Canadian Journal of Surgery最新文献

{"title":"Environmental sustainability in the operating room: perspectives and practice patterns of general surgeons in Canada.","authors":"Odelle Ma, Valentin Mocanu, Carmen Ng, Madeleine Kruth, Andrea Lin, Kevin Verhoeff, Shahzeer Karmali, David Bigam","doi":"10.1503/cjs.012325","DOIUrl":"10.1503/cjs.012325","url":null,"abstract":"<p><p>SummaryAs key contributors to surgical emissions and leaders in the operating room (OR) environment, surgeons are uniquely poised to address surgical sustainability. The University of Alberta conducted a survey to characterize Canadian general surgeons' attitudes on OR sustainability, identify practice patterns nationwide that contribute to the OR carbon footprint, and gather ideas on improving environmental sustainability within surgery. The survey completion rate was 19.8%, with a total of 270 responses. Most surgeons agreed that environmental sustainability in the OR is important and that there is room for improving sustainability in their surgical practices. Most surgeons routinely use disposable materials during an elective laparoscopic cholecystectomy. We identified 3 common perceived barriers to implementing sustainable practices: a lack of reusable options, poor quality of reusable alternatives, and restrictions from the administrative level. We suggest a variety of strategies for improving sustainability at the individual, institutional, and national levels.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E84-E89"},"PeriodicalIF":2.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218440","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":"Provincial agreements for pregnant and parenting orthopedic surgery residents: a call for a national residency guideline.","authors":"Laura J Morrison, Annalise G Abbott, Kristen I Barton, Pascale Thibaudeau, Laurie Hiemstra","doi":"10.1503/cjs.015623","DOIUrl":"10.1503/cjs.015623","url":null,"abstract":"<p><p>SummaryIn Canada, orthopedic surgery residents who identify as women face unique challenges regarding family planning during training. We investigated provincial policies on pregnancy, parental leave, and return to work in 8 provinces across Canada. We also explored the British Orthopaedic Association (BOA) guideline as a potential model for improving support for Canadian orthopedic surgical residents during pregnancy, parental leave, and professional development. Our analysis reveals disparities in duty hours, parental leave benefits, and pregnancy-related restrictions. For instance, Quebec allows relief from call duties at 20 weeks' getation, while Manitoba, Nova Scotia, and Saskatchewan mandate waiting until 28 weeks. Duty-hour restrictions vary across provinces, with British Columbia setting a limit of 12-hour shifts and Quebec setting it at 8 hours. Pay during parental leave also varies, with top-ups ranging from 84% to 100%, inconsistently available to nonbirthing or adoptive parents. Current agreements fail to support informed family planning decisions and lack robust strategies for risk mitigation. We propose implementing a standardized national guideline based on the BOA model. This guideline would offer clear policies for trainees during pregnancy, parental leave, and return to work, along with strategies to minimize occupational hazards. Adoption of such a guideline would empower trainees, promote inclusivity, and encourage more women to consider careers in orthopedic surgery.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E97-E101"},"PeriodicalIF":2.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218646","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":"Assessing the fragility index of randomized controlled trials on carotid artery stenosis: a systematic review.","authors":"Eva Liu, Natalie Tilbury, Amy Zhou, Hsuan Ming Su, Braeden D Newton, Amit Persad, Uzair Ahmed, Lissa Ogieglo, Michael Kelly","doi":"10.1503/cjs.008525","DOIUrl":"10.1503/cjs.008525","url":null,"abstract":"<p><strong>Background: </strong>The fragility index (FI) measures the robustness of randomized controlled trials (RCTs) with dichotomous outcomes, calculated as the number of patients whose outcome would need to change for a significant result to become non-significant. Many RCTs have compared carotid endarterectomy (CEA) and carotid artery stenting (CAS), with variable results; thus, in this systematic review, we sought to explore the FI as a possible explanation for the variability in trial results between CEA and CAS.</p><p><strong>Methods: </strong>We conducted a search in MEDLINE (1946 to Apr. 22, 2024), Embase (1974 to Apr. 22, 2024), and PubMed (up to Apr. 22, 2024) for RCTs comparing CEA and CAS. We included RCTs with statistically significant results and dichotomous primary outcomes.</p><p><strong>Results: </strong>Our literature search identified 11 RCTs involving 5296 patients (<i>n</i> = 2640 CEA, <i>n</i> = 2656 CAS). All studies except 1 favoured CEA, with the exception favouring CAS. The median FI was 11 (interquartile range 2 to 22). Interestingly, 100% of the studies had loss to follow-up (LTFU) greater than its FI.</p><p><strong>Conclusion: </strong>A small number of events is required to change the findings of RCTs comparing CEA to CAS from statistically significant to statistically nonsignificant. All studies that reported LTFU had LTFU greater than its FI, calling into question the robustness of these results.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E90-E96"},"PeriodicalIF":2.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218425","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":"Les médecins mis à mal par François Legault.","authors":"Edward J Harvey","doi":"10.1503/cjs.003826","DOIUrl":"10.1503/cjs.003826","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E104-E105"},"PeriodicalIF":2.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218408","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":"Surgical outcomes in nonagenarian versus octogenarian patients: a propensity-matched analysis with implications for shared decision-making.","authors":"Fahim Kanani, Eduard Khabarov, Andrey Chopen, Nir Messer, Narmin Zoabi, Alaa Zahalka, Mordechai Shimonov, Catia Dayan, Moshe Kamar","doi":"10.1503/cjs.009525","DOIUrl":"10.1503/cjs.009525","url":null,"abstract":"<p><strong>Background: </strong>Although surgical outcomes among octogenarian patients are well documented, evidence for nonagenarian patients is limited. We sought to compare surgical outcomes between these age groups to guide clinical decision-making.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study (2013 to 2023) with 1:1 propensity-score matching. We included patients aged 80 to 99 years who underwent general surgery. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 90-day and 1-year mortality, functional status at last follow-up, complications (Clavien-Dindo classification), and hospital readmissions.</p><p><strong>Results: </strong>From 700 screened patients aged 80 to 99 years who underwent general surgery, 174 met inclusion criteria (73 nonagenarian and 101 octogenarian patients), yielding 73 matched pairs for analysis. Nonagenarian patients had significantly higher 30-day mortality (26.0% v. 9.6%, <i>p</i> = 0.02), 90-day mortality (49.3% v. 23.3%, <i>p</i> = 0.002), and 1-year mortality (75.3% v. 39.7%, <i>p</i> < 0.001) than octogenarian patients. At last follow-up (median 11 to 12 mo), poor functional status was observed in 34.2% of nonagenarian versus 23.3% of octogenarian patients. Hospital readmissions within 30 days occurred in 42.5% of nonagenarian versus 21.9% of octogenarian patients (<i>p</i> = 0.002). Despite propensity matching, the Fried frailty phenotype remained significantly imbalanced between groups (standardized mean difference 0.714, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Nonagenarian patients face substantially worse surgical outcomes than octogenarian patients, with nearly triple the 30-day mortality and high rates of functional impairment among survivors. The persistent frailty imbalance despite matching suggests inherent selection bias in surgical nonagenarians. Unlike octogenarians, for whom selective surgery may be justified, these findings support careful consideration of nonoperative management as the default approach for nonagenarians, with surgery reserved for highly select cases after comprehensive geriatric assessment and thorough shared decision-making with the patient.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E71-E83"},"PeriodicalIF":2.2,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117905","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":"The migration of hysteroscopy from the operating room to an ambulatory setting.","authors":"John Thiel, Chelsie Warshafsky, Tin Yan Ngan, Chandrew Rajakumar, Margot Rosenthal, Liane Belland, Olga Bougie, Meghan O'Leary","doi":"10.1503/cjs.008825","DOIUrl":"10.1503/cjs.008825","url":null,"abstract":"<p><p>SummaryThe relocation of appropriate gynecologic procedures, such as diagnostic and operative hysteroscopy, from the operating room to an ambulatory setting meets all 3 arms of Kissick's \"Iron Triangle\": providing quality care with improved access without an associated increase in cost to the system.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E68-E70"},"PeriodicalIF":2.2,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117876","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":"The impact of incomplete colonoscopies: a single-centre retrospective study.","authors":"Rim Abdelli, Tania Smith-Doiron, Shanel Normandin, Sonia Gabriela Cheng-Oviedo, Valérie Leblanc, Nathalie McFadden","doi":"10.1503/cjs.003425","DOIUrl":"10.1503/cjs.003425","url":null,"abstract":"<p><strong>Background: </strong>Screening for colorectal cancer reduces mortality by enabling early detection. In Quebec, follow-up within 60 days after an incomplete colonoscopy is recommended. In this study, we sought to assess the impact of delays in follow-up on patient outcomes.</p><p><strong>Methods: </strong>In this retrospective study, we included adults who underwent a colonoscopy following a positive immunochemical fecal occult blood test at the Centre intégré universitaire de santé et de services sociaux de l'Estrie-Centre hospitalier de l'université de Sherbrooke between Jan. 1, 2013, and Dec. 31, 2015. We verified colonoscopy adequacy and guideline adherence. We classified advanced polyps and colorectal cancer as clinically significant lesions (CSLs) to assess the clinical impact of incomplete or missing follow-up colonoscopies.</p><p><strong>Results: </strong>In 89 cases of incomplete colonoscopies, inadequate bowel preparation was the leading cause of exam interruption (61.8%). A total of 57 patients had a subsequent follow-up, and 23 colonoscopies were completed within the 60-day time frame. Six CSLs, including advanced polyps and cancer, were detected within the recommended 60-day time frame, and 4 were identified after 60 days. We found a statistically significant difference in the rates of colorectal cancer diagnosis (<i>p</i> < 0.001), the need for surgery (<i>p</i> < 0.02), and death (<i>p</i> < 0.001) between patients who had a complete colonoscopy diagnostic process and those who did not.</p><p><strong>Conclusion: </strong>The poorer prognosis associated with patients who had a delayed or missing follow-up highlights the importance of respecting provincial guidelines concerning follow-up after incomplete colonoscopies.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E59-E67"},"PeriodicalIF":2.2,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117922","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":"Health care costs of major upper-extremity amputations in Ontario: a retrospective matched-cohort analysis with considerations for transplantation.","authors":"Çağdaş Duru, Nina Hadzimustafic, Siba Haykal","doi":"10.1503/cjs.000525","DOIUrl":"10.1503/cjs.000525","url":null,"abstract":"<p><strong>Background: </strong>Major upper-extremity amputation, defined as loss above the wrist, profoundly affects all aspects of life and imposes substantial health care burdens. Standard care involves prosthetics, which have limitations, while vascularized composite allotransplantation (VCA) offers improved functionality but raises cost-effectiveness concerns. We sought to evaluate health care use and cost of major upper-extremity amputation in Ontario.</p><p><strong>Methods: </strong>We conducted a 20-year retrospective matched-cohort study using administrative health care data from Ontario. We matched patients with major upper-extremity amputations (April 2002 to March 2023) 4:1 with general population and hospital-based trauma controls. We analyzed health care use and costs by follow-up duration (1 yr, 1 to 4 yr, 5 to 9 yr, > 10 yr).</p><p><strong>Results: </strong>We identified 617 patients with a mean follow-up of 6.95 years, including 41.7% with traumatic amputations and 58.3% with nontraumatic amputations. Forearm-level amputations were most common. Median health care costs were $52 661 (interquartile range [IQR] $22 009 to $120 120) for traumatic amputations and $90 928 (IQR $43 128 to $213 034) for nontraumatic amputations, both exceeding controls. Bilateral amputations incurred higher costs than unilateral amputations ($104 895 [IQR $41 290 to $243 967] for traumatic and $117 006 [IQR $68 447 to $226 491] for nontraumatic cases), excluding prosthetics. Total treatment costs with myoelectric prosthetics exceeded $344 895 for patients with bilateral amputations and $171 860 for those unilateral amputations, surpassing prior projections.</p><p><strong>Conclusion: </strong>Although lifetime VCA costs remain higher than for prosthetics, the lack of Canadian utility measures, societal cost data, and return-to-work outcomes underscores the need for further study to assess whether the functional and quality-of-life benefits could justify these expenditures for patients with bilateral amputations.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E48-E58"},"PeriodicalIF":2.2,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008908","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":"Reconstructive surgery and immigration status among females with breast cancer.","authors":"Olivia Lovrics, David Kirkwood, Christopher J Coroneos, Gregory Pond, Nicole Hodgson, Aristithes G Doumouras, Jessica Bogach, Mark Levine, Elena Parvez","doi":"10.1503/cjs.012324","DOIUrl":"10.1503/cjs.012324","url":null,"abstract":"<p><strong>Background: </strong>Immigrants are susceptible to marginalization within health care systems, and breast reconstruction after mastectomy is a procedure prone to disparities in delivery. We sought to measure differences in immediate and delayed reconstruction between immigrant and nonimmigrant females with breast cancer in urban Ontario, Canada.</p><p><strong>Methods: </strong>We conducted a retrospective population-based study using linked administrative databases held at ICES. We included female patients with stage I to III breast cancer, diagnosed from January 2010 through April 2016, who were treated with mastectomy. We excluded those with in situ disease only, missing staging data, another cancer diagnosis, no provincial health coverage, or rural residence. We categorized patients as immigrants if they arrived in Canada from 1985 onward. We compared the proportions of immigrants and nonimmigrants who underwent breast reconstruction.</p><p><strong>Results: </strong>We identified 2174 immigrants and 12 052 nonimmigrants. Immigrants were younger (mean age 53.3 yr v. 62.2 yr) and more often had stage III disease (32.8% v. 29.7%). They were less likely to undergo reconstruction (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.48 to 0.62). In stratified analyses by age (< 50 yr and ≥ 50 yr), compared with nonimmigrants, the odds ratio for reconstruction was 0.51 (95% CI 0.44 to 0.60) in immigrants younger than 50 years and 1.12 (95% CI 0.94 to 1.30) in those aged 50 years and older. The difference between groups was more pronounced for delayed (OR 0.48, 95% CI 0.41 to 0.56) than immediate (OR 0.83, 95% CI 0.68 to 1.00) reconstruction. Immigrants were less likely to undergo reconstruction regardless of disease stage. Those from East Asian or Pacific, South Asian, and sub-Saharan African regions were least likely to undergo reconstruction.</p><p><strong>Conclusion: </strong>Immigrant females were less likely to undergo breast reconstruction than nonimmigrant females. This study identified subgroups for further research to understand how to ensure equitable access to this important health care resource.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E38-E47"},"PeriodicalIF":2.2,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12854801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146008865","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":"The burden of trauma in Eeyou Istchee (Cree territories, James Bay): epidemiology, transfers, and patient outcomes.","authors":"Hamad Alsuwaidi, Jeongyoon Moon, Steven Di Marco, Gregory Clark, Evan Wong, Kosar Khwaja, Dan Deckelbaum, Guillaume Groleau, Jeremy Grushka","doi":"10.1503/cjs.011325","DOIUrl":"10.1503/cjs.011325","url":null,"abstract":"<p><strong>Background: </strong>In this study, we sought to characterize the epidemiologic features of trauma in Eeyou Istchee and describe outcomes for patients referred to our institution. Our primary objectives were to better define the regional burden of injury, identify potentially hidden trauma mortality, and explore opportunities for injury prevention and trauma system optimization in this unique setting in northern Quebec.</p><p><strong>Methods: </strong>We conducted a retrospective review of our institutional trauma registry, identifying all trauma patients transferred to the Montreal General Hospital from Eeyou Istchee between 2012 and 2022. We extracted and analyzed patient demographics, mechanisms of injury, and outcomes. We also reviewed the coroner's reports for all trauma-related deaths in Eeyou Istchee over the same period. We used descriptive statistics for analysis.</p><p><strong>Results: </strong>A total of 587 patients (aged 18 to 91 yr) were transferred, including 353 males (60.1%) and 234 females (39.9%). The highest number of transfers (<i>n</i> = 84, 14.3%) occurred in 2022. The most common mechanisms of injury were blunt trauma (<i>n</i> = 228, 38.8%) and falls (<i>n</i> = 163, 27.8%). We also observed motor vehicle collisions (<i>n</i> = 103, 17.5%) and penetrating trauma (<i>n</i> = 50, 8.5%), while 17 cases (2.9%) involved other mechanisms, and 26 (4.4%) were of unknown origin. Assault was reported by 211 (35.9%) patients. Of all patients, 146 (24.9%) were admitted, and 441 (75.1%) were discharged from the emergency department. Computed tomography was performed for 376 patients (85.3%), among whom 222 (59.0%) patients had no injuries identified. Coroner data identified 82 trauma-related deaths, including 61 males (74.4%) and 21 females (25.6%). Motor vehicle collisions were the most common cause of death (<i>n</i> = 23, 28.0%). The trauma-related mortality rate in Eeyou Istchee was 47.8 per 10 000 population, compared with 27.8 per 10 000 in the rest of Quebec, yielding a relative risk of 1.72.</p><p><strong>Conclusion: </strong>There is a marked disparity in trauma-related mortality between Eeyou Istchee and the rest of Quebec, with motor vehicle collisions representing the leading cause of trauma death. Strengthening partnerships with local communities in Eeyou Istchee is essential to enhance awareness, promote injury prevention, and improve trauma system effectiveness in the region.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E30-E36"},"PeriodicalIF":2.2,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12826693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965444","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}