Updates in Surgery最新文献

{"title":"A SICE (Società Italiana di Chirurgia Endoscopica e Nuove Tecnologie) observational prospective multicenter study on lymphadenectomy during right hemicolectomy: Should anatomical variability of the right colic artery influence the surgical strategy?-CoDIG 2 database (ColonDx Italian Group).","authors":"G Anania, A Campagnaro, G Resta, S Pedon, G Silecchia, D Cuccurullo, J Randolph, A De Troia, M Chiozza, S Marino, R Cirocchi","doi":"10.1007/s13304-025-02312-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02312-z","url":null,"abstract":"<p><p>Colon cancer is a worldwide common disease in both gender. Surgery is the best option for the treatment of advanced colon cancer without distant metasisis, but some aspects are still debated, such as the extent of lymphadenectomy. In Japanese guidelines the gold standard was D3 dissection to remove the central lymphonodes (203,213,223), but in 2009 Hoenberger et al. introduced the concept of complete mesocolic excision (CME) in which surgical dissection should follow the embryological planes in order to remove mesentery entirely. This way to prevent leakege of cancer cells and collect more lymphonodes. However, it is not possibile to verify that CME has improved onclogical survival, so our tudy shows how lymphadenectomy is currently performed in major italian centers against an unclear indication on the type of lymphadenectomy that should be performed during right hemicolectomy (RH). CoDIG2 is observational multicenter national study that involves 76 italian general surgery ward highly specialized in colorectal surgery. Each centers was asked not to modify their traditional surgical and clinical practice. Exclusion criteria were: aged < 18 years old, emergency surgery, laparotomic RH, ASA > IV and pregnant women. The aim of study was comparing the risk of postoperative complicationd during RH related to lymphadenectomy performed and the differences between CoDIG 1 study coducted 4 years ago. 788 patients was enrolled. The most used surgical technique was laparoscopic (82.1%) with intracorporeal (73.4%) side-to-side (98.7%) isoperistaltic (96.0%) anastomosis. Comparison between CoDIG1 and CoDIG2 shows a stable trend in surgical technique and complications, with the exception of the robotic approach which has been increasing in recent years (7.7% vs 12.3%). About lymphadenectomy the integrity of mesocolic sail has been in 88.3% of cases and the average lymph nodes harvest was 23, more frequently collected along colic vessels. Instead, sampling of lymph nodes at the origin of the colic vessels was more difficult and associated with more complications, even if the robotic surgery was most used. This analysis show a promising trend regarding how lymphadenectomy is performed in Italy to achieve the oncological outcomes in the RH, even if the technique to achieve a higher lymph nodes count has not been standardized yet.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561299","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":"Liver resection following neoadjuvant immunotherapy: a single center retrospective study.","authors":"Vanja Podrascanin, Markus Ammann, Yawen Dong, Cornelius A Thiels, Susanne G Warner, Mark J Truty, Michael L Kendrick, Rory L Smoot, David M Nagorney, Patrick P Starlinger","doi":"10.1007/s13304-025-02310-1","DOIUrl":"https://doi.org/10.1007/s13304-025-02310-1","url":null,"abstract":"<p><p>Liver resection remains an important treatment approach in both primary and metastatic liver malignancies. However, the impact of neoadjuvant immune checkpoint inhibitor (ICI) therapy on surgical outcomes remains incompletely explored. This study aimed to evaluate safety and surgical and oncological outcomes of liver resections after neoadjuvant immunotherapy. This retrospective single-institution analysis included a total of 20 patients receiving immunotherapy (Pembrolizumab, Durvalumab or Atezolizumab) prior to hepatic resection at Mayo Clinic Rochester from February 2019 until October 2023. Surgical outcomes as well as radiological and pathological response were assessed. A total of 20 patients were identified. The cohort comprised primary liver cancer (n = 5), colorectal cancer liver metastasis (CRLM) (n = 4), and non-CRLM (n = 11). Overall, severe postoperative morbidity was observed in 4 patients, with 2 cases of post hepatectomy liver failure (PHLF Grade B) and no postoperative mortality within 90 days. Histopathological examination delineated complete pathological response (pCR) response in 10 out of 16 evaluated patients, of whom one experienced recurrence within our follow-up period. Radiological response did not correlate with pathological response. Neoadjuvant ICI therapy showed excellent pathological response rates in highly selected patients, while maintaining surgical safety and expected postoperative morbidity. Standard radiological assessment appears to be insufficient to predict pCR.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561301","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":"Management of rectal prolapse in octogenarians: lesson learned in 13 years' experience from a high-volume center.","authors":"Giulia De Carlo, Mikhael Belkovsky, Kristen A Ban, Tracy L Hull, Anna R Spivak","doi":"10.1007/s13304-025-02313-y","DOIUrl":"https://doi.org/10.1007/s13304-025-02313-y","url":null,"abstract":"<p><p>When treating rectal prolapse, traditionally perineal procedures are recommended for elderly patients, while abdominal approaches are usually preferred in healthier and younger ones. We hypothesize that octogenarian patients can be safely treated with abdominal approaches. Our study aimed to evaluate the safety of abdominal procedures in the treatment of rectal prolapsed and to evaluate the recurrence rate. We conducted a retrospective IRB approved review of all patients ≥ 80 years old who underwent rectal prolapse surgery from 2010 to 2023 in our tertiary referral center. Patients were grouped according to the approach used to treat the prolapse (perineal or abdominal). Of the 164 patients included, abdominal approaches were performed in 58 (35.4%) and perineal in 106 (64.6%). Comparing the two approaches, no differences were observed in the female sex (96.6% vs 93.4%. p = 0.5), mean BMI (22.7 vs 23.8 kg/m², p = 0.14), mean ASA class (2.9 vs 2.72, p = 0.4), comorbidities and history of prior rectal prolapse surgery. No differences were found in the use of general anesthesia (100% vs 93.4% p = 0.052) hospitalization course, 30-day morbidity, and mortality rates. Rectal prolapse recurrence was significantly more common following perineal procedures (8.6% vs 18.9%, p = 0.001), with a mean follow-up period of 6.8 months. When treating rectal prolapse in octogenarians, abdominal approaches are safe and have a lower recurrence rate. We recommend for abdominal approaches whenever possible and limiting perineal approaches exclusively to patients with non-permissible risk for general anesthesia or abdominal surgery.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545044","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":"Anatomical variations of the hepatic artery in duodenopancreatectomy: tips and tricks in the minimally invasive surgical approach.","authors":"Alberto García-Picazo, Patricia Sánchez-Velázquez, Fernando Burdio, Benedetto Ielpo","doi":"10.1007/s13304-025-02307-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02307-w","url":null,"abstract":"<p><p>Anatomical variations of the hepatic artery (HA) are frequent (25-45%), representing a special challenge in minimally invasive surgery. Preoperative knowledge of these variations is essential in pancreaticoduodenectomy (PD) to avoid vascular injury and without compromising mesopancreas resection. Patients with anatomical variants of HA, who underwent PD, were selected including robotic and laparoscopy surgery. In all cases, the \"Artery First\" approach of the superior mesenteric artery (SMA) was performed allowing the identification of the origin of arterial variants and the gastroduodenal artery to be sectioned. The objective of this multimedia article is to describe the different surgical approaches, including some tips and trick in case of vascular variants.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144545043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First Touch course-the impact of a nation-wide boot camp on the transition to Surgical residency.","authors":"Sofia Gaspar Reis, Mário Rui Gonçalves, Constança Azevedo, Ana Ruivo, Gonçalo Guidi, Ricardo Marinho, Joana Pinto Teles, Ana Sofia Domingos, André Luís Borges, Filipe Rodrigues Quintas, Liliana Grilo Miranda, António Oliveira, José Novo de Matos","doi":"10.1007/s13304-025-02265-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02265-3","url":null,"abstract":"<p><p>Surgical residents face numerous challenges and undergo significant changes at the beginning of their residency. Although there are several courses throughout residency, it is difficult to address all of them in a single activity. Boot camps (BC) have been a way for easing this transition period. Our team developed the \"First Touch Course\" boot camp in 2017 to join all residents of the same year, before they initiate Surgical residency. Since then, 8 editions have been organised (one per year) with the participation of a total of 481 residents. Eighty-four residents have enrolled in the last two editions, mainly from General Surgery, Gynecology and Urology. The present study analysed the 2023 and 2024 editions to evaluate the impact of this BC on residents' preparedness and confidence to face residency. More than 71% of the participants rated the course as excellent and 100% considered it exceeded their expectations. Almost 100% considered it will have a significant impact and more than 75% felt better prepared to start residency after the course. More than 73% believe that having a laparoscopic simulator will be useful for continuous skills acquisition. This is the first nationwide, multi-speciality boot camp that promotes continuing education, providing each resident with a personal laparoscopy simulator and laparoscopic instruments, allowing for home-based training. This study highlights the importance and impact of this kind of boot camps in preparing residents for the early stages of surgical residency and the impact it may have on basic skills acquisition.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529653","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":"Polidocanol foam for hemorrhoids: promising, yet premature without long-term evidence.","authors":"Muhammad Zahir Shah, Azka Mustaan","doi":"10.1007/s13304-025-02315-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02315-w","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529654","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":"Comparison of robotic liver resection in obese vs. non-obese patients: a multicentric propensity score-matched analysis of perioperative outcomes.","authors":"Antonella Delvecchio, Silvio Caringi, Michele Tedeschi, Francesca Ratti, Paolo Magistri, Andrea Belli, Graziano Ceccarelli, Francesco Izzo, Marcello Giuseppe Spampinato, Nicola de'Angelis, Patrick Pessaux, Tullio Piardi, Fabrizio Di Benedetto, Luca Aldrighetti, Riccardo Memeo","doi":"10.1007/s13304-025-02303-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02303-0","url":null,"abstract":"<p><p>Obesity poses unique challenges in liver surgery, potentially affecting perioperative outcomes. While laparoscopic liver resection (LLR) has demonstrated clear benefits over open surgery, evidence regarding the impact of body mass index (BMI) on robotic liver resection (RLR) outcomes remains limited. This study aims to evaluate the influence of BMI on perioperative outcomes following RLR. A retrospective, multicenter analysis was conducted on patients undergoing RLR. A 3:1 propensity score matching (PSM) was performed to minimize confounding factors, creating two well-balanced groups: patients with BMI <30 and BMI ≥30. Perioperative outcomes, including operative time, blood loss, conversion rates, postoperative complications and R0 resection were compared between the two groups. After PSM, 472 patients were included (BMI <30: n = 354; BMI ≥30: n = 118). No significant differences were observed in operative time (244 ± 107 min vs. 256±120 min, p=0.271), blood loss (225 ± 254 mL vs. 201 ± 186 mL, p = 0.273), or conversion rates (4.5 vs. 3.4%, p=0.601). Overall postoperative complications were comparable between the two groups (14.4% vs.19.5%, p=0.203). ICU stay and hospital length of stay were similar between groups. R0 resection rate was comparable between the groups (95.4 vs. 95.4%, p = 1.000). The 90-day mortality rate was low in both groups (0.3 vs. 0%, p = 0.987). Our findings suggest that RLR is a safe and effective approach for patients regardless of BMI. Despite concerns regarding surgical complexity in obese patients, the robotic approach provides comparable perioperative outcomes in both obese and non-obese patients.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529652","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":"Comparative clinical outcomes of ventral rectopexy versus STARR in the management of obstructed defecation syndrome: a clinical review.","authors":"Michele Schiano di Visconte","doi":"10.1007/s13304-025-02314-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02314-x","url":null,"abstract":"<p><p>Obstructed defecation syndrome (ODS) is a multifactorial pelvic floor disorder commonly affecting women, characterized by straining, incomplete evacuation, and dependence on manual maneuvers. Among various surgical options, stapled transanal rectal resection (STARR) and laparoscopic or robotic ventral mesh rectopexy (LVMR/RVMR) are frequently employed. However, the comparative effectiveness of these procedures remains debated. This narrative review synthesizes evidence from 43 studies including randomized trials, cohort studies, registries, and systematic reviews published between 2004 and 2025. Clinical outcomes assessed include symptom relief, recurrence, quality of life (QoL), complications, and cost-effectiveness. The methodological quality of included studies was evaluated using the SANRA tool. Both STARR and LVMR/RVMR provide significant early symptom relief in ODS. STARR shows 70-90% short-term improvement, but recurrence rates up to 40% have been reported at 10 years. LVMR achieves durable functional outcomes with recurrence rates < 10%, superior QoL metrics, and fewer anatomical relapses. Mesh-related complications after LVMR are rare (~ 1.4%), but require long-term monitoring. Economically, while STARR has lower initial costs, LVMR/RVMR demonstrates greater long-term cost-effectiveness due to reduced reoperations. RVMR may enhance surgical precision, but increases upfront expenses. STARR remains a valid option for isolated rectocele or low-grade intussusception, whereas LVMR/RVMR is preferable for complex pelvic floor dysfunction. Current evidence favors ventral rectopexy for sustained outcomes, although methodological heterogeneity limits definitive conclusions. Prospective, standardized, long-term comparative trials are essential to optimize surgical strategies for ODS.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529651","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":"Research status, hotspots and perspectives of artificial intelligence applied to pain management: a bibliometric and visual analysis.","authors":"Feng Li, ChangHao Hu, Xu Luo","doi":"10.1007/s13304-025-02296-w","DOIUrl":"https://doi.org/10.1007/s13304-025-02296-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;With the advent of big data, artificial intelligence (AI) is rapidly emerging as a promising avenue for pain management research. Integrating big data analytics, machine learning, and intelligent algorithms within AI can facilitate several significant advancements in healthcare. These include the ability to provide clinical diagnoses of pain, risk prediction, and the development of precision medicine. The number of articles on the application of AI to pain management is on the rise. However, there needs to be more information regarding the quality of the research output in this area, as well as the current hotspots and trends in research. At the same time, no bibliometric metrics have been identified that assess scientific progress in this area. In order to gain an understanding of the current status and potential future directions in the application of AI within the field of pain management, it is first necessary to undertake a visual and analytical study of the relevant research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;A bibliometric and visual analysis was conducted to identify research hotspots and trends in the application of AI in pain management over the past 30 years.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The data information source was the SCI-EXPANDED subset database of the WOS database. A manual search was conducted of all articles and reviews from the database's inception to June 29, 2024. The search was limited to English language sources. A bibliometric analysis was conducted using VOSviewer, CiteSpace, and Bibliometrix (an R-Tool of R-Studio). The analysis encompassed a range of aspects related to the global publication status of papers in the field, including countries and regions, institutions, authors, journals, keywords, and co-cited references.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 970 published papers were obtained for this study. The articles were published in 496 journals by 5679 authors affiliated with 2030 academic institutions in 84 countries or regions. From 2014 to 2024, there was a gradual increase in the number of papers published within this field, with 97% of the total published papers. The United States and China contribute the most to this growth. The most prominent research institutions are Harvard University, the University of California system, and Harvard Medical School. At the author level, Mork, Paul Jarle, Bach, and Kerstin of the Norwegian University of Science & Technology (NTNU) were identified as the authors with the highest research output. Breiman, L. of the University of California, Berkeley, emerged as the most influential author, exhibiting the highest co-citation frequency. From the perspective of journals, the Journal of Medical Internet Research, Scientific Reports, PAIN, PLOS ONE, and SPINE are the primary core journals in the field. They have a high number of published papers and co-citation frequency. Furthermore, of the 46,170 co-cited references, Loetsch J's \"Mach","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529666","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":"Preoperative serum protein concentration as a predictor of staple-line leak after sleeve gastrectomy: a retrospective cohort study.","authors":"Simone Arolfo, Serena Mantova, Roberto Passera, Nicola Leone, Mario Morino","doi":"10.1007/s13304-025-02281-3","DOIUrl":"https://doi.org/10.1007/s13304-025-02281-3","url":null,"abstract":"<p><strong>Background: </strong>Staple-line leak is the most frequent post-operative complication after sleeve gastrectomy (SG). Low serum protein concentration (SPC), a condition associated with malnutrition, is common among people with obesity. Whether low SPC represents a risk factor for staple-line leak has been actually not extensively investigated. The objective of this study is to assess the relationship between low SPC and staple-line leak in patients undergoing SG.</p><p><strong>Methods: </strong>A prospectively collected database was queried for consecutive patients who underwent SG between January 1st 2010 and December 31st 2022 at a single institution.</p><p><strong>Primary endpoint: </strong>to investigate the relationship between low pre-operative SPC and staple-line leak occurred within 30 days. Secondary endpoint: to investigate other patients' and surgeon's related risk factors for leak.</p><p><strong>Results: </strong>1669 patients were included in the study. Staple-line leak occurred in 53 patients (3.2%). Patients with staple-line leak had a significantly lower SPC than patients with a normal post-operative course (median 6.8 vs. 7.1 g/L; p < 0.001). High values of SPC significantly reduced the risk of leak (OR 0.20; 95% CI 0.09-0.45; p = 0.001). Major intraoperative bleeding and need of blood transfusions were significantly associated with a higher rate of leak (OR 3,58, 95% CI 1,45-8,86; p = 0,006; OR 9,79, 95% CI 3,66-26,22; p < 0,001) at a multivariable analysis.</p><p><strong>Conclusion: </strong>The occurrence of staple-line leak after SG is directly related to pre-operative low SPC, an index of malnutrition. Nutritional assessment and optimization of protein intake could potentially reduce the rate of leak.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529665","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}