Indian Journal of Surgical Oncology最新文献

{"title":"Is It Worth Performing Intersphincteric Resection in Patients Having Rectal Adenocarcinoma with Oligometastasis.","authors":"Abdeali Saif Arif Kaderi, Sanjay Singh, Ankit Sharma, Mufaddal Kazi, Ashwin Desouza, Avanish Saklani","doi":"10.1007/s13193-024-02117-3","DOIUrl":"https://doi.org/10.1007/s13193-024-02117-3","url":null,"abstract":"<p><p>Intersphincteric resection (ISR) is being increasingly performed in metastatic rectal adenocarcinoma (with oligometastasis) patients. There has been a trend towards worse prognosis in this group. This study compares the oncological and surgical outcomes of patients with and without pre-operative oligometastasis who underwent ISR. The outcomes compared include prognostic factors like margin positivity, recurrence rates, stoma reversal rate, and surgical failure rate (defined as a combination of one or more of the aforestated factors). The demographic pattern, American Society of Anaesthesia grade (ASA), treatment received, clinical and histopathological T and N stage, grade, type of minimally invasive surgery (MIS) approach, neoadjuvant therapy, and pathological high-risk features are also studied. Patients who underwent minimally invasive ISR over 10 years at a high-volume tertiary cancer center were selected for the study. Factors used for the assessment of oncological outcomes were margin positivity (circumferential resection and distal margin), recurrence (both local and systemic), and stoma reversal rate. A descriptive and comparative analyses were performed. Four hundred and eight patients underwent minimally invasive ISR of which 25 (6.12%) patients were oligometastatic. While R0 resection was similar in both groups, higher overall recurrence (24% versus 18.5%) and low stoma reversal rate (36.8% versus 67.3%) were observed in the oligometastatic group with statistically significant differences. No local recurrence was seen in the oligometastatic group, and the difference compared to non-metastatic group was not statistically different. This study indicates that oligometastatic patients who underwent ISR experienced lower stoma reversal rates, maintaining similar local control but facing higher rates of systemic recurrence.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13193-024-02117-3.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"645-650"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045936","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":"External Validation of Briganti and Memorial Sloan-Kettering Cancer Centre Nomograms for Predicting Lymph Node Invasion in the Indian Cohort of Patients with Prostate Cancer.","authors":"Mayank Agrawal, Milap Shah, Danny Darlington Carbin, Puneet Ahluwalia, Gagan Gautam, Gopal Sharma","doi":"10.1007/s13193-023-01732-w","DOIUrl":"10.1007/s13193-023-01732-w","url":null,"abstract":"<p><p>Briganti and Memorial Sloan-Kettering Cancer Centre (MSKCC) nomograms are the two commonly used models for predicting lymph node invasion (LNI) in patients with prostate cancer. However, they have never been validated in the Indian cohort of patients with prostate cancer. Hence, with this study, we aimed to externally validate Briganti (2012) and MSKCC nomograms in our dataset of patients who underwent robot-assisted radical prostatectomy (RARP). We reviewed our prospectively maintained RARP data to predict the probability of LNI using Briganti (2012) and MSKCC nomograms. The two models were validated by receiver operating characteristic (ROC) curve analysis, calibration plots, and decision curve analysis (DCA). Of the 482 patients included in this study, 127 (26.3%) had lymph nodal metastasis. ROC analysis revealed an area under the curve of 0.75 (0.70-0.80) and 0.76 (0.71-0.80) for the Briganti and MSKCC nomograms, respectively, in predicting LNI. Calibration plots for both Briganti and MSKCC nomograms showed under or overestimation at different predicted probabilities. DCA showed a net clinical benefit of both models at a threshold probability of 10%. Using 5% cut-off for threshold for lymph node dissection, Briganti nomogram would have sensitivity, specificity, PPV, and NPV of (126/127) 99.2%, (14/355) 3.9%, (126/467) 26.9%, and (14/15) 93.3%, respectively. Using the same cut-off, MSKCC nomogram would have sensitivity, specificity, PPV, and NPV of (126/127) 99.2%, (56/355) 15.7%, (126/425) 29%, and (56/57) 98%, respectively. With this study, we independently validated Briganti and MSKCC nomograms for predicting LNI in the Indian cohort of patients with prostate cancer.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":" ","pages":"450-455"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44275502","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":"Does the Planning Target Volume Correlate with Toxicity for Head and Neck Cancer Patients Undergoing Radiation? A Prospective Observational Study.","authors":"Sneha Ujjayani, Manur Gururajachar Janaki","doi":"10.1007/s13193-024-01905-1","DOIUrl":"10.1007/s13193-024-01905-1","url":null,"abstract":"<p><p>Tolerance to radiation depends on the tumor volume; the greater the volume, the higher the toxicities. In this study, we aimed to study the impact of planning target volume (PTV) on toxicities in head and neck cancer (HNC) patients assigned to receive radiation with or without chemotherapy. Planning target volume (PTV) of 35 histologically proven non-nasopharyngeal head and neck cancer patients undergoing radiation with or without chemotherapy was recorded in cubic centimeters (cc). Their PTV high risk (PTVH) and PTV low risk (PTVL) were correlated with mucositis and dermatitis assessed weekly during treatment and at 2 weeks and 6 weeks post treatment. Thirty-five patients were treated with chemoradiation. Their mean PTVH was 278.08 cc (83-812 cc). The mean PTVL was 505.5 (44-1173 cc). Grade II and above mucositis was seen around fourth week and dermatitis and dysphagia by the end of fifth week which persisted till 2 weeks post follow-up in majority of patients. A cutoff of PTVH > 220 cc and PTVL > 550 cc correlated with grade 2 and above toxicities. Head and neck cancer patients with PTV 66 Gy > 220 cc need to be monitored closely during chemoradiation as they are likely to develop severe grades of toxicities.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"516-520"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991343","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":"Clinico-Demographic Profile of Carcinoma Rectum-Experience from a Tertiary Care Centre of Eastern India.","authors":"Linkon Biswas, Firdoushi Khatun, Tanmoy Basak, Bidyut Biswas, Koustav Biswas, Sumitava De, Srikrishna Mandal","doi":"10.1007/s13193-024-02114-6","DOIUrl":"10.1007/s13193-024-02114-6","url":null,"abstract":"<p><p>Carcinoma rectum is a major health issue in India as well as the rest of the world. Cases of rectal cancers are often diagnosed late because of mimicking symptoms with haemorrhoids/fissures and lack of awareness. In this study, we analysed the clinico-demographic profile of patients with carcinoma rectum, attending a tertiary care centre of Eastern India over the last 2 years. We analysed the database of radiotherapy OPD of a tertiary care centre of Eastern India, and collected the demographic, clinical and treatment data of rectal carcinoma patients who attended our OPD between 2021 and 2023. The objective was to assess the demographic and clinical profile of these patients and compare with those reported from other parts of the India as well as rest of the world. Data of total 76 patients were analysed in this study. The mean age of the study population was 50.7 (± 13.59) years. A striking 40% of patients were below 50 years of age. Stage III was the most common (43%) TNM stage at presentation. 15.7% presented with metastatic disease with the liver being the most common site of metastasis. 15.7% of patients underwent upfront surgery either as trans-anal resection or trans-abdominal resection of tumour. Most of the patients (56.5%) had gone through surgery after neo-adjuvant therapy (either total neo-adjuvant therapy or neo-adjuvant radiotherapy). Around 64.4% (<i>n</i> = 49) of patients received radiation as part of total neo-adjuvant therapy (TNT). Eight (10.5%) patients received adjuvant therapy after definitive surgery. To conclude, it can be said that this study revealed involvement of younger population, emergence of poor prognostic histologies and presence of disease at an advanced stage, all of which should be counted as warning signs for the picture rectal carcinoma of India. More researches are required in this field for detection of risk factors, prevention and treatment.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"595-600"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021374","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":"Prognostic Role of Tumor-Infiltrating Lymphocytes, Tumor Budding, Tumor Border Configuration, and Tumor Stroma Ratio in Colorectal Carcinoma.","authors":"Mukta Pujani, Kanika Singh, Charu Agarwal, Varsha Chauhan, Sneha Prasad, Mitasha Singh, Ruchira Wadhwa, Alka Yadav","doi":"10.1007/s13193-024-02127-1","DOIUrl":"10.1007/s13193-024-02127-1","url":null,"abstract":"<p><p>Histomorphological features like tumor-infiltrating lymphocytes (TIL), tumor budding (TB), tumor stroma ratio (TSR), and tumor border configuration (TBC) may provide important prognostic information for more accurate stratification and personalized therapeutic approach in colorectal cancer (CRC). The objective of the current study was to investigate the prognostic impact of novel histopathological features (TIL, TB, TBC, TSR) and a new combined risk score (CRS) in primary CRC. This cross-sectional observational study was conducted on hematoxylin and eosin (H&E)-stained slides of 65 primary CRC cases. Stromal TIL was categorized into 3 groups: low (0 to 10%), intermediate (15 to 50%), and high (55 to 100%). Tumor budding was counted in 10 HPFs and graded as follows: 0-4 buds-low TB, 5-9 buds-intermediate TB, and 10 or more buds-high TB. TBC was labeled as either pushing or infiltrative. TSR was scored into two groups as high TSR (low stroma as ≤ 50%) and low TSR (high stroma > 50%). A novel CRS was constructed based on TBC, TB, and TSR: Infiltrating TBC, TB score > 5 (median), and low TSR were categorized as risk items. Final categories were as follows: low-risk tumors with ≤ 1 risk item and high-risk tumors with > 1 risk items. TIL showed a significant correlation with histological tumor type; TB was significantly associated with tumor location, grade, T stage, and perineural invasion, while TBC significantly correlated with tumor location only. TSR showed significant association with tumor location and perineural invasion, while the combined risk score significantly correlated with tumor location and grade. Tumor border configuration, tumor budding, tumor stroma ratio, and the newly formed combined risk score are simple, cost-effective, potential markers in colorectal cancer patients, suggesting that their incorporation in the routine histopathological evaluation could be useful in determining the prognosis of colorectal cancer cases.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"691-697"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021265","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":"Surgical Management of Solid Pseudopapillary Neoplasm of the Pancreas-an Experience from Tertiary Care Centre.","authors":"Rohit Bhatta, Santosh Irrinki, Vikas Gupta, Thakur Deen Yadav, Yashwant Raj Sakaray, Hemanth Kumar, Ritambhra Nada, Harjeet Singh","doi":"10.1007/s13193-023-01805-w","DOIUrl":"10.1007/s13193-023-01805-w","url":null,"abstract":"<p><p>Solid pseudopapillary neoplasm (SPN) is uncommon and constitutes to 1-2% of pancreatic tumours. Owing to its rarity, literature is sparse on its clinicopathological characteristics and surgical outcomes. Our study is a retrospective analysis of prospectively maintained data of patients with histologically proven SPN between January 2012 and December 2019. Patients' demography, clinical presentation, preoperative imaging, operative details, perioperative outcomes, and long-term follow-up were recorded and analyzed. A total of 14 patients were included in the study, all were females with a median age of 19.5 years (range 15-35 years). All presented with pain abdomen. Eight (57.1%) out of 14 patients were correctly diagnosed with contrast-enhanced computed tomography (CECT) abdomen. CECT revealed solid cystic well-encapsulated lesions in 12(85.7%) and homogenous mass lesions without cystic changes in 2 (14.2%) patients. The most common tumour location was head/uncinate process (57.1%). Eight (57.1%) underwent pancreaticoduodenectomy and 6 (42.8%) had undergone distal pancreatectomy. The median size of tumour was 10 cm (4.5-14 cm). The median postoperative stay was 9 days (range 4-20 days). Seven patients (50%) developed postoperative pancreatic fistula (Grade-A-6/7, Grade-B-1/7) and delayed gastric emptying (DGE) was noted in two (14.2%). R0 resection could be achieved in 13 patients (92.8%). Median follow-up period was 49.5 months. One patient had postoperative recurrence after 48 months of surgery. SPN is a rare tumour of pancreas. Surgical resection is associated with acceptable morbidity and is required for potential cure.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":" ","pages":"502-507"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47371903","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":"From Statistics to Stories: Unveiling the Epidemiology of Breast Carcinoma in Northwestern India.","authors":"Naina Kumar, Kriti Gera, Pinakin Patel, Kamal Kishore Lakhera, Suresh Singh, Bhairulal Gurjar, Arjun Kumar, Pranav Singhal, Bhoopendra Gora, Raj Govind Sharma","doi":"10.1007/s13193-024-02104-8","DOIUrl":"10.1007/s13193-024-02104-8","url":null,"abstract":"<p><p>After receiving the pathology report for breast cancer, the first question most patients ask their doctor is about their journey ahead. The type of cancer and how it spreads can give us an idea of what to expect during follow-up. Unfortunately, there is a lack of reporting, management, and documentation of breast cancer cases in India, resulting in a shortage of information on the different types of breast cancer. To address this issue, a study was conducted to gain a better understanding of the pattern of breast carcinoma in Northwestern India. A total of 2619 breast cancer pathology reports were gathered from four major diagnostic centres in Northwest India. Out of all breast cancer patients, 97.74% (2560) were women, while men accounted for only 2.25% (59) of the sample. At the time of diagnosis, 72% of patients were in stages III and IV, while only 28% of patients were in the early stages of cancer (stages I and II). The most common type of breast cancer was infiltrating duct carcinoma (IDC), which constituted 80.71% (2114/2619) of all malignant lesions. infiltrating lobular carcinoma was the second most common pathology, accounting for 5.38% (141/2619) of all cases. The rarer pathologies had a presentation rate below 10%. Our study revealed the most common symptom as a painless lump. Significant majority presented in advanced stages. An alarming 20% presented with foul-smelling ulceration or fungation of the skin. Varied presentations of breast cancer subtypes were evident. As the age-old saying goes-the 'most common' is often ignored as a large portion of the researcher's attention is focused on 'rarer stuff'. Similarly, IDC being the commonest deserves most of our attention. Not just the histology but its grades too. The lack of awareness regarding the risk factors and early detection methods of breast cancer is unfortunately even prevalent in 49% of healthcare workers. What India needs are more data reporting, timely diagnostic strategies, standardized reporting for pathology, and guideline-based management strategies. Increasing data collection electronically in the coming years will help India in displaying more data.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"543-549"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034299","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":"Preoperative Platelet/Albumin Ratio Predicts Morbidity and Mortality in Patients with Retroperitoneal Liposarcoma.","authors":"Dorian Yarih Garcia-Ortega, Julián Diaz-Rico, Ana Paulina Melendez-Fernandez, Constanza Palma-Rebollar, Kuauhyama Luna-Ortiz","doi":"10.1007/s13193-024-02106-6","DOIUrl":"10.1007/s13193-024-02106-6","url":null,"abstract":"<p><p>Retroperitoneal sarcomas are a rare and heterogeneous group of malignant neoplasms. The most frequent sarcoma in this location is liposarcoma; complete resection is the gold standard of treatment. To achieve this, a multivisceral resection is often necessary to reduce local recurrence. However, this approach must be balanced by the potential for added morbidity. This study aims to evaluate the platelet-albumin ratio as a predictor of morbidity risk. A retrospective review of the medical records of patients with retroperitoneal liposarcomas operated with curative intent at our institution between January 2010 and December 2020 was performed. The platelet-albumin ratio was calculated, and a cutoff point of 78.86 was determined to predict morbidity by receiver operating characteristic (ROC) curve analysis, divided into high-risk and low-risk groups with a sensitivity of 83% and a specificity of 71.6%. These risk groups were contrasted with the different demographic and evolution variables. One hundred thirty-six patients were analyzed, and 91 met the inclusion criteria; age at presentation was 52.55 years (SD 12.96), tumor size was 29.31 (SD 12.43), and 40.7% underwent multivisceral resections, identifying a difference between the presence of a high platelet/albumin ratio and the appearance of complications at 30 days with an OR of 8 (CI 1.0052 to 63.6698, <i>p</i> 0.0494). The platelet-albumin ratio is an easy-to-use test that could help clarify the group of patients who require preoperative prehabilitation to reduce significant complications.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"558-566"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029996","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":"From the Desk of Editors: Surgical Oncology-Embracing Change and Enduring Relevance.","authors":"Pankaj Kumar Garg, S P Somashekhar","doi":"10.1007/s13193-025-02309-5","DOIUrl":"10.1007/s13193-025-02309-5","url":null,"abstract":"","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"377-381"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054369","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":"Non-Hodgkin Lymphoma Presenting as an Ulcerated Soft Tissue Mass on Left Thigh: A Rare Case Report.","authors":"Arshi Khan, Ruquiya Afrose, Sadia Afreen, Karthik Dasari, Mohammad Akram, Sayeedul Hasan Arif, Mohammad Jaseem Hassan","doi":"10.1007/s13193-024-02105-7","DOIUrl":"10.1007/s13193-024-02105-7","url":null,"abstract":"","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"16 2","pages":"712-716"},"PeriodicalIF":0.6,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144050142","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}