Updates in Surgery最新文献

{"title":"Comments on 'Should we adopt a 'laparoscopy first' strategy? A comparison of 30‑day outcomes between converted open from laparoscopic and planned open colectomy for volvulus'.","authors":"Sabri Selcuk Atamanalp","doi":"10.1007/s13304-025-02188-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02188-z","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765150","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":"Genetic predictors of postoperative recurrence in node-negative intrahepatic cholangiocarcinoma.","authors":"Bo Zhang, Xiang-Yu Wang, Lu-Yu Yang, Xiao-Tian Shen, Ying Zhu, Wen-Wei Zhu, Jie Fan, Lu Lu, Jin-Hong Chen","doi":"10.1007/s13304-025-02189-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02189-y","url":null,"abstract":"<p><p>Recent studies have revealed the prognostic value of genetic alterations in intrahepatic cholangiocarcinoma (ICC). However, the influence of individual mutations on postoperative recurrence has not been comprehensively evaluated, especially for lymph node-negative cases. A total of 589 localized ICCs with clinically or pathologically negative lymph node (cN0M0 or pN0M0) from 3 independent cohorts were included. The impact of clinicopathological and mutational parameters on recurrence-free survival (RFS) and post-recurrence survival (PRS) was analyzed using the Cox proportional hazards model. The effect of prognostic mutations on RFS and PRS was estimated by Kaplan-Meier analysis. Extremes of survivorship analysis was used to reveal distinct genomic profiles between cases with very early recurrence (VER) and long-term no recurrence (LNR). Among the recurrent mutations, only TP53 and KRAS showed significant association with RFS in both of the two screening cohorts. In the validation cohort, TP53 and KRAS mutations were both independent predictors for shorter RFS. Compared with wild-type patients, TP53 and KRAS mutations were more frequently observed in VER group than in LNR group, and were more enriched in patients with intrahepatic and extra-hepatic recurrence (IER). Furthermore, TP53 mutation was significantly associated with worse survival and lower probability of repeated hepatectomy in patients suffered from recurrence. TP53 and KRAS mutations were important genetic predictors that correlated with earlier and more aggressive recurrence in node-negative ICC patients after surgery. Effective peri-operative therapies for these high-risk tumor biology are needed to improve the clinical outcome for related patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773435","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":"Laparoscopic versus open liver resection for large (≥ 5 cm) hepatocellular carcinoma in elderly patients: a multicenter propensity score-matched study.","authors":"Gianluca Cassese, Fabio Giannone, Federica Cipriani, Antonio Cubisino, Rami Rhaiem, Bruno Branciforte, Edoardo Maria Muttillo, Bader Al Taweel, Alessandro Tropea, Emanuele Felli, Raffaele Brustia, Daniele Sommacale, Ephrem Salame, Patrick Pessaux, Salvatore Gruttadauria, Gian Luca Grazi, Guido Torzilli, Tullio Piardi, Ho-Seong Han, Mickael Lesurtel, Luca Aldrighetti, Fabrizio Panaro","doi":"10.1007/s13304-025-02113-4","DOIUrl":"https://doi.org/10.1007/s13304-025-02113-4","url":null,"abstract":"<p><p>The outcomes of laparoscopic liver resection (LLR) for large (≥ 5 cm) hepatocellular carcinoma (HCC) in elderly (≥ 70 years old) patients have not been deeply investigated so far. The aim of the study was to compare short- and long-term results of LLR vs. open liver resection (OLR) in this setting. Data regarding all patients undergoing liver resection for large HCC were retrospectively collected from referral European and Asian HPB centers. The cases were propensity score matched for age, BMI, center, underlying liver cirrhosis, comorbidities, extent of the resection, tumor size, and numbers. After matching 363 patients with large HCC aged ≥ 70 years old, two cohorts of 90 patients were compared. The laparoscopic group showed a shorter median length of hospital stay (7 vs 9 days, p = 0.01), with a lower rate of R1 resections (4.4% vs 13.3%, p = 0.03). No statistically significant differences were found in the median operative time (p = 0.34), intraoperative blood transfusions (p = 1.00), severe postoperative complications (p = 0.29), postoperative hemorrhage (p = 0.30), post-hepatectomy liver failure (p = 0.47), or in-hospital mortality (p = 0.31). After a median follow-up of 35 months (95% CI 27.6-42.3), there were no statistically significant differences in both overall survival (p = 0.28) and disease-free survival (p = 0.42). LLR was safe and effective in selected cases of large HCC in elderly patients and was proven to shorten median hospital stay and to reduce the R1 rates, without affecting both short- and long-term survival outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765155","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":"Robotic bariatric surgery: the Italian point of view to go beyond.","authors":"Giovanni Fantola, Beniamino Pascotto, Giuseppe Navarra, Marco Raffaelli","doi":"10.1007/s13304-025-02146-9","DOIUrl":"https://doi.org/10.1007/s13304-025-02146-9","url":null,"abstract":"<p><p>Italian robotic community discussed critical issues about data of robotic bariatric surgery activity in Italy. A working group of Italian bariatric surgeon evaluated the current evidence on robotic use discussed its limits, advantages and future perspective in bariatric field. The chair of the working group (MR) and a group of participants (G.F., B.P., G.N.) reported results of Italian SICOB Registry data and discussed about future perspective on the behalf of the Italian Working Group on Robotic Bariatric Surgery (IGRoBS).</p><p><strong>Material: </strong>Database of SICOB Italian Registry was analysed since 2014. All procedures were categorized by years from 2014 to October 2024 and evaluated compared than total bariatric procedures (robotic rate). Type of procedures was classified: Roux-en-Y gastric bypass (RYGB), One-anastomosis gastric bypass (OAGB), Sleeve Gastrectomy (SG), Single anastomosis duodenal-ileal bypass (SADIS), Gastric Plication (GP), Gastric Banding (GB) .</p><p><strong>Results: </strong>168.309 bariatric procedures from 2014 to October 2024 was recorded in SICOB Registry. 1086 procedures (0.64%) were recorded as robotic approach. Robotic bariatric procedures increased by years from 19 robotic procedures in 2014 to 344 procedures in the first 10 months in 2024. Robotic bariatric rate increased in the last years from 0,2% in 2014 to 3,7% in 2024. Robotic procedure types were RYGB 549, SG 433, OAGB 73, SADIS 21, GP 10, GB 5. In the last year, robotic SG was more widespread than other procedures (174 SG versus 147 RYGB).</p><p><strong>Conclusion: </strong>Data showed an increased robotic activity in Italy. Literature reported that more complex procedures, such as revisional procedures, bariatric procedures combined with hiatal hernia repair, and complex cases, including superobese patients and procedures requiring manual anastomosis are promising areas for validating the use of robotic surgery. Future prospective could be resume in three answer: could robotic platforms be more useful than laparoscopy for achieving a safe and efficient learning curve? Could it offer a viable path toward solo-surgery? Could it value for AI applications, and for training and proctoring of new users?</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773527","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 and oncological implications of the presence of hepatic artery anatomical variations in patients undergoing pancreaticoduodenectomy: a single center experience.","authors":"Laura Alberici, Claudio Ricci, Vincenzo D'Ambra, Carlo Ingaldi, Margherita Minghetti, Carlo Mazzucchelli, Riccardo Casadei","doi":"10.1007/s13304-025-02079-3","DOIUrl":"10.1007/s13304-025-02079-3","url":null,"abstract":"<p><p>The presence of an aberrant right hepatic artery (a-RHA) could influence the oncological and postoperative outcomes after pancreaticoduodenectomy (PD). A comparative study was conducted, including patients who underwent PD with a-RHA or with normal RHA anatomy. The primary endpoints were R1 resection in all margins (pancreatic, anterior, posterior, superior mesenteric artery, and portal groove), overall survival (OS), and disease-free survival (DFS). The secondary endpoints were morbidity, mortality, biliary leak (BL), postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), post pancreatectomy hemorrhage (PPH), length of stay (LOS), and operative time (OT). The selection bias was measured using the d-value and limited using entropy balancing analysis. Patients with arterial variants were 84 (37.5%), 39 (17.4%) of whom had a-RHA from SMA. The patients with a-RHA were more frequently symptomatic (d = 0.652), often affected by PDAC (d = 0.369), and judged borderline resectable (d = 0.588). Neoadjuvant therapy was more frequently proposed for patients with a-RHA (d = 0.465). The patients with a-RHA often had the Wirsung dilated compared to those without a-RHA (d = 0.336). After bias correction, the R1 resection rate on the superior mesenteric artery (SMA) margin was higher in the a-RHA group than in patients with normal RHA anatomy (OR 2.3; 1.1-5.2; P = 0.045). OS, DFS, morbidity, mortality, biliary leak (BL), postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), post pancreatectomy hemorrhage (PPH), length of stay (LOS), and operative time (OT) were similar in unmatched and matched population. The presence of a-RHA seems to increase the risk of R1 resection in the SMA margin.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"511-521"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068219","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":"Outcome prediction after emergency cholecystectomy: performance evaluation of the ACS-NSQIP surgical risk calculator and the 5-item modified frailty index.","authors":"Andrea Spota, Stefano Granieri, Amir Hassanpour, Eran Shlomovitz, Eisar Al-Sukhni","doi":"10.1007/s13304-025-02128-x","DOIUrl":"10.1007/s13304-025-02128-x","url":null,"abstract":"<p><p>Pre-operative risk assessment tools and frailty scores are increasingly common due to the growing number of elderly, comorbid and frail patients. This study aims to assess the performance of the ACS-NSQIP-SRC (American College of Surgeons- National Surgical Quality Improvement Program- Surgical Risk Calculator) and the 5mFI (5-items modified Frailty Index) in predicting clinical outcomes after emergency cholecystectomy. This is a retrospective cohort study of patients with acute calculous cholecystitis admitted at our tertiary care center from 2018 to 2023. We evaluated discrimination, calibration, and accuracy of the ACS-NSQIP-SRC and 5mFI in predicting any complication, mortality, length of hospital stay (LOS), need for readmission and supported discharge (30-day follow-up). Among 365/642 patients who underwent surgery, the 5mFI showed poor discrimination for all outcomes but good overall accuracy in the prediction of a supported discharge. In 198 operated patients with available data for the ACS-NSQIP-SRC, it underestimated complications and need for readmission while overestimated the need for supported discharge. There was no concordance between predicted and observed LOS. Among 277/642 patients undergoing non-operative management, 2/3 were frail or mild frail and had a predicted rate of any unfavorable outcome after surgery between 0 and 20%, being 95% above the average risk of each outcome. Mortality couldn't be studied because no death was reported. ACS-NSQIP-SRC and 5mFI performance in predicting outcomes after emergency cholecystectomy for acute cholecystitis was poor. In the emergency cholecystectomy setting, the ACS-NSQIP-SRC may be less informative, and the 5mFI may be excessively simplistic by neglecting the multidimensional nature of frailty.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"481-491"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493869","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":"Presentation and outcomes of surgery for choledochal cyst in children and adults: an experience of 329 cases.","authors":"Sukanta Ray, Hemabha Saha, Swapnil Sen, Suman Das, Somdatta Lahiri, Somak Das, Tuhin Subhra Mandal, Jayanta Biswas, Sujan Khamrui","doi":"10.1007/s13304-025-02138-9","DOIUrl":"10.1007/s13304-025-02138-9","url":null,"abstract":"<p><p>The purpose of this study is to report our experience in patients with choledochal cyst (CDC) and to evaluate whether there is any difference in the clinical presentation, cyst -related complications, and long-term biliary outcomes after surgery among children and adults. All the patients who underwent CDC excision between January 2008 and December 2023 were retrospectively reviewed. The patients were divided into two groups: children (< 18 years) and adults (≥ 18 years). There were 329 patients with CDC excision (77.5% were female, adult/children = 251/78). Abdominal pain was the predominant presenting symptom in both groups. Abdominal lump (10.3% vs 3.2%; p = 0.011) and the triad of CDC (9% vs 2.4%; p = 0.009) were more common in children. But, the preoperative biliary intervention (37.8% vs 15.4%; p =  < 0.001), previous biliary surgery (32.7% vs 3.8%; p =  < 0.001), and prevalence of gallstones (36.7% vs 3.8%; p =  < 0.001), cystolithiasis (56.6% vs 38.5%; p = 0.005), and intrahepatic stones (7.6% vs 1.3%; p = 0.054) were more common in adults. Most patients were presented with type I CDC (71.4%). Extrahepatic bile duct excision with Roux en-Y hepaticojejunostomy was performed in all the patients. Although overall postoperative complications were comparable between adults and children (31.1% vs 26.9%; p = 0.485), wound infection was more common in adults (19.9% vs 6.4%; p = 0.005) and bile leak was more common in children (12.8% vs 5.2%; p = 0.021). There was no operative mortality. Over a mean follow-up of 59 (40) months, 2 patients (0.78%) developed malignancy. Excellent or good Long-term biliary outcome was significantly better in children than adults (98.1% vs 90.5%; p = 0.010). Independent predictors for unsatisfactory biliary outcomes were type IVA cysts, postoperative bile leak, adult patients, and longer duration of follow-up. In conclusion, presentation and cyst-related complications differ between adults and children. Surgery offers excellent results in the vast majority of patients. Long-term biliary complications were more in adults. Long-term follow-up is recommended for the possibility of future development of hepato-biliary-pancreatic malignancy and delayed biliary complications.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"459-470"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543614","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":"Comment to: Preliminary experience in using the lateral single-incision laparoscopic totally extraperitoneal approach for inguinal hernia repair.","authors":"Abdullah Hilmi Yilmaz","doi":"10.1007/s13304-025-02068-6","DOIUrl":"10.1007/s13304-025-02068-6","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"589-590"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142955715","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":"Synergistic effect of sarcopenia and ASA status in predicting mortality after emergency laparotomy: a systematic review and meta-analysis with meta-regression.","authors":"Ahmad Al-Sarireh, Hashim Al-Sarireh, Olivia Ambler, Shahin Hajibandeh, Shahab Hajibandeh","doi":"10.1007/s13304-025-02105-4","DOIUrl":"10.1007/s13304-025-02105-4","url":null,"abstract":"<p><p>The aim of this study was to investigate the relationship between sarcopenia and American Society of Anesthesiologists (ASA) status in predicting post-operative mortality after emergency laparotomy. A PRISMA-compliant systematic review and meta-analysis (using random effects modelling) was performed searching for studies reporting 30-day mortality risk in patients with sarcopenia undergoing emergency laparotomy. The ASA status of sarcopenic and non-sarcopenic patients was determined, and the effect of difference in ASA status on 30-day mortality in sarcopenic and non-sarcopenic patients was determined via a meta-regression model. The risk of bias and certainty was assessed using the QUIPS tool and the GRADE system, respectively. Seven studies comprising 2663 patients were included. Thirty-day mortality risk was 22.9% (95% CI 11.6-40.0%) in sarcopenic patients and 6.2% (95% CI 2.9-13.0%) in non-sarcopenic patients; the risk was significantly higher in sarcopenic patients (OR: 4.452, p = 0.016). In sarcopenic patients, ASA status IV-V increased the risk of mortality (Coefficient: 0.07612, p < 0.0001), while ASA status I-II (Coefficient: - 0.09039, p < 0.0001) or ASA status III (Coefficient: 0.01300, p = 0.344) did not. In non-sarcopenic patients, ASA status III (Coefficient: 0.06830, p < 0.0001) and ASA status IV-V (Coefficient: 0.17809, p < 0.0001) increased the risk of mortality, while ASA status I-II (Coefficient: - 0.05841, p < 0.0001) did not. The GRADE certainty was moderate. Sarcopenia and ASA status are two independent predictors of mortality after emergency laparotomy with no significant collinearity. Sarcopenia and ASA status synergistically increase the risk of mortality after emergency laparotomy. ASA status IV and ASA status III are critical thresholds for increased risk of mortality in sarcopenic and non-sarcopenic patients, respectively.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"591-603"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012417","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":"A cross-sectional study to evaluate responses generated by two AI software programs for common patient queries about laparoscopic repair of inguinal hernia.","authors":"Meeran Banday, Kirat Kaur","doi":"10.1007/s13304-025-02158-5","DOIUrl":"10.1007/s13304-025-02158-5","url":null,"abstract":"<p><p>This study aimed to evaluate the quality and accuracy of responses provided by two user-interactive AI chatbots, namely ChatGPT and ChatSonic, in response to patient queries regarding laparoscopic repair of inguinal hernias, and additionally determine the suitability of these chatbots in addressing patient queries related to inguinal hernia repair. Ten questions regarding laparoscopic repair of inguinal hernias were developed and presented to ChatGPT 4.0 and ChatSonic. Responses were evaluated by two experienced surgeons blinded to the source, using the Global Quality Score (GQS) and modified DISCERN Score to gauge response quality and reliability. ChatGPT demonstrated high-quality responses (GQS = 4 & 5) for all ten questions according to one evaluator, and for seven out of ten questions according to the other. Similarly, ChatGPT showed high reliability (DISCERN = 4 & 5) for nine responses according to one evaluator, and for three responses according to the other, with only slight agreement between evaluators for both GQS (kappa = 0.20) and modified DISCERN scores (kappa = 0.08). ChatSonic also provided high-quality and reliable responses for a majority of questions, albeit to a lesser extent than ChatGPT, and both demonstrating limited concordance in responses (p > 0.05). Overall, Both ChatGPT and ChatSonic demonstrated potential utility in providing responses to patient queries about hernia surgery. However, due to inconsistencies in reliability and quality, ongoing refinement and validation of AI generated medical information remain necessary before widespread clinical adoption.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"583-588"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557739","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}