Techniques in Coloproctology最新文献

{"title":"Preoperative anorectal manometry as a predictor of function after ileal pouch anal anastomosis: a systematic review and meta-analysis.","authors":"I J B Stephens, K G Byrnes, N McCawley, J P Burke","doi":"10.1007/s10151-024-03035-w","DOIUrl":"10.1007/s10151-024-03035-w","url":null,"abstract":"<p><strong>Background: </strong>Since the ileal pouch anal anastomosis (IPAA) was first described, anorectal manometry (ARM) has been used to study its physiology and function. Few studies have investigated if preoperative ARM can predict pouch function.</p><p><strong>Methods: </strong>Pubmed, EMBASE, and the Cochrane Library databases were systematically searched. Papers detailing preoperative ARM results and postoperative functional outcomes of patients with IPAA were included. Meta-analysis with meta-regression was performed, assessing the relationship between preoperative manometric results and objective postoperative functional outcomes including frequency, seepage, pad usage and medications, and functional scoring systems including Wexner Incontinence and Oresland Scores.</p><p><strong>Results: </strong>Results from 31 studies were analysed. Mean resting pressure (MRP) decreased significantly (- 23.16 mmHg, 95% CI - 27.98 to - 18.35, p < 0.01) after pouch formation but before ileostomy reversal, with subsequent minor increase (3.51 mmHg, 95% CI 0.93 to 6.09, p = 0.01) by 6 months after reversal of ileostomy. Pooled bowel frequency was 5.4 per 24 h (4.90-5.91), day and night-time soiling, incontinence, and pad usage rates were 16% (9-24%), 26% (19-33%), 12% (4-20%), and 21% (13-30%) respectively. Pooled Oresland and Wexner Scores were 3.81 (2.92-4.70) and 3.45 (2.71-4.19). A significant association between preoperative MRP and Wexner Score was observed (p < 0.001). As a result of risk of bias, study heterogeneity, and variation in manometry systems, certainty of evidence was low or very low.</p><p><strong>Conclusion: </strong>Preoperative predictors of function inform patient and clinician decision-making. Further investigations into the association between preoperative MRP and Wexner Score using modern ARM techniques are warranted.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"1"},"PeriodicalIF":2.7,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689522","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":"Open versus robotic-assisted techniques for multivisceral pelvic resections of locally advanced or recurrent colorectal and anal cancers: short-term outcomes from a single centre.","authors":"J Wyatt, E O'Connell, M Choi, S G Powell, V Hanchanale, S Ahmed, M A Javed","doi":"10.1007/s10151-024-03044-9","DOIUrl":"10.1007/s10151-024-03044-9","url":null,"abstract":"<p><strong>Background: </strong>Pelvic exenterations are now established as a standard of care for locally advanced and recurrent rectal cancer. Traditionally, these radical and complex operations have been performed via an open approach, but with the increasing expertise in robotic-assisted surgery (RAS), there is scope to perform such cases robotically. This study compares outcomes from open and RAS pelvic exenterations.</p><p><strong>Methods: </strong>This retrospective observational study includes all pelvic exenterations for locally advanced or recurrent colorectal cancers performed in a single centre between September 2018 and September 2023. Cases were grouped into open or RAS surgery and classified in terms of operative extent and complexity. The primary outcome was resection margin status. Secondary outcomes were postoperative morbidity, length of stay and blood loss.</p><p><strong>Results: </strong>Thirty-three patients were included. Nineteen (57.6%) cases utilised an open technique, and 14 (42.4%) used RAS. Patient characteristics and operative complexity were equivalent between groups. R0 rate (63.1% vs 71.4%, p = 0.719), median haemoglobin drop (19 (11-30) g/L vs 13 (5-26) g/L, p = 0.208) and postoperative morbidity (18/19 (94.7%) vs 9/14 (64.3%), p = 0.062) were equivalent. Length of stay (16.0 days (8-25) vs 9.5 days (6-16), p = 0.047) was shorter in the RAS group.</p><p><strong>Conclusions: </strong>Short-term surgical and histopathological outcomes are equivalent in this small cohort of patients. This study suggests that RAS may be a safe and effective method for performing pelvic exenterations for colorectal malignancies. Larger-scale and robustly designed prospective studies are required to confirm these preliminary findings and report on long-term oncological outcomes.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"161"},"PeriodicalIF":2.7,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669993","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":"Safe implementation of minimally invasive surgery in a specialized colorectal cancer unit.","authors":"José Azevedo, Anna Kashpor, Laura Fernandez, Ignacio Herrando, Pedro Vieira, Hugo Domingos, Carlos Carvalho, Richard Heald, Amjad Parvaiz","doi":"10.1007/s10151-024-03019-w","DOIUrl":"10.1007/s10151-024-03019-w","url":null,"abstract":"<p><strong>Introduction: </strong>In the past 30 years, minimally invasive surgery (MIS) has made remarkable progress and has become the standard of care in colorectal cancer treatment. The implementation of new techniques or platforms is, therefore, a challenge for surgical teams. This study aims to analyze the experience in the implementation of minimally invasive surgery in the colorectal unit in a specialized colorectal cancer center. We will report and compare the clinical outcomes of the patients submitted to the different surgical approaches, reflecting the importance of surgical training in the laparoscopic and robotic field for the reduction of surgical complications and improve short-term outcomes.</p><p><strong>Methods: </strong>This study involved a retrospective analysis of data collected from a prospectively maintained database at the colorectal unit of Champalimaud Foundation between 2012 and 2023. Data were collected as part of routine clinical documentation and included variables on patient's demographics, staging, short-term outcomes, and follow-up.</p><p><strong>Results: </strong>A total of 661 patients treated at the Champalimaud Foundation between 2012 and 2023 were included, of which 389 (59%) had colon and 272 (41%) rectal cancer. Most of the patients underwent elective surgery, with a minimally invasive approach performed in 91% of cases. A complete resection (R0) was achieved in 95.1% (619) of the procedures with a pathology report staging 64.5% (409) of tumors as pT3-4. Eleven percent (70) of patients had complications classified as Clavien-Dindo (CD) ≥ 3.</p><p><strong>Conclusion: </strong>This study supports the safety of the implementation of minimally invasive surgery in colorectal cancer care, with improvement in postoperative outcomes and surgical quality, supporting the importance of surgical training and specialized teams.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"160"},"PeriodicalIF":2.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11569026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142645119","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":"Long-term outcome of transanal irrigation for individuals with spina bifida: a 12-year experience study.","authors":"Y Ji, J E Ji, B Kim, S W Han, Y S Lee, S W Kim, E K Choi","doi":"10.1007/s10151-024-03041-y","DOIUrl":"10.1007/s10151-024-03041-y","url":null,"abstract":"<p><strong>Background: </strong>Transanal irrigation (TAI) effectively addresses fecal incontinence and improves quality of life in individuals with spina bifida. Given the scarcity of follow-up studies lasting > 5 years and reports of numerous TAI discontinuations, we assessed the enduring effectiveness and impact of TAI > 10 years after its initiation on the quality of life in individuals with spina bifida.</p><p><strong>Methods: </strong>We recruited individuals with spina bifida enrolled in a bowel management program who initiated TAI in 2010 and participated in 4-month and 3-year follow-up studies at a spina bifida clinic. Raw data on bowel-related characteristics at baseline and after 4 months and 3 years of TAI were collected, and new survey-based demographic information, bowel-related characteristics, and the Fecal Incontinence Quality of Life scale scores were analyzed alongside extant datasets.</p><p><strong>Results: </strong>Among 34 participants (age, mean [standard deviation] 17.7 [3.2] years), the mean follow-up was 11.8 (0.3) years; 21 participants persistently used TAI (persistent users), 12 discontinued TAI (discontinued users), and 1 used TAI and antegrade continence enema at the time of analysis. The fecal incontinence rate among persistent users decreased from 76.2% at baseline to 14.3% at the time of analysis; 11 (91.7%) discontinued users had fecal incontinence before TAI initiation, and the majority of discontinued users (66.7%) discontinued TAI because of improved bowel function. The fecal incontinence rate and quality of life did not differ significantly between discontinued users and persistent users.</p><p><strong>Conclusions: </strong>TAI effectively alleviated fecal incontinence among persistent users. One-third of users discontinued TAI but had improved fecal continence. We recommend periodic bowel function evaluation in TAI users and to reevaluate the necessity for TAI maintenance.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"159"},"PeriodicalIF":2.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631704","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":"Systematic literature review and meta-analysis of surgical treatment of complete rectal prolapse in male patients.","authors":"S H Emile, A Wignakumar, N Horesh, Z Garoufalia, V Strassmann, M Boutros, S D Wexner","doi":"10.1007/s10151-024-03039-6","DOIUrl":"10.1007/s10151-024-03039-6","url":null,"abstract":"<p><strong>Background: </strong>Rectal prolapse often affects women but may also affect men. This systematic review aimed to provide outcomes of surgery for complete rectal prolapse reported in studies with a predominantly male population.</p><p><strong>Methods: </strong>This PRISMA-compliant systematic literature review searched PubMed and Scopus between January 2000 and February 2024; Google Scholar was queried for studies reporting outcomes of complete rectal prolapse surgery in predominately (> 90%) male populations. Main outcome measures were recurrence, complications, operative time, and bowel function.</p><p><strong>Results: </strong>Eight studies (452 patients; median age 45.6 years) were included; 80.5% of patients underwent abdominal procedures whereas 19.5% underwent perineal procedures. The prevalence of recurrence was 11.2% after ventral mesh rectopexy (VMR), 0.8% after posterior mesh rectopexy (PMR), 0 after resection rectopexy, and 19.3% after perineal procedures. The prevalence of complications was 13.9% after VMR, 13.1% after PMR, 43.3% after resection rectopexy, and 17.4% after perineal procedures. The most improvement in constipation was noted after resection rectopexy (83.3-100%) and in fecal incontinence (FI) was noted after posterior mesh rectopexy (86.4-90%). Abdominal procedures had lower rates of recurrence (6% vs. 19.3%, RR 0.50, 95% CI 0.21-1.18, p = 0.113), similar complication rates (14.3% vs. 13.6%, RR 0.41, 95% CI 0.06-2.9, p = 0.374), and longer operative times (116 ± 47.2 vs. 74.2 ± 23.6 min, p < 0.001).</p><p><strong>Conclusions: </strong>Treatment of rectal prolapse in male patients undergoing abdominal procedures was associated with longer operative times, lower recurrence rates, and similar complications to perineal procedures. PMR and resection rectopexy had the lowest recurrence. The most improvement in FI and constipation was noted after PMR and resection rectopexy, respectively.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"158"},"PeriodicalIF":2.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631730","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":"Management of a complex case of Fournier's gangrene in a female patient with ulcerative colitis.","authors":"A Pecorino, U Grossi, T Picone, A Iacomino, E Mammano, G Sarzo, N Passuello","doi":"10.1007/s10151-024-03032-z","DOIUrl":"10.1007/s10151-024-03032-z","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"155"},"PeriodicalIF":2.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631727","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":"Gracilis flap intervention for recurrent recto-neovaginal fistula post-sex-reassignment surgery.","authors":"L Cebolla, R Colombari, S Kayser, E Hurtado, P Dujovne, J M Lasso, L M Jiménez, P Tejedor","doi":"10.1007/s10151-024-03025-y","DOIUrl":"10.1007/s10151-024-03025-y","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"154"},"PeriodicalIF":2.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631699","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":"Effect of left colonic artery preservation on perfusion at the anastomosis in rectal cancer surgery evaluated with intraoperative ultrasound.","authors":"Ke Lan, Hua Yang, Shi Long Shu, Fa Qiang Zhang, Chong Sun, Xuan Yu, Xuan Di Yue, Kai Lu, Fu Rui Zhong, Sheng Jin Tu, Jin Long Luo, Xue Feng Peng, Ke Rui Zeng","doi":"10.1007/s10151-024-03037-8","DOIUrl":"10.1007/s10151-024-03037-8","url":null,"abstract":"<p><strong>Purpose: </strong>Intraoperative ultrasound was used to assess the flow velocity in the marginal vessel arch adjacent to the anastomosis, critical for evaluating the anastomotic blood supply. This technique also enabled us to investigate the potential effects of preserving the left colonic artery on the perfusion of the anastomosis.</p><p><strong>Methods: </strong>This prospective study included 40 rectal cancer patients who underwent laparoscopic anterior resection between January 2021 and January 2023. The length of the inferior mesenteric artery (IMA) was measured from its origin to the first branch, and the diameters of the mesenteric vessel IMA, left colonic artery (LCA), and marginal mesenteric artery (MMA) were recorded. Blood flow velocity and Doppler ultrasound waveforms of the MMA near the anastomosis were collected. Measurements were taken both before and after clamping the IMA using atraumatic forceps. The tardus parvus pattern of the MMA ultrasound waveforms was recorded to evaluate the hypoperfusion status of the anastomosis.</p><p><strong>Results: </strong>The mean velocities of MMA were 47.9 cm/s before clamping and 34.9 cm/s after atraumatic clamping, indicating significant differences (p < 0.05). Thirteen patients (32.5%) exhibited a Tardus parvus pattern after IMA atraumatic clamping. Multivariate analysis revealed older age and LCA diameter as independent clinical predictors of the hypoperfusion status after IMA clamping.</p><p><strong>Conclusions: </strong>Preservation of the LCA may improve perfusion near the anastomosis during rectal cancer surgery. Older age and LCA diameter can be considered useful predictors of the mesenteric hypoperfusion status after IMA ligation. Intraoperative ultrasound can evaluate the perfusion of the MMA near the anastomosis. Chinese Clinical Trial Registry-Registration number: ChiCTR2000041475.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"157"},"PeriodicalIF":2.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631622","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":"Domains of four-step technique training program for laparoscopic colorectal surgery.","authors":"Y-J Chern, Y-J Hsu, H-Y Hsu, W-S Tsai, P-S Hsieh, C-K Liao, C-C Cheng, J-F You","doi":"10.1007/s10151-024-03042-x","DOIUrl":"10.1007/s10151-024-03042-x","url":null,"abstract":"<p><strong>Background: </strong>Many surgeons have begun learning about colorectal surgery using laparoscopy rather than laparotomy. The domains of four-step technique training program (DOF) for laparoscopic colorectal surgery have been designed and implemented by our institute since 2011, and they are expected to provide a safe and effective program for trainees with limited experience in laparoscopic colorectal surgery.</p><p><strong>Method: </strong>The DOF were established with standard surgical procedures, a four-step technique, and learning passports using point credits after the procedure was completed. Patients who underwent minimally invasive colorectal resection at the Chang Gung Memorial Hospital between January 2013 and April 2019 were enrolled.</p><p><strong>Results: </strong>Overall, 2604 and 478 patients were enrolled in the non-training and training groups, respectively. Multivariable logistic regression analysis revealed that the postoperative short-term outcomes were not significantly associated with the training or non-training groups. However, the training group had a significantly longer operative time than the non-training group in the linear regression model. Once the trainee passed the proficiency point (passed 100 points or 30 cases), no significant difference in postoperative short-term outcomes was found between the patients in the non-training and training groups that underwent the entire surgery performed by the trainee.</p><p><strong>Conclusion: </strong>When patients' safety was evaluated in the training cases under the DOF, no higher rates of postoperative morbidity and mortality were found compared to those in cases performed by experienced surgeons. Additionally, trainees who passed the proficiency point during DOF could safely perform the entire laparoscopic colorectal surgery under supervision without further adverse effects on the patients.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"156"},"PeriodicalIF":2.7,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631618","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":"Consensus-driven protocol for transanal irrigation in patients with low anterior resection syndrome and functional constipation.","authors":"J Martellucci, E Falletto, S Ascanelli, A Bondurri, S Borin, C Bottini, E Caproli, M Carrera, G Cestaro, L Chimisso, G Clarizia, I Clementi, S Cornaglia, S Costa, G Gallo, C Guerci, C Lambiase, A Lauretta, P Luffarelli, M C Neri, D Piccolo, E Rosati, P Rossitti, A Spolini, G Torchia, E Valloncini, D Zattoni, E Zucchi, P Biotti, A Cambareri, G Coniglio, A Coppola, K Nepote Fus, S Graziani, M Grilli, A Grego, E Guerra, E Livio, L Manganini, P Mazzeo, A Minonne, M Mirafiori, G Negri, V Palazzolo, C Di Pasquale, V Tantolo","doi":"10.1007/s10151-024-03033-y","DOIUrl":"10.1007/s10151-024-03033-y","url":null,"abstract":"<p><strong>Background: </strong>This study aims to establish a consensus-based standard protocol for transanal irrigation (TAI) in patients with low anterior resection syndrome (LARS) and functional constipation.</p><p><strong>Methods: </strong>The Delphi method was utilized to reach a consensus among clinicians and nurses expert in the field of colorectal surgery and gastroenterology. To address various uncertainties concerning technical aspects, difficulties, and prescription of TAI, two questionnaires were developed and analyzed in two rounds. A binary approach was employed, setting a consensus threshold of 75% agreement.</p><p><strong>Results: </strong>In the first round, nurses achieved consensus on all statements, while clinicians required a second round to reach consensus, particularly regarding prescription and technical aspects. Clinicians reached consensus on prescribing TAI as a second-line treatment for LARS and functional constipation, following the failure of conservative measures such as dietary and lifestyle interventions. Timing considerations for patients with LARS encompass avoiding TAI within 1 month of stoma closure and waiting a minimum of 3 months. For functional constipation, TAI is recommended for slow transit constipation, emphasizing its preference over surgical options. Consensus was also reached on the choice of catheter for patients with LARS, training requirements for patients and caregivers, preparation of the patient's intestine before TAI, and recommended irrigations.</p><p><strong>Conclusions: </strong>This consensus study successfully developed a standardized TAI protocol for LARS and functional constipation. It provides comprehensive guidelines for prescription and technical aspects, addressing the challenges encountered by healthcare professionals. The protocol aims to enhance patient care, improve treatment outcomes, and contribute to the advancement of TAI.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"28 1","pages":"153"},"PeriodicalIF":2.7,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631617","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}