World journal for pediatric & congenital heart surgery最新文献

{"title":"Timing the Repair in Truncus Arteriosus: A Systematic Review and Meta-analysis with Reconstructed Time-to-Event Data Comparing Staged Repair and Primary Correction.","authors":"Kristine Santos, Wellgner Fernandes Oliveira Amador, Sriharsha Koduru, Pandora Eloa Oliveira Fonseca, Amorim Domingos Neves, Mislav Planinc","doi":"10.1177/21501351261423199","DOIUrl":"10.1177/21501351261423199","url":null,"abstract":"<p><p><b>Introduction:</b> Truncus arteriosus (TA) is a rare congenital cardiac anomaly requiring early surgical intervention, typically through either a single-stage neonatal repair {primary correction (PC)} or staged repair (SR), involving initial palliation followed by definitive correction. The optimal approach remains debatable. <b>Methods</b> A systematic search of multiple databases identified studies comparing SR and PC in TA. Pooled odds ratios (ORs), mean differences (MDs), and 95% confidence intervals (CIs) were calculated using RevMan v8.13.0. Time-to-event data for freedom from reoperation were reconstructed from published Kaplan-Meier (KM) curves, and pooled hazard ratios (HRs) with 95% CI were estimated using a Cox frailty model. <b>Results:</b> Five studies comprising 534 pediatric patients were included, with 274 (51.3%) in the SR cohort. SR was associated with a significantly lower incidence of unplanned surgical reinterventions following complete repair at the end of follow-up [OR 0.28; 95% CI 0.14-0.55; <i>P</i> = .02], while mortality at follow-up did not differ significantly between the approaches [OR 0.59; 95% CI 0.10-3.34; <i>P</i> = .32]. Reconstructed KM curve demonstrated greater freedom from reoperation in the SR group over 12 years [HR 0.39; 95% CI 0.17-0.89; <i>P</i> = .025]. Early perioperative outcomes, including cardiopulmonary bypass and aortic cross-clamp times, delayed sternal closure, intubation duration, early mortality, intensive care unit, and hospital stay, were similar between groups. <b>Conclusion</b> SR demonstrated fewer late unplanned reoperations over 12 years with comparable survival and perioperative outcomes to PC. However, these findings are based on low-certainty evidence from limited retrospective studies, warranting cautious interpretation.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"751-760"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629602","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 Aortic Uncrossing Procedure in a Two-Year Old Child with a Circumflex Left Aortic Arch and a Right Sided Arterial Duct: Technical Details with 1-Year Follow-Up.","authors":"Mani Ram Krishna, Usha Nandhini Sennaiyan, Naveen Srinivasan, Vijaykumar Raju","doi":"10.1177/21501351261434186","DOIUrl":"10.1177/21501351261434186","url":null,"abstract":"<p><p>Circumflex aortic arch is a rare vascular ring, with the circumflex right aortic arch much more common than a left aortic arch. The aortic uncrossing procedure has become the surgical intervention of choice for this anomaly. In younger children, some surgeons prefer a simpler procedure, such as resection of the descending aortic diverticulum or ligation and division of the arterial duct, with the uncrossing procedure reserved for those with residual airway or esophageal compression. We report an aortic uncrossing procedure in a 2-year-old girl with the very rare left circumflex aortic arch who remained symptom-free at 1 year follow-up.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"871-875"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147950637","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":"An Innovative Hybrid Process for Realistic Three-Dimensional Heart Modeling and Surgical Simulation of Tetralogy of Fallot.","authors":"Aya Abiya, Fatima Bouyahia, Mouhcine El Mardouli, Drissi Boumzebra","doi":"10.1177/21501351261419053","DOIUrl":"10.1177/21501351261419053","url":null,"abstract":"<p><p><b>Background:</b> Realistic three-dimensional (3D) heart models are essential for understanding complex congenital defects and improving surgical training. However, conventional rigid models lack the tactile and anatomical fidelity required for procedures such as Tetralogy of Fallot (TOF) repair. <b>Objectives:</b> To develop a reproducible, flexible, and anatomically accurate TOF heart model using a computer aided design (CAD)-driven hybrid workflow, validated against magnetic resonance imaging (MRI) data and assessed through hands-on surgical training. <b>Methods:</b> Anonymized MRI datasets were segmented and refined using a three-dimensional (3D) slicer. The resulting stereolithography (STL) files were imported into Autodesk Inventor to design molds, which were produced via 3D printing and silicone casting. Cardiologists and surgeons assessed anatomical fidelity during segmentation and mold design. Models were tested during an international surgical workshop, where participants practiced key TOF procedures. A structured survey evaluated anatomical accuracy, tactile realism, and educational value. <b>Results:</b> Among 125 participants from 60 countries, 100% reported that the model improved their understanding of cardiac anatomy; 91% (113/125) emphasized its educational usefulness; 82% (103/125) to 88% (110/125) confirmed anatomical fidelity; and 75% (94/125) rated tactile realism as comparable with real cardiac tissue. <b>Conclusions:</b> This CAD-silicone workflow produces reproducible, flexible, and anatomically faithful TOF heart models, effectively bridging imaging data and hands-on surgical simulation to enhance both surgical education and preoperative planning.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"761-765"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629650","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":"Yasui Procedure with Aberrant Right Subclavian Artery Patch for Interrupted Aortic Arch (Type B).","authors":"Vivek Bagaria, Arul Narayanan, Michael Bowes, Attilio Lotto","doi":"10.1177/21501351261434205","DOIUrl":"10.1177/21501351261434205","url":null,"abstract":"<p><p>Reconstructing an interrupted aortic arch requiring a Damus-Kaye-Stansel (DKS) anastomosis can result in \"gothic arch\" formation due to extensive aortic mobilization, which is linked to late hypertension and bronchial compression. This repair is further complicated in the presence of an anomalous aberrant right subclavian artery (RSCA). We describe the use of a free aberrant RSCA patch (rather than a pedicled flap) to reconstruct the posterior aortic arch wall in 2 infants, both undergoing a staged Yasui procedure for interrupted aortic arch (type B) with hypoplastic left ventricular outflow tract. The harvested aberrant RSCA was opened longitudinally and fashioned into a patch to bridge the posterior aortic gap, with anterior reconstruction completed using a pulmonary homograft patch. Postoperative computed tomography scans confirmed smooth, rounded arch anatomy without a gothic appearance or signs of compression. This free patch modification provided greater surgical flexibility compared with previously described pedicled flap techniques while achieving excellent midterm anatomical outcomes optimized for subsequent DKS anastomosis and potential for growth.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"855-858"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147793666","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":"Impact of Adjustable Pulmonary Artery Band on Outcomes of Anomalous Left Coronary Artery From the Pulmonary Artery (ALCAPA) Repair.","authors":"Steve Bibevski, Mark Ruzmetov, John N Dentel, Melanie Holtrup, Kak-Chen Chan, Edward Bove, Frank G Scholl","doi":"10.1177/21501351261436747","DOIUrl":"10.1177/21501351261436747","url":null,"abstract":"<p><p><b>Objective:</b> Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly resulting in myocardial ischemia, global left ventricular (LV) dysfunction, and mitral regurgitation (MR). Surgical placement of a pulmonary artery band (PAB) at ALCAPA repair may assist with recovery of patients with severe LV dysfunction. We assessed the outcomes of patients with ALCAPA and severe dysfunction treated with, and without a PAB. <b>Methods:</b> We performed a retrospective analysis of cases presented to our center between January 2007 and December 2023. Baseline and follow-up data were collected from records. Ventricular function was assessed by standardized transthoracic echocardiogram. <b>Results:</b> Twenty-six patients underwent ALCAPA repair at a median age of 4 months (range 19 days-8 years). Surgery was performed by direct coronary reimplantation in all patients. Beginning in 2017, we have placedan adjustable PAB in 5 patients with severe LV dysfunction (<25% ejection fraction [EF]). No patients required mitral valve repair at the time of ALCAPA surgery. Two patients with EF < 25% from the non-PAB group required support with extracorporeal membrane oxygenation (ECMO). In patients with EF < 25% who received PAB, none required ECMO or transplant. Recovery of function was near normal in the patients with EF < 25% plus a PA band, but did not reach normal in those with no PA band. <b>Conclusion:</b> There is marked improvement of MR grade and LV function, and no mortality during a 10-year period in the group with EF > 25%. Patients with EF < 25% treated with a PAB demonstrated an improved trajectory toward EF improvement, achieving normal function earlier than those without PA band. Temporary adjustable PAB may be beneficial in ALCAPA patients with severe dysfunction.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"715-723"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848245","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":"Middle Aortic Syndrome Repair in a 14-Month-Old Child: A 24-Year Case Study.","authors":"Mauricio Gonzalez-Urquijo, Francisco Valdes, Jose Francisco Vargas, Michel Bergoeing, Leopoldo Marine","doi":"10.1177/21501351261434206","DOIUrl":"10.1177/21501351261434206","url":null,"abstract":"<p><p>We present the 24-year follow-up of a patient treated for mid-aortic syndrome (MAS) in early childhood, highlighting the role of surgical and endovascular techniques in long-term management. A 14-month-old male with severe hypertension and recurrent cardiac failure was diagnosed with juxta-diaphragmatic aortic coarctation. He underwent an aorto-aortic thoracoabdominal bypass using an 8 mm polytetrafluoroethylene graft, which resolved his symptoms. At age 14, he developed exercise-induced claudication due to outgrowing the graft. Endovascular recanalization of the native aorta with a 9 × 59 mm covered stent restored distal perfusion. One year later, stent compression was successfully treated with a 12 × 40 mm bare metal stent. At age 24, the patient remains asymptomatic, normotensive, and physically active, with normal ankle-brachial indices. Imaging revealed a widely patent native aorta and occlusion of the original bypass, with normal distal perfusion confirmed by pulse volume recordings. This case underscores the importance of early diagnosis, well-planned surgical intervention, and long-term surveillance in MAS. The successful outcome highlights the complementary roles of surgical and endovascular approaches in achieving durable clinical results.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"859-863"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635572","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":"Invited Commentary: Playing With the Band.","authors":"Michael C Mongé","doi":"10.1177/21501351261445083","DOIUrl":"10.1177/21501351261445083","url":null,"abstract":"","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"724-725"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148045244","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":"Impact of Neighborhood and Individual Social Drivers of Health on Outcomes Following Congenital Heart Surgery.","authors":"Andrew Well, Heather Van Diest, Brett R Anderson, Wei Zhang, Kathleen Carberry, Alexandra Lamari-Fisher, Jeremy T Affolter, Erin A Gottlieb, Jeffery P Jacobs, Charles D Fraser, Carlos M Mery","doi":"10.1177/21501351261418279","DOIUrl":"10.1177/21501351261418279","url":null,"abstract":"<p><p>BackgroundDespite advances in congenital heart surgery (CHS) and improvements in outcomes, disparities continue to exist. Social Drivers of Health (SDoH) have been associated with many aspects of health and wellness including congenital heart disease. The goal was to evaluate the impact of individual and neighborhood-level SDoH on outcomes following CHS.MethodsRetrospective review of the Society of Thoracic Surgeons Congenital Heart Surgery Database from 2014 to 2022 linked via ZIP code with the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). ZIP codes were ranked by their SVI score with the first quintile the least vulnerable and the fifth the most vulnerable. The primary outcome was STS perioperative mortality.ResultsA total of 49 centers with ≥85% ZIP code completion rate were included. Those with missing ZIP codes (<i>n</i> = 1329) or missing data (<i>n</i> = 5651) were excluded resulting in a final cohort of 16,238 (69.5%, 11,285/16,238) cases. Of the final cohort, 8,977/16,238 (55.3%) were Non-Hispanic White and 7084/16,238 (43.6%) had private insurance. There were 448/16,238 (2.8%) STS perioperative mortalities. In the fully adjusted model, individual Non-Hispanic Black race (OR:1.76 [95% CI: 1.20-2.52]), Non-Hispanic Other race (OR: 2.39 [95% CI: 1.10-4.99]), Medicaid (OR:1.55 [95% CI: 1.04-2.30]), None/Self/Charity Insurance (OR:2.60 [95% CI: 1.09-5.93]), as well as increasing SVI quintile with SVI2 (OR: 1.22 [95% CI: 0.86-1.75]), SVI3 (OR: 1.71 [95% CI: 1.07-2.73]), SVI4 (OR: 1.92 [95% CI: 1.04-3.53]) and SVI5 (OR: 3.09 [95% CI: 1.36-6.87]), had increased odds of STS perioperative mortality.ConclusionsAfter adjusting for clinical characteristics, both individual and neighborhood Social Drivers of Health conferred increased odds of perioperative mortality following CHS. These results spotlight the disparities driven by individual circumstances beyond clinical characteristics and reinforce the need to intervene at both the individual and community levels to improve outcomes.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"733-742"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446713","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":"Unplanned Readmissions due to Pleural Effusion Following the Fontan Operation.","authors":"Jean M Meneses, Mohan Pankhuri, Jake Beerel, Joseph B Clark, John L Myers, Allen R Kunselman, Akif Ündar, Vincent P R Aluquin","doi":"10.1177/21501351261418295","DOIUrl":"10.1177/21501351261418295","url":null,"abstract":"<p><p>BackgroundThe Fontan operation is the final stage of palliation for single-ventricle patients. While operative survival has improved, pleural effusions remain a common postoperative complication, increasing morbidity and hospitalization. Our aim was to investigate the incidence and risk factors for unplanned readmissions due to post-Fontan pleural effusion.MethodsA retrospective review of all single ventricle patients who underwent the Fontan procedure from 2012-2023 was performed. This case-control study compared post-Fontan patients readmitted to the hospital due to pleural effusion with those who were not. Readmission was defined as rehospitalization for recurrent pleural effusion requiring intravenous diuretics and/or chest tube placement. Demographics, baseline clinical features, pre-Fontan hemodynamics, type of Fontan surgery, presence of fenestration, cardiac medications and doses, perioperative and post-discharge factors were analyzed between groups.ResultsSixty-one patients who were 42 ± 12.4 months of age underwent the Fontan operation. Of these, 31/61 (51%) had a diagnosis of hypoplastic left heart syndrome, 32/61 (52%) underwent extracardiac Fontan surgery, and 33/61 (54%) had a Fontan fenestration. Nine of 66 (14.7%) patients were readmitted for pleural effusion at a median of 7 days (IQR 5-15) post-discharge. Readmitted patients were older at Fontan (50.4 ± 13 vs 40.5 ± 11.8 months, <i>P</i> = .025), had increased chylothorax incidence (33.3% [3/9] vs 5.8% [3/52], <i>P</i> = .04), absent or restrictive fenestration at discharge (88.9% [8/9] vs 44.2% [23/52], <i>P</i> = .03) and were more likely to have pleural effusion at the first postoperative clinic visit (100% [9/9] vs 13.5% [7/52], <i>P</i> < .01). When comparing maximal diuretic usage, the readmitted patients required more diuretics (median 3 vs 2, <i>P</i> = .01). There were no significant differences in race, gender, weight at Fontan, cardiac anatomy, pre-Fontan hemodynamics, Fontan type, initial fenestration status, cardiopulmonary bypass duration time, supplemental oxygen duration, chest tube duration, number and doses of cardiac medications prior to and at Fontan discharge, or length of hospital stay. No patient required catheter-based intervention or surgery within 3 months post-Fontan discharge.ConclusionOlder age at Fontan, chylothorax, absent/restrictive fenestration at discharge, and detection of pleural effusion at the first postoperative clinic visit are risk factors for readmission due to pleural effusion. Earlier Fontan timing, optimizing diuretic management, and ensuring Fontan fenestration patency may reduce readmissions.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"776-784"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147629655","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 Potent Complement Stimulus of Sanguineous Versus Crystalloid Cardiopulmonary Bypass Prime during Pediatric Cardiac Surgery.","authors":"Joel David Bierer, Roger Stanzel, Mark Henderson, John Sapp, Pantelis Andreou, Jean S Marshall, David Horne","doi":"10.1177/21501351261418297","DOIUrl":"10.1177/21501351261418297","url":null,"abstract":"<p><p><b>Background:</b> Sanguineous preparation of the cardiopulmonary bypass (CPB) circuit with allogeneic blood products is known to contain substantial complement mediator burden. This study aims to assess the longitudinal immunologic impacts during pediatric CPB. <b>Methods:</b> In this post-hoc analysis of a prospective observational cohort study, 40 pediatric patients undergoing cardiac surgery with CPB were grouped by CPB prime type indicated by standard of care (<i>sanguineous</i> vs <i>crystalloid</i>). Arterial samples were collected before CPB, after CPB initiation, and at 30-min intervals until weaning or 180 min. Luminex^® measured concentrations of 33 inflammatory mediators for time series and fold change comparison between groups. <b>Results:</b> The <i>sanguineous prime</i> group (n = 26) was younger (4.0 [0.2-6.0] versus 48.5 [39.0-69.5] months; <i>P</i> < .001) and smaller (4.9 [3.4-6.6] versus 17.2 [14.9-19.6] kg; <i>P</i> < .001) than the <i>crystalloid prime</i> group (n = 14). The <i>sanguineous</i> group had significantly more circulating complement mediators, including C3a, C3b, and C5a, and soluble adhesion molecules throughout the CPB time series (<i>P</i> < .05). TNF, IL-1α, and IL-1β were relatively static in both groups, although slightly more prominent in the <i>crystalloid</i> group (<i>P</i> < .05). IL-6, IL-10, and CXCL8 profiles were comparable between groups. <b>Conclusions:</b> Patients who receive sanguineous CPB prime have elevated complement and soluble cellular adhesion molecule burden throughout CPB, relative to a crystalloid prime. Therefore, these allogeneic preparations should be considered an immunogenic stimulus during pediatric CPB, and future innovation should focus on less inciting alternatives.</p>","PeriodicalId":94270,"journal":{"name":"World journal for pediatric & congenital heart surgery","volume":" ","pages":"791-802"},"PeriodicalIF":0.0,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624339/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147461558","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}