Techniques in Coloproctology最新文献

{"title":"Sphincter repair procedures may be favored in the treatment of obstetrical recto-vaginal fistula: a systematic review of the literature and meta-analysis.","authors":"A Venara, E Houlet, E Poupard, M André, P E Bouet, J Gillet, J F Hamel","doi":"10.1007/s10151-025-03133-3","DOIUrl":"10.1007/s10151-025-03133-3","url":null,"abstract":"<p><strong>Background: </strong>The management of obstetric rectovaginal fistula (RVF) is challenging for the surgeon. The best surgical procedure to repair RVFs, specifically after obstetric anal sphincter injury, has not been extensively studied. The objective was to compare the success of the different procedures performed to repair obstetric RVF.</p><p><strong>Methods: </strong>The literature search was carried out on PubMed^® and Web of Science^® from database inception until 31 December 2022. Selection criteria were: (1) patients with a diagnosis of obstetric-related RVF; (2) patients treated surgically with no restriction concerning the considered surgery; (3) clinical trials or epidemiological studies. Meta-analysis was conducted considering the network meta-analysis framework to allow studying the relative value of each treatment mentioned in the selected articles.</p><p><strong>Results: </strong>The quantitative synthesis included 32 studies (18 retrospective and 14 prospective) accounting for 595 patients. The quality of these studies was low because of the lack of prospective randomization. Nineteen procedure types were described and assessed. Most patients (n = 180) underwent endorectal advancement flap (ERAF) followed by excision and layered closure (ELC) (n = 213) and Musset procedure (n = 65). A diverting stoma was performed in 66/132 patients. Only 13 studies reported the functional results of the procedure. In the meta-analysis, the Musset procedure (OR = 4.29; 95% CI: 1.18-16.14), transvaginal ELC (OR = 11.84; 95% CI: 2.18-91.80) and transperineal ELC (OR = 3.56; 95% CI: 1.26-10) significantly improved the anatomical results compared to ERAF.</p><p><strong>Conclusions: </strong>A further randomized controlled trial in the literature assessing ERAF and sphincteroplasty to compare the anatomical results, functional results and morbidity of this treatment is needed.</p><p><strong>Registration: </strong>PROSPERO CRD42023447875.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"95"},"PeriodicalIF":2.9,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796383","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":"Correction: Why did we encounter a pCRM-positive specimen whose preoperative MRI indicates negative mesorectal fascia involvement in middle to low rectal cancer?","authors":"F Sumiyama, M Hamada, T Kobayashi, Y Matsumi, R Inada, H Kurokawa, Y Uemura","doi":"10.1007/s10151-025-03150-2","DOIUrl":"10.1007/s10151-025-03150-2","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"94"},"PeriodicalIF":2.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796379","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":"Using inflammatory parameters for safe and early discharge after minimally invasive colorectal surgery for colorectal cancer.","authors":"B D N Dos Santos, C Beruti, J Azevedo, I Herrando, P Vieira, H Domingos, R Heald, L Fernandez, A Parvaiz","doi":"10.1007/s10151-025-03134-2","DOIUrl":"10.1007/s10151-025-03134-2","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive surgery has become the gold standard for colorectal cancer treatment. Approximately 40% of patients undergoing elective colorectal resection develop postoperative complications. The median time to clinical diagnosis of a postoperative complication ranges between 5 and 8 days. Early detection of complications can reduce their morbidity and negative impact. This study aims to evaluate the effectiveness of routine postoperative inflammatory markers in predicting early postoperative complications in patients undergoing elective minimally invasive surgery for colorectal cancer.</p><p><strong>Methods: </strong>This study was conducted at a single center and is a retrospective analysis of a prospectively mantained database. We included 397 consecutive patients who underwent elective minimally invasive surgery for colorectal cancer between May 2012 and September 2023. Routine inflammatory parameters, including C-reactive protein, Glasgow Prognostic Score, and neutrophil-lymphocyte ratio, were analyzed to identify those associated with postoperative complications. The cutoff values for these markers were determined using receiver-operating characteristic (ROC) curve analysis with the Youden index method.</p><p><strong>Results: </strong>Of the patients, 29.2% experienced postoperative complications, with major complications (Clavien-Dindo ≥ III) occurring in 11.3%. On postoperative day 3, C-reactive protein level < 125 mg/L, Glasgow Prognostic Score < 2.12, and neutrophil-lymphocyte ratio < 5.26 were significantly associated with lower risk of postoperative complications (p < 0.0001). NLR was the best parameter to identify patients unlikely to experience a postoperative complication on day 3, with a cutoff value of 5.26 and a negative predictive value (NPV) of 83%.</p><p><strong>Conclusions: </strong>Neutrophil-lymphocyte ratio, C-reactive protein, and Glasgow Prognostic Score on POD3 can predict postoperative complications in patients who undergoing minimally invasive surgery for colorectal cancer. These inflammatory markers demonstrated high negative predictive value, effectively identifying patients who are unlikely to develop complications and providing valuable information for safe early discharge.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"97"},"PeriodicalIF":2.7,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11976749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143796388","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":"Circular (purse-string) vs primary skin closure following stoma closure: an up-to-date systematic review and meta-analysis.","authors":"F Menegon Tasselli, F Pata, G Fuschillo, G Signoriello, A Bondurri, G Sciaudone, F Selvaggi, G Pellino","doi":"10.1007/s10151-025-03135-1","DOIUrl":"10.1007/s10151-025-03135-1","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSI) are the most common complication after stoma closure. Circular skin closure (CSC) has been proposed to reduce SSI with comparable or even better outcomes than conventional primary sutures (PS). The aim of this meta-analysis is to compare circular with primary skin closure in stoma closure.</p><p><strong>Method: </strong>A systematic review of the literature was performed for articles published between January 2010 and June 2023, including all randomized control trials (RCT) on wound infection of adult patients following stoma reversal. The primary outcome was 30-day SSI; secondary outcomes were operative time, length of stay, and incisional hernia.</p><p><strong>Results: </strong>Eight RCTs were identified that included a total of 606 patients undergoing stoma closure surgery. Four percent of patients in the CSC group developed SSI, compared to 27% of patients undergoing PS. The 30-day SSI rate was lower after the circular skin closure (OR 0.11, 95% CI 0.06-0.21; p < 0.00001, I² = 0%). There was no difference in the operative time (99.2 vs 103.5 min; MD - 0.17, 95% CI - 0.37, 0.03; p = 0.10), length of stay (7.1 vs 7.7 days; MD - 0.34, 95% CI - 0.55, - 0.12; p = 0.002), and incisional hernia rate (2% vs 4%; OR 0.61, 95% CI 0.23, 1.60; p = 0.31).</p><p><strong>Conclusion: </strong>CSC is associated with lower SSI rate and should be preferred to linear skin closure technique after stoma closure surgery.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"93"},"PeriodicalIF":2.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789336","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":"Early detection and correction of preoperative anemia in patients undergoing colorectal surgery-a prospective study.","authors":"A de Wit, B T Bootsma, D E Huisman, G Kazemier, F Daams","doi":"10.1007/s10151-025-03131-5","DOIUrl":"10.1007/s10151-025-03131-5","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative anemia is an important target in preventing colorectal anastomotic leakage (CAL). However, it is not consistently detected and corrected in patients undergoing colorectal surgery. This study aimed to evaluate the impact of early detection and correction of preoperative anemia on perioperative outcomes and CAL.</p><p><strong>Methods: </strong>This was a prospective subanalysis of an international open-labeled trial, which implemented an enhanced care bundle to prevent CAL after elective colorectal surgeries. It introduced interventions for early detection and correction of preoperative anemia. Primary outcome was the incidence of preoperative anemia and the effect of early correction. Secondary outcomes included the impact on CAL, postoperative course, and mortality.</p><p><strong>Results: </strong>The study included 899 patients across eight European hospitals (September 2021-December 2023). Preoperative anemia was identified in 35.0% (n = 315) of participants, with 77.4% (n = 192) receiving iron therapy. Hemoglobin levels decreased in 4.2% (n = 13), remained stable in 45.8% (n = 143), and increased in 50.0% (n = 156) (p < 0.001). Perioperative hyperglycemia was more common among patients with anemia (7.8% versus 16.4%, p < 0.001). CAL occurred in 6.1% (n = 53) of patients. Anemia correction and changes in hemoglobin levels after iron treatment were not significantly associated with CAL, other complications, or mortality.</p><p><strong>Conclusions: </strong>Early detection and correction of preoperative anemia is achievable. However, routine preoperative administration of iron alone, without concurrently optimizing other CAL risk factors, does not result in CAL prevention. Preoperative anemia indicates overall poor physiological fitness rather than being an isolated risk factor.</p><p><strong>Trial number: </strong>NCT05250882 (20-01-2022).</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"92"},"PeriodicalIF":2.7,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11972174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789340","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":"First description of endoscopic dilation of stricturing Kono-S anastomosis in Crohn's disease.","authors":"A Rispo, A D Guarino, F P Tropeano, F Castiglione, M Cricrì, G D De Palma, G Luglio","doi":"10.1007/s10151-025-03127-1","DOIUrl":"10.1007/s10151-025-03127-1","url":null,"abstract":"","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"91"},"PeriodicalIF":2.7,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765688","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":"A novel technique for treating complex anal fistulas with intersphincteric extension: intra-anal fistulotomy with fistula opening closure (IFOC).","authors":"S Jearanai, J Pattana-Arun","doi":"10.1007/s10151-025-03111-9","DOIUrl":"10.1007/s10151-025-03111-9","url":null,"abstract":"<p><strong>Background: </strong>Complex anal fistulas, particularly those with intersphincteric extensions, pose significant challenges in surgical management due to their high recurrence rates. Often, recurrence is attributed to surgeons' inability to precisely identify the fistula tract in the intersphincteric plane and to achieve secure ligation.</p><p><strong>Objective: </strong>This video aims to present a novel surgical technique derived from our experience to address the challenges and reduc recurrences in treating complex fistulas, especially those with intersphincteric extensions.</p><p><strong>Materials and methods: </strong>A patient with a posterior complex anal fistula was examined. The external opening was situated at the 9 o'clock position, while proctoscopy revealed the internal opening at 6 o'clock. Our surgical strategy entailed the utilization of an arterial clamp to determine the fistula tract's orientation. Verification of the tract's connection was achieved by injecting water through the external opening. Subsequently, an intra-anal fistulotomy was executed using electrocauterization. A key aspect of this procedure was the continuous observation of the fistula tract's granulation tissue to prevent inaccurate dissection. This tissue was later eradicated with a curette. To further ascertain the internal opening's location at the external sphincter, another water injection was administered. The internal opening was then securely sealed using absorbable sutures employing the horizontal mattress technique. The success of this procedure was confirmed with a water injection post-tract ligation, which displayed no seepage. Additional curettage was conducted to eliminate granulation at the external tract, succeeded by the placement of a tube drain. Finally, sutures were used to overlay the internal opening, promoting optimal healing.</p><p><strong>Results: </strong>The patient did not face any postoperative complications. The healing process of the wound was satisfactory, with no observed recurrence six months subsequent to the operation.</p><p><strong>Conclusions: </strong>Our innovative surgical method demonstrates a promising alternative to conventional techniques. It bears significant potential in diminishing recurrence rates in intricate fistula situations that encompass intersphincteric extensions.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"90"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744412","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":"Early diagnosis of Crohn's disease in patients presenting with a perianal fistula: systematic review and development of a perianal red flags index.","authors":"L J Munster, G R Meriba, J Schuitema, S van Dieren, E J de Groof, M W Mundt, G R D'Haens, W A Bemelman, C J Buskens, J D W van der Bilt","doi":"10.1007/s10151-024-03106-y","DOIUrl":"10.1007/s10151-024-03106-y","url":null,"abstract":"<p><strong>Background: </strong>Delay in diagnosing Crohn's disease (CD) in patients presenting with perianal abscess (PAA) and/or fistula (PAF) is common. The aim of this study was to identify red flags suggestive of CD.</p><p><strong>Methods: </strong>A systematic literature review was conducted to identify symptoms associated with CD in patients presenting with PAA/PAF. A questionnaire including those symptoms, supplemented with items from the International Organization for the Study of Inflammatory Bowel Diseases (IO-IBD) red flags index for luminal CD, was administered to all adult patients presenting with a PAF and eventually diagnosed with CD and matched patients (1:3) from the same study period with a cryptoglandular PAF (2012-2023) at a single non-academic teaching hospital. All patients were asked to recall symptoms/signs experienced during their first PAF.</p><p><strong>Results: </strong>The systematic review identified 8 articles reporting on 15 clinical characteristics in patients presenting with PAA (n = 2)/PAF (n = 6), supplemented with 13 items from the IO-IBD red flags index (28 items in total). A total of 25 patients with CD and 75 patients with PAF without CD answered the questionnaire. Univariate analysis identified seven items associated with CD (age, family history, > 2 perianal interventions, weight loss, abdominal pain, diarrhoea and fatigue), and four items remained significant in multivariate analysis: age (OR 3.4 [1.0-11.5]), > 2 previous perianal interventions (OR 3.4 [1.0-10.1]), weight loss (OR 14.4 [3.7-55.6]) and abdominal pain (OR 9.8 [1.9-49.8]). Receiver-operating characteristic curve (ROC) analysis showed that a combination of these red flags was associated with good discrimination of CD versus non-CD (AUC 0.83 [0.72-0.94]).</p><p><strong>Conclusions: </strong>The perianal red flags index has a good predictive value for early identification of patients with PAF at risk for underlying CD.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"89"},"PeriodicalIF":2.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11953225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744415","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":"The outcomes of robotic ileocolic resection in Crohn's disease compared with laparoscopic and open surgery: a meta-analysis and systematic review.","authors":"M Flaifel, S Eichenberg, B Mohandes, E Taha, L Kollmann, S Flemming, A Haberstroh, N Ortlieb, N Melling, K Neumann, S Taha-Mehlitz, T Poškus, D M Frey, P C Cattin, A Taha, J Zeindler, R Rosenberg, B Saad, M D Honaker","doi":"10.1007/s10151-025-03116-4","DOIUrl":"10.1007/s10151-025-03116-4","url":null,"abstract":"<p><strong>Background: </strong>This is the first review providing insights into the outcomes of robotic ileocolic resection for Crohn's disease, potentially guiding improved surgical decisions and patient outcomes and comparing outcomes with laparoscopic and open approaches.</p><p><strong>Methods: </strong>The review was registered prospectively with PROSPERO (CRD42024504839). A comprehensive search of MEDLINE, Embase, Scopus, and Cochrane Central databases for studies on robotic ileocolic resection for Crohn's disease from inception to February 2024 was conducted. Eligible studies included participants over 18 years of age with Crohn's disease undergoing robotic ileocolic resection. Data were extracted according to PRISMA guidelines. For single-arm analyses, the random-effects model was used, while two-arm analyses employed the inverse variance and Mantel-Haenszel methods.</p><p><strong>Results: </strong>The analysis included eight studies with 5760 patients, among whom 369 underwent robotic ileocolic resection. The mean operative time for robotic procedures was 226 min. Postoperative complications included ileus in 12.50% and wound complications in 7.00%, while reoperations and readmissions occurred in 3.60% and 13.20% of patients, respectively. When compared with laparoscopic procedures, robotic procedures showed shorter length of hospital stay and longer operative times but similar total complication, reoperation, and conversion rates. In contrast, robotic procedures had fewer total postoperative complications compared with open surgeries, despite longer operative times.</p><p><strong>Conclusions: </strong>Robotic ileocolic resection for Crohn's disease, while having a longer operative time, results in fewer postoperative complications compared with open surgery and shows comparable outcomes to laparoscopic procedures with shorter hospital stays.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"88"},"PeriodicalIF":2.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11946954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732971","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":"Bionic concepts for assessment of defecatory function and dysfunction.","authors":"D Sun, S Bao, H Yao, Y Hu, Z Huang, P Ran, L Bao, H Gregersen","doi":"10.1007/s10151-025-03125-3","DOIUrl":"10.1007/s10151-025-03125-3","url":null,"abstract":"<p><p>Bionic technology is gaining momentum in medical research. In gastroenterology, bionic technologies such as the PillCam and SmartPill assess intestinal mucosa morphology and function during the gastrointestinal passage of the devices. Oral drug delivery devices and intestinal robots are other bionic technologies under development. Recently, Fecobionics, a simulated feces, was developed for assessment of anorectal (defecatory) function. It is an anally insertable device with shape and consistency like feces. The integrated device measures anorectal pressures, orientation, bending (a proxy of the anorectal angle), and the shape of the device when located in rectum and when being evacuated by patients. It integrates most elements of the current technologies on the market (balloon expulsion technology, high-resolution anorectal manometry, defecography, and the functional luminal imaging probe). Multiple measurements in a single study by a bionic device have obvious advantages since novel functional parameters can be computed. Several Fecobionics prototypes have been developed and evaluated in normal human subjects and in patients with fecal incontinence and defecatory disorders such as obstructed defecation. This paper provides an overview of the Fecobionics platform for assessment of defecatory function and dysfunction with a focus on design, signal processing, data analysis, current clinical trials, and future applications in diagnostics, therapy assessment, and therapy.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"86"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712045","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}