Annals of surgery最新文献

{"title":"Research Agenda for Entrustable Professional Activities Among US Surgical Specialties.","authors":"Gurjit Sandhu, Andrew Jones, Carol L Barry, Jo Buyske, John D Mellinger, Brenessa Lindeman","doi":"10.1097/SLA.0000000000006623","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006623","url":null,"abstract":"<p><p>The magnitude of advances in surgical care inspires awe consistent with the impact of these developments on patients' lives. With this comes greater knowledge, new practices, and novel technologies for integration into residency training, making the skillset required of today's residents quite different from those in the past. Competency-based medical education and learner-centered approaches offer innovative and studied methodologies for teaching, learning, and assessment to meet the demands of today's educational environment. The authors provide an overview of competency-based medical education, its association with Accreditation Council for Graduate Medical Education Milestones as a competency framework, a description and outline of the emerging execution of Entrustable Professional Activities in the surgical disciplines, and a research agenda focused on Entrustable Professional Activities for American Board of Surgery certified surgical specialties in the United States. The research agenda includes five domains of inquiry: entrustment and practice readiness; bias and environment; distinguishing features and certification; qualitative feedback; and patient outcomes, and builds upon prior work by ten Cate et al. by expanding upon their organizing framework to also include the element of time. Additionally, the authors provide questions and suggest data integration strategies that might foster a breadth of studies investigating the utility of Entrustable Professional Activities in surgical training. Collectively engaging in such a process of evaluation early in the process of competency-based reform will serve to optimize education, assessment, and ultimately patient care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943172","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":"\"Gender-Affirming Vaginoplasty Using Robotic Peritoneal Flap Method: Long Term Outcomes of 500 Cases\".","authors":"Gaines Blasdel, Kshipra Hemal, Charlie Dubach-Reinhold, Augustus Parker, Chris Amro, Lee C Zhao, Rachel Bluebond-Langner","doi":"10.1097/SLA.0000000000006621","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006621","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to determine the outcomes of robotic peritoneal flap vaginoplasty.</p><p><strong>Background: </strong>There is a lack of long-term outcomes data for gender-affirming vaginoplasty to inform patient decision-making.</p><p><strong>Methods: </strong>A retrospective cohort of 500 consecutive patients undergoing robotic peritoneal flap vaginoplasty from 2017-2023 were reviewed. Complications requiring procedural intervention, self-reported vaginal dimensions, and orgasm were recorded at each follow up visit and analyzed as outcomes.</p><p><strong>Results: </strong>487 (97%) of patients were followed to 3 months, and 425 (85%) to 1 year or greater. Twenty patients (4%) had a complication requiring procedural intervention, and 61(12%) had elective revision surgery. Median self-reported vaginal depth and width at 1 year was 14.5 cm (14.5-14.5) and 3.8 cm (3.8-3.8 cm). There were 12 patients (4%) no longer dilating using standard dilators at this pre-scheduled 1-year appointment, and at last follow-up ≥1 year, 8% were no longer dilating. Thirty-six (8%) of patients were considered anorgasmic at last follow up. Difficulty with orgasm prior to surgery was associated with lower rates of achieving orgasm after surgery and less consistent vaginal depth at 1 year, however 80% of these patients were able to orgasm after surgery.</p><p><strong>Conclusions: </strong>Clinician-observed and patient-reported outcomes for robotic gender-affirming peritoneal flap vaginoplasty were superior to those reported in the literature for penile inversion vaginoplasty. Patients who do not achieve orgasm prior to surgery are less likely to achieve orgasm and maintain vaginal depth afterwards, however the majority of these patients have improved sexual health after surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943258","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":"Clinicopathological Characteristics and Long-Term Outcomes of Cystic vs. Solid Pancreatic Neuroendocrine Tumors: A Multi-Institutional Experience with 1727 Patients.","authors":"Marco Ventin, Shahrzad Arya, Giulia Cattaneo, Carlos Fernandez-Del Castillo, Alice C Wei, Amer H Zureikat, Jurgis Alvikas, Ammar A Javed, Brady A Campbell, Yurie Sekigami, Jian Zheng, Motaz Qadan, Keith D Lillemoe, Jin He, Cristina R Ferrone","doi":"10.1097/SLA.0000000000006624","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006624","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the clinicopathological features and long-term outcomes of cystic and solid pancreatic neuroendocrine tumors (PanNETs).</p><p><strong>Summary background data: </strong>PanNETs uncommonly present as cystic lesions. Whether cystic PanNETs represent a distinct clinical entity compared to solid PanNETs is controversial.</p><p><strong>Methods: </strong>Clinicopathologic data of patients with resected PanNETs were collected from 4 high-volume centers between 2000-2019. Clinicopathological characteristics and outcomes of patients with cystic and solid PanNETs were compared based on a 3 cm tumor size cut-off using the Chi-squared test and Mann-Whitney U test. Survival estimates were calculated with the Kaplan-Meier method and log-rank test and multivariable analysis using a Cox proportional hazard model.</p><p><strong>Results: </strong>Of the 1727 patients undergoing pancreatectomy for PanNET, the median age was 58.1 years (IQR, 18.4), and 53.3% were male. Of these, 177 (10.3%) were cystic and 1550 (89.7%) solid. Cystic PanNETs were more prevalent in patients with hereditary syndromes, less frequently functional, and more often located in the body/tail of the pancreas. After the exclusion of patients with functional tumors, WHO G3 tumors, hereditary syndromes, neoadjuvant treatment, and metastatic stage, 145 cystic PanNETs were compared to 1059 solid PanNETs, and the median follow-up period of the cohort was 64 months. Cystic PanNETs demonstrated significantly fewer high-risk histopathological features, lymph node metastases (5.5% vs. 24.0%, P<0.001), and distant recurrence (4.1% vs. 14.4%; P<0.001). Among tumors ≤3 cm, cystic PanNETs had a low rate of lymph node metastases (3.9% vs. 17.8%; P<0.001), recurrence (3.1% vs. 8.4%; P=0.041), and low propensity to recur distantly. Cystic PanNETs had favorable long-term survival regardless of tumor size.</p><p><strong>Conclusion: </strong>Cystic PanNETs have a more benign course than their solid counterparts and conservative management can be considered for EUS-FNA-proven cystic PanNETs ≤3 cm. Parenchyma and lymph-node sparing resections are warranted in patients with cystic PanNETs>3 cm. Patients with poor baseline performance status may forego cystic PanNET resection and not affect their overall survival.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943259","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":"Enhanced Recovery After Surgery Protocol Compliance and Early Outcomes for Elective Colorectal Procedures by Race/Ethnicity and Socioeconomic Status.","authors":"Marta Antoniv, Luisa Jane Maldonado, Andrei Nikiforchin, Esteban Fabian Gershanik, Ronald Bleday","doi":"10.1097/SLA.0000000000006622","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006622","url":null,"abstract":"<p><strong>Objective: </strong>To explore the association of socioeconomic status (SES) and race/ethnicity with perioperative metrics within the Enhanced Recovery After Surgery (ERAS) framework to identify gaps for equity-informed improvements.</p><p><strong>Summary background data: </strong>Although ERAS pathways improve perioperative outcomes through standardized care, disparities in protocol adherence and postoperative outcomes persist, particularly for vulnerable populations.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using a single-institution database of elective colorectal surgeries (2018-2021). Patients were categorized and assessed by SES and race/ethnicity.</p><p><strong>Results: </strong>Overall, 1,519 patients were analyzed: 180 had low SES (11.8%) and 1,339 - high SES (88.2%). Low SES patients had lower rates of bowel preparation completion, use of the electronic patient portal, and carbohydrate loading pre-surgery. Low SES was associated with a longer median length of stay (LOS) (4 vs. 3 days, P<0.001). Multivariate logistic regression analysis showed low SES was linked to higher odds of infectious (OR 2.46, 95%CI: 1.31-4.63) and all in-hospital complications (OR 1.50, 95%CI: 1.06-2.12). Among racial/ethnic cohorts, Black patients had lower rates of documented preoperative patient education, longer median LOS (5 vs. 3-4 days, P=0.002), and increased odds of respiratory complications (OR 4.11, 95%CI: 1.56-10.85).</p><p><strong>Conclusions: </strong>Low SES was linked to lower compliance with important process measures, higher infectious and all in-hospital complication rates, and longer LOS. Despite high rates of protocol compliance, Black race/ethnicity showed an association with increased odds of respiratory complications and extended LOS. Adjustments to perioperative protocols could address such disparities, helping to improve postoperative outcomes of colorectal surgeries.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943260","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":"Life after Pelvic Exenteration for Rectal Cancer: The Patient and Carer Perspective on Long Term Consequences and Survivorship.","authors":"Kilian G M Brown, Kate White, Michael J Solomon, Paul Sutton, Kheng-Seong Ng, Daniel Steffens","doi":"10.1097/SLA.0000000000006625","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006625","url":null,"abstract":"<p><strong>Objective: </strong>To explore the perspectives and experiences of patients and carers living with the long-term consequences of pelvic exenteration.</p><p><strong>Summary background data: </strong>Pelvic exenteration is accepted as the standard of care for selected patients with locally advanced or recurrent rectal cancer. With contemporary 5-year survival reported at 40-60%, the number of long-term survivors is expected to increase. The long-term consequences of such radical surgery for patients and their survivorship needs are not well understood.</p><p><strong>Methods: </strong>This was an exploratory, qualitative study conducted at a high-volume pelvic exenteration centre. Semi-structured interviews were conducted with survivors of pelvic exenteration surgery for locally advanced or recurrent rectal cancer and their carers. Purposive sampling was used to ensure a diverse cohort. Data were thematically analysed.</p><p><strong>Results: </strong>Three major themes were identified: 1. The consequences of surgery are the price you pay for survival: the majority of participants accepted the sequelae of surgery as the cost of survival. 2. Our lives are changed forever: Adjusting to changes in body appearance and function was an ongoing challenge. Chronic pain, stomas, altered bowel function and mobility issues impacted work and social life. 3. The good days and bad days as a survivor: While several participants reported a more positive approach to life, many were living with a pervasive fear of recurrence and/or dying, and the ripple effect on family and friends was significant.</p><p><strong>Conclusions: </strong>Although survivors of pelvic exenteration accept the long-term consequences of surgery as the price of survival, these are significant, and improved access to support services in the community may better equip survivors to manage these challenges.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943170","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":"Remote Symptom Monitoring in Thoracic Surgery Patients After Discharge.","authors":"Marisa Sewell, Thomas Boerner, Caitlin Harrington, Meier Hsu, Kay See Tan, Rebecca A Carr, Susan Jones, Daniel Zocco, Prasad S Adusumilli, Manjit S Bains, Matthew J Bott, Robert J Downey, James Huang, James M Isbell, Bernard J Park, Gaetano Rocco, Valerie W Rusch, Smita Sihag, David R Jones, Jennifer Cracchiolo, Daniela Molena","doi":"10.1097/SLA.0000000000006619","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006619","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate an electronic platform for remote symptom monitoring to enhance postdischarge care in thoracic surgery using patient reporting of symptoms.</p><p><strong>Summary background data: </strong>Owing to the increased use of enhanced recovery after surgery protocols, patients are spending a larger portion of their postoperative course at home. For patients undergoing complex operations, this represents an opportunity for early identification of abnormal symptoms at home before deterioration.</p><p><strong>Methods: </strong>An online symptom-tracking platform for thoracic surgery patients was created on the basis of opinions from stakeholders and a review of the literature. Starting in February 2021, patients were educated about the symptom tracker in preoperative clinics. After discharge, patients received a series of electronic surveys covering 23 symptom domains assessed using a Likert scale for severity. Moderate symptoms prompted a \"yellow alert,\" and severe symptoms prompted a \"red alert,\" both notifying the nursing team and prompting appropriate action. Patients were considered responders if they completed at least 1 survey.</p><p><strong>Results: </strong>In total, 1997 patients were enrolled; 76% (n=1520) were responders. Responders were younger, more likely to be White, less likely to have medical comorbidities, and less likely to be readmitted (odds ratio, 0.53 [95% CI, 0.37-0.76]; P<0.001). Responders who were readmitted had a higher percentage of red alerts (47% vs. 24%; P<0.001) and yellow alerts (74% vs. 61%; P=0.016), compared with responders who were not readmitted.</p><p><strong>Conclusions: </strong>Electronic reporting adds an additional mechanism of communication between the patient and the clinical team, with the potential to lower the odds of readmission.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943171","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":"Homelessness Research Has a Data Problem.","authors":"Hannah Decker, Elizabeth Wick","doi":"10.1097/SLA.0000000000006620","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006620","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142943261","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":"Private Equity Investment in Surgical Care.","authors":"Maxwell T Sievers, Andrew Neevel, Adrian Diaz, Eva Rouanet, Kyle Sheetz, David Brophy, Justin B Dimick, Karan R Chhabra","doi":"10.1097/SLA.0000000000006238","DOIUrl":"10.1097/SLA.0000000000006238","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the extent of private equity (PE) investment affecting surgical care.</p><p><strong>Background: </strong>Over the last decade, investor-backed, for-profit PE groups have invested in health care at an unprecedented rate, but the breadth of these investments affecting surgical practice remains largely unknown.</p><p><strong>Methods: </strong>Four nationally representative databases were used to identify all merger/acquisitions involving surgical practices between 2015 and 2019, determine PE investment in those transactions, and link the acquisitions with a physician data set.</p><p><strong>Results: </strong>A total of 1542 unique transactions were identified, of which 539 were financed by PE. Fifty-eight transactions were then classified into their respective categories within surgical care: digestive disease, orthopedics, urology, vascular surgery, and plastic/cosmetic surgery. These transactions accounted for 199 practice sites and 1405 physicians, averaging 24.2 physicians per transaction. Acquisition activity peaked in 2017, with a total of 63 practices involved. Digestive disease, urology, and orthopedic surgery accounted for the most activity. General surgeons were involved in a small share of the digestive disease practice acquisitions. Three \"surgery-adjacent\" categories were also identified: anesthesiology, ambulatory surgery centers, and surgical staffing firms. Among these, anesthesia was the largest category in terms of practices (194) and physicians (2660) involved in transactions across the study period. Medical Service Organizations were a key mechanism through which PE firms invested in surgical care.</p><p><strong>Conclusions: </strong>PE has engaged in substantial investment within surgical specialties, creating increased practice consolidation. These investments affect all levels of medical care and have notable implications for patients, practitioners, and policymakers.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"56-64"},"PeriodicalIF":7.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899251","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":"Introduction to the Contemporary Assessment and Recommendations to Enhance Surgical Education and Training: Reports of the Subcommittees of the Blue Ribbon Committee II.","authors":"Edwin Christopher Ellison, Steven C Stain, Keith D Lillemoe","doi":"10.1097/SLA.0000000000006495","DOIUrl":"10.1097/SLA.0000000000006495","url":null,"abstract":"<p><strong>Objective: </strong>Provide reports of the Blue Ribbon II Subcommittees.</p><p><strong>Background: </strong>The Blue Ribbon Committee II (BRC II) was a panel of 67 experts selected on the basis of experience and leadership in surgical education and training.</p><p><strong>Methods: </strong>It was organized into subcommittees, each of which was asked to prepare a manuscript on their findings and recommendations. The BRC II Subcommittees were: Blue Ribbon Committee 1 Review and Assessment, Surgical Workforce, Medical Student Education, Work Life Integration, Resident Education, Goals, Structure and Financing of Training, Education Support and Faculty Development, Research Training, and Educational Technology and Assessment. BRC II used the Delphi approach with consensus defined as equal to or greater than 80% and identified and recommended 31 priorities for surgical education in 2024.</p><p><strong>Results: </strong>The initial findings were presented to a general surgery and related specialty resident and fellow focus group for comments and written feedback, and they were asked to prepare a manuscript as well.</p><p><strong>Conclusions: </strong>The reports of the Subcommittees of the BRC II provide an assessment and key recommendations concerning surgical education and training in 2024.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1-2"},"PeriodicalIF":7.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896590","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":"Key Issues in Surgical Residency Education: Recommendations of the Blue Ribbon II Committee Residency Education Subcommittee.","authors":"John D Mellinger, Karen Brasel, Eric Elster, Gerald Fried, Daniel A Hashimoto, Benjamin Jarman, Amit R T Joshi, Rachel R Kelz, Brenessa Lindeman, Carla Pugh, Richard Reznick","doi":"10.1097/SLA.0000000000006434","DOIUrl":"10.1097/SLA.0000000000006434","url":null,"abstract":"<p><strong>Background: </strong>In September 2022, a summit was convened by the American Board of Surgery (ABS) to discuss competency-based reform in surgical education. A key output of that summit was the recommendation that the prior work of the Blue Ribbon I Committee convened 20 years earlier be revived. With leadership from the American College of Surgeons (ACS) and the American Surgical Association (ASA), the Blue Ribbon Committee (BRC) II was subsequently convened. This paper describes the output of the Residency Education Subcommittee of the BRC II Committee.</p><p><strong>Methods: </strong>The Subcommittee organized its work around prioritized themes, including curriculum, assessment, and transition to practice. Top recommendations, time-based action steps, potential barriers, and required resources were detailed and vetted through group discussion, broader Committee review and critique, and subsequent refinement.</p><p><strong>Results: </strong>Primary concluding emphases included transitioning to a competency-based training model, facilitating dynamically capable curricular reform emphasizing the digital transformation of surgical care, using predictive analytic assessment strategies to optimize training effectiveness and efficiency, and creating mentorship strategies to govern the transition from training to independent practice in an outcomes-accountable fashion.</p><p><strong>Conclusions: </strong>To implement the recommendations outlined, it was recognized that coordinated efforts across existing organizational structures will be required, informed by data set integration strategies that meaningfully measure educational and related patient outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"16-20"},"PeriodicalIF":7.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465776","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}