World Journal of Surgery最新文献

{"title":"Breast Cancer Heterogeneity in Latin America: A Scoping Review of Clinical-Pathological Characteristics, Molecular Subtypes, and Survival.","authors":"María Eugenia Aponte-Rueda, Fela Mar Gómez-González, Belén Merck","doi":"10.1002/wjs.70096","DOIUrl":"https://doi.org/10.1002/wjs.70096","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer in Latin America (LATAM) exhibits distinct clinical-pathological and molecular features, shaped by genetic diversity and healthcare disparities. This scoping review evaluates these characteristics, focusing on histopathological, molecular subtype, and survival patterns and their implications for future research and public health initiatives.</p><p><strong>Methods: </strong>A systematic search across MEDLINE (via PubMed), LILACS (Latin American and Caribbean Health Sciences Literature), SciELO (Scientific Electronic Library Online), and Web of Science identified 54 studies across 19 Latin American countries. Data were extracted on histological grading, molecular subtypes, staging, and survival outcomes. Findings were analyzed in the context of regional and global trends.</p><p><strong>Results: </strong>Fifty-four studies involving 49,223 women from 19 countries were analyzed. The mean age at diagnosis was 54.3 years. Invasive ductal carcinoma was the most common (79.2%). Advanced-stage disease (Stages III/IV) was identified in 36.1% of cases. Luminal subtypes were most prevalent (Luminal A: 36.95% and Luminal B: 28.72%), whereas triple-negative (TNBC) and HER2-enriched subtypes accounted for 17.45% and 12.69%, respectively. Subtype prevalence varied by country, age, and tumor grade. Five-year survival rates ranged from 50.5% to 92.5%, with worse outcomes linked to advanced stage, high grade, and TNBC or HER2-enriched tumors.</p><p><strong>Conclusion: </strong>Breast cancer in LATAM is characterized by significant heterogeneity in biological subtypes and clinical presentation, often diagnosed at advanced stages, with limited capacity for molecular testing. These findings highlight the urgent need for standardized diagnostic protocols, equitable access to treatment, and region-specific cancer control strategies to improve outcomes for Latin American women.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193293","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":"Pulmonary Artery Thrombosis in Trauma: Not as Deadly as Previously Thought.","authors":"Jack Carlson, Upuli Pahalawatta, Madeleine Hinwood, Thomas Giles, Zsolt J Balogh","doi":"10.1002/wjs.70120","DOIUrl":"https://doi.org/10.1002/wjs.70120","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary embolism (PE) is a well-known morbid and potentially life-threatening complication of polytrauma. There is growing evidence to suggest that patients with trauma are suspected to be prone to in situ pulmonary artery thrombosis (PAT) as a consequence of trauma-induced coagulopathy and endotheliopathy in addition to the classic PE preceded by deep venous thrombosis (DVT). Whether PAT on admission requires attention or can be safely ignored is currently unknown. This study aims to characterize the incidence, risk factors, and clinical outcomes of PAT in all patients with trauma admitted via the trauma resuscitation bay.</p><p><strong>Methods: </strong>This study is a 1-year retrospective study of patients admitted to a Level 1 Trauma Center in 2019. All initial trauma scans were retrospectively reviewed by a radiologist to assess for the presence of any visible clots in the pulmonary vasculature on admission. PAT was defined as pulmonary clots identified on the initial trauma pan-scan, PE was defined as a pulmonary clot detected on CTPA performed for diagnosis of suspected PE. The primary outcome was the identification of a pulmonary clot. Secondary outcomes were mortality, length of stay in intensive care unit (ICU), overall length of stay, number of days requiring ventilation, development of respiratory failure, multiple organ failure (MOF), and its association with polytrauma.</p><p><strong>Results: </strong>Of the 597 patients admitted, 278 (46.6%) patients had CT chest with IV contrast during admission and were included in this study. 45/278 (16.2%) patients were identified to have pulmonary clots; 43 (15.5%) were PAT and 2 (0.7%) were PE. There was no significant difference in the patient population or ISS between groups. PAT was associated with higher AIS scores in the extremities (p = 0.004) and external (p = 0.006) body regions. PAT was also associated with shock on presentation with lower systolic (p = 0.004) and diastolic blood pressure (p = 0.015) and elevated lactate (p = 0.002). PAT was associated with the development of early respiratory failure (p = 0.004). There was no difference in ICU admission or ventilator requirements.</p><p><strong>Conclusion: </strong>In conclusion, this study demonstrates that post-trauma PAT is frequently identified on initial trauma imaging and is associated with early respiratory failure, shock on presentation, and extremity trauma but not with injury severity, mortality or intensive care admission. This study will inform future prospective studies on power and design to identify predictors for adverse outcomes and potential causal relationships with the risk factors identified.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145193037","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":"Commentary: Pediatric Surgery in Low-Income Countries-From Neglect to Necessity.","authors":"Zipporah Gathuya, Elizabeth T Drum","doi":"10.1002/wjs.70113","DOIUrl":"https://doi.org/10.1002/wjs.70113","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186855","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":"When the Knife Cuts Both Ways: Fear, Guilt, and the Emotional Toll of Surgical Complications.","authors":"Dimitrios Moris, Theodore Pappas","doi":"10.1002/wjs.70116","DOIUrl":"https://doi.org/10.1002/wjs.70116","url":null,"abstract":"","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179264","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":"Prejudice or Parity? Exploring Gender Bias and Perceived Disparities in the Careers of Gastrointestinal and Hepatopancreatobiliary Surgeons in India.","authors":"Manpreet Uppal, Deep Shikha Mishra, Sunita Suman, Deeksha Kapoor","doi":"10.1002/wjs.70117","DOIUrl":"https://doi.org/10.1002/wjs.70117","url":null,"abstract":"<p><strong>Background: </strong>Gender disparities in high-intensity surgical specialties, such as gastrointestinal (GI) and hepato-pancreato-biliary (HPB), surgery are a major concern. Various gender-related challenges exist, including explicit and implicit biases, epistemic injustice, work-life balance issues, and stereotyping. Cultural and institutional factors may worsen these disparities in India, affecting training, career advancement, and leadership representation. We aimed to examine the \"perceived\" gender bias and disparities impacting GI and HPB surgeons in India, offering data-driven insights that may shape policy and institutional reforms.</p><p><strong>Methods: </strong>A nationwide, cross-sectional, and questionnaire-based survey was conducted among GI and HPB surgeons, identified through the Indian Association of Surgical Gastroenterology (IASG) database. The online questionnaire was distributed via email and messaging forums. The survey assessed demographics, work environment, research opportunities, leadership roles, mentorship, and personal life. Data were analyzed using descriptive statistics and comparative tests, with a significance threshold of p < 0.05.</p><p><strong>Results: </strong>A total of 190 responses were received, including 26.8% female surgeons (FS) and 73.2% male surgeons (MS). FS were younger, with a mean age of 36.9 years compared to 43.3 years for MS (p < 0.001) and were predominantly in the early- or mid-career stages. FS reported significantly higher perceptions of gender-based differential treatment in the workplace, particularly from senior faculty and patients. Although both FS and MS reported comparable salaries, FS felt they had fewer career advancement opportunities and were underrepresented in leadership roles and mentorship networks. Additionally, FS expressed greater dissatisfaction with work-life balance, especially regarding family planning and maternity leave, which they believed negatively impacted their careers. Research output and leadership roles exhibited modest gender differences, with FS being less likely to serve on editorial boards or in clinical leadership positions.</p><p><strong>Conclusion: </strong>Our study provides evidence of gender-based disparities in the careers of GI and HPB surgeons in India, with FS facing greater challenges in career advancement, mentorship access, and work-life balance. These findings underscore the need for targeted interventions, including mentorship programs, policy reforms, and institutional changes, to promote gender equity in surgical specialties. Addressing these disparities is essential to foster an inclusive, diverse, and effective surgical workforce in India.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179198","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":"Burn Care: A Review-Part 2: Beyond 48 Hours.","authors":"David G Greenhalgh, Vinita Puri","doi":"10.1002/wjs.70115","DOIUrl":"https://doi.org/10.1002/wjs.70115","url":null,"abstract":"<p><strong>Background: </strong>After 48 h, care of the burn patient becomes more prolonged and difficult. The second part of the review discusses the long-term care of the burn patient.</p><p><strong>Methods: </strong>Current literature and authors' experience were used to provide guidelines for the management of burns. No artificial intelligence was used to create this manuscript.</p><p><strong>Results: </strong>The profound hypermetabolic response leads to significant demands on the patient that must be addressed by the caregiver. Patients require more nutritional and metabolic support than other diagnoses. Since the skin, which is the barrier to microorganism invasion, is destroyed, sepsis becomes a major concern. The primary goal of the clinician is to heal the wound as quickly as possible. As burn size increases, this task becomes much more difficult.</p><p><strong>Conclusion: </strong>The complete management of extensive burns requires an experienced team that can handle the long-term demands of the patient.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179231","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":"Association of Enhanced Recovery After Surgery Implementation and Comparative Outcomes Improvement at an Academic Medical Center.","authors":"Abid Khan, Elliott R Haut, Marvin Borja, Lilly D Engineer, Michael C Grant, Deborah B Hobson, Lisa E Ishii, Jill A Marsteller, Elizabeth C Wick, Greg de Lissovoy","doi":"10.1002/wjs.70112","DOIUrl":"https://doi.org/10.1002/wjs.70112","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) has been hypothesized to improve surgical outcomes following colorectal surgery; however, the long-term sustainability of improvement remains unclear.</p><p><strong>Materials and methods: </strong>A comprehensive ERAS program was implemented for patients undergoing colorectal surgery at Johns Hopkins Hospital (JHH) in 2014. This study investigated inpatient elective colorectal surgery outcomes at JHH during three two-year postimplementation periods (2014-19) relative to a two-year baseline (2012-2013) via pre-post analyses and using difference-in-differences (DID) regression comparing JHH with a national sample of > 700 hospitals participating in the National Surgical Quality Improvement Program (NSQIP). Length of stay (LOS) was evaluated using multivariable zero-truncated negative binomial regression, whereas Surgical Site Infections (SSIs) and readmission rates were analyzed using multivariable logistic regression. Analyses controlled for ASA score, procedure type, age, sex, race, and surgical approach.</p><p><strong>Results: </strong>The study included 1851 patients at JHH and 303,175 patients from the national sample. In pre-post analyses comparing JHH from baseline (2012-2013) to the final period (2018-2019), statistically significant improvements were seen for SSIs with a 4.4% reduction (OR 0.54 and 95% CI 0.35-0.86) and for readmissions with a 5.6% reduction (OR 0.57 and 95% CI 0.39-0.85), while LOS was statistically unchanged (0.41 days reduction; IRR 0.93 and 95% CI 0.85-1.01). DID analyses showed statistical equivalence for SSIs (OR 0.80 and 95% CI 0.51-1.26), greater improvement for readmission rates at JHH (OR 0.62 and 95% CI 0.42-0.92), and lower improvement for LOS at JHH (IRR 1.17 and 95% CI 1.07-1.27).</p><p><strong>Conclusions: </strong>ERAS implementation at JHH was associated with sustained improvement that was comparable (SSIs) or superior (readmissions) to national improvement trends over a period of 6 years (postimplementation), suggesting ERAS adoption in colorectal surgery is warranted for long-term outcomes improvement. Results were suggestive of a tradeoff between readmission rates and LOS.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145179216","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":"Splenic Lymphatic Malformations: Clinical Characteristics of 35 Patients and Literature Review.","authors":"Congxia Yang, Tong Qiu, Min Yang, Tianliang Li, Zilong Zhou, Yujia Zhang, Siyuan Chen, Xuepeng Zhang, Yi Ji","doi":"10.1002/wjs.70109","DOIUrl":"https://doi.org/10.1002/wjs.70109","url":null,"abstract":"<p><strong>Background: </strong>Primary lesions of the spleen are very rare, and splenic lymphatic malformations (SLMs) account for 0.007% of all splenic lesions; thus, SLMs are often ignored in clinical practice. The aim of this study was to review the clinical and imaging features of 35 patients with SLMs, classify them on imaging and provide a reference for treatment.</p><p><strong>Methods: </strong>We reviewed the records of patients with SLMs who entered the medical system at our institution from December 2008 to March 2023. The clinical characteristics and imaging features of these patients were collected to classify SLMs.</p><p><strong>Results: </strong>In our case series, 82.9% (29/35) of the patients with SLMs were adults, whereas only 6 patients were children, and 97.1% of (34/35) patients were women. A total of 68.6% (24/35) of the patients were asymptomatic. Seven patients experienced complications, such as cyst rupture, cyst bleeding, and mass effects. On imaging, the average cyst diameter of the SLMs was 5.2 cm, and macrocystic SLMs (23/35) were the most common. SLMs can be divided into isolated SLMs, multiple SLMs, and diffuse SLMs, of which 17 cases were isolated lesions, 14 cases were multiple lesions, and 4 cases were diffuse lesions. Some lesions were accompanied by cyst wall calcification. All patients underwent surgical removal, and no signs of recurrence were found during the 5-year postoperative follow-up.</p><p><strong>Conclusion: </strong>SLMs are uncommon with insidious onset, and most patients are asymptomatic; however, complications still exist. Partial splenectomy is an option for isolated SLMs, whereas total splenectomy is necessary for diffuse SLMs.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145150769","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":"Prognostic Significance of Platelet-Lymphocyte Ratio (PLR) and Prognostic Nutritional Index (PNI) in Remnant Gastric Cancer: A Multicenter Retrospective Study.","authors":"Kensuke Kudou, Mitsuhiko Ota, Kippei Ogaki, Yasue Kimura, Yuta Kasagi, Naomichi Koga, Hirofumi Hasuda, Hirotada Tajiri, Tetsuro Kawazoe, Yasuo Tsuda, Tomonori Nakanoko, Koji Ando, Eiji Oki, Tomoharu Yoshizumi","doi":"10.1002/wjs.70111","DOIUrl":"https://doi.org/10.1002/wjs.70111","url":null,"abstract":"<p><strong>Background: </strong>Remnant gastric cancer (RGC) is known to have a poorer prognosis compared to primary gastric cancer. Inflammation-based prognostic scores (IBPSs), which reflect systemic inflammation and nutritional status, have recently emerged as useful prognostic markers in various malignancies. However, their significance in RGC remains unclear due to the rarity of the disease and the limited number of cases available at single institutions.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter study of 135 patients who underwent surgery for RGC between 2013 and 2024 at Kyushu University and four affiliated hospitals. After excluding nine patients with synchronous malignancies or noncurative resections, 126 patients were included in the final analysis. Associations between IBPSs-including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI)-and both short- and long-term outcomes were evaluated.</p><p><strong>Results: </strong>Receiver operating characteristic (ROC) analysis determined optimal cutoff values for each IBPS. Kaplan-Meier analysis revealed that PLR ≥ 195 and PNI < 43.5 were significantly associated with poorer overall survival (OS) (P = 0.008 and P < 0.001, respectively). Multivariate analysis identified PLR ≥ 195 and PNI < 43.5 as independent predictors of poor OS and recurrence-free survival (RFS). Additionally, PLR ≥ 260 was identified as an independent risk factor for postoperative complications (P = 0.047).</p><p><strong>Conclusion: </strong>PLR and PNI are independent prognostic markers for both OS and RFS in patients undergoing curative surgery for RGC. Elevated PLR also predicts postoperative complications, highlighting its potential role in perioperative risk stratification.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138715","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":"Comparing Effectiveness of Communication Channels in Increasing Utilization of Surgical Services in Rural Eastern Uganda.","authors":"Haritha Reddy, Saran Kunaprayoon, Job Nanyiri, Ambrose Nuwahereza, Michael Marin, Linda Zhang","doi":"10.1002/wjs.70093","DOIUrl":"https://doi.org/10.1002/wjs.70093","url":null,"abstract":"<p><strong>Background: </strong>Access to surgical care in low- and middle-income countries (LMICs) is hindered by multiple factors. Although healthcare initiatives have sought to enhance accessibility, surgical conditions still contribute to 32.9% of the global disease burden. Effective communication and outreach methods-including community engagement, mass media, and interpersonal interactions-have been widely used to improve global health outcomes. However, their roles in promoting surgical care in LMICs remains underexplored. This study evaluates the effectiveness of different communication strategies on patient care access at an ambulatory surgical center in rural Uganda.</p><p><strong>Methods: </strong>This is a retrospective descriptive case study of patients who sought surgical consultation at Kyabirwa Surgical Center (KSC) in rural Uganda from 1/2021 to 7/2023. Records from KSC's electronic medical record system, financial records, and attendance logs were reviewed to extract demographic, communication channel, and cost data. RStudio was used for statistical analysis.</p><p><strong>Results: </strong>In total, 3515 patients had documented communication channels that led them to seek surgical consultation at KSC. Among this cohort, 842 patients (24.01%) were reached through channels initiated by KSC, termed \"active channels,\" and the remaining through referrals or word-of-mouth, termed \"passive channels.\" Active channels include community mobilization via in-person outreach visits (550/842, 65.3%), interpersonal communication via radio talk-shows (254/842, 30.1%), and mass communication via text message broadcasts (38/842, 4.5%). Consultation confirmed surgically correctable diseases in 78.9% of patients reached through community mobilization, 78.3% through interpersonal communication, and 100% through mass communication. Active channels were more likely to recruit patients with surgically correctable diseases than passive channels (p = 0.01). Cost analysis demonstrated that community mobilization was most expensive ($76.39/patient) compared to radio talk-shows ($7.11/patient) and mass communication ($22.59/patient).</p><p><strong>Conclusions: </strong>This study demonstrates the pivotal role of proactive community outreach and patient engagement in recruiting individuals with surgically treatable conditions. Although community mobilization emerged as the most effective active recruitment method, cost continues to be a challenge. Additional research into health system development through communication channels will be valuable in identifying strategies to enhance efficiency.</p>","PeriodicalId":23926,"journal":{"name":"World Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138701","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}