Cirugia Espanola最新文献

{"title":"Resultados de la implementación de un área de atención integral del paciente frágil que debe ser intervenido. Cuatrocientos trece pacientes: morbilidad postoperatoria a corto y largo plazo y calidad de vida","authors":"Jordi Castellví Valls,&nbsp;Amparo Rodríguez,&nbsp;Lucía Gil,&nbsp;Julia Pareja,&nbsp;Sira García,&nbsp;Elisenda Pujol,&nbsp;Esther Sotelo,&nbsp;Lluís Pascual,&nbsp;Jesús Badía,&nbsp;Isidre Martí","doi":"10.1016/j.ciresp.2026.800381","DOIUrl":"10.1016/j.ciresp.2026.800381","url":null,"abstract":"<div><h3>Introduction</h3><div>The objective was to analyze the functioning and short and long-term outcomes of an Integrated Care Area for frail patients requiring surgery.</div></div><div><h3>Methods</h3><div>Observational, descriptive study with prospective data collection. From December 2016 to January 2025, 413 frail patients were included in an Integrated Care Area for the Complex Surgical Patient (AAPQC). Age, sex, referring service, ASA, frailty index (VGI-Frail and Clinical Frailty scale), Barthel, Pfeiffer, Complex Chronic Patient (PCC), and Advanced Chronic care Model (MACA) were analyzed. Operated and non-operated patients were compared. Complications (Clavien-Dindo), mean length of stay, 30-day mortality, readmissions, and quality of life at 3 months and one year were evaluated.</div></div><div><h3>Results</h3><div>Four hundred thirteen patients, mean age 80 years, 251 men (60.8%). The 91.8% were ASA III-IV, 259 (53%) PCC and 61 (14.7%) MACA. Two hundred ninety-eight (77.6%) came from general surgery. The 7.3% lived in care facilities. One hundred twenty-five (30.3%) were recommended not to undergo surgery. Age, ASA, PCC, MACA, VGI-frail, Clinical Frailty Score, Barthel and Pfeiffer were significantly (<em>P</em>&lt;.0001) better in those operated. Postoperative complications (Clavien-Dindo III-IV-V), readmissions and mortality were 9.7%, 13.2% and 3.1% respectively. The 10% required convalescence resources at discharge. The 82.5% of operated patients were better or the same as before surgery at three months and one year. Of those not operated (n<!--> <!-->=<!--> <!-->125), 48.3% died during the first year.</div></div><div><h3>Conclusions</h3><div>The establishment of an integrated care area for frail patients requiring surgery facilitates decision-making and reduces postoperative morbidity with acceptable quality of life.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 9","pages":"Article 800381"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148994851","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":"Fallo de rescate tras una esofagectomía. La importancia de registrar las complicaciones. Estudio retrospectivo a lo largo de 20 años","authors":"Silvia Carbonell-Morote,&nbsp;Miriam Menéndez-Jiménez,&nbsp;Marcos Bruna Esteban,&nbsp;Roberto Adriano Castro,&nbsp;Fabián Velázquez-Rebosa,&nbsp;Inmaculada Mesa-Ruiz,&nbsp;Javier Vaqué,&nbsp;Fernando Mingol-Navarro","doi":"10.1016/j.ciresp.2026.800376","DOIUrl":"10.1016/j.ciresp.2026.800376","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal cancer is a rare type of neoplasm in Western countries, yet it ranks as the seventh leading cause of death. Due to its anatomical location, esophageal surgery is a highly complex procedure. The morbidity and mortality associated with esophagectomy are significant, highlighting the need for a multidisciplinary approach to minimize complications. The measure of failure to rescue (FTR) reflects surgical outcomes and indicates the capacity to prevent death after a major complication (MC). It serves as a valuable metric for comparing results among different medical centers.</div></div><div><h3>Objective</h3><div>To evaluate the failure to rescue rate following esophagectomy at a high-volume tertiary esophageal surgery center.</div></div><div><h3>Methods</h3><div>This retrospective study analyzed FTR, mortality, and morbidity rates following esophageal surgery from 2003 to 2024. Preoperative, intraoperative, and postoperative variables were assessed across patient groups. Comorbidities were evaluated using the ASA score, and complications were classified according to the Clavien-Dindo classification.</div></div><div><h3>Results</h3><div>268 patients underwent esophagectomy during the period of study. 129 (48%) experienced MC. Among these, 25 patients died within the first 90 days after surgery: FTR rate of 19.3%. Univariate and multivariate logistic regression analyses identified respiratory complications, including pneumonia and adult respiratory distress syndrome, as independent factors associated with FTR.</div></div><div><h3>Conclusion</h3><div>Respiratory complications are identified as the most significant risk factor for FTR following esophagectomy.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 9","pages":"Article 800376"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148994850","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":"Deficiencies in preoperative CT staging reports for colon cancer: A national survey of colorectal surgeons","authors":"Sergio García-Hernández,&nbsp;Álvaro García-Granero,&nbsp;Sebastián Jerí-McFarlane,&nbsp;Noemí Torres-Marí,&nbsp;Margalida Campaner-Payeras,&nbsp;Juan Díaz-Ferrando,&nbsp;Margarita Gamundí-Cuesta,&nbsp;Francisco Javier González-Argente","doi":"10.1016/j.ciresp.2026.800366","DOIUrl":"10.1016/j.ciresp.2026.800366","url":null,"abstract":"<div><h3>Aim</h3><div>To identify the main deficiencies in preoperative staging reports using computed tomography (CT) in colon cancer and to assess their impact on surgical planning as well as the need for a national standardized radiological protocol.</div></div><div><h3>Method</h3><div>A cross-sectional study was conducted using a national survey of colorectal surgeons, members of the Young Group of the Spanish Association of Coloproctology (GJ-AECP). The anonymous and voluntary survey included 30 items organized into 8 domains related to tumor staging by CT: location and T stage, lymph node involvement, tumor deposits, anatomical lymph node territories, vascular landmarks, surgical planning, standards of radiological practice, and the use of 3D reconstruction and standardized protocols. The results were analyzed descriptively.</div></div><div><h3>Results</h3><div>Forty-six surgeons from 37 Spanish hospitals responded. Although tumor location was reported in 84.8% of cases, the T stage was not mentioned in 45.7%, and the differentiation between T4a and T4b was omitted in 56.5%. Retroperitoneal fascial infiltration was not reported in 30.4%. While lymphadenopathy was routinely described, the number of lymph nodes and affected stations were detailed in only 58.7% and 19.6% of cases, respectively. Tumor deposits were omitted in 56.5%. The description of specific lymph node territories and key vascular landmarks was exceptionally low. Only 10.9% of centers had a structured CT staging protocol.</div></div><div><h3>Conclusions</h3><div>Preoperative CT reports in colon cancer have significant shortcomings that limit their usefulness for surgical planning. There is an urgent need to implement a standardized national radiology reporting protocol tailored to the surgical requirements of oncology.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 9","pages":"Article 800366"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149050506","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":"Liver transplantation training and career interest among residents in related specialties: A national survey","authors":"Gerardo Blanco-Fernández,&nbsp;Isabel Campos-Varela,&nbsp;Sara Lorente,&nbsp;Sonia Pascual,&nbsp;Patricia Ruiz,&nbsp;Gloria Sánchez-Antolín,&nbsp;Maria Trapero-Marugán,&nbsp;Laura Lladó","doi":"10.1016/j.ciresp.2026.800365","DOIUrl":"10.1016/j.ciresp.2026.800365","url":null,"abstract":"<div><h3>Introduction</h3><div>Liver transplantation (LT) is a demanding and highly specialized procedure requiring coordination among different specialists. Ensuring that future professionals acquire the necessary expertise is essential, yet a career in LT is often perceived by residents as inaccessible or unattractive. In Spain, LT training is not systematically integrated into residency programs. This study aimed to explore the training experiences, motivations and perceptions of medical residents from LT-related specialties.</div></div><div><h3>Methods</h3><div>A working group from the Spanish Society of Liver Transplantation (SETH) designed an online survey assessing demographics, LT exposure and attitudes toward LT, including perceptions of workload, burnout and motivation to pursue a future career in LT. The survey was sent through national scientific societies to residents in general and digestive surgery, gastroenterology, internal medicine and anesthesiology.</div></div><div><h3>Results</h3><div>A total of 280 residents completed the survey (60.3% women). Most respondents (62.1%) trained at hospitals with an LT program, as LT training is significantly more common at these hospitals than at hospitals without LT programs (86.8% vs 41.5%; <em>P</em> &lt; .001). Only 14.6% considered it an accessible career path. Although 38.2% expressed interest in pursuing a career in LT, 86.9% viewed it as difficult to achieve. The main disincentives were poor work–life balance and frequent night shifts.</div></div><div><h3>Conclusions</h3><div>LT training among Spanish residents remains inconsistent and largely unstructured. Despite recognizing its prestige and educational value, residents perceive LT as demanding and inaccessible. Establishing standardized LT training and offering targeted incentives may help attract future specialists to this critical field.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 9","pages":"Article 800365"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149050507","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":"Migración distal de una endoprótesis esofágica autoexpandible al intestino delgado","authors":"Lucía Hernández Ramos,&nbsp;Begoña Pastor Costa,&nbsp;María Teresa Soriano Palao,&nbsp;David Ruiz de Angulo Martín","doi":"10.1016/j.ciresp.2026.800371","DOIUrl":"10.1016/j.ciresp.2026.800371","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 9","pages":"Article 800371"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148934694","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":"Omic analysis of the protein profile in digestive tumours, from proteomics to clinical practice","authors":"Florina I. Bura,&nbsp;Rafaela Pezzopane,&nbsp;Melissa Granados,&nbsp;Lidia Rodríguez-Ortiz,&nbsp;Blanca Rufián-Andújar,&nbsp;Ana Martínez-López,&nbsp;María del Carmen Vázquez-Borrego,&nbsp;Antonio Romero-Ruiz,&nbsp;Alvaro Arjona-Sánchez","doi":"10.1016/j.ciresp.2026.800303","DOIUrl":"10.1016/j.ciresp.2026.800303","url":null,"abstract":"<div><div>Proteomics has emerged as a key tool in precision medicine, enabling in-depth molecular characterization of digestive tumours. This article outlines a standardised workflow, encompassing sample collection, protein extraction, and unbiased proteomic analysis using high-resolution liquid chromatography coupled with mass spectrometry. These approaches allow for the identification of biomarkers for early diagnosis, prognosis, and the development of targeted therapies. The review also highlights the value of single-cell proteomics to dissect tumour heterogeneity and discusses the use of <em>in vitro</em> and <em>in vivo</em> models to validate therapeutic targets. Additionally, it explores the potential of intraoperative molecular indicators to improve surgical outcomes. Altogether, the integration of proteomics with bioinformatics and artificial intelligence offers new opportunities to translate molecular discoveries into clinical practice, ultimately improving the management and quality of life of patients with digestive tumours.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 9","pages":"Article 800303"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149050505","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":"From trial to practice: real-world outcomes of neoadjuvant chemoimmunotherapy versus chemotherapy ± radiotherapy in resectable locally advanced NSCLC","authors":"Cristina E. Rivas Duarte,&nbsp;María Teresa Gómez-Hernández,&nbsp;Mario Manama,&nbsp;Francisco Gómez,&nbsp;Carmen Taboada,&nbsp;Marta G. Fuentes,&nbsp;Oscar Colmenares,&nbsp;Marcelo F. Jiménez","doi":"10.1016/j.ciresp.2026.800330","DOIUrl":"10.1016/j.ciresp.2026.800330","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Neoadjuvant chemotherapy combined with immune checkpoint inhibitors (ChT–ICI) has shown promising efficacy in resectable locally advanced non-small cell lung cancer (NSCLC), but real-world data comparing it with conventional chemotherapy or chemoradiotherapy (ChT/ChT–RT) are limited. This study evaluated perioperative safety and oncologic outcomes of both approaches in a real-world setting.</div></div><div><h3>Methods</h3><div>A single-center retrospective analysis included consecutive patients with locally advanced NSCLC who received neoadjuvant therapy and underwent pulmonary resection between January 2017 and October 2025. Patients were grouped as ChT–ICI or ChT/ChT–RT. Primary endpoints were overall and cardiopulmonary morbidity; secondary endpoints included pathological complete response (pCR), overall survival (OS), and disease-free survival (DFS).</div></div><div><h3>Results</h3><div>Eighty-two patients were analyzed (36 ChT–ICI, 46 ChT/ChT–RT). Overall complications occurred in 36.1% and 43.5%, and cardiopulmonary morbidity in 8.3% and 15.2%, respectively (adjusted OR 0.359; <em>P</em> = .211). pCR was significantly higher with ChT–ICI (33.3% vs 8.7%; adjusted OR 4.53; <em>P</em> = .021). No significant differences were observed in OS or DFS.</div></div><div><h3>Conclusions</h3><div>In this real-world cohort, neoadjuvant ChT–ICI demonstrated similar perioperative safety and a significantly higher pCR rate than conventional regimens, supporting its feasibility and therapeutic potential in resectable locally advanced NSCLC.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 8","pages":"Article 800330"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731393","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":"Current status of robotic thoracic surgery in Spain: Results from a national survey","authors":"Alejandra Libreros Niño,&nbsp;Anna Minasyan,&nbsp;Carlos Martinez Barenys,&nbsp;José Luis Recuero Díaz,&nbsp;Giovanna Foschini Martínez,&nbsp;Carlos Déniz Armengol,&nbsp;Alba María Fernández González,&nbsp;Patricia Carmona Soto,&nbsp;José Soro García,&nbsp;Lucía Milla Collado,&nbsp;Rudith Guzmán Portillo,&nbsp;Paloma Rofso Raboso,&nbsp;Héctor Milián Goicoechea,&nbsp;Sergio Maroto Molina,&nbsp;John A. Villamil,&nbsp;Andrés Obeso,&nbsp;Andrea Lora Ibarra","doi":"10.1016/j.ciresp.2026.800340","DOIUrl":"10.1016/j.ciresp.2026.800340","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to conduct the first national survey to characterize the current practice, training and perceived barriers associated with robotic-assisted thoracic surgery (RATS) among thoracic surgeons in Spain.</div></div><div><h3>Methods</h3><div>Between February and March 2025, a nationwide electronic survey was distributed to thoracic surgeons through a scientific society. The questionnaire assessed institutional demographic variables, the volume and types of robotic procedures, perceived benefits and barriers, training models and access to the technology.</div></div><div><h3>Results</h3><div>A total of 120 responses from thoracic surgeons representing 55 hospitals were analyzed. Among these, 103 respondents (85.8%) worked in centers with an active RATS program and were included in analyses related to robotic activity. Most respondents practiced within the public healthcare system (87.4%).</div><div>Although more than 63% of RATS programs had been established for at least 2 years, only 27.2% of survey participants reported that most surgeons in their department were trained as console surgeons. At the institutional level, 69.9% indicated that all types of thoracic procedures were performed using RATS, and 31.1% reported more than 200 accumulated robotic cases. However, in over half of the hospitals, robotic surgery accounted for less than 25% of total thoracic surgical activity.</div></div><div><h3>Conclusions</h3><div>This study provides the first national overview of the status of RATS in Spain, highlighting its potential as well as the challenges limiting broader clinical consolidation. Standardized training, particularly among residents, and equitable access to robotic platforms have emerged as key priorities for the nationwide consolidation of RATS.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 8","pages":"Article 800340"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148731394","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":"SEPAR–SECT recommendations for perioperative invasive mediastinal staging of non-small cell lung cancer","authors":"Sergi Call,&nbsp;Maribel Botana-Rial,&nbsp;Rosa Cordovilla,&nbsp;Carlos Gálvez,&nbsp;David Gómez de Antonio,&nbsp;Virginia Leiro-Fernández,&nbsp;Carlos Martínez-Barenys,&nbsp;José Luís Recuero-Díaz,&nbsp;José Sanz-Santos,&nbsp;Pere Serra-Mitjà,&nbsp;Ramón Rami-Porta","doi":"10.1016/j.ciresp.2026.800335","DOIUrl":"10.1016/j.ciresp.2026.800335","url":null,"abstract":"<div><div>Accurate mediastinal nodal staging is essential for the management of non-small cell lung cancer (NSCLC), as it refines prognosis, guides multimodal treatment, and improves survival. This joint consensus document from the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) and the Spanish Society of Thoracic Surgeons (SECT) updates and expands the 2011 SEPAR guidelines, incorporating the 9th edition of the TNM classification and extending recommendations to the entire perioperative setting, including both preoperative and intraoperative mediastinal staging. The recommendations were developed through a structured review of the literature and multidisciplinary expert consensus. This document synthesizes current evidence on the role of endoscopic and surgical approaches for perioperative invasive staging, including endobronchial and oesophageal ultrasound-guided techniques, mediastinoscopy and its variants, transcervical lymphadenectomies and intraoperative lymphadenectomies. In addition, the consensus integrates the International Association for the Study of Lung Cancer (IASLC) definitions of completeness of resection and proposes quality standards for intraoperative lymphadenectomy. A practical staging algorithm is provided, stratifying tumours according to risk factors of occult mediastinal disease such as tumour size and radiological nodal involvement. The new recommendations emphasise that invasive mediastinal staging is not required for T1a and T1b tumours without radiological evidence of nodal disease, regardless of their location. Conversely, particular attention is given to the role of N1 disease, which is now recognised as a setting associated with a high risk of unsuspected mediastinal involvement. For cases with intermediate suspicion of mediastinal disease, surgical staging techniques demonstrate superior accuracy compared with endosonography alone. Overall, these recommendations aim to harmonize perioperative invasive staging across disciplines, minimize under- and overstaging, and support precise therapeutic decision-making in the evolving era of targeted and immune-based treatments for NSCLC.</div></div>","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 8","pages":"Article 800335"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148730283","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":"Revolución de la imagen en cirugía: del ojo al algoritmo en la era digital","authors":"María Asunción Acosta-Mérida","doi":"10.1016/j.ciresp.2026.800355","DOIUrl":"10.1016/j.ciresp.2026.800355","url":null,"abstract":"","PeriodicalId":50690,"journal":{"name":"Cirugia Espanola","volume":"104 7","pages":"Article 800355"},"PeriodicalIF":1.5,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148499691","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}