Annals of surgery最新文献

{"title":"Improvement of the Natural Progression of Extremity Lymphedema Treated With Lymphatic Microsurgery.","authors":"Marco Pappalardo,Chia-Yu Lin,Chieh Lin,Kevin Chung,Ming-Huei Cheng","doi":"10.1097/sla.0000000000006860","DOIUrl":"https://doi.org/10.1097/sla.0000000000006860","url":null,"abstract":"OBJECTIVETo assess the effect of complete decongestive therapy (CDT) and lymphedema microsurgery (LM) on the natural progression of extremity lymphedema.SUMMARY BACKGROUND DATAThe natural progression of extremity lymphedema includes interstitial lymph accumulation, frequent cellulitis, adipose deposition, and fibrosis, which remain unexplored.METHODSProspectively collected data of patients with extremity lymphedema managed with either CDT (61 patients) or LM (118 patients) with a follow-up of 2 years between November 2011 and September 2019 were analyzed. The primary outcomes included Taiwan lymphoscintigraphy staging (TLS) to assess lymphatic drainage; episodes of cellulitis for infection; limb circumferential and volumetric differences for adipogenesis; and tissue softness for fibrosis. The secondary outcome was a lymphedema-specific quality-of-life (LymQoL) questionnaire.RESULTSAt 1-year follow-up, the LM group demonstrated significant improvements in mean TLS (3.77±1.48 vs. 2.67±1.33, P<0.0001), and volumetric difference (43.2±25.8% vs. 31.7%±21.7%, P=0.00025). Moreover, at 2-year follow-up, the LM group exhibited a significant reduction of episodes of cellulitis (2.39±2.05 vs. 0.77±1.04, P<0.0001), circumferential difference (23.4±11.3% vs. 14.3±11.0%, P<0.0001), and tissue-softness grade (2.41±1.15 vs. 1.42±0.633, P<0.0001). Improvements were observed across all five LymQoL domains at 1 and 2 years in patients with LM (all P<0.0001). No significant improvements in the primary or secondary outcomes were noted in the CDT group.CONCLUSIONSThe LM group had significantly increased lymphatic drainage, decreased episodes of cellulitis and adipogenesis, reduced fibrosis, and improved quality of life compared to the CDT group.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"721 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756146","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 Association of Preoperative Opioid Use with Postdischarge Outcomes: A Cohort Study of the Michigan Surgical Quality Collaborative.","authors":"Stephan G Frangakis, Bethany Kavalakatt, Vidhya Gunaseelan, Yenling Lai, Jennifer Waljee, Michael Englesbe, Chad M Brummett, Mark C Bicket","doi":"10.1097/SLA.0000000000006265","DOIUrl":"10.1097/SLA.0000000000006265","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association of prescription opioid fills over the year before surgery with postoperative outcomes.</p><p><strong>Background: </strong>Nearly one-third of patients report opioid use in the year preceding surgery, yet an understanding of how opioid exposure influences patient-reported outcomes after surgery remains incomplete. Therefore, this study was designed to test the hypothesis that preoperative opioid exposure may impede recovery in the postoperative period.</p><p><strong>Methods: </strong>This retrospective cohort study used a statewide clinical registry from 70 hospitals linked to opioid fulfillment data from the state's prescription drug monitoring program to categorize patients' preoperative opioid exposure as none (naïve), minimal, intermittent, or chronic. Outcomes were patient-reported pain intensity (primary), as well as 30-day clinical and patient-reported outcomes (secondary).</p><p><strong>Results: </strong>Compared with opioid-naïve patients, opioid exposure was associated with higher reported pain scores at 30 days after surgery. Predicted probabilities were higher among the opioid exposed versus naive group for reporting moderate pain [43.5% (95% CI: 42.6%-44.4%) vs 39.3% (95% CI: 38.5%-40.1%)] and severe pain [13.% (95% CI: 12.5%-14.0%) vs 10.0% (95% CI: 9.5%-10.5%)], and increasing probability was associated increased opioid exposure for both outcomes. Clinical outcomes (incidence of emergency department visits, readmissions, and reoperation within 30 days) and patient-reported outcomes (reported satisfaction, regret, and quality of life) were also worse with increasing preoperative opioid exposure for most outcomes.</p><p><strong>Conclusions: </strong>This study is the first to examine the effect of presurgical opioid exposure on both clinical and nonclinical outcomes in a broad cohort of patients and shows that exposure is associated with worse postsurgical outcomes. A key question to be addressed is whether and to what extent opioid tapering before surgery mitigates these risks after surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"234-241"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140118614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Making Choices: A Multi-institutional, Longitudinal Cohort Study Assessing Changes in Treatment Outcome Valuation for Low-risk Thyroid Cancer.","authors":"Alexis G Antunez, Brandy R Sinco, Megan C Saucke, Kyle J Bushaw, Catherine B Jensen, Sophie Dream, Abbey L Fingeret, Masha J Livhits, Aarti Mathur, Alexandria McDow, Sanziana A Roman, Corrine I Voils, Justin Sydnor, Susan C Pitt","doi":"10.1097/SLA.0000000000006347","DOIUrl":"10.1097/SLA.0000000000006347","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the relative importance of treatment outcomes to patients with low-risk thyroid cancer (TC).</p><p><strong>Background: </strong>Overuse of total thyroidectomy (TT) for low-risk TC is common. Emotions from a cancer diagnosis may lead patients to choose TT, resulting in outcomes that do not align with their preferences.</p><p><strong>Methods: </strong>Adults with clinically low-risk TC enrolled in a prospective, multi-institutional, longitudinal cohort study from November 2019 to June 2021. Participants rated treatment outcomes at the time of their surgical decision and again 9 months later by allocating 100 points among 10 outcomes. t tests and Hotelling T 2 statistic compared outcome valuation within and between subjects based on chosen extent of surgery (TT vs lobectomy).</p><p><strong>Results: </strong>Of 177 eligible patients, 125 participated (70.6% response) and 114 completed the 9-month follow-up (91.2% retention). At the time of the treatment decision, patients choosing TT valued the risk of recurrence more than those choosing lobectomy and the need to take thyroid hormone less ( P <0.05). At repeat valuation, all patients assigned fewer points to cancer being removed and the impact of treatment on their voice and more points to energy levels ( P <0.05). The importance of the risk of recurrence increased for those who chose lobectomy and decreased for those choosing TT ( P <0.05).</p><p><strong>Conclusions: </strong>The relative importance of treatment outcomes changes for patients with low-risk TC once the outcome has been experienced to favor quality of life over emotion-related outcomes. Surgeons can use this information to discuss the potential for asthenia or changes in energy levels associated with total thyroidectomy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"275-282"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telesurgery: A Systematic Literature Review and Future Directions.","authors":"Sumeet Kumar Reddy, Shady Saikali, Ahmed Gamal, Marcio Covas Moschovas, Travis Rogers, Mischa Dohler, Jacques Marescaux, Vipul Patel","doi":"10.1097/SLA.0000000000006570","DOIUrl":"10.1097/SLA.0000000000006570","url":null,"abstract":"<p><strong>Objective: </strong>To undertake a systematic review of the medical literature on telesurgery, with a key focus on identifying the key technical and nontechnical themes searched in medical articles and to analyze gaps in the current knowledge base on telesurgery.</p><p><strong>Background: </strong>It has now been over 2 decades since the first successful case of telesurgery and since this time, there have been significant technological and telecommunications advancements.</p><p><strong>Methods: </strong>A systematic review of the literature was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Details of the protocol for this systematic review were registered on PROSPERO (CRD42024511530).</p><p><strong>Results: </strong>In total, 102 unique references were allocated into 5 categories: technical, cybersecurity, ethical, financial, and regulatory considerations to discuss key themes. The vast majority of references were related to technical considerations, which have demonstrated the feasibility of telesurgery. The nontechnical considerations have a paucity of literature and a lack of guidance on telesurgery which appears to still be the major barriers to telesurgery.</p><p><strong>Conclusions: </strong>Telesurgery presents many interdisciplinary challenges, encompassing both important technical and nontechnical (such as cybersecurity, ethical, financial, and regulatory) considerations. Further research, collaboration between stakeholders, a collaborative community of experts, and the development of comprehensive consensus frameworks are essential steps toward the widespread adoption of telesurgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"219-227"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456552","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":"Clinical and Pathologic features of 535 Patients with Congenital Mesoblastic Nephroma: A Report from the Children's Oncology Group.","authors":"Jonathan J Davick,Lindsay A Renfro,Nicholas G Cost,Jennifer H Aldrink,James I Geller,Geetika Khanna,Peter F Ehrlich,Conrad V Fernandez,Jeffrey S Dome,Elizabeth J Perlman,Elizabeth A Mullen, ","doi":"10.1097/sla.0000000000006862","DOIUrl":"https://doi.org/10.1097/sla.0000000000006862","url":null,"abstract":"OBJECTIVETo explore clinicopathologic features of children with congenital mesoblastic nephroma (CMN) enrolled on Children's Oncology Group study AREN03B2 and a historical cohort of CMN patients.BACKGROUNDCMN is a pediatric renal tumor of infancy, with histologic subtypes of cellular, mixed, and classic. Given its rarity, evidence-based clinical practice guidelines are unavailable. We collected clinicopathologic findings and outcomes data in 2 large cohorts of children with CMN.METHODSFrom 2004-2019, 6412 patients enrolled in AREN03B2 and underwent prospective central review of pathology materials, imaging studies, and operative reports. CMNs were identified and subclassified. Similar data was extracted from a historical cohort of CMNs collected by pathology reviewers between 1973-2001.RESULTSIn total, 535 children were included (139 from AREN03B2; 396 from the historical cohort). In the ARE03B2 cohort, 137 had available follow-up data (median follow-up: 4.5 y). Ten children (7.2%) relapsed, and 4/10 children died of disease. Four of 55 (7.3%) children with local stage II cellular or mixed CMNs relapsed, and 6/37 (16.2%) children with local stage III cellular or mixed CMNs relapsed. No child with local stage I or classic CMNs (of any stage) relapsed. All relapses occurred within 1.5 years of diagnosis, and 4/10 relapses occurred within 3 months. In the historical cohort, 31 children (7.8%) relapsed; all relapses were local stage II or III cellular or mixed.CONCLUSIONSWhile recurrences are uncommon, they are highly associated with cellular or mixed histologic subtypes and stage, providing key clinical information that may guide consideration of therapy and surveillance.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"117 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756142","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":"Beyond the Scalpel: Tackling Challenges Faced by LGBTQ+ Surgical Trainees and Faculty.","authors":"Steven Xie, Andrew Schlussel, Jenny Shao","doi":"10.1097/SLA.0000000000006715","DOIUrl":"10.1097/SLA.0000000000006715","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"196-198"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762449","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":"Change Is Hardest Right Before the Glass Ceiling Breaks: An Update on Women Pursuing Careers in Academic Surgery at a National Level.","authors":"Haley Harris, Isabelle Tan, Yuqing Qiu, Julianna Brouwer, Jonathan Abelson, Julie Ann Sosa, Heather Yeo","doi":"10.1097/SLA.0000000000006718","DOIUrl":"10.1097/SLA.0000000000006718","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to provide a comprehensive update on the representation of women in academic surgery by specialty, measuring progress and opportunity with regard to women \"breaking\" the glass ceiling at the trainee, faculty, and department chair levels.</p><p><strong>Background: </strong>Over the past 2 decades, initiatives have contributed to educational awareness, culture shifts, and a focus on inclusive excellence in surgery, leading to an increase in the number of women surgeons. Despite progress, a persistent gender gap in surgical faculty positions remains, and projections suggest that it will take more than a century to reach parity at the highest levels of academic surgery.</p><p><strong>Methods: </strong>Data from the Association of American Medical Colleges' FACTS and Faculty Rosters and the American Medical Colleges' Graduate Medical Education reports from 2006 to 2023 were analyzed to assess gender representation in surgery. Linear regression analyses were used to describe trends in the proportions of women who were promoted along the professional development pathway (resident to faculty to department chair) from 2006 to 2023.</p><p><strong>Results: </strong>Over our 17-year study period, all included surgical subspecialties increased in the proportion of women trainees, with the largest average annual increases observed in pediatric, plastic, and vascular surgery training programs. Although all surgical faculty levels experienced growth in the proportion of women faculty, the average annual change in the proportion of women decreased as seniority increased. At the observed trend, it is projected that surgical department chairs will not achieve equal proportions of men and women until the year 2102.</p><p><strong>Conclusions: </strong>Across the board, the proportion of women in surgery has increased. However, there remains opportunity for improvement, particularly at the senior faculty and department chair levels.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"176-183"},"PeriodicalIF":7.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794647","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":"Defining Biological Borderline Resectable Non-Functioning Pancreatic Neuroendocrine Tumors (NF-PanNETs): A Predictive Model for Preoperative Assessment of Early Recurrence Risk.","authors":"Stefano Partelli,Giovanni Guarneri,Paola Mv Rancoita,Ino De Martino,Lorenzo Provinciali,Louis De Mestier,Safi Dokmak,Julie Hallet,Alain Sauvanet,Massimo Falconi","doi":"10.1097/sla.0000000000006867","DOIUrl":"https://doi.org/10.1097/sla.0000000000006867","url":null,"abstract":"OBJECTIVEThis study aimed to develop and validate a preoperative predictive model to identify patients at high risk of early recurrence (ER), with a view to establish a framework for biological borderline resectability of non-functioning pancreatic neuroendocrine tumors (NF-PanNETs).SUMMARY BACKGROUND DATARadical surgery is curative for most localized NF-PanNETs, but a subset of patients experiences ER. No standardized criteria define preoperative high-risk disease.METHODSA retrospective multicentric study was conducted at three tertiary centers. Patients undergoing curative resection for localized NF-PanNETs were included, and preoperative clinicopathological and imaging variables were analyzed. ER was defined as a recurrence within 24 months. A classification tree model was developed, and performance was assessed using the AUC of the ROC curve.RESULTSA total of 496 patients were analyzed, with 290 in the derivation cohort and 206 in the validation cohort. ER occurred in 55 patients (11%), including 26 (9%) in the derivation and 29 (14%) in the validation cohort. The median disease-free survival for ER patients was 16 months (IQR: 10-20 months). Neoplastic venous thrombosis was the strongest predictor of ER, with an ER probability of 71%. Among patients without venous thrombosis, those with a Ki-67 index ≥5% and tumor size ≥3 cm had an ER probability of 41% in case of adenopathy and 19% otherwise. The model achieved an AUC of 0.91 in the derivation cohort and 0.84 in the validation cohort.CONCLUSIONSThis externally validated model provides a reliable preoperative tool to identify NF-PanNETs at high-risk of ER and introduces the concept of biological borderline resectable NF-PanNETs.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"27 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756101","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":"Living Donor Liver Transplantation reduced Waitlist Mortality in Acute-on-chronic Liver Failure.","authors":"Tiffany Cho-LamWong,Keith Kin-Pun Au,Milles Miu-Yee Chan,Tracy Yushi Cui,Kin-Hang Lam,Chloe Huen-Wai Choy,Hoi-Yan Tam,Jeff Wing-Chiu Dai,James Yan-Yue Fung,Albert Chi-Yan Chan,Simon Ying-Kit Law","doi":"10.1097/sla.0000000000006866","DOIUrl":"https://doi.org/10.1097/sla.0000000000006866","url":null,"abstract":"OBJECTIVETo compare intention-to-treat (ITT) and post-transplant outcomes of living donor liver transplant (LDLT) and deceased donor liver transplant (DDLT) in patients with acute-on-chronic liver failure (ACLF).SUMMARY BACKGROUND DATALimited data exist comparing LDLT and DDLT outcomes in ACLF, particularly addressing waitlist mortality.METHODSRetrospective analysis of all ACLF patients listed for transplant (2008-2023). Patients with living donors were categorized as intention-to-treat LDLT (ITT-LDLT) group and others as ITT-DDLT group. Primary outcome was to compare ITT-overall survival (ITT-OS), defined as survival from listing to death. Secondary outcomes included waitlist outcomes, post-transplant complication and long-term survival.RESULTS270 patients were accepted for transplant (ITT-LDLT n=127, ITT-DDLT n=143) with similar clinical characteristics at listing. ITT-LDLT achieved superior ITT-OS, with 92.9% survival at 3 months vs. 67.1% for ITT-DDLT (P<0.001), driven by higher transplant rates (94.5% vs. 53.8%, P<0.001) and shorter waiting times. ACLF grade 2 and 3 patients had the greatest survival benefit in ITT analysis. Futile waitlist outcomes, defined as death or delisting were more common in ITT-DDLT (4.7% vs. 35.7%, P<0.001). Post-transplant outcomes were comparable; 30-day mortality (2.0% vs. 1.0%, P=0.62), severe complication (28.6% vs. 33.3%, P=0.47) and 5-year survival (74.5% vs. 74.7%, P=0.46). Even for ACLF grade 2 and 3, LDLT achieved a 5-year survival at 87.2% and 68.0% respectively. Older age, higher ACLF grade and ITT-DDLT predicted waitlist futility. Neither ACLF grades nor transplant type predicted graft survival.CONCLUSIONITT-LDLT improved ITT-OS especially in ACLF grade 2/3 cohort and provided similar perioperative and long-term outcomes to DDLT.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"49 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756103","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":"From Clinics to Courtrooms: Strategies to Protect Surgeons and Preserve Access to Gender-Affirming Surgery.","authors":"Coral Katave,Ryan P Knox,Kavitha Ranganathan","doi":"10.1097/sla.0000000000006861","DOIUrl":"https://doi.org/10.1097/sla.0000000000006861","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"15 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747963","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}