Journal of endourology最新文献

{"title":"Does Mini-Percutaneous Nephrolithotomy Cause Increased Intrarenal Pressure During Percutaneous Nephrolithotomy and is This Mitigated by a Suctioning Sheath? A Randomized Control Trial.","authors":"Raymond Khargi, Juan S Serna, Kavita Gupta, Alan J Yaghoubian, Christopher Connors, Kasmira R Gupta, Anna Ricapito, William M Atallah, Mantu Gupta","doi":"10.1089/end.2024.0390","DOIUrl":"10.1089/end.2024.0390","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Intrarenal pressure (IRP) generated during percutaneous nephrolithotomy (PCNL) may have the potential to cause renal damage and/or sepsis. It has been suggested that mini-PCNL (mPCNL) can further increase IRP but that a suctioning sheath may mitigate this elevation. We sought to measure IRP throughout the PCNL process, randomizing patients getting mPCNL to receiving two different mPCNL sheaths, one suctioning and the other nonsuctioning, and then comparing them with patients undergoing standard PCNL (sPCNL) using a 24F sheath. <b><i>Patients and Methods:</i></b> Twenty patients meeting the eligibility criteria for mPCNL were randomized into two groups: suctioning mPCNL (s-mPCNL) with a single-step dilator and continuous suction sheath (ClearPetra™, 18F, <i>n</i> = 10) and nonsuctioning mPCNL (ns-mPCNL) with a metallic dilator and sheath (Storz MIP-M™, 17.5F, <i>n</i> = 10). A group of 10 patients undergoing sPCNL using a balloon dilator with a Polytetrafluoroethylene (PTFE) sheath (NephroMax™, 24F, <i>n</i> = 10) were included as a control. IRP was measured with a 0.014″ COMET™ II Pressure guidewire retrogradely positioned in the renal pelvis. Gravity irrigation was utilized. Pressure data captured include baseline IRPs, retrograde pyelogram (RPG), needle entry, fascial dilation, tract dilation, sheath insertion, nephroscopy, and lithotripsy. The primary outcome was differences in mean and peak IRP during each stage. Categorical data were compared using chi-square or Fisher's exact tests. Continuous variables were analyzed using one-way analysis of variance. <b><i>Results:</i></b> Peak and mean IRPs (millimeters of mercury or mm Hg) were similar at baseline and during RPG, needle insertion, and fascial dilation in the two experimental groups and in the control group. During tract dilation and sheath placement, both the mPCNL sheaths generated much higher peak IRP compared with the 24F balloon dilation control group but similar to each other (dilation: 36.6 and 38.6 vs 6.9, <i>p</i> < 0.001; sheath placement: 36.6 and 35.3 vs 13.8, <i>p </i>= 0.039). During nephroscopy, ns-mPCNL generated greater peak IRP compared with s-mPCNL and the control group (41.8 vs 19.09 and 24.15; <i>p</i> = 0.019). The highest peak IRP for each group occurred during RPG and when a nephroscope was placed through a narrow infundibulum. <b><i>Conclusions:</i></b> Compared with balloon dilation, coaxial dilation with mPCNL sheaths generates significantly higher IRP. During nephroscopy, ns-mPCNL sheaths generate higher IRP compared with standard and suctioning sheaths. Highest IRPs are generated during RPG and when a nephroscope goes through a narrow infundibulum. These findings can inform improved sheath and nephroscope design. Further research assessing the effect of high IRP on postoperative pain, sepsis, and renal injury is needed.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"214-221"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080041","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":"Hood Technique for Radical Prostatectomy.","authors":"Asher Mandel, Manish Choudhary, Neeraja Tillu, Ashutosh Maheshwari, Kaushik Kolanukuduru, Vinayak Wagaskar, Ash Tewari","doi":"10.1089/end.2024.0303","DOIUrl":"https://doi.org/10.1089/end.2024.0303","url":null,"abstract":"<p><p>The hood technique is a modification of the robotic-assisted radical prostatectomy used for the treatment of prostate cancer. The hood technique was developed in 2018 with the goal of preserving the structures anterior to the urethra during apical dissection to facilitate early postoperative recovery of urinary continence. Similar techniques have been published in the past, reporting excellent continence recovery rates, including the PERUSIA extraperitoneal technique and the retrograde release of the neurovascular bundle. Additionally, puboprostatic ligament sparing was shown to reduce postoperative urinary incontinence in the open era. The hood technique is an alternative to Retzius-sparing radical prostatectomy, which also spares the anterior structures by preserving the entire anterior space of Retzius.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S1","pages":"S35-S38"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657372","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":"New Techniques and Technologies in Flexible Ureteroscopy.","authors":"Mohannad A Awad, Brett A Johnson, Margaret S Pearle","doi":"10.1089/end.2024.0669","DOIUrl":"https://doi.org/10.1089/end.2024.0669","url":null,"abstract":"<p><p>This article provides a step-by-step guide to flexible ureteroscopy (URS), with focus on some of the newer techniques and technologies available to facilitate treatment of complex stones. In it we review indications, preoperative evaluation, surgical steps, postoperative care, troubleshooting methods, and complication management. Furthermore, we will explore advances in laser technologies, the integration of suction mechanisms, and the incorporation of intrarenal pressure measurement systems in flexible URS.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S1","pages":"S8-S17"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657417","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 Vesico-Vaginal Fistula Repair.","authors":"Anup Kumar, Aravind Tk, Harshdeep Singh, Siddharth Yadav, Ruchi Mittal, Preet Mohan Singh, Ankit Goel","doi":"10.1089/end.2024.0302","DOIUrl":"https://doi.org/10.1089/end.2024.0302","url":null,"abstract":"<p><p>Vesico-vaginal fistulae require complex reconstructions and robotic assistance can be beneficial in obtaining successful outcomes. In this video, we demonstrate two of our techniques of vesicle-vaginal fistula repair, one with transverse cystotomy and other with vertical cystotomy, along with salient steps of the procedure. The indication, preparation, instrumentation, and surgical steps are also discussed along with a review of available literature.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S1","pages":"S47-S51"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657440","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":"A Trifecta-Based Evaluation of Patients Treated with Percutaneous Thermal Ablation of Small Renal Masses.","authors":"Gianpaolo Lucignani, Michele Rizzo, Anna Maria Ierardi, Andrea Piasentin, Elisa De Lorenzis, Carlo Trombetta, Giovanni Liguori, Michele Bertolotto, Gianpaolo Carrafiello, Emanuele Montanari, Luca Boeri","doi":"10.1089/end.2024.0091.fts24","DOIUrl":"10.1089/end.2024.0091.fts24","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; Scoring metrics are important to compare outcomes of different percutaneous treatments for small renal masses (RMs). The concept of trifecta (no complications, kidney function preservation, and absence of local recurrence) has been recently introduced in percutaneous thermal ablation of RM. In this context, previous studies have shown that cryoablation (CA) and microwave ablation (MWA) have similar outcomes. We aimed to validate the trifecta in CA and MWA and factors associated with treatment success. &lt;b&gt;&lt;i&gt;Materials and Methods:&lt;/i&gt;&lt;/b&gt; A retrospective comparative analysis of two cohorts was carried out on 190 consecutive patients with RMs treated using percutaneous CA or MWA. Nephrometry scores described RM complexity. Postoperative complications were categorized according to the Clavien-Dindo system. Glomerular filtration rate (GFR) at the last follow-up was calculated through the chronic kidney disease-epidemiology collaboration (EPI) formula, whereas detection of contrast enhancement during follow-up defined local recurrence. Last, trifecta was defined by the combination of no major (Clavien &gt;2) complications, estimation of GFR (eGFR) decline &lt;10%, and absence of local recurrence. Descriptive statistics and logistic regression models tested the association between predictors and trifecta achievement. Factors associated with recurrence were compared by the log-rank test. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Of 175 patients, 121 (69.1%) and 54 (30.8%) patients underwent CA and MWA, respectively. Median (interquartile range [IQR]) age and RM diameter were 75 years (66-80) and 2.4 cm (1.8-3.0). The CA group had a lower preoperative GFR but also had a lower rate of comorbidities (both &lt;i&gt;p&lt;/i&gt; = 0.01). Other demographics and tumor characteristics were comparable between groups. In the CA and MWA groups, major complications occurred after 1.6% and 4.8% of procedures (&lt;i&gt;p&lt;/i&gt; = 0.33), whereas an eGFR decline &gt;10% was found in 31.5% and 38.8% of cases (&lt;i&gt;p&lt;/i&gt; = 0.40), respectively. Similarly, in the CA and MWA groups, at a median follow-up of 21 (8-39) and 24 (9.5-36) months, local recurrence was observed after 10 (8.3%) and 5 (9.3%) cases (&lt;i&gt;p&lt;/i&gt; = 0.78), trifecta was accomplished after 72 (59.5%) and 32 (59.3%; &lt;i&gt;p&lt;/i&gt; = 1.00) procedures, respectively. Of note, recurrence-free survival (RFS) was comparable among groups (&lt;i&gt;p&lt;/i&gt; = 0.57). Moreover, trifecta achievement was comparable when stratifying for demographics and tumor characteristics in the whole cohort and in the CA group (&lt;i&gt;p&lt;/i&gt; &gt; 0.05). Conversely, logistic regression showed a lower odds ratio (OR) of trifecta for lesions close to renal collecting system treated by MWA, even when accounting for maximum diameter and preoperative GFR (OR 0.21, confidence interval 0.60-0.72, &lt;i&gt;p&lt;/i&gt; = 0.010). Of note, this factor was also associated with a significantly lower RFS (log-rank &lt;i&gt;p&lt;/i&gt; = 0.002). &lt;b&gt;&lt;i&gt;Conclusions:&lt;/i&gt;&lt;/b&gt; Both percutaneous CA and MWA of RM can safely","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"S38-S45"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750836","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":"Focal Therapy: The Art of Harmonizing Cancer Control with Quality of Life.","authors":"Thomas J Polascik, Mahdi Mottaghi, Rafael Sanchez-Salas","doi":"10.1089/end.2025.32121.ed","DOIUrl":"https://doi.org/10.1089/end.2025.32121.ed","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S2","pages":"S1-S2"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663647","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":"Natural History of Patients Undergoing Transperineal Fusion Biopsies to Transperineal Fusion Cryoablation: 5-Year Outcomes.","authors":"Fernando J Bianco, Juan I Martinez-Salamanca, Alberto Lopez Prieto, Edward L Gheiler, Farshad Shafizadeh, Miachael J Zachareas, Sheldon Pike, Ariel M Kaufman, David Kaufman, Gloria Egui-Benatuil, Michael W Kattan","doi":"10.1089/end.2024.0864","DOIUrl":"https://doi.org/10.1089/end.2024.0864","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Randomized trials comparing radical treatments with surveillance for prostate cancer (PCa) have shown marginal survival benefit with significant detriment in quality of life. MR fusion cryoablation (MRFC) has emerged as a promising approach. We evaluated outcomes of men diagnosed with transperineal fusion biopsies (TPFBx) and treated with MRFC providing intermediate oncological and functional outcomes. <b><i>Methods:</i></b> Clinical trial NCT02381990 is a longitudinal registry designed to evaluate outcomes of MRFC for PCa. In this multi-institutional study, we evaluated men with clinically significant PCa (CSPCa) determined by TPFBx, managed with MRFC (<40% of the prostate) in an office setting under local anesthesia. Disease progression (DP), considered a natural history event, was defined as conversion to whole gland treatment, or androgen deprivation or development of metastasis. Univariate and Cox proportional hazards models along with competing risk (CRA) were used against DP. Secondary and functional outcomes are also reported to provide a comprehensive understanding of the therapeutic impact of MRFC. <b><i>Results:</i></b> In total, 632 patients met CSPCa criteria managed with MRFC. Median procedure time and pain score were 52 minutes and 2/10, respectively. The 5-year DP rate was 10%. Prostate-specific antigen density was the only independent predictor. Urinary outcomes improved in 3 months and held overtime. Sexual function was affected modestly. A 1-year TPFBx was performed in 439/632 (69%) with PCa and CSPCa found in 144 and 54. IN-field CSPCa and OUT-field CSPCa were present in 19 and 43, respectively. Eight had CSPCa in both fields. Significant reduction in cancer burden at the 1-year biopsy was observed as both IN-field and OUT-field lesions showed a median tumor size under 5 mm. Overall, a second MRFC was conducted in 106/632 men; 17 and 89 were for IN-field and OUT-field tumors, respectively. <b><i>Conclusions:</i></b> Office-based MRFC affects the natural progression of PCa while causing minimal impact on functional outcomes. Comprehensive evaluations through randomized controlled trials are necessary to further validate these findings and confirm their effectiveness.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S2","pages":"S3-S12"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143663648","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":"Transurethral Ultrasound Ablation for Treatment of Localized Prostate Cancer and Benign Prostatic Hyperplasia (BPH).","authors":"Lucas Engelage, Rolf Muschter","doi":"10.1089/end.2024.0301","DOIUrl":"https://doi.org/10.1089/end.2024.0301","url":null,"abstract":"<p><p><b><i>Indications:</i></b> Transurethral ultrasound ablation (TULSA) is used for treating localized prostate cancer and benign prostatic hyperplasia (BPH). It's particularly suitable for patients with low to intermediate risk, uni- and multifocal organ-confined prostate carcinomas, symptomatic obstructive BPH coinciding with prostate cancer, and postradiation therapy recurrences. <b><i>Technique:</i></b> The TULSA procedure involves meticulous preoperative preparation, precise surgical steps, and comprehensive postoperative care. Treatment is performed under magnetic resonance imaging (MRI) guidance using specialized MRI-compatible instruments, including a transurethrally inserted ultrasound applicator and an endorectal cooling device. Ablation is conducted through robot-driven rotation of the applicator, with real-time MRI thermometry used for monitoring and control. <b><i>Outcomes:</i></b> A retrospective single-center clinical evaluation involved 300 men with primary localized prostate cancer (PCa) confirmed by biopsy. The median age was 66 years, prostate-specific antigen levels were 6.85 ng/mL, cancer length was 7.6 mm, and prostate volume was 49.2 cc. The median follow-up period was 14 months. Treatments included whole-gland (163 men) and focal TULSA (137 men), with neurovascular bundle sparing in 248 men. Additionally, 88 patients received combined therapy for PCa and BPH. <b><i>Safety:</i></b> Grade 1 and 2 complications occurred in 57 patients, resolving within 4 weeks. Grade 3 adverse events were seen in seven patients, resolving within 3 months. No grade 4 or higher adverse events and no bowel-related complications were observed. <b><i>Functional Outcomes:</i></b> The median international index of erectile function score remained stable from 24 to 25 over 48 months. The international prostate symptom score initially worsened post-treatment but improved to better than baseline levels over 48 months. Pad-free continence was preserved in 96% of patients. <b><i>Oncological Outcomes:</i></b> Biochemical failure occurred in 26 men, with residual cancer confirmed by biopsy in 14 men. Salvage therapy was required for 14 patients, with 12 patients under active surveillance.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":"39 S1","pages":"S23-S26"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657469","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":"<i>Letter to the Editor:</i> Caution in Interpreting Retrospective Data on Percutaneous Nephrostomy and Retrograde Ureteral Stenting for Obstructive Pyelonephritis.","authors":"Mi Zhou, Xin Zhu","doi":"10.1089/end.2024.0903","DOIUrl":"10.1089/end.2024.0903","url":null,"abstract":"","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"e322-e323"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255787","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":"Predictive Value of Combined Serum Nuclear Factor Erythroid 2-Related Factor 2 and Prognostic Nutritional Index for Sepsis after Percutaneous Nephrolithotomy.","authors":"Shengwei Qi, Shuangying Huang, Rong Qian","doi":"10.1089/end.2024.0519","DOIUrl":"10.1089/end.2024.0519","url":null,"abstract":"<p><p><b><i>Objective:</i></b> This prospective observational study aimed to explore the predictive value of serum nuclear factor erythroid 2-related factor 2 (Nrf2) levels and its combination with the prognostic nutritional index (PNI) for postoperative sepsis in patients undergoing percutaneous nephrolithotomy (PCNL) for renal stones. <b><i>Methods:</i></b> This prospective observational study included 112 patients with renal stones who underwent PCNL surgery in our hospital from January 2023 to December 2023. The diagnosis of sepsis was based on the third international consensus definitions for sepsis and septic shock (Sepsis-3). Clinical data on all patients were collected, and the PNI index was calculated. The serum levels of Nrf2, interleukin-6 (IL-6), interleukin-1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) in all patients were measured using enzyme-linked immunosorbent assay. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) 25.0 statistical software. <b><i>Results:</i></b> Compared with the nonsepsis patients, the sepsis patients had a higher proportion of positive preoperative urine cultures, longer activated partial thromboplastin time, and lower PNI scores. At 6, 12, and 24 hours after surgery, the sepsis patients had significantly lower serum Nrf2 levels and higher levels of IL-6, IL-1β, TNF-α, and CRP. Pearson's analysis showed a negative correlation between serum Nrf2 levels and IL-6 and CRP levels. The combination of PNI and serum Nrf2 levels at 24 hours after surgery had a higher predictive level, with an Area Under the Curve (AUC) of 0.844, a sensitivity of 75.3%, and a specificity of 77.8%. Finally, logistic regression analysis showed that decreased serum Nrf2 level at 24 hours after surgery was a risk factor for postoperative sepsis in renal stone patients. <b><i>Conclusion:</i></b> In conclusion, our study results indicate significantly lower serum Nrf2 levels in postoperative sepsis patients undergoing PCNL. Serum Nrf2 levels in combination with PNI can be used to predict the occurrence of postoperative sepsis in renal stone patients undergoing PCNL.</p>","PeriodicalId":15723,"journal":{"name":"Journal of endourology","volume":" ","pages":"222-230"},"PeriodicalIF":2.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143449174","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}