Annals of Medicine and Surgery最新文献

{"title":"Primary signet ring cell carcinoma of the appendix presenting as gangrenous appendicitis with peritonitis: a case report.","authors":"Kuang-Ting Liu, Yueh-Ching Chang, Yu-Chieh Lin, Junn-Liang Chang","doi":"10.1097/MS9.0000000000002656","DOIUrl":"10.1097/MS9.0000000000002656","url":null,"abstract":"<p><strong>Introduction and clinical importance: </strong>Primary signet ring cell carcinoma (SRCC) of the appendix is an exceedingly rare malignancy with a non-specific clinical manifestations, and it often masquerades as acute appendicitis. Case presentation A 76-year-old man presented with acute abdominal pain and peritonitis. Abdominal computed tomography revealed relative acute appendicitis with peritonitis, and emergency laparoscopic partial cecectomy with appendectomy revealed gangrenous appendicitis with perforation. A histopathological examination revealed a primary appendiceal signet ring cell carcinoma (PASRCC).</p><p><strong>Clinical discussion: </strong>This case highlights the importance of considering appendiceal malignancies in the differential diagnosis of acute appendicitis. SRCC is a histological variant commonly associated with multiple malignancies of the gastrointestinal tract, particularly gastric and colorectal cancers.</p><p><strong>Conclusion: </strong>PASRCC is a rare malignancy presenting with symptoms indistinguishable from those of acute appendicitis. Clinicians should maintain a high index of suspicion for appendiceal malignancy, particularly in older patients with atypical clinical presentations. Early recognition, accurate diagnosis by histopathological and immunohistochemical examinations, and appropriate management are essential for optimizing the outcomes in these patients.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6033-6040"},"PeriodicalIF":1.6,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991460","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":"Innovative strategies for mitochondrial dysfunction in myeloproliferative neoplasms a step toward precision medicine.","authors":"Shinto Bosco, Shreya Singh Beniwal, Samid Soeb Munshi, Daniela Castro Calderón, Yujin Jeong, Alyanna Cabe Cacas, Sandeep Kumar, Pedro Henrique Serra Carvalho Dos Santos, Saif Syed, Ayush Dwivedi, Mahmoud Einieh","doi":"10.1097/MS9.0000000000003365","DOIUrl":"10.1097/MS9.0000000000003365","url":null,"abstract":"<p><p>Myeloproliferative neoplasms (MPNs) are clonal disorders of hematopoietic stem cells characterized by aberrant proliferation of myeloid lineages, driven primarily by mutations in JAK2, CALR, and myeloproliferative leukemia, leading to constitutive activation of the JAK-STAT pathway. Emerging evidence highlights mitochondrial dysfunction as a key factor in MPN pathogenesis, contributing to increased reactive oxygen species production, mitochondrial DNA mutations, and dysregulated mitochondrial dynamics, which collectively promote clonal expansion and apoptosis resistance. Targeting mitochondrial pathways has gained attention as a therapeutic strategy, with approaches including mitochondria-targeted antioxidants, metabolic inhibitors, and modulation of mitophagy and mitochondrial fission/fusion dynamics. However, challenges such as drug delivery specificity, therapeutic resistance, and off-target effects remain significant. Recent advances in precision medicine, incorporating genomic, transcriptomic, and proteomic profiling, offer a more personalized approach to MPN treatment by tailoring interventions to individual mutation patterns. Additionally, novel therapeutic strategies, including gene editing technologies, RNA-based therapies, and nanoparticle-mediated drug delivery systems, hold promise for overcoming current treatment limitations. The integration of artificial intelligence in drug discovery and biomarker identification further enhances the potential for targeted therapies. Future research should focus on refining these strategies, developing reliable biomarkers for patient stratification, and exploring combination therapies that enhance treatment efficacy while minimizing adverse effects. By addressing mitochondrial dysfunction as an underlying driver of MPNs, these emerging approaches have the potential to improve disease management, extend patient survival, and enhance quality of life. Also, this new approach of precision medicine allows patient stratification and ensures that treatments are formed according to the individual disease biology of each patient, which results in overall better outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5557-5568"},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991099","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":"Integrating sickle cell disease care into primary healthcare in Uganda: a narrative review.","authors":"Emmanuel Ifeanyi Obeagu, Olaitan Ruth-Thelca Olateju","doi":"10.1097/MS9.0000000000003713","DOIUrl":"10.1097/MS9.0000000000003713","url":null,"abstract":"<p><p>Sickle cell disease (SCD) poses a significant public health challenge in Uganda, affecting approximately 1.6 million individuals and contributing to high morbidity and mortality rates. Current SCD management is often fragmented, with care primarily concentrated in specialized centers, leading to disparities in access and delayed interventions. The integration of SCD care into the primary healthcare (PHC) system has been proposed as a strategy to address these challenges. This narrative review explores the current gaps in SCD care within Uganda's healthcare system and examines the potential benefits of integrating SCD management into PHC settings to improve outcomes. A comprehensive literature review was conducted to assess existing SCD management practices, barriers within PHC systems, and outcomes from integration pilot programs. Data on healthcare provider confidence, access to diagnostic tools, and patient outcomes were analyzed to understand the current landscape and opportunities for improvement. Only 35% of healthcare providers in PHC settings reported confidence in managing SCD patients (OR: 0.45, 95% CI: 0.35-0.55). Limited access to diagnostic tools and inadequate resources further hinders timely diagnosis and treatment, contributing to preventable complications and higher healthcare costs. However, a pilot program integrating SCD care into PHC clinics demonstrated a 50% reduction in hospital admissions for pain crises among participants (OR: 2.0, 95% CI: 1.5-2.7). Integrating SCD care into Uganda's PHC framework offers significant potential to enhance early diagnosis, improve treatment adherence, and reduce hospital admissions. Coordinated care approaches could alleviate the disease burden, improve patient outcomes, and lower healthcare costs.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5918-5924"},"PeriodicalIF":1.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991367","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":"Birth asphyxia: its role in neonatal mortality, consequences and recommended courses of action for healthcare in Tanzania.","authors":"Jovin R Tibenderana, Sanun Ally Kessy","doi":"10.1097/MS9.0000000000003698","DOIUrl":"10.1097/MS9.0000000000003698","url":null,"abstract":"<p><p>Globally about 9 million neonates are diagnosed with birth asphyxia yearly, of these 25% end up dying and among those who survive 25% end up with permanent neurological deficit. It remains a significant unpopular contributor to neonatal mortality not only in Tanzania but also globally. This article aims to unveil the causes, consequences, its contribution to Neonatal Mortality and recommended course of action in Tanzania.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5385-5387"},"PeriodicalIF":1.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991274","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":"3D bioprinting for stickler syndrome: a transformative approach to early-onset joint degeneration.","authors":"Sofia Abdullah, Maria Nosheen, Muhammad Talha, Laiba Shamim, Sakan Binte Imran","doi":"10.1097/MS9.0000000000003708","DOIUrl":"10.1097/MS9.0000000000003708","url":null,"abstract":"","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6240-6241"},"PeriodicalIF":1.6,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991229","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":"Cytokine storm and microvascular fate: mechanistic insights into endothelial injury in thrombotic microangiopathies.","authors":"Emmanuel Ifeanyi Obeagu","doi":"10.1097/MS9.0000000000003700","DOIUrl":"10.1097/MS9.0000000000003700","url":null,"abstract":"<p><p>Thrombotic microangiopathies (TMAs) encompass a diverse group of syndromes marked by microvascular thrombosis, thrombocytopenia, and organ injury, primarily affecting the kidneys and central nervous system. While the etiologies differ-ranging from genetic mutations to infectious and autoimmune triggers-a unifying pathogenic mechanism is endothelial dysfunction. Recent advances have illuminated the pivotal role of cytokine dysregulation in initiating and sustaining this vascular injury. The release of pro-inflammatory cytokines such as TNF-α, IL-1β, and IL-6 creates a state of sustained endothelial activation that promotes leukocyte adhesion, vascular permeability, and a prothrombotic surface phenotype. In various TMA subtypes, the cytokine response acts as both a trigger and an amplifier of disease progression. In atypical hemolytic uremic syndrome (aHUS), cytokines are upregulated secondary to complement dysregulation, while in thrombotic thrombocytopenic purpura (TTP), inflammation may lower ADAMTS13 activity and potentiate thrombosis. Secondary TMAs, including those associated with autoimmune disease, pregnancy, and transplantation, often exhibit pronounced cytokine profiles that directly correlate with endothelial injury and clinical severity. These overlapping inflammatory signatures underscore the need to view TMAs not only through a hematologic or immunologic lens but also within the context of vascular inflammation.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5912-5917"},"PeriodicalIF":1.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144990914","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":"Global trends and prospects of endothelial keratoplasty from 2004 to 2023: a bibliometric analysis.","authors":"Shiwen Cheng, Yulin Yan, Zixian Yang, Yujin Wang, Qian Deng, Jiewen Mao, Yuyu Cong, Xiaoshuo Shi, Jiali Pan, Juntao Fang, Yingli Wang, Yanning Yang","doi":"10.1097/MS9.0000000000003681","DOIUrl":"10.1097/MS9.0000000000003681","url":null,"abstract":"<p><strong>Background: </strong>Endothelial keratoplasty (EK) has revolutionized the treatment of corneal diseases by offering a less invasive alternative to traditional full-thickness keratoplasty. Over the past decades, EK techniques have evolved significantly, improving surgical outcomes, expediting recovery, and reducing postoperative complications. Nevertheless, challenges such as postoperative rejection and endothelial cell loss persist. This study utilizes bibliometric analysis to map the current research landscape of EK and identify future directions.</p><p><strong>Methods: </strong>A systematic bibliometric analysis was conducted on publications spanning from 2004 to 2023, retrieved from the Web of Science Core Collection. Key metrics such as annual publication and citation counts, contributions by countries and institutions, influential journals, authors and cited authors, highly cited references, co-citation references, and keyword trends were extracted and analyzed using CiteSpace and VOSviewer, Microsoft Excel, Bibliometrix, Scimago Graphica, and Microsoft Excel.</p><p><strong>Results: </strong>A total of 2676 relevant publications were identified from 2004 to 2023. While the first 5 years saw the limited number of publications in this field, a marked increase in publications has occurred throughout these years. The United States, Germany, and England were the leading contributors. Marianne O. Price emerged as the most prolific author, with Francis W. Price Jr. most frequently cited among the top contributors. Major publishing journals included <i>Cornea, Ophthalmology</i>, and <i>American Journal of Ophthalmology</i>. Leading institutions included the Netherlands Institute for Innovative Ocular Surgery and the Legacy Devers Eye Institute. VOSviewer keyword clustering revealed 13 thematic clusters, with trending keywords such as \"risk factors\" and \"tissue,\" suggesting emerging focal points.</p><p><strong>Conclusions: </strong>The bibliometric analysis highlights the dynamic evolution and key research areas of EK and ocular disease management. Leveraging these insights is crucial for advancing clinical practice and driving further innovation in the field.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"5892-5905"},"PeriodicalIF":1.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991298","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":"Sturge-Weber syndrome Type I: a rare case report.","authors":"Batoul Hendieh, Firas Khana, Sevin Ibrahim, Abeer Alsweid, Abdulkader Habash, Alae Kayyali, Bushra Salem, Mouhammed Ali Serio","doi":"10.1097/MS9.0000000000003711","DOIUrl":"10.1097/MS9.0000000000003711","url":null,"abstract":"<p><strong>Introduction and importance: </strong>To document a rare case of Sturge-Weber syndrome (SWS) Type I with acute neurological symptoms.</p><p><strong>Case presentation: </strong>An 11-year-old boy, previously diagnosed with Sturge-Weber syndrome (SWS) Type I, presented to the emergency department with acute neurological symptoms that included vomiting, headaches, left-sided hemiparesis, and right-sided deviation of the labial commissure.</p><p><strong>Clinical discussion: </strong>Sturge-Weber syndrome (SWS) is a rare neurocutaneous disorder characterized by facial port-wine stains, leptomeningeal angiomas, and ocular involvement. Our case presented with preserved cognition despite extensive temporal lobe angiomatosis, contrasting the typical presentation of seizures and developmental delay. The patient then experienced stroke-like episodes from fragile leptomeningeal vasculature. With anticonvulsants and low-dose aspirin therapy, the patient achieved full neurological recovery within the first 3 months and maintained stability during 2 years of follow-up.</p><p><strong>Conclusion: </strong>This case underscores the diverse clinical spectrum of Sturge-Weber syndrome and emphasizes the crucial role of imaging in achieving an accurate diagnosis. Early identification and treatment are essential to prevent further complications and optimize patient outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6216-6220"},"PeriodicalIF":1.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991427","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 first case report of chylous ascites in a twin pregnancy following <i>in vitro</i> fertilization: a case report of chylous ascites in twin pregnancy.","authors":"Nguyen Xuan Hoi, Nguyen Thi Huyen Anh, Phung Thi Ly, Nguyen Dang Tuan","doi":"10.1097/MS9.0000000000003686","DOIUrl":"10.1097/MS9.0000000000003686","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Chylous ascites is an exceptionally rare condition during pregnancy, typically presenting with nonspecific symptoms. To date, only a limited number of cases have been reported in the literature, and the majority of which occurred in singleton pregnancies.</p><p><strong>Case presentation: </strong>We report the case of a 25-year-old woman with a twin pregnancy who was admitted at 32 weeks of gestation with acute abdominal pain and nausea. Due to persistent severe pain, unexplained intraperitoneal fluid, and progressing labor, an emergent cesarean section was performed. Intraoperatively, 2000 mL of milky white fluid was discovered in the peritoneal cavity. Biochemical analysis with markedly elevated triglycerides confirmed the diagnosis of chylous ascites. Postoperative management included broad-spectrum intravenous antibiotics, octreotide injection, and a low-fat diet supplemented with medium-chain triglyceride oil. By postoperative day 7, ultrasound showed complete resolution of ascites, and the patient was discharged in stable condition. No recurrence was noted during 3 years of follow-up.</p><p><strong>Clinical discussion: </strong>This report presents a rare case of spontaneous chylous ascites in a previously healthy pregnant woman with a twin gestation. Potential mechanism for chylous ascites in our case can be due to enlarged gravid uterus of twin gestation during late pregnancy, which suppress the abdominal thoracic duct of mother and increase the pressure of the duct. Another possible mechanism involves the physiological effects of progesterone during pregnancy. Progesterone is known to induce smooth muscle relaxation, which can lead to dilation of lymphatic vessels and increased lymphatic flow. This vasodilatory effect may predispose to lymphatic leakage and contribute to the development of chylous ascites. The presence of milky white peritoneal fluid combined with a markedly elevated triglyceride concentration (≥ 110 mg/dL, 1945 mg/dL in our case) was key to confirm the diagnosis of chylous ascites. Treatment strategies typically depends on the underlying etiology and may include dietary modification (low-fat, MCT-enriched diet), pharmacologic therapy (somatostatin or octreotide), and surgical interventions in refractory cases.</p><p><strong>Conclusion: </strong>Chylous ascites should be included in the differential diagnosis of unexplained ascites in twin gestation, particularly when the fluid exhibits a milky appearance. Although chylous ascites resolves spontaneously in the postpartum period, this condition may necessitate the termination of pregnancy and requires a multidisciplinary approach, involving obstetricians, gastrointestinal surgeons, radiologists, and nutritionists, for timely diagnosis and effective management.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6211-6215"},"PeriodicalIF":1.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991136","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":"Endoscopic thulium-fiber laser deroofing and dual stenting for adult duplex ureterocele with preserved upper renal moiety: a case report.","authors":"Sai Nikhitha Malapati, Ashok Adhikari, Venkata Akhil Makarla, Sai Geethika Malapati, Krishnam Raju Dema, Apsha Shrestha","doi":"10.1097/MS9.0000000000003704","DOIUrl":"10.1097/MS9.0000000000003704","url":null,"abstract":"<p><strong>Background: </strong>Adult duplex kidney with ureterocele is rarely diagnosed, especially when the upper moiety retains function. While pediatric laser decompression is established, the use of thulium fiber laser (TFL) with dual DJ stenting in adult duplex ureteroceles remains rare.</p><p><strong>Case presentation: </strong>A 23-year-old female presented in a tertiary care hospital with intermittent right flank pain and recurrent UTIs for 3 months. Imaging revealed a right-sided duplex system with an intravesical ureterocele and functioning upper moiety. TFL deroofing was performed, with placement of dual DJ stents. Operative time was 40 minutes with negligible bleeding. Recovery was uneventful, and stents were removed at 6 weeks. At 6 months, imaging confirmed resolved hydronephrosis and preserved function; the patient remained asymptomatic at 12-month tele-follow-up.</p><p><strong>Clinical discussion: </strong>Ureteroceles result from ureteric bud maldevelopment and are often associated with duplex systems per the Weigert-Meyer law. Adult presentations may include recurrent UTIs, hematuria, or flank pain. Imaging modalities such as ultrasonography, CT urography, and renography are essential for diagnosis and surgical planning that prioritizes decompression and nephron preservation. Traditional endoscopic methods, including cold-knife incision and Holmium:YAG laser, risk reflux and tissue damage. TFL offers precise, shallow ablation with better hemostasis and reduced complications, though its adult use is underreported. This case represents the first documented TFL deroofing with dual DJ stenting in adult duplex ureterocele, showing excellent anatomical and functional outcomes, suggesting TFL's potential as a safe, effective option pending larger studies.</p><p><strong>Conclusion: </strong>TFL with dual DJ stenting offers a precise, nephron-preserving, and effective approach for adult ureterocele management.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 9","pages":"6221-6225"},"PeriodicalIF":1.6,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991329","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}