Updates in Surgery最新文献

{"title":"Development and clinical assessment of a novel AI-based diagnostic model for Hirschsprung's disease.","authors":"Mustafa Alper Akay, Ozan Can Tatar, Semih Metin, Elif Tatar, Onursal Varlıklı, Gülşen Ekingen Yıldız","doi":"10.1007/s13304-025-02284-0","DOIUrl":"https://doi.org/10.1007/s13304-025-02284-0","url":null,"abstract":"<p><p>This study aimed to develop an AI-based diagnostic model for Hirschsprung's disease (HD) using deep learning on contrast enema (CE) images, with the goal of improving diagnostic accuracy while reducing invasiveness. The dataset included 725 CE images from histopathologically confirmed HD patients from 2013 to 2022. Employing Python and PyTorch, a deep learning model based on the YOLOv8 algorithm was trained and validated, emphasizing key metrics like mean average precision (mAP), precision, recall, and F1 score. This model exhibited high precision (0.87477) and recall (0.87317), with an mAP50 score of 0.91. External validation showed promising results, including a sensitivity of 86.96%, a specificity of 72.22%, and an overall accuracy of 80.49%. This AI model offers a less-invasive and accurate alternative to traditional HD diagnostics, especially beneficial for initial screening in pediatric gastroenterology, with the potential to enhance healthcare diagnostics through AI integration.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006666","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 superior mesenteric and portal vein resections in major liver, biliary, and pancreatic surgery.","authors":"Jacopo Mascherini, Paolo Magistri, Cristiano Guidetti, Giuseppe Esposito, Barbara Catellani, Roberta Odorizzi, Daniela Caracciolo, Beatrice Pelloni, Roberto Ballarin, Gian Piero Guerrini, Stefano Di Sandro, Fabrizio Di Benedetto","doi":"10.1007/s13304-025-02200-6","DOIUrl":"https://doi.org/10.1007/s13304-025-02200-6","url":null,"abstract":"<p><p>The robotic approach to liver and pancreatic surgery is expanding worldwide. However, limited data are available on vascular management in these complex procedures. The unique characteristics of the robotic platform may enhance the feasibility of minimally invasive vascular resection and reconstruction. This retrospective, single-arm, single-center study includes patients who underwent liver, biliary, and pancreatic resections with superior mesenteric and portal vein resection performed robotically between April 2021 and June 2024. The study evaluates short-term outcomes and provides technical insights. Eight patients underwent superior mesenteric or portal vein resection during the study period. Among them, six cases occurred during pancreatic resections, while two were performed during liver resections. In four cases, the chosen strategy involved tangential clamping and direct suturing (Type 1). In two cases, the vessel was repaired using a patch (Type 2). The remaining two cases required end-to-end anastomosis-one performed directly (Type 3) and one with the interposition of a prosthetic graft (Type 4). Postoperatively, only two patients developed complications classified as > 3a according to the Clavien classification, with Comprehensive Complication Index (CCI) scores of 47.6 and 37.1, respectively. Vascular reconstructive skills are essential for surgeons performing hepatopancreatobiliary (HPB) surgery to achieve R0 resections in locally advanced cases. The robotic approach to vascular resection and reconstruction requires a stepwise implementation to ensure favorable oncologic and postoperative outcomes.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145001171","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":"Adoption and implementation of robotic colorectal surgery using structured training approach: an experience from tertiary referral center.","authors":"Mahmood Al Dhaheri, Reem Mubarak, Ali Toffaha, Noof Al Naimi, Ayman Abdelhafiz Ahmed, Mohamed AbuNada, Amjad Parvaiz","doi":"10.1007/s13304-025-02376-x","DOIUrl":"https://doi.org/10.1007/s13304-025-02376-x","url":null,"abstract":"<p><p>Robotic colorectal surgery is rapidly growing field. It offers potential benefits over laparoscopy and these benefits are best realized with proper training. This study reports the outcomes of our first 150 consecutive cases of robotic colorectal surgery following standardized training program. Prospectively collected data for the first consecutive 150 robotic colorectal surgery procedures were analyzed for short-term outcomes. The training program followed the curriculum of the European Academy for Robotic Colorectal Surgery (EARCS) which included theoretical knowledge, online simulator training, console and bedside skills training under direct expert supervision, and objective assessment using the Global Assessment Score (GAS) form. 133/150 (89%) cases were for colorectal cancer with 61% of cases performed for rectal cancer. Two-thirds of the patients were male, median age of 54 years (range 29-87) and BMI of 28.5 (range 21-57). All procedures (n = 150) were performed by three surgeons. There were no mortalities or conversions to open or laparoscopy. Anastomotic leak rate was 1.3% and the overall R0 resection was achieved in 95.5% of cases. Standardized training program expedited the safe adoption of robotic colorectal surgery in our center with satisfactory oncological and clinical short-term outcomes. This study contributes valuable data on the safe adoption of robotic colorectal surgery and the application of standardized training program in the Middle East and other regions.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970429","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":"At the earliest: a Hub and Spoke referral and referral-back pilot project increases access to liver transplantation and ensures good long-term care.","authors":"Cecilia Pravadelli, Alberto Ferrarese, Luisa Moser, Francesco Paolo Russo, Giacomo Germani, Marco Senzolo, Martina Gambato, Alberto Zanetto, Sara Battistella, Elisa Menotti, Flora Agugiaro, Giovanni Vettori, Giovanni de Pretis, Pamela Ballotta, Ivana Maioli, Armando Gabbrielli, Lucia Pilati, Tiziano Martello, Umberto Cillo, Patrizia Burra","doi":"10.1007/s13304-025-02262-6","DOIUrl":"10.1007/s13304-025-02262-6","url":null,"abstract":"<p><p>Liver transplantation (LT) represents an effective therapeutic option for patients with end-stage liver disease and hepatocellular carcinoma. However, barriers to access LT programs still exist for many patients, including distance from transplant centers and delays in referral. Furthermore, long-term care is required also in stable LT recipients. This pilot study aims to evaluate the characteristics and outcomes of patients with end-stage liver disease referred to Padua University Hospital following the implementation of a structured referral program with Trento Hospital. Furthermore, the study assesses the outcomes of LT recipients who were referred back and continued follow-up care at the Spoke Center. After an internal work reorganization at the Spoke Center to improve care for patients with liver disease, we designed this prospective pilot study based on a structured referral and referral-back program for managing patients before and after LT. Accordingly, all inpatients potentially eligible for LT were transferred from the Gastroenterology Unit at Trento Hospital to the Multivisceral Transplant Unit at Padua University Hospital between 2020-2023. Similarly, stable LT recipients were referred back to the Spoke Center for management of long-term follow-up. During the study period, 27 adult inpatients (59% male; median age 50 [42-51] years) deemed eligible for LT were consecutively referred from Trento to Padua. The median [IQR] MELD score at the time of referral was 26 [23-30], and the length of stay at the LT Center was 21 [18-23] days. At the end of follow-up, 6 (22%) patients underwent LT, while the transplant-free survival rate was 37%. During the same period, 27 stable adult LT recipients (55% male; median age at referral back 56 years; median time since LT 9 years) living near Trento were referred back to the Spoke Center. During the follow-up, n.19 (70%) patients experienced at least one medical complication (40% liver-related), the majority of these being managed at the Spoke Center. LT recipient satisfaction of this way of care Center was high. A structured Hub and Spoke collaboration increase access to LT, making it more equitable, and improves the management of stable LT recipients closer to home.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1535-1543"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12420682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143564","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":"Predictive factors for long-term survival in pancreatic ductal adenocarcinoma that underwent surgery: a systematic review and meta-analysis of literature.","authors":"Vincenzo D'Ambra, Claudio Ricci, Carlo Ingaldi, Laura Alberici, Riccardo Casadei","doi":"10.1007/s13304-025-02382-z","DOIUrl":"https://doi.org/10.1007/s13304-025-02382-z","url":null,"abstract":"<p><p>Long-term survivors after pancreatic resection for PDAC are rare, constituting a specific subset of patients that remains poorly understood. This study aims to identify the clinic-pathological, molecular, and therapeutic factors for predicting long-term survival (LTS). A systematic review and random-effect meta-analysis were conducted. Inclusion criteria were PDAC histology, resected patients, studies reporting risk factors, and comparing two groups. The primary endpoint was to evaluate predictive factors for LTS in patients with PDAC who underwent surgery. Results were reported with the Mantel-Haenszel random effects model using Risk Ratio (RR) or Mean Difference (MD). Meta-regression analysis was used to clarify heterogeneity. Nineteen studies, involving a total of 5412 patients, were included: 1097 (20,3%) in group LTS and 4334 (79,7%) in group STS (short-term survivors). These factors were associated to LTS: small size (RR 1.53, 95% IC 1.14; 2.05); T1-T2 stage (RR 1.07, 95% IC 1.03; 1.11); N0 (RR 1.82, 95% IC 1.60; 2.09); AJCC Stage I (RR 2.28 95% IC 1.87; 2.79); low-grade G1-2 (RR 1.21, 95% IC 1.09; 1.34); R0 resection (RR 1.11, 95% IC 1.08; 1.13); low levels of CEA (MD - 4.41, 95% IC - 6.23; - 2.59) and Ca 19.9 (MD - 66.4, 95% IC: - 71.9; - 60.9); absence of perineural invasion (RR 0.93, 95% IC: 0.90; 0.96), lymph-vascular invasion (RR 0.87, 95% IC: 0.83; 0.91), venous invasion (RR 0.63, 95% IC: 0.48; 0.83) and perioperative transfusions (RR 0.56, 95% IC: 0.40; 0.79). Several factors are associated with an LTS. They can be considered reliable indicators for predicting tumor progression.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144970673","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 single and double stapling anastomosis in restorative surgery for ulcerative colitis: short- and long-term outcomes and functional results.","authors":"Serena Perotti, Michela Mineccia, Federica Gonella, Filippo Pepe, Paolo Massucco, Alessandro Ferrero","doi":"10.1007/s13304-025-02294-y","DOIUrl":"10.1007/s13304-025-02294-y","url":null,"abstract":"<p><strong>Background: </strong>Ulcerative colitis (UC) often requires surgery, with restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) considered the standard treatment. While the double-stapled (DS-IPAA) anastomotic technique remains commonly used, single-stapled (SS-IPAA) techniques, including transanal IPAA (ta-IPAA) and transanal transection with single-stapled anastomosis (TTSS), are gaining popularity. This study compares short-term, long-term, and functional outcomes between DS-IPAA and SS-IPAA in UC patients.</p><p><strong>Methods: </strong>In this retrospective cohort study, 80 UC patients who underwent a three-stage restorative procedure at a single IBD referral center from June 2018 to June 2023 were analyzed. The patients were divided into two groups: Group 1 (40 DS-IPAA) and Group 2 (40 SS-IPAA, including ta-IPAA and TTSS). The key outcomes assessed included early and late postoperative complications, functional outcomes (measured using the Ileoanal Pouch Syndrome Severity Score, Low Anterior Resection Syndrome score, and IBDQ-32), and quality of life.</p><p><strong>Results: </strong>The perioperative complications were similar between the groups. The SS-IPAA group had a significantly shorter hospital stay (6 vs. 8 days, p = 0.008). No significant difference in readmission rates was observed (7.5% DS-IPAA vs. 5.0% SS-IPAA, p = 0.644). The long-term results revealed a higher incidence of cuffitis in the DS-IPAA group (p = 0.002). The functional outcomes were significantly worse in DS-IPAA group, with worse IPSS scores (p = 0.003), higher incidence of major (37.5% vs. 17.5%, p = 0.007), and lower median IBDQ-32 (176 vs. 208, p < 0.001).</p><p><strong>Conclusions: </strong>This study supports SS-IPAA as a favorable surgical option for UC patients, with implications for individualized surgical decision-making in specialized centers.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1401-1411"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567876","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 on: \"textbook outcome following pancreaticoduodenectomy in elderly patients: age-stratified analysis and predictive factors\".","authors":"Qin Wang, Xinglang Wu","doi":"10.1007/s13304-025-02368-x","DOIUrl":"10.1007/s13304-025-02368-x","url":null,"abstract":"","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1513-1514"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856464","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":"Biodegradable internal stent versus no stent for patients at increased risk of pancreatic fistula after pancreaticoduodenectomy: a single-center propensity score matching analysis.","authors":"Michele Mazzola, Andrea Zironda, Alessandro Giani, Carlotta Bellomo, Davide Paolo Bernasconi, Pietro Calcagno, Michele Paterno, Giovanni Ferrari","doi":"10.1007/s13304-025-02252-8","DOIUrl":"10.1007/s13304-025-02252-8","url":null,"abstract":"<p><p>Postoperative pancreatic fistula (POPF) is considered the main trigger for further dangerous sequelae following pancreaticoduodenectomy (PD). This study compared the short-term postoperative results of patients at increased risk of POPF undergoing pancreaticojejunal (PJ) anastomosis with and without internal biodegradable stent. Data from a prospectively collected database of patients undergoing PD at increased risk of POPF (ISGPS type B, C, D) between January 2017 and June 2023 were retrieved and analyzed, comparing the postoperative outcomes of those with and without an internal biodegradable stent, using a propensity score matching analysis. In the study period, 183 patients were selected. After matching, a total of 59 with stent (SG) and 59 without (NSG) were compared. The overall POPF rate was 21.2%. No difference was seen between the groups regarding POPF and other postoperative outcomes. A higher rate of biochemical leakage in the SG (53.1% vs 31.9%, p 0.033) was found among patients in the type D class of risk. The present study showed no significant difference in terms of 90-day overall, severe and pancreas-specific postoperative complications among patients at increased risk of POPF who received PJ anastomosis with and without internal biodegradable stent.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1525-1533"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144143565","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":"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":"1463-1471"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","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":"Green surgery: a systematic review of the environmental impact of laparotomy, laparoscopy, and robotics.","authors":"Miguel F Cunha, João Cunha Neves, Joana Roseira, Gianluca Pellino, Pedro Castelo-Branco","doi":"10.1007/s13304-025-02221-1","DOIUrl":"10.1007/s13304-025-02221-1","url":null,"abstract":"<p><p>Surgery is the most energy-intensive healthcare sector, but data on the environmental impact of abdominal surgical techniques are limited. This systematic review aims to identify the most sustainable approach among open, laparoscopic, and robotic surgeries. We searched MEDLINE, Cochrane, and Web of Science databases (inception to March 2024) for studies on the carbon footprint of abdominal surgery, focusing on carbon dioxide equivalents (CO_2e) or CO₂ emissions. The Joanna Briggs Institute checklist was used to assess bias. (PROSPERO: 298486). Of 2155 records, eight cohort studies were included, showing low to moderate risk of bias but high heterogeneity. Two studies on hysterectomy found robotic surgery had the highest carbon footprint (12.0-40.3 kgCO_2e) compared to laparoscopic (10.7-29.2 kgCO_2e) and open surgery (7.1-22.7 kgCO_2e). Another study found laparoscopic prostatectomy produced more emissions than robotic surgery (59.7 vs. 47.3 kgCO_2e) due to higher disposable devices, surgery time and length of stay. Single-use devices in laparoscopic cholecystectomy emitted more CO_2e than hybrid devices (7.194 vs. 1.756 kgCO_2e). CO₂ used in minimally invasive surgery had negligible environmental effects (0.9 kgCO_2e). Qualitative subgroup analyses revealed significant differences between surgery types and measurement methodologies, contributing to data heterogeneity. Minimally invasive surgeries often have higher carbon footprints due to disposable tools and waste. However, one study showed robotic surgery may reduce the overall environmental impact by shortening hospital stays. Due to methodological heterogeneity across studies, definitive conclusions remain limited. Standardized life-cycle assessment methodologies and inclusion of clinical outcomes in future studies are urgently needed to clarify the environmental sustainability of surgical practices.</p>","PeriodicalId":23391,"journal":{"name":"Updates in Surgery","volume":" ","pages":"1683-1692"},"PeriodicalIF":2.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12420719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112255","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}