International Journal of Surgery Case Reports最新文献

{"title":"Giant retroperitoneal liposarcoma with colonic infiltration as a cause of gastrointestinal bleeding: Case report and literature review","authors":"Sebastian Forero-Escobedo ,&nbsp;Sandra Milena Gonzalez-Rodriguez ,&nbsp;Jose Alejandro Ramírez-Rincón ,&nbsp;Vanessa Alejandra Garcia-Bernal ,&nbsp;Santiago Polanco-Perdomo ,&nbsp;Sofía Echeverri-Torrents","doi":"10.1016/j.ijscr.2025.111142","DOIUrl":"10.1016/j.ijscr.2025.111142","url":null,"abstract":"<div><h3>Introduction</h3><div>Retroperitoneal liposarcomas are rare malignant tumors that often present asymptomatically until advanced stages. Giant liposarcomas exceeding 30 cm are particularly uncommon, and colonic infiltration causing gastrointestinal bleeding is extremely rare, with only a few cases documented in the literature.</div></div><div><h3>Case presentation</h3><div>A 78-year-old female presented with hematochezia, constipation, and diffuse abdominal pain. Imaging revealed a large left para-aortic retroperitoneal mass compressing the colon. Colonoscopy showed colonic mucosal atrophy without active bleeding. Surgical exploration via midline laparotomy identified a bilobulated 89 × 35 × 40 cm retroperitoneal mass, infiltrating the left colon and compromising adjacent structures. En bloc resection, including hemicolectomy and left salpingo-oophorectomy, was performed. Histopathology confirmed a dedifferentiated liposarcoma with well-differentiated areas and colonic invasion reaching the muscularis propria. Margins were positive (R1). The patient recovered well postoperatively and experienced a single episode of intestinal obstruction at 6 months, resolved medically.</div></div><div><h3>Discussion</h3><div>Retroperitoneal liposarcomas typically exhibit compressive behavior rather than invasion. However, dedifferentiation is associated with aggressive features, including local invasion and higher recurrence rates. Colonic infiltration by giant liposarcomas is exceedingly rare, with only three additional cases reported. Mechanisms of bleeding include mucosal ischemia, compression, or direct histological infiltration, as observed in this case.</div></div><div><h3>Conclusion</h3><div>The relationship between gastrointestinal bleeding and colonic infiltration in retroperitoneal liposarcomas may reflect the association between tumor dedifferentiation and invasive behavior. This underscores the importance of curative-intent surgical management as the primary therapeutic strategy, despite the challenge posed by the proximity to critical neurovascular structures.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111142"},"PeriodicalIF":0.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611324","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":"Limited hiatal dissection versus Dor-fundoplication in laparoscopic Heller myotomy for achalasia: First experience in Morocco - A case control comparison study","authors":"Abdelmounaim Aitali,&nbsp;Othmane Bourouail,&nbsp;Youssef Elmahdaouy,&nbsp;Abderrahman Elhjouji","doi":"10.1016/j.ijscr.2025.111137","DOIUrl":"10.1016/j.ijscr.2025.111137","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Laparoscopic Heller myotomy is a primary treatment for achalasia, addressing impaired esophageal motility. Fundoplication is typically added to prevent postoperative reflux. This study compares outcomes of limited hiatal dissection without antireflux system in laparoscopic Heller myotomy to Dor fundoplication.</div></div><div><h3>Case presentation</h3><div>A retrospective analysis was conducted on 45 patients treated at visceral surgery department (2008–2022). Of these, 29 patients underwent limited hiatal dissection, and 16 underwent Dor fundoplication. A liquid diet was followed on day one, with discharge on day two, and a semi-liquid diet for three weeks. Outcomes included dysphagia resolution, postoperative Eckardt scores &lt;3, and postoperative reflux incidence. The study compared operative and postoperative data between the two groups.</div></div><div><h3>Clinical discussion</h3><div>The limited hiatal dissection group had a slightly younger mean age (46.97 years) compared to the Dor fundoplication group (51.75 years). The limited hiatal dissection group had a higher proportion of men (58.6 %) while the Dor group had more women (56.3 %). Dysphagia (100 %) and weight loss (68.9 %) were prevalent symptoms. Perioperative complications and hospital stay duration were similar. Operative time was significantly shorter in the limited hiatal dissection group (96.7 vs. 118.3 min, p = 0.004). Both groups showed similar (OR = 0.519, CI = 0.066–4.083) and significant improvement in dysphagia (91.3 % vs. 87.5 %, p &lt; 0.001) with comparable postoperative gastroesophageal disease (20.7 % vs. 25 %, p = 0.726 OR = 1.278, 95 % CI: 0.301–5.420).</div></div><div><h3>Conclusion</h3><div>Limited hiatal dissection provides comparable symptom relief and reflux prevention, offering a viable alternative to routine antireflux in achalasia treatment.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111137"},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674725","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":"Gossypiboma-induced ileal obstruction following cholecystectomy: A case report and literature review","authors":"Mohammad Asef Adelyar ,&nbsp;Mahmoud Tavakkoli ,&nbsp;Ghulam Saki Hassani ,&nbsp;Muska Anwary ,&nbsp;Ramin Saadaat ,&nbsp;Maiwand Anwari","doi":"10.1016/j.ijscr.2025.111138","DOIUrl":"10.1016/j.ijscr.2025.111138","url":null,"abstract":"<div><h3>Introduction</h3><div>Gossypiboma, the retention of surgical material in the body post-surgery, is a rare but serious complication often underreported due to legal and reputational concerns. It commonly occurs after abdominal surgeries, with presentations ranging from abscess formation to intestinal obstruction.</div></div><div><h3>Presentation of case</h3><div>An 18-year-old girl presented with abdominal pain and distention, along with vomiting for six weeks after cholecystectomy. Initial misdiagnoses as pancreatitis delayed appropriate treatment. Exploratory laparotomy revealed an intra-abdominal gossypiboma, which had transmigrated into the ileum, causing obstruction. Surgical removal of the retained pack and ileal resection with primary anastomosis were performed, leading to a successful recovery.</div></div><div><h3>Discussion</h3><div>The incidence of gossypiboma varies widely and depends on surgical practices. Transmural migration into the gastrointestinal tract, as seen in this case, is rare and potentially life-threatening. Accurate sponge counts, use of radio-opaque materials, and adherence to safety protocols are crucial preventive measures. Imaging modalities aid diagnosis, but surgical exploration remains definitive in uncertain cases.</div></div><div><h3>Conclusion</h3><div>This case highlights the critical need for awareness, accurate surgical protocols, and vigilance in postoperative management to prevent and manage gossypibomas. Early recognition and intervention can mitigate complications and improve patient outcomes.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111138"},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143601845","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":"Conservative management of a cervical hematoma after anterior cervical discectomy and fusion: A case report","authors":"Mohammad Daher ,&nbsp;Gilles el Hage ,&nbsp;Andrea Achkouty ,&nbsp;Nadim Khoueir ,&nbsp;Amer Sebaaly","doi":"10.1016/j.ijscr.2025.111132","DOIUrl":"10.1016/j.ijscr.2025.111132","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>With an incidence ranging from 0.4 % to 2.4 %, post-operative hematoma after anterior cervical discectomy and fusion (ACDF) is considered as potentially fatal since it can rapidly lead to acute airway obstruction and respiratory failure.</div></div><div><h3>Case report</h3><div>A 31-year-old male patient underwent a 2-level ACDF. On postoperative day 2, the patient developed thoracic pain and dysphagia. Imaging revealed a cervical hematoma without airway compromise or other critical symptoms. Conservative management was initiated with corticosteroids and close monitoring. Over the next several days, the hematoma reduced in size, and the patient recovered without requiring surgical intervention.</div></div><div><h3>Clinical discussion</h3><div>Hematoma formation after ACDF is rare but can be life-threatening due to potential airway compromise, often necessitating reoperation. While the patient had a large hematoma, conservative management was chosen due to a patent airway, normal vitals, and symptom resolution after 8 h, avoiding the risks of surgery.</div></div><div><h3>Conclusion</h3><div>This case highlights that with careful patient selection, including stable vital signs, patent airway, and favorable response to steroids, conservative management may avoid the morbidity of reoperation.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111132"},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621325","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":"Delayed minimally invasive treatment of an infected mandibular angle fracture after wisdom tooth removal: A case report with 2 years follow up","authors":"Andi Setiawan Budihardja ,&nbsp;Bakhrul Lutfianto","doi":"10.1016/j.ijscr.2025.111136","DOIUrl":"10.1016/j.ijscr.2025.111136","url":null,"abstract":"<div><h3>Introduction</h3><div>This case report describes the treatment of an infected mandibular angle fracture 50 days after wisdom tooth removal.</div></div><div><h3>Case presentation</h3><div>A 57-year-old woman with a history of mandibular right wisdom tooth extraction 50 days earlier presented to our clinic with restricted mouth opening, significant pain, paresthesia in her right chin, and fever (temperature, 38.5 °C). Intraoral examination revealed malocclusion and an open purulent laceration of the soft tissue in the 48 region. Orthopantomography and computed tomography revealed a displaced fracture of the right mandibular angle and bone loss secondary to infection.</div><div>Three-phase treatment comprising wound debridement, open reduction internal fixation, mandibulomaxillary fixation, and reconstruction using autologous iliac bone graft resulted in successful osseous healing. Satisfactory centric occlusion and jaw opening within the normal range with no mandibular deviation were achieved.</div></div><div><h3>Clinical discussion</h3><div>Wisdom tooth extraction is a common oral and maxillofacial procedure, of which mandibular fracture is an uncommon complication. Iatrogenic mandibular fractures are extremely rare, with an incidence of 0.005 %. Treatment involving debridement of the infected site and rigid internal fixation via an intraoral approach can reduce the incidence of facial nerve injury and scarring.</div></div><div><h3>Conclusion</h3><div>Impacted wisdom teeth must be extracted after careful consideration and using appropriate techniques. Complications such as mandibular fractures warrant early treatment in a specialist clinic to minimize further complications.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111136"},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143644340","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":"Amniotic band syndrome: Insights from first documented case report in Somalia's low-resource setting","authors":"Salah Haji Hassan Muhumad ,&nbsp;Abdirahman Omer Ali ,&nbsp;Hassan Elmi Moumin ,&nbsp;Ahmed Abdi Aw Egge ,&nbsp;Roukia Mahamad Nour ,&nbsp;Mohamed Abubakar Muhumed","doi":"10.1016/j.ijscr.2025.111135","DOIUrl":"10.1016/j.ijscr.2025.111135","url":null,"abstract":"<div><h3>Introduction</h3><div>Amniotic Band Syndrome (ABS) is a rare congenital anomaly resulting from the entanglement of fetal body parts in ruptured amniotic bands, leading to structural abnormalities. It is associated with significant stillbirth rates and presents various manifestations affecting limbs and other regions. This report documents the first case of ABS in Somalia.</div></div><div><h3>Case presentation</h3><div>A term neonate was delivered vaginally at 37 weeks and 2 days to a 28-year-old woman with a history of preterm premature rupture of membranes (PPROM). The infant presented with a constriction ring on the right forearm and bilateral clubfoot, but normal limb function and perfusion. Antenatal ultrasounds indicated normal development and moderate oligohydramnios; Doppler ultrasound ruled out vascular compromise.</div></div><div><h3>Discussion</h3><div>The diagnosis of ABS was made postnatally, revealing gaps in prenatal detection capabilities. Conservative management, including local wound care, resulted in satisfactory outcomes. The etiology supports the “extrinsic theory,” linking limb malformations to amniotic rupture. This case highlights the need for improved prenatal screening and training for healthcare providers in Somalia to enhance early detection of congenital anomalies.</div></div><div><h3>Conclusion</h3><div>This case underscores the importance of recognizing ABS and improving healthcare practices for congenital anomaly management in resource-limited settings.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111135"},"PeriodicalIF":0.6,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611321","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":"Giant perineal lipoma: A rare case report","authors":"Suraj Shrestha ,&nbsp;Surya Prakash Joshi ,&nbsp;Roshan Aryal ,&nbsp;Sital Thapa ,&nbsp;Bibek Man Shrestha ,&nbsp;Bishal Panthi","doi":"10.1016/j.ijscr.2025.111134","DOIUrl":"10.1016/j.ijscr.2025.111134","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Lipomas are one of the most common benign tumors. The perineum, head, and acral areas are uncommon sites that require careful differential diagnosis and imaging.</div></div><div><h3>Case presentation</h3><div>We here report a case of a 39-year-old female with a mass in the groin region. Ultrasonography of the mass revealed a large ill-defined iso to a hyperechoic lesion with no evidence of deeper muscular plane extension. Surgical exploration was done through an incision made near the perineal area adjacent to the mass surface.</div></div><div><h3>Clinical discussion</h3><div>Adults with perineal lipoma have soft tissue tumors, dermoid cysts, and epidermoid cysts as differential diagnoses. Ultrasonography is the recommended first investigation since it successfully identifies superficial lipomas with good sensitivity and specificity.</div></div><div><h3>Conclusion</h3><div>Perineal lipomas are uncommon benign tumors. The effective treatment option is surgical excision.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111134"},"PeriodicalIF":0.6,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143637174","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":"Trophoblastic tumor in perimenopausal women: A case report and literature review","authors":"Ghaddab Imen ,&nbsp;Medemagh Malek ,&nbsp;Toumi Dhekra ,&nbsp;Njima Manel ,&nbsp;Jmaa Yosra ,&nbsp;Hajji Ahmed","doi":"10.1016/j.ijscr.2025.111130","DOIUrl":"10.1016/j.ijscr.2025.111130","url":null,"abstract":"<div><h3>Background and importance</h3><div>Placental site trophoblastic tumor (PSTT) a rare form of gestational trophoblastic disease, originates from intermediate trophoblastic cells and presents with nonspecific symptoms, complicating diagnosis. PSTT primarily affects women of childbearing age, but occurrences in perimenopausal women are exceptionally rare.</div></div><div><h3>Case presentation</h3><div>We report a case of a 54-year-old perimenopausal woman presenting with a two-month history of abnormal uterine bleeding. Clinical and imaging evaluations revealed an enlarged uterus and an intracavitary mass. Elevated β-hCG levels prompted suspicion of a trophoblastic tumor. Histopathological examination confirmed PSTT. The patient underwent total hysterectomy with bilateral salpingo-oophorectomy as definitive treatment. Postoperative outcomes were favorable, with normalization of β-hCG levels and no evidence of recurrence during two years of follow-up. Immunohistochemical staining for HPL and cytokeratin further confirmed the diagnosis.</div></div><div><h3>Clinical discussion</h3><div>This case highlights the importance of integrating clinical, imaging, and histopathological findings for the accurate diagnosis of PSTT. Unlike other gestational trophoblastic neoplasms, PSTT is characterized by low sensitivity to chemotherapy, making surgical management the cornerstone of treatment. Long-term follow-up is essential to monitor for potential recurrence.</div></div><div><h3>Conclusion</h3><div>PSTT is a rare and diagnostically challenging condition, particularly in atypical presentations such as in perimenopausal women. Early and accurate diagnosis, followed by surgical intervention, is critical for favorable outcomes. This case emphasizes the need for heightened clinical awareness and a multidisciplinary approach in managing such rare conditions.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111130"},"PeriodicalIF":0.6,"publicationDate":"2025-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577680","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":"Response to “follicular cystitis, a rare diagnosis in an emergency setting: A case report and literature review","authors":"Vilas Sabale,&nbsp;Onkar Sangha","doi":"10.1016/j.ijscr.2025.111131","DOIUrl":"10.1016/j.ijscr.2025.111131","url":null,"abstract":"","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111131"},"PeriodicalIF":0.6,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577681","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":"Brachiocephalic trunk injuries after central venous catheterization: A case series of surgical management and outcomes","authors":"Houssem Messaoudi ,&nbsp;Ahmed Omry ,&nbsp;Habib Bessrour ,&nbsp;Wafa Ragmoun ,&nbsp;Yosr Ben Attig ,&nbsp;Mokhles Lajmi","doi":"10.1016/j.ijscr.2025.111133","DOIUrl":"10.1016/j.ijscr.2025.111133","url":null,"abstract":"<div><h3>Introduction and importance</h3><div>Central venous catheter (CVC) placement is a common procedure, particularly in critically ill patients. However, it carries the risk of vascular complications, including rare and severe injuries to the brachiocephalic trunk (BCT). We present a case series of two patients who developed BCT injuries following tunneled CVC placements, highlighting the critical importance of early diagnosis to prevent fatal outcomes.</div></div><div><h3>Case presentation</h3><div>An 89-year-old female with chronic renal failure on hemodialysis developed hypotension, tachycardia, and dyspnea after left subclavian catheter placement. CT imaging revealed a BCT injury with hemomediastinum. Despite urgent median sternotomy for repair, she developed transfusion-related acute lung injury and passed away on postoperative day 1. In contrast, a 68-year-old female with multiple myeloma and chronic kidney disease developed swelling and a drop in hemoglobin following left internal jugular catheter placement. Imaging confirmed a left BCT injury without active bleeding, and she underwent successful surgical repair with recovery, being discharged on postoperative day 6.</div></div><div><h3>Discussion</h3><div>BCT injury during CVC placement, although rare, is a life-threatening complication. Early diagnosis through imaging, particularly CT, is crucial for guiding surgical intervention. Median sternotomy remains the standard approach for BCT repair, and careful postoperative monitoring is essential, particularly in patients with significant comorbidities.</div></div><div><h3>Conclusion</h3><div>This case series underscores the importance of prompt recognition and effective management of BCT injuries following CVC placement. Despite the rarity of this complication, these cases emphasize the need for meticulous procedural techniques and vigilant postoperative care to improve patient outcomes in high-risk patient populations.</div></div>","PeriodicalId":48113,"journal":{"name":"International Journal of Surgery Case Reports","volume":"129 ","pages":"Article 111133"},"PeriodicalIF":0.6,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143577675","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}