Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"Multi-disciplinary teams for Crohn's disease: Who should be presented?","authors":"Meagan Derbyshire, Yaniv Zager, Katherine Carson, Lindsey Bridges, Leonardo Bustamante-Lopez, Norbert Garcia-Henriquez, Christopher T Aquina, Matthew R Albert, Mark Soliman, John Rt Monson","doi":"10.1016/j.surge.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.surge.2025.03.002","url":null,"abstract":"<p><strong>Background: </strong>Multi-disciplinary team (MDT) conferences are used within the realm of colorectal surgery for both benign and malignant disease to assist in both diagnostic workup and to guide treatment. Usually, teams encompass colorectal surgery (CRS), gastroenterology (GE), pathology and radiology. Although it is believed that MDT discussion is associated with improved outcomes, there is a scarcity of evidence regarding the benefit or patient selection criteria among patients with inflammatory bowel disease (IBD). Due to advancements in both medical and surgical management in the management of IBD, clinical decision making may be challenging. Our aim is to identify which patients are currently being presented in MDT meetings and to assess compliance with the MDT's recommendations.</p><p><strong>Methods: </strong>We conducted a retrospective, observational, multiple campus study including all patients with Crohn's Disease (CD) treated within our system during a twelve-month period. Data was collected from a prospective database of MDT patients and retrospective chart review, including demographics, medical and surgical history, disease course and treatment provided. We compared patients presented at MDT to patients without conference review. Outcomes considered included medical versus surgical management. Analysis included chi square and student t-test, with p < 0.05 considered statistically significant.</p><p><strong>Results: </strong>From September 2022 to September 2023, 766 patients were presented to our hospital system for management of CD disease and 52 patients were reviewed at a multi-disciplinary conference for IBD. On comparison of the two groups, those presented at the conferences were on average younger (43.4 vs. 44.9 years; p < 0.05) and had lower body mass index (BMI) compared to those not presented (23.6 vs. 26.1; p < 0.05). There was no difference in gender (p = 0.55) or race distribution between the two groups (p = 0.07). Surgical intervention was more frequent in patients that were presented in MDT meetings (46.2 % vs. 23.2 %; p < 0.05).</p><p><strong>Conclusion: </strong>Multi-disciplinary conferences can be used in IBD and CD disease to guide treatment. Our results suggest a tendency to present younger, lower BMI patients for surgical management of CD disease. Further analysis will target the role of this conference in new diagnoses, in the setting of medical refractory disease or those with multiple prior operative interventions, and in patients who require additional consultants outside of gastroenterology and colorectal surgery. Prospective studies are warranted to establish criteria for presentation of CD Disease patients at MDT conferences.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774611","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":"Evaluating the use of absorbable sutures versus sTaples versus tIssue glue in laparoscopic port skin closure (STILS) trial: A prospective, multi-centre randomised clinical trial (RCT).","authors":"Sinead E Ramjit, Matthew G Davey, Stephen Keelan, Emer Herlihy, Marie Dromey, Chris Garvey, Timothy S Nugent, Aisling Fawaz, Lauren O'Connell, Melanie Cunningham, Matthew Fahy, Eanna J Ryan, Brendan Moran, Lylas Aljohmani, Jeyanthi Narayanasamy, Michael E Kelly, Clara Healy, Claire Donohoe, Narayansamy Ravi, Paul Neary, John V Reynolds, Noel E Donlon","doi":"10.1016/j.surge.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.015","url":null,"abstract":"<p><strong>Methods: </strong>This prospective, multi-centre RCT was conducted in accordance with the CONSORT guidelines for prospective, parallel group randomised studies. Adult patients undergoing elective laparoscopic surgery at two teaching hospitals in Dublin, Ireland were recruited and assigned to one of three closure methods (sutures (SU), staples (ST) or tissue glue (TG)) with primary outcome being cosmesis and secondary outcomes being closure speed, wound complications, cost effectiveness and sustainability outcomes being assessed by a blinded outcomes assessor.</p><p><strong>Results: </strong>A total of 147 patients were recruited and randomised with a total of 138 being examined in the final analysis (SU = 48, ST = 63, TG = 27). Patient demographics were similar across all groups for gender, mean age, body mass index and American Society of Anaesthesiologists grade (all p > 0.050). For cosmesis, SU had the lowest overall mean observer (p < 0.001) and patient (p = 0.005) scar scores. Furthermore, when evaluating the breakdown for Observer Scar Score (OSS), SU had the lowest vascularity (p = 0.001), pigmentation (p = 0.006), thickness (p < 0.001), relief (p = 0.003) and pliability (p < 0.001). For patient scar score (PSS), SU had the lowest irregularity (p = 0.035). SU was the most cost-effective (p < 0.001) and had the lowest total produced non-recyclable waste (p < 0.001). ST had the shortest closure time (p < 0.001). Overall, there was a no difference in wound complication rates (SU = 6.3 %, ST = 6.4 %, TG = 18.5 %; p = 0.130).</p><p><strong>Conclusion: </strong>In conclusion, SU was the most effective method for laparoscopic port site closure with regards to cosmesis, cost-efficiency and surgical sustainability. ST was the marginally quicker method of closure and demonstrated equipoise in terms of complication rate. We advocate for SU as the current 'gold standard' with reduced non-recyclable waste generated and a valuable training opportunity for junior trainees.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03843866.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659543","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":"A joint effort: Evaluating the quality and readability of online resources relating to total hip arthroplasty.","authors":"Samher Jassim, Conor J Kilkenny, Alex Price, Thomas Moore, Niall P McGoldrick, John F Quinlan","doi":"10.1016/j.surge.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.016","url":null,"abstract":"<p><strong>Background: </strong>The internet serves as a major source of information for patients undergoing total hip arthroplasty (THA). However, prior research has shown that online medical information often exceeds recommended readability levels, posing a barrier to patient comprehension. The average reading level in the United States is between 7th and 8th grade, while leading health organizations recommend that patient information not exceed a 6th-grade level. This study aims to evaluate the readability and quality of information available online regarding THA.</p><p><strong>Methods: </strong>A systematic search was conducted on Google, Bing, and Yahoo using the terms \"total hip arthroplasty\" and \"hip replacement surgery,\" with the top 30 URLs from each search engine selected. Readability was assessed using three readability scores (Gunning FOG, Flesch-Kincaid Grade, and Flesch Reading Ease). Quality was evaluated based on HONcode certification and the JAMA benchmark criteria.</p><p><strong>Results: </strong>Ninety webpages were included in the analysis. The mean Flesch-Kincaid Grade level was 9.5 ± 2.4, the mean Gunning FOG grade was 11.1 ± 3.0, and the mean Flesch Reading Ease score was 48.5 ± 13.8. Only 6 webpages were at or below a 6th-grade reading level. The mean JAMA score was 1.4 ± 1.3 out of 4, and 13 websites were HONcode accredited.</p><p><strong>Conclusion: </strong>Online THA-related medical information is often too complex for the average patient, with inconsistent quality. This study assessed readability and credibility but did not evaluate medical accuracy or include hospital-based resources. Improving both readability and reliability is essential to enhance patient comprehension, support informed decision-making, and promote better health literacy.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634799","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":"Early failure following pelvic exenteration: Who are the bad actors?","authors":"Ben Creavin, Michael Eamon Kelly, Jawed Noori, Greg Turner, Glen Guerra, Cori Behrenbruch, Helen Mohan, Joe Kong, Jacob McCormick, Satish Warrier, Alexander Heriot","doi":"10.1016/j.surge.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.010","url":null,"abstract":"<p><strong>Background: </strong>Pelvic exenteration for locally advanced (LARC) or recurrent rectal cancer (LRRC) is technically challenging with considerable morbidity for the patient. Though surgery can confer long-term survival in selected patients, early failure, defined as recurrence with one year, represents a major issue as both survival and quality of life are severely impacted. This study aims to highlight the \"bad actors\" associated with early failure.</p><p><strong>Methods: </strong>A retrospective study of patients who underwent exenteration for LARC & LRRC in a quaternary referral unit was performed. Specifically, characteristics of patients with early recurrence were identified and compared to those who recurred after one year.</p><p><strong>Results: </strong>159 and 85 patients underwent pelvic exenteration for LARC and LRRC, respectively. Of these, there were 61 (38.3 %) recurrences in the LARC and 74 (87.1 %) LRRC cohorts. For LARC, 18 patients had an early failure. Expectantly, these patients had a higher proportion of positive margins (R1) (50 % vs. 21 % in the remaining 141 patients, ∗p = 0.04). Interestingly, early failure was also associated with more genetic mutations (33 % vs. 22 %), extramural venous invasion (32 % vs. 24 %), lymphovascular invasion (38 % vs. 22 %), and other adverse histopathological features including poor-differentiation, signet-ring and/or mucinous disease (38 % vs. 21 %). Median and 3-year overall survival (OS) in the early failure group compared to the rest of the cohort was 96 months versus 30 months and 35 % versus 73 %, respectively (∗p = 0.003). There were 18 early failures in the LRRC cohort. Similarly, there were more patients with positive margins in the early failure group (55 % versus 39 %, ∗p = 0.02). The early failure group was also associated with extramural venous invasion (38 % versus 23 %) and adverse histopathological features (55 % versus 28 %). Median and 3-year overall survival (OS) in the early failure group compared to the non-early-failure group was 15 versus 0 months and 17 % versus 68 % respectively (∗p=<0.001).</p><p><strong>Conclusion: </strong>Tailoring treatment strategies according to tumour characteristics is increasingly important in the management of advanced rectal cancer. Multicentre data is needed to validate these findings and would have a profound impact to patient counselling and outcome expectations.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630922","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":"Perception in surgical practice: Navigating cognitive biases and enhancing decision-making.","authors":"Suresh Annamalai","doi":"10.1016/j.surge.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.014","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626412","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":"Women in Irish orthopaedics - A review of female representation at the Irish Orthopaedic Association annual meeting over a 16-year period.","authors":"Carl O'Flanagan, Conor J Kilkenny, Adam Abdelmoneim, Niall McGoldrick, John F Quinlan","doi":"10.1016/j.surge.2025.02.009","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.009","url":null,"abstract":"<p><strong>Introduction: </strong>There is underrepresentation of women in orthopaedics worldwide. As of 2017, 10 % of Irish orthopaedic consultants and 12.24 % of higher specialist trainees were female. Workplace diversity can promote innovation, creativity, and encourage staff retention. To realise these benefits, it is quoted that there must be 30 % minority representation. We examine the representation of women in academic orthopaedics in Ireland by looking at gender breakdown at the Irish Orthopaedic Association (IOA) annual conference.</p><p><strong>Methods: </strong>IOA programmes from 2008 to 2023 were examined assessing for representation of women. Non-consultant hospital doctors (NCHD's), session chairs and guest speakers were examined. Linear regression analysis for male and female speakers was performed to evaluate for statistical significance.</p><p><strong>Results: </strong>Fourteen annual conferences were evaluated equating to 740 NCHD-delivered oral presentations. Women delivered 126 presentations (17.03 %). While there was a general trend of increasing female representation over the years examined, linear regression analysis did not show this to be statistically significant (Coefficient: 0.3746, P-value: 0.077, R²: 0.237). There was a statistically significant decline in male speakers (Coefficient: 1.9775, P-value: 0.007, R²: 0.473). 41 guest lectures were delivered, 14.63 % by women. Session chairs were disclosed for 7 meetings equating to 54 sessions presided over by 79 chairs. Six chairs were female (7.59 %).</p><p><strong>Conclusion: </strong>Orthopaedics is likely to be better served by more diverse workforces that are representative of their populations. Our study highlights that while gender disparity persists in Irish academic orthopaedics, there appears to be a shift towards diversity. This is particularly evident at trainee level over the past 7 years; however, efforts should be made to support these into leadership roles where women are currently underrepresented. Their visibility can then serve as inspiration for future female trainees.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587779","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":"List of editors","authors":"","doi":"10.1016/S1479-666X(25)00036-8","DOIUrl":"10.1016/S1479-666X(25)00036-8","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 2","pages":"Page i"},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143552344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Needlestick injury incidence and reporting in Irish surgical trainees.","authors":"Fergus J McCabe, Niamh Dunne, Shane K Farrington, Robert P Piggott, Catherine Bossut, Tom McCarthy, Joseph M Queally","doi":"10.1016/j.surge.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.011","url":null,"abstract":"<p><strong>Introduction: </strong>Needlestick injuries (NSI) in healthcare workers are common and rising in Ireland. Surgical trainees are particularly at-risk of NSIs. The aim of this study was to assess the estimated NSIs suffered by Irish surgical trainees, the reporting behaviours of NSI and the perceived barriers to reporting.</p><p><strong>Methods: </strong>This was an anonymous, online survey of surgical trainees on the Irish surgical training programmes. Trainees were asked the estimated NSIs ever received, perceived NSI contributing factors, NSIs reported to occupational health, and perceived barriers to reporting of NSIs. Independent predictors of needlestick injury were assessed by ordinal logistic regression. Data analysis was performed with R, version 4.1.1.</p><p><strong>Results: </strong>There were 73 participants, with 66 % male and a median age group of 30-34 years. The median year of surgical training was 4. All but one trainee reported an NSI prior, with the median 6 (range of 0 to over 20). On ordinal logistic regression, year of training was the only independent factor associated with greater reported NSIs (OR 1.32). Most NSIs were from a suture needle in the non-dominant hand. Time pressure (79%) and mental fatigue (78%) were the most frequently perceived contributory factors. Only 14% of participants report all NSIs. The time requirements (82%) and reporting pathway complexity (81%) were the primary listed reasons for non-reporting of NSIs.</p><p><strong>Conclusion: </strong>Despite being at high risk of needlesticks and the associated risks, few surgical trainees report all needlestick injuries. Reporting pathways of needlestick injuries should be streamlined to encourage greater reporting.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587766","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":"Weight changes following total hip and total knee arthroplasty - A systematic review.","authors":"James Toale, Ciarán Stanley, John F Quinlan","doi":"10.1016/j.surge.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.013","url":null,"abstract":"<p><strong>The background and purpose of the study: </strong>Symptomatic osteoarthritis can result in reduced mobility and exercise tolerance, leading to weight gain. Patients often feel that arthroplasty will result in improved mobility, reduced pain, and subsequent weight loss. The purpose of this systematic review was to assess weight changes following lower limb arthroplasty from available published literature.</p><p><strong>Methods: </strong>A systematic review of PubMed, EMBASE and Cochrane Library databases were performed in accordance to PRISMA guidelines. Studies reporting significant weight changes of 5 % of pre-operative weight, 5 % of BMI and total weight change in kilograms following hip and knee arthroplasty were included. Outcomes assessed were weight changes according to groupings 'weight gain', 'maintained weight' and 'weight loss'. Secondarily we assessed weight changes in kilograms. Methodological quality of evidence was assessed using MINORS criteria.</p><p><strong>Results: </strong>In total, 21 studies were included with a total of 55,245 patients. In the '5 % of total weight' group 12.5 % gained weight, 74.2 % maintained weight and 13.3 % lost weight (weighted means). In the '5 % of BMI' group 22.1 % gained weight, 66.3 % maintained weight and 13.9 % lost weight (weighted means). Overall, 13 studies reported a weighted mean weight change of +0.7 kg. The majority of studies were of moderate/poor quality using MINORS criteria.</p><p><strong>Conclusions: </strong>This systematic review found that the majority of patients maintain their preoperative weight following hip and knee arthroplasty. This study suggests that arthroplasty does not lead to weight loss from improved pain and mobility in the majority of patients. This study presents data that is important for surgeons and patients alike when considering potential weight changes following arthroplasty.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574402","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":"Reduction of carbon footprint is a benefit of the virtual interview.","authors":"Tarek Elliott-Diab, Monica Coughlan","doi":"10.1016/j.surge.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.008","url":null,"abstract":"<p><strong>Introduction: </strong>Climate change is a global crisis. One strategy to reduce climate change is to reduce carbon footprint. In medicine, this can be done using various methods, including virtual interviews in addition or instead of in-person.</p><p><strong>Materials and methods: </strong>We used data from the U.S. National Residency Matching Program (NRMP) and terrapass™, an online calculator, to measure the carbon footprints of residency interviews for Orthopædic Surgery.</p><p><strong>Results: </strong>DISCUSSION AND CONCLUSION: Carbon footprint provides support for the addition of a virtual format to the medical training process. The virtual interview may serve as a substitute or a compliment to the traditional in-person format, which has a significantly greater carbon footprint. This approach will reduce significantly the environmental impact of the residency interviews, a recognition and thought process that will align medical postgraduate education with a growing wave of organizations and industries worldwide.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574400","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}