BACKGROUNDAlthough loop ileostomy as a diverting stoma has been considered to affect renal dysfunction, few reports have compared loop colostomy with loop ileostomy regarding renal function. This is an important issue in the current setting of increased opportunities to perform surgery on patients with poor renal function.OBJECTIVEThis study aims to reveal the effect of ileostomy on renal dysfunction compared to colostomy following sphincter-preserving rectal surgery.DESIGNThis study was a retrospective analysis. We compared preoperative and postoperative blood urea nitrogen, serum creatinine and estimated glomerular filtration rate values.SETTINGSThe study was conducted at a single academic institution in Osaka, Japan.PATIENTSFrom October 2013 to November 2021, 135 consecutive patients underwent rectal surgery with diverting stoma are included.MAIN OUTCOME MEASURESDifferences in pre- and postoperative renal function values by stoma creation site in patients with preoperative chronic kidney disease. Risk factors for patients with newly kidney disease after stoma creation.RESULTSIn the preoperative chronic kidney disease (+) patients, the differences between the pre- and post-values in the blood urea nitrogen (p = 0.047) and the serum creatinine (P = 0.028) values were higher than in the preoperative chronic kidney disease (-) patients. In the preoperative chronic kidney disease (+) patients, ileostomy was significantly associated with an elevation of the serum creatinine value (p = 0.025) and a decrease in estimated glomerular filtration rate value (p = 0.041) from the pre-operative one compared with that of colostomy. In multivariate analysis, ileostomy (odds ratio; 7.443, p = 0.011) and hypertension (4.226, p = 0.008) were independent risk factors of newly kidney disease postoperatively.LIMITATIONSLimitations to our study includes its retrospective nature and bias due to the stoma site being determined by each surgeon.CONCLUSIONWe should take care to choose diverting stoma especially in patients with a risk of kidney disfunction. See Video Abstract.
{"title":"Impact of the Diverting Stoma on Renal Function.","authors":"Takuki Yagyu,Madoka Hamada,Masahiko Hatta,Toshinori Kobayashi,Yuki Matsumi,Ryo Inada,Tomoko Matsumoto,Masaharu Oishi","doi":"10.1097/dcr.0000000000003517","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003517","url":null,"abstract":"BACKGROUNDAlthough loop ileostomy as a diverting stoma has been considered to affect renal dysfunction, few reports have compared loop colostomy with loop ileostomy regarding renal function. This is an important issue in the current setting of increased opportunities to perform surgery on patients with poor renal function.OBJECTIVEThis study aims to reveal the effect of ileostomy on renal dysfunction compared to colostomy following sphincter-preserving rectal surgery.DESIGNThis study was a retrospective analysis. We compared preoperative and postoperative blood urea nitrogen, serum creatinine and estimated glomerular filtration rate values.SETTINGSThe study was conducted at a single academic institution in Osaka, Japan.PATIENTSFrom October 2013 to November 2021, 135 consecutive patients underwent rectal surgery with diverting stoma are included.MAIN OUTCOME MEASURESDifferences in pre- and postoperative renal function values by stoma creation site in patients with preoperative chronic kidney disease. Risk factors for patients with newly kidney disease after stoma creation.RESULTSIn the preoperative chronic kidney disease (+) patients, the differences between the pre- and post-values in the blood urea nitrogen (p = 0.047) and the serum creatinine (P = 0.028) values were higher than in the preoperative chronic kidney disease (-) patients. In the preoperative chronic kidney disease (+) patients, ileostomy was significantly associated with an elevation of the serum creatinine value (p = 0.025) and a decrease in estimated glomerular filtration rate value (p = 0.041) from the pre-operative one compared with that of colostomy. In multivariate analysis, ileostomy (odds ratio; 7.443, p = 0.011) and hypertension (4.226, p = 0.008) were independent risk factors of newly kidney disease postoperatively.LIMITATIONSLimitations to our study includes its retrospective nature and bias due to the stoma site being determined by each surgeon.CONCLUSIONWe should take care to choose diverting stoma especially in patients with a risk of kidney disfunction. See Video Abstract.","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-11DOI: 10.1097/dcr.0000000000003536
Stephen Sentovich,Kelly M Tyler
{"title":"How do you code a low anterior resection with a diverting loop ileostomy?","authors":"Stephen Sentovich,Kelly M Tyler","doi":"10.1097/dcr.0000000000003536","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003536","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/dcr.0000000000003486
Nan Ge,Yue Hu,Kai Zhang,Nan Liu,Ji-Tong Jiang,Jianyu Wei,Siyu Sun
BACKGROUNDContinuous advancements and breakthroughs in flexible gastrointestinal endoscopy have led to alternatives to colonic anastomosis.OBJECTIVEThis study aimed to evaluate the feasibility and safety of end-to-end colonic anastomosis using a single flexible endoscope with the novel through-the-scope "bow-tie" (TTS-BT) device and conventional metal clips in a porcine model.DESIGNAnimal study.SETTINGSAnimal laboratory at China Medical University.PATIENTSEight healthy pigs were included.INTERVENTIONSEight animals underwent total colonic severance and anastomoses with through-the-scope "bow-tie" devices and metal clips.MAIN OUTCOME MEASURESThe primary outcomes were the success rate of the anastomosis and survival rate during 3-month follow-up. Furthermore, the secondary outcomes were anastomotic site healing, reintervention rate, and rate of anastomotic complications such as bleeding, leakage, stenosis, and obstruction. Six pigs were euthanized, and necropsies were performed 3 months postoperatively, while two pigs were fed for long-term observation. The anastomotic stoma was histologically analyzed using Hematoxylin-eosin and Masson's trichrome staining.RESULTSEnd-to-end colonic anastomoses were successfully performed using through-the-scope "bow-tie" devices, and satisfactory healing was achieved in all pigs. The success rate of anastomosis was 100% (8/8). All animals survived postoperatively without anastomotic complications, including bleeding, leakage, or obstruction; however, two cases of stenosis occurred (25%), and one case (12.5%) required reintervention.LIMITATIONSLarge-scale studies should be conducted to verify the feasibility and safety of the through-the-scope "bow-tie" device in other parts of the intestine.CONCLUSIONSFlexible endoscopy with the through-the-scope "bow-tie" device is feasible and safe for intraluminal colonic anastomosis. This study may expand the indications for full-thickness endoscopic resection in the future. See Video abstract.
{"title":"First Fully Endoscopic End-to-End Colonic Anastomoses With a Novel Endoscopic Device: A Feasibility Study in a Porcine Model.","authors":"Nan Ge,Yue Hu,Kai Zhang,Nan Liu,Ji-Tong Jiang,Jianyu Wei,Siyu Sun","doi":"10.1097/dcr.0000000000003486","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003486","url":null,"abstract":"BACKGROUNDContinuous advancements and breakthroughs in flexible gastrointestinal endoscopy have led to alternatives to colonic anastomosis.OBJECTIVEThis study aimed to evaluate the feasibility and safety of end-to-end colonic anastomosis using a single flexible endoscope with the novel through-the-scope \"bow-tie\" (TTS-BT) device and conventional metal clips in a porcine model.DESIGNAnimal study.SETTINGSAnimal laboratory at China Medical University.PATIENTSEight healthy pigs were included.INTERVENTIONSEight animals underwent total colonic severance and anastomoses with through-the-scope \"bow-tie\" devices and metal clips.MAIN OUTCOME MEASURESThe primary outcomes were the success rate of the anastomosis and survival rate during 3-month follow-up. Furthermore, the secondary outcomes were anastomotic site healing, reintervention rate, and rate of anastomotic complications such as bleeding, leakage, stenosis, and obstruction. Six pigs were euthanized, and necropsies were performed 3 months postoperatively, while two pigs were fed for long-term observation. The anastomotic stoma was histologically analyzed using Hematoxylin-eosin and Masson's trichrome staining.RESULTSEnd-to-end colonic anastomoses were successfully performed using through-the-scope \"bow-tie\" devices, and satisfactory healing was achieved in all pigs. The success rate of anastomosis was 100% (8/8). All animals survived postoperatively without anastomotic complications, including bleeding, leakage, or obstruction; however, two cases of stenosis occurred (25%), and one case (12.5%) required reintervention.LIMITATIONSLarge-scale studies should be conducted to verify the feasibility and safety of the through-the-scope \"bow-tie\" device in other parts of the intestine.CONCLUSIONSFlexible endoscopy with the through-the-scope \"bow-tie\" device is feasible and safe for intraluminal colonic anastomosis. This study may expand the indications for full-thickness endoscopic resection in the future. See Video abstract.","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/dcr.0000000000003468
Feng Zhu,Ting Dong,Chunxiang Tang,Juan Wei,Wenwen Guo,Chao Ding,Luying Gui,Jianfeng Gong
BACKGROUNDEvidence suggested the lesion of ulcerative colitis stretches beyond mucosa. The application of radiomics on ulcerative colitis fibrosis is unclear.OBJECTIVEWe aimed to characterize the colonic fibrosis and treatment response to biologics in chronic ulcerative colitis using radiomic features extracted from bowel wall and mesenteric adipose tissue.DESIGNRetrospective analysis of prospective database.SETTINGSThis study was conducted in a single tertiary center.PATIENTSA total of 72 patients who underwent proctocolectomy and 47 patients who received biologics induction were included.INTERVENTIONComputed Tomography images were collected and radiomic features were extracted to develop radiomic models using logistic regression.MAIN OUTCOME MEASURESMain outcome was colonic fibrosis, which was classified into mild and severe based on histological scoring.RESULTSThe area under curve of the bowel wall model to predict severe fibrosis was 0.931 (p < 0.001) and 0.869 (p < 0.001) in the training and test cohort, respectively. For mesenteric adipose tissue model, area under curve was 0.947 (p < 0.001) and 0.837 (p < 0.001), respectively. The mesenteric adipose tissue model was superior to bowel wall model (area under curve, 0.809, p < 0.001 and 0.722, p = 0.006) in predicting response to biologics in chronic ulcerative colitis.LIMITATIONSRetrospective single center study.CONCLUSIONSTwo radiomic models derived from bowel wall and mesenteric adipose tissue features readily predicted colonic fibrosis and treatment response of biologics in chronic ulcerative colitis. The mesentery harbors critical information and was essentially involved in fibrogenesis. See Video Abstract.
{"title":"A Mesenteric Fat-Derived Radiomic Model to Identify Colonic Fibrosis and Predict Treatment Response to Biologics in Chronic Ulcerative Colitis.","authors":"Feng Zhu,Ting Dong,Chunxiang Tang,Juan Wei,Wenwen Guo,Chao Ding,Luying Gui,Jianfeng Gong","doi":"10.1097/dcr.0000000000003468","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003468","url":null,"abstract":"BACKGROUNDEvidence suggested the lesion of ulcerative colitis stretches beyond mucosa. The application of radiomics on ulcerative colitis fibrosis is unclear.OBJECTIVEWe aimed to characterize the colonic fibrosis and treatment response to biologics in chronic ulcerative colitis using radiomic features extracted from bowel wall and mesenteric adipose tissue.DESIGNRetrospective analysis of prospective database.SETTINGSThis study was conducted in a single tertiary center.PATIENTSA total of 72 patients who underwent proctocolectomy and 47 patients who received biologics induction were included.INTERVENTIONComputed Tomography images were collected and radiomic features were extracted to develop radiomic models using logistic regression.MAIN OUTCOME MEASURESMain outcome was colonic fibrosis, which was classified into mild and severe based on histological scoring.RESULTSThe area under curve of the bowel wall model to predict severe fibrosis was 0.931 (p < 0.001) and 0.869 (p < 0.001) in the training and test cohort, respectively. For mesenteric adipose tissue model, area under curve was 0.947 (p < 0.001) and 0.837 (p < 0.001), respectively. The mesenteric adipose tissue model was superior to bowel wall model (area under curve, 0.809, p < 0.001 and 0.722, p = 0.006) in predicting response to biologics in chronic ulcerative colitis.LIMITATIONSRetrospective single center study.CONCLUSIONSTwo radiomic models derived from bowel wall and mesenteric adipose tissue features readily predicted colonic fibrosis and treatment response of biologics in chronic ulcerative colitis. The mesentery harbors critical information and was essentially involved in fibrogenesis. See Video Abstract.","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/dcr.0000000000003487
Morgan E Jones,Gregory A Turner,Amrish K S Rajkomar,Alexander G Heriot,Satish K Warrier
{"title":"Salvage Robotic Deloyers Procedure With Transanal Total Mesorectal Excision for Symptomatic Colovaginal Fistula.","authors":"Morgan E Jones,Gregory A Turner,Amrish K S Rajkomar,Alexander G Heriot,Satish K Warrier","doi":"10.1097/dcr.0000000000003487","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003487","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/dcr.0000000000003425
Thomas E Ueland,Praveen Vimalathas,Raeshell S Sweeting,Megan M Shroder,Samuel A Younan,Alexander T Hawkins
BACKGROUNDThere is growing interest in social determinants of health for surgical populations. Within diverticulitis, no systematic collation of available evidence has been performed.OBJECTIVETo assess frequency, variety, and association directions for social determinants of health in colonic diverticular disease.DATA SOURCESFour electronic databases were queried: PubMed, Embase, Cochrane, and Web of Science.STUDY SELECTIONIncluded studies reported symptomatic left-sided colonic diverticular disease with respect to a social determinant of health according to the Healthy People 2030 initiative or applicable proxy variable. Studies with non-English full text, cohort size fewer than 50, pediatric cohorts, and exclusively non-left sided disease were excluded.MAIN OUTCOME MEASURESQuality assessment through modified Newcastle-Ottawa scale, frequency of variables reported, and effect size trends for common comparisons.RESULTSAmong 50 included studies, 40 were good and 10 were fair in quality. Social determinants of health in diverticulitis were identified across Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context domains. The two most common variables were self-reported race and ethnicity (n = 33) and insurance (n = 22). Among 18 unique studies reporting comparisons of white versus any other self-reported race and ethnicity, twelve identified a disparity disadvantaging non-white groups with effect sizes (95% confidence interval ranging from 1.23 [1.10 -1.37] to 5.35 [1.32 - 21.61]). Among 15 unique studies reporting a non-private versus private insurance comparison, nine identified non-private insurance as a risk factor with effect sizes (95% confidence intervals ranging from 1.15 [1.02 - 1.29] to 3.83 [3.01 - 4.87]).LIMITATIONSRetrospective studies, heterogeneity across cohort and variable definitions.CONCLUSIONSSocial determinants of health domains are associated with a variety of diverticulitis outcomes. Additional studies are needed to address infrequently reported domains and identify optimal strategies for intervening in clinical settings.PROSPERO IDCRD42023422606.
{"title":"Social Determinants of Health in Diverticulitis: A Systematic Review.","authors":"Thomas E Ueland,Praveen Vimalathas,Raeshell S Sweeting,Megan M Shroder,Samuel A Younan,Alexander T Hawkins","doi":"10.1097/dcr.0000000000003425","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003425","url":null,"abstract":"BACKGROUNDThere is growing interest in social determinants of health for surgical populations. Within diverticulitis, no systematic collation of available evidence has been performed.OBJECTIVETo assess frequency, variety, and association directions for social determinants of health in colonic diverticular disease.DATA SOURCESFour electronic databases were queried: PubMed, Embase, Cochrane, and Web of Science.STUDY SELECTIONIncluded studies reported symptomatic left-sided colonic diverticular disease with respect to a social determinant of health according to the Healthy People 2030 initiative or applicable proxy variable. Studies with non-English full text, cohort size fewer than 50, pediatric cohorts, and exclusively non-left sided disease were excluded.MAIN OUTCOME MEASURESQuality assessment through modified Newcastle-Ottawa scale, frequency of variables reported, and effect size trends for common comparisons.RESULTSAmong 50 included studies, 40 were good and 10 were fair in quality. Social determinants of health in diverticulitis were identified across Economic Stability, Education Access and Quality, Health Care Access and Quality, Neighborhood and Built Environment, and Social and Community Context domains. The two most common variables were self-reported race and ethnicity (n = 33) and insurance (n = 22). Among 18 unique studies reporting comparisons of white versus any other self-reported race and ethnicity, twelve identified a disparity disadvantaging non-white groups with effect sizes (95% confidence interval ranging from 1.23 [1.10 -1.37] to 5.35 [1.32 - 21.61]). Among 15 unique studies reporting a non-private versus private insurance comparison, nine identified non-private insurance as a risk factor with effect sizes (95% confidence intervals ranging from 1.15 [1.02 - 1.29] to 3.83 [3.01 - 4.87]).LIMITATIONSRetrospective studies, heterogeneity across cohort and variable definitions.CONCLUSIONSSocial determinants of health domains are associated with a variety of diverticulitis outcomes. Additional studies are needed to address infrequently reported domains and identify optimal strategies for intervening in clinical settings.PROSPERO IDCRD42023422606.","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/DCR.0000000000003513
Greg A Turner, Amrish K Rajkomar, Alexander G Heriot, Satish K Warrier
{"title":"Robotic Pelvic Sidewall Vascular Resection.","authors":"Greg A Turner, Amrish K Rajkomar, Alexander G Heriot, Satish K Warrier","doi":"10.1097/DCR.0000000000003513","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003513","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1097/dcr.0000000000003535
Amy L Lightner
{"title":"Rethinking the Pathophysiology of Ulcerative Colitis: Beyond the Mucosa.","authors":"Amy L Lightner","doi":"10.1097/dcr.0000000000003535","DOIUrl":"https://doi.org/10.1097/dcr.0000000000003535","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142201256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1097/DCR.0000000000003462
Isabela Sandigo-Saballos, Elias Altamirano, Hanjoo Lee
{"title":"Revisiting the Barcelona Technique for Loop Ileostomy Closure.","authors":"Isabela Sandigo-Saballos, Elias Altamirano, Hanjoo Lee","doi":"10.1097/DCR.0000000000003462","DOIUrl":"https://doi.org/10.1097/DCR.0000000000003462","url":null,"abstract":"","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142139606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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