{"id":"https://openalex.org/W7166114604","doi":"https://doi.org/10.1080/09513590.2026.2695508","title":"Peripheral precocious puberty with unilateral ovarian agenesis in early childhood: a case report and review of literature","display_name":"Peripheral precocious puberty with unilateral ovarian agenesis in early childhood: a case report and review of literature","publication_year":2026,"publication_date":"2026-06-26","ids":{"openalex":"https://openalex.org/W7166114604","doi":"https://doi.org/10.1080/09513590.2026.2695508","pmid":"https://pubmed.ncbi.nlm.nih.gov/42360895"},"language":"en","primary_location":{"id":"doi:10.1080/09513590.2026.2695508","doi":"https://doi.org/10.1080/09513590.2026.2695508","is_oa":true,"landing_page_url":"https://doi.org/10.1080/09513590.2026.2695508","pdf_url":null,"source":{"id":"https://openalex.org/S144560499","display_name":"Gynecological Endocrinology","issn_l":"0951-3590","issn":["0951-3590","1473-0766"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320449","host_organization_name":"Informa","host_organization_lineage":["https://openalex.org/P4310320449"],"host_organization_lineage_names":["Informa"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Gynecological Endocrinology","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","doaj","pubmed"],"open_access":{"is_oa":true,"oa_status":"diamond","oa_url":"https://doi.org/10.1080/09513590.2026.2695508","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5063894463","display_name":"Elene Asanidze","orcid":"https://orcid.org/0000-0002-8779-7731","observed_orcids":["https://orcid.org/0000-0002-8779-7731"]},"institutions":[{"id":"https://openalex.org/I4210139549","display_name":"Petre Shotadze Tbilisi Medical Academy","ror":"https://ror.org/032pgwm02","country_code":"GE","type":"education","lineage":["https://openalex.org/I4210139549"]}],"countries":["GE"],"is_corresponding":true,"raw_author_name":"Elene Asanidze","raw_affiliation_strings":["Medical Faculty of Petre Shotadze Tbilisi Medical Academy"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medical Faculty of Petre Shotadze Tbilisi Medical Academy","institution_ids":["https://openalex.org/I4210139549"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5019814463","display_name":"Alla Vash\u2010Margita","orcid":"https://orcid.org/0000-0002-3510-3945","observed_orcids":["https://orcid.org/0000-0002-3510-3945"]},"institutions":[{"id":"https://openalex.org/I32971472","display_name":"Yale University","ror":"https://ror.org/03v76x132","country_code":"US","type":"education","lineage":["https://openalex.org/I32971472"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Alla Vash-Margita","raw_affiliation_strings":["Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, Division of Pediatric and Adolescent Gynecology"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, Division of Pediatric and Adolescent Gynecology","institution_ids":["https://openalex.org/I32971472"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5139434048","display_name":"Besik Asanidze","orcid":"https://orcid.org/0009-0009-9119-2979","observed_orcids":["https://orcid.org/0009-0009-9119-2979"]},"institutions":[{"id":"https://openalex.org/I7848551","display_name":"Tbilisi State Medical University","ror":"https://ror.org/020jbrt22","country_code":"GE","type":"education","lineage":["https://openalex.org/I7848551"]}],"countries":["GE"],"is_corresponding":false,"raw_author_name":"Besik Asanidze","raw_affiliation_strings":["Medical Faculty of Tbilisi State Medical University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medical Faculty of Tbilisi State Medical University","institution_ids":["https://openalex.org/I7848551"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5063546421","display_name":"Mariam Kharaishvili","orcid":null,"observed_orcids":[]},"institutions":[{"id":"https://openalex.org/I4210148604","display_name":"Georgian American University","ror":"https://ror.org/04qb0r423","country_code":"GE","type":"education","lineage":["https://openalex.org/I4210148604"]}],"countries":["GE"],"is_corresponding":false,"raw_author_name":"Mariam Kharaishvili","raw_affiliation_strings":["Medical Faculty of Georgian American University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medical Faculty of Georgian American University","institution_ids":["https://openalex.org/I4210148604"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5060155198","display_name":"Maia Chiokadze","orcid":"https://orcid.org/0000-0002-1339-0832","observed_orcids":["https://orcid.org/0000-0002-1339-0832"]},"institutions":[{"id":"https://openalex.org/I4210148604","display_name":"Georgian American University","ror":"https://ror.org/04qb0r423","country_code":"GE","type":"education","lineage":["https://openalex.org/I4210148604"]}],"countries":["GE"],"is_corresponding":false,"raw_author_name":"Maia Chiokadze","raw_affiliation_strings":["Medical Faculty of Georgian American University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medical Faculty of Georgian American University","institution_ids":["https://openalex.org/I4210148604"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5093920851","display_name":"Ana Jibladze","orcid":"https://orcid.org/0000-0002-3434-2530","observed_orcids":["https://orcid.org/0000-0002-3434-2530"]},"institutions":[{"id":"https://openalex.org/I102808428","display_name":"Tbilisi State University","ror":"https://ror.org/05fd1hd85","country_code":"GE","type":"education","lineage":["https://openalex.org/I102808428"]}],"countries":["GE"],"is_corresponding":false,"raw_author_name":"Ana Jibladze","raw_affiliation_strings":["Medical Faculty of Ivane Javakhishvili Tbilisi State University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medical Faculty of Ivane Javakhishvili Tbilisi State University","institution_ids":["https://openalex.org/I102808428"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5054319302","display_name":"Jenaro Kristesashvili","orcid":"https://orcid.org/0000-0001-9216-1407","observed_orcids":["https://orcid.org/0000-0001-9216-1407"]},"institutions":[{"id":"https://openalex.org/I102808428","display_name":"Tbilisi State University","ror":"https://ror.org/05fd1hd85","country_code":"GE","type":"education","lineage":["https://openalex.org/I102808428"]}],"countries":["GE"],"is_corresponding":false,"raw_author_name":"Jenaro Kristesashvili","raw_affiliation_strings":["Medical Faculty of Ivane Javakhishvili Tbilisi State University"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"Medical Faculty of Ivane Javakhishvili Tbilisi State University","institution_ids":["https://openalex.org/I102808428"]}]}],"institutions":[],"countries_distinct_count":2,"institutions_distinct_count":5,"corresponding_author_ids":["https://openalex.org/A5063894463"],"corresponding_institution_ids":["https://openalex.org/I4210139549"],"apc_list":null,"apc_paid":null,"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"42","issue":"1","first_page":"2695508","last_page":"2695508"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10390","display_name":"Ovarian function and disorders","score":0.5630000233650208,"subfield":{"id":"https://openalex.org/subfields/2743","display_name":"Reproductive Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},"topics":[{"id":"https://openalex.org/T10390","display_name":"Ovarian function and disorders","score":0.5630000233650208,"subfield":{"id":"https://openalex.org/subfields/2743","display_name":"Reproductive Medicine"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11956","display_name":"Sexual Differentiation and Disorders","score":0.271699994802475,"subfield":{"id":"https://openalex.org/subfields/2712","display_name":"Endocrinology, Diabetes and Metabolism"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T10550","display_name":"Ovarian cancer diagnosis and treatment","score":0.0430000014603138,"subfield":{"id":"https://openalex.org/subfields/2730","display_name":"Oncology"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/peripheral-precocious-puberty","display_name":"peripheral precocious puberty","score":1.0},{"id":"https://openalex.org/keywords/functional-ovarian-cysts","display_name":"functional ovarian cysts","score":0.828000009059906},{"id":"https://openalex.org/keywords/ovarian-follicular-cysts","display_name":"ovarian follicular cysts","score":0.652999997138977},{"id":"https://openalex.org/keywords/early-childhood","display_name":"early childhood","score":0.5370000004768372},{"id":"https://openalex.org/keywords/breast-development","display_name":"breast development","score":0.7570000290870667},{"id":"https://openalex.org/keywords/pubarche","display_name":"pubarche","score":0.9860000014305115},{"id":"https://openalex.org/keywords/vaginal-bleeding","display_name":"vaginal bleeding","score":0.7919999957084656},{"id":"https://openalex.org/keywords/ovarian-torsion","display_name":"ovarian torsion","score":0.8600000143051147},{"id":"https://openalex.org/keywords/congenital-ovarian-anomaly","display_name":"congenital ovarian anomaly","score":0.6840000152587891}],"concepts":[{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.8258000016212463},{"id":"https://openalex.org/C2908795679","wikidata":"https://www.wikidata.org/wiki/Q5464656","display_name":"Follicular Cyst","level":3,"score":0.7897999882698059},{"id":"https://openalex.org/C2777943302","wikidata":"https://www.wikidata.org/wiki/Q392604","display_name":"Agenesis","level":2,"score":0.5830000042915344},{"id":"https://openalex.org/C2778367240","wikidata":"https://www.wikidata.org/wiki/Q224513","display_name":"Precocious puberty","level":3,"score":0.5435000061988831},{"id":"https://openalex.org/C2778324911","wikidata":"https://www.wikidata.org/wiki/Q9631","display_name":"Ovary","level":2,"score":0.5264999866485596},{"id":"https://openalex.org/C2780302416","wikidata":"https://www.wikidata.org/wiki/Q147362","display_name":"Ovarian cyst","level":3,"score":0.5189999938011169},{"id":"https://openalex.org/C544855455","wikidata":"https://www.wikidata.org/wiki/Q1070952","display_name":"Histopathology","level":2,"score":0.4909999966621399},{"id":"https://openalex.org/C2777395788","wikidata":"https://www.wikidata.org/wiki/Q647630","display_name":"Premature ovarian failure","level":2,"score":0.482699990272522},{"id":"https://openalex.org/C2780597408","wikidata":"https://www.wikidata.org/wiki/Q193211","display_name":"Cyst","level":2,"score":0.47690001130104065},{"id":"https://openalex.org/C2779522080","wikidata":"https://www.wikidata.org/wiki/Q205764","display_name":"Endometriosis","level":2,"score":0.4113999903202057},{"id":"https://openalex.org/C187785154","wikidata":"https://www.wikidata.org/wiki/Q5464664","display_name":"Follicular phase","level":2,"score":0.367900013923645},{"id":"https://openalex.org/C2780047204","wikidata":"https://www.wikidata.org/wiki/Q675754","display_name":"Laparoscopy","level":2,"score":0.36059999465942383},{"id":"https://openalex.org/C29456083","wikidata":"https://www.wikidata.org/wiki/Q1221899","display_name":"Gynecology","level":1,"score":0.3411000072956085},{"id":"https://openalex.org/C141071460","wikidata":"https://www.wikidata.org/wiki/Q40821","display_name":"Surgery","level":1,"score":0.29440000653266907},{"id":"https://openalex.org/C2781230225","wikidata":"https://www.wikidata.org/wiki/Q3150564","display_name":"Ovulation induction","level":4,"score":0.2815999984741211},{"id":"https://openalex.org/C2911074991","wikidata":"https://www.wikidata.org/wiki/Q1473749","display_name":"Mayer-Rokitansky-Kuster-Hauser Syndrome","level":3,"score":0.275299996137619},{"id":"https://openalex.org/C3018442814","wikidata":"https://www.wikidata.org/wiki/Q500816","display_name":"Polycystic ovary","level":4,"score":0.26350000500679016},{"id":"https://openalex.org/C2909633097","wikidata":"https://www.wikidata.org/wiki/Q3083434","display_name":"Endometrial Polyp","level":3,"score":0.25870001316070557},{"id":"https://openalex.org/C2780218171","wikidata":"https://www.wikidata.org/wiki/Q244913","display_name":"Vaginal bleeding","level":3,"score":0.2581999897956848},{"id":"https://openalex.org/C2776880931","wikidata":"https://www.wikidata.org/wiki/Q6745783","display_name":"Breast development","level":3,"score":0.2515999972820282},{"id":"https://openalex.org/C2777164284","wikidata":"https://www.wikidata.org/wiki/Q277954","display_name":"Estrogen","level":2,"score":0.2506999969482422}],"mesh":[{"descriptor_ui":"D002675","descriptor_name":"Child, Preschool","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010048","descriptor_name":"Ovarian Cysts","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":true},{"descriptor_ui":"D010048","descriptor_name":"Ovarian Cysts","qualifier_ui":"Q000601","qualifier_name":"surgery","is_major_topic":true},{"descriptor_ui":"D010053","descriptor_name":"Ovary","qualifier_ui":"Q000000981","qualifier_name":"diagnostic imaging","is_major_topic":true},{"descriptor_ui":"D010053","descriptor_name":"Ovary","qualifier_ui":"Q000002","qualifier_name":"abnormalities","is_major_topic":true},{"descriptor_ui":"D010053","descriptor_name":"Ovary","qualifier_ui":"Q000601","qualifier_name":"surgery","is_major_topic":true},{"descriptor_ui":"D010535","descriptor_name":"Laparoscopy","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011629","descriptor_name":"Puberty, Precocious","qualifier_ui":"Q000150","qualifier_name":"complications","is_major_topic":true},{"descriptor_ui":"D011629","descriptor_name":"Puberty, Precocious","qualifier_ui":"Q000175","qualifier_name":"diagnosis","is_major_topic":true},{"descriptor_ui":"D011629","descriptor_name":"Puberty, Precocious","qualifier_ui":"Q000209","qualifier_name":"etiology","is_major_topic":true},{"descriptor_ui":"D011629","descriptor_name":"Puberty, Precocious","qualifier_ui":"Q000601","qualifier_name":"surgery","is_major_topic":true}],"locations_count":3,"locations":[{"id":"doi:10.1080/09513590.2026.2695508","doi":"https://doi.org/10.1080/09513590.2026.2695508","is_oa":true,"landing_page_url":"https://doi.org/10.1080/09513590.2026.2695508","pdf_url":null,"source":{"id":"https://openalex.org/S144560499","display_name":"Gynecological Endocrinology","issn_l":"0951-3590","issn":["0951-3590","1473-0766"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320449","host_organization_name":"Informa","host_organization_lineage":["https://openalex.org/P4310320449"],"host_organization_lineage_names":["Informa"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Gynecological Endocrinology","raw_type":"journal-article"},{"id":"pmid:42360895","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42360895","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology","raw_type":"Journal Article"},{"id":"pmh:oai:doaj.org/article:4144ba08016f4326ac747e5e53494704","doi":null,"is_oa":false,"landing_page_url":"https://doaj.org/article/4144ba08016f4326ac747e5e53494704","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Gynecological Endocrinology, Vol 42, Iss 1 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.1080/09513590.2026.2695508","doi":"https://doi.org/10.1080/09513590.2026.2695508","is_oa":true,"landing_page_url":"https://doi.org/10.1080/09513590.2026.2695508","pdf_url":null,"source":{"id":"https://openalex.org/S144560499","display_name":"Gynecological Endocrinology","issn_l":"0951-3590","issn":["0951-3590","1473-0766"],"is_oa":true,"is_in_doaj":true,"is_core":true,"listed_in":["anvur-scientific","cwts-core","doaj","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","oarl","poland-70","russia-white-list-2"],"host_organization":"https://openalex.org/P4310320449","host_organization_name":"Informa","host_organization_lineage":["https://openalex.org/P4310320449"],"host_organization_lineage_names":["Informa"],"type":"journal"},"license":"cc-by-nc","license_id":"https://openalex.org/licenses/cc-by-nc","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Gynecological Endocrinology","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","id":"https://metadata.un.org/sdg/3","score":0.98580002784729}],"study_designs":[{"display_name":"Case Report","id":"https://openalex.org/study-designs/case-report"}],"awards":[],"funders":[],"has_content":{"pdf":false,"grobid_xml":false},"content_urls":null,"referenced_works_count":17,"referenced_works":["https://openalex.org/W1600036903","https://openalex.org/W1990863531","https://openalex.org/W2100760890","https://openalex.org/W2157899016","https://openalex.org/W2224205296","https://openalex.org/W2410361020","https://openalex.org/W2753414062","https://openalex.org/W2939910109","https://openalex.org/W3158358538","https://openalex.org/W4316345181","https://openalex.org/W4382583131","https://openalex.org/W4387030146","https://openalex.org/W4387877512","https://openalex.org/W4402269766","https://openalex.org/W4409009841","https://openalex.org/W4410300918","https://openalex.org/W4410382901"],"related_works":["https://openalex.org/W4387379976","https://openalex.org/W7135067250","https://openalex.org/W2967448213","https://openalex.org/W4382631102","https://openalex.org/W4221120820","https://openalex.org/W4413304371","https://openalex.org/W2944253663","https://openalex.org/W1987767315","https://openalex.org/W3201481754","https://openalex.org/W2170475724"],"abstract_inverted_index":{"Peripheral":[0],"precocious":[1],"puberty":[2],"(PPP)":[3],"is":[4,23,45,59],"a":[5,56,74,92,122,128,148,163],"rare":[6,61],"condition":[7],"in":[8,55,94,141,190,193],"early":[9],"childhood,":[10],"particularly":[11],"among":[12],"girls":[13],"under":[14],"3":[15],"years":[16],"of":[17,21,37,52,73,100,107,124,138,152,173,179,187,196],"age.":[18],"One":[19],"cause":[20],"PPP":[22,125],"functional":[24,129],"ovarian":[25,43,130],"cysts":[26],"that":[27],"secrete":[28],"estrogen":[29],"at":[30],"levels":[31],"sufficient":[32],"to":[33,127],"trigger":[34],"the":[35,71,95,101,108,135,168,185,194],"development":[36],"premature":[38],"secondary":[39],"sexual":[40],"characteristics.":[41],"Unilateral":[42],"agenesis":[44,99],"an":[46],"uncommon":[47],"congenital":[48,197],"anomaly.":[49],"The":[50],"coexistence":[51],"both":[53],"conditions":[54],"single":[57],"patient":[58,169],"extremely":[60],"and":[62,66,76,85,98,111,119,144,176],"poses":[63],"unique":[64],"diagnostic":[65],"management":[67],"challenges.":[68],"We":[69],"report":[70],"case":[72,183],"2-year":[75],"10-month-old":[77],"girl":[78],"presenting":[79],"with":[80],"concurrent":[81],"breast":[82],"development,":[83],"pubarche,":[84],"recurrent":[86],"vaginal":[87,180],"bleeding.":[88,181],"Pelvic":[89],"imaging":[90],"revealed":[91],"cyst":[93,131,142],"left":[96],"ovary":[97,110],"right":[102,109],"ovary.":[103],"Laparoscopy":[104],"confirmed":[105,162],"absence":[106],"ipsilateral":[112],"fallopian":[113],"tube.":[114],"Based":[115],"on":[116],"clinical,":[117],"hormonal,":[118],"radiologic":[120],"findings,":[121],"diagnosis":[123],"due":[126],"was":[132,155],"made.":[133],"Given":[134],"rapid":[136],"progression":[137],"symptoms,":[139],"increase":[140],"size,":[143],"concern":[145],"for":[146],"torsion,":[147],"short":[149],"observation":[150],"period":[151],"three":[153],"months":[154],"followed":[156],"by":[157],"ovarian-preserving":[158],"laparoscopic":[159],"cystectomy.":[160],"Histopathology":[161],"benign":[164],"follicular":[165],"cyst.":[166],"Postoperatively,":[167],"experienced":[170],"partial":[171],"regression":[172],"pubertal":[174],"signs":[175],"complete":[177],"resolution":[178],"This":[182],"highlights":[184],"importance":[186],"individualized":[188],"decision-making":[189],"managing":[191],"PPP,especially":[192],"presence":[195],"anomalies.":[198]},"counts_by_year":[],"updated_date":"2026-10-31T12:09:11.096373","created_date":"2026-06-27T00:00:00"}
