American Surgeon最新文献

{"title":"Total Prehospital Time and Tractor Injuries: A Nebraska State Trauma Registry Analysis.","authors":"Curtis Rich, Stevin Lu, Joel R Narveson, Alex G Hall, Adrian Flores, Eric Kuncir","doi":"10.1177/00031348241312126","DOIUrl":"10.1177/00031348241312126","url":null,"abstract":"<p><p>BackgroundAgriculture is a hazardous industry, with tractor-related incidents being among the leading causes of traumatic injury and death. These injuries tend to take place far away from hospitals, thus leading to increased prehospital time to receive care. Understanding the relationship between prehospital time and outcomes such as hospital length of stay and mortality in the state of Nebraska could inform resource allocation for tractor related injuries.Study DesignA 10-year retrospective study abstracting adults involved in tractor injuries using The Nebraska State Trauma Registry was performed. Mortality was evaluated using standard logistic regression, while length of stay outcomes were estimated using the negative binomial distribution. Adjusted model covariates included age, arrived from status, and Injury Severity Score.ResultsA total of 100 tractor-related injuries were included. Extremity injuries made up the largest percentage of injury types (44%). Injury severity scores were considered low in most patients. The majority of injuries were experienced by a party not operating the tractor. After adjusting for age, the scene of patient arrival, and Injury Severity Score, total prehospital time was not a significant predictor of facility length of stay or mortality.ConclusionAccess to care is an ongoing problem for many communities in the United States, with the Midwest having some of the largest regions with poor access to care. We did not find a significant relationship between prehospital time and outcomes related to length of stay or mortality. Future studies should assess for differences in outcomes among accident types such as roll-over accidents vs collisions.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"621-625"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930706","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":"Reconstruction of a Sternal Cleft and Ventral Hernia in an Adolescent with Pentalogy of Cantrell Utilizing Titanium Plates.","authors":"Allison B Frederick, Terence J Camilon, Evert A Eriksson, Minoo N Kavarana, Christian J Streck","doi":"10.1177/00031348251332686","DOIUrl":"https://doi.org/10.1177/00031348251332686","url":null,"abstract":"<p><p>Pentalogy of Cantrell (PC) is a rare congenital disorder that presents with several midline defects including the abdominal wall, sternum, diaphragm, pericardium, and heart. Surgical intervention for omphaloceles and cardiac defects typically occur in infancy, but the optimal surgical repair for thoracoabdominal wall defects varies by patient. We present a 15-year-old female with PC, who underwent previous omphalocele, diaphragm, and cardiac repair as an infant, with recurrent ventral and diaphragmatic defects as well as a large sternal cleft with ectopia cordis. This case demonstrates the feasibility of delayed definitive surgical repair of the abdominal wall, diaphragm, and sternum utilizing titanium plates, sternal wires, and myocutaneous advancement flaps. While several surgical approaches have been described for repair of sternal defects in infants and children with PC, large defects remain challenging to obtain rigid and lasting cardiac coverage without compressing the heart but still allowing for growth of the chest wall.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348251332686"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750709","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 Association Between Body Mass Index and 28-day Mortality in Patients With Sepsis: A Retrospective Cohort Study.","authors":"Xu Zhang, Weiwei Yuan, Tingting Li, Haiwang Sha, Zhiyan Hui","doi":"10.1177/00031348241304040","DOIUrl":"10.1177/00031348241304040","url":null,"abstract":"<p><p>BackgroundSepsis is a severe clinical syndrome with high morbidity and mortality in intensive care units (ICUs). Body Mass Index (BMI) shows a rising trend of obese patients being admitted to ICUs. The relationship between BMI and the clinical outcome of sepsis remains highly debated.MethodsThe data used in this study were sourced from the Intensive Care Information Center IV (MIMIC-IV) database. Baseline information extracted within 24 hours of ICU admission was categorized according to World Health Organization (WHO)'s BMI classifications. A multivariate Cox regression model and curve fitting assessed the independent correlation between BMI and the primary outcome.ResultsA total of 7836 patients were included in the study and categorized into five groups based on BMI. The overall 28-day mortality rate was 21.94% (1719/7836). Class I obesity (17.14%) and class II/III obesity (13.49%) individuals tended to be younger and male. Compared to patients with normal BMI (32.55%), those with low BMI (5.79%) had a 47% increased risk of 28-day mortality (HR 1.47, 95% CI 1.16-1.85, <i>P</i> = 0.0013), while class II/III obesity patients had a 17% lower 28-day mortality rate (HR 0.83, 95% CI 0.71-0.97, <i>P</i> = 0.0218). Curve fitting revealed a nonlinear relationship between BMI and 28-day mortality. The Kaplan-Meier survival analysis highlighted variations in survival rates across the five groups (<i>P</i> = 0.0123), with underweight patients exhibiting poorer survival outcomes.ConclusionIn sepsis patients, a low BMI is related to higher 28-day mortality compared to those with a normal BMI. Conversely, patients with a BMI≥35 kg/m² have significantly reduced mortality risks.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"494-504"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738130","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":"Diagnostic Value of Joint Detection of Serum TK1, TSGF, CA199, and CA724 for Gastric Cancer and Its Relationship With Clinicopathologic Features and Prognosis.","authors":"Aiwen Sun, Hui Chen, Xiaojuan Shi, Zhanmin Shang, Jishun Zhang","doi":"10.1177/00031348241307397","DOIUrl":"10.1177/00031348241307397","url":null,"abstract":"<p><p>ObjectiveTo assess the diagnostic value of joint detection of serum TK1, TSGF, CA199, and CA724 for gastric cancer and its relationship with clinicopathologic features and prognosis.MethodsThe 105 gastric cancer patients were enrolled. The diagnostic value of serum TK1, TSGF, CA199, and CA724 for gastric cancer and the relationship between these indicators and the clinicopathologic characteristics of gastric cancer patients were evaluated. During the follow-up period, recurrence, metastasis, and death were considered as poor prognosis. The relationships between serum TK1, TSGF, CA199, and CA724 levels and poor prognosis and factors affecting the poor prognosis of gastric cancer patients were analyzed.ResultsTK1, TSGF, CA199, and CA724 levels in the gastric cancer group were higher; serum TK1, TSGF, CA199, and CA724 levels were higher in gastric cancer patients with tumor diameters ≥3 cm, TNM stages III and IV, low/moderate degree of differentiation, infiltration depths of the muscular or plasma layer, and lymphatic metastases; AUC of combined TK1, TSGF, CA199, and CA724 (0.894) was higher than that of the four indicators alone; the percentage of gastric cancer patients with poor prognosis in patients with low serum TK1, TSGF, CA199, and CA724 levels was lower; serum TK1, TSGF, CA199, and CA724 levels were factors influencing poor prognosis of gastric cancer patients (all <i>P</i> < 0.05).ConclusionElevated serum levels of TK1, TSGF, CA199, and CA724 are associated with clinicopathologic features and poor prognosis of gastric cancer and may be used as serum biomarkers for prognostic evaluation of gastric cancer patients.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"570-578"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142816994","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":"Pathological Examination in Pilonidal Sinus Surgery: Evaluating Necessity and Cost-Effectiveness: A 10-Year Retrospective Analysis.","authors":"İlyas Kudaş, Fatih Başak, Yahya K Çalışkan, Aylin Acar, Hüsna Tosun","doi":"10.1177/00031348241300362","DOIUrl":"10.1177/00031348241300362","url":null,"abstract":"<p><p>BackgroundMalignancy in pilonidal sinus disease (PSD) is rare, with squamous cell carcinoma (SCC) being the most common type. This study aims to assess the incidence of malignancy in PSD and identify risk factors to guide more targeted pathological examination strategies.MethodsA retrospective analysis was conducted on 1505 patients who underwent surgical excision of PSD between January 1, 2014, and December 31, 2023. Patients with incomplete or missing histopathological data were excluded, and no imputation methods were used for missing data. All specimens underwent histopathological examination to detect malignancies.ResultsTwo cases (0.13%) of SCC were identified, both in males aged 50 and 58 years without a history of Crohn's disease, HIV, prior radiation, or other cancers. Significant risk factors for malignancy included age over 40 years (OR 3.2, 95% CI 1.1-9.5) and disease duration over 3 years (OR 2.8, 95% CI 1.0-7.6). Both cases were treated surgically and received adjuvant radiotherapy, with both patients being disease-free at the 2-year follow-up.ConclusionWhile malignancy in PSD is rare (0.13%), older age and prolonged disease duration are associated with increased risk. Selective pathological examination based on these risk factors could enhance cost-effectiveness by reducing unnecessary routine examinations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"477-481"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612377","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":"Disparities in Advanced Stage Colorectal Cancer Outcomes in Appalachia: A Comprehensive Review.","authors":"Chen Chia Wang, Trevor Farmer, Mary Garland-Kledzik, Deepa R Magge","doi":"10.1177/00031348241312124","DOIUrl":"10.1177/00031348241312124","url":null,"abstract":"<p><p>The Appalachian region consists of over 26 million Americans, of whom almost 2.5 million live in rural areas. Various social determinants of health including but not limited to rural living conditions and geographic isolation, food insecurity, and low income contribute to disparate health outcomes compared to the rest of the country. Obesity, hypertension, diabetes, stroke, and chronic heart diseases are all more prevalent in Appalachia. These comorbidities, combined with the aforementioned social vulnerabilities, place the Appalachian population at increased risk of higher cancer incidence and poorer outcomes. Lung, cervical, breast, penile, prostate, colorectal, and head and neck cancers are all shown to have higher rates and poorer outcomes within Appalachia relative to the country. Advanced staged colorectal cancer patients are a unique population that may be even further impacted by the social inequities in Appalachia, given the resource-intensive and multi-disciplinary approach required for effective treatment. Unfortunately, there is a dire lack of investigation into the incidence and outcomes of advanced stage colorectal cancer in Appalachian residents. This review summarizes the existing literature on disparate cancer outcomes in the Appalachian population, with a focus on advanced stage colorectal cancer. We also propose various approaches that could decrease malignancy rates and improve outcomes, such as dietary adjustments, screening tools, and public educational endeavors. We also acknowledge the role high-volume centers can play in working towards accessible care and the potential for collaborations between large institutions within Appalachian regions to spur the change that is greatly needed.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"633-638"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920600","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":"Clinical Value of Abnormal Prothrombin and Carbohydrate Antigen 125 in the Diagnosis of Patients With Gallbladder Cancer.","authors":"Yanguo Liu, Yanfang Wu, Shujie He","doi":"10.1177/00031348241312119","DOIUrl":"10.1177/00031348241312119","url":null,"abstract":"<p><p>ObjectiveThis study was aimed at ascertaining the application value of abnormal prothrombin (PIVKA-II) and carbohydrate antigen 125 (CA125) in gallbladder cancer (GBC) diagnosis.MethodsA total of 70 GBC patients, 70 patients with benign gallbladder diseases (gallbladder stones and gallbladder polyps), and 70 normal health examination people were selected as the malignant, benign, and normal groups, respectively. The differences in serum levels and positive rates of PIVKA-II and CA125 were compared. The correlation between serum PIVKA-II and CA125 levels and different clinicopathological characteristics (TNM stage and differentiation degree) of GBC patients was analyzed. The receiver operating characteristic curve was plotted to evaluate the diagnostic value of serum PIVKA-II and CA125 for GBC, and sensitivity, specificity, and Youden's index were calculated.ResultsSerum PIVKA-II and CA125 levels and positive rates of patients in the malignant group were higher vs those in the benign and normal groups. Gallbladder cancer patients at stages III-IV had higher serum PIVKA-II and CA125 levels than those at stages I-II, and poorly differentiated GBC patients had higher serum PIVKA-II and CA125 levels than moderately differentiated and well-differentiated GBC patients. The AUC of serum PIVKA-II and CA125 alone and in combination were 0.771, 0.789, and 0.866, respectively, and the AUC of the two combined was higher vs that of the two alone.ConclusionSerum PIVKA-II and CA125 levels in GBC patients are increased and have significant clinical application value in the diagnosis of GBC.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"608-613"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926241","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":"A Novel Microbe, Immunization Deaths, and Vaccination on Trial: BCG and the Lübeck Disaster of 1930.","authors":"Don K Nakayama","doi":"10.1177/00031348251313994","DOIUrl":"10.1177/00031348251313994","url":null,"abstract":"<p><p>Today's controversies of gain-of-function virological research and mRNA COVID vaccination policies had an antecedent nearly a century ago in an event often referred to as \"the Lübeck disaster.\" From April through September 1930, 77 newborn infants in Lübeck, Germany, died after receiving oral BCG immunizations tainted with active human <i>Mycobacterium tuberculosis</i>. The tragedy threatened to end BCG immunizations. BCG and its originators, the French scientists Albert Calmette and Camille Guérin, were exonerated from liability. An inquest uncovered careless laboratory practices that contaminated doses of the vaccine with a human pathogen. The calamity underscored the necessity for exacting standards when handling dangerous infective microbes. The physician and bacteriologist responsible for the immunization program in Lübeck were tried and convicted for negligence, a concrete example of the civic responsibility expected of scientists when an experimental venture inflicts harm on an unwitting public. The example of Lübeck stands as an object lesson on the necessity of an informed, measured approach to any novel treatment. Controversies continue whether BCG vaccination is the preferred public health strategy against tuberculosis. Calmette and Guérin's lasting scientific achievement is the creation of a microbe that over a century has kept its essential features of inciting a vigorous immunological reaction that was tolerated by its host and never regaining its pathogenicity. The features form the basis of modern cancer immunotherapy, where intravesical BCG is first-line therapy against non-muscle invasive bladder cancer.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"672-676"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142942892","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":"Socioeconomic and Racial Disparities in the Use of Robotic-Assisted Proctectomy in Rectal Cancer.","authors":"Sameh Hany Emile, Zoe Garoufalia, Rachel Gefen, Giovanna Dasilva, Steven D Wexner","doi":"10.1177/00031348241304013","DOIUrl":"10.1177/00031348241304013","url":null,"abstract":"<p><p>BackgroundRectal cancer surgery is technically demanding, especially in males. Robotic assistance may help overcome these challenges. This study aimed to identify factors associated with robotic-assisted proctectomy in rectal cancer.MethodsRetrospective case-control analysis of patients with clinical stage I-III rectal adenocarcinoma who underwent proctectomy from the National Cancer Database (2010-2019) was conducted. Univariable and multivariable binary logistic regression analyses were conducted to determine predictive factors of robotic-assisted proctectomy in rectal cancer.Results67 145 patients (60.9% male; mean age: 61.15 ± 12.49 years) were included. 44.7% had stage III disease and 66.2% received neoadjuvant radiation. The surgical approach was laparotomy (n = 29 725), laparoscopy (n = 21 657), and robotic-assisted proctectomy (n = 15 763). Independent predictors for the use of robotic-assisted proctectomy were age <50 years (OR: 1.06; <i>P</i> = .032), male sex (OR: 1.07, <i>P</i> < .001), Asian race (OR: 1.25; <i>P</i> < .001), private insurance (OR: 1.25; <i>P</i> < .001), rectal cancer treatment between 2015 and 2019 (OR: 3.52; <i>P</i> < .001), stage III disease (OR: 1.06; <i>P</i> = .048), neoadjuvant radiation (OR: 1.26; <i>P</i> < .001), and pull-through coloanal anastomosis (OR: 1.15; <i>P</i> < .001). Robotic-assisted surgery was less often used in Black (OR: .857, <i>P</i> < .001) and American Indian patients (OR: .62, <i>P</i> = .002) and those with a Charlson score = 3 (OR: .818, <i>P</i> = .002), living in rural areas (OR: .865, <i>P</i> = .033), who were uninsured (OR: .611, <i>P</i> < .001), and undergoing pelvic exenteration (OR: .461, <i>P</i> < .001).ConclusionsDemographic and insurance disparities of robotic-assisted proctectomy are Black and American Indian patients and those with higher Charlson comorbidity index scores and uninsured patients were less likely to undergo robotic-assisted proctectomy. While patients with advanced disease and/or received neoadjuvant radiation were more likely to undergo robotic-assisted proctectomy, robotic-assisted surgery was less often performed in pelvic exenteration.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"528-538"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765398","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":"Influence of Trauma Patients Aged ≥55 With PEC in Long Stay in the Hospital and Intensive Care Unit.","authors":"Zulmari Resto, Ilko Luque, Nicole López, Hector Mendez, Mariel Javier, Marcela Ramirez, Orlando Morejón, Mark McKenney","doi":"10.1177/00031348241304041","DOIUrl":"10.1177/00031348241304041","url":null,"abstract":"<p><p>BackgroundTrauma and pre-existing conditions (PECs) can independently impact patient hospital length of stay (H-LOS) or intensive care unit (ICU) ICU-LOS. Pre-existing conditions impact on LOS has rarely been studied in older trauma patients aged ≥55. Our purpose is to examine the relationship between PEC status and ICU-LOS and H-LOS in this population.MethodsThis is a 3-year retrospective study, for calendar years 2020 through 2022. Multiple linear regression was used for analysis. Confounding factors were controlled for. Statistical significance was defined as <i>P</i> < 0.05.ResultsThere were 5168 patients (54.9% female) reviewed. The age breakdown was 51.6% were 70-80 years old. The injury breakdown showed 49.1% mild injury. The mean H-LOS was 6.00 and mean ICU-LOS was 2.55. Having certain PECs increases H-LOS, including congestive heart failure (CHF) by 2.29 days (<i>P</i> < 0.001), chronic obstructive pulmonary disease (COPD) by 1.10 days (<i>P</i> < 0.001), and chronic renal failure (CRF) by 0.96 days (<i>P</i> = 0.02). Increases in ICU-LOS were associated with having certain PECs, specially CRF by 1.03 days (<i>P</i> < 0.001) and CHF by 1.47 days (<i>P</i> < 0.001).ConclusionOlder trauma patients aged ≥55 with certain PECs had an associated increase in ICU and hospital length of stay. Identifying PEC is essential for the care and management of any patient. Identification of PECs on injured patients is essential since this can prolong the LOS. Early involvement of specialists in patient care directed to each PEC may improve these outcomes.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"512-517"},"PeriodicalIF":1.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142754579","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}