Surgery open science最新文献

{"title":"Outcomes and costs in splenectomy after failed splenic arterial embolization for blunt splenic injury","authors":"Nam Yong Cho BS ,&nbsp;Bill Kwon MD ,&nbsp;Esteban Aguayo MD ,&nbsp;Zeyu Liu BS ,&nbsp;Areti Tillou MD ,&nbsp;Peyman Benharash MD","doi":"10.1016/j.sopen.2025.06.011","DOIUrl":"10.1016/j.sopen.2025.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Splenic injury (BSI) is present in nearly 45 % of abdominal blunt trauma cases in the US and splenic artery embolization (SAE) has been increasingly utilized to manage BSI in recent years. However, SAE failure necessitating delayed splenectomy remains a critical concern with significant implications for patient outcomes and healthcare resource utilization.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study utilizing the 2016–2021 Nationwide Readmissions Database. Adult patients (≥18 years) with BSI undergoing SAE or splenectomy were included. Early embolization was defined as SAE within 48 h of admission. Failure of SAE (FE) was defined as splenectomy following unsuccessful SAE during the index hospitalization or within 30 days post-discharge. Multivariable regression models were developed to assess the association of FE with in-hospital mortality, length of stay (LOS), and costs.</div></div><div><h3>Results</h3><div>Of 44,750 included patients, 17,921 (40.0 %) underwent SAE as an initial operative approach. Rates of failed embolization remained stable over the study period (2016: 8.1 % vs 2021: 9.4 %, nptrend = 0.86), as did mortality following FE (2016: 1.9 % vs 2021: 1.3 %, nptrend = 0.05). After risk adjustment, early embolization was associated with reduced odds of FE (AOR 0.78, 95%CI 0.64–0.95). FE was associated with significantly increased odds of mortality (AOR 2.52, 95 % CI 1.86–3.41), prolonged LOS by 4.8 days (95 % CI 4.0–5.5), and increased hospitalization costs by $27,600 (95 % CI $24,400-30,900).</div></div><div><h3>Conclusions</h3><div>Despite growing SAE utilization, its failure rate remains stable with FE being associated with inferior clinical and financial outcomes. Improve patient selection, increased availability of embolization and providing early embolization in select cases may enhance SAE outcomes.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 61-67"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost comparison of laparoscopic versus open surgery for common procedures in Rwandan teaching hospitals","authors":"King Kayondo ,&nbsp;Martin Nyundo ,&nbsp;Miguel Gasakure ,&nbsp;Janvière Mutamuliza ,&nbsp;Leon Ngeruka ,&nbsp;Regis Hitimana ,&nbsp;Julien Gashegu ,&nbsp;Annie Robert","doi":"10.1016/j.sopen.2025.07.001","DOIUrl":"10.1016/j.sopen.2025.07.001","url":null,"abstract":"<div><h3>Objective</h3><div>This study evaluates the economic and clinical impacts of minimally invasive surgery (MIS) compared to open surgery (Open S) for four common procedures—appendectomy, cholecystectomy, hernia repair, and ovarian cystectomy—at two major teaching hospitals in Rwanda, RMRTH and CHUK. The aim is to assess direct costs, hospital stays, complications, and recovery times for MIS versus Open S and to explore the role of health insurance in MIS accessibility.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on data from 206 patients treated between 2019 and 2022, with 100 undergoing Open S and 106 receiving MIS. Data included direct costs, hospital stay lengths, post-operative complications, and recovery times. The study also examined the correlation between MIS utilization and health insurance.</div></div><div><h3>Results</h3><div>The average patient age was 41.7 years, with nearly equal gender distribution (52.4 % male, 47.6 % female). Most patients (79.1 %) had Community-Based Health Insurance coverage. Laparoscopic cholecystectomy showed significant economic advantages, with shorter stays, fewer complications, and faster recovery (<em>p</em> &lt; 0.02). MIS for hernia repair offered quicker recovery but incurred higher costs. For appendectomy and ovarian cystectomy, there was no significant cost difference between MIS and Open S. A strong positive correlation was found between MIS adoption rates and health insurance, supporting improved access.</div></div><div><h3>Conclusion</h3><div>MIS in Rwanda shows promise for economic savings, better patient outcomes, and expanded access through insurance. However, challenges like high consumable costs and limited expertise need to be addressed to fully optimize MIS benefits in Rwanda's healthcare system.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 81-87"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indications, sub-types and complications of surgically treated thyroid disease in Africa: A systematic review and meta-analysis","authors":"Bekalu Getachew ,&nbsp;Mekbeb Afework ,&nbsp;Girmaye Tamrat","doi":"10.1016/j.sopen.2025.06.006","DOIUrl":"10.1016/j.sopen.2025.06.006","url":null,"abstract":"<div><h3>Objectives</h3><div>Thyroidectomy is a surgical procedure that reduces or removes the thyroid gland the aim of this systematic review and meta-analysis was to assess the pooled prevalence and sub-types of thyroidectomy and characterize its postoperative complications in some low and middle income African countries.</div></div><div><h3>Methods</h3><div>The studies were identified through an exhaustive search of reputable databases Twenty-two studies were selected based on the inclusion and exclusion criteria. Data were extracted using a standardized and pre-tested data extraction checklist, and the analysis was done using STATA version 14 statistical software. Heterogeneity was assessed using I² statistics.</div></div><div><h3>Result</h3><div>Toxic goiters were the most common indication for thyroidectomy accounting for 46.62 % of cases. Cosmetic reasons (41.07 %) and suspicion of malignancy (11.30 %) were the other common indications. Regarding surgical procedures, sub-total thyroidectomy (39.27 %) was the predominant surgical procedure, followed by lobectomy and isthmusectomy (34.88 %) and near-total thyroidectomy (34.77 %) respectively. The pooled prevalence of postoperative complications following thyroidectomy was 26.6 % [95%CI, 18.3–34.89]. Hypoparathyroidism (8.49 %) was the most common complication, followed by recurrent laryngeal nerve injury (7.96 %) and dysphonia (7.28 %).</div></div><div><h3>Conclusion</h3><div>A toxic goiter was the most common indication for thyroidectomy. The pooled prevalence of postoperative complications was comparably higher than international figures. Hypoparathyroidism was the predominant postoperative complication.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 52-60"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144490489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utilizing the Leap Motion Controller for skill tracking in surgical training: solving line-of-sight issues","authors":"V.E.E. Kleinrensink ,&nbsp;R.H.M. Goossens ,&nbsp;J.F. Lange ,&nbsp;L.W. Kranenburg ,&nbsp;G.J. Kleinrensink","doi":"10.1016/j.sopen.2025.06.009","DOIUrl":"10.1016/j.sopen.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div>Minimally invasive surgery (MIS) requires mastery of complex skills, for which diverse training methods have been developed. While some methods focus on precise instrument tracking and others on realistic practice scenarios, combining these aspects leads to increased costs and impractical setups.</div><div>The Leap Motion Controller (LMC) is a cost-effective device offering precise motion tracking, but previous studies found its utility in surgical training is limited by line-of-sight issues. This study aims to address this challenge.</div></div><div><h3>Methods</h3><div>A novel interface was developed for use of LMC for tracking MIS instruments during practice. To resolve the line-of-sight problem, the traditional enclosed working area was replaced with a single vertical barrier concealing the task while allowing the LMC to maintain a clear horizontal view of the instrument. Performance metrics included time to task completion and total path length of the instrument. Twenty-eight medical students participated, performing 40 consecutive trials each.</div></div><div><h3>Results</h3><div>The LMC provided precise tracking, effectively resolving line-of-sight issues. Participants improved significantly, with task completion time decreasing from 61 s (SD = 40) to 19 s (SD = 8) and path length from 2390 mm (SD = 2569) to 574 mm (SD = 348). Performance plateaued after 20 trials, with reduced variance for all outcomes.</div></div><div><h3>Conclusions</h3><div>The study successfully leveraged the LMC for tracking surgical instruments, overcoming previous limitations. The setup enables real-time monitoring, continuous movement tracking, and tactile interaction with physical objects. Its affordability and simplicity make it a promising tool for traditional and home-based MIS training, especially in resource-limited settings.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 94-98"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A 9 year retrospective review of motorcycle accidents at a level 1 trauma center in Riyadh","authors":"Hussam Alhathlol ,&nbsp;Khalid Alsikhan ,&nbsp;Turki Alharbi ,&nbsp;Ibrahim Alsamaani ,&nbsp;Ali Alhathloul ,&nbsp;Rifan Alyami","doi":"10.1016/j.sopen.2025.09.006","DOIUrl":"10.1016/j.sopen.2025.09.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Motorcycle accidents are a significant cause of morbidity and mortality worldwide, with an increasing trend observed in Saudi Arabia. These accidents often result in severe injuries, leading to long-term disability or death, highlighting the need for better understanding and management in trauma centers. These findings highlight the vulnerability of motorcyclists on the roads and underscore the critical need to address motorcycle safety in order to reduce the burden of road traffic accidents.</div></div><div><h3>Methods</h3><div>This retrospective study assessed the rate, injury patterns, and outcomes of motorcycle accidents at King Abdulaziz Medical City (KAMC) in Riyadh, a level 1 trauma center, from January 2016 to December 2024. A total of 415 adult patients were included, with data on demographics, injury types, and treatment outcomes collected from hospital records. Multivariable logistic regression was performed to identify predictors of intensive care unit (ICU) admission, intubation, and surgical intervention.</div></div><div><h3>Results</h3><div>The cohort consisted predominantly of young males (84.1 %), with the highest incidence observed in the 18–35 age group. Common injuries included fractures (86.7 %), brain injuries/bleeding (38.1 %), and cut/open wounds (27.5 %). Although the incidence peaked in 2023, no statistically significant trend was observed over the study period. Moreover, a surgical intervention was required in 69.9 % of the cases, with 28.2 % experiencing long-term disability, which was defined based on discharge disposition and documented rehabilitation needs Factors significantly associated with ICU admission and intubation included head injuries, chest injuries, and facial trauma.</div></div><div><h3>Conclusion</h3><div>Motorcycle accidents continue to pose a significant public health challenge in Saudi Arabia, with young male motorcyclists being the most vulnerable group. The high incidence of fractures and brain injuries emphasizes the importance of improving safety measures to reduce the severity of injuries.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 144-150"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive value of ultrasound BIRADS in conjunction with cytological and histopathological outcomes in breast disease management","authors":"Hussein Hadi Jaber ,&nbsp;Qutaiba Abd El-Razaq Muner","doi":"10.1016/j.sopen.2025.08.005","DOIUrl":"10.1016/j.sopen.2025.08.005","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer represents the leading cause of cancer-related mortality among Iraqi women (19.5 % of female cancers). Ultrasound BI-RADS classification integrated with tissue sampling requires population-specific validation for optimal diagnostic accuracy.</div></div><div><h3>Objective</h3><div>To evaluate the diagnostic accuracy of ultrasound BI-RADS classification when correlated with cytological and histopathological findings in predicting malignancy risk among Iraqi women.</div></div><div><h3>Methods</h3><div>A prospective cross-sectional analytical study was conducted from February 2024 to February 2025 at two tertiary care teaching hospitals with specialized breast units in Baghdad, Iraq. One hundred sixty women aged ≥18 years with breast lesions classified as BI-RADS 3–5 underwent ultrasound evaluation, fine needle aspiration cytology (FNAC), and core needle biopsy (CNB) or surgical excision when indicated. Both participating radiologists completed formal BI-RADS training workshops by the Iraqi Radiological Society in 2023. Diagnostic performance metrics were calculated using histopathological confirmation as the reference standard.</div></div><div><h3>Results</h3><div>Mean participant age was 48.2 ± 9.7 years. BI-RADS distribution included: category 3 (25.0 %), 4A (18.8 %), 4B (12.5 %), 4C (12.5 %), and 5 (31.2 %). Overall malignancy rate was 40.0 %, varying by BI-RADS category: 2.5 % (category 3), 10.0 % (4A), 25.0 % (4B), 55.0 % (4C), and 88.0 % (category 5). ROC analysis demonstrated good discriminative ability (AUC = 0.85, 95 % CI: 0.79–0.91). At the optimal threshold (BI-RADS ≥4A), sensitivity was 98.4 % and specificity 40.6 %. Inter-modality agreement showed substantial concordance between FNAC and histopathology (κ = 0.76) and almost perfect agreement between CNB and histopathology (κ = 0.92). The integration of BI-RADS with tissue sampling demonstrated a 35–40 % reduction in unnecessary biopsies.</div></div><div><h3>Conclusions</h3><div>Ultrasound BI-RADS classification demonstrates good diagnostic performance in the Iraqi population, with increasing malignancy rates corresponding to higher BI-RADS categories. The integration of BI-RADS with tissue sampling techniques provides reliable diagnostic accuracy for breast disease management in resource-limited settings.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 171-178"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Board Page","authors":"","doi":"10.1016/S2589-8450(25)00084-3","DOIUrl":"10.1016/S2589-8450(25)00084-3","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Page i"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Removal notice to “Surgical procedures and techniques in robot-assisted retrograde para-aortic lymphadenectomy” [Surg Open Sci 23 (2025) 35–41′]","authors":"Xinyou Wang,&nbsp;Jing Na,&nbsp;Ya Li,&nbsp;Shichao Han,&nbsp;Jun Wang","doi":"10.1016/j.sopen.2025.07.002","DOIUrl":"10.1016/j.sopen.2025.07.002","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Page 186"},"PeriodicalIF":1.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic review and meta-analysis of Transanal Opening of Intersphincteric Space (TROPIS) versus conventional treatments for anal fistula","authors":"Yang-Tao Chen ,&nbsp;Zhao-Chu Wang,&nbsp;Ya-Meng Xie,&nbsp;Xun Wang,&nbsp;Xu-Xiong Wu,&nbsp;Yang Li,&nbsp;Rong Shi,&nbsp;Jing Wang","doi":"10.1016/j.sopen.2025.05.010","DOIUrl":"10.1016/j.sopen.2025.05.010","url":null,"abstract":"<div><div>Transanal Opening of Intersphincteric Space (TROPIS) has emerged as a promising surgical approach for anal fistula management over recent years. This meta-analysis comprehensively evaluates the comparative efficacy and safety of TROPIS versus conventional treatments through systematic analysis of 24 clinical studies involving 2813 patients. Through systematic searches across 7 major biomedical databases (including PubMed, EMBASE, and Chinese repositories) from inception to March 2024, we identified comparative studies assessing TROPIS against six established interventions: incision-thread-drawing, seton placement, LIFT, EAFR, fistulotomy, and incision-suture techniques. Pooled analysis demonstrated TROPIS achieved superior clinical outcomes, with a 3.15-fold higher total efficacy rate (95 % CI 1.22–8.13, <em>p</em> = 0.02) and 64 % lower complication risk compared to conventional methods (OR 0.28, 95 % CI 0.18–0.42, <em>p</em> &lt; 0.00001). Sensitivity analyses confirmed result stability across study designs, while publication bias assessment via funnel plots and Egger's test revealed no significant distortion. Importantly, TROPIS maintained its advantage across various complication subtypes including incontinence (OR 0.31), infection (OR 0.27), and recurrence (OR 0.19). These findings establish TROPIS as a clinically superior alternative that significantly improves therapeutic outcomes while reducing procedure-related risks, suggesting its potential to become the new reference standard in anal fistula management. The consistent results across diverse patient populations and comparator procedures underscore the robustness of this evidence synthesis.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 15-30"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144314319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of recurrent nerve injury among esophageal cancer patients undergoing esophagectomy: A systematic review and meta-analysis","authors":"Prakasini Satapathy ,&nbsp;Abhay M. Gaidhane ,&nbsp;Nasir Vadia ,&nbsp;Soumya V. Menon ,&nbsp;Kattela Chennakesavulu ,&nbsp;Rajashree Panigrahi ,&nbsp;Ganesh Bushi ,&nbsp;Mahendra Singh ,&nbsp;Sanjit Sah ,&nbsp;Awakash Turkar ,&nbsp;S. Govinda Rao ,&nbsp;Khang Wen Goh ,&nbsp;Muhammed Shabil","doi":"10.1016/j.sopen.2025.05.009","DOIUrl":"10.1016/j.sopen.2025.05.009","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal cancer remains a major cause of cancer-related mortality worldwide, and esophagectomy is a primary curative treatment for localized disease. However, recurrent laryngeal nerve (RLN) injury is a common and impactful complication that can impair vocal cord function, increase aspiration risk, and hinder postoperative recovery. To quantify its prevalence and explore contributing factors, we conducted a systematic review and meta-analysis including 24 studies and 6015 patients. The overall pooled prevalence of RLN injury was 18.36 % (95 % CI, 11.50 %–28.00 %), with substantial heterogeneity (I² = 95.8 %). Subgroup analysis revealed a lower pooled prevalence in robot-assisted minimally invasive esophagectomy (RAMIE) at 13.39 % (95 % CI, 9.28 %–18.95 %) compared to 21.89 % (95 % CI, 12.92 %–34.62 %) in minimally invasive esophagectomy (MIE). Among surgical techniques, the McKeown approach had the highest RLN injury prevalence (26.32 %; 95 % CI, 15.59 %–40.85 %), whereas the Ivor Lewis approach demonstrated a notably lower rate (5.77 %; 95 % CI, 1.00 %–100.00 %). RLN injury was more frequent in studies from low-volume or early-learning curve centers, while high-volume single-center RAMIE cohorts showed both lower prevalence and reduced heterogeneity. Sensitivity analyses supported the robustness of these findings, and publication bias assessment indicated only minor asymmetry (LFK index −1.81). These results highlight the clinical importance of RLN injury and support the role of robotic-assisted techniques, surgical experience, and intraoperative neuromonitoring in mitigating risk. Standardized definitions and procedural training are essential to improving outcomes and reducing the burden of this complication.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"27 ","pages":"Pages 68-80"},"PeriodicalIF":1.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}