Techniques in Coloproctology最新文献

{"title":"Single-session transanal minimally invasive surgery (TAMIS) and adjuvant radiotherapy in a patient with three synchronous early rectal adenocarcinomas: a video vignette.","authors":"Ata Maden, Noam Shussman, Marc Wygoda, Ido Mizrahi","doi":"10.1007/s10151-026-03335-3","DOIUrl":"https://doi.org/10.1007/s10151-026-03335-3","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing keystone and Limberg flaps for pilonidal sinus: Does flap choice influence patient satisfaction?","authors":"Mohamed Wael, Abdelhamid Ghazal, Ahmed Ismail Ibrahim, Mostafa Refaie Elkeleny, Ahmed Abdelfattah Sabry, Mostafa Seif","doi":"10.1007/s10151-025-03283-4","DOIUrl":"https://doi.org/10.1007/s10151-025-03283-4","url":null,"abstract":"<p><strong>Background: </strong>Pilonidal sinus disease (PSD) is a chronic condition that mainly affects young adults impairing the quality of life. Among several surgical options, flap reconstruction offers faster healing and lower recurrence. This randomized comparative study evaluated the keystone perforator island flap (KSF) versus the Limberg flap (LF) in PSD repair, focusing primarily on patient satisfaction depending on the flap type, alongside perioperative outcomes following PS excision as secondary outcomes.</p><p><strong>Methods: </strong>A total of 50 patients with simple PSD were randomized equally to undergo KSF or LF reconstruction after sinus excision. Operative data, complications, and recovery metrics were recorded. Patient satisfaction, the primary endpoint, was assessed at 6 months using a validated 5-point scale. Statistical analysis employed the t-test, chi-squared test, and multivariate linear regression to identify independent predictors of satisfaction (p < 0.05 significant).</p><p><strong>Results: </strong>The KSF group showed shorter operative time (54.9 ± 3.7 versus 73.4 ± 7.9 min, p < 0.001), faster wound healing (13.5 ± 3.1 versus 17.1 ± 3.5 days, p < 0.001), and earlier return to activity (6.8 ± 0.8 versus 8.5 ± 0.8 days, p < 0.001). Complications were lower (24% versus 56%, p = 0.02). Satisfaction was significantly higher with KSF (96% versus 72%, p = 0.046). Regression analysis identified wound-healing time (p = 0.008) and return to activity (p < 0.001) as the independent predictors of satisfaction.</p><p><strong>Conclusion: </strong>The KSF provides faster recovery, better comfort, and higher patient satisfaction than the LF. Functional recovery parameters, rather than flap type alone, are the strongest determinants of postoperative satisfaction.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"30 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The DICA endoscopic score and the CODA clinical score may predict the severity of acute diverticulitis and the risk of hospitalisation: results from an international multicentre prospective cohort study.","authors":"Antonio Tursi, Daniele Piovani, Giovanni Brandimarte, Francesco Di Mario, Gisella Figlioli, Dan L Dumitrascu, Enio Chaves Oliveira, Valerio Papa, Savvas Papagrigoriadis, Ieva Stundiene, Matthias Christian Reichert, Jaroslaw Regula, Walter Elisei, Marcello Picchio, Gabrio Bassotti, Mauro Bafutto, Giovanni Latella, Giovanni Maconi, Stefanos Bonovas, Alfredo Papa, Silvio Danese","doi":"10.1007/s10151-026-03324-6","DOIUrl":"https://doi.org/10.1007/s10151-026-03324-6","url":null,"abstract":"<p><strong>Background: </strong>We assessed whether baseline endoscopic and clinical scores of diverticular disease (DD) may predict the severity of acute diverticulitis (AD), hospital admission and length of hospital stay (HS).</p><p><strong>Methods: </strong>We conducted a 3-year, multicentre, prospective cohort study involving 2215 patients. DD was scored according to the Diverticular Inflammation and Complication Assessment (DICA) classification and the Combined Overview on Diverticular Assessment (CODA) score.</p><p><strong>Results: </strong>Higher baseline DICA and CODA scores were associated with increased risk of complicated AD [relative risk ratio (RRR) = 5.57; 95% confidence interval (CI): 3.42-9.09 and RRR = 5.17; 95% CI: 3.01-8.88, respectively]. An average HS of 4.62 days (95% CI: 2.93-6.27) for DICA 1, 5.57 days (95% CI: 4.29-6.85) for DICA 2 and 6.73 days (95% CI: 5.81-7.64) for DICA 3 was recorded; an average HS of 4.14 days (95% CI: 2.32-5.96) for CODA A, 5.12 days (95% CI: 3.67-6.56) for CODA B and 6.32 days (95% CI: 5.35-7.30) for CODA C was recorded.</p><p><strong>Conclusions: </strong>DICA and CODA scores may predict the severity of AD and the length of the HS.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial experience in colorectal robotic surgery in a university hospital: the first 100 consecutive cases using Hugo™ RAS platform.","authors":"P Brandão, M J Alves, E Silva, M Sampaio, A C Silva, M D Santos","doi":"10.1007/s10151-026-03302-y","DOIUrl":"https://doi.org/10.1007/s10151-026-03302-y","url":null,"abstract":"<p><strong>Background: </strong>The Hugo™ RAS platform (Medtronic^®), featuring an open-console design and modular configuration, represents a novel alternative to established robotic systems. Limited large-scale series of colorectal procedures using this platform have been published. This study aimed to evaluate the feasibility, safety, and learning curve of implementing the Hugo™ RAS platform for colorectal surgery in a center without prior robotic experience.</p><p><strong>Methods: </strong>We retrospectively analyzed 100 consecutive adult patients (median age 68 years; 51% male) undergoing elective colorectal resection using Hugo™ RAS between April 2023 and December 2024. Surgical indications included malignancy (78%), benign neoplasia, and inflammatory disease. Primary outcomes included operative time, blood loss, conversion rate, oncologic adequacy, complications (Clavien-Dindo classification), and length of stay. Learning curves were assessed via CUSUM analysis.</p><p><strong>Results: </strong>Median operative time was 180 min (IQR 147.5-240.0), with blood loss of 50 mL (IQR 50-100). No conversions occurred. R0 resection was achieved in 93% of applicable cases, with median lymph node harvest of 20. Overall morbidity was 28%, including 5% major complications (Clavien-Dindo ≥ IIIb) and zero grade IV/V events. Median stay was 6 days. Male patients had significantly higher complication rates (39.2% vs 16.3%, p = 0.011). Comparing first versus last 50 cases, complications decreased from 34% to 22% (p = 0.181), while major complications remained stable. CUSUM analysis revealed stabilization after approximately 50 cases.</p><p><strong>Conclusions: </strong>The Hugo™ RAS platform enabled safe and effective colorectal surgery with zero conversions and oncologic outcomes meeting established benchmarks. The learning curve stabilized at 50 cases with progressive reduction in minor complications. These results support Hugo™ RAS as a valuable addition to minimally invasive colorectal surgery.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The revisional burden of colostomy: a temporal analysis of risk, patterns, and survival.","authors":"Medeni Sermet, Ozgur Ekinci, Orhan Alimoglu","doi":"10.1007/s10151-026-03328-2","DOIUrl":"https://doi.org/10.1007/s10151-026-03328-2","url":null,"abstract":"<p><strong>Objective: </strong>This study analyzed patients who underwent colostomy revision to identify risk factors and complications, aiming to provide evidence-based recommendations for the guidelines.</p><p><strong>Materials and methods: </strong>Of 339 colostomy patients treated between 2016 and 2023, 58 who underwent colostomy revision were designated as the study group and compared with 281 non-revision patients in the control group.</p><p><strong>Results: </strong>Of the 339 patients, 58 (17.1%) underwent 78 revision procedures (mean: 1.34 revisions per patient). Early revisions (within 30 days) comprised 60.3% of all procedures (n = 47), primarily due to necrosis (38.3% of early revisions) and retraction (29.8% of early revisions). Late revisions (after 30 days) accounted for 39.7% (n = 31), mainly for parastomal hernia (25.8% of late revisions) and stenosis (19.4% of late revisions). Twenty patients (34.5%) required multiple revisions; the revision group had a higher mean age (66.1 ± 11.8 vs. 61.8 ± 12.1 years, p = 0.021), more females (53.4% vs. 38.0%, p = 0.045), and more emergency surgeries (58.6% vs. 40.5%, p = 0.003). Transverse colostomies had a higher revision rate (24.7%) than sigmoid colostomies (13.8%), p = 0.045.</p><p><strong>Conclusion: </strong>Colostomy revision is associated with significant morbidity and mortality rates. Advanced age, female sex, emergency surgery, and transverse colostomy were identified as independent risk factors. Early complications (necrosis and retraction) differ from late complications (hernias and stenosis). Many patients require multiple revisions, highlighting the need for tailored surgical strategies and updated guidelines to minimize the number of revisions and improve the outcomes.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic treatment versus open excision for pediatric pilonidal disease: technical description of a modified (P)EPSiT approach using standard equipment and retrospective cohort study.","authors":"J Kirsch, S Drossard, K Schriek, U Hübner","doi":"10.1007/s10151-026-03317-5","DOIUrl":"https://doi.org/10.1007/s10151-026-03317-5","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic pilonidal sinus treatment (EPSiT) has emerged as a minimally invasive treatment option for pilonidal disease (PD) in adolescents, yet its adoption has been limited by the need for specialized equipment. We developed a modified EPSiT technique using standard urological instruments, saline irrigation, and lateral positioning, which was introduced in 2019. This study provides a technical description of the modified approach and evaluates the outcomes compared with conventional open excision in a pediatric cohort.</p><p><strong>Methods: </strong>We conducted a single-center retrospective cohort study of 113 pediatric patients treated surgically for PD between 2014 and 2023. Patients were divided into two cohorts: EPSiT (n = 48, 2019-2023) and open excision (n = 65, 2014-2018). Clinical data were collected from medical records for both groups and structured telephone interviews for patients undergoing EPSiT. Outcomes included operative time, hospital stay, recurrence, pain, and satisfaction.</p><p><strong>Results: </strong>Gender distribution was identical in both cohorts (29.2% male, 70.8% female). Operative times were similar between groups (35.8 versus 31.7 min; p = .307). EPSiT was associated with significantly shorter hospital stays (mean difference -2.55 days; 95% CI -3.10 to -2.00; p < .001). Recurrence rates were comparable (16.7% versus 15.4%; p = .808). Patient-reported outcomes were available for the EPSiT cohort only and indicated high cosmetic satisfaction and minimal analgesic use. Among patients undergoing EPSiT, 41.7% returned to school immediately after discharge, and most resumed normal activities within a few days.</p><p><strong>Conclusions: </strong>This modified EPSiT approach is feasible and may increase accessibility in resource-limited settings, representing a less invasive treatment option for PD. Further prospective studies are needed to validate these findings and define the role of EPSiT in the treatment of pediatric PD.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"30 1","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13139232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-cultural validation and reliability of the Turkish version of the anal fistula quality of life scale for cryptoglandular anal fistula.","authors":"E Ergüder, S Leventoğlu, A Rencüzoğulları, B Gülcü, B Menteş, C Akyol, Ç E Şahin, E Öztürk, H Pelgur, I Aydın, I Cem Eray, Ö Işık, T Bişgin, U Özgen, U Sungurtekin","doi":"10.1007/s10151-026-03321-9","DOIUrl":"https://doi.org/10.1007/s10151-026-03321-9","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to adapt and validate the Cryptoglandular Anal Fistula Quality of Life (AF-QoL) scale for Turkish-speaking patients, providing a disease-specific, patient-reported outcome measure (PROM) to assess quality of life (QoL) in cryptoglandular anal fistula.</p><p><strong>Methods: </strong>A prospective, multicenter, cross-sectional study was conducted across seven tertiary centers in Türkiye. The 22-item AF-QoL scale, originally validated in English, was translated and culturally adapted into Turkish following Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines, including expert consensus and a pilot study (n = 10). A total of 220 Turkish-speaking adults with cryptoglandular anal fistula completed the scale. Structural validity was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed using Cronbach's alpha, and item-total correlations. Test-retest reliability was evaluated in a clinically stable subgroup of patients.</p><p><strong>Results: </strong>EFA confirmed a six-domain structure, comprising psychological impact, everyday activities, unpredictability/disease control, seton-related issues, social limitations, and discharge/discomfort, explaining 69.2% of the total variance. CFA demonstrated an acceptable overall model fit (χ²/df = 1.94, root mean square error of approximation [RMSEA] = 0.048, Comparative Fit Index [CFI] = 0.945, standardized root mean square residual [SRMR] = 0.035). The Turkish AF-QoL demonstrated high internal consistency (Cronbach's α = 0.828), satisfactory item-total correlations (r = 0.32-0.76), and good test-retest reliability (intraclass correlation coefficient = 0.74), indicating temporal stability.</p><p><strong>Conclusions: </strong>The Turkish version of the AF-QoL demonstrates satisfactory reliability and structural validity for use in Turkish patients with cryptoglandular anal fistula. This cross-cultural validation provides a disease-specific PROM suitable for clinical and research applications. Further studies assessing additional measurement properties, including structural validity, measurement error, and responsiveness, are warranted.</p><p><strong>Clinical trial registration: </strong>This study was not a clinical trial and thus was not registered in a clinical trial registry.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedicled omental flap construction: A useful adjunct to completion proctectomy or pouch excision for inflammatory bowel disease.","authors":"S D Holubar, J Pangrace, F Dermuth, C Prien, H Kessler","doi":"10.1007/s10151-026-03305-9","DOIUrl":"https://doi.org/10.1007/s10151-026-03305-9","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of sentinel pile on botulinum toxin treatment of chronic anal fissure: A comparative study.","authors":"Javid Ahmadov, Mustafa Anıl Turhan, Ender Ergüder, Sezai Leventoglu, Bülent Mentes","doi":"10.1007/s10151-026-03309-5","DOIUrl":"https://doi.org/10.1007/s10151-026-03309-5","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to investigate if the presence of a prominent sentinel pile (SP) had any impact on the treatment success of botulinum toxin (BT) injection, as well as the clinical presentation of patients with chronic anal fissure (CAF).</p><p><strong>Methods: </strong>Patients with CAF with or without prominent sentinel piles underwent BT injection. In addition to objective healing, a detailed symptom severity score (REALISE) immediately before and 6 months after BT injection was recorded. This was a retrospective, single-center observational cohort study including consecutive patients treated in a specialized proctology unit.</p><p><strong>Results: </strong>Of the 249 patients, 68 presented with prominent SP (27.3%). The overall objective healing rate among all patients who received a single injection of BT was found to be 74.7% at 2 months. When stratified, age distribution was similar between patients with (SP+) and without SP (SP-) (p = 0.545). However, SP was more prevalent in female patients (p = 0.009). The objective healing rates after a single BT injection were 80.7% in the SP- group and 58.8% in the SP+ group (p = 0.001). Pre-treatment REALISE scores were significantly reduced in both groups after BT injection (p < 0.001 for both). However, post-treatment scores were higher in the SP+ group compared with the SP- group (p < 0.001). Multivariable analysis confirmed SP presence as an independent predictor of reduced objective healing after BT injection.</p><p><strong>Conclusions: </strong>Even with the SP, a considerable proportion of patients with CAF heal after BT treatment and their symptoms are generally relieved. However, symptomatic improvement is less marked and the objective healing rates are lower in the SP+ group. The presence of SP may, therefore, negatively influence the clinical effectiveness of BT treatment of CAF. These findings should be interpreted in light of the retrospective single-center design and the potential for selection and recall bias.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Docking optimization for right hemicolectomy with complete mesocolon excision (CME) with HUGO™ robotic system: the \"Gemelli configuration\".","authors":"Claudio Fiorillo, Davide De Sio, Beatrice Biffoni, Flavia Taglioni, Roberta Menghi, Antonio Pio Tortorelli, Sergio Alfieri, Giuseppe Quero","doi":"10.1007/s10151-026-03316-6","DOIUrl":"https://doi.org/10.1007/s10151-026-03316-6","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic complete mesocolic excision (CME) during right hemicolectomy is a complex procedure. The introduction of robotic-assisted surgery has improved dexterity, three-dimensional (3D) visualization, and surgeon ergonomics. However, for the modular HUGO™ Robotic-Assisted Surgery (RAS) system, experience with CME is limited, and the standard docking configuration for right hemicolectomy presents many disadvantages.</p><p><strong>Methods: </strong>We developed a modified docking strategy (the \"Gemelli configuration\") specifically designed to optimize robotic right hemicolectomy with CME using the HUGO™ RAS platform. This setup provides improved instruments triangulation and reduced robotic arm interference. The technique was applied in two consecutive cases.</p><p><strong>Results: </strong>Both procedures were completed fully robotically with a single docking, without arm collisions or the need for repositioning. Compared with the standard setup, the Gemelli configuration yields enhanced visualization of the mesenteric axis and vascular pedicles and improved access to the transverse mesocolon.</p><p><strong>Conclusions: </strong>The \"Gemelli configuration\" represents a safe, simple, and reproducible docking strategy for performing right hemicolectomy with CME using the HUGO™ RAS system. Further validation in larger patient series is warranted to confirm these preliminary benefits.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":" ","pages":""},"PeriodicalIF":2.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}