Central European Journal of Urology最新文献

{"title":"Contrast-enhanced ultrasound in the diagnosis of neoplastic lesions of the urinary bladder.","authors":"Jakub Kufel, Adam Mitręga, Mikołaj Magiera, Michał Bielówka","doi":"10.5173/ceju.2025.0086","DOIUrl":"10.5173/ceju.2025.0086","url":null,"abstract":"<p><strong>Introduction: </strong>Cystoscopy remains the gold standard of diagnosis and follow-up for bladder cancer (BC); however, it is an invasive procedure associated with discomfort and potential complications. Contrastenhanced ultrasound (CEUS) emerges as an alternative, utilizing real-time assessment of tumor vascularization and perfusion. The aim of this systematic review was to evaluate its diagnostic performance for BC detection.</p><p><strong>Material and methods: </strong>MEDLINE (PubMed), Scopus, Web of Science Core Collection and Embase databases were queried through July, 2024. We included studies reporting on the diagnostic accuracy of CEUS for the detection of BC.</p><p><strong>Results: </strong>Out of 883 individual records, we identified 6 reports of prospective and retrospective studies, comprising 894 patients. The included studies indicate that CEUS demonstrates high diagnostic sensitivity, and specificity in discriminating malignant from benign bladder tumors. Moreover, CEUS has been shown promising performance in the preoperative prediction of tumor grade and stage, offering diagnostic capabilities comparable to well-established non-invasive imaging techniques.</p><p><strong>Conclusions: </strong>Our findings support the utilization of CEUS as adjunct to existing BC diagnostic protocols. It represents an alternative for BC diagnosis and could benefit patients contraindicated for conventional imaging modalities or at high-risk of cystoscopy-related complications. Scant amount of standardized, large-scale, prospective, comparative investigations are available, thus further research is necessary to validate the clinical utility of CEUS in BC detection.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 4","pages":"483-493"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12924067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269814","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":"Robotic retrocaval ureter repair.","authors":"Maxwell Sandberg, Randall Bissette, Ashok Hemal","doi":"10.5173/ceju.2024.0251","DOIUrl":"https://doi.org/10.5173/ceju.2024.0251","url":null,"abstract":"","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 1","pages":"102"},"PeriodicalIF":1.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12073510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144074959","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":"Balancing technology and resources: Is robotic pyeloplasty always necessary?","authors":"Kunal Malhotra, Vikas Kumar Panwar, Gautam Shubhankar, Ankur Mittal, Mohammed Taher Mujahid","doi":"10.5173/ceju.2024.0203","DOIUrl":"10.5173/ceju.2024.0203","url":null,"abstract":"<p><strong>Introduction: </strong>Ureteropelvic junction obstruction (UPJO) hinders urine flow from the renal pelvis to the ureter, causing renal dysfunction. Treatment focuses on relieving obstruction to restore urinary drainage and preserve renal function. Robotic-assisted laparoscopic pyeloplasty (RALP) offers enhanced precision compared to laparoscopic pyeloplasty (LP), but limited comparative data exist for adult patients. This study compares RALP and LP outcomes in an adult cohort from a tertiary care centre.</p><p><strong>Material and methods: </strong>A retrospective cohort analysis was conducted on adult patients who underwent RALP or LP between March 2018 and May 2024. Primary outcome measures included operative time, with secondary outcomes such as estimated blood loss (EBL), hospital length of stay (LOS), complication rates, and success (defined by symptom relief and diuretic renogram improvement). Statistical analysis included Mann-Whitney, χ², and Fisher's exact tests, with a significance threshold of p <0.05.</p><p><strong>Results: </strong>The study included 128 patients (87 RALP, 41 LP). Operative time was significantly longer for RALP (200.92 ±59.26 minutes) vs LP (161.92 ±55.21 minutes, p <0.001), largely due to robotic docking. Both groups had similar EBL (47.87 ml for RALP vs 45 ml for LP, p = 0.45) and success rates (97.7% for RALP vs 97.4% for LP). However, RALP patients experienced a longer LOS (3.91 days vs 3.41 days, p = 0.001).</p><p><strong>Conclusions: </strong>RALP demonstrates technical advantages but does not reduce operative time and incurs increased resource utilisation compared to LP. Both techniques achieve high success rates, though further research is needed to assess RALP's cost-effectiveness.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 2","pages":"244-249"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944300","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":"Complications of anatomical endoscopic enucleation of the prostate in real-life practice: What we learnt from the 6,193 patients from the Refinement in Endoscopic Anatomical enucleation of Prostate registry.","authors":"Ee Jean Lim, Thomas R W Herrmann, Daniele Castellani, Khi Yung Fong, Edwin Jonathan Aslim, Sarvajit Biligere, Azimdjon N Tursunkulov, Marco Dellabella, Fernando Gomez Sancha, Mario Sofer, Dmitry Enikeev, Marcelo Langer Wroclawski, Vladislav Petov, Nariman Gadzhiev, Dean Elterman, Abhay Mahajan, Moises Rodriguez Socarras, Dilmurod S Yunusov, Furkat Nasirov, Jeremy Yuen-Chun Teoh, Bhaskar Kumar Somani, Vineet Gauhar","doi":"10.5173/ceju.2024.0060","DOIUrl":"10.5173/ceju.2024.0060","url":null,"abstract":"<p><strong>Introduction: </strong>Anatomical endoscopic enucleation of the prostate (AEEP) is a guideline-recommended treatment for benign prostatic hyperplasia (BPH). We aimed to analyze postoperative complications and outcomes within a large real-world database.</p><p><strong>Material and methods: </strong>The Refinement in Endoscopic Anatomical enucleation of Prostate (REAP) registry includes patients who received AEEP for BPH in 8 centers worldwide from January 2020 to January 2022. Exclusion criteria included previous prostate/urethral surgery, prostate cancer, pelvic radiotherapy, and concomitant lower urinary tract surgery (internal urethrotomy, cystolithotripsy, or transurethral resection of bladder tumor). The primary outcome was postoperative incontinence; secondary outcomes included early complications (<30 days) and late complications (>30 days).</p><p><strong>Results: </strong>We analyzed 6,193 patients; the mean age was 68 years. Thulium laser was used in 37% and high-power holmium laser in 32%. Median operation time was 67 min [IQR 50-95 min]. The 2-lobe enucleation technique was utilized in 49%, and en-bloc resection was utilized in 39%. Early postoperative complications included urinary tract infection (4.7%), acute urinary retention (4.1%), post-operative bleeding requiring additional intervention (0.9%), and sepsis requiring intensive care admission (0.1%). The incidence of postoperative incontinence was 14.8%, of which 54% were stress incontinence; 84% cases resolved by 3 months. On univariate and multivariate analysis, prostate volume >100 ml was a significant predictor of postoperative incontinence. Late complications such as bulbar urethral stricture, bladder neck sclerosis, and need for redo BPH surgery each occurred in <1% of patients.</p><p><strong>Conclusions: </strong>Analysis of the real-world REAP database shows favorable safety outcomes for AEEP, with a low incidence of serious complications and postoperative incontinence beyond 3 months.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 2","pages":"137-143"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944513","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":"Robotic-assisted partial nephrectomy with the Hugo-RAS system: Initial experience, surgical outcomes, and learning-curve assessment.","authors":"Nuno Vinagre, Guilherme Gonçalves, Sofia Mesquita, João Vital, Miguel Marques-Monteiro, Maria Carmo-Pinto, Beatriz Oliveira, Martinha Magalhães, Avelino Fraga, Miguel Silva-Ramos","doi":"10.5173/ceju.2025.0063","DOIUrl":"10.5173/ceju.2025.0063","url":null,"abstract":"<p><strong>Introduction: </strong>Robotic-assisted partial nephrectomy (RAPN) is a standard approach for nephron-sparing surgery. The Hugo-RAS system is an emerging platform, but data on its outcomes and learning curve are limited. This study evaluates the safety, efficacy, and learning curve of RAPN using Hugo-RAS in a high-volume laparoscopic center.</p><p><strong>Material and methods: </strong>We analyzed 42 consecutive RAPN cases performed with the Hugo-RAS system from May 2023 to October 2024. Perioperative outcomes, renal function, and the learning curve were assessed. The primary endpoint was the \"trifecta\" (warm ischemia time <25 min, negative surgical margins, and no major complications). Learning curve analysis used Cumulative Sum Control Chart (CUSUM) methodology.</p><p><strong>Results: </strong>The median console time was 88 minutes (IQR: 74-107), with a docking time of 5 minutes (IQR: 240-420s). The trifecta rate was 83.3%, and no conversions occurred. Docking proficiency was achieved by the 5^th case, while console time proficiency was reached after 7-8 cases. Tumor complexity did not significantly impact surgical time (p = 0.781) but was associated with longer warm ischemia time (p = 0.0037).</p><p><strong>Conclusions: </strong>The Hugo-RAS system allows for safe and effective RAPN with a rapid learning curve. Surgeons adapt quickly, achieving proficiency within a short number of cases. Further studies are needed to validate long-term outcomes and broader applicability.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 4","pages":"435-440"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12924072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269885","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":"Prostate-specific membrane antigen radioguided surgery in prostate cancer: A narrative review.","authors":"Piotr Chuchra, Jakub Karwacki, Akihiro Matsukawa, Bartłomiej Borek, Tomasz Rynkiewicz, Omar Tayara, Bartosz Małkiewicz, Paweł Rajwa, Andrzej Paradysz, Marcin Zyczkowski","doi":"10.5173/ceju.2025.0121","DOIUrl":"10.5173/ceju.2025.0121","url":null,"abstract":"<p><strong>Introduction: </strong>Prostate-specific membrane antigen (PSMA) radioguided surgery (RGS) is being tested to personalize lymph node dissection at radical prostatectomy and in the salvage settings.</p><p><strong>Material and methods: </strong>We conducted a narrative review using the MEDLINE database (via PubMed), selecting key publications on the intravenous administration of PSMA to investigate lymph node involvement during surgery.</p><p><strong>Results: </strong>This review provides an overview of the PSMA-RGS methodology and outcomes. The technique demonstrates high specificity, particularly in <i>ex vivo</i> settings, with a median ranging from 93.5% to 100%. However, sensitivity varies widely, with a median range of 50% to 100%, often limited by reduced detection of micrometastases. Detailed preoperative, perioperative, and oncological evaluations are summarized in tables.</p><p><strong>Conclusions: </strong>PSMA-RGS is feasible and safe in both primary and salvage settings. In appropriately selected patients, it may contribute to longer therapy-free survival (36 months) and prolonged biochemical recurrence-free survival (19 months).</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 4","pages":"470-482"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12924063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147269849","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":"Laser fibers and baskets. How do they affect suction and intrarenal pressures using the novel single-use flexible direct in-scope suction ureteroscopes?","authors":"Arman Tsaturyan, Alberto Olivero, Eugenio Ventimiglia, Arkadya Musayelyan, Hayk Grigoryan, Armen Muradyan, Marat Harutyunyan, Evangelos Liatsikos, Panagiotis Kallidonis, Vineet Gauhar, Steffi Kar Kei Yuen, Olivier Traxer, Bhaskar Somani, Amelia Pietropaolo","doi":"10.5173/ceju.2025.0120","DOIUrl":"10.5173/ceju.2025.0120","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate intrarenal pressures (IRP) and suction performance of two novel flexible ureteroscopes equipped with a direct-in-scope suction (DISS) feature - the 7.5 Fr PU3033AH and the 9.2 Fr PU400A - both with an empty working channel and with various working instruments inserted.</p><p><strong>Material and methods: </strong>An <i>ex vivo</i> experimental study was conducted using a freshly harvested porcine kidney. Measurements were performed under the following conditions: empty working channel, with a 200 µm laser fiber, a 272 µm laser fiber, and a 2.2 Fr nitinol basket. The evaluated parameters included: irrigation flow rates with gravity irrigation and an automated pump, maximum IRP without suctioning, time to collapse of the pelvicalyceal system, and time to regain baseline IRP after suctioning.</p><p><strong>Results: </strong>The highest IRP of 34 mmHg was recorded with the 9.2 Fr scope under 100 mmHg irrigation pressure. Irrespective of the irrigation system used, the introduction of working instruments significantly reduced the IRP for both 7.5 Fr and 9.2 Fr DISS scopes. A longer time was required to collapse the pelvicalyceal system and regain the basal intrarenal pressure when working instruments were used. The thicker the diameter of the instrument, the greater the impact on flowrate, IRP, collapse of the system, and regain of the pressure was observed. The latter trends were less pronounced with the 9.2 Fr scope with a wider 5.1 Fr working channel.</p><p><strong>Conclusions: </strong>The 9.2 Fr DISS ureteroscope demonstrated higher irrigation flow rates and IRP, and shorter times to system collapse and recovery compared to the 7.5 Fr scope. However, the insertion of working instruments negatively affected all measured parameters, with a greater impact observed in the 7.5 Fr scope due to its narrower channel.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 3","pages":"406-412"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12663821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647143","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":"Comparison between single-shot and gradual dilation technique in percutaneous nephrolithotomy: A systematic review and meta-analysis.","authors":"Kharisma Prasetya Adhyatma, Muhammad Ainul Mahfuz, Dianita Halimah Harahap, Muhammad Haritsyah Warli, Fauriski Febrian Prapiska","doi":"10.5173/ceju.2024.0256","DOIUrl":"10.5173/ceju.2024.0256","url":null,"abstract":"<p><strong>Introduction: </strong>Percutaneous nephrolithotomy (PCNL) is efficacious for the management of bigger or complex renal calculi. This study assesses the safety and efficacy of single-shot dilation (one-shot - OD) against gradual dilation (multiple - MD) in fluoroscopy-guided PCNL, with the objective of enhancing stone management techniques.</p><p><strong>Material and methods: </strong>A comprehensive study adhering to PRISMA criteria concentrated on adult patients receiving conventional percutaneous nephrolithotomy for nephrolithiasis. Included were clinical trials and cohort studies comparing OD and MD approaches, but omitting ultrasound-guided, mini, and micro-PCNL methods. Investigations were performed in PubMed, Scopus, EMBASE, Cochrane Library, and Medline from 2008 onwards. Two reviewers independently evaluated and extracted data, employing the Cochrane ROB2 and ROBINS-I instruments for quality evaluation. Statistical analyses utilizing Review Manager 5.4 employed fixed and random-effects models contingent upon heterogeneity (I²).</p><p><strong>Results: </strong>Sixteen studies (14 randomized controlled trials and 2 cohort studies) including 572 individuals with OD and 581 patients with MD were examined. The meta-analysis indicated a markedly reduced complication rate in the OD group (RR = 0.77; 95% CI: 0.63-0.94; p = 0.01), with no statistically significant difference in stone-free rates (RR = 1.02; 95% CI: 0.97-1.08; p = 0.49). Variations in hemoglobin reduction, duration of hospitalization, fluoroscopy exposure, and surgical time were noted. However, the significant variability requires cautious interpretation.</p><p><strong>Conclusions: </strong>The single-shot dilation approach showed a markedly reduced complication rate, indicating it as a safer option for adult patients having conventional PCNL. Additional research is required to corroborate these results across various clinical environments.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 3","pages":"373-384"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12663817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145647481","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":"Another step toward a better understanding of urinary drainage after upper tract endoscopy.","authors":"Jacopo Durante","doi":"10.5173/ceju.2025.0001_EdCom","DOIUrl":"10.5173/ceju.2025.0001_EdCom","url":null,"abstract":"","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 2","pages":"199"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944317","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":"A cross-language analysis of urolithiasis patient online materials: Assessment across 24 European languages.","authors":"Wojciech Tomczak, Wojciech Krajewski, Katarzyna Grunwald, Adam Chełmoński, Joanna Chorbińska, Łukasz Nowak, Jan Łaszkiewicz, Adam Gurwin, Magdalena Krajewska, Bartosz Małkiewicz, Tomasz Szydełko","doi":"10.5173/ceju.2025.0045","DOIUrl":"10.5173/ceju.2025.0045","url":null,"abstract":"<p><strong>Introduction: </strong>Urolithiasis is a prevalent condition with several etiological factors, affecting up to 20% of the population and exhibiting high recurrence rates. Its strain on healthcare systems, exacerbated by high incidence and recurrence, often results in insufficient time for thorough diagnostics and counselling. Consequently, many patients seek easily accessible online sources of information. This study aimed to assess the readability and availability of online urolithiasis materials across 24 official European languages to compare readability across different source types.</p><p><strong>Material and methods: </strong>The phrase \"kidney stones\" was translated into all official European languages, and the first 50 search results for each language were retrieved. Non-functional websites, those requiring accounts or payments, and duplicates were excluded. Relevance was assessed using Google Translate to filter out results lacking medical information. Only patient-oriented materials were included for analysis. Obtained results were then classified by source category, and their readability was assessed using LIX formula.</p><p><strong>Results: </strong>A total of 723 articles were analysed. The English term yielded the highest number of results, followed by Spanish and Portuguese. Overall, the English articles performed best, being the only language with a mean LIX score below 40, which marks the threshold between \"somewhat hard\" and \"hard\" to read. Finnish, Lithuanian, and Hungarian materials had LIX scores significantly exceeding the threshold of 50, classifying them as \"very hard to read\" and among the most difficult to comprehend.A subgroup analysis revealed no statistically significant differences across the source classification.</p><p><strong>Conclusions: </strong>Online materials on kidney stones are generally too complex for patients, limiting their understanding and treatment adherence. Simplification of patient-oriented materials along with artificial intelligence utilisation could enhance comprehension. Improved awareness may promote adherence to preventive measures and help reduce the incidence and economic burden of urolithiasis.</p>","PeriodicalId":9744,"journal":{"name":"Central European Journal of Urology","volume":"78 2","pages":"221-227"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12379832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944332","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}