Digestive Surgery最新文献

{"title":"Pharmacological management for prevention and treatment of posthepatectomy liver failure.","authors":"Arja Gerritsen, Marieke T de Boer, Carlijn I Buis, Hans Blokzijl, Marije Smit, Jan-Willem H L Boldingh, Vincent E de Meijer","doi":"10.1159/000548937","DOIUrl":"https://doi.org/10.1159/000548937","url":null,"abstract":"<p><p>Background Posthepatectomy liver failure (PHLF) remains a leading cause of morbidity and mortality following major liver resection. Despite advances in surgical techniques and perioperative care, treatment options for PHLF are limited. Pharmacological interventions targeting ischemia-reperfusion injury and portal flow modulation have gained interest as potential therapeutic strategies. Summary This review provides a clinically applicable overview of the current evidence on pharmacological management of PHLF. Perioperative glucocorticoids may reduce inflammatory complications and lower PHLF incidence, though patient selection is crucial. N-acetylcysteine demonstrates antioxidant effects in experimental models and omega-3 fatty acids reduce inflammation, but both lack clinical efficacy. Somatostatin and terlipressin, which modulate portal hemodynamics, have shown promise in preclinical and early-phase clinical studies; however, randomized trials have yet to confirm their benefit in reducing PHLF. Non-selective beta-blockers impair liver regeneration in preclinical models and are not recommended post-hepatectomy. Early postoperative heparin administration and hyperinsulinemic-normoglycemic strategies have been associated with reduced PHLF but require further validation. Key Messages While perioperative glucocorticoids may reduce PHLF risk in selected patients, other pharmacological agents show theoretical or preliminary promise, but cannot be routinely recommended based on current evidence. Prospective clinical trials are needed to establish effective pharmacological strategies for the prevention and treatment of PHLF.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-22"},"PeriodicalIF":1.2,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-colorectal liver metastases undergoing liver resection: the NONCOLMET study group.","authors":"Marcello Di Martino, Giorgio Ercolani, Federica Cipriani, Gianluca Baiocchi, Roberto Bordonaro, Matteo Cescon, Antonio Frena, Felice Giuliante, Gianluca Grazi, Salvatore Gruttadauria, Giovanni Marchegiani, Riccardo Memeo, Fabrizio Panaro, Fabrizio Romano, Andrea Ruzzenente, Marcello Spampinato, Guido Alberto Tiberio, Guido Torzilli, Roberto Troisi, Matteo Donadon","doi":"10.1159/000548423","DOIUrl":"https://doi.org/10.1159/000548423","url":null,"abstract":"<p><strong>Background: </strong>While the resection of colorectal liver metastases (CRLM) is a well-established procedure, with survival rates superior to chemotherapy alone, controversial data still exist on liver resection for non-colorectal liver metastases (NCRLM). These patients comprise a diverse and heterogeneous group usually excluded from surgery. To date, only few retrospective reports are available on the surgical treatment of NCRLM. The NONCOLMET study aims to build a comprehensive registry of patients undergoing liver resection for NCRLM, providing robust retrospective and prospective data to describe clinical practices, outcomes, and identify prognostic factors.</p><p><strong>Methods: </strong>The study consists of two phases: (1) retrospective collection of data from patients treated between 2010-2024 and (2) prospective enrolment from 2025. Patients aged ≥18 years with histologically confirmed NCRLM undergoing liver resection will be included. Data will be recorded via a standardized electronic case report form (eCRF) in the RedCap platform. The following endpoints will be evaluated: oncological outcomes including overall survival (OS), disease-free Survival (DFS) and disease relapse; post-operative mortality at 30 and 90 days with causes of death; post-procedural complications; predictor variables of short- and long-term outcomes. These outcomes will be used to elaborate a risk score models. The study protococol was registered on Clincaltrials.gov (NCT06542926).</p><p><strong>Conclusions: </strong>NONCOLMET will offer crucial insights into the surgical management of NCRLM, helping refine patient selection criteria and informing future clinical guidelines.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating Cell-Free DNA as a potential Diagnostic Tool in Pancreatic Cancer: A Comparative Analysis.","authors":"Romualdas Riauka, Rita Kupcinskaite-Noreikiene, Ingrida Grabauskyte, Antanas Gulbinas, Giedrius Barauskas, Aldona Jasukaitiene, Vakare Gruodyte, Povilas Ignatavicius","doi":"10.1159/000547870","DOIUrl":"https://doi.org/10.1159/000547870","url":null,"abstract":"<p><strong>Introduction: </strong>Liquid biopsies enable non-invasive tumor material sampling in patients with pancreatic adenocarcinoma (PDAC). Genetic information, especially alterations in circulating free DNA (cfDNA) levels, might help to predict poorer tumor differentiation, disease progression and might be used as treatment efficacy evaluator. However, the data on this topic is insufficient.</p><p><strong>Methods: </strong>Newly diagnosed, PDAC patients without prior systemic treatment and chronic pancreatitis patients treated at the tertiary university hospital and healthy controls were included in this prospective study. Blood samples were collected pre-treatment, and cfDNA was extracted and measured using necessary equipment according to manufacturer's protocols.</p><p><strong>Results: </strong>57 patients (47 PDAC and 10 chronic pancreatitis) and 8 healthy controls were included. cfDNA levels were significantly higher in cancer patients compared to chronic pancreatitis (p = 0,032) and healthy controls (p < 0.001). The determined cfDNA cut-off value for distinguishing PDAC from chronic pancreatitis was 23.65 ng/ml and for distinguishing PDAC from healthy controls - 22.9 ng/ml. However, no distinctions in cfDNA levels were noted concerning tumor characteristics or survival rates.</p><p><strong>Conclusion: </strong>Liquid biopsies and alterations in cfDNA levels could aid in distinguishing PDAC from benign inflammatory diseases or healthy patients. Nonetheless, further studies are necessary for more comprehensive validation.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-15"},"PeriodicalIF":1.2,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145129954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgery for Multifocal Intrahepatic Cholangiocarcinoma.","authors":"Augustė Andzelytė, Ieva Tveragaitė, Povilas Ignatavicius","doi":"10.1159/000548043","DOIUrl":"10.1159/000548043","url":null,"abstract":"<p><strong>Introduction: </strong>Multifocal intrahepatic cholangiocarcinoma (m-iCCA) is a complex and aggressive form of primary liver cancer, often associated with poor outcomes. Although surgical resection is considered the only curative treatment for intrahepatic cholangiocarcinoma (iCCA), multifocality is frequently regarded as a contraindication due to the high risk of recurrence and limited survival benefits. Advances in surgical techniques and evolving treatment strategies have reopened discussions about the feasibility of resection in these cases.</p><p><strong>Methods: </strong>We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database. We systematically searched PubMed, Web of Science, MEDLINE, and ScienceDirect databases up to July 30, 2024, for studies analyzing surgical treatment outcomes for m-iCCA. We assessed the quality of the included studies according to the Newcastle-Ottawa Scale (NOS).</p><p><strong>Results: </strong>After our initial search, 2,482 articles were found related to this topic and 381 articles were left for screening. We checked each article against the eligibility criteria and selected for the full-text analysis. Ten articles with 2,392 patients who had m-iCCA were included in our review. The reviewed studies reported extensive surgical procedures, such as extended hemihepatectomy and associating liver partition and portal vein ligation for staged hepatectomy, with median survival ranging from 18.9 to 27 months. Recurrence rates were higher in m-iCCA patients (67.8-74.3%) compared to solitary iCCA cases (52.4-60.5%), with recurrence-free survival as short as 4.5 months. Adjuvant chemotherapy was frequently used, although its effectiveness in terms of survival was inconsistent. One study reported a 5-year survival rate of 12.9% for surgical patients compared to 0% for non-operated patients. Survival outcomes were influenced by adverse prognostic indicators such as lymph node metastases and perineural invasion.</p><p><strong>Conclusion: </strong>Surgical resection for m-iCCA, while associated with high recurrence rates (67.8-74.3%), provides a survival advantage over nonsurgical management (median overall survival: 18.9-27 months vs. 8 months; 5-year survival: 12.9% vs. 0%) for carefully selected patients. More studies are needed to improve patient selection and refine treatment approaches to enhance long-term outcomes.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-11"},"PeriodicalIF":1.2,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Textbook Outcomes of Liver Surgery and Overall Survival in Gallbladder Cancer Patients Treated with Curative-Intent Resection: A Multicenter Study.","authors":"Zi-Mu Li, Hui-Ying Ouyang, Yi Gong, Hai-Su Dai, Jie Bai, Yan Jiang, Xian-Yu Yin, Zhi-Yu Chen, Shu-Guo Zheng, Yun-Feng Li, Chao Yu, Fan Huang, Zhao-Ping Wu, Jin-Xue Zhou, Da-Long Yin, Rui Ding, Wei Guo, Yi Zhu, Wei Chen, Ke-Can Lin, Ping Yue, Yao Cheng, Dong Zhang, Yan-Qi Zhang, Zhi-Peng Liu, Tao Qin","doi":"10.1159/000548351","DOIUrl":"10.1159/000548351","url":null,"abstract":"<p><strong>Introduction: </strong>This study investigated the relationship between textbook outcomes of liver surgery (TOLS) and overall survival (OS) in patients who underwent curative-intent resection of GBC.</p><p><strong>Methods: </strong>Patients with GBC who underwent curative-intent resection between 2014 and 2021 were selected from 16 hospitals. Patients were divided into either the TOLS group or the non-TOLS group, according to whether TOLS were observed. Patients who died within 90 days of surgery were excluded prior to the survival analysis. Log-rank test was used to compare the difference in the OS rate between TOLS and non-TOLS groups. Univariate and multivariate analyses were performed using Cox regression analysis to identify factors independently associated with OS.</p><p><strong>Results: </strong>A total of 913 patients were selected, 565 (61.9%) exhibited TOLS. The 5-year OS rate in the TOLS group was significantly higher than that in the non-TOLS group (45.4% vs. 21.9%; p < 0.001). Multivariate Cox regression analysis confirmed TOLS, total bilirubin level >54 µmol/mL, carcinoembryonic antigen level >5 µg/mL, CA 19-9 level >37 U/L, poor differentiation, stages T2 and T3/4 according to the 8th edition AJCC T staging manual, N1 and N2 according to the 8th edition AJCC N staging manual, and adjuvant chemotherapy as independent risk factors that affect OS after curative-intent resection of GBC.</p><p><strong>Conclusion: </strong>Among patients who undergo curative-intent resection of GBC, approximately 61.9% experience TOLS. TOLS are not only the optimal short-term outcome but also associated with long-term survival.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-11"},"PeriodicalIF":1.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Intestinal Fatty Acid Binding Protein in Diagnosing Adhesive Small Bowel Obstruction: A Pilot Study.","authors":"Juliette S van Dam, Claire A J I Leenarts, Thijs R van Oudheusden, Joep P M Derikx, Misha Luyer","doi":"10.1159/000547989","DOIUrl":"10.1159/000547989","url":null,"abstract":"<p><strong>Introduction: </strong>The incidence of adhesive small bowel obstruction (ASBO) after abdominal surgery is 2.4%. Delay in surgery increases morbidity and mortality. Plasma intestinal fatty acid binding protein (I-FABP) levels indicate intestinal damage and may guide treatment. The aim of this study was to investigate whether plasma I-FABP levels may optimize selection of patients requiring surgery presenting with ASBO.</p><p><strong>Methods: </strong>Patients with suspected ASBO underwent a contrast swallow. If bowel transit was absent after 8 h, surgery was performed. I-FABP levels were assessed at several moments. Data were analyzed by comparing groups based on bowel transit, ischemia, and positive or negative laparotomies. Furthermore, a true operative group (patients with mechanical obstruction during surgery and patients needing operative treatment who deceased due to non-operative treatment) was compared to a true non-operative group (patients with negative laparotomies and patients successfully treated with non-operative treatment).</p><p><strong>Results: </strong>Median I-FABP levels were higher in patients without bowel transit (1,207 pg/mL) than in patients with bowel transit (589 pg/mL, p = 0.01). Median I-FABP levels in the negative laparotomy group (301 pg/mL) showed a trend to significance compared to the positive laparotomy group (1,177 pg/mL, p = 0.05). There was no significant difference between the true operative group (1,150 pg/mL) and the true non-operative group (664 pg/mL) or between proven ischemia (975 pg/mL) and no ischemia (921 pg/mL).</p><p><strong>Conclusion: </strong>I-FABP might help identify ASBO patients in whom surgery can be postponed.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.2,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Early Oral Feeding on Postoperative Outcomes after Elective Colorectal Surgery: A Systematic Review and Meta-Analysis.","authors":"Soo Young Lee, Eon Chul Han","doi":"10.1159/000542595","DOIUrl":"10.1159/000542595","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to evaluate the influence of early oral feeding (EOF), a key component of enhanced recovery after surgery protocols, on postoperative outcomes in patients undergoing elective colorectal surgery.</p><p><strong>Methods: </strong>We searched the MEDLINE, Embase, Cochrane Library, and KoreaMed databases to include randomized clinical trials comparing EOF that started on postoperative day 1 and conventional oral feeding that commenced after first flatus. Two authors independently screened the retrieved records and extracted data. The primary outcome was total complications. Data were pooled, and the overall effect size was calculated using a fixed-effect model.</p><p><strong>Results: </strong>We screened 13 studies, and 1,556 patients were included in the analysis. The EOF group exhibited fewer total complications (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.38-0.65). Anastomotic leakage was also reduced in the EOF group (OR: 0.40; 95% CI: 0.19-0.83); however, an increased incidence of vomiting (OR: 1.58; 95% CI: 1.11-2.26) as well as a tendency of higher rate of nasogastric tube reinsertion (OR: 1.49; 95% CI: 0.96-2.31) were observed. The EOF group demonstrated a decreased time to flatus (mean difference [MD] -0.87; 95% CI: -1.00 to -0.74) and shortened hospital stay (MD: -0.76; 95% CI: -0.89 to -0.6). No significant difference in mortality was observed between the two groups (OR: 0.54; 95% CI: 0.15-2.01).</p><p><strong>Conclusion: </strong>EOF proved to be a safe and effective practice for patients undergoing elective colorectal surgery. However, the increased incidence of vomiting necessitates careful consideration.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"26-35"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor regarding the Article: \"Pathologic Outcomes and Survival in Patients with Rectal Cancer and Increased Body Mass Index\".","authors":"Xiaobo Xie","doi":"10.1159/000545530","DOIUrl":"10.1159/000545530","url":null,"abstract":"","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"152-153"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143763335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the Risk of Developing a Crohn's Disease Increased after Appendectomy? A Systematic Review of the Literature and Meta-Analysis.","authors":"Isabelle Uhe, Eleftherios Gialamas, Christophe Combescure, Christian Toso, Emilie Liot, Guillaume Meurette, Frederic Ris, Jeremy Meyer","doi":"10.1159/000545339","DOIUrl":"10.1159/000545339","url":null,"abstract":"<p><strong>Introduction: </strong>The effect of appendectomy on the development of Crohn's disease (CD) is a matter of debate. The aim of this systematic review and meta-analysis was to gather the latest published data to determine whether patients with a history of appendectomy have an increased risk of developing CD or not.</p><p><strong>Methods: </strong>MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for case-control and cohort studies assessing the risk of developing CD after appendectomy. The pooled adjusted and not adjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated for case-control studies. Heterogeneity was assessed. Studies were ranked using the Newcastle-Ottawa Scale (NOS) and were all of good quality.</p><p><strong>Results: </strong>Fourteen case-control studies and 6 cohort studies were included. Meta-analysis of case-control studies (33,243 patients) of raw OR shows a positive association between appendectomy and CD (OR: 1.51, 95% CI: 0.97-2.36, I2 = 87%), which was not statistically significant (p = 0.069). The meta-analysis of adjusted OR shows that appendectomy represents a statistically significant risk factor for the development of CD (OR: 1.86, 95% CI: 1.01-3.45, p = 0.047, I2 = 89%).</p><p><strong>Conclusion: </strong>Appendectomy appears to be a risk factor for the development of CD. However, the discrepant results obtained by meta-analysis of unadjusted OR, the heterogeneity between studies, and the lack of precision of the magnitude of the association mandate confirmation by a large epidemiological study.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"192-203"},"PeriodicalIF":1.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of Telementoring during Robot-Assisted Minimally Invasive Esophagectomy.","authors":"Robin B den Boer, Cas de Jongh, Gijs I van Boxel, Philippe Rouanet, Anne Mourregot, Jelle P Ruurda, Richard van Hillegersberg","doi":"10.1159/000542035","DOIUrl":"10.1159/000542035","url":null,"abstract":"<p><strong>Introduction: </strong>Telementoring could increase the quality, reduce the time, and increase cost efficiency of the proctoring program for robot-assisted minimally invasive esophagectomy (RAMIE). However, feasibility is unclear as no studies assessed telementoring for RAMIE.</p><p><strong>Methods: </strong>The feasibility of telementoring was assessed during the thoracic part of RAMIE procedures in three high-volume centers. RAMIEs were performed by trained surgeons, proctored by two experts. The primary outcome was the impact of the technology on conveying and understanding instructions.</p><p><strong>Results: </strong>Between December 2021 and December 2022, nine RAMIE procedures were proctored using telementoring. Overall quality of the telementoring technique was scored good to excellent (median score: good). The vast majority of the 24 proctor instructions were conveyed and understood fluently (n = 21, 96%). Most proctor instructions were aimed at improving surgical exposure (n = 9, 38%). The major point of criticism was the use of the audio as the communication through the headset of the performing surgeon was not accessible by the complete team.</p><p><strong>Discussion: </strong>Telementoring is deemed feasible for proctoring trained RAMIE surgeons after onsite proctoring. Technical improvements with regard to audio technology are warranted for broad implementation, especially in earlier training settings. The role of telementoring in the training pathway of learning surgeons needs clinical validation.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}