Urogynecology (Hagerstown, Md.)最新文献

{"title":"Effect of Medicaid Expansion on Access to Pelvic Organ Prolapse Surgery.","authors":"Caitlin E Carlton, Brittany Roberts, Ashar Ata, Karissa Leong, Erin C Deverdis, Bradley Jacobs, Cara L Grimes, Rebecca G Rogers","doi":"10.1097/SPV.0000000000001866","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001866","url":null,"abstract":"<p><strong>Importance: </strong>Medicaid expansion increased access to care; however, there are limited data about its effect on access to pelvic organ prolapse (POP) repair.</p><p><strong>Objective: </strong>We aimed to determine the effect of Medicaid expansion on POP surgery by region, socioeconomic status, and race.</p><p><strong>Study design: </strong>This was a retrospective cohort study utilizing the 2012-2019 Healthcare Cost and Utilization Project National Inpatient Sample. Medicaid-funded POP repair surgical procedures were compared over time by region and among marginalized populations.</p><p><strong>Results: </strong>During the study period, 175,355 POP surgical procedures were performed. The proportion of Medicaid-funded POP surgery was highest in the West (16%) and Northeast (10%) and lowest in the Midwest (6%) and South (5%), corresponding to the regions with the highest and lowest rates of Medicaid expansion; this was significant (P<0.001) even after controlling for confounders. The proportion of Medicaid-funded POP surgery for Black, Hispanic, and lowest-income quartile patients decreased or remained the same during the study period in the South, the region with the least Medicaid expansion.</p><p><strong>Conclusion: </strong>The regions with higher rates of Medicaid expansion were found to have higher rates of publicly insured and marginalized patients undergoing POP repair.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730940","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":"CMS Botox Coverage Updates: Key Requirements for Urologic Use.","authors":"Evelyn F Hall","doi":"10.1097/SPV.0000000000001882","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001882","url":null,"abstract":"","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147730936","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":"Evaluation of AI-Generated Surgical Decision Aids for Pelvic Floor Disorders.","authors":"Carolyn S Chen, Taylor Brueseke, Carly Crowder, Olivia H Chang","doi":"10.1097/SPV.0000000000001856","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001856","url":null,"abstract":"<p><strong>Importance: </strong>Decision aid tools are well-utilized resources in shared decision making for the treatment of pelvic floor disorders. With the improvement of large language models like ChatGPT, prior studies have started evaluating whether artificial intelligence can be used to create patient education materials. As treatment of pelvic floor disorders can be complicated and specific to individuals, we assessed the use of ChatGPT for patient decision making.</p><p><strong>Objective: </strong>Our objective was to evaluate the understandability, reliability, accuracy, and readability of ChatGPT-generated decision aid tools for urogynecology surgical procedures.</p><p><strong>Study design: </strong>In this cross-sectional study, 6 questions comparing 2 treatment options for common urogynecological conditions were developed by 6 urogynecologists and entered into ChatGPT to create decision aid tools. Patients and physicians evaluated understandability using a Patient Education Materials Assessment Tool. Physicians also evaluated reliability using a modified DISCERN (mDISCERN) instrument and accuracy using a 5-point Likert scale. Readability was evaluated using the Flesch-Kincaid Reading Ease score. Analysis of all scores was descriptive.</p><p><strong>Results: </strong>All decision aid tools received high patient and physician understandability. The tools had fair reliability with an average mDISCERN score of 26. Accuracy was <4 (unfavorable) on 2 of the decision aid tools, and the reading level required to read them was high overall.</p><p><strong>Conclusions: </strong>ChatGPT-generated decision aid tools for urogynecology surgical counseling have high patient understandability, emphasizing their potential for being well-received by patients deciding on treatment. However, approximately 30% of the topics require improvements to accuracy, while all tools could benefit from improved reliability and readability.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700923","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":"The Role of EMMPRIN Levels in Uterine Ligaments in Pelvic Organ Prolapse.","authors":"Ayşe Ceren Yildiz, Zelal Aydin, Kübra Keskin Toptaş, Fatma Sağlam Karaoğlan, Hande Soyer Somunsu, Berna Aslan Çeti̇n, Kubra Bozali, Eray Metin GuleR","doi":"10.1097/SPV.0000000000001829","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001829","url":null,"abstract":"<p><strong>Importance: </strong>Collagen cannot be underestimated in maintaining the structural integrity of the ligaments and connective tissue, as it plays a crucial role in pelvic organ support.</p><p><strong>Objective: </strong>In this study, extracellular matrix metalloproteinase inducer (EMMPRIN) levels in the uterosacral ligament, cardinal ligament, and ligamentum rotundum tissues of women with pelvic organ prolapse (POP) were compared with women without POP. The aim was to investigate the role of EMMPRIN in the etiopathogenesis of POP.</p><p><strong>Study design: </strong>Our study was planned as a prospective cohort study between August and November 2023. Women who underwent vaginal hysterectomy for POP and women with similar demographic data who underwent hysterectomy for benign reasons other than POP were included in the study. Tissue samples were taken from the cardinal ligament, uterosacral ligament, and ligamentum rotundum; total protein was analyzed, EMMPRIN levels were measured, and the 2 groups were compared.</p><p><strong>Results: </strong>A total of 85 patients, including 41 with POP and 44 without, were included in the study. Uterosacral ligament, cardinal ligament, and ligamentum rotundum EMMPRIN values were found to be significantly lower in the POP group compared with the control group. In the multiple regression model, uterosacral-rotundum EMMPRIN, body mass index, and parity were found to have a statistically significant effect on the development of POP.</p><p><strong>Conclusion: </strong>EMMPRIN levels in the uterosacral ligament, cardinal ligament and ligamentum rotundum were significantly lower in patients with POP. EMMPRIN deficiency may be one mechanism underlying the development of POP, but multicenter studies with larger patient numbers are needed.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700886","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":"The Utility of Simple Cystometry.","authors":"Ashley Huber, Savci B Telek, Lisbet Lundsberg, Oz Harmanli","doi":"10.1097/SPV.0000000000001741","DOIUrl":"10.1097/SPV.0000000000001741","url":null,"abstract":"<p><strong>Importance: </strong>Despite its common use, there is limited contemporary evidence regarding the place of simple cystometry (SC) in the evaluation of urinary function.</p><p><strong>Objectives: </strong>Our objective was to assess the accuracy of SC with respect to complex urodynamic study (UDS), evaluate the correlation between them, and determine whether performing both tests on the same patient offers any additional benefit.</p><p><strong>Study design: </strong>In this retrospective cohort study, 609 consecutive women aged >18 years who underwent both UDS and SC within the same 6-month period between January 1, 2017, and December 31, 2022, were evaluated at a tertiary academic center. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of SC were evaluated for detecting stress urinary incontinence (SUI) and detrusor overactivity (DO), using UDS as the gold standard. Pearson correlation for filling parameters was calculated. Each patient served as their own control for each test.</p><p><strong>Results: </strong>There was a weak correlation between SC and UDS for first sensation ( r =0.30), first urge ( r =0.38), and maximum cystometric capacity (MCC) ( r =0.43). SC detected DO with a sensitivity of 38% (28-48%) and a specificity of 86% (82-89%). SC detected SUI with a sensitivity of 79% (75-83%) and a specificity of 53% (46-60%). When UDS was performed in conjunction with SC, an additional 14% of patients (n=87) were found to have SUI.</p><p><strong>Conclusions: </strong>The correlation between SC and UDS with respect to filling phase parameters is low. SC testing demonstrated a high sensitivity for SUI and a high specificity for DO. The combination of SC and UDS may enhance SUI detection rates.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700948","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":"Age and Perioperative Outcomes Following Minimally Invasive Sacrocolpopexy.","authors":"Samantha Erin Neal, Sarah Ashmore, Jinxuan Shi, Wei Tang, Tara Samsel, Margaret G Mueller, Kimberly Kenton","doi":"10.1097/SPV.0000000000001859","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001859","url":null,"abstract":"<p><strong>Importance: </strong>Literature surrounding the effect of age on perioperative outcomes following minimally invasive sacrocolpopexy (MI-SCP) is limited and conflicting.</p><p><strong>Objective: </strong>The objective of this study was to determine the effect of age on postoperative complications following MI-SCP, utilizing a large, national database.</p><p><strong>Study design: </strong>This was a retrospective cohort study using the 2014-2021 American College of Surgeons National Surgical Quality Improvement Program database to determine the effect of age on postoperative complications following MI-SCP. Women undergoing robotic and laparoscopic sacrocolpopexy for prolapse were included, and surgical procedures were identified using Current Procedural Terminology codes. Our primary outcome was the 30-day postoperative complication rate. Women were stratified into 2 cohorts: (1) 65 years or older and (2) younger than 65 years. Standard group comparisons were performed. A multivariable logistic regression was completed to determine if age affected the postoperative complication rate after accounting for other variables.</p><p><strong>Results: </strong>A total of 6,794 women underwent MI-SCP; 3,726 (54.8%) were younger than 65 years, and 3,068 (45.2%) were 65 years or older. Overall, the 30-day postoperative complication rate following MI-SCP was 5.02%, and women 65 years or older were less likely to experience a postoperative complication compared with women younger than 65 years (3.98% vs 5.88%, P <0.001). In logistic regression, age younger than 65 years was associated with increased odds of 30-day postoperative complications (adjusted odds ratio [aOR], 1.56; 95% CI, 1.22-2.00). Class 3 obesity (aOR, 1.87) and longer length of stay (aOR, 1.13) were also associated with increased odds of postoperative complications.</p><p><strong>Conclusions: </strong>Our findings suggest that age 65 years or older is not associated with increased postoperative complications following MI-SCP.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700877","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":"Pelvic Floor Myofascial Pain With Palpation and Lower Urinary Tract Symptoms.","authors":"Melanie R Meister, Colleen M Fitzgerald, Kimberly A Kenton, Lisa K Low, Emily S Lukacz, Gerald McGwin, Alayne D Markland, Diane K Newman, Sara Putnam, Siobhan Sutcliffe, Jerry L Lowder","doi":"10.1097/SPV.0000000000001854","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001854","url":null,"abstract":"<p><strong>Importance: </strong>In women with pelvic floor disorders, pelvic floor myofascial pain with palpation is associated with lower urinary tract symptoms, but the prevalence in community-dwelling women is unknown.</p><p><strong>Objectives: </strong>Our study describes the prevalence of pelvic pain with palpation in community-dwelling women and its association with bladder health and symptoms.</p><p><strong>Study design: </strong>A subset of adult women from a large population-based, regionally representative cohort across 8 geographic regions of the United States was examined for pain with palpation of the obturator internus and levator ani muscles. Participants were not excluded on the basis of pain or urinary symptoms at baseline. Bladder health and urinary symptoms were measured using validated questionnaires. Linear and Poisson regression were used to examine associations between baseline pain and changes in bladder health and symptoms at follow-up.</p><p><strong>Results: </strong>Of 502 participants, 56% had pain (46% mild [1-3/10], 8% moderate [4-6/10], 2% severe [7-10]; mean 1.1±1.6) on examination. At baseline, higher pain scores were associated with worse bladder function (β, -1.4, CI, -2.6, -0.1), and greater urinary symptoms (β, 0.4, CI, 0.1, 0.8). Baseline pain on palpation was associated with the development of new bothersome urinary symptoms (β, 1.1, CI, 1.0, 1.2) and painful urinary symptoms (β, 1.2, CI, 1.0, 1.3) over 1-2 years.</p><p><strong>Conclusion: </strong>Pain with palpation of the pelvic floor musculature is common in community-dwelling women and is significantly associated with urinary symptoms at baseline and with new-onset urinary symptoms over time. Pelvic muscle pain with palpation may be important to consider in the assessment of factors associated with urinary symptoms and as a precursor to bladder pain.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700929","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":"Away Rotations and Urogynecology Fellowship Match: A Retrospective Study.","authors":"Anna Guanzon, Libby Ratliff, Paige Schultheis, Douglass Hale, Surya S Bhamidipalli, David Guise, Jennifer Hamner, Michael Heit","doi":"10.1097/SPV.0000000000001848","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001848","url":null,"abstract":"<p><strong>Importance: </strong>Whether performing an away rotation increases fellowship match success is important for both cost and logistic considerations.</p><p><strong>Objective: </strong>This study aimed to determine whether away rotations increase the likelihood of urogynecology and pelvic reconstructive surgery (URPS) match success.</p><p><strong>Study design: </strong>This was a retrospective analysis of 246 applications to Indiana University URPS fellowship between 2015 and 2019. Variables included match success, whether an away rotation was performed, demographic data, medical school and residency descriptors, examination scores, prior research, personal statements and letters of recommendation. Data were summarized for the overall cohort and by URPS match (yes/no). The t test was used to compare continuous variables with normal distributions, the Wilcoxon rank sum test for nonnormal distributions, and the χ2 test for categorical variables. Univariate logistic regression was performed to test the association of each variable collected with the URPS match. Backward selection was used to determine variables to include in multivariable logistic regression and identify independent predictors of URPS match success.</p><p><strong>Results: </strong>Of the 245 applicants for whom match data were available, 80 performed a URPS away rotation and 171 (69.8%) successfully matched into a URPS fellowship. Approximately 34% (33.9%) who matched performed a URPS away rotation versus 30.1% (P value 0.57) who did not. Successful match applicants were younger (adjusted OR, 0.82; 95% CI, 0.73, 0.92), had presented at a URPS-related scientific meeting (adjusted OR, 2.53; 95% CI, 1.25-5.13), and had higher personal statement scores (adjusted OR, 1.11; 95% CI, 1.01-1.21).</p><p><strong>Conclusions: </strong>URPS away rotations do not increase the likelihood of match success. Conducting URPS research is likely a more productive focus.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679325","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":"Use of Spanish-Validated Patient-Reported Outcome Measures in Urogynecology.","authors":"Lucie Lefbom, Shreya Venkat, Monique Vaughan","doi":"10.1097/SPV.0000000000001858","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001858","url":null,"abstract":"<p><strong>Importance: </strong>Latinas experience pelvic floor disorders at disproportionately high rates yet remain underrepresented in urogynecologic research. Patient-reported outcome measures (PROMs) are central to urogynecologic research, but their lack of bilingual validation or use may present a barrier to inclusion for Spanish-speaking participants.</p><p><strong>Objectives: </strong>The objectives of this study were to quantify the availability and use of PROMs validated in both English and Spanish in urogynecologic research and to evaluate their association with Latina representation.</p><p><strong>Study design: </strong>We conducted a retrospective review of all studies published in Urogynecology from April 2020 to March 2024 that were performed in the United States and included at least 1 PROMs. Validation status was determined by a structured literature search. Representation quotients were used to assess proportional inclusion of Hispanic/Latina participants. We compared studies exclusively using bilingually validated instruments with those that did not and separately analyzed studies explicitly reporting administration of both English and Spanish versions.</p><p><strong>Results: </strong>Among 123 eligible studies, 98 unique PROMs were identified, 64 (65%) of which were known to be validated in Spanish. Across all instances of use, PROMs that were bilingually validated made up 85% of the measures used, although only 9 studies (7%) explicitly reported use of Spanish versions. Studies reporting use of Spanish versions achieved a representation quotient of 0.95, compared with 0.63 for studies that didn't (P=0.002).</p><p><strong>Conclusions: </strong>Most urogynecologic PROMs are validated in Spanish, but Spanish versions are underutilized. Administering both English and Spanish PROMs is associated with more adequate Latina representation, highlighting their importance for inclusive research practices.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679268","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":"Training and Comfort in the Management of Fecal Incontinence.","authors":"Lei A Qin, Melissa A Ardizzone, Uduak U Andy","doi":"10.1097/SPV.0000000000001855","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001855","url":null,"abstract":"<p><strong>Importance: </strong>Fecal incontinence (FI) is common, underdiagnosed, and often undertreated. Understanding gaps in training, comfort, and confidence in managing FI among urogynecology fellows and attending physicians (attendings) may improve patient access to high-quality care.</p><p><strong>Objective: </strong>The objective of this study was to assess clinical exposure, didactic training, and self-reported comfort with FI management among urogynecology fellows and fellowship-trained attendings in the United States.</p><p><strong>Study design: </strong>A cross-sectional, anonymous electronic survey was distributed to physician members of the American Urogynecologic Society (AUGS) in 2025. The survey evaluated demographic characteristics, exposure to FI during fellowship and current practice, availability of diagnostic and procedural tools, didactic education, and comfort with medical and procedural management. Responses were summarized using descriptive statistics, and 1-way analyses of variance (ANOVA) were used to assess associations between level of training and overall comfort.</p><p><strong>Results: </strong>A total of 202 respondents completed the survey (35 fellows, 167 attendings; response rate 14.3%). More than half of fellows (54.3%) and two thirds of attendings (66.5%) completed a colorectal surgery rotation, while gastroenterology rotations were less common. Most respondents evaluated patients with FI weekly (60.0% of fellows; 51.5% of attendings). Fewer than half felt comfortable performing or interpreting anorectal manometry or endoanal ultrasound. Only 8.6% of fellows and 31.1% of attendings reported feeling very comfortable with FI management. Overall comfort increased with advancing training stage and years in practice (P<0.001) but was not associated with colorectal or gastroenterology rotations. Most respondents (80.0% of fellows; 63.5% of attendings) believed that improving clinician comfort would enhance patient outcomes and access to care.</p><p><strong>Conclusions: </strong>Clinical and didactic exposure to FI varies widely across urogynecology training and practice. Despite frequent encounters, limited procedural experience contributes to persistent discomfort with FI management. Standardizing fellowship education and expanding interdisciplinary, longitudinal training may improve clinician confidence and patient care.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147679311","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}