Intracranial aneurysms (IAs) are uncommon in children, with an incidence of 1%-5%. However, intracranial dissecting aneurysms (IDA) account for a higher proportion (20%-50%) of all aneurysms in this age group. Pediatric IDAs typically result from vascular wall injury, potentially associated with genetic predisposition, congenital defects, or trauma. These lesions most commonly present with ischemic stroke, while subarachnoid hemorrhage (SAH) is relatively rare. Early symptoms include headache and vomiting, with severe cases potentially leading to neurological deficits. Digital subtraction angiography (DSA) remains the gold standard for diagnosis. Timely diagnosis and intervention are critical for improving prognosis. Treatment options include pharmacological therapy, endovascular intervention, and microsurgical repair. This report details a case of a 14-year-old male diagnosed with a dissecting aneurysm in the communicating segment of the left internal carotid artery (ICA). Emergency endovascular intervention with coil occlusion of the parent artery was performed. Short-term follow-up demonstrated favorable outcomes without new neurological deficits. The clinical characteristics of this condition are briefly reviewed in the context of this case.
{"title":"Endovascular treatment of pediatric ruptured intracranial dissecting aneurysm: a case report and literature review.","authors":"Haitong Xu, Yongkai Qin, Liyang Zhang, Jiahong Chen, Bo Li, Junfei Han, Zhengwei Huang, Yingchao Jing","doi":"10.3389/fsurg.2025.1704284","DOIUrl":"10.3389/fsurg.2025.1704284","url":null,"abstract":"<p><p>Intracranial aneurysms (IAs) are uncommon in children, with an incidence of 1%-5%. However, intracranial dissecting aneurysms (IDA) account for a higher proportion (20%-50%) of all aneurysms in this age group. Pediatric IDAs typically result from vascular wall injury, potentially associated with genetic predisposition, congenital defects, or trauma. These lesions most commonly present with ischemic stroke, while subarachnoid hemorrhage (SAH) is relatively rare. Early symptoms include headache and vomiting, with severe cases potentially leading to neurological deficits. Digital subtraction angiography (DSA) remains the gold standard for diagnosis. Timely diagnosis and intervention are critical for improving prognosis. Treatment options include pharmacological therapy, endovascular intervention, and microsurgical repair. This report details a case of a 14-year-old male diagnosed with a dissecting aneurysm in the communicating segment of the left internal carotid artery (ICA). Emergency endovascular intervention with coil occlusion of the parent artery was performed. Short-term follow-up demonstrated favorable outcomes without new neurological deficits. The clinical characteristics of this condition are briefly reviewed in the context of this case.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1704284"},"PeriodicalIF":1.6,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12868202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1693996
Yulong An, Chao Deng, Chong Wen, Jinli Liu, Yongqiang Zhu, Kai Chen, Hao Luo
This report presents a case of hepatic encephalopathy (HE) induced by a spontaneous splenorenal shunt (SSRS). A 73-year-old male patient was admitted to our medical facility due to loss of consciousness. Laboratory analyses revealed elevated blood ammonia levels and varying degrees of reduction in erythrocyte, leucocyte, and platelet levels. Portal vein imaging utilizing 320-slice CT demonstrated enlargement of the portal and splenic veins, splenomegaly, multiple varicose veins at the splenic hilum, and local protrusion of the left renal vein. An initial diagnosis of HE with SSRS and hypersplenism was established. A multi-disciplinary treatment approach was implemented, incorporating a patient-doctor collaborative decision-making model. Two treatment options were presented to the patient, who opted for surgical intervention over interventional treatment. Subsequently, a combined splenectomy and splenorenal shunt vessel ligation procedure was performed. Postoperatively, the patient's condition exhibited significant improvement compared to his pre-operative state, with no recurrence of HE observed. This article reports a case of recurrent hepatic encephalopathy and severe hypersplenism related to SSRS, which was successfully treated by combined splenectomy and vascular disconnection.
{"title":"Case Report: A case of hepatic encephalopathy secondary to a spontaneous splenorenal shunt.","authors":"Yulong An, Chao Deng, Chong Wen, Jinli Liu, Yongqiang Zhu, Kai Chen, Hao Luo","doi":"10.3389/fsurg.2025.1693996","DOIUrl":"10.3389/fsurg.2025.1693996","url":null,"abstract":"<p><p>This report presents a case of hepatic encephalopathy (HE) induced by a spontaneous splenorenal shunt (SSRS). A 73-year-old male patient was admitted to our medical facility due to loss of consciousness. Laboratory analyses revealed elevated blood ammonia levels and varying degrees of reduction in erythrocyte, leucocyte, and platelet levels. Portal vein imaging utilizing 320-slice CT demonstrated enlargement of the portal and splenic veins, splenomegaly, multiple varicose veins at the splenic hilum, and local protrusion of the left renal vein. An initial diagnosis of HE with SSRS and hypersplenism was established. A multi-disciplinary treatment approach was implemented, incorporating a patient-doctor collaborative decision-making model. Two treatment options were presented to the patient, who opted for surgical intervention over interventional treatment. Subsequently, a combined splenectomy and splenorenal shunt vessel ligation procedure was performed. Postoperatively, the patient's condition exhibited significant improvement compared to his pre-operative state, with no recurrence of HE observed. This article reports a case of recurrent hepatic encephalopathy and severe hypersplenism related to SSRS, which was successfully treated by combined splenectomy and vascular disconnection.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1693996"},"PeriodicalIF":1.6,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12868295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Bladder neck contracture (BNC) is a challenging postoperative complication of transurethral resection of the prostate (TURP), especially in patients with small-volume prostates (<40 mL) who are at high risk. This retrospective study aimed to evaluate the efficacy and safety of local betamethasone injection in preventing BNC following TURP in this specific population.
Methods: Clinical data of 248 patients with small-volume benign prostatic hyperplasia (BPH) who underwent TURP at Zhuhai People's Hospital from January 2017 to December 2023 were retrospectively analyzed. Patients were divided into two groups: the betamethasone injection group (n = 128) receiving 8 mg betamethasone injected into the submucosal layer of the bladder neck (3, 6, 9, and 12 o'clock positions) during surgery, and the control group (n = 120) undergoing TURP without betamethasone injection. All procedures were performed using standardized bipolar plasma TURP without bladder neck incision. Baseline characteristics, intraoperative parameters, and postoperative outcomes were collected. The primary endpoint was the incidence of BNC within 12 months of follow-up, diagnosed based on clinical symptoms, uroflowmetry (maximal urine flow <10 ml/sec), and cystoscopy. Secondary endpoints included the incidence of other postoperative complications.
Results: The baseline characteristics of the two groups were comparable (all p > 0.05). During the 12-month follow-up, the incidence of BNC in the betamethasone injection group was significantly lower than that in the control group (2.3% vs. 10.8%, p = 0.004). Multivariate logistic regression analysis identified local betamethasone injection as an independent protective factor against BNC (OR = 0.20, 95% CI: 0.06-0.69, p = 0.011), while prostate volume ≤30 mL was an independent risk factor (OR = 3.21, 95% CI: 1.08-9.53, p = 0.036). There were no significant differences in the incidence of other postoperative complications (urinary tract infection, secondary hemorrhage, urethral stricture, urinary incontinence) between the two groups (all p > 0.05).Conclusion: Local injection of betamethasone during TURP significantly reduces the incidence of BNC in patients with small-volume prostates without increasing perioperative complications. This intervention targets the inflammatory and fibrotic mechanisms underlying BNC and serves as a safe and effective adjuvant strategy to optimize surgical outcomes in this high-risk population.
目的:膀胱颈挛缩(BNC)是经尿道前列腺切除术(TURP)的术后并发症,尤其是小体积前列腺患者。方法:回顾性分析2017年1月至2023年12月珠海市人民医院行TURP手术的248例小体积良性前列腺增生(BPH)患者的临床资料。将患者分为两组:倍他米松注射组(n = 128)术中在膀胱颈部粘膜下层(3、6、9、12点钟体位)注射倍他米松8 mg;对照组(n = 120)行TURP,不注射倍他米松。所有手术均采用标准化双极等离子体TURP,无膀胱颈部切口。收集基线特征、术中参数和术后结果。主要终点是随访12个月内BNC的发生率,根据临床症状、尿流量测定(最大尿流量)进行诊断。结果:两组的基线特征具有可比性(均p < 0.05)。随访12个月,倍他米松注射组BNC发生率显著低于对照组(2.3% vs. 10.8%, p = 0.004)。多因素logistic回归分析发现局部倍他米松注射是BNC的独立保护因素(OR = 0.20, 95% CI: 0.06 ~ 0.69, p = 0.011),前列腺体积≤30 mL是BNC的独立危险因素(OR = 3.21, 95% CI: 1.08 ~ 9.53, p = 0.036)。两组术后其他并发症(尿路感染、继发性出血、尿道狭窄、尿失禁)发生率比较,差异均无统计学意义(p < 0.05)。结论:TURP术中局部注射倍他米松可显著降低小体积前列腺患者BNC的发生率,且未增加围手术期并发症。这种干预针对BNC的炎症和纤维化机制,作为一种安全有效的辅助策略,可以优化这一高危人群的手术效果。
{"title":"Retrospective study on prevention of bladder neck contracture by local injection of betamethasone after transurethral resection of the prostate in patients with small-volume prostate.","authors":"Qiang Wang, Yunlong Jiang, Ping Ao, Houbao Huang, Wenqiang Zhang, Xiaoxu Yuan","doi":"10.3389/fsurg.2025.1726670","DOIUrl":"10.3389/fsurg.2025.1726670","url":null,"abstract":"<p><strong>Objective: </strong>Bladder neck contracture (BNC) is a challenging postoperative complication of transurethral resection of the prostate (TURP), especially in patients with small-volume prostates (<40 mL) who are at high risk. This retrospective study aimed to evaluate the efficacy and safety of local betamethasone injection in preventing BNC following TURP in this specific population.</p><p><strong>Methods: </strong>Clinical data of 248 patients with small-volume benign prostatic hyperplasia (BPH) who underwent TURP at Zhuhai People's Hospital from January 2017 to December 2023 were retrospectively analyzed. Patients were divided into two groups: the betamethasone injection group (<i>n</i> = 128) receiving 8 mg betamethasone injected into the submucosal layer of the bladder neck (3, 6, 9, and 12 o'clock positions) during surgery, and the control group (<i>n</i> = 120) undergoing TURP without betamethasone injection. All procedures were performed using standardized bipolar plasma TURP without bladder neck incision. Baseline characteristics, intraoperative parameters, and postoperative outcomes were collected. The primary endpoint was the incidence of BNC within 12 months of follow-up, diagnosed based on clinical symptoms, uroflowmetry (maximal urine flow <10 ml/sec), and cystoscopy. Secondary endpoints included the incidence of other postoperative complications.</p><p><strong>Results: </strong>The baseline characteristics of the two groups were comparable (all <i>p</i> > 0.05). During the 12-month follow-up, the incidence of BNC in the betamethasone injection group was significantly lower than that in the control group (2.3% vs. 10.8%, <i>p</i> = 0.004). Multivariate logistic regression analysis identified local betamethasone injection as an independent protective factor against BNC (OR = 0.20, 95% CI: 0.06-0.69, <i>p</i> = 0.011), while prostate volume ≤30 mL was an independent risk factor (OR = 3.21, 95% CI: 1.08-9.53, <i>p</i> = 0.036). There were no significant differences in the incidence of other postoperative complications (urinary tract infection, secondary hemorrhage, urethral stricture, urinary incontinence) between the two groups (all <i>p</i> > 0.05).Conclusion: Local injection of betamethasone during TURP significantly reduces the incidence of BNC in patients with small-volume prostates without increasing perioperative complications. This intervention targets the inflammatory and fibrotic mechanisms underlying BNC and serves as a safe and effective adjuvant strategy to optimize surgical outcomes in this high-risk population.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1726670"},"PeriodicalIF":1.6,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869306/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1682214
Fangming Wang, Feiya Yang, Yansong Guo, Nianzeng Xing, Jianxing Li
This study introduces a novel "tunnel method" for single-position laparoscopic nephroureterectomy in women with upper urinary tract urothelial carcinoma (UTUC), enabling complete resection of the kidney and entire ureter while preserving the uterine round ligament during dissection of the intramural ureter and bladder cuff excision. By creating a tunnel-like space beneath the round ligament via precise dissection of the uterine broad ligament, this technique avoids round ligament transection, thereby maintaining pelvic anatomical integrity, reducing risks of pelvic organ prolapse, minimizing postoperative adhesions, and preserving reproductive and pelvic function-particularly critical for women of childbearing age or those at risk of prolapse. This innovative approach ensures effective oncological resection while prioritizing female-specific anatomical and functional considerations, providing a more comprehensive and patient-centered treatment option for UTUC.
{"title":"Tunnel method in laparoscopic single-position nephroureterectomy for women: preserving the uterine round ligament during distal ureter management and bladder cuff excision.","authors":"Fangming Wang, Feiya Yang, Yansong Guo, Nianzeng Xing, Jianxing Li","doi":"10.3389/fsurg.2025.1682214","DOIUrl":"10.3389/fsurg.2025.1682214","url":null,"abstract":"<p><p>This study introduces a novel \"tunnel method\" for single-position laparoscopic nephroureterectomy in women with upper urinary tract urothelial carcinoma (UTUC), enabling complete resection of the kidney and entire ureter while preserving the uterine round ligament during dissection of the intramural ureter and bladder cuff excision. By creating a tunnel-like space beneath the round ligament via precise dissection of the uterine broad ligament, this technique avoids round ligament transection, thereby maintaining pelvic anatomical integrity, reducing risks of pelvic organ prolapse, minimizing postoperative adhesions, and preserving reproductive and pelvic function-particularly critical for women of childbearing age or those at risk of prolapse. This innovative approach ensures effective oncological resection while prioritizing female-specific anatomical and functional considerations, providing a more comprehensive and patient-centered treatment option for UTUC.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1682214"},"PeriodicalIF":1.6,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12868241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1668213
Wenpeng Wang, Shan Gao, Jinghao Huang, Duo Yun, Jiefu Wang
Purpose: To compare perioperative and oncologic outcomes between robotic surgical platforms (Si vs. Xi) in rectal carcinoma.
Methods: A retrospective cohort study of 86 robotic rectal cancer resections (Si: n = 31; Xi: n = 55) were analyzed at Tianjin Medical University Cancer Hospital between November 2019 and June 2024.
Results: Among 86 patients with comparable baseline clinicopathological variables (all p > 0.05), the Xi system showed superior perioperative efficiency: shorter operation (226.7 vs. 282.1 min, p = 0.010), console (p = 0.016) and docking times (p = 0.013), less blood loss (83.8 vs. 155.8 mL, p = 0.005), and a shorter postoperative stay (7.8 vs. 9.7 days, p = 0.016). On multivariable analyses, Xi remained independently associated with a shorter operative time (p = 0.002), reduced blood loss (p = 0.027), and decreased length of stay (p = 0.038). Complication rates, lymph node yield, and short-term oncologic quality indicators (distal resection margin [DRM], circumferential resection margin [CRM], mesorectal integrity) were comparable between two systems (all p > 0.05). In low rectal cancers (≤ 5 cm from the anal verge) with balanced baselines, Xi achieved a higher sphincter preservation rate (90.5% vs. 55.6%, p = 0.049). Survival trends numerically favored Xi (3-year DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%), but differences were not significant (DFS: p = 0.54; OS: p = 0.26). On Cox regression, TNM stage independently predicted both DFS (p = 0.041) and OS (p = 0.029). However, the robotic platform (Xi vs. Si) showed no survival advantage (DFS: HR = 1.33, 95% CI 0.53-3.37, p = 0.548; OS: HR = 1.43, 95% CI 0.76-2.67, p = 0.267).
Conclusions: Compared with Si, the Xi platform confers measurable perioperative advantages-shorter operative time, less blood loss, and reduced hospitalization-without compromising short-term oncologic quality or survival. In low rectal tumors, Xi may facilitate sphincter preservation under comparable baselines. Long-term outcomes appear driven primarily by disease stage rather than platform generation.
目的:比较直肠癌机器人手术平台(Si和Xi)的围手术期和肿瘤预后。方法:对2019年11月至2024年6月在天津医科大学肿瘤医院进行的86例机器人直肠癌切除术(Si: n = 31; Xi: n = 55)进行回顾性队列研究。结果:86例基线临床病理变量比较的患者(均p < 0.05)中,Xi系统表现出更优越的围手术期效率:更短的手术时间(226.7 vs. 282.1 min, p = 0.010),更少的失血量(83.8 vs. 155.8 mL, p = 0.005),更短的术后住院时间(7.8 vs. 9.7 d, p = 0.016)。在多变量分析中,Xi仍然与较短的手术时间(p = 0.002)、减少的出血量(p = 0.027)和缩短的住院时间(p = 0.038)独立相关。两种系统的并发症发生率、淋巴结产量和短期肿瘤质量指标(远端切除缘[DRM]、环周切除缘[CRM]、直肠系膜完整性)具有可比性(均p < 0.05)。在基线平衡的低位直肠癌(距肛门边缘≤5cm)中,Xi获得了更高的括约肌保留率(90.5%比55.6%,p = 0.049)。生存趋势在数字上有利于Xi(3年DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%),但差异不显著(DFS: p = 0.54; OS: p = 0.26)。经Cox回归分析,TNM分期独立预测DFS (p = 0.041)和OS (p = 0.029)。然而,机器人平台(Xi vs. Si)没有表现出生存优势(DFS: HR = 1.33, 95% CI 0.53-3.37, p = 0.548; OS: HR = 1.43, 95% CI 0.76-2.67, p = 0.267)。结论:与Si相比,Xi平台具有可测量的围手术期优势-更短的手术时间,更少的出血量,更少的住院时间-而不会影响短期肿瘤质量或生存。在低位直肠肿瘤中,Xi可能有助于在可比基线下保存括约肌。长期结果似乎主要由疾病阶段而不是平台产生决定。
{"title":"Robotic evolution from Si to Xi in rectal cancer assessing operative performance and oncological outcomes.","authors":"Wenpeng Wang, Shan Gao, Jinghao Huang, Duo Yun, Jiefu Wang","doi":"10.3389/fsurg.2025.1668213","DOIUrl":"10.3389/fsurg.2025.1668213","url":null,"abstract":"<p><strong>Purpose: </strong>To compare perioperative and oncologic outcomes between robotic surgical platforms (Si vs. Xi) in rectal carcinoma.</p><p><strong>Methods: </strong>A retrospective cohort study of 86 robotic rectal cancer resections (Si: <i>n</i> = 31; Xi: <i>n</i> = 55) were analyzed at Tianjin Medical University Cancer Hospital between November 2019 and June 2024.</p><p><strong>Results: </strong>Among 86 patients with comparable baseline clinicopathological variables (all <i>p</i> > 0.05), the Xi system showed superior perioperative efficiency: shorter operation (226.7 vs. 282.1 min, <i>p</i> = 0.010), console (<i>p</i> = 0.016) and docking times (<i>p</i> = 0.013), less blood loss (83.8 vs. 155.8 mL, <i>p</i> = 0.005), and a shorter postoperative stay (7.8 vs. 9.7 days, <i>p</i> = 0.016). On multivariable analyses, Xi remained independently associated with a shorter operative time (<i>p</i> = 0.002), reduced blood loss (<i>p</i> = 0.027), and decreased length of stay (<i>p</i> = 0.038). Complication rates, lymph node yield, and short-term oncologic quality indicators (distal resection margin [DRM], circumferential resection margin [CRM], mesorectal integrity) were comparable between two systems (all <i>p</i> > 0.05). In low rectal cancers (≤ 5 cm from the anal verge) with balanced baselines, Xi achieved a higher sphincter preservation rate (90.5% vs. 55.6%, <i>p</i> = 0.049). Survival trends numerically favored Xi (3-year DFS 79.8% vs. 73.0%; OS 92.0% vs. 83.0%), but differences were not significant (DFS: <i>p</i> = 0.54; OS: <i>p</i> = 0.26). On Cox regression, TNM stage independently predicted both DFS (<i>p</i> = 0.041) and OS (<i>p</i> = 0.029). However, the robotic platform (Xi vs. Si) showed no survival advantage (DFS: HR = 1.33, 95% CI 0.53-3.37, <i>p</i> = 0.548; OS: HR = 1.43, 95% CI 0.76-2.67, <i>p</i> = 0.267).</p><p><strong>Conclusions: </strong>Compared with Si, the Xi platform confers measurable perioperative advantages-shorter operative time, less blood loss, and reduced hospitalization-without compromising short-term oncologic quality or survival. In low rectal tumors, Xi may facilitate sphincter preservation under comparable baselines. Long-term outcomes appear driven primarily by disease stage rather than platform generation.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1668213"},"PeriodicalIF":1.6,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12868149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1755084
Rachid Eduardo Noleto da Nobrega Oliveira, Guilherme Franceschini Machado, Isabella Cabianca Moriguchi Caetano Salvador, Paula Duarte D Ambrosio, Lucas Monteiro Delgado, Felipe S Passos, Tulio Caldonazo
Introduction: The optimal surgical strategy for synchronous bilateral pulmonary nodules remains unclear. One-stage bilateral resections may offer logistical and clinical advantages, but safety concerns persist regarding bilateral complications.
Methods: We conducted a systematic review and meta-analysis of studies comparing one-stage vs. two-stage pulmonary resections in adult patients with synchronous bilateral nodules. Ten observational studies were included, encompassing 1,015 patients. Continuous outcomes were assessed using mean differences (MDs) and binary outcomes with odds ratios (ORs), applying DerSimonian and Laird random-effects models. Subgroup and meta-regression analyses were performed. Statistical analyses were conducted using R software (v4.4.1).
Results: One-stage resection was associated with significantly reduced operative time (MD -24.36 min; 95% CI -40.59 to -8.13), shorter hospital stay (MD -2.79 days; 95% CI -4.25 to -1.33), and lower direct surgical costs (MD -5,543.73 USD; 95% CI -6,601.05 to -4,486.40). No significant differences were observed in intraoperative blood loss, persistent air leak, or arrhythmia. Subgroup analysis revealed that the type of pulmonary lesion influenced hospital stay, while meta-regression showed no effect of lobectomy rate.
Conclusions: One-stage bilateral resection demonstrates greater efficiency without increased morbidity, supporting its use in experienced centers. These findings suggest that a single-anesthetic approach may facilitate earlier recovery and timely systemic therapy in selected patients.
同步双侧肺结节的最佳手术策略尚不清楚。一期双侧切除术可能提供后勤和临床优势,但双侧并发症的安全性问题仍然存在。方法:我们进行了一项系统综述和荟萃分析,比较了成人同步双侧结节患者一期和两期肺切除术的研究。纳入了10项观察性研究,包括1015名患者。采用DerSimonian和Laird随机效应模型,采用均值差异(md)和比值比(ORs)评估连续结局。进行亚组和元回归分析。采用R软件(v4.4.1)进行统计分析。结果:一期切除与显著缩短手术时间(MD -24.36 min; 95% CI -40.59 ~ -8.13)、缩短住院时间(MD -2.79天;95% CI -4.25 ~ -1.33)、降低直接手术费用(MD -5,543.73美元;95% CI -6,601.05 ~ -4,486.40)相关。术中出血量、持续漏气或心律失常方面无显著差异。亚组分析显示肺病变类型影响住院时间,而meta回归显示肺叶切除术率没有影响。结论:一期双侧切除在不增加发病率的情况下显示出更高的效率,支持在经验丰富的中心使用。这些研究结果表明,单一麻醉方法可能有助于选定患者的早期恢复和及时的全身治疗。系统评价注册:https://www.crd.york.ac.uk/PROSPERO/view/CRD420251048804,标识符:CRD420251048804。
{"title":"One-stage vs. two-stage thoracoscopic surgery for synchronous bilateral pulmonary nodules: a systematic review and meta-analysis.","authors":"Rachid Eduardo Noleto da Nobrega Oliveira, Guilherme Franceschini Machado, Isabella Cabianca Moriguchi Caetano Salvador, Paula Duarte D Ambrosio, Lucas Monteiro Delgado, Felipe S Passos, Tulio Caldonazo","doi":"10.3389/fsurg.2025.1755084","DOIUrl":"10.3389/fsurg.2025.1755084","url":null,"abstract":"<p><strong>Introduction: </strong>The optimal surgical strategy for synchronous bilateral pulmonary nodules remains unclear. One-stage bilateral resections may offer logistical and clinical advantages, but safety concerns persist regarding bilateral complications.</p><p><strong>Methods: </strong>We conducted a systematic review and meta-analysis of studies comparing one-stage vs. two-stage pulmonary resections in adult patients with synchronous bilateral nodules. Ten observational studies were included, encompassing 1,015 patients. Continuous outcomes were assessed using mean differences (MDs) and binary outcomes with odds ratios (ORs), applying DerSimonian and Laird random-effects models. Subgroup and meta-regression analyses were performed. Statistical analyses were conducted using R software (v4.4.1).</p><p><strong>Results: </strong>One-stage resection was associated with significantly reduced operative time (MD -24.36 min; 95% CI -40.59 to -8.13), shorter hospital stay (MD -2.79 days; 95% CI -4.25 to -1.33), and lower direct surgical costs (MD -5,543.73 USD; 95% CI -6,601.05 to -4,486.40). No significant differences were observed in intraoperative blood loss, persistent air leak, or arrhythmia. Subgroup analysis revealed that the type of pulmonary lesion influenced hospital stay, while meta-regression showed no effect of lobectomy rate.</p><p><strong>Conclusions: </strong>One-stage bilateral resection demonstrates greater efficiency without increased morbidity, supporting its use in experienced centers. These findings suggest that a single-anesthetic approach may facilitate earlier recovery and timely systemic therapy in selected patients.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/view/CRD420251048804, identifier: CRD420251048804.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1755084"},"PeriodicalIF":1.6,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12868250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-21eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1613472
Long-Ze Zong, Yong Feng, Dong-Yu Bai
Introduction: Anterior ankle impingement syndrome (AAIS) is a degenerative condition that causes anterior ankle pain and limited dorsiflexion, especially in athletes. It results from either osseous (osteophytes) or soft tissue (synovial hypertrophy, fibrosis) pathology.
Methods: Although conservative treatments offer temporary relief, arthroscopic surgery has become the preferred approach due to its minimally invasive technique and surgical precision.
Results: Current evidence shows 80%-90% success rates, with significant improvements in visual analog scale scores (mean reduction of 4.1 points) and American orthopedic foot & ankle society scores (mean increase of 28 points), along with low complication rates (2%-7%). However, outcomes are closely linked to the severity of pre-existing osteoarthritis, with 93% success in non-arthritic joints compared to 53% in cases with moderate osteoarthritis. Key research limitations include heterogeneous study designs, small sample sizes, and a lack of long-term data (only 18.6% of studies report ≥5-year follow-up).
Discussion: Future research should focus on standardizing outcome measures, assessing the cost-effectiveness of advanced techniques, and establishing evidence-based protocols for patient selection and rehabilitation. These efforts will help optimize surgical decision-making and enhance long-term outcomes for patients with AAIS.
{"title":"A perspective on arthroscopic treatment for anterior ankle impingement syndrome: clinical research insights.","authors":"Long-Ze Zong, Yong Feng, Dong-Yu Bai","doi":"10.3389/fsurg.2025.1613472","DOIUrl":"10.3389/fsurg.2025.1613472","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior ankle impingement syndrome (AAIS) is a degenerative condition that causes anterior ankle pain and limited dorsiflexion, especially in athletes. It results from either osseous (osteophytes) or soft tissue (synovial hypertrophy, fibrosis) pathology.</p><p><strong>Methods: </strong>Although conservative treatments offer temporary relief, arthroscopic surgery has become the preferred approach due to its minimally invasive technique and surgical precision.</p><p><strong>Results: </strong>Current evidence shows 80%-90% success rates, with significant improvements in visual analog scale scores (mean reduction of 4.1 points) and American orthopedic foot & ankle society scores (mean increase of 28 points), along with low complication rates (2%-7%). However, outcomes are closely linked to the severity of pre-existing osteoarthritis, with 93% success in non-arthritic joints compared to 53% in cases with moderate osteoarthritis. Key research limitations include heterogeneous study designs, small sample sizes, and a lack of long-term data (only 18.6% of studies report ≥5-year follow-up).</p><p><strong>Discussion: </strong>Future research should focus on standardizing outcome measures, assessing the cost-effectiveness of advanced techniques, and establishing evidence-based protocols for patient selection and rehabilitation. These efforts will help optimize surgical decision-making and enhance long-term outcomes for patients with AAIS.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1613472"},"PeriodicalIF":1.6,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12869312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146124609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1733483
Samantha E Spellicy, Ellen O'Callaghan, Michael Patetta, Dennis A Turner, Muhammad M Abd-El-Barr
Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly that often manifests as chronic low back or radicular pain, a condition clinically referred to as Bertolotti syndrome. One specific cause of Bertolotti syndrome is pseudoarticulation of the L5 transverse process with the sacrum or ilium due to LSTV. Although conventional magnetic resonance imaging (MRI) and computed tomography can identify structural changes, they provide limited functional information regarding sites of active arthropathy. Single-photon emission computed tomography (SPECT-CT) enables the localization of metabolically active pseudoarthrotic joints, thereby improving patient selection and surgical planning. We present the case of a 52-year-old woman with Bertolotti syndrome who presented with severe chronic axial back pain and left-sided pain radiating along portions of the L5 and S1 dermatomes. MRI revealed no significant compression of the neural elements but did demonstrate an incidental Tarlov cyst at S1, measuring 5.7 mm × 5.7 mm. SPECT-CT demonstrated localized, abnormal uptake between an anomalous left L5 transverse process and the sacrum. The patient underwent minimally invasive, image-guided removal of the left L5 transverse process, isolating L5 vertebral motion from the iliac crest. She was discharged on postoperative day 1 with significant improvement in her pain and radiculopathy. At 6-week, 3-, and 6-month follow-up, she reported near-complete resolution of presurgical radicular pain, functional restoration, and a return to normal activities. This case highlights the utility of SPECT-CT in evaluating Bertolotti syndrome. Functional imaging enabled precise structural localization of the pain generator, while targeted minimally invasive resection provided durable symptom relief.
腰骶过渡椎(LSTV)是一种常见的先天性异常,通常表现为慢性腰痛或神经根性疼痛,临床上称为Bertolotti综合征。Bertolotti综合征的一个特殊原因是LSTV引起的L5横突与骶骨或髂骨的假关节。尽管传统的磁共振成像(MRI)和计算机断层扫描可以识别结构变化,但它们提供的有关活动性关节病部位的功能信息有限。单光子发射计算机断层扫描(SPECT-CT)能够定位代谢活跃的假关节,从而改善患者选择和手术计划。我们报告一名患有Bertolotti综合征的52岁女性,她表现为严重的慢性腰轴性疼痛和左侧沿L5和S1部分皮节放射的疼痛。MRI显示神经元件无明显压迫,但在S1处发现偶发的Tarlov囊肿,尺寸为5.7 mm × 5.7 mm。SPECT-CT显示在异常左L5横突和骶骨之间有局部异常摄取。患者在图像引导下微创切除左L5横突,分离L5椎体运动与髂骨。患者术后第1天出院,疼痛和神经根病明显改善。在6周、3和6个月的随访中,患者报告手术前神经根疼痛几乎完全消退,功能恢复,并恢复正常活动。本病例强调SPECT-CT在评估Bertolotti综合征中的应用。功能成像能够精确定位疼痛源的结构,而靶向微创切除提供持久的症状缓解。
{"title":"Case Report: SPECT-CT-guided minimally invasive transverse process resection for Bertolotti syndrome.","authors":"Samantha E Spellicy, Ellen O'Callaghan, Michael Patetta, Dennis A Turner, Muhammad M Abd-El-Barr","doi":"10.3389/fsurg.2025.1733483","DOIUrl":"10.3389/fsurg.2025.1733483","url":null,"abstract":"<p><p>Lumbosacral transitional vertebrae (LSTV) are a common congenital anomaly that often manifests as chronic low back or radicular pain, a condition clinically referred to as Bertolotti syndrome. One specific cause of Bertolotti syndrome is pseudoarticulation of the L5 transverse process with the sacrum or ilium due to LSTV. Although conventional magnetic resonance imaging (MRI) and computed tomography can identify structural changes, they provide limited functional information regarding sites of active arthropathy. Single-photon emission computed tomography (SPECT-CT) enables the localization of metabolically active pseudoarthrotic joints, thereby improving patient selection and surgical planning. We present the case of a 52-year-old woman with Bertolotti syndrome who presented with severe chronic axial back pain and left-sided pain radiating along portions of the L5 and S1 dermatomes. MRI revealed no significant compression of the neural elements but did demonstrate an incidental Tarlov cyst at S1, measuring 5.7 mm × 5.7 mm. SPECT-CT demonstrated localized, abnormal uptake between an anomalous left L5 transverse process and the sacrum. The patient underwent minimally invasive, image-guided removal of the left L5 transverse process, isolating L5 vertebral motion from the iliac crest. She was discharged on postoperative day 1 with significant improvement in her pain and radiculopathy. At 6-week, 3-, and 6-month follow-up, she reported near-complete resolution of presurgical radicular pain, functional restoration, and a return to normal activities. This case highlights the utility of SPECT-CT in evaluating Bertolotti syndrome. Functional imaging enabled precise structural localization of the pain generator, while targeted minimally invasive resection provided durable symptom relief.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1733483"},"PeriodicalIF":1.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12864373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-20eCollection Date: 2025-01-01DOI: 10.3389/fsurg.2025.1732753
Musheng Rao, Guan Lin, Shuzhou Cai
Objective: To evaluate the feasibility, technical nuances, and clinical outcomes of using the LVIS stent as a bridging device for the salvage treatment of a malapposed Lattice flow diverter (FD) in a giant posterior circulation aneurysm.
Methods: We present a detailed case report of a patient with a giant aneurysm in the V4 segment of the vertebral artery. Following implantation of a Lattice blood flow diverter and coils, immediate post-procedural angiography revealed incomplete opening and malapposition at the proximal segment of the stent, accompanied by delayed distal flow. After unsuccessful attempts to improve wall apposition via microcatheter massage, a salvage strategy was employed by deploying an LVIS stent within the malapposed FD segment. This approach aimed to enhance overall wall apposition and metal coverage to achieve ultimate aneurysm occlusion.
Results: The salvage procedure was performed successfully. The LVIS stent was accurately deployed within the malapposed segment of the FD. Angiographic assessment after the procedure demonstrated complete wall apposition of the composite stent construct and total occlusion of the aneurysm sac. The patient experienced no new neurological deficits during the perioperative period. Short-term follow-up indicated an excellent clinical outcome, with a modified Rankin Scale score of 0.
Conclusion: Utilizing the LVIS stent as a bridging salvage strategy is a safe and effective technical option for managing malapposed FDs in complex giant posterior circulation aneurysms. This technique effectively enhances stent wall apposition and structural integrity, potentially promoting intra-aneurysmal thrombosis and eventual occlusion. It provides a valuable clinical approach for managing this challenging complication.
{"title":"Case Report: Application of the LVIS stent as a bridging device for salvage treatment of malapposed lattice flow diverter in a giant posterior circulation aneurysm: technical note and clinical efficacy.","authors":"Musheng Rao, Guan Lin, Shuzhou Cai","doi":"10.3389/fsurg.2025.1732753","DOIUrl":"10.3389/fsurg.2025.1732753","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility, technical nuances, and clinical outcomes of using the LVIS stent as a bridging device for the salvage treatment of a malapposed Lattice flow diverter (FD) in a giant posterior circulation aneurysm.</p><p><strong>Methods: </strong>We present a detailed case report of a patient with a giant aneurysm in the V4 segment of the vertebral artery. Following implantation of a Lattice blood flow diverter and coils, immediate post-procedural angiography revealed incomplete opening and malapposition at the proximal segment of the stent, accompanied by delayed distal flow. After unsuccessful attempts to improve wall apposition via microcatheter massage, a salvage strategy was employed by deploying an LVIS stent within the malapposed FD segment. This approach aimed to enhance overall wall apposition and metal coverage to achieve ultimate aneurysm occlusion.</p><p><strong>Results: </strong>The salvage procedure was performed successfully. The LVIS stent was accurately deployed within the malapposed segment of the FD. Angiographic assessment after the procedure demonstrated complete wall apposition of the composite stent construct and total occlusion of the aneurysm sac. The patient experienced no new neurological deficits during the perioperative period. Short-term follow-up indicated an excellent clinical outcome, with a modified Rankin Scale score of 0.</p><p><strong>Conclusion: </strong>Utilizing the LVIS stent as a bridging salvage strategy is a safe and effective technical option for managing malapposed FDs in complex giant posterior circulation aneurysms. This technique effectively enhances stent wall apposition and structural integrity, potentially promoting intra-aneurysmal thrombosis and eventual occlusion. It provides a valuable clinical approach for managing this challenging complication.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1732753"},"PeriodicalIF":1.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12864494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: To investigate the risk factors associated with prolonged postoperative length of stay (PLOS) in patients undergoing primary total hip arthroplasty (THA) via direct anterior approach (DAA) and develop a perioperative dynamic prediction nomogram for optimizing the perioperative management of THA.
Methods: This single-center, retrospective cohort study analyzed the perioperative clinical data of patients who underwent primary THA through DAA by a single surgical team at our institution between September 2022 to September 2024. Patients were divided into two groups based on postoperative hospital stay duration: the normal group (PLOS < 6 days) and the prolonged group (PLOS > 6 days). LASSO regression was used to screen variables, multivariate logistic regression was applied to establish the model and then a nomogram was developed. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were adopted to evaluate the performance and clinical applicability of the model.
Results: This study included a total of 413 patients. Multivariate logistic regression analysis revealed that higher body mass index (BMI), longer operation time, American Society of Anesthesiologists classification (ASA) > II, postoperative extra opioid use, postoperative nausea and vomiting (PONV), postoperative blood transfusion, lower preoperative albumin (ALB) levels, and no prior contralateral THA history were independent risk factors for prolonged postoperative hospital stay in patients undergoing primary DAA-THA (P < 0.05). The AUC of the established predictive model was 0.766, indicating good predictive performance. The calibration curve demonstrated good consistency between actual delayed discharge rates and predicted probabilities. DCA showed that the model provided maximum net benefit when the threshold probability ranged from 2% to 85%.
Conclusions: BMI, operation time, ASA classification, postoperative extra opioid use, PONV, postoperative transfusion, preoperative ALB, and previous contralateral THA history can be used as predictive factors. The LASSO regression-based model for predicting prolonged hospital stay after primary DAA-THA demonstrates accurate predictive performance and strong clinical utility. It can assist clinicians in stratifying patient risk effectively, thereby supporting enhanced recovery protocols.
{"title":"Construction of prediction models for prolonged length of postoperative hospital stay in patients undergoing primary total hip arthroplasty via direct anterior approach.","authors":"Linjie Hu, Guosong Xu, Weiyi Chen, Yiqun Chen, Qichao Ou, Zhibin Wu, Guoxian Chen","doi":"10.3389/fsurg.2025.1720930","DOIUrl":"10.3389/fsurg.2025.1720930","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the risk factors associated with prolonged postoperative length of stay (PLOS) in patients undergoing primary total hip arthroplasty (THA) via direct anterior approach (DAA) and develop a perioperative dynamic prediction nomogram for optimizing the perioperative management of THA.</p><p><strong>Methods: </strong>This single-center, retrospective cohort study analyzed the perioperative clinical data of patients who underwent primary THA through DAA by a single surgical team at our institution between September 2022 to September 2024. Patients were divided into two groups based on postoperative hospital stay duration: the normal group (PLOS < 6 days) and the prolonged group (PLOS > 6 days). LASSO regression was used to screen variables, multivariate logistic regression was applied to establish the model and then a nomogram was developed. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were adopted to evaluate the performance and clinical applicability of the model.</p><p><strong>Results: </strong>This study included a total of 413 patients. Multivariate logistic regression analysis revealed that higher body mass index (BMI), longer operation time, American Society of Anesthesiologists classification (ASA) > II, postoperative extra opioid use, postoperative nausea and vomiting (PONV), postoperative blood transfusion, lower preoperative albumin (ALB) levels, and no prior contralateral THA history were independent risk factors for prolonged postoperative hospital stay in patients undergoing primary DAA-THA (<i>P</i> < 0.05). The AUC of the established predictive model was 0.766, indicating good predictive performance. The calibration curve demonstrated good consistency between actual delayed discharge rates and predicted probabilities. DCA showed that the model provided maximum net benefit when the threshold probability ranged from 2% to 85%.</p><p><strong>Conclusions: </strong>BMI, operation time, ASA classification, postoperative extra opioid use, PONV, postoperative transfusion, preoperative ALB, and previous contralateral THA history can be used as predictive factors. The LASSO regression-based model for predicting prolonged hospital stay after primary DAA-THA demonstrates accurate predictive performance and strong clinical utility. It can assist clinicians in stratifying patient risk effectively, thereby supporting enhanced recovery protocols.</p>","PeriodicalId":12564,"journal":{"name":"Frontiers in Surgery","volume":"12 ","pages":"1720930"},"PeriodicalIF":1.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12864400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}