Annals of surgery最新文献

{"title":"Implementation of Comprehensive Surgical Guidelines for Hepatoblastoma: Analysis of the Children's Oncology Group AHEP0731 Phase III Trial.","authors":"Zachary J Kastenberg,Sanjeev A Vasudevan,Lucy Dolmadjian,Max R Langham,Jin Piao,Gregory M Tiao,Stephen P Dunn,Eugene D McGahren,Alexander J Towbin,M Beth McCarville,Marcio H Malogolowkin,Wayne L Furman,Patrick A Thompson,Milton J Finegold,Sarangarajan Ranganathan,Dolores Lopez-Terrada,Mark Krailo,Carlos Rodriguez-Galindo,Allison F O'Neill,Howard M Katzenstein,Christopher B Weldon,Rebecka L Meyers","doi":"10.1097/sla.0000000000006951","DOIUrl":"https://doi.org/10.1097/sla.0000000000006951","url":null,"abstract":"OBJECTIVETo evaluate the impact of surgical guidelines on the management of children with hepatoblastoma.BACKGROUNDThe Children's Oncology Group study AHEP0731 was the first pediatric cooperative group trial to propose guidelines for the surgical management of children with hepatoblastoma.METHODSAHEP0731 enrolled children with hepatoblastoma between 2009 and 2018. Surgical guidelines were based upon radiographic extent of disease (PRETEXT, POST-TEXT). Planned non-real-time central review of imaging was completed at diagnosis and after two, four, and six cycles of chemotherapy to determine guideline adherence. Resection rate, event-free survival (EFS), overall survival (OS), and complications were compared between guideline adherent and nonadherent groups.RESULTSOf 226 enrolled patients, 221 were evaluable of whom 205 (93%) underwent definitive surgical resection. Guideline adherence for protocol recommended timing of resection was 65% (133/205). The nonadherent group included 44/205 (21%) patients who underwent early resection and 28/205 (14%) patients who underwent late resection or late transplantation. Eighty-five patients met criteria for early referral to a liver transplant center, of whom 55 (65%) were referred within the recommended timeframe. Twelve patients received liver transplants outside of surgical guidelines. There were no significant differences in EFS, OS, or complication rates between adherent and nonadherent groups.CONCLUSIONSImplementation of surgical guidelines, in combination with effective chemotherapy and radiologic staging, produced a higher rate of definitive tumor resection compared to historical trials. Nonadherence with surgical guidelines resulted in liver transplantation in some patients for whom partial hepatectomy might have been an option.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"41 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operating or Building Capacity? Rethinking International Surgical Missions.","authors":"Javier Arredondo Montero","doi":"10.1097/sla.0000000000006956","DOIUrl":"https://doi.org/10.1097/sla.0000000000006956","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"25 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection: An International Multicentre Cohort Study.","authors":"Peter L Labib,Siobhan C McKay,Stéphanie F Perrodin,Louisa Bolm,Omar A Mownah,Ruben Bellotti,Jane McClements,Asma Sultana,James Ra Skipworth,Anita Balakrishnan,Manuel Durán,Dimitrios Moris,James A Milburn,Gökalp K Kurtoğlu,Nicola De'Liguori Carino,Ismael Domínguez-Rosado,Sanjay Pandanaboyana,Jacob Ghotbi,Giovanni Marchegiani,Tejinderjit S Athwal,Stefan Stättner,Dimitrios D Karavias,Bilal Al-Sarireh,Paul D Morris,Saxon Connor,Asif Halimi,Carl-Stephan Leonhardt,Russell Hodgson,Jaswinder S Samra,Anubhav Mittal,Oliver M Fisher,Christopher Sh Lim,Simon W Banting,Jonathan Koea,Osamu Yoshino,Michael A Silva,Ricky H Bhogal,Daniel Croagh,David J Cavallucci,Benjamin Pt Loveday,Declan Fj Dunne,Somaiah Aroori,Brian R Davidson,Keith J Roberts, ","doi":"10.1097/sla.0000000000006954","DOIUrl":"https://doi.org/10.1097/sla.0000000000006954","url":null,"abstract":"OBJECTIVEAssess anticoagulation practice and portal vein thrombosis (PVT) risk following pancreaticoduodenectomy (PD) or total pancreatectomy (TP) with venous resection (VR).BACKGROUNDRetrospective studies suggest an increased risk of PVT following PD/TP with VR. However, anticoagulation practice is variable and its efficacy at preventing PVT is unknown.METHODSThis multicentre cohort study (Europe, USA, Mexico, Turkey, Australia, New Zealand) included consecutive patients undergoing PD/TP with VR between 2018-2022. A 1:1 age and sex matched cohort undergoing PD/TP without VR was also collected to assess PVT risk without VR.RESULTSAmong 972 patients who underwent PD/TP with VR, 259 (26.6%) received inpatient therapeutic anticoagulation and 242 (25.0%) were discharged on therapeutic anticoagulation. Thirty-day, 90-day and one-year PVT risk following VR was 5.1%, 7.3%, and 11.6%, versus 1.0%, 1.3% and 2.6% in patients without VR (P<0.001). Predictors of 90-day PVT included prior history of venous thromboembolism (odds ratio [OR] 2.67), VR type (OR 2.29, 6.28, 6.90 and 23.75 for type 1-4 VR, P<0.001) and graft material (OR 0.78, 0.94, 5.28, 4.90 and 5.99 for peritoneal, autologous vein, cadaveric vein, bovine and synthetic grafts, P<0.001). Postoperative therapeutic anticoagulation reduced 30-day PVT risk (OR 0.06, P<0.001), but not 90-day (OR 0.06, P=0.075) or >90-day PVT risk (OR 1.23, P=0.466). The strongest predictor of >90-day PVT was cancer recurrence (OR 3.96, P<0.001).CONCLUSIONSVR increases PVT risk following PD/TP, with technical factors influencing <90-day PVT and cancer-related factors influencing >90-day PVT. The benefits of early postoperative anticoagulation in preventing PVT post-VR remain unclear.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"81 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How She was Born.","authors":"Caitlin J Cain-Trivette","doi":"10.1097/SLA.0000000000006955","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006955","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segment 4b/5 versus Wedge Resection for Gallbladder Adenocarcinoma: A Randomized Controlled Trial.","authors":"Shivendra Singh,Abhishek Aggarwal,Shaifali Goel,Syed Asif Iqbal,Vineet Talwar","doi":"10.1097/sla.0000000000006952","DOIUrl":"https://doi.org/10.1097/sla.0000000000006952","url":null,"abstract":"BACKGROUND AND OBJECTIVESThe two techniques for liver resection during radical cholecystectomy for gall bladder cancer (GBC) are: non anatomical wedge resection (wedge) and anatomical segment 4b+ 5 resection (4b/5). There is a lack of prospective studies and randomized controlled trials (RCT) comparing these two techniques . So we conducted this RCT to compare these two techniques with respect to surgical and oncological outcomes.PATIENTS AND METHODSIt was a single-centre, phase 3, balanced allocation (1:1) and open-label RCT. Patients undergoing surgery for GBC were randomised intraoperatively to wedge or segment4b/5 resection after ruling out metastatic or unresectable disease.RESULTSA total of 163 patients were included in final analysis( 4b/5=83, wedge=80). Both the groups were similar in baseline characteristics. Segment4b/5 group had significantly longer duration of surgery ( 318 versus 287 min, P=0.009) and higher blood loss (265 ml versus 223 ml, P=0.05). But there was no difference in morbidity ,mortality and R0 resection rates. At a median follow up of 27 months mean DFS for segment4b/5 and wedge group was 41.8 months and 44.7 months respectively (HR: 0.8, 95% CI : 0.47-1.4, P=0.50). Mean OS for segment 4b/5 and wedge group was 45.3 months and 50.7 months respectively ( HR:0.6, 95% CI :0.36-1.14, P=0.12).CONCLUSIONAnatomical segment 4b/5 resection and wedge resection had similar morbidity, mortality, DFS and OS. So type of liver resection in radical cholecystectomy did not have any impact on long term oncological outcomes.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"57 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel TRG-N Prognostic Classification System for Esophageal Cancer Undergoing Neoadjuvant Therapy Followed by Esophagectomy: A Study Based on the Netherlands Cancer Registry.","authors":"Jingpu Wang,Zhouqiao Wu,Rob H A Verhoeven,Lucas Goense,Nadia Haj Mohammad,Stella Mook,Peter S N van Rossum,Marije Slingerland,Jan Erik Freund,Jelle P Ruurda,Richard van Hillegersberg","doi":"10.1097/sla.0000000000006869","DOIUrl":"https://doi.org/10.1097/sla.0000000000006869","url":null,"abstract":"OBJECTIVETo develop a new prognostic classification system centered on tumor regression grade (TRG) and ypN stage that can effectively stratify overall survival (OS) of esophageal cancer patients undergoing neoadjuvant therapy (NAT) followed by R0 esophagectomy.SUMMARY BACKGROUND DATAAlthough the prognostic value of combining TRG and ypN stage has been demonstrated, a prognostic classification system integrating these factors, trained using large-scale data, remains unavailable.METHODSData from the Netherlands Cancer Registry (2015-2022) were analyzed. A new TRG-N prognostic classification system for OS was developed by grouping patients based on cN stage, ypN stage, and TRG. The prognostic performance of the TRG-N classification was compared with the 8th edition AJCC ypTNM classification using 4 comparative metrics (Log-rank χ², Linear trend χ², Akaike's Information Criterion [AIC], and C-index).RESULTSA total of 3,193 patients were included. Among patients with adenocarcinoma, the TRG-N classification showed superior Linear trend χ² and AIC to the ypTNM classification. However, the Log-rank χ² of the TRG-N classification was inferior to that of the ypTNM classification, with no significant difference in the C-index (P-value=0.206) between the two systems. Among patients with squamous cell carcinoma, the TRG-N classification significantly outperformed the ypTNM classification in Log-rank χ², Linear trend χ², AIC, and C-index (P-value=0.018).CONCLUSIONThe TRG-N classification demonstrated comparable prognostic performance to the AJCC ypTNM classification for esophageal adenocarcinoma but showed superior prognostic value for esophageal squamous cell carcinoma, making it a potentially more effective tool for risk stratification in esophageal cancer patients.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"9 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145116687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to Multidisciplinary Tumor Board Decisions Determines Long-term Survival in Patients with Hepatocellular Carcinoma.","authors":"Robert Oehring,Fabian Jänick,Sharlyn S T Ng,Philipp Haber,Nils Haep,Can Kamali,Dominik Geisel,Uwe Pelzer,Dominik Modest,Matthäus Felsenstein,Wenzel Schöning,Raphael Mohr,Johann Pratschke,Ulrich Keilholz,Felix Krenzien","doi":"10.1097/sla.0000000000006946","DOIUrl":"https://doi.org/10.1097/sla.0000000000006946","url":null,"abstract":"OBJECTIVEThis study evaluated the impact of adherence to hepatobiliary multidisciplinary tumorboard (MDT) recommendations on patient outcomes, summarizing reasons for non-adherence and estimating its effect on survival.SUMMARY OF BACKGROUND DATAMDTs are essential in cancer care and recommended prior to therapy initiation. However, data on adherence to MDT recommendations remain limited.METHODSThis retrospective single-center study analyzed hepatocellular carcinoma (HCC) cases presented at the hepatobiliary MDT at Charité - Universitätsmedizin Berlin between 2014 and 2018. Data were obtained from chart reviews and the clinical cancer registry. Adherence to MDT recommendations was classified as major, minor or non-adherent.RESULTS2,104 conference cases from 879 patients with HCC were assessed. Treatment adherence was noted in 82.7% of presented cases. Overall patient-based adherence was 90.2%, with 72.2% major and 18.0% minor adherence. Median Overall survival (mOS) was significantly longer when MDT recommendations were followed (adherent: mOS 4.7 years, 95% CI: 4.5-5.9; minor adherence: 3.1 years, 95% CI: 2.15-NA; non-adherence: 1.5 years, 95% CI: 0.8-3.1; P<0.001). Reasons for MDT deviations were mainly comorbidities (29.5%), tumor progression (24%), patient preference (13.1%) or individual physician decisions (9.3%). Within the non-adherence group, both patient preferences (mOS: NA; 95% CI: 6.79-NA) and physician decisions (mOS: 4.30 y; 95% CI: 1.37-NA) were associated with comparatively longer mOS.CONCLUSIONSAdherence to MDT recommendations is associated with improved long-term survival for HCC patients. Notably, beyond tumor-related factors, patient preferences and physician decisions contributed to longer mOS and should be highly respected in selected cases.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"39 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145103449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Rise of Robot-Assisted Surgery in the Netherlands: An Overview of its Adoption over the Last Decade.","authors":"Maurits R Visser,Femke J Amelung,J P Maarten Burbach,Tessa E Hendriks,Robin den Boer,Frank J Voskens,Michelle R de Graaff,Nienke Wolfhagen,Jan Willem T Dekker,George P van der Schelling,Esther C J Consten,Quintus I Molenaar,Bas Groot Koerkamp,Robert Luger,Koen J Hartemink,Ad F T M Verhagen,Mike S L Liem,Rutger-Jan Swijnenburg,Jeroen Hagendoorn,Suzanne S Gisbertz,Mark I van Berge Henegouwen,Marc G Besselink,Richard van Hillegersberg,Jelle P Ruurda, ","doi":"10.1097/sla.0000000000006944","DOIUrl":"https://doi.org/10.1097/sla.0000000000006944","url":null,"abstract":"To assess nationwide trends in the use of robot-assisted surgery (RAS) for high-complex, low-volume resections in the Netherlands. RAS is growing globally, offering substantial value in high-complex, low-volume gastrointestinal and thoracic surgery. However, nationwide data on its adoption are lacking. The Netherlands maintains mandatory clinical audits for major oncologic surgeries, offering a unique opportunity to evaluate RAS adoption. All patients undergoing pancreatic, colorectal, liver, thoracic, and esophagogastric cancer surgery registered in national audits in the Netherlands were included (audit start-2023). Primary endpoint was annual RAS rate. Secondary endpoints included number of centers performing RAS and trends in patient, tumor and treatment characteristics of RAS patients. In total, 77,361 resections were included: 10,336 pancreatic, 29,821 thoracic, 30,256 colorectal, 4,762 liver and 2,186 esophagogastric. Nationwide RAS use increased from 1% to 33% in pancreatic (2014-2023), 3% to 11% in thoracic (2016-2023), 6% to 14% in colon, 19% to 45% in rectal (2018-2023), 10% to 25% in liver (2020-2023), and 33% to 40% in esophageal, and remained 19% in gastric surgery (2022-2023). By 2023, RAS was used in 20% of all procedures, with 15/16 (94%) pancreatic centers performing RAS, compared to 12/42 (29%) in thoracic surgery. RAS was adopted mostly in left pancreatectomy (50%), total mesorectal excisions (48%) and mediastinal tumor resections (46%). RAS expanded across multiple patient and tumor types within all disciplines. This study confirms a steep nationwide rise in RAS use for rectal, pancreatic, esophageal, liver, gastric, colon and thoracic surgery, with greater adoption in certain procedures and overseen by national audits.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"6 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing Privatization of Veteran Health Care: Buyer Beware.","authors":"Lauren J Taylor,Nader N Massarweh","doi":"10.1097/sla.0000000000006943","DOIUrl":"https://doi.org/10.1097/sla.0000000000006943","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"78 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145072013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two-Week Course versus Conventionally Fractionated Preoperative Chemoradiotherapy Followed by Total Mesorectal Excision in Locally Advanced Rectal Cancer (Twoarc Trial): A Phase III Randomized Clinical Trial.","authors":"Kyu Hye Choi,Sung Hwan Kim,Hong Seok Jang,Jong Hoon Lee,Mina Yu,Bae Kwon Jeong,Bong Hyeon Kye,Hyung Jin Kim,Yoon Suk Lee,In Kyu Lee,Hyeon Min Cho,Changhyeok An","doi":"10.1097/sla.0000000000006942","DOIUrl":"https://doi.org/10.1097/sla.0000000000006942","url":null,"abstract":"OBJECTIVEThis phase III randomized trial compared two-week course of preoperative chemoradiotherapy (CRT) with conventional long-course CRT followed by total mesorectal excision (TME) in rectal cancer.BACKGROUNDTwo-week schedule of hypofractionated radiotherapy with concurrent capecitabine showed favorable tumor response and safety in a previous phase II study.METHODSThis study enrolled 338 rectal cancer patients with cT3-4N0-2M0 to receive either standard long-course preoperative radiotherapy (50.4 Gy in 28 fractions over 5-6 wk) or two-week course of radiation (33 Gy in 10 fractions over two weeks) with concurrent intravenous 5-fluorouracil or oral capecitabine. The primary endpoint was downstaging (ypT0-2N0M0) rate. TME was performed 6-10 weeks after the completion of radiotherapy.RESULTSOf 338 patients, 167 received standard long-course CRT and 171 received two-week course of CRT. ypCR was achieved in 26 (15.6%) patients of the standard-course arm and in 25 (14.6%) patients of the two-week-course arm (P=0.807). Downstaging was achieved in 67 (40.1%) patients of the standard-course arm and in 62 (36.3%) patients of the two-week-course arm (P=0.465). Sphincter preservation (91.0% vs. 95.3%, P=0.116) and positive circumferential resection margin (9.0% vs. 14.6%, P=0.109) rates were not significantly different between the two arms. The two-week arm demonstrated significantly lower incidence of grade 2 or higher gastrointestinal toxicity than the standard arm (5.8% vs. 13.2%, P=0.021).CONCLUSIONSThis phase III randomized controlled trial suggests that two-week course of preoperative CRT provides comparable tumor response as standard long-course CRT in rectal cancer, with potential advantages of shorter treatment duration and lower gastrointestinal toxicity.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"66 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}