Brachytherapy最新文献

{"title":"Mature effectiveness and toxicity outcomes associated with three treatment schedules of high-dose-rate brachytherapy monotherapy for favorable-risk prostate cancer.","authors":"Kamran Salari, Hong Ye, Alvaro A Martinez, Evelyn Sebastian, Amy Limbacher, Kim Marvin, Andrew B Thompson, Sirisha R Nandalur, Peter Y Chen, Daniel J Krauss","doi":"10.1016/j.brachy.2024.10.008","DOIUrl":"https://doi.org/10.1016/j.brachy.2024.10.008","url":null,"abstract":"<p><strong>Purpose: </strong>To present long-term toxicity and effectiveness outcomes of three prostate high-dose-rate (HDR) brachytherapy schedules: 38 Gy in 4 fractions, 24 Gy in 2 fractions, and 27 Gy in 2 fractions for men with low- or intermediate-risk prostate cancer.</p><p><strong>Methods and materials: </strong>Patients treated with HDR brachytherapy monotherapy for prostate cancer were identified in a prospectively maintained, single institution database. Patients with AJCC T-stage ≤ T2b, Gleason score ≤ 7, prostate-specific antigen level ≤ 20 ng/mL, and ≥2 years of follow-up were included.</p><p><strong>Results: </strong>671 patients were evaluated. 310 patients received 38 Gy in 4 fractions, 129 received 24 Gy in 2 fractions, and 232 received 27 Gy in 2 fractions. Median follow-up was 12.8 years, 10.6 years, and 8.1 years (p < 0.001), respectively. 231 (74.5%), 92 (71.3%), and 81 (34.9%) patients (p < 0.001) had low-risk disease. Rates of acute grade ≥2 GU toxicity were 11.1%, 12.3%, and 25.0% (p = 0.004), while chronic grade ≥2 GU toxicity were 17.0%, 22.6%, and 26.5% (p = 0.06). For low-risk patients, 10-year overall survival (OS), freedom from biochemical failure (ffBF), local control (LC), and freedom from distant metastasis (ffDM) were 86.6%, 93.3%, 97.9%, and 99.3%. For intermediate-risk patients, 10-year OS, ffBF, LC, and ffDM were 89.5%, 82.6%, 90.5%, and 97.4%. Higher PSA, higher Gleason score, perineural invasion, and 24 Gy or 27 Gy treatment schedules were predictors of biochemical failure.</p><p><strong>Conclusions: </strong>HDR brachytherapy monotherapy with 38 Gy in 4 fractions was associated with improved long-term ffBF compared with 24 Gy/27 Gy in 2 fractions, without any associated increase in GI or GU toxicity rates.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824932","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":"High-dose-rate (2 fractions of 13.5 Gy) and low-dose-rate brachytherapy as monotherapy in prostate cancer. Long term outcomes and predictive value of nadir prostate-specific antigen.","authors":"Silvia Rodríguez Villalba, Diana Guevara Barrera, Luis Suso-Martí, Enrique Sanchis-Sánchez, Jose Pérez-Calatayud, Jose Domingo Lago Martín, Francisco Blázquez Molina, Manuel Santos Ortega","doi":"10.1016/j.brachy.2024.10.014","DOIUrl":"https://doi.org/10.1016/j.brachy.2024.10.014","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to evaluate the outcomes of patients treated for low-risk (LR) and favorable intermediate risk (FIR) prostate cancer with brachytherapy (BT) in monotherapy with LDR or HDR and its relationship with nadir PSA (nPSA).</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 139 patients (2005-2019) with exclusive LDR (46%. 145/160 Gy) /HDR (54%. 2 implants of 13.5 Gy each separated 10 days). 69% LR and 31% FIR. PSA nadir was grouped into two categories: ≤ 0.2 ng/mL and > 0.2 ng/mL.</p><p><strong>Results: </strong>Median patient age was 69 years (46-84). Seventy-six patients (55%) received androgen deprivation therapy, and 37% received neoadjuvant therapy. Median follow-up period was 90 months. Actuarial biochemical failure-free survival (BFFS), local control (LC), overall survival (OS), and cause-specific survival (CSS) rates for the total cohort were 78%, 87%, 68%, and 98% at 10 years, respectively. BFFS, LC, OS and CSS in nPSA ≤ 0,2 ng/ml was 90%, 96%, 67%, 100% at 10 years respectively, whereas, those with a nPSA > 0.2 ng/ml had a BFFS, LC, OS and CSS of was 37%, 51%, 72%, 90% at 10 years respectively Statistical significance between both groups was reached in BFFS (p=0,000), LC (p=0,000) and CSS (p=0,007)). In the univariate analysis, there was no difference between risk stratification, BT technique, ADT, or the development of bouncing.</p><p><strong>Conclusions: </strong>Prostate brachytherapy as monotherapy (LDR and HDR) is an effective treatment option for patients with LR and FIR prostate cancer. nPSA ≤0,2 ng/ml is a representative value that provides prognostic information for favorable outcomes in this group of patients.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824928","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":"Towards U-Net-based intraoperative 2D dose prediction in high dose rate prostate brachytherapy.","authors":"Eric Knull, Christopher W Smith, Aaron D Ward, Aaron Fenster, Douglas A Hoover","doi":"10.1016/j.brachy.2024.11.007","DOIUrl":"https://doi.org/10.1016/j.brachy.2024.11.007","url":null,"abstract":"<p><strong>Background: </strong>Poor needle placement in prostate high-dose-rate brachytherapy (HDR-BT) results in sub-optimal dosimetry and mentally predicting these effects during HDR-BT is difficult, creating a barrier to widespread availability of high-quality prostate HDR-BT.</p><p><strong>Purpose: </strong>To provide earlier feedback on needle implantation quality, we trained machine learning models to predict 2D dosimetry for prostate HDR-BT on axial TRUS images.</p><p><strong>Methods and materials: </strong>Clinical treatment plans from 248 prostate HDR-BT patients were retrospectively collected and randomly split 80/20 for training/testing. Fifteen U-Net models were implemented to predict the 90%, 100%, 120%, 150%, and 200% isodose levels in the prostate base, midgland, and apex. Predicted isodose lines were compared to delivered dose using Dice similarity coefficient (DSC), precision, recall, average symmetric surface distance, area percent difference, and 95th percentile Hausdorff distance. To benchmark performance, 10 cases were retrospectively replanned and compared against the clinical plans using the same metrics.</p><p><strong>Results: </strong>Models predicting 90% and 100% isodose lines at midgland performed best, with median DSC of 0.97 and 0.96, respectively. Performance declined as isodose level increased, with median DSC of 0.90, 0.79, and 0.65 in the 120%, 150%, and 200% models. In the base, median DSC was 0.94 for 90% and decreased to 0.64 for 200%. In the apex, median DSC was 0.93 for 90% and decreased to 0.63 for 200%. Median prediction time was 25 ms.</p><p><strong>Conclusion: </strong>U-Net models accurately predicted HDR-BT isodose lines on 2D TRUS images sufficiently quickly for real-time use. Incorporating auto-segmentation algorithms will allow intra-operative feedback on needle implantation quality.</p>","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820425","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":"Prostate Posters PO51","authors":"Nahuel Eduardo Paesano, Nuria Jornet i Sala, Jadi Rojas Cordero, Nahuel Paesano, Alicia Maccagno, Gilberto Chechile Toniolo","doi":"10.1016/j.brachy.2023.06.152","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.152","url":null,"abstract":"Purpose Since 1983, Brachytherapy (BT) has been used for the treatment of localized prostate cancer (CaP). Over the years, this technique has been consolidated, updated and perfected as a curative treatment for low-risk PCa, and its indication has been extended to intermediate-risk cancer as monotherapy. To evaluate oncological outcomes and genitourinary and gastrointestinal adverse events in patients treated with real-time low dose rate (LDR) Iodine-125 BT as a treatment for localized prostate cancer. Materials and Methods To carry out this study, all patients treated with BT in monotherapy with or without associated androgen deprivation therapy for the treatment of localized PCa were prospectively included from June 2003 to August 2021. Strict post-treatment follow-up was performed. was performed every 6 months. Reviews include quality of life (QoL) test, assessment of urinary obstructive symptoms using IPSS (International Prostate Examples Score), SHIM (Sexual Health Inventory for Men), IIEF-15 questionnaires to assess sexual quality, specific total stretching prostate (PSA), ultrasound and flowmetry. The statistical method used was the Kaplan Meier and Cox regression with the SPSS computer system. Results A total of 445 patients were evaluated. The mean age at which the BT was performed was 65.3 years (SD=7.7). The mean prostate volume was 41.0 cm3. (SD=14.3). The mean PSA before BT was 7.28 (SD= 4.33). Regarding the D'Amico risk classification, 48.3% (215/445) of the patients were low risk, 45.1% (201/445) intermediate risk, and 6.6% (29/445). 445) high risk. 22.5% (100/445) received associated hormonal therapy. 47.8% (213/445) of the patients presented urological complications after CT, with urinary frequency being the most frequent. Rectal complications manifested in 17.7% (78/445) of the patients and the most frequent was tenesmus. The main urinary complication was urinary frequency, which was significantly associated between the first 3 months and the year after CT. After one year, most patients had the same micturition quality as before BT. The mean follow-up is 6 years, showing an overall biochemical recurrence-free survival (BLFS) of 92.3% (411/445). Regarding biochemical recurrence according to risk group, 14 patients with treatment failure were low risk, 15 intermediate risk and 5 high risk. No statistically significant association was found between risk stratification and recurrence. However, for the group of patients considered to be at high risk, the percentage of recurrence was higher. Conclusions BT offers excellent oncological control in the treatment of low and intermediate risk prostate cancer with acceptable rates of adverse events. Since 1983, Brachytherapy (BT) has been used for the treatment of localized prostate cancer (CaP). Over the years, this technique has been consolidated, updated and perfected as a curative treatment for low-risk PCa, and its indication has been extended to intermediate-risk cancer as monotherapy","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434225","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":"PO126","authors":"Ron Digiaimo","doi":"10.1016/j.brachy.2023.06.226","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.226","url":null,"abstract":"This session will review common Brachytherapy Coding and Documentation opportunities and risks. The information provided will help the provider and the institution know the appropriate coding for compliant submission to payers as well as reasons for denial of payment. For example Prostate and Breast HDR, Skin HDR, Prostate LDR may be reviewed with associated coding and documentation requirements. Brachytherapy generally requires insurance authorization and may be a cause of denial of payment if not done properly or timely. In addition financial counseling can contribute material benefits to both the provider and institution as well as create psychological benefit to the patient. Examples of coding and denials will be provided along with suggestions on how to deal with appeals for payments from both government and commercial payers. This session will review common Brachytherapy Coding and Documentation opportunities and risks. The information provided will help the provider and the institution know the appropriate coding for compliant submission to payers as well as reasons for denial of payment. For example Prostate and Breast HDR, Skin HDR, Prostate LDR may be reviewed with associated coding and documentation requirements. Brachytherapy generally requires insurance authorization and may be a cause of denial of payment if not done properly or timely. In addition financial counseling can contribute material benefits to both the provider and institution as well as create psychological benefit to the patient. Examples of coding and denials will be provided along with suggestions on how to deal with appeals for payments from both government and commercial payers.","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434363","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":"PO67","authors":"Tyler E. Gutschenritter, Anthony Pham, Homayon Parsai, Joe Bradlo, Merriah Montague, Sarah Reith, Justin Bell, Rosanna Mangibin, Richard Alex Hsi","doi":"10.1016/j.brachy.2023.06.168","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.168","url":null,"abstract":"","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434378","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":"PO38","authors":"Bethel Adefres, Christopher Jason Tien, Shari Damast","doi":"10.1016/j.brachy.2023.06.139","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.139","url":null,"abstract":"Purpose Adjuvant vaginal cuff brachytherapy (VCB) for endometrial cancer (EC) is typically delivered with single-channel vaginal cylinders with diameters ranging from 2.0 to 4.0 cm. Due to the unfavorable dosimetry of 2.0 cm diameter cylinders, larger diameter cylinders are used whenever possible. There are, however, occasional patients with narrow vaginal anatomy for whom only a 2.0 cm cylinder can be accommodated. In this unique population, in addition to the dosimetric challenges for a typical prescription to 5 mm depth (ie., heterogeneity of about 170% and 210% of prescription dose at the surface of the cylinder lateral walls and tip, respectively), there tend to be clinical challenges as well such as insertional pain or difficulty with procedural tolerance. This study reports the clinical outcomes of an EC cohort that received VCB with cylinder size 2.0 cm at a single institution. Materials and Methods From an IRB-approved institutional database of EC patients treated with VCB between 07/01/2014-11/30/2022, all patients that were fitted with 2.0 cm cylinder were retrospectively reviewed. Although our institutional prescriptions for cylinders larger than 2.0cm are at 5mm depth (6-7 Gy x 3 fractions weekly), for the 2.0cm cylinder patients, VCB prescriptions are to the vaginal surface (10Gy x 3 fractions weekly), to avoid issues resulting in unacceptably high surface dose. Patient demographics, disease and treatment characteristics, recurrence rates and complications were descriptively analyzed. Toxicity was recorded via the CTCAE v4.0. The Kaplan-Meier method was used to assess freedom from vaginal recurrence. All computations were performed in IBM SPSS Statistics 28. Results Among 655 consecutive EC patients treated with VCB, there were 36 women (5%) that were treated with cylinder size 2.0 cm. Median age was 68.5 years (range: 46-95 years). The majority were nulliparous (77.8%) and 15 women (42%) had documented baseline pain or anxiety related to pelvic examination prior to VCB. Median BMI was 39 (range: 19-62). Baseline vaginal length was 8.3cm (range: 5-14cm). 78% had stage I-II, 14% had stage IIIA, and 8% had stage IVB EC. The histological subtypes included endometrioid adenocarcinoma (69%), mixed (11%), serous (8%), clear cell (6%) and de-differentiated (6%). 42% of the patients received chemotherapy. None received external beam radiotherapy. Median interval from surgery to VCB was 54 days (range: 43-119 days). All received 10Gy x 3 fractions prescribed to vaginal surface, and active length was 3cm (5.6%), 4cm (63.9%) or 5cm (30.6%). 3D planning was performed in 58% of the cohort, while 2D planning was used in the remainder due to issues related to body habitus and/or poor mobility. Median follow-up was 17.5 months (range: 3-76 months). The 2-year freedom from vaginal recurrence was 96%. There was only 1 vaginal recurrence, which was out of field. 5 patients died from disease, unrelated to radiation treatment. There were no grade 2 or h","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434390","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":"PO42","authors":"Ria Mulherkar, Hong Wang, Mark Jelenik, Hayeon Kim, Christopher J. Houser, Elangovan Doraisamy, Madeleine Courtney-Brooks, Alexander Olawaiye, John Comerci, Michelle Boisen, Jessica Berger, Joseph Kelley, Paniti Sukumvanich, Sarah Taylor, Robert Edwards, Lan Coffman, Ronald Buckanovich, Jamie Lesnock, Haider Mahdi, Shannon Rush, John Austin Vargo, Sushil Beriwal, Parul Barry","doi":"10.1016/j.brachy.2023.06.143","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.143","url":null,"abstract":"Disparities in race and socioeconomic factors affect patient access to cancer screening, treatment, and clinical outcomes. The aim of this project was to evaluate relationship between race and socioeconomic factors including insurance status, employment status, disability status, and distance from brachytherapy center on clinical outcomes including stage at presentation, number of nodes positive, brachytherapy technique, progression-free survival (PFS), and overall survival (OS). All cervical cancer patients treated with brachytherapy at our institution from 2007-2017 were identified. Race and socioeconomic factors including insurance status, employment status, disability status, and distance from brachytherapy center were recorded. Clinical characteristics including stage at presentation, number of involved nodes, and brachytherapy technique were also recorded. PFS and OS were calculated from date of last brachytherapy fraction, with censorship at date of last follow-up. Correlation was tested between racial and socioeconomic factors and survival outcomes (i.e., PFS and OS) using Cox regression models. Their association with other outcomes was examined with Wilcoxon rank sum tests, Fisher's exact tests, and Spearman's rank correlation coefficients where appropriate. 251 cervical cancer patients were identified, with median follow-up 5.2 years (IQR 2.0-7.7 years). On univariate analysis (UVA), there was no correlation between brachytherapy technique utilized, number of nodes positive, or stage at presentation and race, distance from treatment center, insurance status, employment status, or disability status. UVA did show a significant correlation between PFS and race, insurance status, employment status, and disability status. Significantly worse PFS was seen in non-white group (p=0.036), uninsured group (p<0.001), unemployed group (p<0.001), and disabled group (p=0.041). Similarly, there was significant correlation between OS and race, insurance status, employment status, and disability status. Significantly worse OS was seen in non-white group (p=0.005), uninsured group (p<0.001), unemployed group (p<0.001), and disabled group (p=0.008). On multivariate analysis (MVA), there was no significant correlation between race or disability status and PFS, but there was significantly improved PFS seen in patients with insurance (p < 0.001) and patients who were employed (p = 0.002). MVA showed no correlation between disability status and OS, but significantly worse OS in patients who were non-white (p=0.039) and significantly improved OS in patients with insurance (p<0.001), and patients who were employed (p-0.001). MVA showed no significant correlation between stage and insurance or employment status. MVA showed no significant correlation between histology and employment status; on MVA patients with government insurance were less likely to have squamous histology compared with no insurance (p=0.002). Insurance and employment status are significant pred","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434406","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":"PO121","authors":"Hari Menon, Charles R. Wallace, Jessica M. Schuster, Kristin A. Bradley, Bethany M. Anderson","doi":"10.1016/j.brachy.2023.06.222","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.222","url":null,"abstract":"","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434414","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":"PO34","authors":"Devin Van Elburg, Sarah Quirk, Kevin Martell, Tyler Meyer, Michael Roumeliotis","doi":"10.1016/j.brachy.2023.06.135","DOIUrl":"https://doi.org/10.1016/j.brachy.2023.06.135","url":null,"abstract":"","PeriodicalId":93914,"journal":{"name":"Brachytherapy","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135434424","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}