Pub Date : 2019-07-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.07.004
Bing Li, P. Zhou, L. Yao, Meidong Xu, Z. Ren, Qiang Shi, Tao Chen, S. Cai, Z. Qi
Objective To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) on treatment of benign colorectal anastomotic stenosis. Methods Data of 36 patients with benign colorectal anastomotic stenosis undergoing EBD at Zhongshan Hospital from 2011 to 2015 were reviewed retrospectively. The number of dilation, complications rate, short-term effects and recurrence rate of stenosis were analyzed. Results Thirty-six patients had post-surgery anastomotic stenosis within 2-49 months (median 6 months), including 10 (27.8%) patients of grade 1 stenosis, 15 (41.7%) of grade 2 stenosis, and 11 (30.5%) of grade 3 stenosis. The anastomotic distance from anus was 3-24 cm (median 6 cm). The 36 patients underwent 80 times of EBD with mean time of 2.22. Among them, 69.4% (25/36) cases received 1-2 times and 30.6% (11/36) received 3 times or more. During the EBD operation, 14 (17.5%) patients had minor bleeding, and intraoperative or postoperative perforation did not appeared. Postoperative obstructive symptoms were relieved in all patients. The anastomotic diameter was greater than 20 mm and EBD treatment was successful. Postoperative follow-up was 22-76 months (median 44 months). Four (11.1%) patients had recurrence of anastomotic benign stenosis at 7, 11, 18, and 63 months after the last time of EBD, respectively, and the symptoms were improved after the second treatment. Conclusion EBD is safe and effective in treating benign colorectal anastomotic stenosis, with better short-term and long-term outcomes. Key words: Colon; Rectum; Surgical stomas; Benign stenosis; Endoscopic balloon dilation
{"title":"Effects of endoscopic balloon dilatation on treatment of benign stenosis of colorectal anastomosis: a retrospective study","authors":"Bing Li, P. Zhou, L. Yao, Meidong Xu, Z. Ren, Qiang Shi, Tao Chen, S. Cai, Z. Qi","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.07.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.07.004","url":null,"abstract":"Objective \u0000To evaluate the efficacy and safety of endoscopic balloon dilation (EBD) on treatment of benign colorectal anastomotic stenosis. \u0000 \u0000 \u0000Methods \u0000Data of 36 patients with benign colorectal anastomotic stenosis undergoing EBD at Zhongshan Hospital from 2011 to 2015 were reviewed retrospectively. The number of dilation, complications rate, short-term effects and recurrence rate of stenosis were analyzed. \u0000 \u0000 \u0000Results \u0000Thirty-six patients had post-surgery anastomotic stenosis within 2-49 months (median 6 months), including 10 (27.8%) patients of grade 1 stenosis, 15 (41.7%) of grade 2 stenosis, and 11 (30.5%) of grade 3 stenosis. The anastomotic distance from anus was 3-24 cm (median 6 cm). The 36 patients underwent 80 times of EBD with mean time of 2.22. Among them, 69.4% (25/36) cases received 1-2 times and 30.6% (11/36) received 3 times or more. During the EBD operation, 14 (17.5%) patients had minor bleeding, and intraoperative or postoperative perforation did not appeared. Postoperative obstructive symptoms were relieved in all patients. The anastomotic diameter was greater than 20 mm and EBD treatment was successful. Postoperative follow-up was 22-76 months (median 44 months). Four (11.1%) patients had recurrence of anastomotic benign stenosis at 7, 11, 18, and 63 months after the last time of EBD, respectively, and the symptoms were improved after the second treatment. \u0000 \u0000 \u0000Conclusion \u0000EBD is safe and effective in treating benign colorectal anastomotic stenosis, with better short-term and long-term outcomes. \u0000 \u0000 \u0000Key words: \u0000Colon; Rectum; Surgical stomas; Benign stenosis; Endoscopic balloon dilation","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"479-482"},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47255799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.07.003
Xinqi Chen, Jian‐qun Cai, Jie Feng, W. Gong, Qiang Zhang, Wei Zhu, Wen Guo, Z. Han, Ya-li Zhang
Objective To compare the diagnostic accuracy of magnifying chromoendoscopy (MCE) and endoscopic ultrasonography (EUS) for preoperative endoscopic assessment of the invasion depth of colorectal laterally spreading tumour(LST). Methods Data of 104 cases of colorectal LST were included. With the final pathological diagnosis as the golden standard, the accuracies of MCE and EUS for preoperative assessment of the invasion depth of colorectal LST were compared. Results The diagnostic accuracies of MCE and EUS for evaluating the invasion depth of LST were 89.4%(93/104) and 73.1%(76/104), respectively(P<0.05). The lesion size and the endoscopist could affect the accuracy of the EUS evaluation(P=0.017, OR=3.561; P=0.035, OR=1.399). The accuracy of EUS seemed to show a downward trend for colorectal LST of larger diameters. Conclusion Both MCE and EUS are effective for evaluating the invasion depth of colorectal LST, but the accuracy of MCE may be higher than that of EUS. Large diameter of the lesion and the doctor's experience inadequacy may be the risk factors for the accuracy of EUS. Key words: Colorectal neoplasms; Endosonography; Program evaluation; Laterally spreading tumor; Magnifying chromoendoscopy
{"title":"A clinical study of preoperative endoscopic assessment of the invasion depth of colorectal laterally spreading tumor","authors":"Xinqi Chen, Jian‐qun Cai, Jie Feng, W. Gong, Qiang Zhang, Wei Zhu, Wen Guo, Z. Han, Ya-li Zhang","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.07.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.07.003","url":null,"abstract":"Objective \u0000To compare the diagnostic accuracy of magnifying chromoendoscopy (MCE) and endoscopic ultrasonography (EUS) for preoperative endoscopic assessment of the invasion depth of colorectal laterally spreading tumour(LST). \u0000 \u0000 \u0000Methods \u0000Data of 104 cases of colorectal LST were included. With the final pathological diagnosis as the golden standard, the accuracies of MCE and EUS for preoperative assessment of the invasion depth of colorectal LST were compared. \u0000 \u0000 \u0000Results \u0000The diagnostic accuracies of MCE and EUS for evaluating the invasion depth of LST were 89.4%(93/104) and 73.1%(76/104), respectively(P<0.05). The lesion size and the endoscopist could affect the accuracy of the EUS evaluation(P=0.017, OR=3.561; P=0.035, OR=1.399). The accuracy of EUS seemed to show a downward trend for colorectal LST of larger diameters. \u0000 \u0000 \u0000Conclusion \u0000Both MCE and EUS are effective for evaluating the invasion depth of colorectal LST, but the accuracy of MCE may be higher than that of EUS. Large diameter of the lesion and the doctor's experience inadequacy may be the risk factors for the accuracy of EUS. \u0000 \u0000 \u0000Key words: \u0000Colorectal neoplasms; Endosonography; Program evaluation; Laterally spreading tumor; Magnifying chromoendoscopy","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"474-478"},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42421214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.07.010
Wei Zhang, Song Zhang, C. Peng, Feng Zhang, Guifang Xu, Ming Zhang, Xiao-liang Zhou, Lei Wang, Y. Zhuge, X. Zou
Objective To evaluate the feasibility and safety of endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement in the normal porcine model. Methods Four pigs, 2 male and 2 female, aged 8-12 months, weighing 20-30 kg were selected in the experiment. Under general anesthesia and EUS guidance, a 22 G fine needle connected to electrocardiograph monitor with a central vein pressure manometer was used to puncture and measure pressures in the portal vein (PV) and hepatic vein (HV) or inferior vena cava (IVC). Pressures were measured three times for each vessel and the mean pressure was recorded. The PPG was recorded as the difference between the PV pressure and HV or IVC pressure. Vital signs during and after the procedure and operation-related complications were monitored. Results EUS-PPG measurement was successful in all targeted vessels. The PV pressure, HV or IVC pressure, and PPG was 11.0±1.0 mmHg(1 mmHg=0.133 kPa), 7.3±1.1 mmHg and 3.8±0.9 mmHg, respectively. No adverse event occurred. Conclusion EUS-PPG measurement has a high successful rate and reliable accuracy and safety reflecting the portal vein pressure. Key words: Endosonography; Hypertension, portal; Portal pressure gradient; Hepatic venous pressure gradient
{"title":"Endoscopic ultrasound-guided portal pressure gradient measurement: a pilot animal study","authors":"Wei Zhang, Song Zhang, C. Peng, Feng Zhang, Guifang Xu, Ming Zhang, Xiao-liang Zhou, Lei Wang, Y. Zhuge, X. Zou","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.07.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.07.010","url":null,"abstract":"Objective \u0000To evaluate the feasibility and safety of endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement in the normal porcine model. \u0000 \u0000 \u0000Methods \u0000Four pigs, 2 male and 2 female, aged 8-12 months, weighing 20-30 kg were selected in the experiment. Under general anesthesia and EUS guidance, a 22 G fine needle connected to electrocardiograph monitor with a central vein pressure manometer was used to puncture and measure pressures in the portal vein (PV) and hepatic vein (HV) or inferior vena cava (IVC). Pressures were measured three times for each vessel and the mean pressure was recorded. The PPG was recorded as the difference between the PV pressure and HV or IVC pressure. Vital signs during and after the procedure and operation-related complications were monitored. \u0000 \u0000 \u0000Results \u0000EUS-PPG measurement was successful in all targeted vessels. The PV pressure, HV or IVC pressure, and PPG was 11.0±1.0 mmHg(1 mmHg=0.133 kPa), 7.3±1.1 mmHg and 3.8±0.9 mmHg, respectively. No adverse event occurred. \u0000 \u0000 \u0000Conclusion \u0000EUS-PPG measurement has a high successful rate and reliable accuracy and safety reflecting the portal vein pressure. \u0000 \u0000 \u0000Key words: \u0000Endosonography; Hypertension, portal; Portal pressure gradient; Hepatic venous pressure gradient","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"505-508"},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42222918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.07.006
Jie Pan, Liming Zhu, Jiejun Lin, Xiao-qing Jiang
Objective To explore the clinical value of a new scoring system for gastric cancer screening in hospital visits. Methods A new scoring system for gastric cancer screening was used to retrospectively analyze data of patients who visited Wenzhou Central Hospital for various digestive symptoms from April 2017 to August 2018 and met the screening requirements. All patients were divided into three groups according to the grading results of the new scoring system: low-risk group (0-11 points), medium-risk group (12-16 points) and high-risk group (17-23 points). A comparative analysis was performed on the detection of gastric cancer and gastric precancerous conditions among the three groups. Results A total of 2 674 patients were included in this study, 1 694(63.35%) in the low-risk group, 833(31.15%) in the medium-risk group, and 147(5.50%) in the high-risk group. The total detection rate of gastric cancer was 2.73% (73/2 674). The detection rates were 1.06% (18/1 694), 4.32% (36/833) and 12.93%(19/147) in the three groups, respectively. There were significant differences in the detection rate of gastric cancer between any two of the three groups (all P<0.05). The detection rates of early gastric cancer in medium-risk group[2.04%(17/833)] and high-risk group[4.08%(6/147)] were significantly higher than that in the low-risk group[0.35%(6/1 694), all P<0.05]. Conclusion The new gastric cancer screening scoring system can not only significantly improve the detection rate of gastric cancer in hospital visits, but also improve the diagnostic rate of early gastric cancer. Key words: Stomach neoplasm; Precancerous conditions; New scoring system for gastric cancer screening; Early gastric cancer
{"title":"Application of a new scoring system to gastric cancer screening in hospital visits","authors":"Jie Pan, Liming Zhu, Jiejun Lin, Xiao-qing Jiang","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.07.006","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.07.006","url":null,"abstract":"Objective \u0000To explore the clinical value of a new scoring system for gastric cancer screening in hospital visits. \u0000 \u0000 \u0000Methods \u0000A new scoring system for gastric cancer screening was used to retrospectively analyze data of patients who visited Wenzhou Central Hospital for various digestive symptoms from April 2017 to August 2018 and met the screening requirements. All patients were divided into three groups according to the grading results of the new scoring system: low-risk group (0-11 points), medium-risk group (12-16 points) and high-risk group (17-23 points). A comparative analysis was performed on the detection of gastric cancer and gastric precancerous conditions among the three groups. \u0000 \u0000 \u0000Results \u0000A total of 2 674 patients were included in this study, 1 694(63.35%) in the low-risk group, 833(31.15%) in the medium-risk group, and 147(5.50%) in the high-risk group. The total detection rate of gastric cancer was 2.73% (73/2 674). The detection rates were 1.06% (18/1 694), 4.32% (36/833) and 12.93%(19/147) in the three groups, respectively. There were significant differences in the detection rate of gastric cancer between any two of the three groups (all P<0.05). The detection rates of early gastric cancer in medium-risk group[2.04%(17/833)] and high-risk group[4.08%(6/147)] were significantly higher than that in the low-risk group[0.35%(6/1 694), all P<0.05]. \u0000 \u0000 \u0000Conclusion \u0000The new gastric cancer screening scoring system can not only significantly improve the detection rate of gastric cancer in hospital visits, but also improve the diagnostic rate of early gastric cancer. \u0000 \u0000 \u0000Key words: \u0000Stomach neoplasm; Precancerous conditions; New scoring system for gastric cancer screening; Early gastric cancer","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"487-490"},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49090058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Since the beginning of the 21st century, the intersection of medicine and industry has become a new engine driving the progress of clinical medicine. The intersection of medicine and industry is not only a strategic need to promote the upgrading of the health industry and achieve a healthy China, but also a technical support to solve clinical problems and promote the improvement of diagnosis and treatment levels. This article reviews the main fields and representative achievements of the intersection between clinical medicine and engineering since modern times, and takes the development of magnetic controlled capsule gastroscopy system as an example to explain the implementation process of cross research and achievement transformation between medical and engineering. In addition, this article evaluates the current status of medical industry interdisciplinary research in China and puts forward several suggestions for further strengthening medical industry interdisciplinary research in the future.
{"title":"Strenthen medicine-engineering interdisciplinary research to promote the development of clinical medicine","authors":"Ye Gao, Lei Xin","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.07.002","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.07.002","url":null,"abstract":"进入21世纪以来，医工交叉已成为推动临床医学进步的新引擎。医工交叉既是促进健康产业升级、实现健康中国的战略需要，又是解决临床问题、促进诊疗水平提升的技术支撑。本文综述了近代以来临床医学与工程学交叉的主要领域及代表性成果，并以磁控胶囊胃镜系统研发为例，阐述了医工交叉研究及成果转化的实现过程。此外，本文评价了我国医工交叉研究的开展现状，并对未来进一步加强医工交叉提出了几点建议。","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"470-473"},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42997798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To evaluate the clinical efficacy and safety of different stitching methods, over-the-scope-clip (OTSC) and metal clips combined with nylon rope(King closure), for full-layer gastric wall defect. Methods Data of 75 cases, who underwent endoscopic full-thickness resection (EFTR) of gastric SMTs from May 2015 to May 2018 in our endoscopy center were retrospectively analyzed. According to the closure method, the patients were divided into the OTSC group (20 cases) and the King closure group (55 cases). Comparison was made in gender, age, the largest diameter of tumor, the location of tumor, defect surface diameter, total operating time, defect closure time, closure success rate, the length of hospital stays, cost and postoperative complications between the two groups. Results The baseline data were comparable, and there were no significant differences in age, gender, tumor location, tumor diameter, and defect surface diameter between the two groups(all P>0.05). The success rate of closure was 100% in both groups. In terms of length of hospital stay, there was no significant difference between the two groups (t=1.13, P=0.268). The total operating time was 63.24±43.22 min in the King closure group versus 47.60±18.13 min in the OTSC group (t=2.20, P=0.030). The closure time of the defect surface was 20.85±16.35 min in the King closure group versus 10.95±5.20 min in the OTSC group (t=2.65, P=0.010). Hospitalization costs were 24 200±800 yuan in the King closure group versus 36 200±2 350 yuan in the OTSC group (t=6.21, P<0.001). Postoperative abdominal elevation radiographs in both groups indicated a small amount of subphrenic free gas, and no intervention was given due to the small amount of gas and no obvious symptoms. No late bleeding, recurrent perforation, infection or other complications occurred after operation, and all patients were discharged successfully. Six months after surgery, 15 patients (27%) in the King closure group developed metal clips or nylon rope residue, which were successfully removed by endoscopy. The anastomosis clamp of nighteen patients (95%) in the OTSC group were in the original position. None of the patient received open surgery. Conclusion OTSC and King closure are both safe and effective in the treatment of full-thickness defect of gastric wall. OTSC has the advantages of short total operation time and short closure time, but with high cost. Key words: Endoscopes, gastrointestinal; Submucosal tumors; Endoscopic full-thickness resection; Over-the-scope-clip system; King closure
目的评价超镜夹(OTSC)与金属夹联合尼龙绳(King闭合)两种缝合方法治疗全层胃壁缺损的临床疗效和安全性。方法回顾性分析我院内镜中心2015年5月至2018年5月行胃粘膜瘤全层切除术(EFTR)的75例患者的资料。根据闭合方式将患者分为OTSC组(20例)和King闭合组(55例)。比较两组患者的性别、年龄、肿瘤最大直径、肿瘤位置、缺损面直径、总手术时间、缺损闭合时间、闭合成功率、住院时间、费用及术后并发症。结果基线资料具有可比性，两组患者在年龄、性别、肿瘤位置、肿瘤直径、缺损面直径等方面差异无统计学意义(P < 0.05)。两组结扎成功率均为100%。两组住院时间差异无统计学意义(t=1.13, P=0.268)。King闭合组总手术时间为63.24±43.22 min, OTSC组为47.60±18.13 min (t=2.20, P=0.030)。King闭合组缺损表面闭合时间为20.85±16.35 min, OTSC组为10.95±5.20 min (t=2.65, P=0.010)。King闭合组住院费用为24 200±800元，OTSC组住院费用为36 200±2 350元(t=6.21, P<0.001)。两组术后腹部抬高片均提示膈下游离气体量少，因气体量少且无明显症状，不予干预。术后无迟发出血、复发穿孔、感染等并发症发生，均顺利出院。术后6个月，King闭合组15例(27%)患者出现金属夹或尼龙绳残留，经内镜检查成功清除。OTSC组有15例(95%)患者吻合钳处于原位。所有患者均未接受开腹手术。结论OTSC和King缝合术治疗胃壁全层缺损安全有效。OTSC具有总运行时间短、关闭时间短的优点，但成本较高。关键词:内窥镜;胃肠道;黏膜下肿瘤;内镜下全层切除术;Over-the-scope-clip系统;王关闭
{"title":"Comparison of over-the-scope-clip and metal clips combined with nylon rope as endoscopic suture methods for full-thickness defect of gastric wall(with video)","authors":"Xu Li, Chang-Heon Yang, Chao-yang Xu, Xiaoling Zheng, Wan-yin Deng, Jinhui Zheng, Shishun Zhong, Xianbin Guo, Wei Liang","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.07.008","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.07.008","url":null,"abstract":"Objective \u0000To evaluate the clinical efficacy and safety of different stitching methods, over-the-scope-clip (OTSC) and metal clips combined with nylon rope(King closure), for full-layer gastric wall defect. \u0000 \u0000 \u0000Methods \u0000Data of 75 cases, who underwent endoscopic full-thickness resection (EFTR) of gastric SMTs from May 2015 to May 2018 in our endoscopy center were retrospectively analyzed. According to the closure method, the patients were divided into the OTSC group (20 cases) and the King closure group (55 cases). Comparison was made in gender, age, the largest diameter of tumor, the location of tumor, defect surface diameter, total operating time, defect closure time, closure success rate, the length of hospital stays, cost and postoperative complications between the two groups. \u0000 \u0000 \u0000Results \u0000The baseline data were comparable, and there were no significant differences in age, gender, tumor location, tumor diameter, and defect surface diameter between the two groups(all P>0.05). The success rate of closure was 100% in both groups. In terms of length of hospital stay, there was no significant difference between the two groups (t=1.13, P=0.268). The total operating time was 63.24±43.22 min in the King closure group versus 47.60±18.13 min in the OTSC group (t=2.20, P=0.030). The closure time of the defect surface was 20.85±16.35 min in the King closure group versus 10.95±5.20 min in the OTSC group (t=2.65, P=0.010). Hospitalization costs were 24 200±800 yuan in the King closure group versus 36 200±2 350 yuan in the OTSC group (t=6.21, P<0.001). Postoperative abdominal elevation radiographs in both groups indicated a small amount of subphrenic free gas, and no intervention was given due to the small amount of gas and no obvious symptoms. No late bleeding, recurrent perforation, infection or other complications occurred after operation, and all patients were discharged successfully. Six months after surgery, 15 patients (27%) in the King closure group developed metal clips or nylon rope residue, which were successfully removed by endoscopy. The anastomosis clamp of nighteen patients (95%) in the OTSC group were in the original position. None of the patient received open surgery. \u0000 \u0000 \u0000Conclusion \u0000OTSC and King closure are both safe and effective in the treatment of full-thickness defect of gastric wall. OTSC has the advantages of short total operation time and short closure time, but with high cost. \u0000 \u0000 \u0000Key words: \u0000Endoscopes, gastrointestinal; Submucosal tumors; Endoscopic full-thickness resection; Over-the-scope-clip system; King closure","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"495-499"},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42349364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-07-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.07.009
Jia-su Li, Feng Liu, D. Zou, Zhendong Jin, Dong Wang, Xin-Gang Shi, Jie Chen, Zhao-shen Li
Objective To investigate factors affecting ampullary access of endoscopic retrograde cholangiopancreatography (ERCP) in patients undergoing Billroth Ⅱ gastrectomy. Methods A retrospective analysis was performed on data of 261 patients with Billroth Ⅱ gastrectomy who underwent ERCP at Changhai Hospital from January 2008 to December 2017. Multivariate logistic regression analysis was used to analyze the potential factors affecting successful ampullary access, and receiver operating characteristic (ROC) curve was used to assess the predictive ability of potential factors. Results A total of 345 ERCP sessions were collected. The successful ampullary access and cannulation rate were 82.3% (284/345) and 89.1% (253/284), respectively. The main reasons for ERCP procedural failure were unable to reach the duodenal blind end and find the papilla (66.3%, 61/92) and failure of selective cannulation (33.7%, 31/92). The ERCP-related complication rate was 14.2% (49/345), with post-ERCP pancreatitis rate was 3.2% (11/345). Multivariate logistic regression analysis indicated that the first ERCP attempt (OR=7.717, 95%CI: 2.581-23.068. P<0.001), with Braun anastomosis (OR=8.737, 95%CI: 2.479-30.797, P=0.001), and no cap-assisted forward-viewing gastroscope (OR=2.774, 95%CI: 1.283-5.997, P=0.009) were independent risk factors for failure of ampullary access. According to the B value of each risk factor in logistic regression analysis, that is, no cap-assisted as 1 point, the first ERCP attempt as 2 points, and Braun anastomosis as 2 points, the area under ROC curve was 0.773. When the cut-off point was 2.5, the sensitivity and specificity were 75.0% and 70.8%, respectively. Conclusion The first ERCP attempt, with Braun anastomosis, and no cap-assisted forward-viewing gastroscope are risk factors for failure of ampullary access of ERCP in Billroth Ⅱ gastrectomy patients. Early identification of high-risk patients may help to improve the success rate of ampullary access. Key words: Cholangiopancreatography, endoscopic retrograde; Gastrectomy, Billroth Ⅱ; Risk factors
{"title":"Factors affecting ampullary access of ERCP after Billroth II gastrectomy","authors":"Jia-su Li, Feng Liu, D. Zou, Zhendong Jin, Dong Wang, Xin-Gang Shi, Jie Chen, Zhao-shen Li","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.07.009","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.07.009","url":null,"abstract":"Objective \u0000To investigate factors affecting ampullary access of endoscopic retrograde cholangiopancreatography (ERCP) in patients undergoing Billroth Ⅱ gastrectomy. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed on data of 261 patients with Billroth Ⅱ gastrectomy who underwent ERCP at Changhai Hospital from January 2008 to December 2017. Multivariate logistic regression analysis was used to analyze the potential factors affecting successful ampullary access, and receiver operating characteristic (ROC) curve was used to assess the predictive ability of potential factors. \u0000 \u0000 \u0000Results \u0000A total of 345 ERCP sessions were collected. The successful ampullary access and cannulation rate were 82.3% (284/345) and 89.1% (253/284), respectively. The main reasons for ERCP procedural failure were unable to reach the duodenal blind end and find the papilla (66.3%, 61/92) and failure of selective cannulation (33.7%, 31/92). The ERCP-related complication rate was 14.2% (49/345), with post-ERCP pancreatitis rate was 3.2% (11/345). Multivariate logistic regression analysis indicated that the first ERCP attempt (OR=7.717, 95%CI: 2.581-23.068. P<0.001), with Braun anastomosis (OR=8.737, 95%CI: 2.479-30.797, P=0.001), and no cap-assisted forward-viewing gastroscope (OR=2.774, 95%CI: 1.283-5.997, P=0.009) were independent risk factors for failure of ampullary access. According to the B value of each risk factor in logistic regression analysis, that is, no cap-assisted as 1 point, the first ERCP attempt as 2 points, and Braun anastomosis as 2 points, the area under ROC curve was 0.773. When the cut-off point was 2.5, the sensitivity and specificity were 75.0% and 70.8%, respectively. \u0000 \u0000 \u0000Conclusion \u0000The first ERCP attempt, with Braun anastomosis, and no cap-assisted forward-viewing gastroscope are risk factors for failure of ampullary access of ERCP in Billroth Ⅱ gastrectomy patients. Early identification of high-risk patients may help to improve the success rate of ampullary access. \u0000 \u0000 \u0000Key words: \u0000Cholangiopancreatography, endoscopic retrograde; Gastrectomy, Billroth Ⅱ; Risk factors","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"500-504"},"PeriodicalIF":0.0,"publicationDate":"2019-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47176143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To investigate the characteristics of population and the changes of disease spectrum in patients treated by endoscopic retrograde cholangiopancreatography (ERCP) . Methods Data of 20 170 patients, who underwent ERCP in the First People′s Hospital of Hangzhou from May 2004 to February 2018, were enrolled in the retrospective analysis. According to the year of diagnosis and treatment, patients were divided into 2004-2008, 2009-2013, and 2014-2018 group; according to the postoperative diagnosis of ERCP, they were divided into biliary tract diseases (including calculus, benign stenosis, malignant stenosis, and other causes) and pancreatic diseases (including acute pancreatitis, chronic pancreatitis, pancreatic malignant tumor, and other causes) group; and according to the age, they were divided into the younger age (0-18 years old) , young and middle age (19-65 years old) , old age (66-85 years old) , and advanced age (>85 years old) group. Statistical analysis was performed in the different groups. Results Among the 20 170 patients, there were 10 260 males and 9 910 females, with age of 62.65±17.11 years. The proportion of the younger age group and the advanced age group was 1.04% (24/2 308) , 1.69% (127/7 520) , 2.39% (247/10 342) , and 2.95% (68/2 308) , 4.19% (315/7 520) , 6.15% (636/10 342) , respectively, in the 2004-2008, 2009-2013 and 2014-2018 subgroups, with a rising trend (P<0.017) . A total 20 032 patients had a clear postoperative diagnosis, including 15 618 (77.97%) of biliary diseases and 4 414 (22.03%) of pancreatic diseases. Biliary stones accounted for the majority of biliary diseases (63.2%, 9 863/15 618) , and its proportion increased from 59.9% (1 191/1 987) in 2004-2008 to 64.5% (5 118/7 939) in 2014-2018 (P=0.000) . Acute pancreatitis accounted for the majority of pancreatic diseases (67.4%, 1 973/4 414) , and its proportion increased from 52.4% (162/309) in 2004-2008 to 69.9% (1 636/2 340) in 2014-2018 (P=0.000) . The top 3 diseases in the younger group and the advanced age group were acute pancreatitis (32.58%, 129/396) , biliary stones (25.25%, 100/396) , chronic pancreatitis (22.22%, 88/396) , and biliary stones (56.46%, 568/1 006) , malignant biliary stenosis (12.52%, 126/1 006) , benign biliary stricture (10.34%, 104/1 006) , respectively. Conclusion The main disease of patients receiving ERCP is biliary stone, and the proportion of acute pancreatitis is increased. The overall age of the patients is old, and the proportion of the elderly and underaged patients is gradually increasing. Biliary diseases and pancreatic diseases are the main diseases in elderly patients and younger patients, respectively. Key words: Cholangiopancreatography, endoscopic retrograde; Population surveilance; Trend
{"title":"A preliminary study on the characteristics of ERCP population and disease trends in Zhejiang Province","authors":"Haibin Zhou, Jianfeng Yang, Xiao Zhang, Wen Lyu, Qing-feng Yuan, Hangbin Jin, Haitao Huang, Yifeng Zhou, Lou Qifeng, Ma Wencong, Z. Xiaofeng","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.06.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.06.004","url":null,"abstract":"Objective \u0000To investigate the characteristics of population and the changes of disease spectrum in patients treated by endoscopic retrograde cholangiopancreatography (ERCP) . \u0000 \u0000 \u0000Methods \u0000Data of 20 170 patients, who underwent ERCP in the First People′s Hospital of Hangzhou from May 2004 to February 2018, were enrolled in the retrospective analysis. According to the year of diagnosis and treatment, patients were divided into 2004-2008, 2009-2013, and 2014-2018 group; according to the postoperative diagnosis of ERCP, they were divided into biliary tract diseases (including calculus, benign stenosis, malignant stenosis, and other causes) and pancreatic diseases (including acute pancreatitis, chronic pancreatitis, pancreatic malignant tumor, and other causes) group; and according to the age, they were divided into the younger age (0-18 years old) , young and middle age (19-65 years old) , old age (66-85 years old) , and advanced age (>85 years old) group. Statistical analysis was performed in the different groups. \u0000 \u0000 \u0000Results \u0000Among the 20 170 patients, there were 10 260 males and 9 910 females, with age of 62.65±17.11 years. The proportion of the younger age group and the advanced age group was 1.04% (24/2 308) , 1.69% (127/7 520) , 2.39% (247/10 342) , and 2.95% (68/2 308) , 4.19% (315/7 520) , 6.15% (636/10 342) , respectively, in the 2004-2008, 2009-2013 and 2014-2018 subgroups, with a rising trend (P<0.017) . A total 20 032 patients had a clear postoperative diagnosis, including 15 618 (77.97%) of biliary diseases and 4 414 (22.03%) of pancreatic diseases. Biliary stones accounted for the majority of biliary diseases (63.2%, 9 863/15 618) , and its proportion increased from 59.9% (1 191/1 987) in 2004-2008 to 64.5% (5 118/7 939) in 2014-2018 (P=0.000) . Acute pancreatitis accounted for the majority of pancreatic diseases (67.4%, 1 973/4 414) , and its proportion increased from 52.4% (162/309) in 2004-2008 to 69.9% (1 636/2 340) in 2014-2018 (P=0.000) . The top 3 diseases in the younger group and the advanced age group were acute pancreatitis (32.58%, 129/396) , biliary stones (25.25%, 100/396) , chronic pancreatitis (22.22%, 88/396) , and biliary stones (56.46%, 568/1 006) , malignant biliary stenosis (12.52%, 126/1 006) , benign biliary stricture (10.34%, 104/1 006) , respectively. \u0000 \u0000 \u0000Conclusion \u0000The main disease of patients receiving ERCP is biliary stone, and the proportion of acute pancreatitis is increased. The overall age of the patients is old, and the proportion of the elderly and underaged patients is gradually increasing. Biliary diseases and pancreatic diseases are the main diseases in elderly patients and younger patients, respectively. \u0000 \u0000 \u0000Key words: \u0000Cholangiopancreatography, endoscopic retrograde; Population surveilance; Trend","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"402-406"},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46059247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.06.003
J. Zou, N. Chai, Yaqi Zhai, C. Du, Longsong Li, Xiang-dong Wang, Ping Tang
Objective To assess the diagnostic accuracy of preoperative endoscopic ultrasonography (EUS) for tumor size and invasion of non-ampullary duodenal neuroendocrine tumors (NA-DETs) and to compare the efficacy and safety of endoscopic submucosal dissection (ESD) and modified ESD for the treatment of NA-DETs. Methods Data of 22 patients with 22 NAD-NETs confirmed by histopathological examinations from January 2007 to January 2018 were retrospectively analyzed. ESD was performed on 13 tumors, and modified ESD was performed on 9 tumors. R0 resection rate, procedure time and incidence of procedure-related complications in the ESD group and the modified ESD group were compared. The postoperative pathological results were used as the gold standard to assess the accuracy of preoperative EUS in diagnosing tumor size and invasion of NA-DETs. Results The mean size of NA-DETs was 6.9±1.5 mm. The accuracy in assessing the invasion depth by EUS was 95.5% (21/22) compared with histological results. R0 resection was achieved in 13/13 (100.0%) of the ESD group and in 7/9 (77.8%) of the modified ESD group (P=1.000) . The procedure time was significantly shorter in the modified ESD group than that in the ESD group (16.0±2.2 min VS 29.8±4.9 min, P<0.001) . Intraoperative perforation occurred in one patient and delayed perforation occurred in one patient in the ESD group. Delayed bleeding occurred in one patient in the modified ESD group. Follow-up data were available in all cases with a mean period of 30.0±24.8 months. No cases of local recurrence or distant metastasis were detected in the follow-up period. Conclusion EUS can accurately assess the size and depth of NAD-NETs. Modified ESD can provide comparable clinical outcomes to ESD for NAD-NETs ≤10 mm in diameter that are confined to the submucosa. Key words: Neuroendocrine tumors; Duodenum; Safety; Efficiency; Endoscopic submucosal dissection
目的评价术前超声内镜(EUS)对非壶腹性十二指肠神经内分泌肿瘤(NA-DETs)肿瘤大小及侵袭的诊断准确性，比较内镜下粘膜下剥离术(ESD)与改良ESD治疗NA-DETs的疗效和安全性。方法回顾性分析2007年1月至2018年1月22例经组织病理学检查证实的NAD-NETs患者的资料。13例行ESD，改良ESD 9例。比较改良ESD组与改良ESD组的R0切除率、手术时间及手术相关并发症发生率。以术后病理结果为金标准，评价术前EUS诊断肿瘤大小及na - det侵袭的准确性。结果NA-DETs平均大小为6.9±1.5 mm。与组织学结果相比，EUS评估浸润深度的准确率为95.5%(21/22)。ESD组13/13(100.0%)和改良ESD组7/9(77.8%)实现R0切除(P=1.000)。改良ESD组手术时间明显短于ESD组(16.0±2.2 min VS 29.8±4.9 min, P<0.001)。ESD组术中穿孔1例，延迟穿孔1例。改良ESD组1例出现迟发性出血。所有病例均有随访资料，平均随访时间为30.0±24.8个月。随访期间未发现局部复发或远处转移病例。结论EUS能准确评估NAD-NETs的大小和深度。改良的ESD对于内径≤10mm且局限于粘膜下层的NAD-NETs具有与ESD相当的临床效果。关键词:神经内分泌肿瘤;十二指肠;安全;效率;内镜下粘膜夹层
{"title":"Endoscopic resection for non-ampullary duodenal neuroendocrine tumors: a retrospective study","authors":"J. Zou, N. Chai, Yaqi Zhai, C. Du, Longsong Li, Xiang-dong Wang, Ping Tang","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.06.003","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.06.003","url":null,"abstract":"Objective \u0000To assess the diagnostic accuracy of preoperative endoscopic ultrasonography (EUS) for tumor size and invasion of non-ampullary duodenal neuroendocrine tumors (NA-DETs) and to compare the efficacy and safety of endoscopic submucosal dissection (ESD) and modified ESD for the treatment of NA-DETs. \u0000 \u0000 \u0000Methods \u0000Data of 22 patients with 22 NAD-NETs confirmed by histopathological examinations from January 2007 to January 2018 were retrospectively analyzed. ESD was performed on 13 tumors, and modified ESD was performed on 9 tumors. R0 resection rate, procedure time and incidence of procedure-related complications in the ESD group and the modified ESD group were compared. The postoperative pathological results were used as the gold standard to assess the accuracy of preoperative EUS in diagnosing tumor size and invasion of NA-DETs. \u0000 \u0000 \u0000Results \u0000The mean size of NA-DETs was 6.9±1.5 mm. The accuracy in assessing the invasion depth by EUS was 95.5% (21/22) compared with histological results. R0 resection was achieved in 13/13 (100.0%) of the ESD group and in 7/9 (77.8%) of the modified ESD group (P=1.000) . The procedure time was significantly shorter in the modified ESD group than that in the ESD group (16.0±2.2 min VS 29.8±4.9 min, P<0.001) . Intraoperative perforation occurred in one patient and delayed perforation occurred in one patient in the ESD group. Delayed bleeding occurred in one patient in the modified ESD group. Follow-up data were available in all cases with a mean period of 30.0±24.8 months. No cases of local recurrence or distant metastasis were detected in the follow-up period. \u0000 \u0000 \u0000Conclusion \u0000EUS can accurately assess the size and depth of NAD-NETs. Modified ESD can provide comparable clinical outcomes to ESD for NAD-NETs ≤10 mm in diameter that are confined to the submucosa. \u0000 \u0000 \u0000Key words: \u0000Neuroendocrine tumors; Duodenum; Safety; Efficiency; Endoscopic submucosal dissection","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"397-401"},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46134724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-20DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.06.007
Yanyan Lin, Jun Yan, Qi-Yong Zhang, Xiaoliang Zhu, Xun Li
Objective To evaluate safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for patients with decompensated cirrhosis combined with choledocholithiasis. Methods A retrospective analysis was performed on data of 79 patients with decompensated cirrhosis combined with choledocholithiasis, 92 patients with chronic viral hepatitis, and 114 patients without liver disease who underwent ERCP at the First Hospital of Lanzhou University from December 2012 to December 2016. Intraoperative operating conditions, postoperative improvement of liver function indices, and complications among the three groups were compared and analyzed. Results The level of serum prothrombin time before ERCP in patients with cirrhosis (12.9±2.2) s was higher than that in patients with chronic viral hepatitis (12.1±1.9) s and those without liver disease (11.7±1.4) s, the difference was statistically significant (F=21.530, P 0.05) . Conclusion ERCP is safe and effective for Child-Pugh A and B patients with decompensated cirrhosis combined with choledocholithiasis. Liver function and blood coagulation function should be improved in Child-Pugh C patients before ERCP. Key words: Choledocholithiasis; Liver cirrhosis; Hepatitis, viral; Cholangiopancreatography, endoscopic retrograde
{"title":"Safety and effectiveness of ERCP for patients with decompensated cirrhosis combined with choledocholithiasis","authors":"Yanyan Lin, Jun Yan, Qi-Yong Zhang, Xiaoliang Zhu, Xun Li","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.06.007","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.06.007","url":null,"abstract":"Objective \u0000To evaluate safety and effectiveness of endoscopic retrograde cholangiopancreatography (ERCP) for patients with decompensated cirrhosis combined with choledocholithiasis. \u0000 \u0000 \u0000Methods \u0000A retrospective analysis was performed on data of 79 patients with decompensated cirrhosis combined with choledocholithiasis, 92 patients with chronic viral hepatitis, and 114 patients without liver disease who underwent ERCP at the First Hospital of Lanzhou University from December 2012 to December 2016. Intraoperative operating conditions, postoperative improvement of liver function indices, and complications among the three groups were compared and analyzed. \u0000 \u0000 \u0000Results \u0000The level of serum prothrombin time before ERCP in patients with cirrhosis (12.9±2.2) s was higher than that in patients with chronic viral hepatitis (12.1±1.9) s and those without liver disease (11.7±1.4) s, the difference was statistically significant (F=21.530, P 0.05) . \u0000 \u0000 \u0000Conclusion \u0000ERCP is safe and effective for Child-Pugh A and B patients with decompensated cirrhosis combined with choledocholithiasis. Liver function and blood coagulation function should be improved in Child-Pugh C patients before ERCP. \u0000 \u0000 \u0000Key words: \u0000Choledocholithiasis; Liver cirrhosis; Hepatitis, viral; Cholangiopancreatography, endoscopic retrograde","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"416-421"},"PeriodicalIF":0.0,"publicationDate":"2019-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42540701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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