Diseases of the Colon & Rectum最新文献

{"title":"Management of Anal Dysplasia: A Pragmatic Summary of the Current Evidence and Definition of Clinical Practices for Prevention, Diagnosis, and Treatment.","authors":"Marco Bertucci Zoccali, Cintia Mayumi Sakurai Kimura, Brandon C Chapman, Tamzin Cuming, Carmen F Fong, Naomi Jay, Jennifer A Kaplan, Michelle J Khan, Craig A Messick, Vlad V Simianu, Jeremy J Sugrue, Luis F Barroso","doi":"10.1097/DCR.0000000000003444","DOIUrl":"10.1097/DCR.0000000000003444","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"272-286"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"If Nothing Goes Wrong, Is Everything All Right? The Rule of 3.","authors":"Richard L Nelson","doi":"10.1097/DCR.0000000000003604","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003604","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 3","pages":"264-266"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deciphering Early-Onset Colorectal Cancer: Molecular Profiling of the Tumor Microenvironment.","authors":"Munir H Buhaya, Emina H Huang","doi":"10.1097/DCR.0000000000003447","DOIUrl":"10.1097/DCR.0000000000003447","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"257-260"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Value of Infrapyloric Lymph Nodes Dissection in Right Hemicolectomy for Hepatic Flexure Colon Cancer: A Multicenter Analysis Based on Propensity Score Matching.","authors":"Tao Pan, Xian-Wen Liang, Jing Wen, Hui Yang, Yang-Chun Zheng, Jin Yan, Chao Liu, Hai Hu","doi":"10.1097/DCR.0000000000003356","DOIUrl":"10.1097/DCR.0000000000003356","url":null,"abstract":"<p><strong>Background: </strong>There is a dispute regarding the necessity of infrapyloric lymph node dissection in right hemicolectomy for hepatic flexure colon cancer.</p><p><strong>Objective: </strong>To evaluate the risk factors for infrapyloric lymph node metastasis and the prognostic role of infrapyloric lymph node dissection in patients with hepatic flexure colon cancer and identify the population of patients who would benefit from infrapyloric lymph node dissection.</p><p><strong>Design: </strong>Retrospective multicenter propensity score matching study to minimize heterogeneity between 2 groups.</p><p><strong>Settings: </strong>This study was conducted at 3 medical centers.</p><p><strong>Patients: </strong>A total of 531 patients who underwent curative resection for hepatic flexure colon cancer were included.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was the metastasis rate of infrapyloric lymph nodes, whereas secondary outcome measure included overall survival. Logistic regression analysis was used to identify risk factors, and Kaplan-Meier analysis was used to evaluate survival outcomes.</p><p><strong>Results: </strong>The metastasis rate of infrapyloric lymph nodes among patients undergoing infrapyloric lymph node dissection was 11.8% (26/221). Cox multivariate analysis confirmed that infrapyloric lymph node dissection was an independent prognostic factor after propensity score matching (HR 0.60; 95% CI, 0.38-0.84; p = 0.007). A proposed flowchart for infrapyloric lymph node dissection based on preoperative factors was created. Based on the proposed flowchart, patients with preoperative serum CEA level ≤5.0 ng/mL, cN + , and tumor size ≥5 cm and patients with preoperative serum CEA level >5.0 ng/mL were identified as the high-priority infrapyloric lymph node dissection group. The metastasis rate of infrapyloric lymph nodes in the high-priority group was 16.0% (20/125). In the high-priority group, patients undergoing infrapyloric lymph node dissection had better survival outcomes than those not undergoing infrapyloric lymph node dissection ( p = 0.005).</p><p><strong>Limitations: </strong>This study is limited by its retrospective nature.</p><p><strong>Conclusions: </strong>This study suggests that infrapyloric lymph node dissection should be performed in specific patients with hepatic flexure colon cancer. See Video Abstract .</p><p><strong>El valor de la diseccin de los ganglios linfticos infra pilricos en la hemicolectoma derecha para el cncer de colon del angulo heptico un anlisis multicntrico basado en el emparejamiento por puntaje de propensin: </strong>ANTECEDENTES:Existe controversia sobre la necesidad de la disección de los ganglios linfáticos infra pilóricos en la hemicolectomía derecha por cáncer de colon del ángulo hepático.OBJETIVO:Evaluar los factores de riesgo de metástasis de los ganglios linfáticos infra pilóricos y el papel pronóstico de la disección de los ganglios linfáticos infra pil","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"338-350"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11837961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to Colonoscopy Quality Measurement in Rural Wisconsin.","authors":"Jessica R Schumacher, Jennifer M Weiss, Jill S Ties, Nicholas J Kitowski, Jeremy P Levin, Matthew Gigot, Jeanette C May, Daniel R Pung, Elise H Lawson","doi":"10.1097/DCR.0000000000003528","DOIUrl":"10.1097/DCR.0000000000003528","url":null,"abstract":"<p><strong>Background: </strong>Patients in rural areas have limited colonoscopy access, which is critical for colorectal cancer prevention. General surgeons perform most colonoscopies in rural areas. The Surgical Collaborative of Wisconsin's Rural Task Force identified colonoscopy as a high-priority initiative due to high volume and lack of access to quality measurement, which is necessary to assess and ultimately improve colonoscopy performance.</p><p><strong>Objective: </strong>Assess the capacity for colonoscopy quality measurement and improvement in rural Wisconsin hospitals.</p><p><strong>Design: </strong>From October 2019 to January 2020, the Surgical Collaborative of Wisconsin, Rural Wisconsin Health Cooperative, and Wisconsin Collaborative for Healthcare Quality collaborated to design and distribute a survey to 44 Rural Wisconsin Health Cooperative hospitals. Descriptive statistics summarized survey items. Surgeons from 6 rural hospitals participated in stakeholder interviews.</p><p><strong>Setting: </strong>Rural Wisconsin Health Cooperative hospitals.</p><p><strong>Main outcome measures: </strong>Colonoscopy providers, procedure volume/capacity, informatics and quality measurement infrastructure, barriers to quality measurement, and improvement.</p><p><strong>Results: </strong>Twenty-five surveys (57%) were completed. Most colonoscopy providers in rural hospitals were surgeons (66.3%), followed by family/internal medicine physicians (20.0%) and gastroenterologists (13.8%). The average hospital volume/week was 19.9 colonoscopies (SD = 13.4). Hospitals reported operating at ~75% capacity. Withdrawal time was the most tracked measure (44.0%), followed by adenoma detection (36.0%) and cecal intubation (28.0%) rates. Approximately one-third of hospitals (36.0%) used procedure-reporting software. Most hospitals (80.0%) did not have access to on-site pathology. Surgeons reported barriers to quality measurement/improvement, including insufficient resources for electronic medical record-based reporting and the need for targeted educational opportunities that do not require travel.</p><p><strong>Limitations: </strong>Single state may not represent the experience of all rural hospitals.</p><p><strong>Conclusions: </strong>The lack of access to colonoscopy quality measures suggests the opportunity to develop a flexible approach that considers reporting software availability and electronic medical record differences. Improving access to measures and education/training opportunities may improve the availability of high-quality colonoscopies for patients in rural Wisconsin. See Video Abstract .</p><p><strong>Barreras para la medicin de la calidad de la colonoscopia en las zonas rurales de wisconsin: </strong>ANTECEDENTES:Los pacientes de las zonas rurales tienen un acceso reducido a la colonoscopia, que es fundamental para la prevención del cáncer colorrectal. Los cirujanos generales realizan la mayoría de las colonoscopias en las zonas rurales. El S","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"373-379"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142616337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Anus By Any Other Name….","authors":"Lester Gottesman","doi":"10.1097/DCR.0000000000003503","DOIUrl":"10.1097/DCR.0000000000003503","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"261-263"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Intracorporeal Fully Stapled Modified Kono-S Anastomosis: A Technical Demonstration.","authors":"Joseph K Micheal, Nathaniel J Schwartz, Matthew P Zeller, Jessica M Felton, Joshua H Wolf","doi":"10.1097/DCR.0000000000003492","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003492","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":"68 3","pages":"e104-e106"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Has the Use of Enhanced Recovery Protocols in Colorectal Surgery Increased Postoperative Bleeding Complications?","authors":"Eyal Aviran, Dan Assaf, Karen N Zaghiyan, Phillip Fleshner","doi":"10.1097/DCR.0000000000003581","DOIUrl":"10.1097/DCR.0000000000003581","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery protocols are multimodal perioperative care pathways shown to improve postoperative complications and decrease the length of stay after surgery. A critical component of an enhanced recovery after surgery protocol is the use of multimodal nonopiate analgesia using nonsteroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors.</p><p><strong>Objective: </strong>To compare the incidence of postoperative GI bleeding between patients treated with and without an enhanced recovery after surgery protocol.</p><p><strong>Design: </strong>Retrospective review of a prospectively maintained colorectal registry.</p><p><strong>Settings: </strong>Large colorectal referral center.</p><p><strong>Patients: </strong>Preoperative elective colorectal surgery requiring an anastomosis.</p><p><strong>Intervention: </strong>Standardized enhanced recovery after surgery protocol included celecoxib and ketorolac.</p><p><strong>Main outcome: </strong>Postoperative outcomes included bleeding (±sequelae), reduction in hematocrit after the operation, intervention for bleeding (transfusion, endoscopy, or surgery), length of stay, and hospital readmission.</p><p><strong>Results: </strong>The enhanced recovery after surgery group (n = 630) and nonenhanced recovery after surgery group (n = 739) were comparable in baseline clinical features except for surgical indication, with more IBD and less malignant disease in the enhanced recovery after surgery group. Minimally invasive surgery was more commonly performed in the enhanced recovery after surgery group. Both bleeding with sequelae ( p < 0.0001) and bleeding without sequelae ( p = 0.0004) were significantly more common in the enhanced recovery after surgery group compared to the nonenhanced recovery after surgery group. In addition, a significantly larger hematocrit decline after the operation was noted in the enhanced recovery after surgery group ( p < 0.0001). However, both the need for transfusion and intervention for bleeding did not significantly differ between patient groups. Factors associated with bleeding were the use of an enhanced recovery after surgery protocol (OR 2.96; 95% CI, 1.57-5.58; p < 0.001) and performing a small to large bowel anastomosis (OR 2.68; 95% CI, 1.49-4.81; p < 0.001).</p><p><strong>Limitations: </strong>Retrospective observational design and inability to determine which component of the enhanced recovery after surgery protocol increased the risk of bleeding.</p><p><strong>Conclusions: </strong>Use of an enhanced recovery after surgery protocol in patients undergoing colorectal surgery with an anastomosis is associated with an increased incidence of bleeding without significant difference in the need for transfusion or intervention. See Video Abstract .</p><p><strong>El uso de protocolos de recuperacin mejorada en ciruga colorrectal ha aumentado las complicaciones hemorrgicas postoperatorias: </strong>ANTECEDENTES:Los protocolos d","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"366-372"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights Into the Group of Surgically Resectable But Nonoperable Patients With Colorectal Cancer.","authors":"Ilze Ose, Adile Orhan, Sule Eraslan, Enise Gögenur, Christina Alexandersen, Angelina Astrid Righult, Emine Ceren Ayhan, Amalie Thomsen Nielsen, Ida Kolukisa Saqi, Ismail Gögenur","doi":"10.1097/DCR.0000000000003580","DOIUrl":"10.1097/DCR.0000000000003580","url":null,"abstract":"<p><strong>Background: </strong>The incidence of colorectal cancer is expected to increase, particularly among patients with significant frailty and comorbidities. A subgroup of these patients may not be suitable for surgery because of the high risk of postoperative morbidity and mortality.</p><p><strong>Objective: </strong>The aim of this study was to characterize the clinical outcomes, management, social status, and survival of patients deemed nonoperable because of comorbidity and/or frailty.</p><p><strong>Design: </strong>This was a retrospective cohort study.</p><p><strong>Settings: </strong>Overall survival was estimated using the Kaplan-Meier method. The Cox proportional-hazards model was used to estimate HRs and 95% CIs for mortality-associated modifiable risk factors.</p><p><strong>Patients: </strong>Patients diagnosed with resectable colorectal cancer but deemed nonoperable because of comorbidity and/or frailty by a multidisciplinary team between January 1, 2020, and April 30, 2024, were included in this study.</p><p><strong>Main outcome measures: </strong>The primary outcome was to describe the current population, investigate mortality, and explore mortality-related risk factors in the current population.</p><p><strong>Results: </strong>During the study period, 69 of 1667 patients who had colorectal cancer that was potentially resectable but who were deemed nonoperable were included in the study population. The rate of 90-day and 1-year mortality was 20% and 52%, respectively. Three years after the diagnosis, 12% of the patients were alive. At the time of diagnosis, anemia was found in 73% of female patients and 71% of male patients. In addition, 77% of the patients had hypoalbuminemia. Lower albumin levels were associated with poor survival (HR, 0.92; 95% CI, 0.88-0.98; p = 0.007).</p><p><strong>Limitations: </strong>The retrospective nature and small sample size inherently limit the generalizability of the study findings.</p><p><strong>Conclusions: </strong>Mortality in the current population was high. However, our findings highlight potential areas for improvement in the management of these patients. See Video Abstract .</p><p><strong>Informacin sobre el grupo de pacientes con cncer colorrectal resecables quirrgicamente pero no operables: </strong>ANTECEDENTES:Se espera que la incidencia del cáncer colorrectal aumente, en particular entre los pacientes con fragilidad y comorbilidades significativas. Un subgrupo de estos pacientes puede no ser apto para la cirugía debido al alto riesgo de morbilidad y mortalidad posoperatorias.OBJETIVO:El objetivo de este estudio fue caracterizar los resultados clínicos, el tratamiento, el estado social y la supervivencia de los pacientes considerados no operables debido a la comorbilidad y/o fragilidad.DISEÑO:Este fue un estudio de cohorte retrospectivo.ESTABLECIMIENTOS:La supervivencia general se estimó utilizando el método de Kaplan-Meier. Se utilizó el modelo de riesgos proporcionales de Cox para","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"351-358"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival Outcomes in Patients Undergoing Pelvic Exenteration for Pelvic Mucosal Melanomas: Retrospective Single Institution Australian Study.","authors":"Tae-Jun Kim, Elan Novis, Peter J M Lee, Sascha Karunaratne, Mollie Cahill, Kirk K S Austin, Christopher M Byrne, Michael J Solomon","doi":"10.1097/DCR.0000000000003588","DOIUrl":"10.1097/DCR.0000000000003588","url":null,"abstract":"<p><strong>Background: </strong>Pelvic mucosal melanomas, including anorectal and urogenital melanomas, are rare and aggressive, with a median overall survival of up to 20 months. Pelvic mucosal melanomas behave differently from their cutaneous counterparts and present late with locoregional disease, making pelvic exenteration its only curative surgical option.</p><p><strong>Objective: </strong>This study aimed to evaluate the survival outcomes after pelvic exenteration in pelvic mucosal melanomas at Royal Prince Alfred Hospital.</p><p><strong>Design: </strong>Retrospective case series from a prospectively collected pelvic exenteration database from October 1994 to November 2023.</p><p><strong>Setting: </strong>Royal Prince Alfred Hospital (quaternary institution), Camperdown, New South Wales, Australia.</p><p><strong>Patients: </strong>Seven patients undergoing pelvic exenteration for pelvic mucosal melanoma.</p><p><strong>Main outcome measures: </strong>Overall survival, disease-free survival, and complication rates.</p><p><strong>Results: </strong>Of the 7 patients, most were women (n = 5; 71.4%) and had a median age of 65 years (range, 36-79). Five patients (71.4%) underwent pelvic exenteration for primary pelvic mucosal melanoma, 3 of which were anorectal and 2 vaginal melanomas. Two patients (28.6%) had recurrent anorectal melanoma and received neoadjuvant radiotherapy after an initial wide local excision. Three patients (42.9%) required total pelvic exenteration, whereas 2 required a central pelvic exenteration (28.6%). The remaining procedures included central and lateral pelvic exenteration and anterior, central, and lateral pelvic exenteration. The median length of hospital stay was 19.7 days. Five patients had postoperative complications with 1 major complication (Clavien-Dindo grade IIIa). At the completion of the study, there were 4 mortalities. Mean survival was 23.6 months (range, 2-100) with a recurrence rate of 83%. The median time to recurrence was 3 months, despite 6 patients (85.7%) having R0 resections. Distant recurrence, specifically to bone, the lungs, and the liver, was most common.</p><p><strong>Limitations: </strong>Small study cohort due to rarity of disease, limiting generalizability.</p><p><strong>Conclusions: </strong>Pelvic exenteration for pelvic mucosal melanoma appears to help control local disease as recurrence is most commonly distant or regional. See Video Abstract .</p><p><strong>Resultados de supervivencia en pacientes sometidos a exenteracin plvica por melanomas de la mucosa plvica estudio retrospectivo australiano de una sola institucin: </strong>ANTECEDENTES:Los melanomas de la mucosa pélvica (MM), incluidos los melanomas anorrectales y urogenitales, son raros y agresivos, con una supervivencia global media de hasta 20 meses. Los melanomas de la mucosa pélvica se comportan de manera diferente a sus contrapartes cutáneas y se presentan tardíamente con enfermedad locoregional, lo que hace que la exenteraci","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"359-365"},"PeriodicalIF":3.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142767384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}