Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Managing Risk of Dysplasia and Colorectal Cancer in Inflammatory Bowel Disease","authors":"Juan Reyes Genere,&nbsp;Parakkal Deepak","doi":"10.1016/j.tige.2023.02.005","DOIUrl":"https://doi.org/10.1016/j.tige.2023.02.005","url":null,"abstract":"<div><p><span><span>Mitigating colorectal cancer (CRC) risk is a pillar in caring for patients with inflammatory bowel disease (IBD). Over the last decade, there have been significant advances in understanding the natural history of colitis-associated dysplasia (CAD) and its management. The identification of patient- and disease-specific risk factors has enabled a tailored approach to initiating </span>colonoscopy screening and surveillance programs. Improved video </span>endoscopy<span> systems and the development of advanced endoscopic resection techniques have evolved the role of endoscopy in CAD. Modern-era endoscopic instruments can better detect and effectively intervene with CAD, reducing CRC risk. As a result, the last decade has brought forth substantial changes to how endoscopic technologies are applied to IBD surveillance. This review will go over the latest updates in the stratification and management of CAD and CRC risk for patients with IBD, as well as discuss the exciting future in this topic area.</span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 4","pages":"Pages 372-384"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749825","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":"Future Directions for Robotic Endoscopy–Artificial Intelligence (AI), Three-Dimensional (3D) Imaging, and Natural Orifice Transluminal Endoscopic Surgery (NOTES)","authors":"Cem Simsek ,&nbsp;Hung Leng Kaan ,&nbsp;Hiroyuki Aihara","doi":"10.1016/j.tige.2022.10.001","DOIUrl":"https://doi.org/10.1016/j.tige.2022.10.001","url":null,"abstract":"<div><p><span>Artificial intelligence (AI) can aid endoscopic and surgical procedures in various ways, such as detecting and diagnosing gastrointestinal lesions, assisting in procedures, recognizing dissection planes, and predicting adverse events. 3D imaging has also improved the visual and technical aspects of endoscopic and surgical procedures by improving depth recognition. Robotic </span>endoscopy<span> involves aspects of both endoscopy and surgery. It is based on a flexible endoscopic technology; however, it allows for bimanual control of devices for better triangulation. Thus, AI and 3D imaging technologies should be incorporated into robotic endoscopy to improve learning curves and enable more precise operation of robotic instruments. The utilization of robotics will expand the spectrum of current therapeutic endoscopy. Natural orifice transluminal endoscopic surgery<span><span> (NOTES) is associated with shorter operative time, faster patient recovery, and less postoperative pain. However, current efforts to promote NOTES have been hampered by suboptimal NOTES surgical instruments, which have limited maneuverability and degrees of freedom. These challenges are overcome by the robotic </span>endoscope, which has end-effectors with high degrees of freedom. Surgeons performing NOTES using the robotic endoscope can perform triangulation and 360-degree rotation of the robotic wrists. As a 3-armed procedurist, the surgeon can now retract tissues effectively for optimal exposure of the operating field.</span></span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 1","pages":"Pages 95-101"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749890","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":"Current Engineering Developments for Robotic Systems in Flexible Endoscopy","authors":"Amirhosein Alian,&nbsp;Emilia Zari,&nbsp;Zeyu Wang,&nbsp;Enrico Franco,&nbsp;James P. Avery,&nbsp;Mark Runciman,&nbsp;Benny Lo,&nbsp;Ferdinando Rodriguez y Baena,&nbsp;George Mylonas","doi":"10.1016/j.tige.2022.11.006","DOIUrl":"https://doi.org/10.1016/j.tige.2022.11.006","url":null,"abstract":"<div><p>The past four decades have seen an increase in the incidence of early-onset gastrointestinal cancer. Because early-stage cancer detection is vital to reduce mortality rate, mass screening colonoscopy provides the most effective prevention strategy. However, conventional endoscopy is a painful and technically challenging procedure that requires sedation and experienced endoscopists to be performed. To overcome the current limitations, technological innovation is needed in colonoscopy. In recent years, researchers worldwide have worked to enhance the diagnostic and therapeutic capabilities of endoscopes. The new frontier of endoscopic interventions is represented by robotic flexible endoscopy. Among all options, self-propelling soft endoscopes are particularly promising thanks to their dexterity and adaptability to the curvilinear gastrointestinal anatomy. For these devices to replace the standard endoscopes, integration with embedded sensors and advanced surgical navigation technologies must be investigated. In this review, the progress in robotic endoscopy was divided into the fundamental areas of design, sensing, and imaging. The article offers an overview of the most promising advancements on these three topics since 2018. Continuum endoscopes, capsule endoscopes, and add-on endoscopic devices were included, with a focus on fluid-driven, tendon-driven, and magnetic actuation. Sensing methods employed for the shape and force estimation of flexible endoscopes were classified into model- and sensor-based approaches. Finally, some key contributions in molecular imaging technologies, artificial neural networks, and software algorithms are described. Open challenges are discussed to outline a path toward clinical practice for the next generation of endoscopic devices.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 1","pages":"Pages 67-81"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750409","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":"Cold Snare Cut Versus Avulsion for Colonic Mucosal Resection: A Randomized Ex Vivo Porcine Study (the CONVINCE Study)","authors":"Neal A. Mehta ,&nbsp;James K. Stone ,&nbsp;Roberto Trasolini ,&nbsp;Yuho Ono ,&nbsp;Mandeep S. Sawhney","doi":"10.1016/j.tige.2023.05.001","DOIUrl":"https://doi.org/10.1016/j.tige.2023.05.001","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Cold snare polypectomy can only be used for en-bloc resection of small lesions. We describe a new technique, cold snare avulsion, where a cold snare is closed tightly, and traction, at times with substantial force, is applied to resect the ensnared tissue. We aimed to determine the feasibility and safety for lesions up to 15 mm.</p></div><div><h3>Methods</h3><p>A randomized study in ex-vivo porcine colons comparing en-bloc resection (successful mucosal entrapment and resection in one piece) and perforation rate for cold snare cut vs cold snare avulsion for lesions (1) 10 mm without submucosal injection, (2) 10 mm with submucosal injection, and (3) 15 mm with submucosal injection. Mucosal defects were endoscopically examined, and full-thickness punch biopsies were performed to determine histological depth and completeness of resection.</p></div><div><h3>Results</h3><p>For 10-mm lesions without submucosal injection, en-bloc resection occurred in 1 of 15 (6.7%) with cold snare cut vs 10 of 15 (66.7%; <em>P</em> = 0.002) with cold snare avulsion. For 10-mm lesions with submucosal injection, en-bloc resection occurred in 9 of 15 (60%) with cold snare cut vs 14 of 15 (93.3%; <em>P</em> = 0.08) with cold snare avulsion. For 15-mm lesions with submucosal injection, en-bloc resection occurred in 1 of 15 (6.7%) with cold snare cut vs 12 of 14 (85.7%; <em>P</em><span> &lt; 0.001) with cold snare avulsion. No perforations occurred. Resection to the level of the submucosa was confirmed by histologic analysis of the mucosal defect in all but one case.</span></p></div><div><h3>Conclusion</h3><p>In an ex-vivo animal model, cold snare avulsion was superior to cold snare cut for complete en-bloc resection of lesions up to 15 mm, with no adverse outcomes reported.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 4","pages":"Pages 315-322"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49765245","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":"Early Enteral Feeding in Severe Acute Pancreatitis: A Randomized Clinical Trial Between Gastric vs Distal Jejunal Feeding","authors":"Stephen J.D. O'Keefe ,&nbsp;Toby Graham ,&nbsp;Gregory A. Coté ,&nbsp;David C. Whitcomb ,&nbsp;Anna Evans ,&nbsp;Devavrata Soni ,&nbsp;(Study of Nutrition in Acute Pancreatitis) Consortium","doi":"10.1016/j.tige.2023.06.002","DOIUrl":"https://doi.org/10.1016/j.tige.2023.06.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Severe acute pancreatitis is one of the most catabolic illnesses. Meta-analyses have shown that enteral nutrition<span> is safer and more effective than parenteral nutrition in suppressing these losses. However, there is intense debate about how the enteral nutrition should be delivered.</span></p></div><div><h3>Methods</h3><p><span>The design was a randomized controlled trial<span> of early nasogastric (NG) vs distal jejunal (DJ) tube feeding with a semi-elemental diet during the first 4 weeks of severe acute pancreatitis. The setting involved multiple national tertiary care centers. Two hundred and twenty-eight patients were screened, and 26 met the inclusion criteria for new onset severe acute pancreatitis based on an APACHE II score &gt;8, computed tomography evidence of &gt;30% necrosis or computed tomography score &gt;8, and/or a Marshall score &gt;2. The intervention was a randomized allocation to either feeding tube bedside placement by NG or transnasal </span></span>endoscopy for DJ. The primary endpoint was “feeding failure” to tolerate a rate of &gt;10% of the goal for a 48-hour period.</p></div><div><h3>Results</h3><p>Twenty-six eligible patients were randomized, 12 to NG and 14 to DJ, 20 of 26 from the Pittsburgh center. Most were obese (BMI 31.5 kg/m²). Feeding failure occurred in 0 of 14 in the DJ group and in 6 of 11 (55%) in the NG group (<em>P</em> = 0.0026). NG failures were crossed over to DJ feeding with good tolerance and eventual recovery. As a result, the quantity of feed delivered was significantly higher in the DJ group (<em>P</em><span> &lt; 0.05). Serious adverse events (cardiorespiratory arrests, unrelated to endoscopy) occurred in 2 of the DJ and none of the NG group; 3 patients from the DJ group died of progressive organ failure, 2 with associated compartment syndrome.</span></p></div><div><h3>Conclusion</h3><p>This randomized controlled trial indicates that in patients<span> with acute pancreatitis of this level of severity, NG feeding will be ineffective. Although this is a common indication for parenteral nutrition, a safer alternative would be endoscopic-assisted DJ feeding tube placement to bypass the usually dysfunctional or obstructed upper gastrointestinal tract.</span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 4","pages":"Pages 337-346"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749695","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":"Reducing Disparities and Achieving Health Equity in Colorectal Cancer Screening","authors":"Abraham Segura ,&nbsp;Shazia Mehmood Siddique","doi":"10.1016/j.tige.2023.02.007","DOIUrl":"10.1016/j.tige.2023.02.007","url":null,"abstract":"<div><p><span>Increases in colorectal cancer screening are linked to the declining incidence of the disease over the past 3 decades. These favorable trends, however, are not observed in marginalized racial and ethnic populations with disproportionately lower rates of screening, higher disease incidence, and increased mortality, despite advances in </span>health technology and policy. This review describes the differences in screening uptake and test selection among racial and ethnic groups, discusses known obstacles and facilitators that impact screening, and highlights existing frameworks developed to achieve health equity in colorectal cancer screening.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 284-296"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10554575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to Quality Indicators for Diagnosis and Surveillance of Barrett's Esophagus: A Comparative Study of Barrett's Experts and Nonexperts","authors":"Domenico A. Farina ,&nbsp;Claire A. Beveridge ,&nbsp;Leila Kia ,&nbsp;Elizabeth Gray ,&nbsp;Srinadh Komanduri","doi":"10.1016/j.tige.2023.02.008","DOIUrl":"https://doi.org/10.1016/j.tige.2023.02.008","url":null,"abstract":"<div><h3>Background and Aims</h3><p>There is considerable variability in adherence to endoscopic quality indicators (QIs) for Barrett's esophagus (BE). The aims of this study were to (1) assess adherence to published Qis for diagnosis and surveillance of BE, (2) compare adherence between BE experts and nonexperts, and (3) identify factors associated with adherence.</p></div><div><h3>Methods</h3><p><span>We identified all patients with BE on esophagogastroduodenoscopy between 2010 and 2018. QIs evaluated included inspection using high-definition white light </span>endoscopy<span>, use of the Prague Classification, identification of endoscopic landmarks, use of the Seattle Protocol, and guideline-adherent recommendations for surveillance or endoscopic eradication therapy. BE experts and nonexperts were compared using logistic mixed-effects models.</span></p></div><div><h3>Results</h3><p>A total of 467 patients were identified, with BE experts performing fewer overall esophagogastroduodenoscopies (n = 162, 34.7% vs n = 305, 65.3%). Whereas BE experts were more likely to document Prague Classification (52.5% vs 41.3%; <em>P</em> = 0.017) and landmarks (43.2% vs 22.6%; <em>P</em><span> = 0.036), there was no significant difference between experts and nonexperts in use of high-definition white light endoscopy (8.6% vs 3.3%; </span><em>P</em> = 0.123), Seattle Protocol (48.1% vs 40.3%; <em>P</em><span> = 0.313), or guideline-adherent surveillance or treatment recommendations (71.0% vs 67.5%; </span><em>P</em> = 0.509). Patient enrollment in a BE surveillance program was the only factor associated with improved QI adherence, specifically adherence to Prague Classification documentation (OR 1.85, 95% CI 1.08-3.14; <em>P</em> = 0.025), Seattle Protocol (1.28, 95% CI 1.16-1.50; <em>P</em> &lt; 0.001), and follow-up recommendations (OR 2.64, 95% CI 1.55-4.48; <em>P</em> &lt; 0.001).</p></div><div><h3>Conclusion</h3><p>Patterns of adherence to published QIs for endoscopy in patients with BE are mostly independent of expertise. Further training initiatives are needed to standardize the performance of endoscopic practice in patients with BE.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 204-212"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749694","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":"Polypectomy Techniques for Pedunculated and Nonpedunculated Polyps","authors":"Karl Kwok ,&nbsp;Sasan Mosadeghi ,&nbsp;Daniel Lew","doi":"10.1016/j.tige.2023.02.006","DOIUrl":"https://doi.org/10.1016/j.tige.2023.02.006","url":null,"abstract":"<div><p>Colonoscopic polypectomy<span>, when performed appropriately and completely, reduces subsequent risk of colorectal cancer. However, performance of high-quality polypectomy varies widely among endoscopists based on many factors, from exposure during fellowship to continuing education once in practice. Thus, this review is intended for a wide audience, from gastroenterology<span> trainees to practicing physicians. A review of electrosurgery principles is included to cover effective polypectomy techniques and to prevent and troubleshoot problems.</span></span></p><p>Similarly, successful colon polypectomy is heavily dependent on both anatomic position and endoscopic clock-face position within the colon. As a result, both equipment choice and hand technique are discussed, and specific tips are offered to maximize the likelihood of success. Additionally, within this review, we highlight several of the latest advances within the field of polypectomy, such as submucosal injection (including choice of fluid), dynamic injection technique, a thorough discussion on hot vs cold snare, site management, and complication management. Lastly, we explore why incomplete polypectomy occurs, the implications of incomplete polypectomy, and methods to reduce this risk.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 4","pages":"Pages 361-371"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749839","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":"Analysis of Reported Adverse Events Related to Over-the-Scope Clips: A MAUDE Database Analysis","authors":"Daniyal Abbas ,&nbsp;Mohamed Abdallah ,&nbsp;Khalid Ahmed ,&nbsp;Abubaker O. Abdalla ,&nbsp;Nicholas McDonald ,&nbsp;Shifa Umar ,&nbsp;Brian J. Hanson ,&nbsp;Mohammad Bilal","doi":"10.1016/j.tige.2022.11.005","DOIUrl":"https://doi.org/10.1016/j.tige.2022.11.005","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Over-the-scope clips (OTSCs) have been increasingly used in the management of bleeding, perforations, fistulae<span><span>, and anastomotic leaks in the </span>gastrointestinal tract. However, since their Food and Drug Administration (FDA) approval in 2010, data on the adverse events of OTSC systems have been lacking. The aim of our study was to report and analyze adverse events and device failures associated with OTSC systems using the FDA's Manufacturer and User Facility Device Experience (MAUDE) database.</span></p></div><div><h3>Methods</h3><p>We analyzed the FDA MAUDE database post-marketing surveillance data from January 2013 through May 2022 on the two OTSC systems available in the United States.</p></div><div><h3>Results</h3><p>Forty medical device reporting claims were found from January 2013 through May 2022. Adverse events were classified as device-related problems and patient-related adverse events. Forty device-related problems were reported, along with 20 device-related adverse events. Most device-related problems were reported in the Padlock defect closure system (n = 23), followed by the Padlock pro clip system (n = 8) and Ovesco OTSC system (n = 9). The most common device-related problem was related to the failure of OTSC deployment (n = 13), followed by material protrusion or extrusion (n = 7). The most common patient adverse events were perforation (n = 4), esophageal laceration (n = 4), bleeding (n = 3), and luminal stenosis (n = 3). All 4 patients required surgical management of the perforation. No deaths related to the use of OTSCs were reported.</p></div><div><h3>Conclusion</h3><p>Failure of OTSC deployment and perforation were the most common device-related problem and patient-related adverse event, respectively. As the use of OTSC systems continues to increase, it is important for endoscopists to be mindful of both the common and rare adverse events associated with OTSC use.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 2","pages":"Pages 106-112"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750267","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":"Preface: Robotic Endoscopy–Current Engineering Developments, Clinical Applications, and Future Directions","authors":"Hung Leng Kaan ,&nbsp;Philip Wai Yan Chiu","doi":"10.1016/j.tige.2022.10.007","DOIUrl":"https://doi.org/10.1016/j.tige.2022.10.007","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 1","pages":"Page 1"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750268","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}