Surgery open science最新文献

{"title":"Perineural invasion in pancreatic cancer: Current biological function in R status, prognosis, and pain","authors":"Federico Selvaggi ,&nbsp;Elisa Bannone ,&nbsp;Eugenia Melchiorre ,&nbsp;Michele Diana ,&nbsp;Roberto Cotellese ,&nbsp;Gitana Maria Aceto","doi":"10.1016/j.sopen.2025.02.007","DOIUrl":"10.1016/j.sopen.2025.02.007","url":null,"abstract":"<div><div>Pancreatic ductal adenocarcinoma (PDAC) is predicted to become the second leading cause of death in 2030 and it is characterized by poor prognosis, recurrence and resistance to therapies. Several factors contribute to the complexity of this disease, among those the invasion of nerves by PDAC cells. This condition, defined as perineural invasion (PNI), is responsible of PDAC progression and pain generation. To date, PNI emerges as a hallmark feature of PDAC, showing the same oncological weight of lymph node metastasis in terms of prognosis. Targeting PNI could help improve prognosis and pain relief in PDAC patients. Only recently, a severity scoring system has been proposed to quantify PNI in histological samples although prospective validation and standardization are strongly advocated. More information about peripancreatic soft tissue infiltration and a “true” curative surgery could be found in understanding the molecular mechanisms of PNI. The incorporation of PNI markers for grading mesopancreas and retroperitoneal invasion is required to overcome current limitations of the histological workup. We discuss the modern understanding of PNI in PDAC, and the state of the art in clinical setting. Although there are still a lot to learn about PDAC, PNI represents one of the biological detonators and an important focus of future research.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 58-60"},"PeriodicalIF":1.4,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic significance of tumor deposit counts in stage III colorectal cancer based on T/N staging and chemotherapy status: A retrospective cohort study","authors":"Chenxiao Zheng MD ,&nbsp;Lingsha Xu MD ,&nbsp;Binbin Ou MD ,&nbsp;Ibrahim Mohamed Bakour Abdourahaman MD ,&nbsp;Xuanqin Chen MD ,&nbsp;Hangjia Xu MD ,&nbsp;Yating Zheng MD ,&nbsp;Yifei Pan MD","doi":"10.1016/j.sopen.2025.02.004","DOIUrl":"10.1016/j.sopen.2025.02.004","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to evaluate the impact of tumor deposit (TD) count on cancer-specific survival (CSS) and disease-free survival (DFS) in stage III colorectal cancer (CRC) patients stratified by T and N staging, and further explore its impact on chemotherapy effect.</div></div><div><h3>Method</h3><div>We determined the optimal TD cut-off value for stage III CRC patients from the SEER database utilizing X-tile analysis, and retrospectively analyzed the clinicopathological data of 443 patients from the First Affiliated Hospital of Wenzhou Medical University from 2019 to 2020. Chi-square (χ2) tests compared categorical variables. Kaplan–Meier assessed CSS and DFS. Cox regression model evaluated prognostic factors on CSS and DFS.</div></div><div><h3>Results</h3><div>2TD is the optimal cutoff value for prognosis in Stage III CRC, in the low-risk group (T1-T3 and N1), ≥3TD patients faced higher cancer-specific mortality (HR = 3.445, 95%CI = 1.254–9.465, P = 0.017) and recurrence risks (HR = 1.934, 95%CI = 1.095–3.416, P = 0.024) vs. 1-2TD, while 1-2TD and no-TD patients showed no difference in survival. In the high-risk group (T4 or N2), both ≥3TD and 1-2TD patients had poor prognosis. Chemotherapy reduced cancer-specific mortality in both groups (1-2TD: HR = 0.347, 95%CI = 0.138–0.870, P = 0.024; ≥3TD: HR = 0.272, 95%CI = 0.077–0.960, P = 0.043) but did not significantly improve recurrence risk (1-2TD: P = 0.177; ≥3TD: P = 0.058).</div></div><div><h3>Conclusion</h3><div>TD indicates poor prognosis in stage III CRC, with ≥3 TD significantly worsening survival, yet the prognosis remains poor in TD-positive patients with high-risk (T4 or N2) regardless of TD count. Moreover, TD count does not influence chemotherapy's mortality benefit.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 42-50"},"PeriodicalIF":1.4,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Handedness in surgical education: Evaluating suturing proficiency among left- and right-handed trainees","authors":"Elio R. Bitar,&nbsp;Joelle Hassanieh,&nbsp;Salim Rahhal,&nbsp;Batoul Zaiter,&nbsp;Ahmad Zaghal","doi":"10.1016/j.sopen.2025.02.006","DOIUrl":"10.1016/j.sopen.2025.02.006","url":null,"abstract":"<div><h3>Background</h3><div>Left-handedness is often perceived as a disadvantage in surgical training due to the predominance of right-handed instruments and right-handed mentors. Whether this affects the performance of left-handed trainees remains unclear. This study aims to compare the suturing proficiency of left-handed and right-handed novice learners when taught by right-handed instructors using right-handed tools.</div></div><div><h3>Methods</h3><div>A prospective, non-randomized, non-inferiority trial was conducted among students without prior suturing experience, divided by handedness. Participants underwent a teaching session on simple interrupted suturing using right-handed instruments and were assessed using a validated ten-item checklist. Secondary outcomes included satisfaction and were assessed via subjective questionnaires.</div></div><div><h3>Results</h3><div>Among 129 participants (86 right-handed, 43 left-handed), no significant difference in suturing performance was observed between groups. However, left-handed participants reported subjective difficulties using right-handed instruments, and instructors noted challenges teaching them.</div></div><div><h3>Conclusion</h3><div>Handedness does not impact the final outcome of basic surgical skills teaching. However, left-handed students may perceive more challenges due to right-handed tools and techniques. Tailoring teaching strategies and providing hand-specific tools may improve their learning experience.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 51-57"},"PeriodicalIF":1.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging gaps in global surgery: Insights from an international hybrid conference","authors":"Fay Fathima Imtiaz Fareed ,&nbsp;Leshanth Uthayanan ,&nbsp;Robyn Anderson ,&nbsp;Sai Kotecha ,&nbsp;Adele Mazzoleni ,&nbsp;Joshua Erhabor ,&nbsp;Niraj S. Kumar ,&nbsp;William Wong","doi":"10.1016/j.sopen.2025.02.002","DOIUrl":"10.1016/j.sopen.2025.02.002","url":null,"abstract":"<div><div>This study explores the motivations for attendance, methods of conference promotion, and key considerations in implementing a hybrid conference for global surgery education among medical students and trainee doctors. The InciSion UK Global Surgery Conference 2023, held in London, provided a unique platform combining in-person and virtual participation. Pre- and post-conference surveys collected qualitative and quantitative data from 640 and 794 respondents, respectively. Professional development (83.4 %) and learning about global surgery (70.8 %) were primary motivators for attendance. Confidence in global surgery significantly increased post-conference (mean score: 4.21 vs. 2.82, <em>p</em> &lt; 0.001). Social media was the most effective promotional tool, introducing 38.4 % of attendees to the event. Participants highlighted the diversity and quality of talks as strengths, while technical issues were a challenge. Future conferences should enhance technical infrastructure and interactive engagement for virtual attendees. The hybrid model proves effective in broadening access to global surgery education and fostering collaboration across diverse geographical regions.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 38-41"},"PeriodicalIF":1.4,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143437885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feedback differences between upper gastrointestinal and colorectal specialists observing laparoscopic trainee surgeon suturing videos","authors":"Daigo Kuboki ,&nbsp;Teruhiko Unoki ,&nbsp;Yuji Kaneda ,&nbsp;Yoshitaka Maeda ,&nbsp;Kosuke Oiwa ,&nbsp;Hironori Yamaguchi ,&nbsp;Naohiro Sata ,&nbsp;Hiroshi Kawahira","doi":"10.1016/j.sopen.2025.02.001","DOIUrl":"10.1016/j.sopen.2025.02.001","url":null,"abstract":"<div><h3>Background</h3><div>Performing laparoscopic suturing requires quality education. Differences in instruction according to trainer surgeon specialty could affect trainee skill acquisition. This study compares the focus of feedback between Upper gastrointestinal (UGI) specialists and Colorectal (CR) specialists.</div></div><div><h3>Methods</h3><div>A 13-year postgraduate trainee received online feedback for two laparoscopic suturing procedures videos of “low” and “high” difficulty from 16 surgeons (UGI = 8, CR = 8) who are specialists in laparoscopic surgery and qualified by the Endoscopic Surgical Skill Qualification System of the Japan Society for Endoscopic Surgery. The number of feedback comments was compared between specialist groups for grasping the needle, needle driving, knot tying preparation, and knot tying. Both groups were also surveyed regarding suturing procedures.</div></div><div><h3>Results</h3><div>The UGI group had significantly more feedback comment varieties for knot tying preparation during the “high” difficulty video (UGI 4.0 ± 2.1 (mean ± SD), CR 1.9 ± 1.4, p &lt; 0.05). According to questionnaire results, the UGI group performed suturing more routinely than the CR group, was more confident, and less stressed about the procedure.</div></div><div><h3>Conclusion</h3><div>In feedback for laparoscopic suturing videos, the UGI group focused more on the preparatory stage for knot tying than the CR group. This indicates that comment focus differs according to specialty, suggesting that instruction from trainers of multiple specialties is optimal.</div></div><div><h3>Key message</h3><div>In this study, it was shown that the focus of feedback on laparoscopic suturing procedures differs according to the surgeon's subspecialty. These insights could have important implications for optimizing laparoscopic training programs.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 31-37"},"PeriodicalIF":1.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143387552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of a microvascular anastomotic coupler device for kidney transplantation in rats","authors":"Henrik Lauer,&nbsp;Jana Ritter,&nbsp;Patrick Nachtnebel,&nbsp;Kathrin Simmendinger,&nbsp;Emily Lerchbaumer,&nbsp;Vladyslav Kavaka,&nbsp;Dominik Steiner,&nbsp;Jonas Kolbenschlag,&nbsp;Adrien Daigeler,&nbsp;Johannes C. Heinzel","doi":"10.1016/j.sopen.2025.01.008","DOIUrl":"10.1016/j.sopen.2025.01.008","url":null,"abstract":"<div><h3>Background</h3><div>Allogenic kidney transplantation has been the gold standard treatment for end-stage renal disease. In the research setting, rat models are widely utilized to refine surgical techniques and enhance graft viability. One critical factor affecting transplantation outcomes is the efficiency of the venous anastomosis. This study evaluates the utility of a microvascular coupling device for venous anastomosis in a rat kidney transplantation model.</div></div><div><h3>Material and methods</h3><div>Experimental allogenic kidney transplantations were conducted in male Brown Norway rats (<em>n</em> = 10) as donors and Lewis rats as recipients (<em>n</em> = 17), housed according to institutional guidelines. A microvascular coupling device was used for renal venous anastomosis, and creatinine levels were measured postoperatively to assess kidney function. Procedure times, ischemia duration, and postoperative complications were recorded and analyzed.</div></div><div><h3>Results</h3><div>The venous anastomosis time averaged 6.6 ± 2.2 min. Total ischemia time averaged 42.4 ± 4.9 min. Early postoperative serum creatinine levels were slightly elevated about references thresholds, which normalized by postoperative day 3. Four animals died after successful transplantation due to urethral complications and postrenal failure (23.5 %). Other postoperative mortality was primarily linked to complications unrelated to thrombosis (<em>n</em> = 3, 17.6 %).</div></div><div><h3>Conclusion</h3><div>The use of a microvascular coupling device for venous anastomosis in rat kidney transplantation significantly reduces procedure time and ischemia duration, contributing to more consistent graft outcomes. The simplification of the venous anastomosis process and reduced operative time justify the use of coupling devices. This technique holds promise for advancing preclinical transplant research and improving reproducibility in microsurgical procedures.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 16-22"},"PeriodicalIF":1.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143146127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceptions and attitudes of medical students toward opioid education: A qualitative study","authors":"Angelina Luciano ,&nbsp;Mara Schenker ,&nbsp;Dawn L. Comeau ,&nbsp;Courtney R. Yarbrough ,&nbsp;Nicholas A. Giordano","doi":"10.1016/j.sopen.2025.01.007","DOIUrl":"10.1016/j.sopen.2025.01.007","url":null,"abstract":"<div><h3>Objective</h3><div>Explore the perceptions and attitudes of medical students regarding their education in opioid prescribing for pain management.</div></div><div><h3>Design</h3><div>Three focus group discussions elicited open-ended, information-rich responses from medical students attending multiple institutions. Thematic analysis identified common themes from focus group transcript data.</div></div><div><h3>Setting</h3><div>Rollins School of Public Health at Emory University, Atlanta, Georgia, USA.</div></div><div><h3>Participants</h3><div>Medical students (<em>n</em> = 12) from four medical schools in the United States.</div></div><div><h3>Results</h3><div>Focus group participants indicated they experienced changes in their perceptions and attitudes about opioids during their time in medical school, gradually recognizing the importance of treating pain while avoiding overprescribing and opioid-related harms. Discussions revealed that the curriculum on opioid medications and their prescription in medical school is limited and varied, with most opportunities for learning arising during preclinical years. The quantity and quality of the opioid-related education experienced by participants during medical school impacted their perceived knowledge about opioids and, consequently, their confidence in treating pain. Participants noted that important gaps in their knowledge about opioid prescribing persist, which may influence their future prescribing habits. While participants understood they had insufficient knowledge about opioid prescribing, they anticipated there would be additional learning during their residency programs.</div></div><div><h3>Conclusions</h3><div>There is room for improvement for medical school instruction on the safe and effective use of opioids for pain management in the United States. Medical students themselves have expressed a desire for enhanced opioid education. Strengthening opioid education has implications across various healthcare environments, particularly in settings with prevalent opioid prescribing.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 23-28"},"PeriodicalIF":1.4,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propensity matched analysis of DPA or DPL used within the first hour for severely hypotensive blunt trauma patients","authors":"Mallory Jebbia MD,&nbsp;Jeffry Nahmias MD MHPE,&nbsp;Sebastian Schubl MD,&nbsp;Matthew Dolich MD,&nbsp;Michael Lekawa MD,&nbsp;Allen Kong MD,&nbsp;Areg Grigorian MD","doi":"10.1016/j.sopen.2025.01.005","DOIUrl":"10.1016/j.sopen.2025.01.005","url":null,"abstract":"<div><h3>Background</h3><div>Prior single-center reports advocate for use of diagnostic peritoneal aspiration or lavage (DPA/DPL) to identify blunt trauma patients (BTPs) with intra-abdominal hemorrhage who require emergent surgery. Despite this, concerns exist over the potential for DPA/DPL to delay transfer to the operating room (OR). We hypothesized that DPA/DPL application in severely hypotensive BTPs would lead to increased OR transfer time and in-hospital mortality.</div></div><div><h3>Methods</h3><div>The 2017–2019 TQIP database was queried for adult BTPs presenting with severe hypotension (systolic blood pressure &lt;70 mmHg) who underwent any operative intervention within two-hours. Using a 1:2 propensity-score model, patients who underwent DPA/DPL within one-hour of arrival were compared with those who did not, controlling for age, sex, comorbidities, ≥6 units of packed red cells within 4 h, and injury profile.</div></div><div><h3>Results</h3><div>From 5514 patients, 62 (1.1 %) underwent DPA/DPL. We matched 52 DPA/DPL patients to 104 patients not undergoing DPA/DPL. There were no differences in the matched variables between cohorts (all p &gt; 0.05). Compared to those not undergoing DPA/DPL, patients undergoing DPA/DPL had a higher rate/risk of in-hospital complications (59.6 % vs. 39.4 %, p = 0.02) (OR 2.27, CI 1.15–4.47, p = 0.02) but statistically similar rate/risk of death (65.4 % vs. 50.0 %, p = 0.07) (OR 1.89, CI 0.95–3.76, p = 0.07). Time to OR was similar between both groups (DPA/DPL 39 min vs. non-DPA/DPL 42 min, p = 0.87).</div></div><div><h3>Conclusion</h3><div>DPA or DPL used within the first hour of arrival does not appear to delay time to OR and does not increase risk of death. This challenges concerns over potential DPA/DPL-associated delays and heightened mortality risks.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 1-4"},"PeriodicalIF":1.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143147236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative strategies in bile duct repair: Assessing efficacy and safety across varied graft techniques - A systematic review","authors":"Anung Noto Nugroho ,&nbsp;Soetrisno Soetrisno ,&nbsp;Ambar Mudigdo ,&nbsp;Kristanto Yuli Yarso ,&nbsp;Dono Indarto ,&nbsp;Akmal Zhahir Wahyudi ,&nbsp;Enrico Ananda Budiono ,&nbsp;Auliya Yudia Yasyfin","doi":"10.1016/j.sopen.2025.01.006","DOIUrl":"10.1016/j.sopen.2025.01.006","url":null,"abstract":"<div><div>Bile duct injuries (BDI) from surgical procedures pose significant clinical challenges, requiring precise interventions for optimal outcomes. This systematic review explores the utilization of grafts in the repair of bile duct injuries, aiming to gain insights from existing literature. Graft-based techniques show promise in improving postoperative outcomes, but their efficacy varies. A systematic search was conducted across PubMed, Science Direct, and Scopus following the PRISMA 2020 Checklist, focusing on studies published until February 19, 2024. The inclusion criteria involved research using grafts to treat bile duct injuries in pig, swine, or mini-pig models. Out of 2231 studies identified, eleven met the inclusion criteria. These studies evaluated various graft techniques, including autologous tissue with biodegradable stents, decellularized grafts, patches, prosthetic grafts, bacterial cellulose film, and heterogeneous materials. Each method had distinct advantages and limitations, particularly regarding postoperative outcomes and histological findings. This review highlights the need for further research to determine the most effective graft-based strategies for BDI repair and improve patient care.</div></div>","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 5-15"},"PeriodicalIF":1.4,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143146143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introduction from the New Editor of Diversity, Justice and Action","authors":"Mohammad Y. Zaidi","doi":"10.1016/j.sopen.2025.01.004","DOIUrl":"10.1016/j.sopen.2025.01.004","url":null,"abstract":"","PeriodicalId":74892,"journal":{"name":"Surgery open science","volume":"24 ","pages":"Pages 29-30"},"PeriodicalIF":1.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}