Hpb最新文献

{"title":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(25)00589-1","DOIUrl":"10.1016/S1365-182X(25)00589-1","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 6","pages":"Page iii"},"PeriodicalIF":2.7,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144168207","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":"Unraveling the obesity paradox in hepatocellular carcinoma: relative role of elevated body mass index on detrimental effects of postoperative complications.","authors":"Miho Akabane, Jun Kawashima, Abdullah Altaf, Selamawit Woldesenbet, François Cauchy, Federico Aucejo, Irinel Popescu, Minoru Kitago, Guillaume Martel, Francesca Ratti, Luca Aldrighetti, George A Poultsides, Yuki Imaoka, Andrea Ruzzenente, Itaru Endo, Ana Gleisner, Hugo P Marques, Sara Oliveira, Jorge Balaia, Vincent Lam, Tom Hugh, Nazim Bhimani, Feng Shen, Timothy M Pawlik","doi":"10.1016/j.hpb.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.05.005","url":null,"abstract":"<p><strong>Background: </strong>The \"obesity paradox\" suggests higher body mass index (BMI) may correlate with better long-term outcomes in cancers. The impact of BMI on hepatocellular carcinoma (HCC) resection, regarding postoperative complications, remains unclear. We examined the interplay between BMI and complications on recurrence-free survival (RFS) among patients undergoing HCC resection.</p><p><strong>Methods: </strong>Patients undergoing hepatectomy for HCC (2000-2023) were identified from an international database. Kaplan-Meier and Cox analyses assessed the protective impact of high BMI on RFS, considering interactions with complications.</p><p><strong>Results: </strong>Among 1,588 patients (median BMI: 25.2 kg/m²; BMI > 25.0:793, BMI ≤ 25.0:795), 560 (35.3%) experienced complications. BMI > 25.0kg/m² was linked to better 5-year RFS than BMI ≤ 25.0kg/m² (50.3% vs 45.4%; p = 0.006). Patients without complications had better 5-year RFS than those with complications (51.7% vs 40.7%; p < 0.001). Among patients without complications, RFS was comparable among BMI groups (52.9% vs 50.6%; p = 0.215), but among patients with complications BMI > 25.0kg/m² was associated with better RFS (45.6% vs 34.2%; p < 0.001). Patients with complications and BMI > 25.0 kg/m² had RFS comparable to patients without complications, regardless of BMI. Multivariable analysis identified complications (HR:1.31 [1.08-1.60]; p = 0.007) as a predictor of worse RFS, while BMI > 25.0 kg/m² (HR: 0.79 [0.68-0.96]; p = 0.020) was protective. Spline analysis demonstrated recurrence risk declined with increasing BMI among patients with complications, crossing below 1 around 25.0kg/m². Stratifying the complication cohort (BMI ≤ 25.0/25.0-30.0/>30.0 kg/m²) demonstrated dose-dependent RFS improvement (p = 0.005).</p><p><strong>Conclusion: </strong>High BMI correlated with better RFS following HCC resection among patients with complications. Concerns about complications should not deter surgery among high-BMI patients.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144316822","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":"A multi-centre, UK-based, cohort study assessing the role of robotic common bile duct exploration for complex choledocholithiasis.","authors":"Irena Stefanova, Rosie Callahan, Vandana B Giriradder, Tarak Chouari, Javed Latif, Lydia Renardson, Eslam Hassan, Somaiah Aroori, Altaf Awan, Imran Bhatti, Esther Platt, Rajesh Kumar, Angela Riga, Timothy R Worthington, Adam E Frampton, Rajiv P Lahiri, Tim D Pencavel, Jawad Ahmad","doi":"10.1016/j.hpb.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.05.009","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on the gold-standard treatment for choledocholithiasis. This retrospective multicentric cohort study aimed to assess the safety, efficacy, and role of robotic common bile duct exploration (RCBDE) in treating choledocholithiasis.</p><p><strong>Methods: </strong>All adult (≥18 years) consecutive patients undergoing RCBDE either alongside or following cholecystectomy between 2018 and 2024 were included. Primary outcome was success in stone clearance. Secondary outcomes included open conversion, length of hospital stay, post-operative complications and interventions, 30-day re-admission, and 90-day mortality rates.</p><p><strong>Results: </strong>A total of 102 consecutive RCBDEs were performed. Biliary access was transcholedochal in 86.3 % (88/102) and transcystic in 13.7 % (14/102). Stone clearance was achieved in 92.2 % (94/102) of cases, with a bile leak rate of 2.9 % (3/102), and an overall morbidity rate of 19.6 % (20/102), including 7.8 % (8/102) with Clavien-Dindo grade ≥3 complications. Overall conversion rate was 9.8 %, with significantly lower rates in single-stage procedures, where RCBDE was performed alongside cholecystectomy, compared to RCBDE alone, 1.4 % (1/73) vs 30.4 % (7/23), (P < 0.001), respectively.</p><p><strong>Conclusion: </strong>This study highlights the high success rate in stone clearance and low bile leak rate associated with RCBDE. However, open conversion rate was significantly increased when RCBDE was performed following previous cholecystectomy.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266059","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":"Update to the role of staging laparoscopy in the assessment of resectability of perihilar cholangiocarcinoma: have improvements in cross-sectional and functional imaging rendered it redundant?","authors":"Lawrence O'Leary, Ella Botzenhardt, Timothy M Gilbert, Leonard M Quinn, Rafael Díaz-Nieto, Robert P Jones, Louise Jones, Margaret Griffin, Rachel Stanley, Adele Leppert, Hassan Z Malik, Stephen W Fenwick","doi":"10.1016/j.hpb.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.05.008","url":null,"abstract":"<p><strong>Introduction: </strong>Perihilar cholangiocarcinoma has poor prognosis. Accurate staging is paramount in stratifying patients to appropriate treatment: curative surgery or palliative systemic anti-cancer therapy. Conventional CT and MRI are insufficiently sensitive at identifying peritoneal or liver metastases. Since 2020, [¹⁸F]fluorodeoxyglucose positron emission tomography-computerised tomography (FDG PET-CT) has been incorporated into staging, prompting reassessment of staging laparoscopy's role in determining resectability.</p><p><strong>Methods: </strong>This retrospective study reviewed patients referred with suspected perihilar cholangiocarcinoma to a UK hepatobiliary centre between 2020 and 2024 (n = 304). Those with potentially resectable disease on conventional CT and MRI were compared to a matched 2016-2019 cohort (n = 57).</p><p><strong>Results: </strong>Between 2020 and 2024, CT and MRI identified inoperable disease in 248/304 patients. FDG PET-CT further excluded 16/56 patients. Staging laparoscopy in 40 patients excluded 5. Among 35 proceeding to laparotomy, 33 completed curative-intent resection. In 2016-2019, all 57 underwent staging laparoscopy, excluding 9. Of 48 proceeding to laparotomy, 40 completed resection.</p><p><strong>Conclusions: </strong>Advances in cross-sectional imaging, including FDG PET-CT, have improved radiological staging. However, at 1-in-8, the diagnostic yield of staging laparoscopy remains high, justifying its continued role in evaluating resectability.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144283748","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":"Safety and efficacy of tranexamic acid in hepatic surgery: a meta-analysis of randomized controlled trials.","authors":"Breno G A S de Jesus, Eduardo S R Barreto, Gabriel S Medrado Nunes, Caio F Nascimento, Maria E M Vassoler, Felipe C A Meira, Eduardo F Viana","doi":"10.1016/j.hpb.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.05.006","url":null,"abstract":"<p><strong>Background: </strong>Hepatic surgeries involve substantial bleeding risk, associated with perioperative morbidity and mortality. While tranexamic acid (TXA) reduces blood loss in other surgeries, its efficacy in hepatic procedures remains unclear. This meta-analysis evaluates TXA's safety and effectiveness in liver surgeries.</p><p><strong>Methods: </strong>We systematically reviewed randomized controlled trials published until April 2025 from PubMed, Scopus, Embase, and Cochrane CENTRAL. Studies comparing TXA with placebo in adult elective liver surgeries were included. Primary outcomes were blood loss and mortality, while secondary outcomes encompassed blood transfusion needs, thromboembolic, and adverse events. The Cochrane Risk of Bias tool was used for quality assessment.</p><p><strong>Results: </strong>Six trials comprising 1875 patients undergoing liver resections or transplants were included. TXA did not reduce intraoperative blood loss (MD = -0.16 L; 95 % CI: -0.50 to 0.18; I² = 92 %) or mortality (RR = 1.04; 95 % CI: 0.58 to 1.87; I² = 4 %). Thromboembolic risk showed no significant difference overall (RR = 1.58; 95 % CI: 0.94 to 2.64; I² = 0 %), but sensitivity analysis indicated a potential increased risk (RR = 1.70; 95 % CI: 1.01 to 2.87).</p><p><strong>Conclusion: </strong>Our findings suggest that TXA does not improve bleeding or mortality outcomes in liver surgeries and may increase thromboembolic risk. (PROSPERO number, CRD42024585513).</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144247675","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":"The impact of obesity on in-hospital outcome of patients who underwent hepatic resection surgeries; a US national-wide study.","authors":"Ali Esparham, Saeed Shoar, Venkat R Modukuru, George Agriantonis, Jennifer Whittington, Zahra Shafaee","doi":"10.1016/j.hpb.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.05.004","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have shown conflicting results on the effect of obesity on the outcome of liver resection. The current study investigates the impact of obesity in these patients.</p><p><strong>Methods: </strong>We included all the patients with hepatobiliary cancer who underwent liver resection between 2016 and 2020 using the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) codes. A propensity score matching analysis was performed to match obese and non-obese groups.</p><p><strong>Results: </strong>A total of 8,731 patients were included in the study. The trend of obesity increased significantly from 14.6% in 2016 to 19.0% in 2020. After PSM, obesity was independently associated with increased odds of mechanical ventilation (OR: 1.82, 95% CI: 1.30-2.56, p-value<0.001), acute kidney injury (OR: 1.31, 95% CI: 1.04-1.65, p-value=0.023), and vasopressor need (OR: 2.11, 95% CI: 1.32-3.38, p-value=0.002). However, rates of blood transfusion, surgical site infection, pneumonia, sepsis, postoperative delirium, bowel obstruction, cardiac arrest, deep vein thrombosis/pulmonary thromboembolism, ileus, nausea and vomiting, postoperative anemia, post-procedural shock, and in-hospital mortality did not differ significantly between groups. The hospitalization costs were higher in the obese group ($28,272 [19,516-40,842] vs. $26,402 [18,099-37,810], p-value<0.001, respectively).</p><p><strong>Conclusion: </strong>Obesity is linked to higher postoperative complications and hospitalization costs after hepatectomy.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144301982","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":"Survival prediction for CA19-9 non-producers with resected pancreatic cancer.","authors":"Jurgis Alvikas, Ahmed Hamed, Nikhil Tirukkovalur, Sebastiaan Ceuppens, Adam Tcharni, Jiage Qian, Asmita Chopra, Genia Dubrovsky, Kenneth Lee, Amer Zureikat, Alessandro Paniccia","doi":"10.1016/j.hpb.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.05.007","url":null,"abstract":"<p><strong>Background: </strong>CA 19-9 is the most commonly used biomarker for pancreatic ductal adenocarcinoma (PDAC) but prognostication is a challenge for patients with normal CA 19-9 levels. We aimed to define most important prognostic factors for overall survival in PDAC patients with normal range CA 19-9 levels.</p><p><strong>Methods: </strong>We performed a single-center retrospective review of PDAC patients with CA 19-9 level at diagnosis <37 U/mL who underwent curative intent resection. Cohort was divided into CA 19-9 non-producers (CA 19-9 level of <3 U/mL) and normal range CA 19-9 (between 3 U/mL and 37 U/mL). We used a multivariable Cox regression model to define the predictors of overall survival and constructed a nomogram.</p><p><strong>Results: </strong>271 patients were included (75 CA 19-9 non-producers and 196 with normal range CA 19-9). Non-producers had worse overall survival (27.2 months versus 33.6 months) and higher rate of recurrence after resection. Predictors of survival were CA 19-9 level, age, sex, lymph node ratio, perineural invasion, surgical margin status and adjuvant chemotherapy.</p><p><strong>Discussion: </strong>PDAC patients who are CA 19-9 non-producers have worse survival. Our findings highlight this high-risk subgroup, identify useful prognostic features and emphasize the ongoing need for improved biomarker development.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325536","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":"Oncologic impact of perineural invasion in perihilar cholangiocarcinoma: an international multicenter study.","authors":"Jun Kawashima, Miho Akabane, Diamantis I Tsilimigras, Selamawit Woldesenbet, Mujtaba Khalil, Yutaka Endo, Kota Sahara, Federico Aucejo, Hugo P Marques, Beatriz Chumbinho, Tom Hugh, Shishir K Maithel, Bas Groot Koerkamp, Andrea Ruzzenente, Itaru Endo, Timothy M Pawlik","doi":"10.1016/j.hpb.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.05.010","url":null,"abstract":"<p><strong>Background: </strong>We sought to evaluate the prognostic significance of perineural invasion (PNI) among patients undergoing curative-intent resection for perihilar cholangiocarcinoma (pCCA), with a specific focus on early-stage disease.</p><p><strong>Methods: </strong>Data from patients who underwent curative-intent resection for pCCA were collected from eight high-volume international hepatobiliary centers. The association between PNI status, clinicopathological features, and long-term survival was analyzed in both the overall cohort and a subset of patients with early-stage pCCA.</p><p><strong>Results: </strong>Among 435 patients, 364 (83.7 %) were PNI-positive. At the time of surgery, 53 patients with PNI underwent margin re-resection; only 19 (35.8 %) achieved a final R0 margin, whereas 34 (64.2 %) had a persistent R1 margin on the final pathological examination. PNI was independently associated with worse overall survival in the entire cohort (HR 1.52), as well as among patients with T1/2 (HR 1.53) and node-negative (HR 1.60) disease. Although not associated with improved survival among node-negative patients, adjuvant chemotherapy provided a survival benefit among patients with node-negative disease who had PNI (50.8 months vs. 28.6 months; p = 0.044).</p><p><strong>Conclusion: </strong>PNI was an independent predictor of long-term survival, particularly among patients with early-stage pCCA.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266071","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":"The impact of FDG-PET/CT on the diagnostic pathway of surgically treated pancreatic ductal adenocarcinoma: the Surg-Panc-UK study.","authors":"Siobhan C McKay, Thomas W Thorne, Samir Pathak, Richard J W Wilkin, Jenifer Barrie, John Moir, Keith J Roberts","doi":"10.1016/j.hpb.2025.05.003","DOIUrl":"10.1016/j.hpb.2025.05.003","url":null,"abstract":"<p><strong>Background: </strong>In the UK, NICE recommends FDG-PET/CT (PET/CT) in patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC) though the impact upon the patient pathway is unclear and was not tested in the PETPANC study.</p><p><strong>Methods: </strong>National retrospective observational cohort study of consecutive patients undergoing surgery for PDAC. The primary outcome was the difference in diagnostic pathway length with and without a PET/CT. Secondary outcomes determined differences in investigations, resection rates and survival one year after surgery.</p><p><strong>Results: </strong>Of 830 patients included, 26.5% underwent PET/CT, associated with a significantly longer diagnostic pathway (median 20.5 additional days). PET/CT was associated with more multidisciplinary meetings and investigations, but did not alter resectability rates (90.3% vs 89.1%, PET/CT vs no PET/CT; p = .600), or facilitate operating on patients with more borderline disease (vascular resection 15.1% vs 13.6% PET/CT vs no PET/CT; p = .651). There was no difference in intra-operative unresectability or 12-month survival. There was an increase in MRI use after implementation of the guidelines among patients not undergoing PET/CT, suggesting teams developed different staging strategies.</p><p><strong>Conclusion: </strong>This national study demonstrates patients undergoing a PET/CT experience a diagnostic pathway that is one third longer, with more investigations, without a difference in resectability rates or survival.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368829","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":"Do routine narrative style CT reports provide sufficient information to adequately stage pancreatic cancer.","authors":"Hasna Kazi, Lin Li, Samantha J Ellis, John R Zalcberg, Charles H C Pilgrim","doi":"10.1016/j.hpb.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.05.001","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic ductal adenocarcinoma (PDAC) is staged using CT imaging generally reported in a narrative prose style, which can omit key details critical for an operating surgeon. This study assessed sixty-three potential radiological descriptors derived from the International Consensus Guidelines (ICG) to classify the resectability status of PDAC to determine whether reports adequately staged PDAC.</p><p><strong>Methods: </strong>150 CT reports from patients with confirmed PDAC were collected from 19 hospitals across Australia (July-December 2023), as part of the SCANPatient trial. Reports were evaluated based on how many of the 63 relevant features were addressed.</p><p><strong>Results: </strong>Less than half all relevant fields were appropriately addressed in prose reports (41.1 %, 10.7 of an average 26 relevant fields, as not all fields were relevant for each case). Less than 35 % of reports adequately addressed the tumour-vessel relationship with the superior mesenteric artery and vein. The coeliac artery was addressed in just 30 reports (20 %), and non-standard and vague terminology was common.</p><p><strong>Conclusion: </strong>Prose CT reporting for PDAC resectability in Australia does not specifically address many important features determining resectability. Prose reporting is associated with high rates of omission of relevant negatives as well as some errors of commission and considerable language variability.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215708","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}