Hpb最新文献

{"title":"Central hepatectomy for perihilar cholangiocarcinoma: an alternative technique for parenchymal-sparing hepatectomy to prevent post-hepatectomy liver failure.","authors":"Masahiro Fujisawa, Ryuji Yoshioka, Atsushi Takahashi, Shoichi Irie, Yoshinori Takeda, Hirofumi Ichida, Hiroshi Imamura, Yoshihito Kotera, Yoshihiro Mise, Akio Saiura","doi":"10.1016/j.hpb.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>Perihilar cholangiocarcinoma (PHC) often requires major hepatectomy with extrahepatic bile duct resection, carrying the risk of post-hepatectomy liver failure (PHLF). Central hepatectomy (CH), an alternative technique, aims to preserve functional liver reserve. This study evaluated the feasibility of CH and outcomes for patients with PHC within the paradigm of parenchymal-sparing hepatectomy.</p><p><strong>Methods: </strong>A retrospective analysis included PHC patients who underwent CH between March 2019 and January 2023. Preoperative evaluations involved multimodality imaging and assessment of future remnant liver volume.</p><p><strong>Results: </strong>Fourteen patients underwent CH for PHC. Tumor locations were perihilar bile duct (10 patients), and entire extrahepatic bile duct involvement (four patients). Median operative time and intraoperative blood loss were 679.5 min and 450 mL, respectively. Clinically-relevant PHLF occurred in two patients, with one sepsis-related death. Nine patients achieved R0 resection. Functional liver reserve parameters exceeded the standard procedure (p < 0.01).</p><p><strong>Conclusion: </strong>CH for PHC preserves functional liver reserve, potentially reducing PHLF risk. Adequate preoperative evaluation is crucial, and oncological outcomes require further investigation.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448865","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":"Minimally invasive versus open liver resection for nonmetastatic hepatocellular carcinoma staged BCLC - B and - C: an Italian multicentric analysis.","authors":"Gianluca Cassese, Mariano C Giglio, Alessandro Vitale, Andrea Lauterio, Matteo Serenari, Federica Cipriani, Francesco Ardito, Pasquale Perri, Daniele Nicolini, Giulio Di Gioia, Andrea Pierluigi Fontana, Quirino Lai, Simone Conci, Luca Fumagalli, Maurizio Iaria, Mattia Garancini, Sarah Molfino, Matteo Zanello, Giuliano La Barba, Maria Conticchio, Paola Germani, Simone Famularo, Maurizio Romano, Giuseppe Zimmitti, Michela De Angelis, Albert Troci, Andrea Belli, Francesco Izzo, Michele Crespi, Luigi Boccia, Mohamed Abu Hilal, Giacomo Zanus, Guido Torzilli, Paola Tarchi, Riccardo Memeo, Giorgio Ercolani, Elio Jovine, Gianluca Baiocchi, Fabrizio Romano, Raffaele Della Valle, Marco Chiarelli, Andrea Ruzzenente, Massimo Rossi, Alessandro Ferrero, Marcello Maestri, Marco Vivarelli, Gian Luca Grazi, Felice Giuliante, Luca Aldrighetti, Matteo Cescon, Luciano De Carlis, Umberto Cillo, Roberto I Troisi","doi":"10.1016/j.hpb.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.009","url":null,"abstract":"<p><strong>Background: </strong>Recent papers report significant survival gain after liver resection in BCLC-B and -C HCC patients. The results of minimally invasive liver surgery (MILS) in such patients have not been widely investigated so far.</p><p><strong>Methods: </strong>Data regarding patients undergoing MILS or open liver resection (OLR) for HCC staged BCLC -B and -C were extracted from the HERCOLES database. An inverse probability of treatment weighting (IPTW) method was adopted to balance the confounders. The primary outcome was a composite endpoint including post-hepatectomy liver failure, severe postoperative complications and in-hospital mortality.</p><p><strong>Results: </strong>627 patients were included (459 undergoing OLR and 168 receiving MILS). After IPTW, no difference was found in the composite endpoint between MILS and OLR (OR 0.86 [95%CI 0.46-1-60]; p = 0.62). MILS reduced the risk of receiving intra-operative transfusions (OR 0.28 [95%CI 0.13-0.58]; p < 0.001) and of developing postoperative ascites (OR 0.56 [95%CI 0,32-0,98]; p = 0.039), with reduced length of stay (OR 0.82 [95%CI 0.66-1.01]; p = 0.045). The survival analysis showed no differences between MILS and OLR for both OS (p = 0.13) and DFS (p = 0.491).</p><p><strong>Conclusion: </strong>MILS was shown to be safe and feasible for selected non-metastatic HCC patients staged BCLC B and C, reducing the risk of perioperative transfusions and postoperative ascites, and shortening the length of stay.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433179","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":"\"Biological R2\" resection for intrahepatic cholangiocarcinoma: identification of patients at risk for poor oncologic outcomes after curative-intent resection.","authors":"Jun Kawashima, Yutaka Endo, Selamawit Woldesenbet, Mujtaba Khalil, Miho Akabane, François Cauchy, Feng Shen, Shishir Maithel, Irinel Popescu, Minoru Kitago, Matthew J Weiss, Guillaume Martel, Carlo Pulitano, Luca Aldrighetti, George Poultsides, Andrea Ruzzente, Todd W Bauer, Ana Gleisner, Hugo Marques, Bas Groot Koerkamp, Itaru Endo, Timothy M Pawlik","doi":"10.1016/j.hpb.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.006","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to define a cohort of patients with \"biological R2\" (bR2) resection, defined as recurrence within 12 weeks, following curative-intent resection for intrahepatic cholangiocarcinoma (ICC). In addition, we sought to identify factors associated with bR2 risk.</p><p><strong>Methods: </strong>Patients who underwent upfront curative-intent surgery for ICC were identified from an international, multi-institutional database. The weighted beta-coefficients of preoperative risk factors were used to construct an online tool to predict bR2.</p><p><strong>Results: </strong>Among 1138 patients, 106 (9.3 %) patients had a bR2 resection. Patients with bR2 were more likely to be younger (OR 0.97) and non-White (OR 2.19), as well as more often had cirrhosis (OR 2.11), a higher neutrophil-to-lymphocyte ratio (OR 1.07), a higher tumor burden score (OR 1.16), and metastatic nodal disease on preoperative imaging (OR 1.92). Patients categorized as low-risk had a 3.2 % risk of bR2, intermediate-risk patients had an 11.1 % risk of bR2, whereas patients in the high-risk category had a 27.6 % risk of bR2 (p < 0.001). An online tool was made available at https://junkawashima.shinyapps.io/bR2_ICC/, https://junkawashima.shinyapps.io/CRLMfollwingchemotherapy/.</p><p><strong>Conclusions: </strong>Approximately one in ten patients with resectable ICC had a bR2 resection. An online calculator can may help clinicians identify patients with ICC at highest risk of a bR2 resection.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364485","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":"Retrospective comparative analyses of liver transplantation for intrahepatic cholangiocarcinoma and combined hepatocellular cholangiocarcinoma versus hepatocellular carcinoma in Brazil.","authors":"Iron P De Abreu Neto, Vincenzo Pugliese, Paulo C B Massarollo, Bárbara B Benini, Mirella M M Marta, Vanessa S Takenaka, Francisco Monteiro, João Luis E Pessoa, Raymundo S De Azevedo Neto, Adriano M Gonzalez","doi":"10.1016/j.hpb.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.008","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing interest in liver transplantation for cholangiocarcinomas (CCA), conclusive evidence is lacking. We sought to evaluate the outcomes of liver transplantation for intrahepatic cholangiocarcinoma in Brazil.</p><p><strong>Methods: </strong>Retrospective database analysis of patients undergoing liver transplantation for hepatocellular carcinoma (HCC) within Milan criteria in São Paulo, Brazil. Anatomopathological examination of the explanted liver with the presence of intrahepatic cholangiocarcinoma (iCCA) or combined hepatocellular-cholangiocarcinoma (cHCC-CCA) comprised the study group (50 patients). They were compared to a 1:3 HCC-matched cohort.</p><p><strong>Results: </strong>Study group had lower survival rates than HCC controls (survival at 1, 3, and 5 years, 70.0 %, 57.5 %, and 57.5 % versus 78.7 %, 71.4 %, and 66.6 %, p = 0.019). 5-year survival rates of the control group, cHCC-CCA, and iCCA group were 66.6 %, 59.6 %, and 50.0 % (p = 0.017). There was no statistically significant difference in survival for study group patients with tumors up to 3 cm compared to their controls (p = 0.086).</p><p><strong>Discussion: </strong>Patients with CCA had worse outcomes after liver transplantation than those with HCC. Interesting results were found in the more individualized analyses, but because of the limited number of patients, caution should be taken when analyzing them.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074211","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 left renal vein: the optimal interposition graft for pancreatic surgery?","authors":"Ahmer Irfan, Peter Kim, Farah Ladak, David Chan, Sean Cleary, Carol-Anne Moulton, Gonzalo Sapisochin, Trevor Reichman, Chaya Shwaartz, Ian McGilvray","doi":"10.1016/j.hpb.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.004","url":null,"abstract":"<p><strong>Background: </strong>Porto-mesenteric venous resection (PMVR) is employed for advanced pancreatic cancer. When primary anastomosis is not feasible, an interposition graft can be used. At our centre, the left renal vein (LRV) is the preferred choice.</p><p><strong>Methods: </strong>A retrospective analysis of patients undergoing pancreatic resection was performed over a 6-year period. Patients who underwent LRV harvest for a PMVR interposition graft were identified. All patients underwent a contrast-enhanced CT scan on post-operative day 1 to assess for portal vein thrombosis.</p><p><strong>Results: </strong>Pancreatic resection with PMVR was performed in 183 patients. LRV graft was used in 41 patients. Severe complications were observed in 10 patients. There were two deaths within 90 days of the index operation and six readmissions within 30 days of discharge. Post-operative PV thrombus was observed in 4 patients. The serum creatinine increased by 15.7 % on POD1 and peaked at 30.8 %. The majority of patients had returned to a serum creatinine within 10 % or better of their pre-operative creatinine.</p><p><strong>Conclusion: </strong>We present the largest series using the LRV as an interposition graft for PMVR. We propose that the LRV should be used as the first-choice interposition graft. This graft does not cause long-term renal dysfunction and avoids the morbidity of an additional incision.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079182","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":"Visual assessment of liver steatosis at retrieval predicts long term liver transplant outcomes in donation following circulatory death.","authors":"Ning X Ho, Samuel J Tingle, Georgios Kourounis, Balaji Mahendran, Rebecca Bramley, Emily R Thompson, Aimen Amer, Rodrigo Figueiredo, Stuart McPherson, Steve White, Colin Wilson","doi":"10.1016/j.hpb.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>The demand for liver transplantation is rising, as is the prevalence of steatotic liver disease. Steatotic grafts have inferior outcomes post-transplantation, due to increased sensitivity to ischaemia-reperfusion injury. We aimed to formally evaluate the impact of visually assessed liver steatosis in grafts donated following brainstem (DBD) versus circulatory death (DCD).</p><p><strong>Methods: </strong>NHS registry on adult liver transplantation was reviewed retrospectively (2006-2019). We used multiple-imputation for missing data and adjusted regression models with interaction terms to compare the impact of visually assessed donor graft steatosis on transplant outcome.</p><p><strong>Results: </strong>9217 recipients of deceased donor grafts were included (DBD = 7349; DCD = 1868). Multivariable cox regression revealed that the negative impact on graft survival was significantly different in DCD and DBD livers (interaction P = 0.011 and P = 0.043). The largest impact was in DCD livers (moderate steatosis: aHR = 1.851, 1.296-2.645, P = 0.001 and aHR = 5.426; severe steatosis: 1.723-17.090, P = 0.004). Visually assessed steatosis did not predict longer-term graft survival in the DBD cohort.</p><p><strong>Conclusion: </strong>The impact of visually assessed steatosis on post-transplant outcome is far greater in DCD grafts, despite an identical method of steatosis assessment. This highlights novel therapeutics should be considered for steatotic DCD grafts to allow this growing sector of the donor pool to be safely utilised.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370816","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":"Comparison of radiofrequency ablation, microwave ablation and high-intensity focused ultrasound for hepatocellular carcinoma: a retrospective study.","authors":"Wan S Cheung, Wong H She, Simon H Y Tsang, Wing C Dai, Albert C Y Chan, Tan T Cheung","doi":"10.1016/j.hpb.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.003","url":null,"abstract":"<p><strong>Background: </strong>The recommended first-line treatment for respectable hepatocellular carcinoma (HCC) is surgical resection, but local ablation has gained popularity as a safe alternative. This study aims to compare the effectiveness of radiofrequency ablation (RFA), microwave ablation (MWA) and high-intensity focused ultrasound (HIFU) as first-line treatments for HCC.</p><p><strong>Methods: </strong>In this single-centre retrospective study, 352 patients receiving RFA, MWA, or HIFU as first-line treatment for HCC were included. Pre- and post-treatment tumour sizes and overall and disease-free survival rates were analysed to compare the three local ablation modalities. Propensity-score matching was used to reduce the bias due to differences in pre-treatment liver function.</p><p><strong>Results: </strong>Patients receiving HIFU had significantly higher pre-treatment MELD score and Child-Pugh grade. The complete response rates of HIFU patients were significantly lower than those of RFA and MWA groups (p < 0.001) despite propensity-score matching. However, the three groups had similar disease-free survival (p = 0.216) and comparable one-year survival (p = 0.173).</p><p><strong>Discussion: </strong>HIFU serves as a last resort rescue therapy for patients with poor pre-treatment liver function who are not eligible for other local ablative means. Despite the low complete response rate, the overall survival and disease-free survival rates of patients having HIFU were comparable to those having RFA or MWA.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023280","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":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(24)02438-9","DOIUrl":"10.1016/S1365-182X(24)02438-9","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 1","pages":"Page iii"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143102649","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":"Artificial intelligence in the detection of choledocholithiasis: a systematic review","authors":"Joshua Blum ,&nbsp;Lewis Wood ,&nbsp;Richard Turner","doi":"10.1016/j.hpb.2024.09.009","DOIUrl":"10.1016/j.hpb.2024.09.009","url":null,"abstract":"<div><h3>Importance</h3><div>Choledocholithiasis is a potentially life-threatening manifestation of acute biliary dysfunction (ABD) often requiring magnetic resonance cholangiopancreatography (MRCP) for diagnosis when standard investigation findings are inconclusive. Machine learning models (MLMs) may offer alternatives to diagnose choledocholithiasis.</div></div><div><h3>Objective</h3><div>This systematic review seeks to evaluate the performance of MLMs in predicting choledocholithiasis and to compare this performance with the American Society of Gastrointestinal Endoscopy (ASGE) guidelines.</div></div><div><h3>Review</h3><div>This review adhered to PRISMA guidelines. Four databases were searched for relevant records published between January 2000 and April 2024. Two researchers appraised records. MLM performance and ASGE guideline efficacy were compared, and the clinical utility of MLMs was assessed.</div></div><div><h3>Findings</h3><div>408 records were screened; eight were eligible. Model accuracy ranged from 19 % to 97 %. Several records demonstrated a moderate-to-high risk of bias; of those featuring low risk of bias, peak accuracies ranged from 70 % to 85 %. Most MLMs outperformed ASGE guidelines. Important predictor variables included age, total bilirubin, and common bile duct diameter.</div></div><div><h3>Conclusions</h3><div>MLMs outperform ASGE guidelines in predicting choledocholithiasis. Nonetheless, biases in study design and reporting limit their prospective applicability. Current MLMs do not yet rival MRCP in detecting choledocholithiasis. Future guideline development should consider MLM-driven insights for better risk prediction.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 1","pages":"Pages 1-9"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464199","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":"Learning curve in robotic liver surgery: easily achievable, evolving from laparoscopic background and team-based","authors":"Francesca Ratti ,&nbsp;Sara Ingallinella ,&nbsp;Marco Catena ,&nbsp;Diletta Corallino ,&nbsp;Rebecca Marino ,&nbsp;Luca Aldrighetti","doi":"10.1016/j.hpb.2024.10.007","DOIUrl":"10.1016/j.hpb.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Limited and heterogeneous literature data necessitate a focused examination of the learning curve in robotic liver resections. This study aims to assess the learning curve of two surgeons from the same team with differing laparoscopic backgrounds.</div></div><div><h3>Methods</h3><div>Since February 2021, San Raffaele Hospital in Milan has implemented a robotic liver surgery program, performing 250 resections by three trained console surgeons. Using cumulative sum (CUSUM) analysis, the learning curve was evaluated for a Pioneer Surgeon (PS) with around 1200 laparoscopic cases and a New Generation Surgeon (NGS) with approximately 100 laparoscopic cases. Cases were stratified by complexity (38 low, 74 intermediate, 85 high).</div></div><div><h3>Results</h3><div>Both PS and NGS demonstrated a learning curve for operative time after 15 low-complexity and 10 intermediate-complexity cases, with high-complexity learning curves apparent after 10 cases for PS and 18 cases for NGS. Conversion rates remained unaffected, and neither surgeon experienced increased blood loss or postoperative complications. A “team learning curve” effect in terms of operative time emerged after 12 cases, suggesting the importance of a cohesive surgical team.</div></div><div><h3>Conclusion</h3><div>The robotic platform facilitated a relatively brief learning curve for low and intermediate complexity cases, irrespective of laparoscopic background, underscoring the benefits of team collaboration.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 1","pages":"Pages 45-55"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590681","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}