Langenbeck's Archives of Surgery最新文献

{"title":"Skin pedicle expansion technique in dorsal nerve fascial Island flap: enhancing viability in repairing digital soft tissue defects.","authors":"Xun Wang, Rui Yang, Qixiang Yang, Jingdan Lv, Qi Ye, Yaohui Chen, Mingyu Pan, Gaofeng Chen, Lisha Qiu","doi":"10.1007/s00423-025-03800-x","DOIUrl":"10.1007/s00423-025-03800-x","url":null,"abstract":"<p><strong>Purpose: </strong>Various flap techniques have been developed for injuries to the middle and distal phalanges, with the dorsal nerve fascial island (DNFI) flap offering distinct advantages. We aimed to elucidate the process of skin pedicle expansion (SPE) during DNFI flap transplantation and its effectiveness in relieving pressure on the fascial pedicle.</p><p><strong>Methods: </strong>Ninety-two patients with soft tissue defects in the middle and distal phalanges were treated using a DNFI flap from February 2008 to August 2023. Eighty-three patients underwent SPE. The SPE technique involves creating a 3- to 4-mm wide skin strip on the surface of the fascial tissue, which contains a small arterial-venous system along with dorsal nerves, enabling the flap to remain viable. The fascial pedicle reaches the defect area via an incision (the skin channel). The skin pedicle transforms the shape of the channel from triangular to trapezoidal, thereby increasing its capacity. After flap rotation and suturing, the design reduced the pressure of the channel on the fascial pedicle. Theoretically, this should facilitate smoother arterial and venous circulation within the flap, thereby improving survival rates.</p><p><strong>Results: </strong>All 83 flaps treated using the SPE technique survived. However, one patient experienced flap necrosis, and two patients had partial necrosis in the non-SPE group, with only six patients presenting satisfactory survival outcomes.</p><p><strong>Conclusions: </strong>SPE may improve the viability of DNFI flaps by alleviating pressure on the fascial pedicle, ensuring adequate blood flow, and enhancing flap viability. SPE has the potential to be a valuable technique in hand-repair surgery.</p><p><strong>Level of evidence: </strong>Level 4 according to the Oxford Centre for Evidence-Based Medicine (OCEBM).</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"208"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12214020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elevated prealbumin levels after preoperative nutritional intervention is an independent prognostic factor for overall survival after radical gastrectomy in patients with gastric cancer and severe malnutrition.","authors":"Ryota Matsui, Souya Nunobe, Motonari Ri, Rie Makuuchi, Tomoyuki Irino, Masaru Hayami, Manabu Ohashi, Takeshi Sano","doi":"10.1007/s00423-025-03785-7","DOIUrl":"10.1007/s00423-025-03785-7","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to clarify the effects of preoperative nutritional intervention on long-term survival after radical gastrectomy in patients with severe malnutrition.</p><p><strong>Methods: </strong>This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary stages I-III gastric cancer between August 2010 and December 2021. The primary outcome measure was overall survival (OS). We compared OS between the groups with and without nutritional intervention. In the intervention group, we compared OS between the groups with and without nutritional improvement. Prognostic factors were identified using the Cox proportional hazards regression analysis.</p><p><strong>Results: </strong>Median follow-up duration was 51 months. Of the 118 patients, 35 (29.7%) and 83 (70.3%) were in the group without and with nutritional intervention, respectively. Of the 83 patients in the group with nutritional intervention, 24 (28.9%) were classified as group without elevated prealbumin levels and 59 (71.1%) as group with elevated prealbumin levels. There was no difference in OS between the groups with and without nutritional intervention (P = 0.532); however, there was a trend toward better OS in the group with elevated prealbumin levels than in the group without elevated prealbumin levels (P = 0.181). Multivariate analysis showed that elevated prealbumin levels after intervention was an independent, favorable, prognostic factor for OS (hazard ratio, 0.320; 95% confidence interval, 0.112-0.917; P = 0.030).</p><p><strong>Conclusions: </strong>Preoperative nutritional therapy in patients with severe malnutrition does not contribute to long-term survival after gastrectomy. However, in patients who have undergone nutritional therapy, prognosis could be predicted by elevated prealbumin levels.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"206"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An overview of definition and approaches to jugular fossa tumors.","authors":"Fatemeh Riyahi Zaniyani, Alireza Khoshnevisan","doi":"10.1007/s00423-025-03794-6","DOIUrl":"10.1007/s00423-025-03794-6","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"207"},"PeriodicalIF":2.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12213852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144540736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Direction of perforation predicts the failure of non-operative management in patients with acute diverticulitis.","authors":"I Iesalnieks, M Beyer, A Agha, D Hofmann, Maximilian Sohn","doi":"10.1007/s00423-025-03775-9","DOIUrl":"10.1007/s00423-025-03775-9","url":null,"abstract":"","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"199"},"PeriodicalIF":2.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of therapeutic means for postoperative ileus: an umbrella review of meta-analyses.","authors":"Pengcheng Zhang, Yueying Lin, Keqian Yi, Yu Ma, Ting Yang, Liya An, Yuxing Qi, Xingzong Huang, Xianming Su, Yinlong Deng, Jian Hu, Wen Li, Dali Sun","doi":"10.1007/s00423-025-03739-z","DOIUrl":"10.1007/s00423-025-03739-z","url":null,"abstract":"<p><strong>Background & aims: </strong>Postoperative ileus is treated using a large number of methods with variable efficacy. This study further clarifies the advantages and disadvantages of existing treatments through umbrella evaluation.</p><p><strong>Method: </strong>This study conducted a systematic search of databases to select and include meta-analyses discussing the treatment of postoperative ileus. We recalculated the estimated values, 95% confidence intervals, heterogeneity estimates, small study effects, excessive significance tests, and publication biases for each included study using both random and fixed effect models.</p><p><strong>Results: </strong>A total of 24 meta-analyses, including 27 treatment protocols, were reviewed in this study. Among them, chewing gum, coffee, ERAS(Enhanced Recovery After Surgery) protocols, acupuncture, opioid receptor antagonists, Da-Cheng-Qi-Tang, early enteral nutrition, and Zusanli point injection therapy have been shown to significantly improve postoperative ileus (Class II). Opioid receptor antagonists, early enteral nutrition, ERAS, and chewing gum have also been found to significantly reduce the postoperative hospital stay (Class II).</p><p><strong>Conclusion: </strong>Eight treatment options can effectively reduce postoperative ileus, while the effectiveness and safety of other treatment options for postoperative ileus require further confirmation through high-quality research.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"198"},"PeriodicalIF":2.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual multimodal prehabilitation in high-risk patients undergoing major abdominal surgery following neoadjuvant treatment - a feasibility study.","authors":"Maria Wobith, C Oberhoffner, A Müller, M Fischer, M Lurz, B Jansen-Winkeln, A Weimann","doi":"10.1007/s00423-025-03717-5","DOIUrl":"10.1007/s00423-025-03717-5","url":null,"abstract":"<p><strong>Purpose: </strong>Despite advancements in medicine, perioperative complications and functional decline remain challenges for patients undergoing major abdominal surgery, particularly in high-risk individuals with limited functional capacity and impaired nutritional status. Prehabilitation, which involves interventions before surgery, shows promise in addressing these issues, but the heterogeneity of studies limits specific recommendations. The integration of prehabilitation into clinical practice with special regard to the setting and modalities of treatment also remain unclear.</p><p><strong>Methods: </strong>As a feasibility study for home-based prehabilitation high-risk patients (age ≥ 70 years, ASA ≥ 3) undergoing neoadjuvant treatment for non-metastatic esophageal, gastric, or rectal cancer, followed by oncological resection were included. A six-week multimodal supervised home-based prehabilitation program, including nutritional therapy, exercise, and psychological support, was implemented after neoadjuvant treatment and before surgery. Functional, nutritional, and quality of life (QoL) assessments were conducted at multiple points. Feasibility and adherence were assessed. Secondary explorative outcome measures included complication rates, hospital stay, readmission, and mortality, which were compared to a matched cohort.</p><p><strong>Results: </strong>Of 24 enrolled patients, 20 completed the program, with high adherence to home-based workouts (91.8%), respiratory exercises (92.9%), and oral nutritional supplements (ONS) (88.7%). Functional and nutritional improvements were observed, including improved sit-to-stand performance (p = 0.025) and serum albumin levels (p = 0.001). QoL improved in the physical function domain (p = 0.009). Postoperative outcomes were similar between groups.</p><p><strong>Conclusion: </strong>A supervised home-based prehabilitation program is feasible for high-risk patients, with high adherence to interventions and potential benefits in functional and nutritional status. Further research is needed to optimize program content, identify optimal patient populations, and assess long-term outcomes.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"197"},"PeriodicalIF":2.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Signet ring cell adenocarcinoma of the ampulla of Vater: does the presence of signet ring cells always suggest a poorer outcome?","authors":"Kunal Nandy, Akshay Dhaiya, T Vipin, Gauri Deshpande, Vikas Ostwal, Anant Ramaswamy, Vikram Chaudhari, Shailesh V Shrikhande, Manish S Bhandare","doi":"10.1007/s00423-025-03708-6","DOIUrl":"10.1007/s00423-025-03708-6","url":null,"abstract":"<p><strong>Introduction: </strong>Signet ring cell carcinoma (SRCC) of the ampulla of Vater is a rare histology with very limited data. In the present study, we report the outcomes of this rare pathology after pancreaticoduodenectomy from a single high-volume center.</p><p><strong>Materials and methods: </strong>This is a retrospective study from a prospectively maintained database. All patients who presented to our tertiary cancer hospital with ampullary lesions and underwent pancreaticoduodenectomy between January 2017 and January 2024 were included.</p><p><strong>Results: </strong>A total of 494 pancreaticoduodenectomies were performed during the study period for ampullary adenocarcinoma. Signet ring cells were present in 35 (7.1%). After propensity matching, the median OS in the signet ring group was not reached versus 55.7 months in the non-signet ring group (p-value-0.853) whereas the median DFS was 33.5 months in the non-signet ring group versus 18.2 months in the signet ring group (p-value-0.729).</p><p><strong>Conclusion: </strong>The presence of signet ring cells on histology after curative pancreaticoduodenectomy for ampullary adenocarcinoma was not associated with poor outcomes. The percentage of signet ring cells also didn't have any effect on survival.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"195"},"PeriodicalIF":2.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing practice patterns in axillary management for patients with node-positive breast cancer towards increased use of sentinel lymph node biopsy-alone after neoadjuvant chemotherapy: results of a survey (MF17-01) among Turkish surgeons.","authors":"Neslihan Cabıoğlu, Damla Okan Ercan, İrem Karataş, Erhan Eröz, Safa Toprak, Selman Emiroğlu, Elnur Hüseynov, Enver Özkurt, Baran Mollavelioğlu, Mustafa Tükenmez, Mahmut Müslümanoğlu, Abdullah İğci, Vahit Özmen","doi":"10.1007/s00423-025-03767-9","DOIUrl":"10.1007/s00423-025-03767-9","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to determine the knowledge of major benchmark trials among Turkish general surgeons to investigate if they have adopted the results in their practice.</p><p><strong>Methods: </strong>A total of 101 general surgeons from the Turkish Federation of Breast Diseases Society (TFBDS) were asked to complete a survey that included 24 multiple-choice questions regarding the surgical practice in axillary surgery for early and locally advanced breast cancer.</p><p><strong>Results: </strong>Most surgeons were familiar with prospective axillary surgery studies including ACOSOG Z0011 (n = 77, 76.2%), AMAROS (n = 76, 75.2%), IBCSG 23 - 01 (n = 58, 57.4%), ACOSOG Z1071 (n = 63, 62.4%), and SENTINA (n = 67, 66.3%). Among the surgeons participating in the present survey, breast surgeons (38.6%) were less likely to perform axillary lymph node dissection (ALND) in early stage patients with a 1-2 positive sentinel lymph node biopsy (SLNB) with micro- or macrometastases, as opposed to those who defined themselves as general surgeons (ALND; 36.8% vs. 63.9%, p = 0.015). Almost all surgeons suggested neoadjuvant chemotherapy (NAC) for patients presenting with T4 (94.8%) or N2-3 disease (92.0%), whereas almost half of the surgeons (40.5%) always proceeded with NAC in patients with clinically node-positive cN1 breast cancer. Overall, 86.1% of surgeons performed SLNB in patients whose axilla became clinically negative after NAC. More than half of the surgeons (55.2%) preferred blue dye as the SLNB technique and 37 (42.5%) used the combined method. Among 87 surgeons, 24.1% (n = 21) always, 39.1% (n = 34) sometimes, and 36.8% (n = 32) never preferred clip marking of axillary metastatic lymph nodes before NAC, whereas 56.4% performed targeted axillary dissection (TAD) after NAC. In cN+ patients before NAC, the majority of surgeons (74.3%) did not perform ALND in patients with at least three lymph nodes removed and SLNB negative. Of note, more than half of the surgeons (51.5%) did not perform ALND in the presence of isolated tumor cells or micrometastases among the three SLNs as long as regional nodal irradiation was received. However, 54.5% of the patients routinely underwent ALND in the presence of macrometastatic residual nodal disease after NAC.</p><p><strong>Conclusion: </strong>Deescalating strategies in axillary surgery have been increasing in both initially clinically node-negative and-positive breast cancers as long as nodal radiation is provided.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"196"},"PeriodicalIF":2.1,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144302427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of 6 months of structured strength or endurance exercise program on weight loss after gastric bypass surgery in a randomized controlled trial.","authors":"Stefanie Lehmann, Undine Gabriele Lange, Andreas Oberbach, Ulf Retschlag, Roland Morgenroth, Harald Busse, Christiane Prettin, David Petroff, Lena Seidemann, Matthias Blüher, Arne Dietrich","doi":"10.1007/s00423-025-03731-7","DOIUrl":"10.1007/s00423-025-03731-7","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the effects of differently structured exercise programs (strength training (ST) vs endurance training (ET) vs a control group (CG)) on glucose metabolism and weight loss following Roux-en-Y Gastric Bypass (RYGB).</p><p><strong>Methods: </strong>After RYGB, patients were randomized to a standardized ST or ET program or a control group, the intervention started within 28 days. Outcomes at 6 months were glucose and lipid metabolism, anthropometrics, inflammation, and quality of life.</p><p><strong>Results: </strong>93 patients were randomized (30 in ST and 31 in ET, 32 in CG; 28% with type 2 diabetes mellitus, 8.5% insulin-dependent). Total weight was - 2.5 kg (95% CI - 4.7 to - 0.4, p = 0.023) lower in pooled intervention group (PIG) and fat mass according to bioelectrical impedance analysis was - 3.0 kg (95% CI - 5.0 to - 1.0, p = 0.0037) lower in the PIG. Fat-free mass decreased by - 4.2 kg with no difference between the groups. The primary endpoint, glucose concentration after a 2 h oral glucose tolerance test, did not differ between the PIG and the CG, - 0.29 mmol/L (95% CI - 1.22 to 0.63, p = 0.54). Similarly, we did not detect any differences in lipid metabolism, inflammation, and quality of life between the groups.</p><p><strong>Conclusion: </strong>In our study, we found that an additional exercise training 6 months postoperatvely- independent of the type of training- resulted in greater weight loss and loss of fat mass. However, it had no effect on glucose/lipid parameters or inflammation beyond the surgery itself.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"194"},"PeriodicalIF":2.1,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long term results and quality of life after primary excision followed by Limberg plasty in pilonidal sinus disease.","authors":"Jenny König, Utz Settmacher, Aladdin Ali Deeb, Oliver Rohland, Felix Dondorf, Astrid Bauschke, Falk Rauchfuß, Michael Ardelt","doi":"10.1007/s00423-025-03776-8","DOIUrl":"10.1007/s00423-025-03776-8","url":null,"abstract":"<p><strong>Background: </strong>Pilonidal sinus disease (PSD) is a frequently occurring condition that can have a significant impact on quality of life (QoL). In addition to severe pain, particularly with movement or while sitting, this disease imposes restrictions that affect one's professional and private life. These patients frequently suffer from recurrence requiring multiple interventions and hospital stays.</p><p><strong>Methods: </strong>The study enrolled forty-seven patients who presented with PSD from August 2010 until June 2019 and underwent primary excision and LP at the Department of General, Visceral, and Vascular Surgery at University Hospital, Jena. Forty- one of these patients were questioned retrospectively in writing or by telephone interviews between July 2021 to September 2022. The data processed using SPSS software.</p><p><strong>Results: </strong>The median follow-up for all patients was 86 months (range, 23-140 months). Only one recurrence (2.4%) was reported. While the participants' BMIs remained unchanged, they reported significant improvements in QoL, notably in five of the six activities of daily living that were evaluated.</p><p><strong>Conclusion: </strong>The low rate of recurrence suggests that LP is an effective option for post-excision surgical repair of pilonidal sinus. The use of this procedure has no impact on patient's BMI but can significantly improve patients' QoL.</p>","PeriodicalId":17983,"journal":{"name":"Langenbeck's Archives of Surgery","volume":"410 1","pages":"193"},"PeriodicalIF":2.1,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12167314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}