中华胃肠外科杂志最新文献

{"title":"[Feasibility and safety of a fascial space priority approach to total pelvic exenteration in patients with pelvic malignancy].","authors":"H J Yang, Y D Zhou, P S Jiang, Z C Zhang, Q S Zeng, Y Sun","doi":"10.3760/cma.j.cn441530-20250414-00157","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250414-00157","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the feasibility and safety of a fascial space priority approach to total pelvic exenteration (TPE) in patients with pelvic malignancy. <b>Methods:</b> This was a descriptive case series. Relevant clinical data of patients who had undergone TPE via a fascial space priority approach at Tianjin Union Medical Center from September 2017 to March 2025 were retrospectively collected. All operations had been performed via a fascial space priority approach, the guiding principle of which is separating the avascular pelvic spaces first and then transecting the vessels and nerves of the pelvic organs. That is, the avascular planes around all the pelvic organs are dissected first, after which the relevant vessels and nerves are fully dissected and transected, followed by <i>en bloc</i> resection of pelvic organs distally or via perineal approach. The variables studied included relevant surgical parameters, postoperative pathological findings, complications (classified according to the Clavien-Dindo criteria); recurrence-free survival (RFS), overall survival, and tumor-specific survival. <b>Results:</b> The study cohort comprised 41 patients, including 30 (73.2%) with primary tumors and 11 (26.8%) with recurrent tumors. Open TPE was performed on five patients (12.2%) and laparoscopic TPE on the remaining 36 (87.8%). All procedures were successfully completed with a fascial space priority approach and there were no intraoperative deaths. R0 resection was achieved in 34 patients (82.9%) and R1 resection in seven (17.1%). The operation time was 500 (265-740) min, and the amount of bleeding 200 (10-3,500) mL. Twelve patients (29.3%) developed postoperative complications, two of which were Clavien-Dindo Grade III complications. One of these patients required re-operation to manage a pelvic hematoma 29 days after the primary TPE. No active bleeding was observed during the re-operation. Another patient underwent interventional angiography for an episode of postoperative bleeding; this showed a pseudoaneurysm of the internal iliac artery that was successfully treated by interventional embolization via the internal iliac artery. Five days after undergoing a primary TPE with bladder preservation, a third patient was found to have a urinary fistula and underwent laparoscopic bladder resection with percutaneous ureterostomy. The median duration of follow-up was 18 (1-90) months. The 5-year RFS and overall survival were 46.7% and 52.2%, respectively, whereas the 5-year tumor-specific survival was 67.8%. Univariate Cox regression analysis identified a positive surgical margin (<i>P</i> < 0.001), lateral pelvic sidewall invasion (<i>P</i>=0.014), and vascular invasion (<i>P</i>=0.004) as significantly associated with RFS, whereas multivariate analysis identified only a positive surgical margin (HR: 21.93, 95% CI: 3.78-127.42, <i>P</i><0.001) as an independent predictor of RFS. <b>Conclusions:</b> It is safe and feasible to perform TPE wit","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"751-757"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical observation of the application of disposable decomposing soft injection probe in the treatment of complex anal fistula under local infiltration anesthesia induced by propofol].","authors":"L Ma, H X Ma, X G Han, J W Sun","doi":"10.3760/cma.j.cn441530-20241205-00396","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20241205-00396","url":null,"abstract":"<p><p><b>Objective:</b> Summarize the clinical efficacy of using a disposable decomposed soft injection probe under propofol induced local infiltration anesthesia for the treatment of complex anal fistula. <b>Methods:</b> This technology is applied to patients with complex anal fistulas with clear diagnosis and no surgical contraindications. Using propofol to induce local infiltration anesthesia, a disposable decomposed soft injection probe (invention patent number: ZL 2014 1 0173127.3) soft catheter is gently introduced from the outer opening, passing through a cord like hard structure that can be touched on the surface of the body, and exiting through the rectum and anal canal. According to preoperative identification, each probe is explored one by one. If the inner opening and fistula are below the anorectal ring, a \"V\" - shaped incision is made to the skin and mucosal transition area between the inner and outer openings, and the fistula and inner opening are removed; If the exploration of the internal opening and fistula is above the anorectal ring, the internal opening should be enlarged and trimmed, and the skin of the external opening should be cut off in a shuttle shape. A soft catheter should be used to pull out a rubber strip for loose floating drainage. The two ends of the drainage rubber strip should be tied and fixed with 1 # silk thread. Connect a disposable decomposed soft injection probe with extracted methylene blue mixture (methylene blue 0.5 ml+0.9% sodium chloride 9.5 ml), press the external opening of the anal fistula to form a blind tube that seals the external opening, inject methylene blue mixture, implant an anal hook, explore the remaining blue anal sinus area, and inject methylene blue mixture again to determine the accurate position of the internal opening. Trim and enlarge the inner openings that have been accurately detected one by one. For the main fistula that runs below the anorectal ring, perform a \"V\" incision to cut open the soft tissue in the skin and mucosal transition area between the inner and outer openings, and remove the inner opening and fistula at once; For anal fistulas with fistulas above the anorectal ring, internal incision trimming and enlargement, sinus scraping, and floating bridge drainage surgery should be performed; For a complex anal fistula with multiple internal and external openings, the main lesion should be incised and treated with branch drainage. Record the successful time of internal port exploration, intraoperative and postoperative pain score (VAS), degree of fecal incontinence (Wexner incontinence score), wound healing time, and 3-month postoperative recurrence rate. <b>Results:</b> From January 2020 to December 2023, the Proctology Department of Zaozhuang Fourth Hospital and the Proctology Department of Tengzhou Traditional Chinese Medicine Hospital (Workers' Hospital) treated 54 patients with complex anal fistula using a disposable decomposed soft injection probe under propofol ","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"777-780"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Preliminary exploration of esophagogastrostomy with modified Toupet-like anastomosis (mToupet-like) anastomosis after proximal gastrectomy].","authors":"Y Q Zhang, J Y He, M M Le, J F Yu, C Hu, Z Y Xu","doi":"10.3760/cma.j.cn441530-20241109-00368","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20241109-00368","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the functional outcomes and postoperative complications associated with modified Toupet-like (mToupet-like) anastomosis following proximal gastrectomy for patients with gastric tumors. <b>Methods:</b> After proximal gastrectomy, barbed sutures (2-3 stitches) in the seromuscular layer were used to secure the anterior wall of the stomach at a distance of 1-2 cm from the closure line and the posterior wall of the esophagus at a distance of 5.0 cm from the closure line. The remnant stomach was then positioned posterior to the esophagus on the greater curvature side. Esophagogastric anterior wall anastomosis (manual or circular stapling) was performed at the greater curvature of the remnant stomach, 3 cm distal to the gastroesophageal fixation point. A Toupet-like folding procedure was conducted by folding the reconstructed gastric fundus and wall anteriorly from behind the esophagus and embedding the esophagus within a 270° wrap at the site of stomach-esophagus fixation. <b>Results:</b> Twelve patients with gastric tumors underwent proximal partial gastrectomy with mToupet-like anastomosis in the Department of Gastric Surgery at Zhejiang Cancer Hospital from January to March 2024. Among them, 10 diagnosed as upper gastric adenocarcinoma, and 2 diagnosed as gastric gastrointestinal stromal tumors. The cohort included nine male patients and three female patients, aged 46 to 77 years old, with a body mass index (BMI) ranging from 19.7 to 27.3 kg/m². The maximum tumor diameter was less than 4 cm, and the predicted residual gastric volume exceeded one-half. Laparoscopic surgery was performed in 11 patients, while only 1 patient underwent open surgery. The mean duration of mToupet-like anastomosis was 48.3±8.7 minutes with an estimated intraoperative blood loss was 53.0±11.2 ml. All the 12 patients successfully achieved R0 resection. Among these patietns, the median postoperative hospital stay was 8.5 (7.0, 11.0) days, and the average hospitalization cost was 5.0±0.2 ten thousand yuan. No Clavien-Dindo grade II or higher complications were observed during the perioperative period. Patients were followed up for 6 to 8 months after operation, and no cases of reflux esophagitis were detected by gastroscopy, and no patient required long-term oral proton pump inhibitors. <b>Conclusions:</b> mToupet-like anastomosis for digestive tract reconstruction after proximal gastrectomy is a safe and feasible technique, demonstrating favorable preliminary efficacy.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"773-776"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Intestinal Kaposiform hemangioendothelioma presenting with gastrointestinal hemorrhage: a case report].","authors":"Q Jiang, H J Li, X Y Liu, G C Bian, X F Wang","doi":"10.3760/cma.j.cn441530-20240824-00292","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20240824-00292","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"785-788"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Emphasize preoperative imaging interpretation and surgical planning for total pelvic exenteration].","authors":"Y Tao, J Zhang","doi":"10.3760/cma.j.cn441530-20250513-00185","DOIUrl":"10.3760/cma.j.cn441530-20250513-00185","url":null,"abstract":"<p><p>Total pelvic exenteration (TPE) is a critical surgical procedure for treating locally advanced rectal cancer (LARC) at stage T4b and locally recurrent rectal cancer (LRRC), where the resectability of pelvic tumors depends on precise preoperative imaging evaluation. Laparotomy primarily aims to exclude abdominopelvic peritoneal metastases. Preoperative assessment involves contrast-enhanced chest/abdominal CT, contrast-enhanced liver MRI (as a supplement when CT findings are unclear), contrast-enhanced pelvic MRI (the preferred modality for evaluating soft tissue planes, organ involvement, and resection scope), and PET-CT (useful for systemic metastasis detection and differentiating scar/fibrosis from tumor). Key focuses include identifying invasion of pelvic wall structures (vascular, neural, muscular planes in lateral, posterior, and floor regions) and the \"high-risk zone for major hemorrhage\" at the confluence of internal iliac veins. Multidisciplinary team discussions involving radiology, surgery, oncology, and other specialties are essential. These discussions emphasize \"<i>en bloc</i> resection\" principles, using imaging to define resection planes layer-by-layer to assess R0 resection feasibility, reconstructive strategies, and neoadjuvant therapy. The \"Changzheng Surgical Classification\" proposed by our center categorizes PE into intra-pelvic exenteration (resecting ≥50% of tissues from ≥2 systems within the bony pelvis) and combined pelvic wall exenteration (involving ≥50% tissues from ≥1 pelvic system plus ≥1 of the 5 pelvic wall regions or ≥2 pelvic wall regions). Preoperative planning based on detailed pelvic anatomical zoning ensures standardized resection and reconstruction, promoting procedural consistency and improving R0 resection rates.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"725-729"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Extended total pelvic resection combined with pelvic wall with recurrent pelvic metastasis following surgery for locally recurrent rectal cancer: a case report].","authors":"W C Liu, C G Li, Q Qian, C Q Jiang","doi":"10.3760/cma.j.cn441530-20250609-00216","DOIUrl":"10.3760/cma.j.cn441530-20250609-00216","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"781-783"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Clinical application of pelvic floor <i>en bloc</i> resection in combined pelvic organ resection for locally advanced or locally recurrent rectal cancer].","authors":"G L Chen, Y Lu, R X Zhang, N Su, Z G Wang, G Y Shao, J Zhang","doi":"10.3760/cma.j.cn441530-20250424-00169","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250424-00169","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To explore the feasibility, safety, and short-term efficacy of a total pelvic floor resection procedure as a component of combined resection of pelvic organs for locally advanced or locally recurrent rectal cancer. &lt;b&gt;Methods:&lt;/b&gt; This was a descriptive case series. Relevant clinical data of patients with locally advanced or locally recurrent rectal cancer without extrapelvic metastasis or with only oligometastasis who had undergone combined pelvic organ resection with resection of the entire pelvic floor in the Department of Anorectal Surgery of the Second Affiliated Hospital of Naval Medical University from 1 January 2023 to 30 June 2024 were collected from a Chinese database of combined pelvic organ resection for rectal cancer. The study cohort comprised 143 patients, 74 of whom were male (51.7%) and 69 were female (48.3%); their ages averaged 54 (range: 31-75) years; 57 of the patients (39.9%) had locally advanced rectal cancer and 86 (60.1%) locally recurrent rectal cancer. In our institution, the pelvic floor is categorized into two anatomical layers: the levator ani/presacral anterior tissue, and the bone/ligament/pelvic floor soft tissue. The entire pelvic floor was resected &lt;i&gt;en bloc&lt;/i&gt; after making incisions on both sides of the pelvic floor, followed by presacral sacral dissection, and abdominoperineal dissection of the anterior side of the pelvic floor. The main factors studied were related to the following: (1) surgical conditions, comprising the scope of surgical resection, operation time, intraoperative blood loss, tissue reconstruction; (2) postoperative recovery, comprising time to recovery of intestinal function, time to removal of drainage tubes, and time to healing of the empty pelvic cavity; and (3) postoperative complications, classified according to the international Clavien-Dindo classification. &lt;b&gt;Results:&lt;/b&gt; Combined pelvic organ resection with entire pelvic floor resection was successfully completed in all patients. The operation time was 480 (390 to 1,020) minutes, intraoperative blood loss 800 (50 to 3,500) mL, and volume of blood transfused intraoperatively 1, 000 (400 to 7, 400). R0 resection was achieved in 116 cases (81.1%) and R1 resection in 27 (18.9%). The first layer of the pelvic floor wall (levator ani/sacral anterior tissue) was resected in 79 cases (55.2%) and the second layer of the pelvic floor wall (bone/ligament/pelvic floor soft tissue) in 64 (44.8%). The procedure was completed in the lithotomy position in 114 cases (79.7%) were and in the lithotomy + prone jackknife position in 29 (20.3%). The pelvic floor was reconstructed with mesh in 140 cases (97.7%) and with mesh plus pedicled omental flaps in 92 cases (64.3%). The urinary tract was reconstructed in 92 cases (64.3%). The time to recovery of intestinal function was 3.6 (2.0 to 7.0) days, to removal of drainage tubes 29.4 (24.0 to 54.0) days, and to healing of the empty pelvic cavity 36.2 (27.0 to 56.0) days. Twenty-thr","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"743-750"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Combined multivisceral resection for pelvic tumors: safe and expeditious surgical strategies and key points of functional reconstruction].","authors":"G C Wang","doi":"10.3760/cma.j.cn441530-20250414-00158","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250414-00158","url":null,"abstract":"<p><p>The invasion of pelvic tumors into multiple organs frequently necessitates the concurrent resection of the rectum, bladder, sacrococcygeal bone, uterus and its accessories, as well as other organs. This complex surgical procedure stands as a pivotal treatment for locally advanced pelvic tumors, offering patients the potential for long-term survival and improved quality of life. However, the narrow confines of the pelvic cavity, its intricate anatomical structure, limited visual exposure, and the inherent challenges of the operation itself, contribute to a surgery that is highly demanding, risky, traumatic, time-consuming, and prone to causing life-threatening hemorrhage. Despite these challenges, a safe and effective strategy for specimen removal, coupled with precise and comprehensive organ function reconstruction techniques, are paramount in reducing operative time, minimizing perioperative risks, enhancing postoperative quality of life, and mitigating complications. Currently, there exists no universally standardized evaluation framework to guide the swift removal of specimens and the meticulous reconstruction of organs and pelvic floor functions within safe boundaries. Drawing from our team's decade-long experience in pelvic tumor resection and referencing recent literature, this paper aims to provide a comprehensive overview of pelvic tumor resection involving multiple organs. We focus on safe and efficient surgical strategies, as well as the essential aspects of functional reconstruction.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"730-735"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Comprehensive management of locally advanced colorectal cancer undergoing pelvic exenteration: a case report].","authors":"Z G Zhao, Y F Shen, L X Pu, G Y Shao","doi":"10.3760/cma.j.cn441530-20250508-00178","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250508-00178","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"783-785"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Standardized surgical procedure of proximally extended resection and sphincter-preserving surgery (Tianhe procedure^®) for rectal cancer after radiotherapy (2025 version)].","authors":"","doi":"10.3760/cma.j.cn441530-20250526-00201","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250526-00201","url":null,"abstract":"<p><p>Tianhe procedure^® is a functional sphincter-preserving surgical approach developed for rectal cancer patients following radiotherapy. This technique involves extended proximal resection of the colon beyond the pelvic cavity, followed by anastomosis of the non-irradiated proximal colon to the distal rectum or anal canal. This strategy aims to reduce the incidence of anastomotic complications and postoperative bowel dysfunction. However, there is currently a lack of standardized practice guideline for implementing Tianhe procedure^® in China. Therefore, the Chinese Radiation Intestinal Injury Research Group, the Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association, the Anorectal Branch of Chinese Medical Doctor Association, the Colorectal Cancer Committee of the Chinese Medical Doctor Association, and the Colorectal Cancer Committee of China Anti-cancer Association, and the Gastrointestinal Surgical Branch of Guangdong Medical Doctor Association, have jointly convened a panel of national experts to discuss and establish this standardized surgical procedure. This standard, based on the latest evidence from literature, research advancements, and expert experience, focuses on key aspects of the Tianhe procedure^®, including its precise definition, indications, critical procedural steps, postoperative complications, and functional rehabilitation strategies. It aims to promote standardized implementation and broader clinical adoption of this innovative surgical technique.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"707-716"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}