Turkish Journal of Surgery最新文献

{"title":"The coexistence of gastrointestinal stromal tumors and malignancies: Our 10-year results.","authors":"Yavuz Selim Angın, Cengiz Ceylan, Kutay Sağlam, Cemalettin Aydın","doi":"10.47717/turkjsurg.2024.6389","DOIUrl":"10.47717/turkjsurg.2024.6389","url":null,"abstract":"<p><strong>Objectives: </strong>Gastrointestinal stromal tumor (GIST) is one of the most common mesenchymal tumors in the gastrointestinal system, occurring frequently after epithelial tumors. Although rare, secondary epithelial malignancies can be associated with GISTs. It was planned to conduct a retrospective cohort study evaluating the coexistence of GISTs with malignancies and their long-term outcomes through clinical and pathological findings.</p><p><strong>Material and methods: </strong>Demographic and clinicopathological data of 69 patients who underwent surgery for GIST between January 2011 and November 2021 were retrieved from the patient database. Variables between the groups with only GIST and those with a secondary malignancy alongside GIST were analyzed using the Chi-square test and Mann-Whitney U test. Long-term survival analyses were conducted using the Kaplan-Meier test. A p-value of <0.05 was considered statistically significant.</p><p><strong>Results: </strong>Out of the 69 patients in our population, 40 (58%) were male, and the median age was 65 years (interquartile range= 56-75). GIST was the most commonly located in the stomach (59.4%), and nine (13%) patients had a secondary malignancy. Tumor size, smooth muscle antibody (SMA), and S100 antibody expression showed significant differences between the groups (p <0.001, p= 0.015, p= 0.006). Shorter survival was observed in patients with GIST plus secondary malignancy (p= 0.005).</p><p><strong>Conclusion: </strong>The incidence of other intraabdominal malignancies occurring alongside GISTs is more common than have been previously thought. While the presence of a secondary malignancy does not impact the overall survival (OS) in GISTs, it was observed that survival is dependent on the primary malignancy. Patients diagnosed with GISTs require thorough investigation and close monitoring for secondary malignancies.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 3","pages":"197-203"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relation between ABO blood groups and clinicopathologic characteristics of the patients with gastric adenocarcinomas.","authors":"Süleyman Utku Çelik, Yasin Gülap, Mehmet Bahadır Demir, Şahin Kaymak, Rahman Şenocak","doi":"10.47717/turkjsurg.2024.6434","DOIUrl":"10.47717/turkjsurg.2024.6434","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to examine the association between blood groups and clinicopathological factors that could affect the prognosis of patients with gastric cancer.</p><p><strong>Material and methods: </strong>In this retrospective single-center study, patients with gastric adenocarcinoma were obtained from a prospectively maintained database. The association between blood groups and clinicopathologic characteristics including sex, age, tumor location, tumor size, tumor stage, metastatic lymph node ratio (MLR), lymphovascular invasion, and perineural invasion were analyzed.</p><p><strong>Results: </strong>The study included 91 female and 221 male patients. The blood group distribution was A>O>B>AB both in the patients and healthy donors. Non-O blood types were more common in cancer patients than in healthy donors (p= 0.038). However, there was no significant association between sex, age, tumor location, tumor stage, lymph node status, lymphovascular invasion, and perineural involvement and blood groups. ≥7 lymph node involvement and MLR of >0.6 were significantly more common in patients with blood group A than in those with non-A blood groups (p= 0.034 and p= 0.018; respectively).</p><p><strong>Conclusion: </strong>The findings of this study suggest that blood group A patients are associated with higher MLR and N3 involvement, so it is possible that these patients with gastric cancer have a poorer prognosis.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 3","pages":"240-246"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A rare case of multiple gastric duplication cysts in an adult.","authors":"Barış Zülfikaroğlu, Özgür Akgül, Mehmet Mahir Özmen","doi":"10.47717/turkjsurg.2022.4933","DOIUrl":"10.47717/turkjsurg.2022.4933","url":null,"abstract":"<p><p>Intestinal duplications are rare developmental anomalies that can occur anywhere along the gastrointestinal tract. Gastric duplication cysts are uncommon congenital anomalies and are rarely diagnosed in adults. However, diagnosis of the condition in an adult can be difficult as it is usually asymptomatic, or the symptoms are nonspecific. Here we report a rare case of symptomatic gastric duplication cysts in an adult who was treated successfully with surgical resection.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 3","pages":"264-266"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Liver biopsy in patients with gall stone disease and concomitant non-alcoholic fatty liver disease undergoing cholecystectomy: A prospective observational study.","authors":"Aaron John, Utpal Anand, Tarun Kumar, Rohith Kodali, Kunal Parasar, Ramesh Kumar, Rajeev Priyadarshi, Basant Singh, Kislay Kant","doi":"10.47717/turkjsurg.2024.6488","DOIUrl":"10.47717/turkjsurg.2024.6488","url":null,"abstract":"<p><strong>Objectives: </strong>Gallstone disease (GSD) and non-alcoholic fatty liver disease (NAFLD) share common risk factors. NAFLD can progress to non-alcoholic steatohepatitis (NASH), which may lead to severe liver conditions. This study aimed to assess the prevalence of NASH and associated factors in patients with GSD and fatty liver undergoing cholecystectomy.</p><p><strong>Material and methods: </strong>This prospective observational study was conducted from March 2021 to June 2023 and included 134 patients diagnosed with GSD and fatty liver based on preoperative ultrasound. Core liver biopsies were obtained during cholecystectomy. Preoperatively, clinical, anthropometric, demographic, biochemical variables, and FibroScan parameters were recorded.</p><p><strong>Results: </strong>NASH was found in 21 (15.67%) patients, while 50 (37.31%) patients had probable NASH, and 63 (47.01%) had non-NASH scores. Metabolic syndrome was present in 63.6% of the patients. Univariate analysis revealed significant differences in AST and ALT values between the NASH and nonNASH groups. In multivariate analysis, AST was statistically significant (p= 0.041). Mean controlled attenuation parameter in patients with non-NASH was 219.40 ± 60.44 dB/m, and in patients with NASH, it was 265.48 ± 63.47 dB/m (p= 0.006). Fibrosis was present in 33 of the 82 slides examined, with 17 patients having grade 2 and two patients with grade 3 fibrosis.</p><p><strong>Conclusion: </strong>The high prevalence of NASH among GSD patients highlights a significant public health issue, prompting consideration for liver biopsy in individuals with NAFLD and GSD undergoing laparoscopic cholecystectomy.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 3","pages":"190-196"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular and the whole body radiation exposure during endoscopic retrograde cholangiopancreatography.","authors":"Bahtiyar Muhammedoğlu, Mehmet Yasir Pektezel, Murat Ulaş, Sezgin Topuz, Emil Hüseyinoğlu","doi":"10.47717/turkjsurg.2024.6461","DOIUrl":"10.47717/turkjsurg.2024.6461","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to analyze the average whole body radiation exposure, which changes significantly according to during endoscopic retrograde cholangiopancreatography (ERCP) difficulty and to determine whether an ocular protection device must be used by analyzing applied ocular radiation.</p><p><strong>Material and methods: </strong>Patients >18 years of age in whom an ERCP had been indicated were prospectively included in the study.</p><p><strong>Results: </strong>A total of 1173 patients were included. Increased applied radiation dose significantly correlated with increased shot rate (Rho= 0.789, p <0.001), ERCP duration (Rho= 0.487, p <0.001), cost (Rho= 0.129, p <0.001), and LOS (Rho= 0.109, p <0.001). The whole body, skin, and eye radiation exposure doses were found to be lower than the recommended limit per year (20 mSv/year).</p><p><strong>Conclusion: </strong>Limit of ocular radiation exposure during ERCP did not exceed the recommended annual limit (20 mSv/year), and it was also detected to be much lower than that. Therefore, the use of ocular visors is not recommended.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 3","pages":"183-189"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in managing duodenal intussusception: A rare cause of gastric outlet obstruction in adults.","authors":"Payal Kaw, Somanath Malage, Ashish Singh, Rahul R, Nalini Kanta Gosh, Supriya Sharma, Rajneesh Kumar Singh, Ashok Kumar","doi":"10.47717/turkjsurg.2024.6411","DOIUrl":"10.47717/turkjsurg.2024.6411","url":null,"abstract":"<p><p>Intussusception is a rare occurrence in adults and only 5% being adults. Ileocolic intussusception is the most common type in adults whereas duodenal intussusception (DI) is the rarest subtype due to natural retroperitoneal fixation of the duodenum. There are only a few case-reports available in the literature. Here, we aimed to present our experience of five cases with DI in adults, there operative challenges and strategies to deal with the same. Age of presentation ranged from 18-45 years, and four out of five were females. Most common presentation was partial of recurrent gastric outlet obstruction (GOO) along with weight loss. They were all diagnosed on contract-enhanced-CT scan of abdomen, and all had a lead point in form of a benign polypoidal mass arising from duodenum. Two patients were managed with local excision of polyp and retroperitoneal fixation of redundant duodenum, whereas pancreaticoduodenectomy and segmental duodenal resection was required for the other two patients. One patient was lost to follow-up without definitive treatment as was minimally symptomatic. All four operated patients had uneventful recovery post-operatively and are doing well in follow-up. DI is an infrequent occurrence and a rare etiology of GOO in adults. Most of them having benign lead point, require surgical excision of lead point with fixation of duodenum to retroperitoneum. Anatomical proximity of important structures like CBD and pancreatic duct especially at perivaterian location makes surgical resection challenging. With thorough anatomical knowledge and appropriate management, this condition can be managed well.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 2","pages":"168-173"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Juvenile papillomatosis: A case report.","authors":"Yasin Celal Güneş, Pelin Seher Öztekin, Tülin Değirmenci, Funda Uçar, Selma Uysal Ramadan, Pınar Nercis Koşar, Serap Erel, Hatice Ünverdi","doi":"10.47717/turkjsurg.2022.4745","DOIUrl":"10.47717/turkjsurg.2022.4745","url":null,"abstract":"<p><p>Juvenile papillomatosis (JP) is a very rare benign proliferative breast disease, especially in young women under 30 years of age. Its etiology is not clear yet. Although some patients have breast cancer in their family history, up to 10% breast cancer can develop in the follow-up of JP patients. In this pathology, which is diagnosed with biopsy, history, clinical and radiological findings help in diagnosis. In this case report, a 37-year-old patient diagnosed with JP will be discussed in the light of the literature.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 2","pages":"178-182"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of citations and altmetric scores in general surgery literature.","authors":"Divyansh Chaudhary, Shubho Acharya, Vaibhav Aggarwal, Muhammed Huzaifa, Pratischtha Kain, Richa Garg, Khushi Harlalka, Sumit Kumar, Aaditya Vasudev","doi":"10.47717/turkjsurg.2024.6201","DOIUrl":"10.47717/turkjsurg.2024.6201","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to determine various article characteristics influencing the citations and altmetric scores using papers published in a year in four high-ranking surgery journals.</p><p><strong>Material and methods: </strong>We included all papers (n= 819 articles) published between January 2015 to December 2015 in the Annals of Surgery, British Journal of Surgery, JAMA Surgery and Journal of American College of Surgeons. Article characteristics were manually extracted. We determined citation count using the Web of Science database and used univariate analysis and negative binomial regression to determine which article characteristics affect citations and altmetric scores.</p><p><strong>Results: </strong>Mean number of citations and altmetric score received by the article were 44.6 (0-475) and 19.2 (0-665) respectively. Majority of the articles contained at least one citation (98.3%) and altmetric score (98.2%). In regression analysis, citation count was significantly associated with the journal [Annals of Surgery (IRR= 1.93), JAMA surgery (IRR= 1.76)] and non-funded research (IRR= 0.83). The altmetric score was significantly associated with the country of the corresponding author (US) (IRR= 1.3), study subtopic, journal [JAMA surgery (IRR= 2.33)], non-funded (IRR= 0.74) and non-open-access publication (IRR= 0.44).</p><p><strong>Conclusion: </strong>Article metrics were found to be associated with specific study subtopics, country of the corresponding author, funding, open-access publication and the journal. These results might help editors, reviewers and authors to produce, review and publish more impactful studies. A similar study in the future may help to better understand the changing dynamics of academic publishing.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 2","pages":"145-153"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to manage difficult duodenal defects? Single center experience.","authors":"Tufan Egeli, Özgür Çavdaroğlu, Cihan Ağalar, Serhan Derici, Süleyman Aksoy, İnan Yılmaz, Ali Durubey Çevlik, Tayfun Bişgin, Berke Manoğlu, Mücahit Özbilgin, Tarkan Ünek","doi":"10.47717/turkjsurg.2024.6476","DOIUrl":"10.47717/turkjsurg.2024.6476","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to investigate the surgical treatment methods and outcomes of difficult duodenal defects due to perforation.</p><p><strong>Material and methods: </strong>Data of patients who had undergone surgery for difficult duodenal defect between January 2012 and November 2022 were collected. Duodenal defect size of 2 cm or more was defined as difficult duodenal defect. Characteristics of the patients, the etiology of perforation, American Society of Anesthesiology (ASA) scores, Mannheim peritonitis index (MPI), surgical treatment, need for re-operation, and morbidity and mortality were evaluated.</p><p><strong>Results: </strong>Nineteen patients were detected. Etiology was peptic ulcer perforation in 12 (63.1%) patients, aortaduodenal fistula in 2 (10.5%), tumor implant in 2 (10.5%), cholecystoduodenal fistula in 1 (5.2%), endoscopic retrograde cholangio pancreatography (ERCP) in 1 (5.2%), and cholecystectomy related injury in 1 (5.2%) patient. The first surgical procedure was duodenoraphy + omentopexy in 8 (42.1%), Graham repair in 5 (26.3%), duodenal segment 3-4 resection and Roux-en-Y side to side duodenojejunostomy in 4 (21.0%), Roux-en-Y side to side duodenojejunostomy in 1 (0.5%), and 1 (0.5%) subtotal gastrectomy + duodenum 1^st part resection + Roux-en-Y gastroenterostomy, cholecystectomy and external biliary drainage via cystic duct. Four patients who had previously undergone Graham repair (3) and duodenoraphy + omentopexy (1) required salvage surgery. As a salvage surgery; 1 end-to-side and 3 side-to-side Roux-en-Y duodenojejunostomies were performed. Overall, mortality occurred in 6 (31.6%) patients. High ASA score and MPI were considered as significant risk factors for mortality (p= 0.015, p= 0.002).</p><p><strong>Conclusion: </strong>Primary repair techniques can be used in the surgical treatment of difficult duodenal defects when peritonitis is not severe and tensionfree repair is possible. Otherwise, duodenojejunostomy may be preferred as a fast, easy, and safe technique for both initial and salvage surgeries.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 2","pages":"161-167"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for anastomotic complications after elective intestinal resection in Crohn's disease.","authors":"Ali Emre Atıcı, Ayşegül Bahar Özocak, Gülşah Filiz Karpuz, Halil İbrahim Sevindi, Şerif Furkan Dağancı, Şevket Cumhur Yeğen","doi":"10.47717/turkjsurg.2024.6417","DOIUrl":"10.47717/turkjsurg.2024.6417","url":null,"abstract":"<p><strong>Objectives: </strong>Anastomotic leaks are the most feared complications after surgery in patients with Crohn's disease. Identifying associated risk factors is crucial for prevention. We aimed to evaluate possible risk factors for anastomotic complications in our case series.</p><p><strong>Material and methods: </strong>This was a single-center, retrospective, observational study. Eighty-six patients who underwent intestinal resection due to Crohn's disease at the Department of General Surgery, Marmara University, Faculty of Medicine, from 2015 to 2023 were enrolled. Adult patients of either sex who are over 18 years old were included. Cases, where the anastomosis was defunctioned with a proximal diverting ileostomy or colostomy were excluded from the study.</p><p><strong>Results: </strong>The mean (StD) age was 34.8 (14.4) years, and 50 patients (58.1%) were male. Twenty-five patients had post-operative complications (29.1%), and 10 of them (11.6%) were above grade three according to the Clavien-Dindo classification. Anastomotic leakage was observed in two, intra-abdominal collection in two, sepsis in two, enterocutaneous fistula in three, and ileus in the remaining one. While the albumin value <3 gr/dL (OR 5.15, p<0.03) and pre-operative medical treatment (OR= 4.79; p= 0.05) were associated with higher odds of post-operative overall complications, only hypoalbuminemia 3 g/dL (OR= 14.3; p= 0.04) was associated with a higher probability of post-operative anastomotic/septic complications.</p><p><strong>Conclusion: </strong>In patients with pre-operative hypoalbuminemia, temporary stoma creation should be considered due to the potential increased risk of high anastomotic complications. The medical treatments should be discontinued in the pre-operative period due to the increased risk of complications.</p>","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":"40 2","pages":"136-144"},"PeriodicalIF":0.5,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11610615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}