Journal of Minimal Access Surgery最新文献

{"title":"Outcomes of various bailout strategies for managing different categories of difficult laparoscopic cholecystectomy - An experience of over two decades from a single surgical unit at a tertiary care teaching hospital.","authors":"Asuri Krishna, Sanjeet Kumar Rai, Mayank Jain, Om Prakash, Mahesh C Misra, Subodh Kumar, Virinder Kumar Bansal","doi":"10.4103/jmas.jmas_163_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_163_25","url":null,"abstract":"<p><strong>Introduction: </strong>A difficult laparoscopic cholecystectomy (LC), if not handled appropriately, can lead to devastating complications. We hereby describe our experience and outcomes of patients with difficult LC over the last two decades, with various bailout strategies to achieve a very low conversion rate and bile duct injury rate.</p><p><strong>Patients and methods: </strong>This study was a retrospective analysis of patients labelled as difficult LC in a single surgical unit at a tertiary care teaching hospital from January 2004 to December 2020. The pre-operative, peri-operative and follow-up data of all these patients were obtained from a prospectively maintained electronic database.</p><p><strong>Results: </strong>Between January 2004 and December 2020, 3726 patients underwent elective LC, of which 649 (17.4%) cholecystectomies were deemed difficult. Using the various bailout strategies, we were able to achieve a conversion rate of 4.9% and bile duct injury rate of 0.1% with an overall morbidity of 8%.</p><p><strong>Conclusion: </strong>When a difficult situation occurs, the benefit of removing the complete gall bladder is outweighed by the risk of a major injury, so a bailout strategy needs to be used. The present series reiterates the use of bailout strategies to not only decrease conversion but also achieve a minimal BDI rate.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of extended view totally extraperitoneal with intraperitoneal onlay mesh for primary ventral hernia surgery: A randomised controlled study from a tertiary university hospital.","authors":"Pawanindra Lal, Jony Kumar, Tusharindra Lal, Anubhav Vindal","doi":"10.4103/jmas.jmas_52_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_52_25","url":null,"abstract":"<p><strong>Introduction: </strong>Primary ventral hernia remains a common presentation in surgical clinics with reported recurrence rates of 10%-20%. Intraperitoneal onlay mesh (IPOM) repair has been the widely accepted technique for laparoscopic management of ventral hernia. More recently, extended view totally extraperitoneal (eTEP) repair has emerged as a safe procedure in terms of reduced post-operative pain and faster recovery. Studies comparing IPOM with eTEP are limited. The present study was conducted to compare the two surgical techniques in terms of early outcomes in patients presenting with primary ventral hernia.</p><p><strong>Patients and methods: </strong>A total of 30 patients with primary ventral hernias with defect size > 2 and up to 6 cm were randomised using computer-generated sequences into two groups. Operative time was used as the primary endpoint. Patients were followed up at 6 months, 1 year and 2 years postoperatively to look for recurrence, chronic pain and any other complications.</p><p><strong>Results: </strong>Mean operative time in the IPOM group was significantly less than eTEP repair (P < 0.001). Mean pain scores in the eTEP group at discharge, on day 1 and 1 week were significantly lower than corresponding scores in the IPOM group. The mean hospital stay (2.09 ± 0.30 days) in the eTEP group was less than the IPOM group (3.64 ± 1.56 days) (P < 0.001). Return to work was also significantly earlier in eTEP (10.18 ± 1.07 days vs. 13.55 ± 2.16 [P < 0.001]). No recurrence was recorded in 23 of 30 patients followed up till 2 years.</p><p><strong>Conclusions: </strong>Operative time was significantly longer in the eTEP group, reaffirming the published data. Post-operative pain was significantly lower in patients undergoing the eTEP procedure up to 1 week. Consequently, hospital stay was also reduced and return to work was faster in these patients. Both procedures fared equally in terms of no recurrence with a 77% follow-up at 24 months.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors leading to post-cholecystectomy bleeding requiring reoperation: A case series.","authors":"Mena Louis, Nathaniel Grabill, Baraa Mohamed, Emily Murdoch, Morgan A Krause, Bradley Kuhn","doi":"10.4103/jmas.jmas_366_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_366_24","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic cholecystectomy is widely regarded as the standard treatment for symptomatic gall bladder diseases due to its minimally invasive nature and favorable recovery profile. However, hemorrhagic complications pose significant risks to patient safety and outcomes.</p><p><strong>Patients and methods: </strong>This retrospective case series aimed to evaluate the incidence, risk factors and outcomes associated with intraoperative and post-operative hemorrhagic complications in patients undergoing cholecystectomy. Eighteen patients who experienced significant bleeding necessitating unplanned reoperations were included in the analysis. Data were collected encompassing demographic information, comorbidities, surgical details and post-operative outcomes.</p><p><strong>Results: </strong>The study found that older age and higher body mass index (BMI) were strongly correlated with increased estimated blood loss, with each additional year of age increasing the odds of severe hemorrhage by 7% and each unit increase in BMI raising the odds by 15%. Patients with the American Society of Anesthesiologists classifications of 3-4 were 3.5 times more likely to experience severe bleeding. In addition, the use of anticoagulant or antiplatelet therapy was associated with a nearly six-fold increase in the risk of significant hemorrhage. The presence of adhesions or severe inflammation further doubled the risk of substantial blood loss. Hemorrhagic complications were associated with prolonged hospital stays, higher rates of blood transfusions and increased mortality.</p><p><strong>Conclusion: </strong>These findings highlight the importance of pre-operative risk assessment and tailored surgical strategies to mitigate bleeding risks. Enhancing patient evaluation and optimizing surgical techniques are crucial for improving outcomes and ensuring patient safety in cholecystectomy procedures.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What does it take to become a hernia specialist?","authors":"Easwaramoorthy Sundaram","doi":"10.4103/jmas.jmas_35_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_35_25","url":null,"abstract":"<p><strong>Abstract: </strong>Hernia surgery is the most common procedure done by surgeons. The author describes the various pathways to becoming a hernia specialist, considering the strengths, weaknesses, opportunities and threats as in a business model.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastric tumour causing gastroduodenal intussusception - Laparoscopic management.","authors":"Pranav Wadhokar, Guhan Venkatakrishnan, Sudheer Othiyil Vayoth, Vinaya Chandra","doi":"10.4103/jmas.jmas_84_25","DOIUrl":"10.4103/jmas.jmas_84_25","url":null,"abstract":"<p><strong>Abstract: </strong>Adult gastroduodenal intussusceptions are very rare. Presentation of gastric gastrointestinal stromal tumours (GISTs) as gastroduodenal intussusception is atypical and clinically difficult to diagnose due to non-specific symptoms. We report the rare case of an elderly male who presented with clinical features of gastric outlet obstruction. Diagnostic imaging and endoscopy revealed a gastric antral GIST leading to gastroduodenal intussusception. Due to the irreducibility of the intussusception, the patient underwent laparoscopic distal gastrectomy as definitive management. Laparoscopic management in such cases is feasible with equally good oncological outcomes as compared to open surgery, with better cosmetic outcome and faster recovery.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic sleeve gastrectomy and nutritional deficiency: A comprehensive longitudinal analysis.","authors":"Shahbaz Bashir, Zubair Gul Lone, Yawar Nazir, Bilal Ahmad Wagay, Gowhar Aziz Bhat, Mubashir Ahmad Shah","doi":"10.4103/jmas.jmas_91_25","DOIUrl":"10.4103/jmas.jmas_91_25","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic sleeve gastrectomy (LSG) represents a cornerstone in the surgical management of morbid obesity. While the procedure effectively reduces weight and improves obesity-related comorbidities, the anatomical alterations inherent to LSG can lead to significant nutritional challenges. These modifications in gastrointestinal physiology may result in various micronutrient deficiencies, particularly affecting iron, Vitamin B12 and folate status.</p><p><strong>Patients and methods: </strong>We conducted a prospective cohort study of 70 patients undergoing LSG at our tertiary care centre. Participants underwent comprehensive nutritional assessment at baseline and regular intervals postoperatively (6, 12 and 24 months). We measured serum levels of key micronutrients, including iron, Vitamin B12 and folate, while simultaneously tracking supplement adherence. Statistical analysis incorporated both univariate and multivariate approaches to identify patterns and risk factors for nutritional deficiencies.</p><p><strong>Results: </strong>Our analysis revealed distinct gender-specific patterns in nutritional deficiencies. Female patients demonstrated significantly higher rates of iron deficiency throughout the study period, with prevalence rates of 58%, 50% and 36% at 6, 12 and 24 months, respectively. Vitamin B12 deficiency showed a progressive increase in both genders, while supplement adherence declined markedly from 96% at 6 months to 42% at 24 months. Multivariate analysis identified female gender, younger age and poor supplement adherence as significant risk factors for nutritional deficiencies.</p><p><strong>Conclusion: </strong>Post-LSG nutritional deficiencies present a significant clinical challenge, particularly for female patients. Our findings emphasise the critical importance of long-term nutritional monitoring and the need for targeted supplementation and adherence-enhancing intervention strategies to improve supplement adherence.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing laparoscopic transversus abdominis plane block and port-site infiltration in laparoscopic ventral hernia repair: A randomised controlled trial.","authors":"Sourabh Singh, Himanshu Agrawal, Nikhil Gupta, Nitin Agarwal, Aditya Kumar, Shailesh Kumar","doi":"10.4103/jmas.jmas_382_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_382_24","url":null,"abstract":"<p><strong>Introduction: </strong>Adequate analgesia is of utmost importance for apposite in patients undergoing laparoscopic ventral hernia repair (LVHR) for smooth recovery. TAP block and port-site infiltration (PSI) are two most commonly employed methods for pain relief. Therefore, this study was done to compare laparoscopic-guided TAP block versus PSI for post-operative analgesia, hospital stay and rescue dose of analgesic in LVHR.</p><p><strong>Patients and methods: </strong>This single-blinded randomised controlled trial was done in a tertiary hospital of Delhi from 1 April 2023, to 1 August 2024. A total of 60 patients were enrolled. Randomisation was done using computer-generated random number table, and allotment was done using sequentially numbered opaque sealed envelopes. All patients >18 years of age with anterior abdominal wall hernia undergoing LVHR were included in the study. Patients with a history of opioid usage, patients with alcohol abuse within the past 6 months, patients with hernia size >6 cm were excluded from the study. Two groups included: test group (Group A) - laparoscopic-assisted TAP block (LTAP) and control Group (Group B) - port-site local anaesthesia infiltration (PSLAI).</p><p><strong>Results: </strong>In LVHR, the use of TAP blocks showed superior pain management compared to PSLAI (significantly lower VAS scores at 6, 12 and 24-h post-surgery in the LTAP group [P = 0.0031, 0.0037 and 0.00012, respectively]). LTAP was associated with a shorter hospital stay (P = 0.016) and less need for rescue analgesia (P = 0.031).</p><p><strong>Conclusion: </strong>Laparoscopic transverse abdominis plane block is superior to port-site local anaesthesia infiltration in providing effective post-operative analgesia.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic transabdominal preperitoneal repair of the left-sided secondary lumbar hernia.","authors":"Krishna Venkata Rajesh Varma Chundru, P Reddy Abhinaya, Kumbhar Uday Shamrao","doi":"10.4103/jmas.jmas_354_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_354_24","url":null,"abstract":"<p><strong>Abstract: </strong>Lumbar hernias (LHs) are exceedingly rare, with definite management being surgery immediately upon diagnosis when the patient is medically fit. Herein, we report the case of a male patient in his mid-40s who presented with acquired left LH secondary to transabdominal percutaneous drainage of necrotic collection in a case of necrotising pancreatitis as a part of a step-up approach. He underwent robotic transabdominal preperitoneal repair using 15 cm × 12 cm polypropylene mesh. He was discharged on the second post-operative day. The patient returned to regular activity within 10 days, and at 2-month follow-up, he continued with routine daily activities. Robotic repair of the LH is feasible and safe with the advantage of having a three-dimensional high-definition vision, better ergonomics, intuitive motion, higher precision, tremor filtration and self-camera control.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and feasibility of concomitant ventral hernia repair and total laparoscopic hysterectomy: A single-centre experience of over 1000 cases.","authors":"Pradeep Joshua Christopher, Rajapandian Subbiah, Parthasarathi Ramakrishnan, Anand Vijai Natesan, Kavitha Yogini Duraisamy, Praveen Raj Palanivelu, Palanivelu Chinnusamy","doi":"10.4103/jmas.jmas_2_25","DOIUrl":"https://doi.org/10.4103/jmas.jmas_2_25","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic ventral hernia surgery has become the standard of care for most surgeons, offering improved patient outcomes, shorter hospital stays, and fewer complications compared to open surgeries. However, the benefits of combining Intraperitoneal Onlay Meshplasty (IPOM) with other surgeries are rarely discussed and not commonly practiced. This study examines the safety of placing mesh after Total Laparoscopic Hysterectomy (TLH) based on a single center's retrospective experience of over 1,000 cases spanning 15 years.</p><p><strong>Materials and methods: </strong>Data of all the patients who underwent concomitant TLH with IPOM were collected retrospectively. Details of the surgery, immediate post-op outcomes, long term follow ups with complications and recurrences were analysed.</p><p><strong>Results: </strong>Between January 2006 and January 2021, we reviewed 1,273 cases, of which 1,058 met our inclusion and exclusion criteria. There were no open conversions. The mean patient age was 48.23 years with a standard deviation (SD) of 2.19. The mean BMI was 33.21 kg/m² with an SD of 1.83. The average defect size was 5.8 cm with an SD of 1.65. The mean operating time was 231 minutes with an SD of 10.15. The average hospital stay was 3.2 days with an SD of 0.84. There were no 30 day readmissions or mortality. Out of 1,058 cases, 782 patients had a minimum follow-up period of 2 years, conducted through telephone conversations or in-person hospital visits. An additional 155 patients had at least 1 year of follow-up, while 121 patients were lost to follow-up within the first year. The median follow-up duration for all patients was 2.8 years. 52 cases (4.9%) experienced postoperative seroma. We had only one case (0.094%) of mesh infection, which required mesh explantation. There were two instances of recurrence (0.189%): one patient underwent open repair after 24 months, and another underwent eTEP repair 32 months after the initial surgery. Both patients completed 1 year of follow-up post-second procedure and were doing well.</p><p><strong>Conclusion: </strong>Meshes can be safely placed in a clean, contaminated environment alongside total laparoscopic hysterectomy, with the discretion of the operating surgeon considering his expertise and judgment. We can conclude that combining ventral hernia repairs with TLH is safe and feasible with acceptable morbidity.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographics, complications and outcomes of laparoscopic appendectomy in paediatric patients: A 15-year study from western India.","authors":"Prativa Choudhury, Amar Shah, Ria Sharma, Anirudh Shah","doi":"10.4103/jmas.jmas_348_24","DOIUrl":"https://doi.org/10.4103/jmas.jmas_348_24","url":null,"abstract":"<p><strong>Introduction: </strong>Acute appendicitis is one of the most common causes of abdominal pain in children and is considered the most frequent paediatric surgical emergency. The incidence progresses from extremely low in the neonatal period to a peak incidence between ages 12 and 18 years. Prompt diagnosis and management are imperative to prevent serious complications such as perforation, peritonitis, intra-abdominal abscess formation and bowel obstruction. Laparoscopy has improved intra- and post-operative outcomes for children with appendicitis. This study was conducted to evaluate demographics and complications of laparoscopic appendicectomy in Indian children.</p><p><strong>Patients and methods: </strong>This is a retrospective cohort study encompassing 714 consecutive patients of appendicitis operated over 15 years (2006-2021) by a single surgeon at a high-volume private paediatric surgical centre in Western India. Data collected included age and gender, duration of surgery and post-operative variables such as length of stay and early or delayed interventions, if any. The patients were categorised into two groups: complicated appendicitis and non-complicated appendicitis, depending on the operative findings. Patients with acutely inflamed appendix without perforation, peritonitis or collection and patients with chronically inflamed appendix were categorised as non-complicated appendicitis. Patients with perforated or gangrenous appendicitis, appendicular lump and appendicitis with intraperitoneal collection were categorised as complicated appendicitis. Additional pathologies found and treated during the surgery were also documented. The statistical analysis was performed using IBM SPSS Statistics 28.0.0.0.</p><p><strong>Results: </strong>The total cohort of patients who underwent laparoscopic appendectomy in the study was 714. The number of male patients was significantly greater than the female population (P < 0.001). The total number of cases of non-complicated appendicitis was 580 (81.23%). Patients with uncomplicated appendicitis had a mean age of 9.12 ± 3.65 years, while those with complicated appendicitis had a mean age of 7.49 ± 3.58 years. Additional pathologies such as simple ovarian cyst, Meckel's diverticulum and Enterobius vermicularis were found in 11.55% of uncomplicated cases. Post-operative complications were observed to be higher in the complicated group (27.6%) compared to the uncomplicated group (1.72%).</p><p><strong>Conclusion: </strong>This study shows that acute appendicitis affects our study population at a mean age of 8.84 years, with a majority of males (64.14%). It also shows that complicated appendicitis has a higher incidence of post-operative complications of 27.6% and prolonged hospital stay. A multicentre research across various states in India can help establish a clear outlook regarding the demographics of complicated and uncomplicated paediatric appendicitis in the country.</p>","PeriodicalId":48905,"journal":{"name":"Journal of Minimal Access Surgery","volume":" ","pages":""},"PeriodicalIF":1.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}