Pub Date : 2026-02-12DOI: 10.1016/j.jss.2026.01.013
Sarah Macy Lawler MD , Kristen M. HoSang MD , Travis Nace MSLIS , Jocelynne Dorotan BA , Lindsay E. Kuo MD, MBA
Introduction
Secondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), with parathyroid hormone (PTH) overproduction leading to symptoms such as bone pain, pruritus, and fatigue. These symptoms diminish the already compromised quality of life (QoL) in ESRD patients. Parathyroidectomy (PTX) is offered to those who fail medical management, but its association with QoL is not addressed in treatment guidelines. This systematic review examines QoL in SHPT patients after PTX.
Methods
A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched from 2014 to 2024 using terms including ESRD, chronic kidney disease, QoL, PTX, and SHPT. Two reviewers screened titles, abstracts, and full texts. The primary outcome was change in QoL as assessed by validated questionnaires.
Results
Of 6234 articles reviewed, 10 (0.16%) studies met the inclusion criteria. There were 6 case series, 2 prospective cohort studies, 1 case control study, and 1 retrospective cohort study. Across these, 575 patients underwent PTX for symptomatic SHPT. QoL was assessed using Short-Form Health Survey (5 studies), Kidney disease quality of Life Instrument (4), parathyroidectomy assessment of symptoms(2), visual analog scale(2), and median symptom index score(1). All studies reported higher physical QoL scores after PTX compared to baseline. Improvement in mental health symptoms was variable.
Conclusions
PTX in patients with SHPT is associated with improved physical functioning and fewer mental health–related symptoms, with higher overall QoL. QoL and symptom burden may represent important factors in the decision to pursue surgical management for SHPT when medical management is not adequate.
{"title":"Quality of Life After Parathyroidectomy in Patients With End-Stage Renal Disease: A Systematic Review","authors":"Sarah Macy Lawler MD , Kristen M. HoSang MD , Travis Nace MSLIS , Jocelynne Dorotan BA , Lindsay E. Kuo MD, MBA","doi":"10.1016/j.jss.2026.01.013","DOIUrl":"10.1016/j.jss.2026.01.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Secondary hyperparathyroidism (SHPT) is a common complication of end-stage renal disease (ESRD), with parathyroid hormone (PTH) overproduction leading to symptoms such as bone pain, pruritus, and fatigue. These symptoms diminish the already compromised quality of life (QoL) in ESRD patients. Parathyroidectomy (PTX) is offered to those who fail medical management, but its association with QoL is not addressed in treatment guidelines. This systematic review examines QoL in SHPT patients after PTX.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Databases were searched from 2014 to 2024 using terms including ESRD, chronic kidney disease, QoL, PTX, and SHPT. Two reviewers screened titles, abstracts, and full texts. The primary outcome was change in QoL as assessed by validated questionnaires.</div></div><div><h3>Results</h3><div>Of 6234 articles reviewed, 10 (0.16%) studies met the inclusion criteria. There were 6 case series, 2 prospective cohort studies, 1 case control study, and 1 retrospective cohort study. Across these, 575 patients underwent PTX for symptomatic SHPT. QoL was assessed using Short-Form Health Survey (5 studies), Kidney disease quality of Life Instrument (4), parathyroidectomy assessment of symptoms(2), visual analog scale(2), and median symptom index score(1). All studies reported higher physical QoL scores after PTX compared to baseline. Improvement in mental health symptoms was variable.</div></div><div><h3>Conclusions</h3><div>PTX in patients with SHPT is associated with improved physical functioning and fewer mental health–related symptoms, with higher overall QoL. QoL and symptom burden may represent important factors in the decision to pursue surgical management for SHPT when medical management is not adequate.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 160-169"},"PeriodicalIF":1.7,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191641","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}
Pub Date : 2026-02-12DOI: 10.1016/j.jss.2026.01.016
Aryan Rafieezadeh MD, Kartik Prabhakaran MD, Rishwanth Vetri MD, Riddhi Mehta MBBS, Jordan Kirsch DO, Ilya Shnaydman MD, Joshua Klein DO, Gabriel Froula DO, Matthew Bronstein MD, Amanda Carlson MD, Aaron Zuckerman MD, Bardiya Zangbar MD
Introduction
Limb amputation is a challenging decision, and delayed procedures may be associated with higher complication rates. This study compares outcomes between early and late amputation in patients with isolated blunt severe lower limb injuries.
Materials and Methods
We retrospectively reviewed the Trauma Quality Improvement Program (2017-2021), including all ages with isolated severe blunt lower limb injury (Abbreviated Injury Scale ≥ 3) who underwent amputation. Patients were stratified into early (≤48 h) and late (>48 h) amputation groups. The primary outcome was mortality, while secondary outcomes included in-hospital complications, hospital and intensive care unit (ICU) length of stay, and discharge disposition. Propensity score matching was performed to compare outcomes between groups.
Results
Of 4439 patients included, 1959 cases (44.1%) had early amputation (mean procedure time of 1.25 ± 0.43 d), and 2480 cases (55.9%) had late amputations (mean procedure time of 10.34 ± 9.05 d). After matching (1733 per group), mortality did not differ between groups (P = 0.06). Patients in the early amputation group, compared to the late amputation group, had lower rates of acute kidney injury (2.3% versus 4.6%), osteomyelitis (0.7% versus 1.4%), unplanned intubation (1.2% versus 2.4%), unplanned ICU admission (2.8% versus 5.3%), unplanned return to the operation room (2.5% versus 7.9%), and higher rates of home discharge (30.9% versus 27.5%) (P < 0.05). The hospital and ICU length of stay were significantly lower in the early amputation group compared to the late amputation group (P < 0.001).
Conclusions
Early amputation in serious blunt lower limb injuries was associated with fewer observed complications, shorter hospital and ICU stays, and a higher rate of home discharge compared to late amputation.
{"title":"Decisions in Crisis: Amputation Timing and Short-Term Outcomes in Severe Blunt Lower Limb Trauma","authors":"Aryan Rafieezadeh MD, Kartik Prabhakaran MD, Rishwanth Vetri MD, Riddhi Mehta MBBS, Jordan Kirsch DO, Ilya Shnaydman MD, Joshua Klein DO, Gabriel Froula DO, Matthew Bronstein MD, Amanda Carlson MD, Aaron Zuckerman MD, Bardiya Zangbar MD","doi":"10.1016/j.jss.2026.01.016","DOIUrl":"10.1016/j.jss.2026.01.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Limb amputation is a challenging decision, and delayed procedures may be associated with higher complication rates. This study compares outcomes between early and late amputation in patients with isolated blunt severe lower limb injuries.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively reviewed the Trauma Quality Improvement Program (2017-2021), including all ages with isolated severe blunt lower limb injury (Abbreviated Injury Scale ≥ 3) who underwent amputation. Patients were stratified into early (≤48 h) and late (>48 h) amputation groups. The primary outcome was mortality, while secondary outcomes included in-hospital complications, hospital and intensive care unit (ICU) length of stay, and discharge disposition. Propensity score matching was performed to compare outcomes between groups.</div></div><div><h3>Results</h3><div>Of 4439 patients included, 1959 cases (44.1%) had early amputation (mean procedure time of 1.25 ± 0.43 d), and 2480 cases (55.9%) had late amputations (mean procedure time of 10.34 ± 9.05 d). After matching (1733 per group), mortality did not differ between groups (<em>P</em> = 0.06). Patients in the early amputation group, compared to the late amputation group, had lower rates of acute kidney injury (2.3% <em>versus</em> 4.6%), osteomyelitis (0.7% <em>versus</em> 1.4%), unplanned intubation (1.2% <em>versus</em> 2.4%), unplanned ICU admission (2.8% <em>versus</em> 5.3%), unplanned return to the operation room (2.5% <em>versus</em> 7.9%), and higher rates of home discharge (30.9% <em>versus</em> 27.5%) (<em>P</em> < 0.05). The hospital and ICU length of stay were significantly lower in the early amputation group compared to the late amputation group (<em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Early amputation in serious blunt lower limb injuries was associated with fewer observed complications, shorter hospital and ICU stays, and a higher rate of home discharge compared to late amputation.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 170-177"},"PeriodicalIF":1.7,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146191640","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}
Pub Date : 2026-02-10DOI: 10.1016/j.jss.2026.01.010
Sage A. Vincent MD , Lori Silveira PhD, MS , Samantha Bothwell MS , Jonathan Roach MD , Jose Diaz-Miron MD, MSCS , Stephanie L. Bourque MD, MSCS , Shannon N. Acker MD
Introduction
A multidisciplinary protocol for the management of esophageal atresia/tracheoesophageal fistula (EA/TEF) was developed with stakeholders from pediatric surgery and neonatology. Introduced in July 2022, this study aims to assess protocol utilization and association with patient outcomes.
Methods
We performed a single-center, retrospective review of neonatal patients who underwent type C EA/TEF repair between 2010 and 2024. Utilization of protocol elements was assessed, as well as clinical outcomes. Preprotocol and postprotocol management and outcomes were compared using logistic regression. A prospective provider survey was administered to assess protocol sustainability and knowledge.
Results
There were 103 patients who underwent type C EA/TEF repair, 87 preprotocol and 16 postprotocol implementation. Thoracoscopic repair was more common postprotocol (68.8% versus 31.0%, P = 0.003). Patients were more likely to receive total parenteral nutrition until full enteral feeds were reached (odds ratio 75.6; 95% confidence interval 4.2, 1445; P = 0.003) and receive enteral feeds within 24 h of surgery when transanastomotic tube was in place (odds ratio 3.71; 95% confidence interval 1.04, 13.27; P = 0.043) postprotocol. There was no significant change in outcomes including anastomotic leak and stricture. Providers could correctly identify 2/3 of the EA/TEF protocol elements and 22% reported receiving education on its contents.
Conclusions
Implementation of an EA/TEF protocol was associated with a 75 times greater likelihood of patients receiving total parenteral nutrition until full feeds were reached and 3.7 times greater likelihood of starting enteral feeds within 24 h of surgery when transanastomotic tube was in place. There was a shift toward thoracoscopic repair of EA/TEF and no change in clinical outcomes including anastomotic leak and stricture. Implementation and knowledge of the protocol faced challenges and provider surveys identified avenues for improving education strategies.
{"title":"Implementation and Evaluation of a Protocol for the Management of Type C Tracheoesophageal Fistula","authors":"Sage A. Vincent MD , Lori Silveira PhD, MS , Samantha Bothwell MS , Jonathan Roach MD , Jose Diaz-Miron MD, MSCS , Stephanie L. Bourque MD, MSCS , Shannon N. Acker MD","doi":"10.1016/j.jss.2026.01.010","DOIUrl":"10.1016/j.jss.2026.01.010","url":null,"abstract":"<div><h3>Introduction</h3><div>A multidisciplinary protocol for the management of esophageal atresia/tracheoesophageal fistula (EA/TEF) was developed with stakeholders from pediatric surgery and neonatology. Introduced in July 2022, this study aims to assess protocol utilization and association with patient outcomes.</div></div><div><h3>Methods</h3><div>We performed a single-center, retrospective review of neonatal patients who underwent type C EA/TEF repair between 2010 and 2024. Utilization of protocol elements was assessed, as well as clinical outcomes. Preprotocol and postprotocol management and outcomes were compared using logistic regression. A prospective provider survey was administered to assess protocol sustainability and knowledge.</div></div><div><h3>Results</h3><div>There were 103 patients who underwent type C EA/TEF repair, 87 preprotocol and 16 postprotocol implementation. Thoracoscopic repair was more common postprotocol (68.8% <em>versus</em> 31.0%, <em>P</em> = 0.003). Patients were more likely to receive total parenteral nutrition until full enteral feeds were reached (odds ratio 75.6; 95% confidence interval 4.2, 1445; <em>P</em> = 0.003) and receive enteral feeds within 24 h of surgery when transanastomotic tube was in place (odds ratio 3.71; 95% confidence interval 1.04, 13.27; <em>P</em> = 0.043) postprotocol. There was no significant change in outcomes including anastomotic leak and stricture. Providers could correctly identify 2/3 of the EA/TEF protocol elements and 22% reported receiving education on its contents.</div></div><div><h3>Conclusions</h3><div>Implementation of an EA/TEF protocol was associated with a 75 times greater likelihood of patients receiving total parenteral nutrition until full feeds were reached and 3.7 times greater likelihood of starting enteral feeds within 24 h of surgery when transanastomotic tube was in place. There was a shift toward thoracoscopic repair of EA/TEF and no change in clinical outcomes including anastomotic leak and stricture. Implementation and knowledge of the protocol faced challenges and provider surveys identified avenues for improving education strategies.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 108-116"},"PeriodicalIF":1.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165745","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}
Pub Date : 2026-02-10DOI: 10.1016/j.jss.2026.01.017
Alexander Brown MBS , Ariel Hus BS , Ian Bundschu BS , Logan Rogers BS , Yumna Indorewala BS , Alexandra Kata MS , Sanjan Kumar BS , Adel Elkbuli MD, MPH, MBA
Introduction
This study aims to evaluate the association between unplanned ICU admission and clinical outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, this study assesses predictors of worsened outcomes in this population.
Methods
This retrospective cohort study analyzed the ACS-TQIP database (2017-2023) to analyze outcomes associated with unplanned ICU admission in adult and geriatric trauma patients (ISS ≥ 15) with severe sepsis. The primary outcome was in-hospital mortality, and secondary outcomes included discharge disposition, ICU-LOS, ventilator-free days, and complications.
Results
In both adult and geriatric patients, unplanned ICU admission was associated with significantly lower in-hospital mortality (aOR: 0.460, 95% CI: 0.346-0.610, P < 0.001, SE: 0.145) (aOR: 0.657, 95% CI: 0.438-0.987, P = 0.043, SE: 0.207) and more ventilator-free days (β = 5.067, 95% CI: 3.981-6.153, P < 0.001, SE: 0.554) (β = 2.402, 95% CI: 0.625-4.180, P = 0.008, SE: 0.905). Advanced age (over 64 years) (aOR: 1.487, 95% CI: 1.140-1.924, P = 0.003, SE: 0.134), ISS over 25 (aOR: 1.487, 95% CI: 1.251-1.768, P < 0.001, SE: 0.088), and having multiple comorbidities (aOR: 1.402, 95% CI: 1.152-1.706, P < 0.001, SE: 0.100) were found to be associated with worse outcomes.
Conclusions
Findings from this national analysis highlighted predictors associated with worsening outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, while unplanned ICU admission was associated with improved outcomes in both adult and geriatric trauma patients with severe sepsis compared to those admitted to hospital floors, its high resource utilization emphasizes the importance of developing targeted care strategies to prevent resource overutilization and clinical deterioration in this patient population.
本研究旨在评估成人和老年创伤合并严重脓毒症患者非计划入住ICU与临床结局的关系。此外，本研究评估了该人群预后恶化的预测因素。方法：本回顾性队列研究分析ACS-TQIP数据库（2017-2023），分析合并严重脓毒症的成人和老年创伤患者（ISS≥15）非计划入住ICU的结局。主要结局是住院死亡率，次要结局包括出院处置、ICU-LOS、无呼吸机天数和并发症。结果：在成人和老年患者中，非计划入住ICU与较低的住院死亡率（aOR: 0.460, 95% CI: 0.346-0.610, P < 0.001, SE: 0.145） （aOR: 0.657, 95% CI: 0.438-0.987, P = 0.043, SE: 0.207）和较长的无呼吸机天数（β = 5.067, 95% CI: 3.981-6.153, P < 0.001, SE: 0.554） （β = 2.402, 95% CI: 0.625-4.180, P = 0.008, SE: 0.905）相关。高龄（超过64岁）（aOR: 1.487, 95% CI: 1.140-1.924, P = 0.003, SE: 0.134）、ISS超过25 （aOR: 1.487, 95% CI: 1.251-1.768, P < 0.001, SE: 0.088）和合并多种并发症（aOR: 1.402, 95% CI: 1.152-1.706, P < 0.001, SE: 0.100）与预后较差相关。结论：这项全国性分析的结果强调了与成人和老年创伤患者严重败血症预后恶化相关的预测因素。此外，虽然与住院相比，非计划ICU住院与成人和老年创伤严重脓毒症患者的预后改善有关，但其高资源利用率强调了制定有针对性的护理策略的重要性，以防止该患者群体的资源过度利用和临床恶化。
{"title":"Association of Unplanned ICU Admission and Clinical Outcomes in Trauma Patients With Severe Sepsis","authors":"Alexander Brown MBS , Ariel Hus BS , Ian Bundschu BS , Logan Rogers BS , Yumna Indorewala BS , Alexandra Kata MS , Sanjan Kumar BS , Adel Elkbuli MD, MPH, MBA","doi":"10.1016/j.jss.2026.01.017","DOIUrl":"10.1016/j.jss.2026.01.017","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aims to evaluate the association between unplanned ICU admission and clinical outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, this study assesses predictors of worsened outcomes in this population.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed the ACS-TQIP database (2017-2023) to analyze outcomes associated with unplanned ICU admission in adult and geriatric trauma patients (ISS ≥ 15) with severe sepsis. The primary outcome was in-hospital mortality, and secondary outcomes included discharge disposition, ICU-LOS, ventilator-free days, and complications.</div></div><div><h3>Results</h3><div>In both adult and geriatric patients, unplanned ICU admission was associated with significantly lower in-hospital mortality (aOR: 0.460, 95% CI: 0.346-0.610, <em>P</em> < 0.001, SE: 0.145) (aOR: 0.657, 95% CI: 0.438-0.987, <em>P</em> = 0.043, SE: 0.207) and more ventilator-free days (β = 5.067, 95% CI: 3.981-6.153, <em>P</em> < 0.001, SE: 0.554) (β = 2.402, 95% CI: 0.625-4.180, <em>P</em> = 0.008, SE: 0.905). Advanced age (over 64 years) (aOR: 1.487, 95% CI: 1.140-1.924, <em>P</em> = 0.003, SE: 0.134), ISS over 25 (aOR: 1.487, 95% CI: 1.251-1.768, <em>P</em> < 0.001, SE: 0.088), and having multiple comorbidities (aOR: 1.402, 95% CI: 1.152-1.706, <em>P</em> < 0.001, SE: 0.100) were found to be associated with worse outcomes.</div></div><div><h3>Conclusions</h3><div>Findings from this national analysis highlighted predictors associated with worsening outcomes in adult and geriatric trauma patients with severe sepsis. Additionally, while unplanned ICU admission was associated with improved outcomes in both adult and geriatric trauma patients with severe sepsis compared to those admitted to hospital floors, its high resource utilization emphasizes the importance of developing targeted care strategies to prevent resource overutilization and clinical deterioration in this patient population.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 100-107"},"PeriodicalIF":1.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165701","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}
Pub Date : 2026-02-10DOI: 10.1016/j.jss.2026.01.014
Antonio Bozzani MD , Simone Mauramati MD , Vittorio Arici MD , Elvira Visciglia MD , Matteo Crippa MD , Rosa Rossini MD , Marco Benazzo MD , Antonio V. Sterpetti MD , Patrizia Morbini MD , Eloisa Arbustini MD
Introduction
This study aimed to evaluate outcomes in the surgical management of carotid body tumors (CBTs), assess long-term follow-up, and examine the importance of genetic testing for succinate dehydrogenase genes.
Materials and Methods
We retrospectively reviewed 36 patients who had undergone resection of CBTs at our institution from 2013 to 2024. Data on patient history, symptoms, clinical features, diagnostic procedures, treatment modality, perioperative and late (persistent neurological disability and recurrence rate) complications, histological findings, DNA test, and secretory activity were analyzed.
Results
The average tumor size was 34.1 mm. A familial history of head and neck paragangliomas was present in 7 patients. According to the Shamblin classification, we observed 8/38 (21%) type III, 18/38 (47.4%) type II, and 12/38 (31.6) type I CBTs. Malignancy was present in two patients. No postoperative deaths or strokes occurred. Cranial nerve injury occurred in 8 patients (22.2%). Tumor size greater than 4 cm and Shamblin grade 3 were correlated with cranial nerve complications. The average follow-up period was 112.4 mo (range: 15-169 mo), including yearly clinical evaluations with Doppler carotid ultrasound. During this period, we observed 3 local recurrences and 1 new intrathoracic localization of paraganglioma.
Conclusions
Surgery is recommended for all patients with CBT and fit for open surgery. Early detection of small tumors may improve surgical outcomes and reduce complications.
{"title":"Ten-Year Single-Center Experience in the Surgical Treatment of Carotid Body Tumors","authors":"Antonio Bozzani MD , Simone Mauramati MD , Vittorio Arici MD , Elvira Visciglia MD , Matteo Crippa MD , Rosa Rossini MD , Marco Benazzo MD , Antonio V. Sterpetti MD , Patrizia Morbini MD , Eloisa Arbustini MD","doi":"10.1016/j.jss.2026.01.014","DOIUrl":"10.1016/j.jss.2026.01.014","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate outcomes in the surgical management of carotid body tumors (CBTs), assess long-term follow-up, and examine the importance of genetic testing for succinate dehydrogenase genes.</div></div><div><h3>Materials and Methods</h3><div>We retrospectively reviewed 36 patients who had undergone resection of CBTs at our institution from 2013 to 2024. Data on patient history, symptoms, clinical features, diagnostic procedures, treatment modality, perioperative and late (persistent neurological disability and recurrence rate) complications, histological findings, DNA test, and secretory activity were analyzed.</div></div><div><h3>Results</h3><div>The average tumor size was 34.1 mm. A familial history of head and neck paragangliomas was present in 7 patients. According to the Shamblin classification, we observed 8/38 (21%) type III, 18/38 (47.4%) type II, and 12/38 (31.6) type I CBTs. Malignancy was present in two patients. No postoperative deaths or strokes occurred. Cranial nerve injury occurred in 8 patients (22.2%). Tumor size greater than 4 cm and Shamblin grade 3 were correlated with cranial nerve complications. The average follow-up period was 112.4 mo (range: 15-169 mo), including yearly clinical evaluations with Doppler carotid ultrasound. During this period, we observed 3 local recurrences and 1 new intrathoracic localization of paraganglioma.</div></div><div><h3>Conclusions</h3><div>Surgery is recommended for all patients with CBT and fit for open surgery. Early detection of small tumors may improve surgical outcomes and reduce complications.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 90-99"},"PeriodicalIF":1.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165802","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}
Pub Date : 2026-02-10DOI: 10.1016/j.jss.2026.01.009
Elizabeth Palmer Kelly PhD , Julia McGee BS , Celia E. Wills PhD, RN , Robert Strouse MFA , Tanya R. Gure MD , Maryanna Klatt PhD , Timothy M. Pawlik MD, MPH, MTS, PhD, MBA
Introduction
Shared decision-making (SDM) is widely endorsed in surgical care, yet it is inconsistently applied. A lack of attention to decisional antecedents, including patients’ beliefs, goals, experiences, emotions, and social context, may contribute to this gap, particularly in time-constrained preoperative settings. The current study sought to characterize surgeon perspectives on decisional antecedents and identify opportunities to strengthen SDM within routine surgical workflows.
Methods
In-depth, semistructured interviews were conducted with surgeons at a single academic medical center. Surgeons were identified through departmental faculty lists and invited by email. Interviews were conducted via Zoom, transcribed verbatim, and analyzed thematically in NVivo using an inductive approach. Two team members independently coded transcripts and developed themes through iterative discussion.
Results
Eighteen surgeons from six subspecialties participated. Five themes characterized how surgeons approached SDM in preoperative consultations: (1) variability in patient engagement, (2) role of decisional antecedents, (3) time and cognitive constraints, (4) value of pre-encounter context, and (5) third parties reveal patient values. Surgeons reported that patients differ widely in their readiness, informational needs, prior experiences, and desired involvement, yet this information was often not available to them because routine workflows provided few opportunities to uncover it. Surgeons viewed decisional antecedents and third-party perspectives (e.g., family, caregivers) as central to SDM but reported structural barriers to incorporate these factors during time-limited consultations.
Conclusions
Pre-visit strategies are needed to surface key contextual factors to support SDM within existing surgical workflows.
{"title":"Surgeon Perspectives on Decisional Antecedents in Preoperative Decision-Making","authors":"Elizabeth Palmer Kelly PhD , Julia McGee BS , Celia E. Wills PhD, RN , Robert Strouse MFA , Tanya R. Gure MD , Maryanna Klatt PhD , Timothy M. Pawlik MD, MPH, MTS, PhD, MBA","doi":"10.1016/j.jss.2026.01.009","DOIUrl":"10.1016/j.jss.2026.01.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Shared decision-making (SDM) is widely endorsed in surgical care, yet it is inconsistently applied. A lack of attention to decisional antecedents, including patients’ beliefs, goals, experiences, emotions, and social context, may contribute to this gap, particularly in time-constrained preoperative settings. The current study sought to characterize surgeon perspectives on decisional antecedents and identify opportunities to strengthen SDM within routine surgical workflows.</div></div><div><h3>Methods</h3><div>In-depth, semistructured interviews were conducted with surgeons at a single academic medical center. Surgeons were identified through departmental faculty lists and invited by email. Interviews were conducted via Zoom, transcribed verbatim, and analyzed thematically in NVivo using an inductive approach. Two team members independently coded transcripts and developed themes through iterative discussion.</div></div><div><h3>Results</h3><div>Eighteen surgeons from six subspecialties participated. Five themes characterized how surgeons approached SDM in preoperative consultations: (1) variability in patient engagement, (2) role of decisional antecedents, (3) time and cognitive constraints, (4) value of pre-encounter context, and (5) third parties reveal patient values. Surgeons reported that patients differ widely in their readiness, informational needs, prior experiences, and desired involvement, yet this information was often not available to them because routine workflows provided few opportunities to uncover it. Surgeons viewed decisional antecedents and third-party perspectives (e.g., family, caregivers) as central to SDM but reported structural barriers to incorporate these factors during time-limited consultations.</div></div><div><h3>Conclusions</h3><div>Pre-visit strategies are needed to surface key contextual factors to support SDM within existing surgical workflows.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 134-140"},"PeriodicalIF":1.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165820","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}
Pub Date : 2026-02-10DOI: 10.1016/j.jss.2026.01.006
Lauge Hjorth Mikkelsen MD, PhD , Peter Nørgaard Larsen MD , Lucas Alexander Knøfler MD , Torsten Pless MD , Anders Riegels Knudsen MD, PhD , Susanne Dam Nielsen MD, DMSc , Mette Lise Lousdal PhD , Morten Ladekarl MD, DMSc , Mogens Stender MD, PhD , Hans-Christian Pommergaard MD, PhD, DMSc
Introduction
Surgical treatment of noncolorectal, non-neuroendocrine liver metastases (NCNNLM) remains unclear. This nationwide study evaluated the outcome of patients with NCNNLM, evaluated at multidisciplinary team conferences and included in the Danish Liver Cancer Group Database, according to surgery or no surgery.
Methods
We identified all patients with NCNNLM evaluated at multidisciplinary team conferences at the four specialized centers in Denmark between October 2013 and November 2023. Patient characteristics and survival were analyzed using descriptive statistics and illustrated by Kaplan–Meier curves, respectively. Prognostic factors were assessed with logistic regression, Cox regression, and accelerated failure time models.
Results
605 patients were included in the analyses. The median follow-up was 20 mo, none were lost to follow-up. The median age of patients was 64 y, with a female predominance (58%). Most patients (93%) had World Health Organization (WHO) performance status 0-1. The overall 5-y survival rate was 29%, with a median survival of 27 mo. Surgery was performed in 307 patients (51%). Surgical intervention was associated with better survival compared with nonsurgical treatment (median survival 39 versus 13 mo, P < 0.05). Poor prognostic factors included age exceeding 64 y (hazard ratio = 1.022, P < 0.0001) and WHO performance status 2-4 (odds ratio 6.89, P = 0.007).
Conclusions
NCNNLM carries a poor prognosis. Surgery of liver metastasis is associated with improved survival with age, WHO performance status, and primary cancer type serving as important prognostic factors. However, from our study we could not establish a causal effect of surgery and confounding by indication is likely.
{"title":"Survival of Patients With Noncolorectal Non-Neuroendocrine Liver Metastases: A Nationwide Cohort Study From the Danish Liver Cancer Group","authors":"Lauge Hjorth Mikkelsen MD, PhD , Peter Nørgaard Larsen MD , Lucas Alexander Knøfler MD , Torsten Pless MD , Anders Riegels Knudsen MD, PhD , Susanne Dam Nielsen MD, DMSc , Mette Lise Lousdal PhD , Morten Ladekarl MD, DMSc , Mogens Stender MD, PhD , Hans-Christian Pommergaard MD, PhD, DMSc","doi":"10.1016/j.jss.2026.01.006","DOIUrl":"10.1016/j.jss.2026.01.006","url":null,"abstract":"<div><h3>Introduction</h3><div>Surgical treatment of noncolorectal, non-neuroendocrine liver metastases (NCNNLM) remains unclear. This nationwide study evaluated the outcome of patients with NCNNLM, evaluated at multidisciplinary team conferences and included in the Danish Liver Cancer Group Database, according to surgery or no surgery.</div></div><div><h3>Methods</h3><div>We identified all patients with NCNNLM evaluated at multidisciplinary team conferences at the four specialized centers in Denmark between October 2013 and November 2023. Patient characteristics and survival were analyzed using descriptive statistics and illustrated by Kaplan–Meier curves, respectively. Prognostic factors were assessed with logistic regression, Cox regression, and accelerated failure time models.</div></div><div><h3>Results</h3><div>605 patients were included in the analyses. The median follow-up was 20 mo, none were lost to follow-up. The median age of patients was 64 y, with a female predominance (58%). Most patients (93%) had World Health Organization (WHO) performance status 0-1. The overall 5-y survival rate was 29%, with a median survival of 27 mo. Surgery was performed in 307 patients (51%). Surgical intervention was associated with better survival compared with nonsurgical treatment (median survival 39 <em>versus</em> 13 mo, <em>P</em> < 0.05). Poor prognostic factors included age exceeding 64 y (hazard ratio = 1.022, <em>P</em> < 0.0001) and WHO performance status 2-4 (odds ratio 6.89, <em>P</em> = 0.007).</div></div><div><h3>Conclusions</h3><div>NCNNLM carries a poor prognosis. Surgery of liver metastasis is associated with improved survival with age, WHO performance status, and primary cancer type serving as important prognostic factors. However, from our study we could not establish a causal effect of surgery and confounding by indication is likely.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 125-133"},"PeriodicalIF":1.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165833","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}
Pub Date : 2026-02-10DOI: 10.1016/j.jss.2026.01.002
Ana Maria Minaya-Bravo PhD , Cristina Vera-Mansilla MD , Fernando Ruiz-Grande PhD
Introduction
Jejunal artery aneurysms (JAAs) account for 1% of all visceral artery aneurysms (VAAs). Fewer than 100 cases have been reported in the English literature, rupture rates approach 60%, compared with 10%-20% for other VAAs. Their rupture risk and management remain poorly defined.
Methods
We reviewed the English literature from 1944 to June 2025 and identified 44 cases of JAAs with analyzable data. Primary objective was to explore predictors of rupture; secondary objective was management. Given the rarity and heterogeneity of reports, statistical analyses were exploratory. To the best of our knowledge, this is the largest series of JAAs with analyzable data reported to date.
Results
Overall rupture rate was 59%, most (64.7%) measured ≤10 mm and occurred in younger individuals (mean age 41.9 versus 57.3 ys, P = 0.0199). Mortality rate was 9.1% (n = 4), including two with connective tissue disease; 26.9% of ruptured cases had no medical history. Rupture was associated with gastrointestinal hemorrhage (P = 0.0019) but not with pain (P = 0.310). Surgical management most common was: aneurysm excision (47.7%) or bowel resection (27.3%). Embolization was performed in 7 cases, with no mortality.
Conclusions
Most of ruptures occurred in small aneurysms (<10 mm) challenging the conventional 2 cm intervention threshold applied to other VAAs. These findings suggest that arterial wall pathology and unstable flow may contribute to rupture, independently of size. Management should be individualized incorporating patient-specific risk factors and underlying vascular vulnerability. This is consistent with the recent international Society for Vascular Surgery Clinical Practical Guidelines recommendations. Further studies are required to define risk stratification.
{"title":"Rupture Predictors and Clinical Outcomes in Jejunal Artery Aneurysms: A Literature Case Series Review","authors":"Ana Maria Minaya-Bravo PhD , Cristina Vera-Mansilla MD , Fernando Ruiz-Grande PhD","doi":"10.1016/j.jss.2026.01.002","DOIUrl":"10.1016/j.jss.2026.01.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Jejunal artery aneurysms (JAAs) account for 1% of all visceral artery aneurysms (VAAs). Fewer than 100 cases have been reported in the English literature, rupture rates approach 60%, compared with 10%-20% for other VAAs. Their rupture risk and management remain poorly defined.</div></div><div><h3>Methods</h3><div>We reviewed the English literature from 1944 to June 2025 and identified 44 cases of JAAs with analyzable data. Primary objective was to explore predictors of rupture; secondary objective was management. Given the rarity and heterogeneity of reports, statistical analyses were exploratory. To the best of our knowledge, this is the largest series of JAAs with analyzable data reported to date.</div></div><div><h3>Results</h3><div>Overall rupture rate was 59%, most (64.7%) measured ≤10 mm and occurred in younger individuals (mean age 41.9 <em>versus</em> 57.3 ys, <em>P</em> = 0.0199). Mortality rate was 9.1% (<em>n</em> = 4), including two with connective tissue disease; 26.9% of ruptured cases had no medical history. Rupture was associated with gastrointestinal hemorrhage (<em>P</em> = 0.0019) but not with pain (<em>P</em> = 0.310). Surgical management most common was: aneurysm excision (47.7%) or bowel resection (27.3%). Embolization was performed in 7 cases, with no mortality.</div></div><div><h3>Conclusions</h3><div>Most of ruptures occurred in small aneurysms (<10 mm) challenging the conventional 2 cm intervention threshold applied to other VAAs. These findings suggest that arterial wall pathology and unstable flow may contribute to rupture, independently of size. Management should be individualized incorporating patient-specific risk factors and underlying vascular vulnerability. This is consistent with the recent international Society for Vascular Surgery Clinical Practical Guidelines recommendations. Further studies are required to define risk stratification.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 77-89"},"PeriodicalIF":1.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165713","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}
To evaluate steroidogenesis in pediatric adrenal rests in the spermatic cord.
Methods
We reviewed pediatric patients who underwent surgical exploration of the inguinal and scrotal areas retrospectively. When we detected spermatic cord masses during the surgery, we resected it for pathological evaluation.
Results
We first reviewed clinical records of 249 surgeries in 194 male patients in the retrospective fashion and subsequently detected ten adrenal rests in nine cases. Steroid synthases, androgen receptor, Ki-67 were immunolocalized in nine cases to further explore steroidogenesis and potential effects of androgens. All adrenal rests harbored multiple zonae as in eutopic adrenal cortex with fetal adrenal cortex detected in four-fifth adrenal rests in infancy but none after infancy. Age was significantly negatively correlated with adrenocortical areas evaluated by image analysis (P < 0.0001). Immunoreactivity of aldosterone synthase (CYP11B2), 11-beta-hydroxylase, cytochrome P450 17A1, and sulfotransferase 2A1 was diffusely detected mainly in the areas corresponding to the zona glomerulosa (ZG), the zona fasciculata (ZF), the ZF and zona reticularis, and the zona reticularis and fetal adrenal cortex-like structures, respectively. CYP11B2-positive area ratio tended to decrease from birth to early childhood but increase in prepuberty. Diffuse cytoplasmic androgen receptor immunoreactivity was detected in ZG-like cells in prepubertal specimens. Ki-67 positive cells were mainly detected in the ZG- and ZF-like cells, mostly in infancy.
Conclusions
Androgen-dependent aldosterone biosynthesis may differ between adrenal rests and eutopic adrenal glands, but steroidogenesis in adrenal rests in the spermatic cord is considered normal.
{"title":"Steroidogenesis in Pediatric Adrenal Rests in the Spermatic Cord","authors":"Tsubasa Shironomae PhD, MD , Yuto Yamazaki PhD, MD , Shinako Takeda PhD, MD , Keiko Ainoya PhD, MD , Junji Takeyama PhD, MD , Kiyohide Sakai PhD, MD , Hironobu Sasano PhD, MD , Takashi Suzuki PhD, MD","doi":"10.1016/j.jss.2026.01.020","DOIUrl":"10.1016/j.jss.2026.01.020","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate steroidogenesis in pediatric adrenal rests in the spermatic cord.</div></div><div><h3>Methods</h3><div>We reviewed pediatric patients who underwent surgical exploration of the inguinal and scrotal areas retrospectively. When we detected spermatic cord masses during the surgery, we resected it for pathological evaluation.</div></div><div><h3>Results</h3><div>We first reviewed clinical records of 249 surgeries in 194 male patients in the retrospective fashion and subsequently detected ten adrenal rests in nine cases. Steroid synthases, androgen receptor, Ki-67 were immunolocalized in nine cases to further explore steroidogenesis and potential effects of androgens. All adrenal rests harbored multiple zonae as in eutopic adrenal cortex with fetal adrenal cortex detected in four-fifth adrenal rests in infancy but none after infancy. Age was significantly negatively correlated with adrenocortical areas evaluated by image analysis (<em>P</em> < 0.0001). Immunoreactivity of aldosterone synthase (CYP11B2), 11-beta-hydroxylase, cytochrome P450 17A1, and sulfotransferase 2A1 was diffusely detected mainly in the areas corresponding to the zona glomerulosa (ZG), the zona fasciculata (ZF), the ZF and zona reticularis, and the zona reticularis and fetal adrenal cortex-like structures, respectively. CYP11B2-positive area ratio tended to decrease from birth to early childhood but increase in prepuberty. Diffuse cytoplasmic androgen receptor immunoreactivity was detected in ZG-like cells in prepubertal specimens. Ki-67 positive cells were mainly detected in the ZG- and ZF-like cells, mostly in infancy.</div></div><div><h3>Conclusions</h3><div>Androgen-dependent aldosterone biosynthesis may differ between adrenal rests and eutopic adrenal glands, but steroidogenesis in adrenal rests in the spermatic cord is considered normal.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"319 ","pages":"Pages 117-124"},"PeriodicalIF":1.7,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165682","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}
Pub Date : 2026-02-09DOI: 10.1016/j.jss.2025.12.038
Sara Myers, Bachar Halimeh, Sheina Theodore, Olga Beresneva, Veer Sawhney, Samantha Rivard, Sabrina E Sanchez, Jennnifer S Davids
Introduction: Both acute care surgeons (ACS) and colorectal surgeons (CRS) manage patients with acute lower gastrointestinal (GI) surgical conditions. No consensus guidelines exist regarding which service is best suited to manage specific conditions. We investigated surgeon views and practice patterns regarding service allocation for the management of acute lower GI conditions.
Methods: An anonymous survey was emailed to all 237 ACS and CRS at teaching hospitals in New England with both departments (n = 19) in April 2024. Respondents rated 20 conditions on which service should manage each condition and which service usually manages the condition at their institution. Surgeons also assessed factors influencing service allocation. For each condition, the average of each service's responses was calculated and compared between the two specialties. Open-ended responses regarding barriers to creating consensus guidelines were evaluated using qualitative thematic analysis.
Results: The response rate was 41% (n = 96), with 38% ACS (n = 55) and 45% CRS (n = 41). ACS and CRS agreed about who should manage 14 of the 20 surgical conditions. In cases of disagreement, each service preferred to manage the condition, rather than the other service. Although ACS rated CRS availability to be an important factor for decision-making, CRS felt that time of day and day of week were less important.
Conclusions: ACS and CRS in New England agreed on which specialty should manage several acute lower GI surgical conditions and some factors impacting these decisions. These data may be used to develop consensus guidelines to streamline care allocation and potentially limit delays in care.
{"title":"Acute Care and Colorectal Surgeon Views on Management of Patients With Acute Surgical Conditions.","authors":"Sara Myers, Bachar Halimeh, Sheina Theodore, Olga Beresneva, Veer Sawhney, Samantha Rivard, Sabrina E Sanchez, Jennnifer S Davids","doi":"10.1016/j.jss.2025.12.038","DOIUrl":"https://doi.org/10.1016/j.jss.2025.12.038","url":null,"abstract":"<p><strong>Introduction: </strong>Both acute care surgeons (ACS) and colorectal surgeons (CRS) manage patients with acute lower gastrointestinal (GI) surgical conditions. No consensus guidelines exist regarding which service is best suited to manage specific conditions. We investigated surgeon views and practice patterns regarding service allocation for the management of acute lower GI conditions.</p><p><strong>Methods: </strong>An anonymous survey was emailed to all 237 ACS and CRS at teaching hospitals in New England with both departments (n = 19) in April 2024. Respondents rated 20 conditions on which service should manage each condition and which service usually manages the condition at their institution. Surgeons also assessed factors influencing service allocation. For each condition, the average of each service's responses was calculated and compared between the two specialties. Open-ended responses regarding barriers to creating consensus guidelines were evaluated using qualitative thematic analysis.</p><p><strong>Results: </strong>The response rate was 41% (n = 96), with 38% ACS (n = 55) and 45% CRS (n = 41). ACS and CRS agreed about who should manage 14 of the 20 surgical conditions. In cases of disagreement, each service preferred to manage the condition, rather than the other service. Although ACS rated CRS availability to be an important factor for decision-making, CRS felt that time of day and day of week were less important.</p><p><strong>Conclusions: </strong>ACS and CRS in New England agreed on which specialty should manage several acute lower GI surgical conditions and some factors impacting these decisions. These data may be used to develop consensus guidelines to streamline care allocation and potentially limit delays in care.</p>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157615","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}
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