Annals of surgery最新文献

{"title":"Real-world Application of Endoscopic Resection for Early-stage Esophageal Cancer: Do We Need to Rethink the Guidelines?","authors":"Smita Sihag","doi":"10.1097/SLA.0000000000006593","DOIUrl":"10.1097/SLA.0000000000006593","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"371-372"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674996","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":"Comparison of Clinical Outcomes and Postoperative Nutritional Status Between Early and Late Oral Feeding After Esophagectomy: An Open Labeled Randomized Controlled Trial.","authors":"Kwon Joong Na, Chang Hyun Kang, Young Ran Kim, Mi Jin Kang, Eun Hwa Song, Eun Joo Jang, Samina Park, Hyun Joo Lee, In Kyu Park, Young Tae Kim","doi":"10.1097/SLA.0000000000006441","DOIUrl":"10.1097/SLA.0000000000006441","url":null,"abstract":"<p><strong>Objective: </strong>To compare nutritional and postoperative outcomes between early oral feeding and late oral feeding with jejunostomy feeding support after esophagectomy.</p><p><strong>Background: </strong>Esophagectomy is associated with substantial body weight loss and malnutrition, impacting the prognosis of esophageal cancer patients. Despite many studies on postesophagectomy nutritional support, optimal strategies remain elusive. This study investigates the impact of jejunostomy feeding with late oral feeding compared to conventional oral feeding on nutritional and postoperative outcomes.</p><p><strong>Methods: </strong>We performed a single-center prospective open-labelled randomized controlled trial between 2020 and 2022. Patients aged 18 to 75 years with resectable esophageal cancer were randomly assigned to undergo either early oral feeding (early group) or late oral feeding with jejunostomy feeding support (late group) after esophagectomy. The primary endpoint was body weight loss from preoperative body weight at postoperative 4 to 5 weeks and 4 months. Other perioperative and nutritional outcomes were also evaluated.</p><p><strong>Results: </strong>We randomly assigned 29 patients to the early group and 29 patients to the late group. The late group exhibited significantly less body weight loss at both postoperative 4 to 5 weeks (8.3% vs. 5.6%; P =0.002) and 4 months (15.0% vs. 10.5%; P =0.003). The total calorie intake and protein intake were higher in the late group for both postoperative 4 to 5 weeks (1800 kcal/day vs. 1100 kcal/day; P <0.001) and 4 months (1565 kcal/day vs. 1200 kcal/day; P =0.010). Sixty percentage of the early group changed to malnutrition state, while 40% of the late group changed to malnutrition. The complication rate and length of hospital stays were similar.</p><p><strong>Conclusions: </strong>The late group demonstrated prevention of significant body weight loss, enhanced nutritional intake, and reduced malnutrition without compromising short-term surgical outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"388-394"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809704/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141589495","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":"Outcomes Related to New Persistent Opioid Use After Surgery or Trauma: A Population-based Cohort Study.","authors":"Jiayi Gong, Peter Jones, Kebede Beyene, Chris Frampton, Amy Hai Yan Chan","doi":"10.1097/SLA.0000000000006509","DOIUrl":"10.1097/SLA.0000000000006509","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the impact of persistent opioid use (POU) following surgery or trauma on health outcomes using linked data.</p><p><strong>Background: </strong>Surgery and trauma can lead to POU, characterized by continuous opioid consumption following hospital discharge. Outside the United States, there is a lack of population-based studies on POU outcomes in opioid-naive patients following these events.</p><p><strong>Methods: </strong>We included opioid-naïve patients who have dispensed opioids after being discharged following admission for surgery or trauma to any New Zealand (NZ) hospital from 2007 to 2019. Differences in outcomes between individuals with and without POU were assessed between 180 and 360 days after discharge. The primary outcome was all-cause mortality, the secondary outcomes were all-cause and opioid-related hospitalization, and Days Alive and Out of Hospital (DAOH). Cox and quantile multivariable regression models were used to examine the association between POU and outcomes.</p><p><strong>Results: </strong>Overall, 298,928 surgical and 206,663 trauma patients were included in the final analyses, and 17,779 (5.9%) surgical and 17,867 (8.6%) trauma patients developed POU. POU was significantly associated with increased risk of all-cause mortality (surgical, aHR=6.59; 95% CI: 5.82-7.46; trauma, aHR=2.77; 95% CI: 2.47-3.11), all-cause hospitalization (surgical, aHR=2.02; 95% CI: 1.95-2.08; trauma, aHR=1.57; 95% CI: 1.52-1.62), opioid-related hospitalization (surgical, aHR=2.49; 95% CI: 2.24-2.76; trauma, aHR=1.89; 95% CI: 1.73-2.05) and reduced DAOH.</p><p><strong>Conclusions: </strong>Among opioid-naive patients who received opioids after surgery or trauma, POU was associated with worse outcomes, including increased mortality. Further investigation is warranted to understand the reasons for continued opioid use beyond 90 days and mechanisms associated with harm.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"354-360"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071802","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":"The Surgical Mini-Sabbatical: A Path to Elevate Professional Engagement, Expand Patient Care, and Enhance Trainee Skills.","authors":"Drew J Braet, David W Schechtman, Robert J Beaulieu, Dawn M Coleman, Matthew A Corriere, Nicholas H Osborne, Jonathan L Eliason","doi":"10.1097/SLA.0000000000006424","DOIUrl":"10.1097/SLA.0000000000006424","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"376-377"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141431221","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":"Consortium for the Holistic Assessment of Risk in Transplant: Harmonizing Data for Research, Transparency, and Equity.","authors":"Lisa M McElroy, Rhiannon D Reed, Elisa J Gordon, Alexandra T Strauss, Jessica Harding, Andrew Adams, Juan Carlos Caicedo, Katie Ross Driscoll, David J Taber, Yue Harn Ng, Nrupen A Bhavsar, Rachel E Patzer, Allan D Kirk","doi":"10.1097/SLA.0000000000006410","DOIUrl":"10.1097/SLA.0000000000006410","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"373-375"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11659506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141426169","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":"A Randomized, Controlled Trial Evaluating Perioperative Risk-stratification and Risk-based, Protocol-driven Management After Elective Major Cancer Surgery.","authors":"Nestor F Esnaola, Raju Chelluri, Jason Castellanos, Ariella Altman, David Y T Chen, Christina Chu, Jeffrey M Farma, Alan Haber, Fathima Sheriff, Christine Huang, Alexander Kutikov, Sameer Patel, Kenneth Patrick, Sanjay Reddy, Stephen Rubin, Rosalia Viterbo, John A Ridge, Martin Edelman, Eric Ross, Marc Smaldone, Robert G Uzzo","doi":"10.1097/SLA.0000000000006446","DOIUrl":"10.1097/SLA.0000000000006446","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of risk-based, protocol-driven management versus usual management after elective major cancer surgery to reduce 30-day rates of postoperative death or serious complications (DSCs).</p><p><strong>Background: </strong>Major cancer surgery is associated with significant perioperative risks, which result in worse long-term outcomes.</p><p><strong>Methods: </strong>Adults scheduled for elective major cancer surgery were stratified/randomized to risk-based escalating levels of care, monitoring, and comanagement versus usual management. The primary study outcome was a 30-day rate of DSC. Additional outcomes included complications, adverse events, health care utilization, health-related quality of life (HRQOL), and disease-free survival and overall survival.</p><p><strong>Results: </strong>Between August 2014 and June 2020, 1529 patients were enrolled and randomly allocated to the study arms; 738 patients in the intervention arm and 732 patients in the control arm were eligible for analysis. Thirty-day rate of DSC with the intervention was 15.0% (95% CI: 12.5%-17.6%) versus 14.1%, (95% CI: 11.6%-16.6%) with usual management ( P = 0.65). There were no differences in 30-day rates of complications or adverse events (including return to the operating room), postoperative length of stay, rate of discharge to home, or 30, 60, or 90-day HRQOL or rates of hospital readmission or receipt of antineoplastic therapy between the study arms. At a median follow-up of 48 months, overall survival ( P = 0.57) and disease-free survival ( P = 0.91) were similar.</p><p><strong>Conclusions: </strong>Risk-based, protocol-driven management did not reduce the 30-day rate of DSC after elective major cancer surgery compared with usual management, nor did it improve postoperative health care utilization, HRQOL, or cancer outcomes. Trials are needed to identify cost-effective, tailored perioperative strategies to optimize outcomes after major cancer surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"395-403"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141750861","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":"Conversion during Minimally Invasive Left Pancreatectomy: A Nationwide Study of Causes and Consequences.","authors":"Charles De Ponthaud, Alexandra Nassar, Safi Dokmak, Thibaud Bertrand, Julien De Martino, Clément Pastier, Antoine Castel, Raffaele De Rosa, Mehdi Boubaddi, Abdallah Iben-Khayat, Fabio Giannone, Elsa Jolly, Jonathan Garnier, Clément Louis-Gaubert, Alessandro D Mazzotta, Marie André, Johan Gagnière, Manon Viennet, François-Régis Souche, Reza Kianmanesh, Renato Micelli Lupinacci, Jean-Marc Regimbeau, François Paye, Pietro Addeo, Alexis Laurent, Morgan Vandermeulen, Robert Caiazzo, Mehdi El Amrani, Christophe Tresallet, Alexandre Doussot, Martin Brunel, Lionel Jouffret, Amandine Pinto, Alain Valverde, Rodolfo Romero Vece, Régis Fara, Samir Mahfouf, Benjamin Darnis, Amine Chamakhi, Jeremie Thereaux, Jean Lubrano, Edouard Girard, Julie Veziant, David Jérémie Birnbaum, Jérôme Danion, Helene Corté, Johanna Zemour, Tullio Piardi, Anne de Carbonnières, Emilia Ragot, Alban Zarzavadjian Le Bian, Patrice David, Laurent Brunaud, Emilie Lermite, Laura Chreim, Ana Lucia Charlaix, Jean Gugenheim, Lilian Schwarz, Jean Marc Bigourdan, Bertrand Le Roy, Elias Karam, Rami Rhaiem, Jean-Michel Fabre, Jean-Baptiste Lequeu, Marie Noirault, Ahmet Ayav, Olivier Soubrane, Nicolas Regenet, Olivier Turrini, Fabrice Muscari, Patrick Pessaux, Baudouin Thébault, Christophe Laurent, Laurent Sulpice, Alain Sauvanet, David Fuks, Sébastien Gaujoux","doi":"10.1097/SLA.0000000000006685","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006685","url":null,"abstract":"<p><strong>Objectives: </strong>To identify risk factors for conversion, develop a predictive Conversion Risk Score (CRS), and assess the association between conversion and severe postoperative complications.</p><p><strong>Background: </strong>Conversion occurs in 15-30% of minimally invasive left pancreatectomies (MILP). Risk factors and potential negative impacts on postoperative outcomes are poorly described.</p><p><strong>Methods: </strong>Retrospective, nationwide, multicenter study including all MILP (laparoscopy and robot) performed between 2010 and 2021. Risk factors for conversion were identified by multivariate mixed model, and a CRS was developed on a \"training-set\" and validated (calibration diagrams and ROC curves) on a \"validation-set.\" The association between severe complications and conversion was assessed using a propensity score based on the main risk factors for severe complications: age, sex, BMI, ASA score, tumor malignancy, multi-organ resection, operative duration, blood loss, splenectomy.</p><p><strong>Results: </strong>2104 patients included from 55 centers. Conversion occurred in 15.6% of MILP. Its risk factors were male sex (OR=1.67;P=0.048), BMI≥25 kg/m2 (OR=2.15;P=0.004), history of laparotomy (OR=2.9;P<0.001), initial pancreatitis (OR=3.58;P=0.007), tumor size≥40 mm (OR=2.12;P=0.003), planned splenectomy (OR=2.63;P<0.001), unplanned splenectomy (OR=4.05;P=0.028), portal vein resection (OR=36.3;P=0.002), multi-organ resection (OR=12.97;P<0.001). A predictive CRS was created based only on preoperatively available variables (the first six), with scores ranging from 0 to 7, corresponding to a conversion risk of 2% to 100%. No association was observed with tumor malignancy, robotic approach, or pancreatectomy volume. Conversion was significantly associated with severe complications [OR=1.80(1.16-2.54)], independent of other risk factors for complications.</p><p><strong>Conclusions: </strong>Conversion during MILP can be predicted by CRS, aiding surgeons in decision-making, given its significant association with severe complications.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143522333","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 Systematic Review and Independent Patient Data Meta-Analysis of Prophylactic Mesh Augmentation for Incisional Hernia Prevention after Abdominal Aortic Aneurysm Surgery (I-PREVENT-AAA) A Collaborative European Hernia Society Project.","authors":"Rudolf van den Berg, Floris P J Den Hartog, Sara J Baart, Christina Bali, Miltiadis Matsagkas, Paul M Bevis, Jonothan J Earnshaw, Eike S Debus, Susanne Honig, Frederik Berrevoet, Olivier Detry, Cesare Stabilini, Filip E Muysoms, Pieter J Tanis","doi":"10.1097/SLA.0000000000006684","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006684","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the effectiveness of prophylactic mesh augmentation (PMA) of the abdominal wall following open aortic aneurysm repair as compared to primary sutured closure in preventing incisional hernia (IH) formation by performing an individual patient-data meta-analysis (IPDMA).</p><p><strong>Summary background data: </strong>IH is a prevalent complication after abdominal surgery, especially in high-risk groups. PMA of the abdominal wall has been studied as a preventive measure for IH-formation, but strong recommendations are lacking.</p><p><strong>Methods: </strong>A systematic literature search was conducted till 23 September 2024 to identify randomized controlled trials (RCTs) that compared PMA with PS after open AAA surgery. Lead authors of eligible studies were asked to share individual patient-data. A one-stage analysis was performed, and Cox-regression analyses were used to assess time-to-event outcomes.</p><p><strong>Results: </strong>Five randomized trials with a total of 493 patients were included. Intention to treat analysis revealed that PMA was associated with significantly lower risk of IH (hazard ratio of 0.25 (95% CI 0.12-0.50)) as compared to PS closure. Three-year incisional hernia rates were 13.2% and 39.6%, respectively, with a number needed to treat of 3.7. The effect was similar for onlay and retro-rectus PMA. PMA resulted in longer operative time (mean 27 minutes) and more seroma formation (especially onlay PMA) but did not increase the risk of surgical site infection.</p><p><strong>Conclusions: </strong>PMA after elective open abdominal aortic aneurysm surgery is proven to be an effective measure to reduce IH formation and should be considered in future guidelines as standard of care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498029","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":"Trainee Perspective on \"Roadmap for Research and Scholarship in General Surgery Residency Training\".","authors":"Tiffany R Bellomo, Jiwoo Lee, Michael Kochis","doi":"10.1097/SLA.0000000000006683","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006683","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143498033","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":"Effect of Laparoscopic versus Open Distal Pancreatectomy on Recurrence-Free Survival in Patients with Left-sided Pancreatic Cancer: A randomized controlled trial.","authors":"Chen Liu, He Cheng, Min Wang, Yunqiang Cai, Chongyi Jiang, Liang Tang, Guopei Luo, Kaizhou Jin, Shunrong Ji, Wenyan Xu, Si Shi, Xu Wang, Meng Liu, Weihong Zhao, Xiaowu Xu, Jin Xu, Weiding Wu, Wei Wang, Jianhua Liu, Chenghao Shao, Bing Peng, Renyi Qin, Xianjun Yu","doi":"10.1097/SLA.0000000000006681","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006681","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this trial was to evaluate the oncological superiority of laparoscopic versus open distal pancreatectomy in left-sided pancreatic cancer.</p><p><strong>Background: </strong>The oncological efficacy of laparoscopic distal pancreatectomy in left-sided pancreatic cancer remains controversial.</p><p><strong>Methods: </strong>We performed a multi-center, open-label, randomized controlled trial of laparoscopic versus open distal pancreatectomy in left-sided pancreatic cancer patients. Candidates were recruited from six centers in China, and randomly assigned to receive either LDP or ODP. The primary outcome was recurrence-free survival, and the secondary outcomes were overall survival, R0 resection rate, and retrieved lymph node numbers.</p><p><strong>Results: </strong>Of the 481 eligible pancreatic cancer patients between Jan. 9, 2019 and Dec. 8, 2021, 306 candidates were initially enrolled and randomly assigned at 1:1 to receive either LDP or ODP. The last follow-up was performed on Dec. 15, 2023, and 130 patients in the LDP group and 129 patients in the ODP group were included for per-protocol analysis. Median RFS was 15.5 (12.5-18.5) months in the LDP group compared to 15 (9.5-20.5) months in the ODP group (P=0.471). The R0 resection rate in two groups was 88.5% versus 89.1%, respectively. Median retrieved lymph node numbers in two groups were similar (13.5 [10-20] versus 12 [7-17], P=0.165). Complications with a Clavien-Dindo score ≥ 3 occurred in 10 of 130 patients in the LDP group, and 11 of 129 patients in the ODP group.</p><p><strong>Conclusion: </strong>Although LDP did not provide significant oncological benefits for left-sided pancreatic cancer, it was safe and applicable appropriate. ClinicalTrials.gov NCT03792932.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143490552","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}