p><strong>Conclusion: </strong>Our findings suggest the existence of an obesity paradox in most adult surgical patients, yet the trend dissipates with high procedural complexity and comorbidity burden.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e531"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878463","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":"Highland Park Shooting Anniversary: From Tragedy to Strategy.","authors":"John Malcolm Hollingsworth, Margaret Gurley, Sarah Farley, John N Cram, Bryan P Hendren","doi":"10.1097/AS9.0000000000000533","DOIUrl":"10.1097/AS9.0000000000000533","url":null,"abstract":"","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"5 4","pages":"e533"},"PeriodicalIF":0.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11661705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878780","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}