American Surgeon最新文献

{"title":"The First 10 Days After Discharge: Timing and Causes of Unplanned Hospital Revisits Following Colorectal Cancer Surgery.","authors":"Yunpeng Zhang, Yuan Tian, Quanjun Lin, Jue Wang, Peng Sun, Daqing Cheng, Ming Xu","doi":"10.1177/00031348261501341","DOIUrl":"https://doi.org/10.1177/00031348261501341","url":null,"abstract":"<p><p>BackgroundDespite advances in laparoscopic techniques and widespread adoption of Enhanced Recovery After Surgery (ERAS) protocols, post-discharge readmission rates remain high following colorectal cancer surgery, driven especially by stoma-related complications. This study aimed to define the temporal distribution of unplanned hospital revisits and evaluate whether early, structured post-discharge surveillance can reduce these risks within a mature ERAS system.MethodsWe retrospectively enrolled 440 patients undergoing laparoscopic colorectal resection between 2019 and 2022. A Peri-discharge Quality Improvement (PQI) protocol was implemented, including standardized pre-discharge education and intensive follow-up: telephone assessment within 24 hours, specialist outpatient review on post-discharge day 3, and community follow-up on days 7 and 30. Patients managed under the PQI program were compared against national benchmark reference data derived from the National Surgical Quality Improvement Program (NSQIP) database, instead of a contemporaneous institutional control group.ResultsThe overall 30-day readmission rate was 7.7%, showing a non-significant downward trend compared with historical benchmarks. Notably, 83.0% of all unplanned hospital revisits occurred within the first 10 days after discharge. Targeted early surveillance was associated with lower stoma-related readmission rates relative to historical NSQIP benchmark controls (8.8% vs 19.0%; <i>P</i> = 0.028).ConclusionsThe first 10 days after discharge represent a critical high-risk window for unplanned hospital visits after colorectal cancer surgery. Implementation of the structured peri-discharge PQI program was associated with favorable stoma-related outcomes in elective colorectal surgery patients. Causal effects of the PQI and its superiority over usual care remain unproven.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261501341"},"PeriodicalIF":1.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal and Urological Tract Injuries During Cesarean Delivery: A Surgical Review With National Epidemiologic Data.","authors":"Ahmad Zeineddin, Mariana N Olivencia-Delgado, Kindha E Nasef, Juan Carmona-Tamayo, Kendra Outler, Mallory Williams","doi":"10.1177/00031348261500322","DOIUrl":"https://doi.org/10.1177/00031348261500322","url":null,"abstract":"<p><p>BackgroundCesarean delivery is the most common major surgical procedure performed worldwide, accounting for approximately one-third of US deliveries. Gastrointestinal (GI) and urological (URO) tract injuries are uncommon but disproportionately morbid complications. Increasing complexity, particularly repeat cesarean and placenta accreta spectrum (PAS), and uneven on-site subspecialty coverage have expanded the role of general surgeons as intraoperative consultants for these injuries, especially outside large tertiary centers.MethodsWe analyzed the National Inpatient Sample (NIS, 2005-2019) to characterize the contemporary epidemiology, predictors, and outcomes of GI/URO injuries during cesarean delivery, complemented by a literature review focused on intraoperative recognition and management principles most relevant to the consulting general surgeon.ResultsAmong 3 816 895 cesarean deliveries, 8891 involved a documented GI/URO injury requiring surgical intervention (≈233 per 100 000). Bladder injuries predominated (78.2%), followed by bowel repair (13.3%), bowel resection (7.8%), and ureteral injuries (1.3%). Injuries were associated with markedly higher ICU admission (3.4% vs 0.2%), respiratory failure (1.7% vs 0.1%), in-hospital mortality (0.22% vs 0.01%), and resource utilization. Prior cesarean delivery was the strongest predictor of URO injury (OR 2.92; 95% CI 2.71-3.13).ConclusionsGI/URO injuries during cesarean delivery are uncommon but highly morbid, and the operative complexity that produces them is rising. With variable on-site subspecialty coverage, the general surgeon is frequently the first operative consultant. Familiarity with intraoperative principles, prevention strategies in high-risk cases, structured recognition, and initial repair or damage-control temporization should be considered a core competency for surgeons covering trauma, rural, or emergency general surgery call.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261500322"},"PeriodicalIF":1.0,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Barrett's Esophagus Length Still Matter? Contemporary Implications for Risk Stratification, Surveillance, and Endoscopic Therapy.","authors":"Fernando A M Herbella, Rafael C Katayama, Francisco Sandro Menezes-Rodrigues, Francisco Schlottmann, Marco G Patti","doi":"10.1177/00031348261499927","DOIUrl":"https://doi.org/10.1177/00031348261499927","url":null,"abstract":"<p><p>Longer Barrett esophagus (BE) segments are associated with worse outcomes than shorter segments. However, it remains uncertain whether BE length is still a clinically actionable variable in modern surveillance, risk stratification, and treatment pathways. We reviewed current literature on the relevance of BE length as a predictor of gastroesophageal reflux disease (GERD) severity, cancer risk, treatment outcomes, regression after treatment, and remission after ablation. BE length correlates with hiatal hernia size, esophageal dysmotility, esophagitis, and acid exposure time. Long-segment BE carries a greater risk of dysplasia or progression to esophageal adenocarcinoma than short-segment BE, although smaller segments are not risk-free. Longer BE length was associated with treatment failure and increased post-treatment pain. BE length also predicted recurrence of BE, dysplasia, or adenocarcinoma after endoscopic ablation therapy. In conclusion, most current studies report BE outcomes without stratifying results by length. BE length, however, functions as a continuous clinical variable that influences multiple aspects of care, including progression risk, surveillance intervals, treatment complexity, likelihood of eradication, recurrence after therapy, and incorporation into emerging prediction models. In other words, the contemporary importance of length lies less in preserving a historical cutoff than in recognizing length as one component of multidimensional risk stratification.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499927"},"PeriodicalIF":1.0,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Version Control for Surgical Data Science: A Primer on Git and GitHub.","authors":"Andrew C Kuo, Marissa C Kuo, Paul C Kuo","doi":"10.1177/00031348261499198","DOIUrl":"https://doi.org/10.1177/00031348261499198","url":null,"abstract":"<p><p>Surgical research increasingly relies on computational analysis of large clinical datasets, and major journals now request code availability statements for publication. Yet most surgical trainees and faculty receive no formal training in software version control, despite its central role in reproducible research. This article provides a practical introduction to Git, a widely used version control system in academic and industrial software development, and GitHub, a leading hosting platform. The presentation implements workflows specific to surgical research, including retrospective registry analysis, multi-institutional collaboration, and reviewer reproducibility requests. Core concepts covered include the four mental models that are the basis for Git usage (repository, commit, branch, and remote), the daily edit-stage-commit cycle that is the dominant workflow, and the use of branches and pull requests for collaboration. Attention is given to clinical data security: identifiable patient data must never enter a version-controlled repository, and the article details the use of a.gitignore file to prevent inadvertent commits. The article also illustrates the installation of community-developed tools through a worked example involving Stash, an open-source persistent memory layer for artificial intelligence (AI) research assistants. Three recovery scenarios are demonstrated: restoring deleted code, reproducing the exact state of a manuscript at submission, and resolving merge conflicts. This allows surgical researchers to adopt version control practices that protect their work, support reproducibility, and meet emerging standards for transparent computational research.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499198"},"PeriodicalIF":1.0,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149214915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing Agricultural Trauma: What Rural Surgeons Should Know About Injury Patterns and Evidence-Based Mitigation.","authors":"Abby M Markstrom, Laurel Vaughan, Barbara A Bennie, C Isaiah Fitzmaurice","doi":"10.1177/00031348261499584","DOIUrl":"https://doi.org/10.1177/00031348261499584","url":null,"abstract":"<p><p>BackgroundMore than half of the global workforce is employed in agriculture-related occupations, and farm-related injuries remain prevalent to rural trauma centers. Agricultural activities have numerous inherent dangers, and this study aimed to describe the characteristics and clinical outcomes of patients with agriculture-related injuries in rural America.MethodsWe performed a retrospective review of adult and pediatric patients with agriculture-related injuries who sought care at a Level II Trauma Center in Wisconsin between 2013 and 2022. Demographic variables as well as primary diagnosis, mechanism of injury, injury severity score (ISS), and hospital length of stay (LOS) were determined. Descriptive statistics were performed, and a <i>P</i> level of .05 was considered statistically significant.ResultsA total of 462 patients met inclusion criteria. The most common mode of injury was blunt force trauma (95%, 441/462). Fifteen percent (67/462) of injuries were animal-related, 34% (157/462) were equipment-related, and 39% (179/462) were fall-related. Median hospital LOS was significantly longer for equipment-related than for animal-related injuries (2 days vs 1 day, respectively; <i>P</i> = .014). Employment status was significantly associated (<i>P</i> = .016) with injury type, with retired individuals experiencing a higher rate of falls (68%, 23/34) when compared with other employment categories (33%-39%).DiscussionThe most common injuries seen were falls and equipment-related, where equipment-related injuries required significantly longer hospital stays than animal-related injuries. Retired individuals experienced a higher rate of falls. These data provide insights into our largely rural population and identified areas of trauma education and prevention efforts regarding equipment safety and fall prevention.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499584"},"PeriodicalIF":1.0,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Surgery in Acute Care: Development of an Educational Pathway and Single-Institution Outcomes.","authors":"Juliette Lewis, Mary Friend, Corinne Gautreaux, Carlyse Salter, Fion Chang, William Richards, Jon Simmons, Steven Miller, Maryann Mbaka","doi":"10.1177/00031348261500238","DOIUrl":"https://doi.org/10.1177/00031348261500238","url":null,"abstract":"<p><p>BackgroundRobotic surgery has been adopted across surgical subspecialties, but integration within Acute Care Surgery (ACS) has lagged. Barriers include unpredictable operative timing, competing demands for operating room (OR) resources, variable staffing, and limited access to structure robotic education for practicing acute care surgeons. We hypothesized that implementation of a robotic ACS program would require coordinated educational, operational, and staffing processes rather than reliance on surgeon training alone.MethodsThis single-institution retrospective cohort study, approved by the Institutional Review Board, evaluated a structured robotic ACS education pathway at a tertiary academic medical center. Program development centered on three components: surgeon training, staff preparedness, and staged case selection. Clinical implementation progressed from scheduled clinic cases to selected emergency department (ED) presentations and, subsequently, later-day and nighttime cases. Following adoption, the first fifty patients undergoing robotic operations between 5/2022 and 12/2024 by ACS service were evaluated to assess feasibility of implementation, and early perioperative outcomes (conversion to open surgery, complications, reoperations, and readmissions).ResultsRobotic surgery was successfully integrated into the ACS service despite initial barriers, fifty cases were successfully performed without conversions to open surgery, and no intraoperative complications. One patient (2%) required both readmission and reoperation for trapped preperitoneal fat following ventral hernia repair. Case origins include clinic (78%) and ED (22%) presentations and were performed during scheduled and off-hours periods.DiscussionA structured, multidisciplinary service-line implementation pathway enables integration of robotic surgery within ACS practice. Institutional leadership engagement, coordinated training, staff preparation, and reliable access allowed safe adoption across varied presentations without compromising outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261500238"},"PeriodicalIF":1.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Prior Androgen Exposure Alter Outcomes After Gynecomastia Surgery? A Propensity-Matched Analysis.","authors":"Ron Skorochod, Yitzhak Skorochod, Yoav Gronovich","doi":"10.1177/00031348261499862","DOIUrl":"https://doi.org/10.1177/00031348261499862","url":null,"abstract":"<p><p>BackgroundGynecomastia is a benign condition associated with proliferation of male breast glandular tissue. Persistent symptoms that lead to psychological distress ultimately necessitate surgical treatment. Androgenic and anabolic steroids are a well-recognized contributor to the development of gynecomastia. With the increase in testosterone-supplementation over the past decades, surgeons are increasingly encountering documented androgen exposure presenting for gynecomastia reduction and correction.Materials and MethodsThis retrospective cohort study utilized data from the TriNetX Global Collaborative Network. Male patients who underwent surgical treatment for gynecomastia were identified using standardized diagnostic and procedural codes. Patients were stratified according to documented exposure to androgenic or anabolic agents within three years prior to surgery and were propensity score-matched in a 1:1 ratio to control patients without androgen exposure. Age-stratified analyses were additionally performed in patients younger than 50 years and those aged 50 years or older. The primary outcomes were short-term postoperative adverse events occurring within 30, 60, and 90 days after surgery. Secondary outcomes included revision surgery.ResultsAfter propensity-score matching, 6963 patients with documented androgen exposure were matched to 6963 controls. Androgen exposure was associated with increased risks of several early postoperative complications, including hematoma, wound dehiscence, wound debridement, and emergency department visits within 90 days of surgery. Age-stratified analyses demonstrated more pronounced increases in surgical complications among patients aged 50 years or older, whereas younger patients primarily demonstrated increased health care utilization. Despite higher rates of early postoperative morbidity, androgen exposure was associated with lower rates of revision surgery.ConclusionsIn this large propensity score-matched cohort study, documented androgen or anabolic-agent exposure was associated with increased early postoperative morbidity following gynecomastia surgery but fewer revision procedures. These findings identify prior androgen exposure as a clinically relevant risk marker that should be considered during preoperative assessment and counseling. However, the results do not establish a causal relationship or support a specific preoperative cessation interval.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499862"},"PeriodicalIF":1.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Underwater Mindset in Emergency Surgery.","authors":"Perini Davina","doi":"10.1177/00031348261499924","DOIUrl":"https://doi.org/10.1177/00031348261499924","url":null,"abstract":"<p><p>Emergency surgery requires decision-making in environments characterized by uncertainty, evolving conditions, and narrowing margins of safety. Scuba diving presents similar challenges, requiring continuous reassessment of the environment, individual capacity, equipment, and team while preserving sufficient reserve to respond to unexpected events. This Surgical Reflection uses the underwater environment as a conceptual framework to explore adaptive expertise in emergency surgery. Three interconnected capabilities are considered: maintaining situational awareness beyond the immediate technical task, preserving cognitive reserve and team function as workload increases, and recognizing when persistence should give way to a change in strategy. The underwater mindset reframes adaptation-including conversion, damage-control approaches, seeking additional expertise, or abandoning an unsafe operative plan-not as failure, but as an expression of surgical judgment. In dynamic high-risk environments, expertise may ultimately depend not only on the ability to proceed, but on recognizing when the conditions that justified the original plan have changed.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499924"},"PeriodicalIF":1.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed Opportunities: Toxicology Screening Remains Incomplete Among Firearm-Injured Adolescents.","authors":"Amber N Hannah, Andrea Abi-Karam, Vignesh Jayaraman Muralidharan, Jasmin Strong, Randi N Smith","doi":"10.1177/00031348261499835","DOIUrl":"https://doi.org/10.1177/00031348261499835","url":null,"abstract":"<p><p>BackgroundFirearm injury remains the leading cause of death among children and adolescents in the United States. Firearm-injured adolescents are at increased risk for substance use and behavioral disorders, yet toxicology testing remains inconsistent despite national recommendations. We evaluated toxicology testing among firearm-injured adolescents compared with adults and temporal trends.MethodsWe retrospectively studied firearm-injured patients treated at an urban Level I trauma center from 2013-2024. Adolescents were classified as early (11-14), middle (15-17), or late (18-21) and compared with adults ≥22 years. Testing and substance-specific results were evaluated using multivariable logistic regression.ResultsAmong 10,853 patients, 2713 (25.0%) were adolescents. EtOH and illicit drug testing occurred in 37.7 and 15.5% of patients, respectively. Adolescents had lower rates of EtOH (33.9 vs 39.1%) and illicit drug testing (12.2 vs 16.6%) than adults, decreasing among younger adolescent age groups. After adjustment for sex, race, and clinical severity, adolescents remained less likely to undergo EtOH (aOR 0.77, 95% CI 0.70-0.85) and illicit drug (aOR 0.69, 95% CI 0.60-0.78) testing. White patients had higher odds of EtOH (aOR 1.67, 95% CI 1.44-1.95) and illicit drug testing (aOR 1.66, 95% CI 1.39-1.97) than Black/African American patients. Among those tested for illicit drugs, 67.9% had at least one non-prescription substance detected. Adolescent testing declined substantially over time.ConclusionsBiochemical toxicology testing remains inconsistent among firearm-injured adolescents, with persistent age- and race-based differences and declining testing. Standardized toxicology screening may improve identification of at-risk populations and facilitate linkage to evidence-based interventions following injury.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499835"},"PeriodicalIF":1.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative Management Strategies for Unresectable Pancreatic Adenocarcinoma: A Propensity-Weighted Cohort Study.","authors":"Lior Orbach, Guy Levenberg, Noa Gosher, Yonatan Lessing, Nir Lubezky, Guy Lahat","doi":"10.1177/00031348261499335","DOIUrl":"https://doi.org/10.1177/00031348261499335","url":null,"abstract":"<p><p>BackgroundWhen pancreatic adenocarcinoma is found unresectable during surgery, the decision to perform palliation must balance symptom relief against recovery and subsequent cancer treatment. We compared clinical outcomes after palliative procedures and nontherapeutic exploration.Patients and MethodsWe retrospectively studied 201 patients with intraoperatively unresectable pancreatic adenocarcinoma treated from 2006 to 2023. Operative findings and procedures were described, and postoperative outcomes, systemic-therapy receipt, and survival were compared using propensity-score overlap weighting.ResultsOf 201 patients, 54 underwent palliation and 147 underwent nontherapeutic exploration. Palliation more often accompanied locally advanced disease and vascular invasion. Observed major complications occurred in 18.5% vs 4.8%, ICU admission in 20.4% vs 3.4%, and 30-day mortality in 11.1% vs 3.4%. Adjusted estimates did not exclude clinically important differences; the ICU-admission odds ratio was 4.40 (95% CI, 0.997-19.43). Systemic-therapy receipt was 46.3% vs 46.9% (weighted odds ratio, 0.78; 95% CI, 0.35-1.71). The weighted survival hazard ratio was 1.43 (95% CI, 0.99-2.07).DiscussionPatients selected for palliation experienced more postoperative complications and ICU use, without clearly greater systemic-therapy receipt. Selection differences and uncertainty in adjusted estimates prevent causal conclusions. Operative decisions should prioritize the patient's symptoms, functional status, expected survival, anatomy, and available less-invasive alternatives.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348261499335"},"PeriodicalIF":1.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149190645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}