Annals of the Royal College of Surgeons of England最新文献

{"title":"Vitamin D deficiency and thyroid cancer: is there a true association? A prospective observational study.","authors":"S Lanitis, V Gkanis, S Peristeraki, P Chortis, N Kalogeris, A Vryonidou","doi":"10.1308/rcsann.2024.0041","DOIUrl":"10.1308/rcsann.2024.0041","url":null,"abstract":"<p><strong>Introduction: </strong>Literature data indicate a correlation between vitamin D deficiency and thyroid cancer (TC). We conducted this observational study to test this hypothesis.</p><p><strong>Methods: </strong>We studied 327 consecutive thyroidectomy cases, and compared patients with TC and those who had benign thyroid disease (BTD). In total, 183 cases with well-differentiated TC (group B) were compared with 144 cases of BTD (group A). We defined 25-hydroxyvitamin D (25(OH)VitD) values <10ng/ml as severe vitamin D deficiency (15.4%), 10-30ng/ml as inadequacy (70.4%) and >30ng/ml as adequate (14.2%). We further used a cut-off point of 30ng/ml (used in a recent meta-analysis) to classify patients as vitamin D deficient or not.</p><p><strong>Results: </strong>There was no statistically significant difference in the following: age, size of the thyroid gland, preoperative calcium levels, preoperative parathormone and vitamin D levels, body mass index and anti-thyroid antibodies. Only thyroid-stimulating hormone and weight of the thyroid gland were found to differ. There was no significant difference in mean vitamin D levels (group A = 19.82ng/ml [sd 9.59] vs group B = 19.69ng/ml [sd 11.34]; <i>p</i> = 0.917). The same was found when we compared the two groups according to the three categories of vitamin D values (deficiency, inadequacy, adequacy; <i>p</i> = 0.485) and when we performed the analysis based on all threshold levels (10, 20 and 30ng/ml; <i>p</i> = 0.328). Using various statistical methods, no correlation was found between vitamin D deficiency and differentiated TC (overall, microcarcinomas, macrocarcinomas).</p><p><strong>Conclusions: </strong>Based on our results, no correlation between vitamin D deficiency and TC was confirmed, contradicting and questioning the results of two recent meta-analyses.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":"423-428"},"PeriodicalIF":1.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12208738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal therapy and precision-imaging extends the limits of treatment for a patient with initially unresectable synchronous colorectal liver metastases.","authors":"M Sidhom, V Morrison-Jones, S Harinarayanan, L Nolan, F Welsh","doi":"10.1308/rcsann.2025.0031","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0031","url":null,"abstract":"<p><p>The cancer journey of a young patient who presented with an obstructing metastatic (Stage 4) colon cancer is described. The addition of bevacizumab to an established chemotherapy regimen of 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX) ameliorated their chemotherapy-associated liver injury (CALI). This improvement in liver quality was demonstrated non-invasively with multi-parametric magnetic resonance imaging (mpMRI). Both the response to chemotherapy and the improvement in liver quality provided by additional bevacizumab allowed this patient with initially unresectable synchronous colorectal liver metastases to undergo resection of their bowel primary, followed by an extended liver resection, uncomplicated by post-hepatectomy liver failure (PHLF). They had subsequent planned ablative therapy with stereotactic ablative radiotherapy (SABR) to a residual central metastasis, and are currently disease free. This case illlustrates the importance of a multi-modal, multidisciplinary and individualised approach to patients' cancer care.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144493755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of short-term functional outcomes of colorectal resections in older adults aged 75 years and older: a prospective single health board cohort study.","authors":"V May, C MacKay, G Ramsay","doi":"10.1308/rcsann.2025.0042","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0042","url":null,"abstract":"<p><strong>Introduction: </strong>The global increase in life expectancy is likely to lead to a higher number of older patients undergoing colorectal resections. This is an understudied cohort, with available data concentrating on generic surgical outcomes such as postoperative complications and mortality rates. Few studies have explored quality of life and return to baseline in this cohort.</p><p><strong>Methods: </strong>Inpatient outcome data on all patients aged 75 years and over who underwent colorectal resection in our region between 2018 and 2023 were collected prospectively. Patient characteristics, complication rates, functional decline and mortality data were documented. These data were supplemented with a subsequent review of death, readmission, and admission to a non-own home environment post-surgery.</p><p><strong>Results: </strong>Of 408 colorectal surgery patients, 303 were elective and 105 were emergency cases. Of these cases, 59.4% (<i>n</i> = 180) of elective cases and 71.4% (<i>n</i> = 75) of emergency patients experienced a postoperative complication. In total, 35.5% of patients experienced a functional decline with reduced mobility or ability to perform independent care. Emergency patients (<i>n</i> = 21, 20%) demonstrated a higher mortality rate at 1 year than elective cases (<i>n</i> = 25, 8.3%).</p><p><strong>Conclusion: </strong>Colorectal surgery in patients aged 75 years and older presents significant risks, particularly in emergencies. This study documents high rates of functional decline, complications and mortality in elderly patients. It highlights the need for individualised surgical care planning and enhanced perioperative counselling, and helps quantify this functional deterioration.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nonemergency colectomy for inflammatory bowel disease: the National Consultant Information Programme (NCIP) used to highlight colorectal surgery practice and outcomes in England 2018-2022.","authors":"A Galla, E Okoye, M Booth, L Young, A Taib, N Williams, J Hatt, C Maxwell-Armstrong","doi":"10.1308/rcsann.2025.0041","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0041","url":null,"abstract":"<p><strong>Introduction: </strong>The National Consultant Information Programme (NCIP) tool provides a platform for NHS consultants to benchmark their practice and for trusts to have a purview of the range, variation and outcomes of surgical procedures. Surgery remains an effective strategy for the treatment of inflammatory bowel disease (IBD) despite advances in medical therapy. This study leverages the NCIP data to assess the current trends of colectomies for IBD and the impact of COVID-19.</p><p><strong>Methods: </strong>Pseudonymised data (demographics, number and types of colectomy per provider, resection approach and stoma formation) were collected from the NCIP for IBD Dashboard and analysed against outcomes such as readmission, length of hospital stay and mortality.</p><p><strong>Results: </strong>A total of 132 providers performed 3,907 colectomies for Crohn's and 1,942 colectomies for ulcerative colitis (UC), with 76 (57.58%) performing more than 20 cases over the four-year period. More cases were performed laparoscopically, 55.46% and 61.17% for Crohn's and UC, respectively. Transverse colectomy had the highest readmission rate (29%) for Crohn's, whereas ileoanal anastomosis was highest at 29.37% for UC. Mortality rate was 0.23% and 0.82% for Crohn's and UC, respectively. Length of hospital stay was increased significantly in both Crohn's disease and UC by open procedure and stoma creation.</p><p><strong>Conclusions: </strong>This study showed significant variation in practice across centres, with the volume of procedures performed in each centre being an influencing factor in the variation, especially when considering the incidence of stoma creation and surgical approach. This achieved the aim of the NCIP to keep a benchmark of standardisation across NHS practice.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustainability in breast surgery: a narrative review and guide for change.","authors":"J Worsfold, S Saha","doi":"10.1308/rcsann.2025.0036","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0036","url":null,"abstract":"<p><strong>Introduction: </strong>The purpose of this review was to evaluate sustainable interventions in breast surgery that reduce carbon dioxide equivalent (CO₂e) emissions and financial costs, supporting the National Health Service (NHS) goal of net zero carbon emissions by 2040.</p><p><strong>Methods: </strong>A literature search was conducted using MEDLINE via PubMed up to 2024, targeting studies on sustainability in breast surgery. Search terms included sustainability-related and breast surgery-specific keywords. Owing to limited evidence, a narrative review was performed, incorporating findings from published literature, local audits and environmental impact assessments. Interventions were analysed across the perioperative pathway.</p><p><strong>Findings: </strong>Only one study specifically addressed sustainability in breast surgery, highlighting a significant evidence gap. However, multiple practical interventions were identified. The use of total intravenous anaesthesia reduced CO₂e emissions by more than 90% compared with inhalational agents. Reusable surgical gowns and drapes offered a lower CO₂e (0.44kg vs 0.77kg per gown) and were cost effective. Switching from intravenous to oral paracetamol saved 47kg CO₂e annually and reduced costs (£0.02 vs £0.49 per dose). Other sustainable practices included waste segregation, minimising unused equipment and implementing electronic documentation. Local audits revealed that 7.5% of opened sutures were unused, highlighting opportunities to reduce waste.</p><p><strong>Conclusions: </strong>Simple, sustainable changes in breast surgery can significantly reduce both environmental and financial costs. Despite a lack of robust data, practical measures already in use show clear benefits. Future research should focus on whole lifecycle analyses of sustainable interventions, providing evidence to support sustainable practices. Incorporating these interventions across surgical disciplines can meaningfully contribute to achieving NHS net zero goals.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal timing of chest radiograph following chest tube removal in detecting recurrent pneumothorax: analysis of 163 patients with thoracic stab wounds at a major trauma centre in South Africa.","authors":"V Kong, J Ko, C Cheung, H Lee, R He, J Wang, D Clarke","doi":"10.1308/rcsann.2025.0018","DOIUrl":"10.1308/rcsann.2025.0018","url":null,"abstract":"<p><strong>Introduction: </strong>Routine chest radiograph (CXR) following chest tube removal is a common practice, yet the optimal timing of CXR in detecting recurrent pneumothorax (RPTX) remains unknown. This study reviewed the incidence of RPTX and its relationship to the timing of the detection of CXR.</p><p><strong>Methods: </strong>A prospective study was conducted over a 24-month period on patients with thoracic stab wounds who underwent CXR following chest tube removal at a major trauma centre in South Africa.</p><p><strong>Results: </strong>One hundred and sixty-three patients were included (91% male, mean age: 25 years). Eleven patients (7%) had RPTX, one (9%) of whom required reinsertion of a chest tube. No patients were readmitted following discharge. The timing of the CXR was: <2h (11%), 2-4h (21%), 4-6h (28%), 6-8h (31%) and >8h (9%). Of the 11 RPTX, 55% were detected on CXR at <2h, 36% at 2-4h, 9% at 4-6h, 0% at 6-8h (0%) and 0% at >8h. All RPTX were detected within <6h of chest tube removal. There was no re-presentation of any patients following discharge.</p><p><strong>Conclusion: </strong>RPTX following chest tube removal is uncommon, and the need for reintervention is low. All patients with RPTX were detected on CXR obtained within 6h of removal. It would appear that routinely delaying CXR anytime beyond 6 hours is unnecessary.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Theatre etiquette Delphi: the development of a guide on professional conduct and best practices in operating environments.","authors":"M El Boghdady, J Hardie, P A Brennan","doi":"10.1308/rcsann.2025.0040","DOIUrl":"10.1308/rcsann.2025.0040","url":null,"abstract":"<p><strong>Introduction: </strong>The importance of non-technical skills (NTS) to surgical performance and patient safety has been increasingly recognised by surgical teams. Inductions for new surgical team members in theatre often provide insufficient, non-standard and 'ad hoc' training in theatre behaviour and etiquette. We conducted a Delphi consensus study among senior surgeons to develop standardised guidance on theatre etiquette for those unfamiliar with the theatre environment, including resident surgical trainees and medical students.</p><p><strong>Methods: </strong>An international Delphi process of two rounds was conducted. An electronic survey was distributed among senior surgeons, anaesthetists and senior scrub nurses/practitioners, with participants recruited via surgical societies. Participants were asked to rank each statement on a Likert scale of 1 to 5. Consensus was considered if achieved for any statement for which 75% or more indicated agreement. The study was registered with the Open Science Framework.</p><p><strong>Results: </strong>A total of 261 participants completed the Delphi process; 239 valid responses were included in round 1, with a 23% dropout in round 2. Participants were from 23 countries, 66% were from the UK, 58.2% were male, 51% were from the 30 to 40-year age group, 39% were consultant surgeons and 49% were senior trainees. General surgeons made up 68.6% of respondents, trauma and orthopaedic surgeons 13.4%, healthcare practitioners 2.1% and anaesthetists 1.3%. Thirteen statements were excluded, and 29 reached agreement and were included in the final guidance.</p><p><strong>Conclusion: </strong>There was agreement among a large international group of surgeons to develop a standardised guidance for theatre etiquette, addressing most of the key aspects of professional conduct and team dynamics. We anticipate that this guidance will serve as a valuable resource for orienting new members of the surgical team, providing a clear framework for maintaining professionalism and fostering effective communication within the theatre environment.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of reverse shoulder arthroplasty as a day case procedure: a population-based cohort study using the National Joint Registry and Hospital Episode Statistics.","authors":"O O'Malley, A Davies, A Rangan, S Sabharwal, P Reilly","doi":"10.1308/rcsann.2025.0035","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0035","url":null,"abstract":"<p><strong>Introduction: </strong>Reverse shoulder arthroplasty (RSA) is the most common shoulder replacement in the United Kingdom and has traditionally been an inpatient procedure. Advances in anaesthetic and surgical techniques have made day case RSA increasingly popular, yet published data on its outcomes are limited. This study assesses the outcomes of day case RSA using the National Joint Registry (NJR).</p><p><strong>Methods: </strong>NJR data (April 2012-March 2022) were linked with Hospital Episode Statistics. All patients undergoing RSA for any indication were included. Primary outcomes were revision surgery rates; secondary outcomes included non-revision reoperation, medical complications requiring readmission and patient-reported outcomes for day case vs non-day case patients.</p><p><strong>Results: </strong>Among 320 day case and 25,748 non-day case RSA patients, day case patients were younger, predominantly male and had lower comorbidity scores. Day case revision rates were 1.45% at 1 year, 1.93% at 3 and 5 years, and 3.96% at 7 years compared with 1.76%, 2.84%, 3.53% and 4.35% for non-day cases. Readmissions for medical complications occurred in 1.56% of day case patients vs 6.34% of non-day cases. Mean Oxford Shoulder Score improvements were 19.83 (±11.32) and 19.16 (±11.80) for day and non-day case groups, respectively.</p><p><strong>Conclusion: </strong>Day case RSA demonstrates low revision, reoperation and complication rates, with similar patient satisfaction to non-day cases. These findings highlight the safety of day case RSA with careful patient selection and its potential to improve healthcare efficiency from a policy perspective.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A national survey of the diagnosis and management of Ménière's disease among ENT consultants, UK.","authors":"S Parihar, F S Koumpa, C Neumann, R G Kanegaonkar","doi":"10.1308/rcsann.2025.0028","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0028","url":null,"abstract":"<p><strong>Introduction: </strong>Ménière's disease (MD) is a rare condition whose diagnosis can be challenging. The American Academy of Otorhinolaryngology-Head and Neck Surgeons (AAO-HNS) has published new guidance to facilitate the diagnosis of MD. We surveyed ear, nose and throat (ENT) consultants in the United Kingdom (UK) to assess their confidence in diagnosing MD, their use of the AAO-HNS guidance and current diagnostic and treatment approaches.</p><p><strong>Methods: </strong>An online questionnaire was distributed. It asked respondents to anonymously rank their confidence in diagnosing MD, identify the minimum investigations required to make a diagnosis, describe their use of the AAO-HNS criteria, share their preferred treatment for acute attacks and state first- and second-line preventative treatment options.</p><p><strong>Results: </strong>A total of 86 responses were collected. In total, 88% of respondents reported high levels of confidence in diagnosing MD. Most respondents (29.1%) stated the minimum tests required were 'history', 'otoscopy', 'pure tone audiometry' and 'MRI' (magnetic resonance imaging), although some chose as few as one test (3.49%) and others up to seven (1.2%). Regarding use of the AAO-HNS criteria, responses ranged from 'always' (34.9%) to 'never' (20.9%). Prochlorperazine was the first-line treatment for acute attacks for 81.4% of respondents. Betahistine (38.4%) and dietary restrictions (37.2%) were recommended almost equally as first-line preventative measures. The most popular second-line measure was intratympanic steroids (34.9%), followed by betahistine (24.4%).</p><p><strong>Conclusion: </strong>Our survey revealed wide disparities in the diagnosis and management of MD by ENT consultants in the UK, and AAO-HNS guidelines were not universally used. We propose developing greater consensus and intend to conduct a similar international survey to gather a broader perspective.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute exertional compartment syndrome of the supraspinatus.","authors":"S Walters, S Yousaf, M Baker, V Patel","doi":"10.1308/rcsann.2025.0019","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0019","url":null,"abstract":"<p><p>Acute exertional compartment syndrome (AECS) is increasingly recognised as an emergency presentation requiring urgent surgical intervention. This can theoretically affect any myofascial compartment, but is rare around the shoulder, with very limited literature relating to AECS of the supraspinatus muscle. It is vital for the treating medical team to have an index of suspicion for this condition in patients presenting with acute severe shoulder pain secondary to exertion, and act promptly to assess and investigate. Clinical assessment can be combined with important adjunctive investigations including magnetic resonance imaging and compartment pressure measurement, and if the diagnosis is confirmed or strongly suspected, emergency fasciotomy should be performed. We present a case of a patient with AECS of the supraspinatus, treated with emergency fasciotomy, who made a good long-term recovery.</p>","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}