Journal of Gastrointestinal Surgery最新文献

{"title":"Oral Microbiome Signatures as Potential Biomarkers for Gastric Cancer Risk Assessment.","authors":"Haejin In, Shruthi R Perati, Mykhaylo Usyk, Julie Yang, Srawani Sarkar, Brijesh Rana, Fei Wang, Aaron Oh, Alexandra Adams, Laurence P Diggs, Christopher Sollecito, Robert D Burk","doi":"10.1016/j.gassur.2024.101933","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101933","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer (GC) is the fifth leading cause of cancer-related death worldwide. The oral microbiota was investigated for distinguishable characteristics between GC, premalignant gastric conditions (Pre-GC), and control participants.</p><p><strong>Methods: </strong>Mouthwash samples from GC, Pre-GC, and control participants at a tertiary care center were prospectively collected. Following DNA extraction and sequencing, analyses of oral microbiome biodiversity and composition were performed, and receiver operating characteristic curves were created to evaluate the discriminative power of oral microbiome signatures.</p><p><strong>Results: </strong>Oral samples from 98 participants included 30 (30.6%) GC, 30 (30.6%) Pre-GC and 38 (38.8%) controls. Of these, 61 (62.2%) were female, 31 (31.6%) were Hispanic, and 18 (18.3%) were smokers. GC compared to controls demonstrated notable differences in beta diversity (Jensen-Shannon Divergence and Bray-Curtis Dissimilarity, p<0.02). 32 bacterial genera were found to be differentially abundant when comparing GC and controls, and 23 bacterial genera demonstrated differential abundance when comparing Pre-GC and controls (W-statistic >2). Minimal compositional differences between GC and Pre-GC were found, with only three differentially abundant bacterial genera (W-statistic >2). Models were constructed from the most significant bacterial signatures (W-statistic >5). These models discriminated between GC and control oral samples with an AUC of 0.880 (95% CI 0.808, 0.952) and between Pre-GC and control oral samples with an AUC of 0.943 (95% CI 0.887, 0.999).</p><p><strong>Conclusions: </strong>Oral rinses of GC and Pre-GC participants exhibited distinct but similar microbiome profiles, distinguishing them from controls. This compositional difference raises the possibility of utilizing these microbial signatures to predict GC risk.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101933"},"PeriodicalIF":2.2,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872327","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":"Surgical Technique and Safety of Gastrectomy for Gastric Cancer with Duodenal Invasion, Including Minimally Invasive Approach.","authors":"Hiroki Yokoo, Shingo Kanaji, Taro Ikeda, Yasufumi Koterazawa, Ryuichiro Sawada, Hitoshi Harada, Naoki Urakawa, Hironobu Goto, Hiroshi Hasegawa, Kimihiro Yamashita, Takeru Matsuda, Yoshihiro Kakeji","doi":"10.1016/j.gassur.2024.101934","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101934","url":null,"abstract":"<p><strong>Background: </strong>Gastrectomy for gastric cancer with duodenal invasion poses an oncological (high positive rate of resection line infiltration) and a surgical (high risk of duodenal fistula) challenge. The purpose of this study was to validate the safety of gastrectomy for gastric cancer with duodenal invasion.</p><p><strong>Methods: </strong>We included 82 patients with distal gastric cancer who underwent gastrectomy and reconstruction via the Bill-II or R-Y procedure at Kobe University Hospital between 2011 and 2021 were retrospectively reviewed. Of these, 37 patients had duodenal invasion (Duo+ group) and 45 patients did not have duodenal invasion (Duo- group). Clinicopathological findings were compared between groups. A video is provided to demonstrate our surgical technique for duodenal resection and duodenal stump reinforcement.</p><p><strong>Results: </strong>Resected duodenum length was significantly longer in the Duo+ group than in the Duo- group (3 vs. 1cm, P < 0.001). None of the patients in either group had positive distal resection line infiltration in the surgical specimen. Incidence of duodenal stump fistula (2.7% vs. 0%, P = 0.27) and 5-year overall survival rate (30% vs. 30%, P = 0.67) were comparable between the two groups.</p><p><strong>Conclusion: </strong>Gastrectomy for gastric cancer with duodenal invasion can be performed safely. Our surgical approach may have contributed to the safety of gastrectomy for gastric cancer with duodenal invasion.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101934"},"PeriodicalIF":2.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864538","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 incidence and temporal trend of appendicitis in children: An analysis from the Global Burden of Disease Study 2021.","authors":"Ran He, Jianxiong Lai, Ou Jiang, Jian Li","doi":"10.1016/j.gassur.2024.101935","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101935","url":null,"abstract":"<p><strong>Background: </strong>Challenges persist in the management of appendicitis in children, but its incidence and temporal trends have been reported in only a few developed countries. This study aimed to comprehensively investigate the incidence and temporal trends of appendicitis in children at the global, regional, and national levels, providing evidence for implementing and scaling up intervention services to reduce adverse health outcomes.</p><p><strong>Methods: </strong>This study downloaded incidence data on appendicitis in children from the Global Burden of Diseases (GBD) 2021. Data on number and rate of appendicitis in children were analyzed at the global, gender, age, sociodemographical, regional, and national levels. The percentage changes and average annual percentage changes were calculated. The association between the sociodemographic index (SDI) and incidence of appendicitis in children were also determined by Pearson correlation analysis.</p><p><strong>Results: </strong>In 2021, the newly diagnosed appendicitis in children was estimated to be 2193020, accounting for 12.93% of all cases of appendicitis in the general population. The corresponding incidence rate was estimated to be 109 per 100000. From 1990 to 2021, the incidence of appendicitis in children increased by 0.3% annually. The incidence varied widely across regions and countries, while there was a significant positive association between the incidence rates (R=0.6620, P <0.001) and its percentage changes (R=0.2234, P=0.0013) of appendicitis in children and the SDI.</p><p><strong>Conclusions: </strong>Appendicitis will continue to be a major public health challenge in children globally, especially in transitioning countries and regions. A comprehensive description of the incidence and its changing patterns, increasing awareness, and rational resource allocation are needed to reduce the burden of pediatric appendicitis.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101935"},"PeriodicalIF":2.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864557","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":"University hospital status and gastric cancer mortality - a population-based nationwide study in Finland.","authors":"Urgena Maharjan, Joonas H Kauppila","doi":"10.1016/j.gassur.2024.101932","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101932","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer remains a significant global health issue with rising mortality, despite advancements in treatment. Previous studies suggest that surgery performed in university hospitals may influence surgical outcomes and mortality rates, but evidence on its impact for gastric cancer remains limited. This study investigated whether gastrectomy performed at university hospitals reduce short-term and long-term mortality in Finland.</p><p><strong>Methods: </strong>This nationwide population-based retrospective cohort study analysed gastric cancer patients who underwent gastrectomy in Finland from 1987 to 2016, using data from the Finnish Cancer Registry, Finnish Patient Registry, and Finnish Death Registry. The study compared 5-year, 30-day, and 90-day all-cause mortality between patients treated at university hospitals vs non-university hospitals, with adjustments for confounders using multivariable Cox regression models.</p><p><strong>Results: </strong>Out of 10,455 patients who underwent gastrectomy in Finland between 1987 and 2016, most were treated in non-university hospitals. Patients undergoing gastrectomy in university hospitals were generally younger, with more comorbidities and more advanced cancer stages. Survival rates were higher in university hospitals, with 30-day, 90-day, and 5-year survival rates being better compared to non-university hospitals, although the differences in 90-day and 5-year survival were not statistically significant in more recent years.</p><p><strong>Conclusion: </strong>The study suggests that gastrectomy performed at university hospitals in Finland is associated with lower short-term and long-term mortality compared to non-university hospitals. The findings support the potential benefits of centralizing gastric cancer surgeries at university hospitals, but further research is needed to explore the underlying reasons.</p><p><strong>Data sharing statement: </strong>All presented data are available from THL/Findata, Finland. Data access to collaboration can be granted given that relevant government and health officials approve the collaborative study.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101932"},"PeriodicalIF":2.2,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864565","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":"GASTRIC METASTASIS OF MERKEL CELL CARCINOMA.","authors":"Juliana Maria Napoli, Felipe Higuera, Fernando Gabriel Wright","doi":"10.1016/j.gassur.2024.101925","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101925","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101925"},"PeriodicalIF":2.2,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829106","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":"Change and Predictors of Body Composition After Gastrectomy for Gastric Cancer During First Postoperative Year.","authors":"Tomohiro Osaki, Tomoyuki Matsunaga, Masahiro Makinoya, Shota Shimizu, Yuji Shishido, Kozo Miyatani, Ayumi Tsuda, Kanenori Endo, Keigo Ashida, Shigeru Tatebe, Yoshiyuki Fujiwara","doi":"10.1016/j.gassur.2024.101931","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101931","url":null,"abstract":"<p><strong>Purpose: </strong>After gastrectomy for gastric cancer, patients often lose significant body weight owing to decreased caloric intake and nutrient absorption. Body weight typically requires approximately 1 year to stabilize. This study aimed to examine the changes and predictors associated with body composition during the first postoperative year.</p><p><strong>Methods: </strong>Two hundred thirty patients underwent radical gastrectomy for Stage I-III gastric cancer. Body composition was measured using bioelectrical impedance analysis, and changes were analyzed over 1 year. Multiple regression analysis was used to identify predictors of body composition changes.</p><p><strong>Results: </strong>Body composition changes and significant body weight and body fat mass reductions occurred primarily within the first 6 months postoperatively. Skeletal muscle mass initially decreased but improved by 6 months, without significant changes related to adjuvant chemotherapy. Increased edema was seen at 6 and 12 months postoperatively in patients after total gastrectomy and adjuvant chemotherapy. Gastrectomy type and body mass index significantly affected postoperative body weight changes. Gastrectomy type was also associated with changes in skeletal muscle mass and bone mineral content. Adjuvant chemotherapy significantly affected the whole-body phase angle at 6 and 12 months.</p><p><strong>Conclusions: </strong>These findings emphasized the initial significant reductions postoperatively and subsequent adjustments over time and elucidate the complex interplay between surgical techniques, adjuvant treatment, and patient characteristics and mid-term changes in body composition.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101931"},"PeriodicalIF":2.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824225","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":"DELTA-IRP AS A NEW HIGH-RESOLUTION MANOMETRY METRIC TO PREDICT THE POSITIVE OUTCOME OF LAPAROSCOPIC HELLER-DOR IN PATIENTS WITH ACHALASIA.","authors":"Andrea Costantini, Matteo Pittacolo, Giulia Nezi, Giovanni Capovilla, Mario Costantini, Arianna Vittori, Matteo Santangelo, Luca Provenzano, Loredana Nicoletti, Francesca Forattini, Lucia Moletta, Michele Valmasoni, Edoardo V Savarino, Renato Salvador","doi":"10.1016/j.gassur.2024.101928","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101928","url":null,"abstract":"<p><strong>Introduction: </strong>There is no consensus on the definition of failure after treatment in patients with achalasia. The Eckardt score (ES) is used to define clinical outcomes, but objective metrics are lacking. The aim of this study was to identify if any high-resolution manometry (HRM) parameters may be useful to predict a positive outcome after laparoscopic Heller-Dor (LHD).</p><p><strong>Methods: </strong>Patients undergoing LHD between 2012-2022 were enrolled. They were divided according to the outcome into success (SG) and failure group (FG). Alongside with the common HRM parameters, we also measured the difference between pre- and postoperative integrated relaxation pressure (∆-IRP). A ROC curve analysis was applied to assess the accuracy of each HRM parameter.</p><p><strong>Results: </strong>Three-hundred-thirty-six patients (92.3%) were classified in the SG and 28 (7.7%) in the FG. No difference was found in terms of manometric types, symptom duration and history of previous treatments; preoperative lower esophageal sphincter (LES) pressure and IRP were higher in the SG than in the FG (41 vs 35mmHg, p=0.03 and 33 vs 26mmHg, p=0.002, respectively). The postoperative LES metrics were similar between the two groups, except for the ∆-IRP that was higher in the SG (23mmHg, IQR:15-31) than in the FG (14mmHg, IQR:9-17, p=0.0002). At univariable analysis, age, LES preoperative pressure, IRP and ∆-IRP were factors able to predict a positive clinical outcome. At multivariable analysis, the ∆-IRP was the only parameter independently related to clinical success (p<0.01, OR:0.94, CI 5%-95%:0.89-0.99). The ROC curve for the ∆-IRP showed an area under the curve of 0.71, with a threshold value set at 16.5mmHg (sensibility 71%, specificity 70%).</p><p><strong>Conclusions: </strong>Our data showed that the ∆-IRP with a threshold of 16.5mmHg could represent a new objective tool in order to predict the long-term positive outcome of LHD in patients with esophageal achalasia.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101928"},"PeriodicalIF":2.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824228","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":"Intersigmoid hernia.","authors":"Taiki Mori, Hisashi Kametaka, Kazuhiro Seike","doi":"10.1016/j.gassur.2024.101930","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101930","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101930"},"PeriodicalIF":2.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824150","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":"First Clinical Report of the International Single Port Robotic Rectal Cancer Registry.","authors":"John H Marks, Hye Jin Kim, Gyu-Seog Choi","doi":"10.1016/j.gassur.2024.101929","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101929","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer surgery remains a significant technical challenge. Development and implementation of new technology offers hope for more accurate and precise surgery. To evaluate if single port robotic technology (SPR) helps achieve this goal we established an international SP robotic registry. This study reports short-term clinical and oncological outcomes from an international SPR registry for rectal cancer.</p><p><strong>Methods: </strong>Review of a prospective international registry of SPR procedures approved for colorectal surgery under an investigational design exemption (IDE) was performed. Patients with rectal adenocarcinoma that had resection for curative intent using the SPR platform from 11/2018-9/2022 were included. Frequency statistics described patient and tumor characteristics and intraoperative, oncological and clinical outcome variables. The main outcome measure was the quality of the TME specimen. Secondary outcome measures were intraoperative conversions; 30-day postoperative morbidity and mortality.</p><p><strong>Results: </strong>113 SPR rectal cancer cases were performed at 2 centers by 4 colorectal surgeons. 9 local excisions were excluded, leaving 104 cases analyzed. The cohort was 50.96% men, mean age of 60.0years (SD 11.29) and BMI 25.8kg/m2 (SD 6.18). The most common T-stage was 3 (n=55, 52.8%), followed by 2 (n=19, 18.26%). Over 60% of patients had preoperative neoadjuvant chemoradiation. The cancers were a mean 2.9cm (SD 2.62) from the anorectal ring and 4.52cm (SD 1.82) in size. The procedures performed were a TATA/TaTME (n=52, 46%), low anterior resection (n=49, 43.3%), and abdominoperineal resections (n=3, 2.7%). The mean operating time was 168min (SD 56.9). There were no intraoperative complications and 2 (1.9%) conversions to laparoscopy. There was a median of 2 incisions, with a mean size of 2.3cm (SD 1.31). The TME specimen was complete in 97.1% (n=101) and near complete in 2.9% (n=3). R1 rate was 3.8% with 3 distal and 1 circumferential positive margins. Post-operatively, there were 15 total complications, 4 major and 11 minor. There were 2 readmissions (ileus and small bowel obstruction). There were no mortalities.</p><p><strong>Conclusions: </strong>This early international experience with the SPR showed it was a safe and effective technique for distal rectal cancers, with excellent specimen quality. The complication and conversion rates seen with other techniques and platforms used in rectal cancer surgery were not demonstrated. With the use of an international registry, we hope to develop a better understanding of the opportunities and limitations of SPR in rectal cancer surgery as the technology is adopted and applied more widely. While structured training and controlled trials will be required to develop best practices and define the use of the SPR, initial international registry data is encouraging.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101929"},"PeriodicalIF":2.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824230","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 fellowship training on current practice patterns and the job market: a survey of Fellowship Council graduates.","authors":"Michael Jureller, D Rohan Jeyarajah, Imran Hassan, Maria S Altieri","doi":"10.1016/j.gassur.2024.101893","DOIUrl":"https://doi.org/10.1016/j.gassur.2024.101893","url":null,"abstract":"<p><strong>Background: </strong>General surgery has changed significantly over the last decades, with the need for advanced training and expertise. The Fellowship Council (FC) accredits fellowships that train approximately 200 fellows annually. This study aimed to analyze FC graduates' perceptions of training, current practices, and the job market.</p><p><strong>Methods: </strong>Data were collected between May 2022 and June 2022 via a survey (SurveyMonkey; Momentive Inc) distributed via email to 2119 previous FC graduates from 2012 to 2021.</p><p><strong>Results: </strong>There were 257 respondents. However, less than half of the respondents (47%) came from surgeons within the first 3 years after training. Of the respondents, 38% had advanced gastrointestinal (GI) minimally invasive surgery (MIS) training, 26% had bariatric surgery training, 14% had foregut surgery training, and the remaining 22% had hepatobiliary, advanced/complex GI, advanced endoscopy, and colorectal surgery training. Most respondents performed acute care surgery (ACS) as part of their training. Of note, 75% of respondents take ACS call, and 55% of respondents do not perform some operations that they trained in during their fellowship. More than 60% of surgeons had difficulty securing employment.</p><p><strong>Conclusion: </strong>Despite niche training, there exists a demand for ACS care. There may be an underutilization of advanced training, or this may reflect how surgeons enter practice and gain experience. The challenge in obtaining employment may be due to the saturation of the market, selectivity of the applicants, or hiring challenges during the COVID-19 pandemic. Most surgeons who undertook FC training practice surgery within their domains of training and with some components of ACS. Despite the desire to hire fellowship-trained surgeons, most FC graduates experience difficulty securing employment.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101893"},"PeriodicalIF":2.2,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142818316","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}