Urogynecology (Hagerstown, Md.)最新文献

{"title":"Optimizing the Laparoscopic Vecchietti Procedure: Tips and Tricks.","authors":"Annika Sinha, Abbigail Woll, Cassandra K Kisby","doi":"10.1097/SPV.0000000000001613","DOIUrl":"10.1097/SPV.0000000000001613","url":null,"abstract":"<p><strong>Background: </strong>The Vecchietti procedure is a staged procedure that, through use of an acrylic olive, allows for expedited traction and dilation to create a neovagina in patients with congenital vaginal agenesis. Although the steps are fairly standardized for the laparoscopic Vecchietti procedure, we have appreciated specific nuances in technique that have optimized our surgical approach and efficiency.</p><p><strong>Case: </strong>We present a case of congenital vaginal agenesis in a genetically female patient who completed neovaginal creation using the laparoscopic Vecchietti technique. During this case, we review each step of the procedure and offer technical strategies to enhance efficiency and effectiveness in the operating room. We also describe these specific preoperative, intraoperative, and postoperative considerations in a video.</p><p><strong>Conclusions: </strong>This optimized Vecchietti procedure, or traction vaginoplasty, is an excellent option for neovagina creation in those patients with vaginal agenesis. With the use of our techniques, we have had successful cosmetic and functional outcomes.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"465-468"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Rates of Urethral Bulking: A Retrospective Study of a National Database.","authors":"Taylor Whitaker, Samantha DeAndrade, K Marie Douglass, Tajnoos Yazdany","doi":"10.1097/SPV.0000000000001655","DOIUrl":"10.1097/SPV.0000000000001655","url":null,"abstract":"<p><strong>Importance: </strong>Stress urinary incontinence (SUI) affects approximately 50% of women. There are limited data regarding trends in management as treatment options have changed.</p><p><strong>Objective: </strong>This study aimed to analyze trends in the surgical management of SUI, including slings and urethral bulking, from 2012 to 2022.</p><p><strong>Study design: </strong>Patients from the American College of Surgeons National Surgical Quality Improvement Program database who had undergone a sling or urethral bulking procedure were identified by Current Procedural Terminology code. Descriptive statistics and independent paired t tests were performed.</p><p><strong>Results: </strong>A total of 81,657 patients received either slings or urethral bulking from 2012 to 2022. The number of slings performed peaked in 2017, decreased in 2020, and has subsequently increased. The rate of urethral bulking increased from 2019 to 2022. The average age patients who received urethral bulking was 64 years versus 56 years for sling patients ( P < 0.05). These patients were more likely to be American Society of Anesthesiology class III compared to those receiving slings (39% vs 25%, respectively, P < 0.05). Readmission and reoperation rates were not statistically different. Less invasive procedures were more likely to be performed concurrently with bulking.</p><p><strong>Conclusions: </strong>Sling placement is the most common surgical procedure for SUI but it decreased in 2020, likely due to COVID-19-related delays, and has not yet returned to prepandemic levels. Urethral bulking has become more common, possibly due to new agents available in U.S. markets. Patients who received urethral bulking were more likely to be older, have severe systemic disease, and underwent a less invasive concurrent procedure. Further research is needed to understand these trends.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"337-343"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Uterine Preservation at the Time of Pelvic Organ Prolapse Surgery.","authors":"Olivia H Chang, Alison Carter Ramirez, Allison Edwards, Henry H Chill, Juraj Letko, Katherine L Woodburn, Geoffrey W Cundiff","doi":"10.1097/SPV.0000000000001667","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001667","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to synthesize the current literature and provide surgeons with data to inform counseling of eligible patients for uterine-preserving prolapse surgery (UPPS).</p><p><strong>Methods: </strong>We compared UPPS to similar techniques incorporating hysterectomy, including native-tissue repairs by vaginal, laparoscopic, or open approach; mesh-reinforced repairs by vaginal, laparoscopic, or open approach; obliterative repairs; and the Manchester procedure. Reviewed outcomes include surgical and patient-reported outcomes, complications, uterine pathology, and sexual function. We conducted a structured literature search of English language articles published 1990-2023, combining MeSH terms for pelvic organ prolapse and UPPS. Data were categorized by procedure and approach, and evaluated to provide recommendations and strength of evidence based on group consensus.</p><p><strong>Results: </strong>Patient counseling on prolapse surgery should follow a benefit/risk assessment related to techniques that preserve the uterus. The discussion should include the benefits of hysterectomy for cancer detection and prevention and acknowledgment that patients should continue cervical cancer screening and evaluation of abnormal uterine bleeding following UPPS. The rate of hysterectomy after UPPS is low and most commonly for recurrent prolapse. If cervical elongation is present, trachelectomy should be considered at the time of UPPS. There is no difference in sexual function between UPPS and prolapse repair with hysterectomy. Data on pregnancy outcomes following UPPS are limited.</p><p><strong>Conclusions: </strong>Uterine-preserving prolapse surgery should be a surgical option for all patients considering surgical treatment for symptomatic pelvic organ prolapse unless contraindications exist. Uterine-preserving prolapse surgery should be offered using an individualized benefit and risk discussion of both approaches to help patients make an informed decision based on their own values.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pessary Placement for Voiding Dysfunction Due to Prolapse Among Neurologically Intact Women.","authors":"Sarah Ashmore, Margaret G Mueller, Kimberly Kenton, C Emi Bretschneider","doi":"10.1097/SPV.0000000000001629","DOIUrl":"10.1097/SPV.0000000000001629","url":null,"abstract":"<p><strong>Importance: </strong>Literature surrounding conservative management of voiding dysfunction (VD) due to pelvic organ prolapse (POP) is limited.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the effect of pessaries on VD in women with symptomatic POP.</p><p><strong>Study design: </strong>This was a retrospective case series of adult women who underwent a pessary fitting for POP and VD between January 2010 to December 2022 at 2 tertiary care centers. Voiding dysfunction was defined as a composite outcome of participant report of obstructive voiding symptoms and postvoid residual volume (PVR) ≥150 mL prior to pessary fitting. Obstructive voiding symptoms were determined by positive response on the Pelvic Floor Distress Inventory-20 to items 5, 6, 19, and/or 20.</p><p><strong>Results: </strong>Sixty-one participants with POP and VD underwent successful pessary fitting at 2 large academic institutions. Median (range) age was 75 years (35-89) and body mass index of 26.5 (18.0-46.3). Participant reports of \"difficult bladder emptying\" and \"sensation of incomplete bladder emptying\" were the most reported symptoms of obstructive voiding. Advanced staged prolapse (prolapse ≥ stage 3) was documented for 84% of participants. Median point C, Ba, and genital hiatus were -2 cm, +3 cm, and 4 cm, respectively, on examination. Median PVR prior to pessary fitting was 263 mL (150-810). Voiding dysfunction resolved in 60 out of 61 participants (98%). Median repeat PVR after pessary placement was 50 mL (0-250).</p><p><strong>Conclusion: </strong>Pessary placement resolved VD due to POP in 98% of participants. Clinicians can offer pessary placement as nonsurgical management for participants with VD due to POP.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"384-389"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Residents' Exposure to Obstetric Anal Sphincter Injury: A 16-Year Temporal Trend.","authors":"Courtney K Pfeuti, Lindsay Gugerty, John A Occhino, Suneet P Chauhan","doi":"10.1097/SPV.0000000000001618","DOIUrl":"10.1097/SPV.0000000000001618","url":null,"abstract":"<p><strong>Importance: </strong>Exposure to the surgical management of obstetric anal sphincter injuries (OASIS) is limited during obstetrics training.</p><p><strong>Objectives: </strong>The objective of this study was to quantify residents' exposure to OASI repair during 4-year obstetrics and gynecology (OBGYN) residency and examine temporal trends over a 16-year period.</p><p><strong>Study design: </strong>This was a retrospective cohort study of residents' exposure to OASIS at a community academic hospital from 2007 to 2022. Individuals with documented OASIS (third- or fourth-degree laceration) by International Classification of Diseases, Ninth and Tenth Revisions, codes during vaginal delivery (VD), spontaneous vaginal delivery (SVD), or operative vaginal delivery (OVD), were included. Delivery rates and OBGYN resident positions were examined. Temporal trends in OASIS were analyzed in 4-year epoch to determine average resident exposure during OBGYN residency.</p><p><strong>Results: </strong>During the 16-year study period, there were 103,234 deliveries (62% VD, 4% OVD, 34% cesarean delivery). Among VDs, there were 2,344 (3.4%) OASIS with 88.5% classified as third-degree and 11.5% as fourth degree. The OASI rate decreased from 4.2% (2007-2010) to 2.9% (2019-2022), whereas OBGYN residents increased by 49% (67 to 99; P < 0.001). Average resident exposure to OASIS decreased from 11 (2007-2010) to 5 (2019-2022; P = 0.55). Subclassification revealed that residents were exposed to 5 third-degree repairs and less than 1 fourth-degree repair, on average, during 2019-2022.</p><p><strong>Conclusions: </strong>During 4 years of training, average resident exposure was to 7 OASIS, 6 third degree, and 1 fourth degree. Limited exposure to OASIS during residency may be detrimental, as surgical treatment is a complicated yet essential obstetric procedure that carries significant risk of patient morbidity and potential long-term sequelae. Therefore, reliance on supplementation with simulation may improve surgeon competence in OASI management.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"436-443"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tamsulosin to Prevent Urinary Retention After Vaginal Urogynecologic Surgery.","authors":"Jun Song, Luis Carrillo, Jasmine Tibon, Sylvia Botros-Brey, Elizabeth Evans, Alexandriah Alas","doi":"10.1097/SPV.0000000000001632","DOIUrl":"10.1097/SPV.0000000000001632","url":null,"abstract":"<p><strong>Importance: </strong>Postoperative urinary retention (POUR) affects up to 51% of women undergoing surgery for pelvic organ prolapse (POP). Effective prevention strategies remain elusive, although alpha receptor antagonists show promise in recent literature.</p><p><strong>Objectives: </strong>This study sought to evaluate the effect of preoperative tamsulosin on POUR after vaginal surgery for POP.</p><p><strong>Study design: </strong>We conducted a retrospective cohort study of female patients undergoing vaginal surgery for POP, with or without concomitant midurethral sling. Patients who received preoperative tamsulosin were compared with controls. All patients were discharged on the day of surgery after undergoing a standardized voiding trial. The primary outcome was the rate of POUR, defined by a failed voiding trial. Secondary outcomes included complication rates and risk factors for POUR.</p><p><strong>Results: </strong>A total of 195 patients were included for analysis, with 60 patients (30.8%) receiving tamsulosin and 135 (69.2%) not. Baseline demographics were similar between groups, except the tamsulosin group had lower parity and were less likely to splint to void. The tamsulosin group had similar rates of POUR compared with control (31.7% vs 34.8%, P = 0.67). Multivariate logistic regression controlling for confounders showed no significant effect of tamsulosin on POUR rates (odds ratio, 0.65; 95% confidence interval, 0.31-1.35; P = 0.24). Concomitant sling placement was identified as the only independent risk factor for POUR (odds ratio, 3.00; 95% confidence interval, 1.55-5.81; P = 0.001).</p><p><strong>Conclusions: </strong>Preoperative tamsulosin does not appear to be effective in preventing postoperative urinary retention in women undergoing vaginal surgery for POP, whereas concomitant sling placement appears to increase its risk.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":"397-404"},"PeriodicalIF":0.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged Second Stage of Labor and Postpartum Pelvic Floor Dysfunction.","authors":"Andrea Marcheti Silveira, Glaucia Miranda Varella Pereira, Elaine Christine Dantas Moises, Cassia Raquel Teatin Juliato, Luiz Gustavo Oliveira Brito","doi":"10.1097/SPV.0000000000001687","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001687","url":null,"abstract":"<p><strong>Importance: </strong>Parity and mode of delivery are common risk factors for pelvic floor dysfunction. The prolonged second stage of labor, defined as the time between complete cervical dilation and the expulsion of the fetal head, may be related to these changes and no pooled evidence has been tabulated to seek this association.</p><p><strong>Objective: </strong>The aim of the study was to carry on a systematic review on the association between pelvic floor dysfunction symptoms and prolonged second stage of labor (PSSL).</p><p><strong>Study design: </strong>A systematic search was conducted in the databases PubMed, Cochrane Library, Embase, SCOPUS, Web of Science, and LILACS on July and December 2024. Studies involving populations of women who experienced PSSL and in which the analyzed outcomes were symptoms of pelvic floor dysfunction were included. The ROBINS-I scale was used to assess methodological quality for observational studies.</p><p><strong>Results: </strong>A total of 92 articles were fully analyzed, and 6 articles were selected. A meta-analysis could not be performed because of the heterogeneity of the primary outcome and the definition for PSSL. Two of 6 studies considered PSSL over 3 hours. Among the 6 studies, 3 showed no association between PSSL and pelvic floor dysfunction, 2 indicated an association with urinary incontinence, and one suggested a partial association. All studies presented a moderate overall risk of bias.</p><p><strong>Conclusions: </strong>Half of the studies did not demonstrate an association between PSSL and pelvic floor dysfunction and the other half suggested an association. Further studies with PSSL as primary outcomes with cohort design are needed to clarify this question.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presacral Space Surgical Anatomy: Piriformis Fascia as Lateral Border.","authors":"Adam M Hare, Polina Sawyer, Samantha Hull, Marlene M Corton","doi":"10.1097/SPV.0000000000001681","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001681","url":null,"abstract":"<p><strong>Importance: </strong>Safe surgery requires an understanding of the anatomic boundaries and neurovascular structures of the presacral space.</p><p><strong>Objective: </strong>The aim of the study was to characterize anatomy of the presacral space applicable to sacrocolpopexy or rectopexy while highlighting cadaveric findings of the lateral border of the space.</p><p><strong>Study design: </strong>Structures and boundaries of the presacral space of 18 unembalmed female cadavers were studied. Anatomic relationships and distances to landmarks were established.</p><p><strong>Results: </strong>A dense connective tissue layer ≤1 mm thick on the piriformis muscle's medial surface attaches to the anterior sacrum just medial to the sacral foramina, separating the lateral sacral vein and sacral nerves laterally from the presacral space contents medially. Median transverse distance from midsacral promontory to right sympathetic trunk was 19.5 (range, 15-31) mm. Distances from right S1, S2, S3, and S4 foramina to midsacral promontory were 28.8 (22-47.5), 48.3 (38.5-72.5), 65.8 (54.5-89.5), and 80.8 (65-104.5) mm and to midline sacrum were 16.5 (14-22), 15.3 (13-20.5), 13.5 (10.5-19.5) and 13.3 (10.5-19.5) mm, respectively. Transverse communicating veins, measuring 3 (2-4) mm in width, penetrated the piriformis fascia, joining the lateral sacral vein to form the sacral venous plexus. Vertical distance from midsacral promontory to the most cephalad communicating vein was 38.3 (7.5-60.5) mm.</p><p><strong>Conclusions: </strong>During presacral space surgical procedures, avoiding suture placement and mesh fixation beyond 1.5 cm from the sacrum midline should prevent injury to the sacral sympathetic trunk, sacral nerves, and lateral sacral vein. Transverse communicating vessels of the sacral venous plexus are usually encountered below the S1 foramina level. The piriformis fascia is the lateral boundary of the presacral space over the greater sciatic foramen.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re. DeLancey, J., Is POP-Q II Now Overdue?","authors":"Hans Peter Dietz, Ka Lai Shek","doi":"10.1097/SPV.0000000000001690","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001690","url":null,"abstract":"","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidural Analgesia and the Risk of Obstetric Anal Sphincter Injury.","authors":"Do Hee Lee, Celia Kucera, Melissa Salinas, Charelle M Carter-Brooks","doi":"10.1097/SPV.0000000000001677","DOIUrl":"https://doi.org/10.1097/SPV.0000000000001677","url":null,"abstract":"<p><strong>Importance: </strong>There are conflicting data regarding the association between epidural analgesia and obstetric anal sphincter injuries (OASIs). There are also few predictive models that document assessment for multicollinearity among risk factors or precisely identify effect modifiers and confounders.</p><p><strong>Objective: </strong>The objective of this study was to evaluate the association between epidural analgesia and OASIs, using rigorous statistical methods to identify effect modifiers and confounders in a diverse, urban population.</p><p><strong>Study design: </strong>This was a secondary analysis of a retrospective case-control study of women with singleton vaginal deliveries. Our primary analysis was to assess the association between epidural analgesia and OASIs, adjusting for modifiable and nonmodifiable risk factors. These risk factors were additionally assessed for effect modification and confounding effect.</p><p><strong>Results: </strong>Our sample consisted of 1,326 women who had a vaginal delivery. Among the women with OASIs, 218 women (75.4%) had an epidural, and among those without OASIs, 620 women (59.8%) had an epidural (P < 0.001). Epidural analgesia increased the odds of OASIs by 107% (odds ratio 2.07, 95% confidence interval [1.54 to 2.77]). Through further examination of the relationship between OASIs and epidurals, while considering multiple risk factors and addressing multicollinearity, effect modification, and confounding, we identified operative delivery and labor induction as confounding variables. Accounting for these factors mitigated the association between epidural use and OASIs (adjusted odds ratio 1.38, 95% confidence interval [1.00 to 1.91]).</p><p><strong>Conclusions: </strong>Initially, we found epidural analgesia to be associated with OASIs; however, after performing additional statistical analysis and accounting for additional risk factors, this association was no longer statistically significant.</p>","PeriodicalId":75288,"journal":{"name":"Urogynecology (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}