Journal of Gastrointestinal Surgery最新文献

{"title":"Thrombosis and anticoagulation after portal vein reconstruction during pancreatic surgery: a systematic review","authors":"Max Heckler ,&nbsp;Georgios Polychronidis ,&nbsp;Benedict Kinny-Köster ,&nbsp;Susanne Roth ,&nbsp;Thomas Hank ,&nbsp;Joerg Kaiser ,&nbsp;Christoph Michalski ,&nbsp;Martin Loos","doi":"10.1016/j.gassur.2024.10.007","DOIUrl":"10.1016/j.gassur.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Portal vein (PV) resection and reconstruction, which includes the resection and reconstruction of the PV and superior mesenteric vein, enable surgical removal of borderline resectable and locally advanced pancreatic cancer. Thrombosis of the reconstructed PV represents a major cause of early postoperative and long-term morbidity and mortality. No universally accepted standard for anticoagulation exists. This study aimed to assess early and late thrombosis rates after PV reconstruction with special regard to the type of PV reconstruction and anticoagulation regimen and to comprehensively assess thrombotic events and their clinical effect in patients receiving pancreatic surgery with venous resection and reconstruction.</div></div><div><h3>Methods</h3><div>The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies reporting on PV resection and reconstruction providing data on thrombosis rates were included. The following parameters were assessed: study type, year of publication, number of patients, type/number of PV reconstruction, follow-up period, postoperative mortality, thrombosis rate of the reconstructed PV axis, intraoperative blood loss, and anticoagulation.</div></div><div><h3>Results</h3><div>A total of 23 studies with 2751 patients were included in the final analysis. Of note, 670 patients received tangential resection of the PV with venorrhaphy or patch repair, 1505 patients had segmental resection with end-to-end reconstruction, and 576 patients received reconstruction with an interposition graft/conduit. The pooled overall thrombosis rate was 15%. Reconstruction of tangential defects with either venorrhaphy or patch repair and end-to-end repair of segmental defects resulted in a thrombosis rate of 12%. Subgroup analysis according to the type of graft reconstruction revealed the highest occlusion rates of 55% in patients with allogeneic grafts, followed by up to 27% in patients with synthetic PV conduits. Autologous conduits had a thrombosis rate of 10%. Early thrombotic events were detected in 5% of patients after venorrhaphy/patch reconstruction and end-to-end reconstruction. Early events were most common in the allogeneic graft subgroup (22%), followed by synthetic conduits (15%). There were fewer early events in the autologous graft group (7%). Early PV thrombosis was associated with relevant mortality of up to 26%. Anticoagulation regimens varied between studies.</div></div><div><h3>Conclusion</h3><div>The overall thrombosis rate after PV resection is low. However, among the different reconstruction techniques, allogeneic interposition grafts/conduits had the highest thrombosis rates among the different types of reconstruction after PV resection. No specific anticoagulation strategy can be considered beneficial based on the existing literature.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101852"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival outcomes of adjuvant treatment in upstaged clinical T2N0 rectal cancer: are we underutilizing therapy?","authors":"Simran Kripalani ,&nbsp;Caroline Westwood ,&nbsp;Jill S. Hasler ,&nbsp;Vanessa Wookey ,&nbsp;Andrea S. Porpiglia ,&nbsp;Stephanie H. Greco ,&nbsp;Sanjay S. Reddy ,&nbsp;Joshua E. Meyer ,&nbsp;Jeffrey M. Farma ,&nbsp;Anthony M. Villano","doi":"10.1016/j.gassur.2024.10.024","DOIUrl":"10.1016/j.gassur.2024.10.024","url":null,"abstract":"<div><h3>Background</h3><div>Patients with rectal cancer staged as clinical T2N0 (cT2N0) are recommended to undergo upfront resection. However, when the tumor is subsequently upstaged to pathologic T3N0 (pT3N0), there are no clear guidelines for adjuvant treatment. This study aimed to analyze national trends in adjuvant management and to identify differences in morbidity or survival.</div></div><div><h3>Methods</h3><div>Using the National Cancer Database (2004–2020), adult patients with cT2N0 rectal adenocarcinoma that were upstaged to pT3N0 after resection were identified. The treatment groups included (i) surgery alone, (ii) surgery + postoperative (post-op) chemotherapy alone, (iii) surgery + post-op chemoradiation (CRT), and (iv) surgery + chemotherapy + CRT. Cox proportional hazard models and Kaplan-Meier curves (6-month landmark analysis) were used to compare survival outcomes.</div></div><div><h3>Results</h3><div>The analytic cohort included 800 patients who received the following treatments: surgery alone (496 [60%]), surgery + post-op chemotherapy (139 [17%]), surgery + post-op CRT (137 [15%]), and surgery + chemotherapy + CRT (69 [8%]). Patients who underwent post-op chemotherapy or chemotherapy + CRT had higher rates of poor/undifferentiated tumors (15.7% and 15.4%, respectively) than those who underwent surgery alone (8.8%) (<em>P</em> = .047). Over the study period, surgery alone decreased from 86.7% to 65.6%, with concomitant increases in post-op adjuvant therapy. Post-op chemotherapy (hazard ratio [HR], 0.336; 95% CI, 0.196–0.575) and chemotherapy + CRT (HR, 0.447; 95% CI, 0.231–0.866) remained independently associated with improved overall survival. Of note, 5-year survival was the lowest in the surgery-alone group (62.5%).</div></div><div><h3>Conclusion</h3><div>Post-op adjuvant regimens, including chemotherapy, were independently associated with improved survival in patients with cT2N0 rectal cancer upstaged to pT3N0. Adjuvant therapy may be underutilized in this setting.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101869"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited commentary on: Optimal radiation dose intensity: low- vs high-dose in the neoadjuvant treatment of locally advanced esophageal adenocarcinoma","authors":"Puja Gaur Khaitan","doi":"10.1016/j.gassur.2024.101887","DOIUrl":"10.1016/j.gassur.2024.101887","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101887"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142621994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision regret and satisfaction with shared decision-making in pancreatic surgery","authors":"Nicholas Galouzis ,&nbsp;Maria Khawam ,&nbsp;Evelyn V. Alexander ,&nbsp;Michael D. Yallourakis ,&nbsp;Lusine Mesropyan ,&nbsp;Carrie Luu ,&nbsp;Mohammad R. Khreiss ,&nbsp;Taylor S. Riall","doi":"10.1016/j.gassur.2024.10.025","DOIUrl":"10.1016/j.gassur.2024.10.025","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic surgery often does not provide long-term survival in patients with cancer or consistently improve symptoms in benign disease. This study aimed to assess decision regret and satisfaction with the decision-making process among patients who underwent pancreatectomy.</div></div><div><h3>Methods</h3><div>This study administered the Brehaut Decision Regret Scale (DRS), 9-Item Shared Decision-Making Questionnaire (SDM-Q-9), and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) to all patients who underwent elective pancreatectomies from 2021 to 2023. Decision regret was defined as a DRS of &gt;25. In addition, this study evaluated SDM-Q-9 responses in patients with and without regret.</div></div><div><h3>Results</h3><div>A total of 143 patients were included in this study, of whom 71 patients (49.6%) completed the distributed surveys. Demographics, pathology, and major complication rates were similar between responders and nonresponders. The indications for surgery were malignancy (67.6%) and benign disease (32.4%). Decision regret after pancreatic surgery was reported in 18.3% of patients. Patients who experienced regret were younger (50.8 ± 18.7 years [younger group] vs 62.0 ± 14.9 years [older group]; <em>P</em> = .03), more likely to have benign disease (39.1% [benign disease] vs 8.3% [malignant disease]; <em>P</em> &lt; .01), underwent a distal pancreatectomy (34.5% [distal pancreatectomy] vs 7.7% [pancreaticoduodenectomy]; <em>P</em> = .02), or experienced a major complication (36.8% [major complication] vs 11.5% [no major complication]; <em>P</em> = .03). Patients with regret had lower global health (57.1 ± 20.1 [patients with regret] vs 76.2 ± 22.2 [patients without regret]; <em>P</em> &lt; .01) and social function scores (61.5 ± 31.5 [patients with regret] vs 77.6 ± 22.0 [patients without regret]; <em>P</em> = .03) on the EORTC QLQ-C30. Patients with regret were less satisfied with the shared decision-making process.</div></div><div><h3>Conclusion</h3><div>Strong decision regret was reported in 18% of patients who underwent pancreatectomy. Younger age, distal pancreatectomy, benign indications, and major postoperative complications were associated with regret. Data from the SDM-9 highlight areas for potential improvement to help patients make decisions aligned with their goals of care.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101870"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastrointestinal Stromal Tumor (GIST) Quiz: Test your knowledge","authors":"Sadie Munter ,&nbsp;Ashwyn Sharma ,&nbsp;Mark Antkowiak ,&nbsp;Tannaz Ranjbarian ,&nbsp;Mojgan Hosseini ,&nbsp;Jason K. Sicklick","doi":"10.1016/j.gassur.2024.10.014","DOIUrl":"10.1016/j.gassur.2024.10.014","url":null,"abstract":"<div><div>Having a strong understanding of the epidemiology, pathophysiology, and clinical management of gastrointestinal stromal tumors (GISTs) is crucial for clinicians who may encounter this cancer. The quiz below is designed for medical students, residents, fellows, and practicing physicians to test their knowledge and review key concepts for understanding GIST.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101859"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pyloric impedance planimetry during endoscopic per-oral pyloromyotomy guides myotomy extent","authors":"Hee Kyung (Jenny) Kim ,&nbsp;Jamie DeCicco ,&nbsp;Rachna Prasad ,&nbsp;Hemasat Alkhatib ,&nbsp;Kevin El-Hayek","doi":"10.1016/j.gassur.2024.10.011","DOIUrl":"10.1016/j.gassur.2024.10.011","url":null,"abstract":"<div><h3>Background</h3><div>Per-oral pyloromyotomy (POP), also known as gastric per-oral endoscopic myotomy, is the first-line endoscopic intervention for medically refractory gastroparesis. This study aimed to assess the value of pyloric impedance planimetry using a functional lumen imaging probe (FLIP) during POP.</div></div><div><h3>Methods</h3><div>Patients who underwent POP between October 2019 and February 2024 were retrospectively reviewed. FLIP measurements, symptoms measured using the Gastroparesis Cardinal Symptom Index (GCSI), and gastric emptying scintigraphy (GES) were evaluated before and after POP.</div></div><div><h3>Results</h3><div>Of 35 patients who underwent POP, 29 (82.9%) were female, the median age was 51.3 years (IQR, 38.4–60.9), and the median body mass index was 29.26 kg/m² (IQR, 25.46–32.56). In addition, 23 patients had pre- and post-POP FLIP measurements. The median pyloric diameter increased from 14.4 (IQR, 12.0–16.0) to 16.0 (IQR, 14.8–18.0) mm (S = 116.5; <em>P</em> &lt; .0001). The median distensibility index increased from 4.85 (IQR, 3.38–6.00) to 8.45 (IQR, 5.25–11.00) mm²/mm Hg (S = 112; <em>P</em> &lt; .0001). The management changed based on FLIP values for 5 patients (21.7%), prompting additional myotomy. At 18.0 days (IQR, 12.8–47.8) after the procedure, the median GCSI score decreased from 3.33 (IQR, 2.56–4.12) preoperatively to 2.00 (IQR, 1.00–2.89) postoperatively (S = −193; <em>P</em> &lt; .001). At a median follow-up of 136 days (IQR, 114–277), improvement in GCSI score persisted, with a median score of 2.44 (IQR, 1.44–3.67) (S = −61; <em>P</em> = .021). The median retention at 4 hours on GES decreased from 29.0% (IQR, 16.5–52.0%) to 19.5% (IQR, 5.75–35.30%) at 97 days (IQR, 88–130) after the procedure (S = −108; <em>P</em> = .0038). There was a 75% improvement and a 40% normalization in objective gastric emptying (n = 26). A greater increase in diameter after pyloromyotomy was associated with a greater decrease in 4-hour gastric retention (<em>r</em> = −0.4886; <em>P</em> = .021).</div></div><div><h3>Conclusion</h3><div>POP with FLIP resulted in clinical and radiographic improvements in patients with gastroparesis. FLIP measurements guided myotomy extent, changing the management in 21.7% of patients, and were associated with gastric emptying, demonstrating its distinct utility in the treatment of gastroparesis.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101856"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraperitoneal infiltration of Exparel, post-operative pain and the need for opioids after laparoscopic hiatal hernia repair with fundopexy","authors":"Anthony Basta ,&nbsp;Joshua Haag ,&nbsp;Karsten Fields ,&nbsp;Neel Aligave ,&nbsp;Connor Fritz ,&nbsp;Andre Miller ,&nbsp;Farzaneh Banki","doi":"10.1016/j.gassur.2024.10.021","DOIUrl":"10.1016/j.gassur.2024.10.021","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101866"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal treatment strategies for borderline resectable liver metastases from colorectal cancer","authors":"Gurudutt P. Varty,&nbsp;Shraddha Patkar,&nbsp;Kaival Gundavda,&nbsp;Niket Shah,&nbsp;Mahesh Goel","doi":"10.1016/j.gassur.2024.10.023","DOIUrl":"10.1016/j.gassur.2024.10.023","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally, colorectal liver metastases (CRLMs) are divided into “initially resectable” and “initially unresectable.” The terminology “borderline resectable” continues to be elusive without any common consensus or definition. This narrative review aims to decode the conundrum of “borderline resectable CRLM (BR-CRLM)” and to discuss optimal treatment strategies.</div></div><div><h3>Methods</h3><div>A comprehensive review was performed using Medline/PubMed and Web of Science databases with a search period ending on January 1, 2024. Using PubMed, the terms “CRLM,” “BR-CRLM,” and “management of BR-CRLM” were searched.</div></div><div><h3>Results</h3><div>The 2016 European Society for Medical Oncology guidelines defined the term “resectability” in CRLM using the “technical (surgical) criteria” and the “oncologically criteria.” These 2 criteria form the basis of defining BR-CRLM. Thus, BR-CRLM can be either technically easy but with unfavorable oncologically criteria or technically difficult with favorable oncologically criteria. Although defining BR-CRLM by incorporating both these criteria seems to be the most logical way forward, there is currently a lot of heterogeneity in the literature. It is generally agreed upon that some form of chemotherapy needs to be administered in BR-CRLM before embarking on surgery. Conversion chemotherapy is used in patients with BR-CRLM in which there is a possibility of resection after effective downsizing. Along with improved effective chemotherapy, great strides have been made in pushing the limits of surgery to achieve resectability in this subset of patients.</div></div><div><h3>Conclusion</h3><div>Advanced surgical techniques and locoregional liver-directed therapies coupled with perioperative chemotherapy with or without targeted therapy have made long-term survival benefit, a reality in patients with BR-CRLM. Thus, the time has come to recognize “BR-CRLM” as a distinct entity.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101868"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative body composition changes and their clinical implications in patients with gastric cancer undergoing radical gastric cancer surgery: a prospective cohort study","authors":"Haimei Zhao ,&nbsp;Qiantong Dong ,&nbsp;Chenbin Chen ,&nbsp;Luofeng Pan ,&nbsp;Shu Liu ,&nbsp;Jun Cheng ,&nbsp;Xian Shen ,&nbsp;Sulin Wang","doi":"10.1016/j.gassur.2024.101877","DOIUrl":"10.1016/j.gassur.2024.101877","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to investigate perioperative body composition changes and their clinical implications in patients undergoing radical gastric cancer surgery.</div></div><div><h3>Methods</h3><div>Patient data are prospectively collected. Computed tomography scans were conducted within 30 days preoperatively and on the seventh postoperative day to assess skeletal muscle mass index (SMI), skeletal muscle density (SMD), and subcutaneous adipose tissue (SAT). Changes in these parameters between the 2 scans were quantified. Logistic regression analysis was used to determine factors influencing body composition loss and clinical outcomes.</div></div><div><h3>Results</h3><div>A total of 335 patients were included, showing varying degrees of decline in SMI, SMD, and SAT during the perioperative period. Multivariate analysis identified age ≥65 and low handgrip strength as independent risk factors for excessive SMI loss, whereas laparoscopic surgery served as a protective factor. For excessive SMD loss, independent risk factors included preoperative low SMD, Nutritional Risk Screening 2002 score ≥3, and hypoalbuminemia. Moreover, age ≥65 was identified as an independent risk factor for excessive SAT loss, whereas laparoscopic surgery remained protective. Excessive SMI and SMD loss are correlated with increased postoperative complications, prolonged hospital stays, and higher costs. Both excessive losses in SMI and SMD are independently associated with the incidence of postoperative complications. Further analysis revealed that excessive SMD loss (odds ratio, 3.164; 95% CI, 1.214–8.243) independently contributed to readmission risk.</div></div><div><h3>Conclusion</h3><div>Excessive SMI and SMD loss are associated with adverse clinical outcomes. It is essential to address and improve preoperative modifiable risk factors to reduce perioperative muscle loss and enhance prognosis.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101877"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Solid conclusions and wild inferences about pancreatic cancer and the immune system","authors":"Clifford S. Cho","doi":"10.1016/j.gassur.2024.10.020","DOIUrl":"10.1016/j.gassur.2024.10.020","url":null,"abstract":"","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101865"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}