Surgery Today最新文献

Impact of data compression and security devices on telesurgery systems. 数据压缩和安全设备对远程手术系统的影响。

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-07 DOI: 10.1007/s00595-025-03142-7

Hajime Morohashi, Kenichi Hakamada, Yusuke Wakasa, Kazuki Yokoyama, Yuma Ebihara, Satoshi Hirano, Eiji Oki, Norihiko Ikeda, Akinobu Taketomi, Masaki Mori

{"title":"Impact of data compression and security devices on telesurgery systems.","authors":"Hajime Morohashi, Kenichi Hakamada, Yusuke Wakasa, Kazuki Yokoyama, Yuma Ebihara, Satoshi Hirano, Eiji Oki, Norihiko Ikeda, Akinobu Taketomi, Masaki Mori","doi":"10.1007/s00595-025-03142-7","DOIUrl":"https://doi.org/10.1007/s00595-025-03142-7","url":null,"abstract":"Purpose: To evaluate the feasibility of secure telesurgery by assessing the impact of image compression and cybersecurity devices on surgical performance and data transmission.Methods: Telesurgical procedures using the hinotori™ surgical robot were performed remotely between Hirosaki and Goshogawara, which are 30 km apart, over a secure line provided by NTT East. Image compression was tested at 120, 80, 60, 40, and 20 Mbps. A surgical specialist operated on artificial organ models. Simulated cyberattacks were introduced to assess the performance of security devices.Results: Even at 20 Mbps, there was no significant loss in operability or image quality. Security devices detected simulated attacks and permitted essential robot communications. No visual distortion or operational issues occurred, and only a small delay of ≤ 2 min was introduced. The transmission control protocol (TCP) error rates remained low, with or without security devices (0.00-0.04%).Conclusion: Security implementation enables safe telesurgery by detecting cyber threats without impairing surgical performance. This finding supports the practical development of economically and technologically viable telesurgical systems.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145239686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Correction: Impact of obesity on the short-term outcomes of robotic surgery for rectal cancer: a Japanese multicenter study. 更正：肥胖对直肠癌机器人手术短期结果的影响：一项日本多中心研究。

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-06 DOI: 10.1007/s00595-025-03138-3

Hiroki Katayama, Tetsuro Tominaga, Yuma Takamura, Shintaro Hashimoto, Mariko Yamashita, Shoko Tei, Rika Ono, Mitsutoshi Ishii, Makoto Hisanaga, Kaido Oishi, Masaaki Moriyama, Fumitake Uchida, Toshio Shiraishi, Takashi Nonaka, Keitaro Matsumoto

引用次数: 0

Impact of the 2024 work style reform on cardiovascular surgeons in Japan: a comparative cross-sectional study using pre- and post-reform survey data. 2024年工作方式改革对日本心血管外科医生的影响：一项使用改革前后调查数据的比较横断面研究

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-06 DOI: 10.1007/s00595-025-03144-5

Ikuko Shibasaki, Akira Shiose, Yasushi Takagi, Aya Saito, Yuji Hiramatsu, Takashi Miura, Minoru Ono

{"title":"Impact of the 2024 work style reform on cardiovascular surgeons in Japan: a comparative cross-sectional study using pre- and post-reform survey data.","authors":"Ikuko Shibasaki, Akira Shiose, Yasushi Takagi, Aya Saito, Yuji Hiramatsu, Takashi Miura, Minoru Ono","doi":"10.1007/s00595-025-03144-5","DOIUrl":"https://doi.org/10.1007/s00595-025-03144-5","url":null,"abstract":"Purpose: Traditionally, cardiovascular surgeons (CSs) in Japan work long hours. To evaluate the impact of the 2024 Work Style Reform on their work environment, we analyzed how the working conditions of CSs have changed since the reform's implementation.Methods: We conducted an anonymous web-based survey during a patient-safety session at the 55th Annual Meeting of the Japanese Society for Cardiovascular Surgery.Results: Of the 1,229 respondents, 1,124 board-certified CSs were included in the analysis. Among them, 64.6% reported working over 60 h per week and 29.5% were unaware of their institution's designated work-hour category. Younger age (adjusted odds ratio [aOR]: 0.594) and employment at a university hospital (aOR: 2.071) were independently associated with extended working hours. Over 80% of respondents reported no significant change in their working hours or job responsibilities post-reform. The availability of nurse practitioners (NPs) or nurses certified in specified medical-acts training (SNs) had no significant impact on workload, although most surgeons perceived their benefit.Conclusion: Extended working hours remain prevalent among CSs in Japan despite the implementation of the work-style reforms. Strategic adoption of task-shifting and enhanced staffing is required urgently to ensure the sustainability of cardiovascular surgical care.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Back to the battlefield: minimally invasive management of postcholecystectomy remnants: a systematic appraisal of safety and efficacy. 回到战场：胆囊切除术后残余的微创治疗：安全性和有效性的系统评价。

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-02 DOI: 10.1007/s00595-025-03143-6

Alessia Fassari, Edoardo Rosso, Maleyko Mohamed-Wais, Jyoti Lakshmi Anafack, Sonia Ursino, Vito De Blasi

{"title":"Back to the battlefield: minimally invasive management of postcholecystectomy remnants: a systematic appraisal of safety and efficacy.","authors":"Alessia Fassari, Edoardo Rosso, Maleyko Mohamed-Wais, Jyoti Lakshmi Anafack, Sonia Ursino, Vito De Blasi","doi":"10.1007/s00595-025-03143-6","DOIUrl":"https://doi.org/10.1007/s00595-025-03143-6","url":null,"abstract":"Postcholecystectomy syndrome (PCS) may result from either subtotal cholecystectomy or unintentional incomplete resection, leading to remnant gallbladder or residual cystic duct pathology. This scenario often presents years later, complicated by lithiasis that is not amenable to endoscopic treatment and prior surgery performed via laparotomy, typically due to difficult anatomy. Thus, reoperation becomes a technically demanding scenario, revisiting a surgical battlefield shaped by dense adhesions and distorted landmarks. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review across five databases, including studies with five or more patients undergoing laparoscopic or robotic reoperation for remnant gallbladder or cystic ducts. Data on the surgical approach, complications, conversion, and symptom resolution were collected and analyzed descriptively. Nineteen studies (443 patients) were included (407 laparoscopies and 36 robotic surgeries). The overall morbidity rate was 9.0%; conversion to open surgery occurred in 3.6% of the patients in the laparoscopic group. The robotic subgroup showed no conversions and a slightly lower morbidity (5.6%) than the laparoscopic cohort. The symptom resolution rate was 98.4%. Reoperations are often indicated after failed endoscopic retrograde cholangiopancreatography. Minimally invasive reoperation is feasible and safe in select cases of PCS, even in hostile surgical fields. Robotics offers enhanced precision and visualization and is particularly valuable in reoperative biliary surgery. Prospective studies are needed to determine optimal indications.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Postoperative outcomes of pulmonary resection in patients with non small-cell lung cancer with chronic kidney disease: a retrospective study. 非小细胞肺癌合并慢性肾脏疾病患者肺切除术的术后疗效：一项回顾性研究

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-02 DOI: 10.1007/s00595-025-03135-6

Yoshihito Iijima, Takaki Mizoguchi, Masahito Ishikawa, Shun Iwai, Nozomu Motono, Hidetaka Uramoto

{"title":"Postoperative outcomes of pulmonary resection in patients with non small-cell lung cancer with chronic kidney disease: a retrospective study.","authors":"Yoshihito Iijima, Takaki Mizoguchi, Masahito Ishikawa, Shun Iwai, Nozomu Motono, Hidetaka Uramoto","doi":"10.1007/s00595-025-03135-6","DOIUrl":"https://doi.org/10.1007/s00595-025-03135-6","url":null,"abstract":"Purpose: To investigate the impact of chronic kidney disease (CKD) on perioperative and long-term outcomes of pulmonary resection in patients with lung cancer.Methods: Data from 331 patients who underwent pulmonary surgery for non-small-cell Lung cancer associated with CKD between 2016 and 2020 were analyzed. Patients were categorized based on preoperative reduced renal function (estimated glomerular filtration rate [eGFR] < 45 mL/min/1.73m2 [CKD grade ≥ G3b]). Patients with (n = 20) and without (n = 311) CKD were compared based on their clinicopathological characteristics and outcomes.Results: Grades ≥ 2 and ≥ 3 postoperative pulmonary complications (PPCs) in the Clavien-Dindo classification and postoperative air leaks were common in the CKD group (p = 0.015, 0.005, and 0.025, respectively). The duration of drainage and hospital stay was long (p = 0.003, and p = 0.040, respectively). Kaplan-Meier curves showed a poor prognosis with regard to the overall survival (p = 0.022) and disease-free survival (p = 0.018) in the CKD group. A multivariate analysis confirmed that CKD with an eGFR < 45 mL/min/1.73 m2 was a significant risk factor for grade ≥ 3 PPCs (p = 0.037).Conclusions: CKD with an eGFR < 45 mL/min/1.73 m2 involves various perioperative risks; therefore, care must be taken in intraoperative and perioperative management, and long-term collaboration with a nephrologist even before surgery is necessary.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Simplified predictive model for intussusception in children: combining radiographic and clinical features. 儿童肠套叠的简化预测模型：结合影像学和临床特征。

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-01 Epub Date: 2025-04-24 DOI: 10.1007/s00595-025-03052-8

Takayuki Fujii, Aya Tanaka, Hiroto Katami, Ryuichi Shimono

{"title":"Simplified predictive model for intussusception in children: combining radiographic and clinical features.","authors":"Takayuki Fujii, Aya Tanaka, Hiroto Katami, Ryuichi Shimono","doi":"10.1007/s00595-025-03052-8","DOIUrl":"10.1007/s00595-025-03052-8","url":null,"abstract":"Purpose: To evaluate the utility of combining plain abdominal radiography findings with clinical symptoms for the primary screening of intussusception in children.Methods: A total of 152 children aged < 16 years, who were admitted with suspected intussusception between April, 2008 and October, 2024, were enrolled in this retrospective cohort study. We analyzed the demographic data, clinical symptoms, laboratory findings, and abdominal radiography results of all participants. Logistic regression and receiver operating characteristic curves were used to identify significant predictors and assess the diagnostic performance, respectively.Results: Intussusception was diagnosed in 90 of the 152 patients. Vomiting (odds ratio [OR], 8.1; 95% confidence interval [CI] 2.1-32.2), intermittent pain (OR 9.8; 95% CI 2.3-41.4), and abdominal radiography positivity (OR 85.1; 95% CI 12.6-575.0) were identified as significant predictors. Abdominal radiography demonstrated a high sensitivity (97%) and negative predictive value (93%). In contrast, combining the three predictors improved the diagnostic specificity and positive predictive value to 95% and 91%, respectively. The combined predictors achieved an area under the curve of 0.92, indicating excellent diagnostic performance.Conclusions: Combining abdominal radiography findings with clinical symptoms enhances the diagnostic accuracy of intussusception and provides a practical approach for primary screening.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1430-1435"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Geometric change in the aortic annulus after aortic root remodeling in Japanese patients. 日本患者主动脉根重塑后主动脉环的几何变化。

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-01 Epub Date: 2025-04-29 DOI: 10.1007/s00595-025-03046-6

Hiroyuki Morokuma, Keiji Kamohara, Hisashi Satoh, Hideyuki Fumoto, Yuji Katayama, Kazuhisa Rikitake, Satoshi Ohtsubo, Masaru Yoshikai, Kojiro Furukawa, Shigeki Morita, Tsuyoshi Itoh

{"title":"Geometric change in the aortic annulus after aortic root remodeling in Japanese patients.","authors":"Hiroyuki Morokuma, Keiji Kamohara, Hisashi Satoh, Hideyuki Fumoto, Yuji Katayama, Kazuhisa Rikitake, Satoshi Ohtsubo, Masaru Yoshikai, Kojiro Furukawa, Shigeki Morita, Tsuyoshi Itoh","doi":"10.1007/s00595-025-03046-6","DOIUrl":"10.1007/s00595-025-03046-6","url":null,"abstract":"Purpose: The progression of aortic root dilation after remodeling remains unclear. This study investigated the geometric changes in aortic root morphology during the mid- to long-term period after aortic root remodeling in Japanese patients.Methods: Seventy-six patients underwent aortic root remodeling between August 1996 and January 2022. We compared the echocardiographic findings of the aortic root morphology in the preoperative, early postoperative, and most recent late postoperative periods. The postoperative clinical outcomes were also assessed.Results: The mean preoperative diameters of the aortic annulus, sinus of Valsalva, and sinotubular junction were 25.2 ± 2.8 mm, 50.0 ± 7.6 mm, and 42.7 ± 9.5 mm, respectively. The mean grade of aortic regurgitation was 2.9°. Postoperatively, all diameters decreased significantly. The aortic annulus measured 21.3 ± 2.4 mm early postoperatively and 22.0 ± 2.4 mm late postoperatively, without significant enlargement over time. Ten patients required reoperation during the follow-up period; however, no significant aortic annulus enlargement was observed.Conclusion: Aortic root remodeling preserved the aortic root morphology without any late enlargement of the aortic annulus, even in reoperation cases.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1454-1460"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144014247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impedance-based detection of cervical lymph-node involvement in thyroid cancer patients: a human model study. 基于阻抗检测甲状腺癌患者颈部淋巴结受累：一项人体模型研究。

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-01 Epub Date: 2025-04-03 DOI: 10.1007/s00595-025-03033-x

Hossein Ataee, Mohammad Seraj, Reihane Mahdavi, Ali Fardoost, Abdollah Shafiee, Khosro Shamsi, Mohammadreza Fattahi, Hojat Ebrahiminik, Parisa Hoseinpour, Shahram Sane, Mehran Ghazimoghaddam, Mohammad Esmaeel Akbari, Mohammad Abdolahad

{"title":"Impedance-based detection of cervical lymph-node involvement in thyroid cancer patients: a human model study.","authors":"Hossein Ataee, Mohammad Seraj, Reihane Mahdavi, Ali Fardoost, Abdollah Shafiee, Khosro Shamsi, Mohammadreza Fattahi, Hojat Ebrahiminik, Parisa Hoseinpour, Shahram Sane, Mehran Ghazimoghaddam, Mohammad Esmaeel Akbari, Mohammad Abdolahad","doi":"10.1007/s00595-025-03033-x","DOIUrl":"10.1007/s00595-025-03033-x","url":null,"abstract":"Purpose: Current diagnostic modalities for differentiating between benign and malignant cervical lymph nodes in patients with thyroid cancer are imprecise and time-consuming. The real-time intraoperative detection of malignancy in suspicious lesions could improve the medical management of these patients. This human study was undertaken to evaluate a precise, newly developed Electrical Lymph-Node Scanning (ELS) system to facilitate the effective treatment of cervical LNs in thyroid cancer patients.Methods: Using the ELS, we examined a collective 109 radiologically suspicious lymph nodes from 36 patients after dissection and compared the ELS results with the histopathological findings.Results: A total of 27 involved lymph nodes were correctly diagnosed, while 75 reactive or free lymph nodes were correctly identified as uninvolved lymph nodes by ELS (as 3 false negatives and 4 false positives) with total sensitivity and specificity of 90% and 94.9%, respectively. The corresponding negative and positive predictive values were 87.1% and 96.2%, respectively.Conclusions: Results from this clinical study demonstrate the value of the ELS as a surgical assist adjunct for differentiating equivocal lesions during neck dissection surgery for patients with different types of thyroid cancer.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1497-1505"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Gender disparity and overestimation of the involvement of male surgeons in childcare in the Japanese Surgical Community. 日本外科社区中男性外科医生参与儿童保育的性别差异和高估。

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-01 Epub Date: 2025-04-29 DOI: 10.1007/s00595-025-03045-7

Junko Mukohyama, Kae Okoshi

引用次数: 0

Impact of an improvement in the early left ventricular ejection fraction on the 1-year clinical outcomes and its predictors after transcatheter aortic valve replacement. 早期左室射血分数改善对经导管主动脉瓣置换术后1年临床结果及其预测因素的影响

IF 1.6 4区医学

Surgery Today Pub Date : 2025-10-01 Epub Date: 2025-05-03 DOI: 10.1007/s00595-025-03036-8

Ikuko Shibasaki, Yusuke Takei, Suguru Hirose, Michiaki Tokura, Masahiro Tezuka, Shohei Yokoyama, Ryujiro Suzuki, Riichi Nishikawa, Shu Inami, Yasuo Haruyama, Shigeru Toyoda, Hirotsugu Fukuda

{"title":"Impact of an improvement in the early left ventricular ejection fraction on the 1-year clinical outcomes and its predictors after transcatheter aortic valve replacement.","authors":"Ikuko Shibasaki, Yusuke Takei, Suguru Hirose, Michiaki Tokura, Masahiro Tezuka, Shohei Yokoyama, Ryujiro Suzuki, Riichi Nishikawa, Shu Inami, Yasuo Haruyama, Shigeru Toyoda, Hirotsugu Fukuda","doi":"10.1007/s00595-025-03036-8","DOIUrl":"10.1007/s00595-025-03036-8","url":null,"abstract":"Purpose: We evaluated the 1-year clinical outcomes (all-cause mortality, heart failure rehospitalization, and their composite) in patients with severe aortic stenosis (AS) and a preoperative left ventricular ejection fraction (LVEF) < 50% who underwent transcatheter aortic valve replacement (TAVR), and examined the baseline factors predicting ≥ 10% early LVEF improvement.Methods: We retrospectively analyzed 44 patients who underwent TAVR and divided them into Group R (≥ 10% LVEF improvement, n = 25) or Group N (< 10% improvement, n = 19). A Kaplan-Meier analysis was used to assess the survival rates, and multivariable logistic regression was applied to identify the predictors of LVEF improvement.Results: The mean patient age was 84.8 ± 4.8 years, and 40.9% were male. Post-TAVR, 56.8% of patients showed ≥ 10% LVEF improvement (mean increase: 16.7 ± 6.1%). The one-year mortality was similar between the groups (p = 0.383), whereas the composite endpoint tended to be higher in Group N (0.4% vs. 21.1%, p = 0.072). The peak aortic valve velocity was the only significant predictor (OR = 0.255, p = 0.048; cutoff: 4.45 m/s, sensitivity, 0.840; specificity, 0.684).Conclusion: In patients with severe AS and a preoperative LVEF of < 50%, 56.8% demonstrated a significant early LVEF improvement post-TAVR. Patients with a ≥ 10% improvement had a significantly lower 1-year mortality rate.","PeriodicalId":22163,"journal":{"name":"Surgery Today","volume":" ","pages":"1471-1480"},"PeriodicalIF":1.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144032437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0