Annals of surgery最新文献

{"title":"Assessing Surgical Innovation. ALPPS: An IDEAL Example of Disruptive Innovation.","authors":"Michael Linecker,Matthias Pfister,Patryk Kambakamba,Hauke Lang,Eduardo de Santibañes,Jeffrey Barkun,Pierre-Alain Clavien","doi":"10.1097/sla.0000000000006865","DOIUrl":"https://doi.org/10.1097/sla.0000000000006865","url":null,"abstract":"OBJECTIVETo assess the impact of the IDEAL (Innovation, Development, Exploration, Assessment and Long-term) paradigm on the development of ALPPS (Associating Liver Partition and Portal vein ligation for Staged hepatectomy) in comparison to the evaluation of two other revolutionary innovations: laparoscopic cholecystectomy (LC) and robotic surgery.BACKGROUND AND AIMSThe assessment and development of disruptive procedures often follow a chaotic and unstructured approach. The IDEAL paradigm has offered a sequential 5-stage process to assess controversial surgical strategies like ALPPS, which was introduced in 2012 to expand liver surgery for primarily non-resectable disease.RESULTSBy October 2024, the international ALPPS registry collected 1349 cases from 146 centers in 46 countries. Early reports unveiled an alarming morbidity and peri-operative mortality. Accumulating cases in the registry and a consensus conference enabled to reduce the initial 90-day mortality rates>15% to<5% in high-volume centers. Meta-analyses, long-term follow-up and a RCT were available through the growing data in the registry. In comparison, the development of LC was similarly marked by technical advances and a registry to highlight safety (especially bile duct injuries). A small multi- center RCT (as well as a larger one later) supported an unstoppable wave of rapid adoption by patients and surgeons. Robotic surgery is currently going through close scrutinization by many stakeholders in view of the massive promotion by the industry, but a compelling registry is still missing.CONCLUSIONSALPPS has now reached a high-level of evaluation with clear guidelines for use thanks to international collaborations and the IDEAL paradigm. This may serve as template for future evaluations of surgical innovations.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"69 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792148","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":"Benchmarking Oncologic Outcomes of Liver Resection For Colorectal Metastases LiverMetSurvey-based Reference Values For Evaluating Alternative Treatments.","authors":"Luca Viganò,Luca Risi,Bobby Vm Dasari,Hugo Pinto Marques,Felice Giuliante,Arno Nordin,Real Lapointe,Gernot Kaiser,Maximiliano Gelli,Santiago Lopez Ben,José Guilherme Tralhao,Alessandro Ferrero,Cristina Dopazo,Luisa Anderloni,René Adam","doi":"10.1097/sla.0000000000006884","DOIUrl":"https://doi.org/10.1097/sla.0000000000006884","url":null,"abstract":"OBJECTIVEThe present study aims to establish reference standard values for liver resection outcomes in patients with colorectal liver metastases (CRLM) across different tumor burdens.SUMMARY BACKGROUND DATALiver surgery has long been the only potentially curative treatment for CRLM, but now options are rising, such as thermal ablation for patients with small oligonodular lesions and liver transplantation for those with high tumor burden. Elucidating surgical outcomes is crucial to defining its role.METHODSAll patients included in the LiverMetSurvey registry between 2000 and 2022 were considered. Only patients undergoing complete resection in high-volume centers without extrahepatic disease and with follow-up >1 year were included. The analyzed outcomes were: 90-day mortality, and one-, three-, and five-year overall survival (OS) and recurrence-free survival (RFS). Patients were divided into subgroups based on tumor burden, and the analysis was restricted to \"benchmark\" patients, selected on preoperative chemotherapy administration and response.RESULTSOverall, 12154 patients treated across 43 centers were enrolled. Ninety-day mortality rate was <5% for most groups. Benchmark value for one-year OS rate exceeded 85% across all subgroups, except for patients with ten or more CRLM (≥78%). Benchmark values for five-year OS rates were: ≥45% for solitary synchronous metastases and ≥58% for solitary metachronous ones (if ≤30 mm, ≥54% and ≥67%, respectively); ≥48% for 2-3 metastases; ≥28% for more than 3 metastases; and ≥29% for initially unresectable disease. Benchmark values for five-year RFS rates were: ≥22% for solitary synchronous metastases; ≥36% for solitary metachronous ones; ≥21% for 2-3 metastases; ≥15% for 4-9 metastases; ≥4% for 10 or more metastases; and ≥10% for initially unresectable disease.CONCLUSIONSLiver resection has an excellent oncologic effectiveness, even in patients with severe tumor burden. The reference standard values for key oncologic outcomes should serve as benchmarks for evaluating and testing alternative treatments.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"55 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792063","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":"Mesenteric Versus Conventional Approach During Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma (MAPLE-PD trial): A Multicenter Randomized Controlled Trial.","authors":"Seiko Hirono,Yuji Kitahata,Hideki Motobayashi,Sohei Satoi,Masayuki Sho,Hideki Takami,Keiko Kamei,Kazuto Shibuya,Masaaki Hidaka,Kenichiro Uemura,Kenjiro Kimura,Yuko Mataki,Yuichi Nagakawa,Hiromitsu Hayashi,Ryo Morimura,Masafumi Nakamura,Ke Wan,Toshio Shimokawa,Akimasa Nakao,Hiroki Yamaue, ","doi":"10.1097/sla.0000000000006900","DOIUrl":"https://doi.org/10.1097/sla.0000000000006900","url":null,"abstract":"OBJECTIVEThis multicenter randomized controlled trial investigated whether the mesenteric approach, which is an infracolic superior mesenteric artery (SMA)-first approach during pancreatoduodenectomy (PD), can improve survival in patients with pancreatic ductal adenocarcinoma (PDAC), compared to the Kocher-first conventional approach.SUMMARY BACKGROUND DATAThe mesenteric approach might improve surgical outcomes through a non-touch isolation technique for PDAC.METHODSThis trial was conducted in 24 Japanese high-volume centers. Patients who were scheduled to undergo PD for resectable PDAC or borderline resectable PDAC with portal vein invasion (BR-PV PDAC) were randomly assigned (1:1) via a central web-based application to the conventional or mesenteric approach. The primary endpoint was overall survival (OS). We also analyzed circulating tumor cell (CTC) DNA in the PV blood obtained during surgery. This trial is registered with ClinicalTrials.gov. NCT03317886, and UMIN Clinical Trials UMIN000029615.RESULTSBetween 2018 and 2021, 360 patients were randomly assigned to conventional (n=181) and mesenteric groups (n=179). With a median follow-up of 39.3 months, the median OS was comparable between conventional and mesenteric groups (41.7 vs. 39.3 months; hazard ratio 1.02, 95% confidence interval: 0.76-1.37, P=0.897). CTC analysis showed that the mean change in CTC DNA copy number in PV obtained at laparotomy and just before removal of the specimen was significantly different between the conventional (10.1±2.7) and mesenteric (-7.3±2.6) groups (P<0.001).CONCLUSIONSThe mesenteric approach does not improve survival in patients with resectable or BR-PV PDAC, although it might prevent spread of cancer cells via vessels during surgery through the non-touch isolation procedure.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"34 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792065","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":"Applied Artificial Intelligence: The Next Frontier.","authors":"Natalie M Guzman,Amy M Kilbourne,Dana A Telem","doi":"10.1097/sla.0000000000006879","DOIUrl":"https://doi.org/10.1097/sla.0000000000006879","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"1 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787084","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":"Ensuring Quality Surgical Care in the 21st Century.","authors":"Patricia L Turner,James Merlino,Genevieve B Melton,Ronald J Weigel","doi":"10.1097/sla.0000000000006885","DOIUrl":"https://doi.org/10.1097/sla.0000000000006885","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"27 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787011","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":"Refining Bariatric Surgery: A Nationwide 15-Year Study to Reduce Morbidity and Improve Recovery.","authors":"Olivier Muller,Camille Marciniak,Xavier Lenne,Vincent Chouraki,Grégory Baud,Mathilde Gobert,Johanna Vermeire,Mikael Chetboun,Helene Verkindt,Amelie Bruandet,Didier Theis,Francois Pattou,Robert Caiazzo","doi":"10.1097/sla.0000000000006881","DOIUrl":"https://doi.org/10.1097/sla.0000000000006881","url":null,"abstract":"OBJECTIVETo evaluate the evolution of postoperative mortality and morbidity associated with bariatric surgery over a 15-year period using a nationwide database.SUMMARY BACKGROUND DATABariatric surgery is a cornerstone in obesity management, demonstrating significant benefits in weight loss and comorbidity resolution. However, despite its proven efficacy, it remains underutilized, with only a small fraction of eligible patients undergoing surgery. Advances in surgical techniques and perioperative care have improved safety, yet long-term trends in mortality and morbidity require further evaluation.METHODSThis retrospective cohort study utilized data from the SNDS (Système National des Données de Santé), France's national healthcare database, covering all bariatric procedures performed between 2009 and 2023. Patients aged 18-65 years with a primary diagnosis of obesity were included. Outcomes assessed included 90-day and 180-day mortality, severe complications (Clavien-Dindo IV), reoperations, hospital readmissions, and postoperative medication use.RESULTSAmong 486,161 first-time bariatric procedures, sleeve gastrectomy (SG) and gastric bypass (GBP) dominated. The overall 90-day mortality rate was 0.1%, varying significantly by procedure (P<0.001), with AGB exhibiting the lowest rate. Mortality decreased by 40% over time, but SG and GBP showed a plateau effect since 2018. Reoperations declined (4.9% to 4.5%), and ICU admissions for severe complications fell by 58%. Medication analysis revealed reduced analgesic (-29.4%), antidepressant (-15.7%), and anxiolytic (-12.7%) use, while laxative consumption increased (+86.4%).CONCLUSIONSBariatric surgery has become safer over time, with declining mortality and complication rates. However, the stagnation of improvements in recent years highlights the need for further optimization strategies. These findings support the continued integration of surgery within a multimodal obesity treatment paradigm.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"11 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787012","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":"Bringing to Light the Invisible Lymphatic Anatomy of the Upper Extremity: Report From the 2024 Harvard Radcliffe Institute Accelerator Workshop.","authors":"James E Fanning,Leo L Tsai,Miguel A Amore,Rachelle Crescenzi,Katja N De Paepe,Kevin J Donohoe,Jeffrey H Maki,Timothy P Padera,Claus C Pieper,Hayley M Reynolds,Hiroo Suami,Dhruv Singhal","doi":"10.1097/sla.0000000000006893","DOIUrl":"https://doi.org/10.1097/sla.0000000000006893","url":null,"abstract":"OBJECTIVETo identify vulnerable upper extremity regions in native lymphatic anatomy that predispose women to the development of breast cancer-related lymphedema. Additionally, to identify currently available imaging technologies that could be repurposed for in-vivo lymphatic imaging of these anatomic regions and pathways.BACKGROUNDBreast cancer-related lymphedema remains an incurable complication of breast cancer treatment, but improvements to knowledge of upper extremity lymphatic anatomy and imaging can unlock new techniques for prevention and treatment.METHODS\"Bringing to Light the Invisible Lymphatic Anatomy of the Human Body\" was a two day accelerator workshop held in May 2024 at the Harvard Radcliffe Institute attended by sixteen experts in lymphatic anatomy and imaging including four lymphatic anatomists, five imaging clinicians, three lymphatic scientists, and three program officers from the National Heart, Lung and Blood Institute (NHLBI) and Advanced Research Projects Agency for Health (ARPA-H).RESULTSCollateral pathways of the superficial lymphatic system, perforating lymphatic vessels, and the deep lymphatic system were implicated in preventing or reducing the severity of BCRL. Several strategies were proposed for repurposing existing imaging technology and developing new imaging technology that can improve understanding of the anatomy, function, and connectivity of lymphatic vessels in these three regions of the arm.CONCLUSIONAdvancements in lymphatic imaging are central to refining our knowledge of lymphatic anatomy. Key challenges to lymphatic imaging are visualization of the deep lymphatic system and perforating lymphatic vessels.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"54 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787014","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":"Synthetic Data Generated by Artificial Intelligence to Optimize Surgical Trial Design.","authors":"Caterina Foppa,Saverio D'Amico,Mattia Delleani,Annalisa Maroli,Victor Savevski,Matteo Giovanni Della Porta,Michele Carvello,Marco Montorsi,Alessandro Repici,Cesare Hassan,Antonino Spinelli","doi":"10.1097/sla.0000000000006871","DOIUrl":"https://doi.org/10.1097/sla.0000000000006871","url":null,"abstract":"OBJECTIVEThis study aimed to assess artificial intelligence (AI)-based synthetic data (SD) generation technology in surgery, evaluating the accuracy of the generated data and comparing the derived outcomes with real-world data.SUMMARY BACKGROUND DATATrials evaluating new surgical techniques face numerous challenges. SD can play a pivotal role in optimizing clinical trial design but must be used alongside real-world data to ensure accuracy. Transanal transection and single-stapled anastomosis (TTSS) is a technique with the potential to decrease the anastomotic leak (AL) rate over the double-stapled (DS) technique, according to preliminary data.METHODSThe original dataset included consecutive patients undergoing minimally invasive Total Mesorectal Excision for rectal cancer with DS or TTSS anastomosis between 2010 and 2024. An AI-based generative model was trained to create high-fidelity SD, implemented and tested in a clinical trial setting using the 90-day AL rate as a primary endpoint.RESULTSWe created a synthetic copy of the original cohort (n=653) using the real data to train the model and evaluate its performance using the Synthetic vAlidation FramEwork powered by Train (SAFE). The comparison between synthetic vs real data demonstrated high statistical fidelity, clinical utility, and privacy preservation. We conditionally generated a balanced cohort (n=1200) with an equal number of patients for both types of anastomoses and strong performances using SAFE. The SD analysis confirmed real data findings, showing a significantly lower AL rate in the TTSS cohort (P<0.0001).CONCLUSIONSAI-generated SD showed a high fidelity in replicating the statistical properties and complexity of the clinical features observed in the real-world population being a very promising tool to improve surgical research.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"121 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144787428","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":"Failure to Rescue in Early Versus Late Severe Anastomotic leakage after Colorectal Surgery: A Population-based Multicenter Study.","authors":"Marie T Grönroos-Korhonen,Laura Koskenvuo,Panu J Mentula,Ville J Sallinen","doi":"10.1097/sla.0000000000006864","DOIUrl":"https://doi.org/10.1097/sla.0000000000006864","url":null,"abstract":"OBJECTIVEWe aimed to assess the failure-to-rescue (FTR) rates for severe early and late anastomotic leakage (EAL and LAL) after elective and emergency colorectal surgery.BACKGROUNDSevere anastomotic leakage (AL), defined as the need for reoperation (grade C), is a potentially fatal complication of colorectal surgery. Severe AL can occur within a variable timeframe post-surgery and is divided into EAL and LAL.METHODSThis population-based, retrospective, multicenter cohort study included adult patients with severe AL who underwent elective or emergency colorectal surgery between 2006 and 2017. FTR was defined as the 90-day mortality rate after reoperation. Cut-off point for EAL and LAL was defined at the sixth postoperative day.RESULTSOverall, 8,562 patients underwent colorectal surgery, of whom 283 (3.3%) had severe AL (EAL: 168 [2.0%]; LAL: 115 [1.3%]). The FTR rates were 13.7% and 20.0% in patients with EAL and LAL, respectively (P=0.158). FTR was significantly higher after emergency index operation versus elective index operation for all patients (29.1% vs. 10.7, P<0.001) and those with EAL (35.9% vs. 7.0%, P<0.001), whereas no significant difference was noted in patients with LAL. After elective index operation, FTR was significantly higher in the LAL group versus EAL group (17.6% vs. 7.0%, P=0.021). Age >80 years, body mass index <20 kg/m², longer operative time, and having at least one complication prior to AL detection were independent risk factors for FTR after severe AL.CONCLUSIONSThe FTR rate after severe AL is dependent on the timeframe of its occurrence and urgency of the index operation.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"58 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144778088","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 Validation of NerveTrend vs. NerveAssure Mode of Intraoperative Neuromonitoring in Prevention of Recurrent Laryngeal Nerve Injury During Thyroid Surgery: A Randomized Controlled Trial.","authors":"Marcin Barczyński,Mateusz Dworak,Karolina Krakowska,Agnieszka Pac,Aleksander Konturek","doi":"10.1097/sla.0000000000006872","DOIUrl":"https://doi.org/10.1097/sla.0000000000006872","url":null,"abstract":"OBJECTIVETo compare two modes of NIM Vital application in thyroid surgery: NerveTrendTM vs. NerveAssureTM with respect to the prevalence of postoperative recurrent laryngeal nerve (RLN) injury.BACKGROUNDThe use of NerveTrendTM compared to intermittent neuromonitoring (i-IONM) in thyroid surgery has recently been reported to result in a tendency towards reduced RLN injury on postoperative day 1 (POD1) and a significant decrease in the need for staged thyroidectomy. However, it remains unclear whether this technique is inferior to continuous neuromonitoring (NerveAssureTM).METHODSprospective, single-center, two-arm randomized clinical trial. The primary outcome was the prevalence of RLN injury on POD1. In the NerveTrendTM group, the surgeon-operated i-IONM stimulation probe was used for trending amplitude and latency changes from the initial vagal electromyographic baseline (at pace based on surgical judgment) to tailor the surgical strategy. In the NerveAssureTM group, it was performed using an Automatic Periodic Stimulation (APS) electrode placed on the vagus nerve.RESULTSA total of 264 patients were randomized into the intervention group (NerveTrendTM) and the control group (NerveAssureTM), 132 patients, and 264 nerves at risk (NAR), each. RLN injury was found on POD1 in 3/264 (1.14%) versus 1/264 (0.38%) NAR, whereas staged thyroidectomy was not necessary in any of the patients in the study (P=0.624 and P=1.0, respectively).CONCLUSIONSNerveTrendTM mode was not inferior to the NerveAssureTM mode in thyroid surgery with respect to the risk of RLN injury, and both modes had the potential to abolish the need for staged thyroidectomy.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"15 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144778132","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}