Annals of surgery最新文献

{"title":"Neoadjuvant Chemotherapy with Gemcitabine and S-1 versus Upfront Surgery for Resectable Pancreatic Cancer: Results of the Randomized Phase II/III Prep-02/JSAP05 Trial.","authors":"Michiaki Unno,Fuyuhiko Motoi,Yutaka Matsuyama,Sohei Satoi,Hirochika Toyama,Ippei Matsumoto,Suefumi Aosasa,Hirofumi Shirakawa,Keita Wada,Tsutomu Fujii,Hideyuki Yoshitomi,Shinichiro Takahashi,Masayuki Sho,Hideki Ueno,Tomoo Kosuge","doi":"10.1097/sla.0000000000006730","DOIUrl":"https://doi.org/10.1097/sla.0000000000006730","url":null,"abstract":"OBJECTIVEThis randomized phase II/III study evaluated the superiority of neoadjuvant therapy with gemcitabine plus S-1 over upfront surgery for patients with resectable pancreatic ductal adenocarcinoma (PDAC).SUMMARY BACKGROUND DATAPancreatic ductal adenocarcinoma is a leading cause of cancer mortality that urgently requires better treatment.METHODSPatients with resectable PDAC (without arterial abutment) were randomly assigned to upfront surgery or neoadjuvant chemotherapy with gemcitabine (1000 mg/m2 days 1 and 8) and S-1 (40-60 mg orally twice daily, days 1-14 every 3 wk for 2 cycles). Phase II and III primary endpoints were resection rate and overall survival, respectively. UMIN Clinical Trials Registry number: UMIN000009634.RESULTSPatients (n=364) were enrolled and randomly allocated to upfront surgery (UPS; n=182) or neoadjuvant gemcitabine plus S-1 (NAC-GS; n=182). Patient demographics and tumor characteristics were balanced between groups. Median overall survival in the UPS and NAC-GS groups was 26.6 (95% confidence interval [CI] 21.5, 31.5) and 37.0 (95% CI 28.6, 43.3) months, respectively. The hazard ratio for mortality in the NAC-GS group compared with the UPS group was 0.73 (95% CI 0.56, 0.95; P=0.018). Median relapse-free survival in the UPS and NAC-GS groups was 11.3 (95% CI 9.41, 13.5) and 14.3 (95% CI 11.7, 17.0) months, respectively. The hazard ratio for relapse in the NAC-GS group compared with the UPS group was 0.77 (95% CI 0.61, 0.98; P=0.030).CONCLUSIONThe Prep-02/JSAP05 trial results showed that neoadjuvant chemotherapy with gemcitabine plus S-1 significantly extends survival compared with upfront surgery in patients with resectable PDAC.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"3 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841259","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":"Perspectives of Older Adults Undergoing Elective Major Surgery: A Qualitative Study of Patients Undergoing Colectomy.","authors":"Christy Cauley,Atziri Rubio-Chavez,Zara Cooper,Sevdenur Cizginer,Ana Maria Vranceanu,Christine S Ritchie","doi":"10.1097/sla.0000000000006734","DOIUrl":"https://doi.org/10.1097/sla.0000000000006734","url":null,"abstract":"OBJECTIVEUnderstand challenges faced by older adults who undergo elective major surgery.BACKGROUNDPreparation for and recovery from elective major surgery is often described from clinician perspectives, limiting insights into older patients' experiences.METHODSWe conducted a qualitative study with adults age 65+ years, 30-90 days post colectomy, using interviews and surveys at a Northeastern U.S. tertiary surgical clinic. Guided by a modified Framework method, we arranged data into domains, themes and subthemes. We categorized patient-identified challenges using the Geriatric 5 Ms framework as deductive themes. Then, we identified additional themes and subthemes inductively.RESULTSFrom November 2022 to August 2023, twenty patients completed the study. Themes of personal patient challenges included: the mind (i.e., coping with uncertainty, anxiety/frustration, and underappreciated cognitive challenges), mobility (i.e., physical limitations and challenges completing activities of daily living), medications (i.e., understanding medication frequency and side effects), multi-complexity (i.e., surgical recovery in the context of multi-morbidity), and what matters most (i.e., matters related to self, care-partners, and recovery expectations). Themes of process characteristics included challenges discussing the decision for surgery, understanding expectations for surgical recovery, and obtaining anticipatory guidance. Patients with fecal ostomy described heightened emotional challenges and social support needs.CONCLUSIONSModifiable challenges older adult patients perceive after elective major surgery often stemmed from perioperative anxiety, uncertainty, inadequate communication and insufficient social support. These findings can guide clinicians in optimizing surgical care and inform future research developing interventions aimed at addressing emotional stressors and enhancing communication between patients and surgical teams.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"108 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841073","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":"Preoperative Patient Education on Opioid Use and Pain after Surgery: A Randomized Trial.","authors":"Alparslan Turan,Tyler Karras,Sara Medellin,Amita Kharabe,Elyad Ekrami,Jiayi Wang,Esra Kutlu Yalcin,Karan Shah,Kenneth Cummings,Kurt Ruetzler,Daniel I Sessler,","doi":"10.1097/sla.0000000000006717","DOIUrl":"https://doi.org/10.1097/sla.0000000000006717","url":null,"abstract":"OBJECTIVETo evaluate the impact of preoperative analgesic education on postoperative opioid consumption, pain scores, and patient satisfaction with analgesia.BACKGROUNDEffective postoperative pain management is crucial for patient recovery and satisfaction, yet opioid use poses risks of tolerance and addiction. Preoperative patient education offers a potential avenue to mitigate opioid reliance and improve pain management outcomes.METHODSThis single-center randomized controlled trial was conducted at the Cleveland Clinic Main Campus between October 2021 and October 2023. Adult patients scheduled for hip arthroplasty or laparoscopic-assisted abdominal surgery with an ASA physical status of 1-4 were eligible. Patients with a history of prolonged opioid use, planned regional block or epidural analgesia, or limited English fluency were excluded. Participants were randomized 1:1 to receive either an analgesic educational video or a generic video about surgery and hospitalization. The primary outcome was opioid consumption during the initial 72 postoperative hours. Secondary outcomes included time-weighted average pain scores and patient satisfaction with analgesia.RESULTSAmong 957 analyzed patients, preoperative analgesic education did not significantly reduce opioid consumption (adjusted ratio of geometric means, 1.01; 95% CI, 0.86 to 1.18; P = 0.890) or improve pain scores (adjusted mean difference, -0.1; 95% CI, -0.3 to 0.2; P = 0.617). Patient satisfaction scores also did not differ significantly between groups (adjusted mean difference, -0.1; 95% CI, -0.3 to 0.2; P = 0.611).CONCLUSIONSPreoperative analgesic education did not result in clinically meaningful reductions in opioid consumption or improvements in pain management outcomes. Further research may explore more intensive educational interventions to optimize postoperative pain management strategies.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"34 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831684","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":"110,000 Preventable Deaths: The Most Impactful Gaps in Firearm Suicide Prevention Laws 2010-2019.","authors":"Aksel D Laudon,Jeffrey A Franks,Elizabeth S Davis,Xuewei Zhao,Kelly Kenzik,Crisanto M Torres,Sophia Smith,Lisa Allee,Dane R Scantling","doi":"10.1097/sla.0000000000006732","DOIUrl":"https://doi.org/10.1097/sla.0000000000006732","url":null,"abstract":"OBJECTIVEWe sought to identify which absent firearm laws would have prevented the most firearm suicides (FS) in each state of the US.SUMMARY BACKGROUND DATAPrior studies suggested efficacy for FS prevention varies greatly between different firearm laws. However, this body of work did not probe how this efficacy may differ by state.METHODSThis state-level, retrospective cohort study of firearm laws among the contiguous United States from 2010-2019 used Poisson models for the association between state FS per 100,000 population and implementation of state firearm laws lagged by 7 years, spatially weighted total firearm laws in surrounding states, and state demographics. These models were applied to each absent law in each state to estimate the reduction in FS associated with law implementation. The law associated with the greatest reduction in each state was the most impactful missing law.RESULTSEight of 12 law categories were significantly associated with decreased FS rates. The largest associated reductions in FS were with child access prevention, or CAP (IRR 0.53; 95% CI 0.48-0.59; P<0.001), and concealed carry permitting, or CCP (IRR 0.59; 95% CI 0.54-0.65; P<0.001). Five states had all law categories for the study duration, and CAP and CCP were the most impactful missing law categories in 22 (51%) and 9 (21%) of remaining states, respectively. A total of 114,106 FS were associated with all states not having implemented their most effective missing law category across the study period.CONCLUSIONSThis study found that FS rates in most states would have decreased most with passage of CAP or CCP, which can inform policymaking in respective states.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"66 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822619","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":"Toward Competency Based Medical Education: A Plea to Synergize Frameworks and Tools.","authors":"Brigitte K Smith,Holly Caretta-Weyer,Adnan Alseidi","doi":"10.1097/sla.0000000000006729","DOIUrl":"https://doi.org/10.1097/sla.0000000000006729","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"39 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822618","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":"Attitudes toward Sustainability among Surgeons at Ten Academic Hospitals in the United States: Are we Ready, Willing, and Incentivized to Change?","authors":"Tejas S Sathe,Jaeyun Jane Wang,Kaiyi Wang,Thomas A Sorrentino,Ava Yap,Amir Ashraf Ganjouei,Patricia O'Sullivan,Garrett R Roll,Seema Gandhi,Hanmin Lee,Adnan Alseidi,","doi":"10.1097/sla.0000000000006728","DOIUrl":"https://doi.org/10.1097/sla.0000000000006728","url":null,"abstract":"OBJECTIVEGiven the outsized contribution of surgical care to the carbon footprint of the health sector, we aim to understand attitudes towards sustainability among academic surgeons in the United States (U.S.).SUMMARY BACKGROUND DATAThe healthcare sector accounts for 8.5% of United States (U.S.) greenhouse gas emissions-of which one third come from surgical care. Though prior studies suggested that surgeons are aware of operating room waste and interested in improving sustainability, they were not nationally representative and did not ask about specific changes surgeons were willing to make or what incentives would promote such changes. In this study, we aim to ascertain a more granular understanding of surgeons' views on sustainability in a representative sample of U.S. academic surgeons.METHODSWe surveyed surgeons at ten academic surgery programs representing all U.S. geographic regions. The survey contained questions on general attitudes towards sustainability, willingness to make sustainable changes, and the degree to which certain incentives would motivate change. Surgeons rated questions on Likert scales, and we calculated the proportion of respondents who indicated strongly positive responses.RESULTSOverall, 247 out of 523 surgeons (47%) responded to the survey. Similar majorities of respondents felt that the problem of operating room waste was critical (n=155, 63%) and were motivated to improve the sustainability of their practices (n=160, 65%). Five respondents (2%) felt their institution put effort into sustainability education. Most respondents (n=243, 98%) were willing to make at least one of the sustainable practice changes in our survey, with the greatest number willing to reduce items on their preference cards following periodic review (n=227, 92%). Respondents were more motivated by personal cash incentives than non-cash or departmental incentives. Using factor analysis, we derived five factors from survey responses: (1) general attitudes, (2) education, (3) willingness, (4) responsiveness to personal cash incentives, and (5) responsiveness to other incentives.CONCLUSIONSSurgeons understand that operating room waste is a problem and most say they are willing to make individual changes to improve operating room sustainability. However, a majority would be motivated to improve sustainability by personal cash incentives which are rarely implemented. Additional work will be needed to operationalize surgeons' positive views on sustainability into practice changes that meaningfully impact climate change.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"75 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822620","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":"Randomized Controlled Trial - Perioperative Telemonitoring of Patient Generated Health Data in Gastrointestinal Oncologic (GI) Surgery: Assessing Outcomes.","authors":"Kelly M Mahuron,Patricia Esslin,Virginia Sun,Oluwatimilehin Okunowo,Darrell Fan,Andreas M Kaiser,I Benjamin Paz,Mustafa Raoof,Aaron Lewis,Kurt A Melstrom,Lily I Lai,Yanghee Woo,Gagandeep Singh,Yuman Fong,Laleh G Melstrom","doi":"10.1097/sla.0000000000006724","DOIUrl":"https://doi.org/10.1097/sla.0000000000006724","url":null,"abstract":"OBJECTIVETo determine whether perioperative monitoring with nursing triage intervention is feasible and improves surgical outcomes and recovery.BACKGROUNDThere are increased demands for outpatient recovery after complex gastrointestinal oncologic surgery with simultaneous expectations of improving quality of life and expedited functional recovery. Telemonitoring is a proposed mechanism to achieve these goals.METHODSThis prospective randomized controlled trial was conducted at a single institution from October 2021 to July 2023, and follow-up was completed in August 2023. Adult patients undergoing gastrointestinal oncologic surgery were randomized to either the telemonitoring intervention arm or the enhanced usual care control arm. Patient-generated health data (PGHD) and electronic patient-reported outcomes (ePROs) were assessed at discharge, 2 days, 7 days, 14 days, and 30 days post-discharge. The telemonitoring intervention arm additionally received nursing triage support when PGHD deviated from defined thresholds.RESULTS129 participants (median [IQR] age, 53 [47-65]; 43% female) were randomized. 50 (39%) lived >50 miles from the medical center. Overall attrition was 12%, and there were no differences in feasibility, retention, or acceptability between arms. Postoperative complications and readmission rates were similar between arms. The intervention arm reported significantly lower MD Anderson Symptom Inventory (MDASI) interference with activity and symptom severity scores at multiple time points compared to the control arm (P<0.05).CONCLUSIONSThis trial demonstrates that perioperative telemonitoring is feasible and acceptable. Improved ePROs in the intervention arm suggests that nursing triage intervention may help augment postoperative recovery.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"25 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822622","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":"Associations of Patient Age, Tumor Nephrectomy Weight, and Tumor Diameter with Event-Free and Overall Survival in Stage I or II Favorable Histology Wilms Tumor: A Pooled Analysis of Children's Oncology Group Studies AREN0532 and AREN03B2.","authors":"Lindsay A Renfro,Kelly L Vallance,Ian C Tfirn,Nicholas Evageliou,Daniel J Benedetti,Robert C Shamberger,Peter F Ehrlich,Nicholas G Cost,Jennifer H Aldrink,Ann Schechter,Amy Treece,Lauren N Parsons,Amy L Walz,Kathryn S Sutton,Amy E Armstrong,Conrad V Fernandez,Jeffrey S Dome,James I Geller,Elizabeth A Mullen,","doi":"10.1097/sla.0000000000006726","DOIUrl":"https://doi.org/10.1097/sla.0000000000006726","url":null,"abstract":"OBJECTIVETo evaluate age, TNW, or tumor diameter (TD) as continuous prognostic variables for outcomes in early stage FHWT after accounting for biology and treatment.SUMMARY OF BACKGROUND DATAPatient age (< 2 vs. ≥ 2 years) and tumor nephrectomy weight (TNW; < 550g vs. ≥ 550 grams) have been used to risk stratify children with stage I favorable histology Wilms tumor (FHWT) on Children's Oncology Group (COG) studies and select patients for omission of chemotherapy.METHODSIncluded patients had stage I or II FHWT per central review and were treated with nephrectomy only, EE4A, or DD4A on COG trials. Restricted cubic splines models were used to estimate the stage-specific effects of age, TNW, and TD on event-free survival (EFS) and overall survival (OS), accounting for treatment and biology.RESULTSIn pooled analyses of 775 stage I and 936 stage II patients, age was not significantly associated with EFS or OS for stage I or II patients after accounting for adverse biology that is more prevalent with older age. Greater TNW and larger TD were associated with increased risk of relapse in stage I and increased risk of death in stage II, but not when restricted to patients less than 4 years old.CONCLUSIONSAge, TNW, and TD are each prognostic for EFS or OS in some cohorts of patients with stage I or II FHWT. However, after accounting for adverse biology that becomes more prevalent at older ages, these factors are no longer independently prognostic. The next COG FHWT study will implement and validate these findings.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"10 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822624","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":"Automatic Generation of Liver Virtual Models with Artificial Intelligence: Application to Liver Resection Complexity Prediction.","authors":"Omar Ali,Alexandre Bône,Caterina Accardo,Belkacem Acidi,Amaury Facque,Paul Valleur,Chady Salloum,Marc-Michel Rohe,Irene Vignon-Clementel,Eric Vibert,","doi":"10.1097/sla.0000000000006722","DOIUrl":"https://doi.org/10.1097/sla.0000000000006722","url":null,"abstract":"OBJECTIVEThe clinical aim of this work is to predict intraoperative LRC from preoperative CT scans only.SUMMARY OF BACKGROUND DATALiver resection (LR) is the most prevalent curative treatment for primary liver cancer, yet overall mortality/morbidity rates remain elevated. The conventional definition and classification of LR complexity (LRC) lack inclusion of the disease-induced 3D anatomical surgery complexity.METHODS3D models of the organ, tumors and blood vessels were generated from Deep Learning models trained on patients CT scans. The surgeons' expertise on which anatomical factors lead to LRC was translated into a new anatomical frame of reference around the Hepatic Central Zone (HCZ). A fully automatic pipeline to generate the HCZ and quantify the tumors position relative to it was assessed. An AI model was then trained to predict LRC from a patient cohort for whom LRC was annotated at the end of each surgery. The AI-prediction was finally compared to prediction of surgeons that only saw the patient preoperative CT scan.RESULTSThe 3D reconstructions are successfully evaluated on benchmark datasets. The HCZ is accurately generated for a variety of atypical vascular anatomies (dice score 82±4.6%). The automatic pipeline is successfully run on a 145 HCC patient cohort. The predicted LRC outperforms the surgeons' individual and combined anticipated complexities (accuracy and AUC scores: 79.4±3.4% and 85.1±3.2% respectively).CONCLUSIONThis automatic digital tool accurately predicts intraoperative LRC and paves the way for an innovative oncology surgery planning. This tool could help orient patients towards appropriate medical centers depending on the predicted LRC level.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"249 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822625","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":"An Alternative to \"Checkmark Credentialling\" for Effective Physician Benchmarking and Professional Improvement.","authors":"Thoralf M Sundt, John B Herman, Michael Jellinek","doi":"10.1097/SLA.0000000000006725","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006725","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810039","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}