Pub Date : 2024-09-27DOI: 10.4240/wjgs.v16.i9.2870
Xiao-Yan Li, Yao Li, Wen-Qiang Li, Shuai Ju, Zhi-Hui Dong, Jian-Jun Luo
Background: Transjugular intrahepatic portosystemic shunt (TIPS) is a pivotal intervention for managing esophagogastric variceal bleeding in patients with chronic hepatic schistosomiasis.
Aim: To evaluate the efficacy of digital subtraction angiography image overlay technology (DIT) in guiding the TIPS procedure.
Methods: We conducted a retrospective analysis of patients who underwent TIPS at our hospital, comparing outcomes between an ultrasound-guided group and a DIT-guided group. Our analysis focused on the duration of the portosystemic shunt puncture, the number of punctures needed, the total surgical time, and various clinical indicators related to the surgery.
Results: The study included 52 patients with esophagogastric varices due to chronic hepatic schistosomiasis. Results demonstrated that the DIT-guided group experienced significantly shorter puncture times (P < 0.001) and surgical durations (P = 0.022) compared to the ultrasound-guided group. Additionally, postoperative assessments showed significant reductions in aspartate aminotransferase, B-type natriuretic peptide, and portal vein pressure in both groups. Notably, the DIT-guided group also showed significant reductions in total bilirubin (P = 0.001) and alanine aminotransferase (P = 0.023).
Conclusion: The use of DIT for guiding TIPS procedures highlights its potential to enhance procedural efficiency and reduce surgical times in the treatment of esophagogastric variceal bleeding in patients with chronic hepatic schistosomiasis.
背景:经颈静脉肝内门体分流术(TIPS)是治疗慢性肝血吸虫病患者食管胃底静脉曲张出血的关键干预措施:我们对在本院接受 TIPS 手术的患者进行了回顾性分析,比较了超声引导组和 DIT 引导组的疗效。我们的分析重点是门静脉分流穿刺的持续时间、所需穿刺次数、手术总时间以及与手术相关的各种临床指标:研究纳入了52名因慢性肝血吸虫病导致食管胃静脉曲张的患者。结果表明,与超声引导组相比,DIT引导组的穿刺时间(P < 0.001)和手术时间(P = 0.022)明显缩短。此外,术后评估显示,两组的天门冬氨酸氨基转移酶、B 型钠尿肽和门静脉压力均显著降低。值得注意的是,DIT 引导组的总胆红素(P = 0.001)和丙氨酸氨基转移酶(P = 0.023)也明显下降:结论:在治疗慢性肝血吸虫病患者食管胃底静脉曲张出血的过程中,使用 DIT 引导 TIPS 手术突显了其提高手术效率和缩短手术时间的潜力。
{"title":"Enhancing transjugular intrahepatic portosystemic shunt procedure efficiency with digital subtraction angiography image overlay technology in esophagogastric variceal bleeding.","authors":"Xiao-Yan Li, Yao Li, Wen-Qiang Li, Shuai Ju, Zhi-Hui Dong, Jian-Jun Luo","doi":"10.4240/wjgs.v16.i9.2870","DOIUrl":"10.4240/wjgs.v16.i9.2870","url":null,"abstract":"<p><strong>Background: </strong>Transjugular intrahepatic portosystemic shunt (TIPS) is a pivotal intervention for managing esophagogastric variceal bleeding in patients with chronic hepatic schistosomiasis.</p><p><strong>Aim: </strong>To evaluate the efficacy of digital subtraction angiography image overlay technology (DIT) in guiding the TIPS procedure.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patients who underwent TIPS at our hospital, comparing outcomes between an ultrasound-guided group and a DIT-guided group. Our analysis focused on the duration of the portosystemic shunt puncture, the number of punctures needed, the total surgical time, and various clinical indicators related to the surgery.</p><p><strong>Results: </strong>The study included 52 patients with esophagogastric varices due to chronic hepatic schistosomiasis. Results demonstrated that the DIT-guided group experienced significantly shorter puncture times (<i>P</i> < 0.001) and surgical durations (<i>P</i> = 0.022) compared to the ultrasound-guided group. Additionally, postoperative assessments showed significant reductions in aspartate aminotransferase, B-type natriuretic peptide, and portal vein pressure in both groups. Notably, the DIT-guided group also showed significant reductions in total bilirubin (<i>P</i> = 0.001) and alanine aminotransferase (<i>P</i> = 0.023).</p><p><strong>Conclusion: </strong>The use of DIT for guiding TIPS procedures highlights its potential to enhance procedural efficiency and reduce surgical times in the treatment of esophagogastric variceal bleeding in patients with chronic hepatic schistosomiasis.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.4240/wjgs.v16.i9.2755
Raffaele Pellegrino, Antonietta Gerarda Gravina
The recent study, "Predicting short-term major postoperative complications in intestinal resection for Crohn's disease: A machine learning-based study" investigated the predictive efficacy of a machine learning model for major postoperative complications within 30 days of surgery in Crohn's disease (CD) patients. Employing a random forest analysis and Shapley Additive Explanations, the study prioritizes factors such as preoperative nutritional status, operative time, and CD activity index. Despite the retrospective design's limitations, the model's robustness, with area under the curve values surpassing 0.8, highlights its clinical potential. The findings align with literature supporting preoperative nutritional therapy in inflammatory bowel diseases, emphasizing the importance of comprehensive assessment and optimization. While a significant advancement, further research is crucial for refining preoperative strategies in CD patients.
最近一项名为 "预测克罗恩病肠切除术后短期主要并发症:基于机器学习的研究 "调查了机器学习模型对克罗恩病(CD)患者手术后 30 天内主要术后并发症的预测效果。该研究采用随机森林分析法和夏普利相加解释法,优先考虑术前营养状况、手术时间和克罗恩病活动指数等因素。尽管回顾性设计存在局限性,但该模型的稳健性(曲线下面积值超过 0.8)凸显了其临床潜力。研究结果与支持炎症性肠病术前营养治疗的文献一致,强调了全面评估和优化的重要性。虽然这是一项重大进展,但进一步的研究对于完善 CD 患者的术前策略至关重要。
{"title":"Machine learning as a tool predicting short-term postoperative complications in Crohn's disease patients undergoing intestinal resection: What frontiers?","authors":"Raffaele Pellegrino, Antonietta Gerarda Gravina","doi":"10.4240/wjgs.v16.i9.2755","DOIUrl":"10.4240/wjgs.v16.i9.2755","url":null,"abstract":"<p><p>The recent study, \"Predicting short-term major postoperative complications in intestinal resection for Crohn's disease: A machine learning-based study\" investigated the predictive efficacy of a machine learning model for major postoperative complications within 30 days of surgery in Crohn's disease (CD) patients. Employing a random forest analysis and Shapley Additive Explanations, the study prioritizes factors such as preoperative nutritional status, operative time, and CD activity index. Despite the retrospective design's limitations, the model's robustness, with area under the curve values surpassing 0.8, highlights its clinical potential. The findings align with literature supporting preoperative nutritional therapy in inflammatory bowel diseases, emphasizing the importance of comprehensive assessment and optimization. While a significant advancement, further research is crucial for refining preoperative strategies in CD patients.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.4240/wjgs.v16.i9.2961
Zhen Wu, Hong-Qin Cai, Chun-Feng Wang, Xiang-Yuan Yu, Jie-Qiong Wang
Background: Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.
Aim: To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer (GC) surgery to provide a reference basis for the formulation of anesthesia protocols for radical GC surgery.
Methods: This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024. There was no restriction on sex. The patient grouping method used was a digital random table method, and the number of cases in each group was 56. The control group was administered total intravenous anesthesia, and the observation group compounded the stellate ganglion block according to the total intravenous anesthesia protocol. Postoperative hemodynamics, pain levels, and immune indices were compared between the groups.
Results: The heart rate and mean arterial pressure in the observation group after intubation were lower than those in the control group (P < 0.05). Pain levels were compared between the two groups at 2 hours, 12 hours, 24 hours, and 48 hours after surgery (P > 0.05). The number of CD3+, CD4+, and CD4+/CD8+ cells at the end of surgery was higher in the observation group than in the control group, and the number of CD8+ cells was lower in the observation group than in the control group (P < 0.05). There were no significant differences between the two groups in terms of propofol dosage, awakening time, extubation time, or postoperative adverse reactions (P > 0.05).
Conclusion: The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery. However, it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.
{"title":"Pain and immune function in patients undergoing gastric cancer surgery following stellate ganglion block with total intravenous anesthesia.","authors":"Zhen Wu, Hong-Qin Cai, Chun-Feng Wang, Xiang-Yuan Yu, Jie-Qiong Wang","doi":"10.4240/wjgs.v16.i9.2961","DOIUrl":"10.4240/wjgs.v16.i9.2961","url":null,"abstract":"<p><strong>Background: </strong>Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.</p><p><strong>Aim: </strong>To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer (GC) surgery to provide a reference basis for the formulation of anesthesia protocols for radical GC surgery.</p><p><strong>Methods: </strong>This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024. There was no restriction on sex. The patient grouping method used was a digital random table method, and the number of cases in each group was 56. The control group was administered total intravenous anesthesia, and the observation group compounded the stellate ganglion block according to the total intravenous anesthesia protocol. Postoperative hemodynamics, pain levels, and immune indices were compared between the groups.</p><p><strong>Results: </strong>The heart rate and mean arterial pressure in the observation group after intubation were lower than those in the control group (<i>P</i> < 0.05). Pain levels were compared between the two groups at 2 hours, 12 hours, 24 hours, and 48 hours after surgery (<i>P</i> > 0.05). The number of CD3<sup>+</sup>, CD4<sup>+</sup>, and CD4<sup>+</sup>/CD8<sup>+</sup> cells at the end of surgery was higher in the observation group than in the control group, and the number of CD8<sup>+</sup> cells was lower in the observation group than in the control group (<i>P</i> < 0.05). There were no significant differences between the two groups in terms of propofol dosage, awakening time, extubation time, or postoperative adverse reactions (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery. However, it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.4240/wjgs.v16.i9.2769
He-Nan Tang, Ming-Wei Wang, Xue-Song Liu, Yan Jiao
This editorial discusses the article written by Tchilikidi et al that was published in the latest edition of the World Journal of Gastrointestinal Surgery. Genetic and molecular profiling of perihilar cholangiocarcinoma (pCCA) has identified a number of key abnormalities that drive tumor growth and spread, including pyruvate kinase M2, proline rich 11, and transcription factor 7, etc. pCCA has specific genetic and molecular features that can be used to develop personalized treatment plans. Personalized treatment approaches offer new opportunities for effectively targeting the underlying drivers of tumor growth and progression. The findings based on tumor genetic and molecular characteristics highlight the importance of developing personalized treatment strategies.
{"title":"Personalized treatment of perihilar cholangiocarcinoma based on tumor genetic and molecular characteristics.","authors":"He-Nan Tang, Ming-Wei Wang, Xue-Song Liu, Yan Jiao","doi":"10.4240/wjgs.v16.i9.2769","DOIUrl":"10.4240/wjgs.v16.i9.2769","url":null,"abstract":"<p><p>This editorial discusses the article written by Tchilikidi <i>et al</i> that was published in the latest edition of the <i>World Journal of Gastrointestinal Surgery</i>. Genetic and molecular profiling of perihilar cholangiocarcinoma (pCCA) has identified a number of key abnormalities that drive tumor growth and spread, including pyruvate kinase M2, proline rich 11, and transcription factor 7, <i>etc</i>. pCCA has specific genetic and molecular features that can be used to develop personalized treatment plans. Personalized treatment approaches offer new opportunities for effectively targeting the underlying drivers of tumor growth and progression. The findings based on tumor genetic and molecular characteristics highlight the importance of developing personalized treatment strategies.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.4240/wjgs.v16.i9.2968
Bin He, Yi Xin, Rui Li, Fu-Cai Lin, Guang-Ming Zhang, Hai-Jing Zhu
Background: The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation, which in turn affects the quality of the colonoscopy. Colonoscopy is an essential procedure for postoperative follow-up monitoring of colorectal cancer (CRC) patients. Previous studies have shown that advanced age and a history of colorectal resection are both risk factors for inadequate bowel preparation. However, little attention has been paid to the bowel preparation experiences and needs of predominantly older adult postoperative CRC patients.
Aim: To explore the experiences and needs of older adult postoperative CRC patients during bowel preparation for follow-up colonoscopy.
Methods: Fifteen older adult postoperative CRC patients who underwent follow-up colonoscopy at a tertiary hospital in Shanghai were selected using purposive sampling from August 2023 to November 2023. The phenomenological method in qualitative research was employed to construct an interview outline and conduct semi-structured interviews with the patients. Colaizzi's seven-step analysis was utilized to organize, code, categorize, summarize, and verify the interview data.
Results: The results of this study were summarized into four themes and eight sub-themes: (1) Inadequate knowledge about bowel preparation; (2) Decreased physiological comfort during bowel preparation (gastrointestinal discomfort and sleep deprivation caused by bowel cleansing agents, and hunger caused by dietary restrictions; (3) Psychological changes during different stages of bowel preparation (pre-preparation: Fear and resistance due to previous experiences; during preparation: Irritation and helplessness caused by taking bowel cleansing agents, and post-preparation: Anxiety and worry while waiting for the colonoscopy); and (4) Needs related to bowel preparation (detailed instructions from healthcare professionals; more ideal bowel cleansing agents; and shortened waiting times for colonoscopy).
Conclusion: Older adult postoperative CRC patients' knowledge of bowel preparation is not adequate, and they may encounter numerous difficulties and challenges during the process. Healthcare professionals should place great emphasis on providing instruction for their bowel preparation.
{"title":"Bowel preparation experiences and needs before follow-up colonoscopy in older adult postoperative colorectal cancer patients: A qualitative study.","authors":"Bin He, Yi Xin, Rui Li, Fu-Cai Lin, Guang-Ming Zhang, Hai-Jing Zhu","doi":"10.4240/wjgs.v16.i9.2968","DOIUrl":"10.4240/wjgs.v16.i9.2968","url":null,"abstract":"<p><strong>Background: </strong>The bowel preparation process prior to colonoscopy determines the quality of the bowel preparation, which in turn affects the quality of the colonoscopy. Colonoscopy is an essential procedure for postoperative follow-up monitoring of colorectal cancer (CRC) patients. Previous studies have shown that advanced age and a history of colorectal resection are both risk factors for inadequate bowel preparation. However, little attention has been paid to the bowel preparation experiences and needs of predominantly older adult postoperative CRC patients.</p><p><strong>Aim: </strong>To explore the experiences and needs of older adult postoperative CRC patients during bowel preparation for follow-up colonoscopy.</p><p><strong>Methods: </strong>Fifteen older adult postoperative CRC patients who underwent follow-up colonoscopy at a tertiary hospital in Shanghai were selected using purposive sampling from August 2023 to November 2023. The phenomenological method in qualitative research was employed to construct an interview outline and conduct semi-structured interviews with the patients. Colaizzi's seven-step analysis was utilized to organize, code, categorize, summarize, and verify the interview data.</p><p><strong>Results: </strong>The results of this study were summarized into four themes and eight sub-themes: (1) Inadequate knowledge about bowel preparation; (2) Decreased physiological comfort during bowel preparation (gastrointestinal discomfort and sleep deprivation caused by bowel cleansing agents, and hunger caused by dietary restrictions; (3) Psychological changes during different stages of bowel preparation (pre-preparation: Fear and resistance due to previous experiences; during preparation: Irritation and helplessness caused by taking bowel cleansing agents, and post-preparation: Anxiety and worry while waiting for the colonoscopy); and (4) Needs related to bowel preparation (detailed instructions from healthcare professionals; more ideal bowel cleansing agents; and shortened waiting times for colonoscopy).</p><p><strong>Conclusion: </strong>Older adult postoperative CRC patients' knowledge of bowel preparation is not adequate, and they may encounter numerous difficulties and challenges during the process. Healthcare professionals should place great emphasis on providing instruction for their bowel preparation.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Colorectal cancer is a common malignancy and various methods have been introduced to decrease the possibility of recurrence. Early recurrence (ER) is related to worse prognosis. To date, few observational studies have reported on the analysis of rectal cancer. Hence, we reported on the timing and risk factors for the ER of resectable rectal cancer at our institute.
Aim: To analyze a cohort of patients with local and/or distant recurrence following the radical resection of the primary tumor.
Methods: Data were retrospectively collected from the institutional database from March 2011 to January 2021. Clinicopathological data at diagnosis, perioperative and postoperative data, and first recurrence were collected and analyzed. ER was defined via receiver operating characteristic curve. Prognostic factors were evaluated using the Kaplan-Meier method and Cox proportional hazards modeling.
Results: We included 131 patients. The optimal cut off value of recurrence-free survival (RFS) to differentiate between ER (n = 55, 41.9%) and late recurrence (LR) (n = 76, 58.1%) was 8 mo. The median post-recurrence survival (PRS) of ER and LR was 1.4 mo and 2.9 mo, respectively (P = 0.008) but PRS was not strongly associated with RFS (R² = 0.04). Risk factors included age ≥ 70 years [hazard ratio (HR) = 1.752, P = 0.047], preoperative concurrent chemoradiotherapy (HR = 3.683, P < 0.001), colostomy creation (HR = 2.221, P = 0.036), and length of stay > 9 d (HR = 0.441, P = 0.006).
Conclusion: RFS of 8 mo was the optimal cut-off value. Although ER was not associated with PRS, it was still related to prognosis; thus, intense surveillance is recommended.
{"title":"Identifying timing and risk factors for early recurrence of resectable rectal cancer: A single center retrospective study.","authors":"Tsung-Jung Tsai, Kai-Jyun Syu, Xuan-Yuan Huang, Yu Shih Liu, Chang-Wei Chen, Yen-Hang Wu, Ching-Min Lin, Yu-Yao Chang","doi":"10.4240/wjgs.v16.i9.2842","DOIUrl":"10.4240/wjgs.v16.i9.2842","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer is a common malignancy and various methods have been introduced to decrease the possibility of recurrence. Early recurrence (ER) is related to worse prognosis. To date, few observational studies have reported on the analysis of rectal cancer. Hence, we reported on the timing and risk factors for the ER of resectable rectal cancer at our institute.</p><p><strong>Aim: </strong>To analyze a cohort of patients with local and/or distant recurrence following the radical resection of the primary tumor.</p><p><strong>Methods: </strong>Data were retrospectively collected from the institutional database from March 2011 to January 2021. Clinicopathological data at diagnosis, perioperative and postoperative data, and first recurrence were collected and analyzed. ER was defined <i>via</i> receiver operating characteristic curve. Prognostic factors were evaluated using the Kaplan-Meier method and Cox proportional hazards modeling.</p><p><strong>Results: </strong>We included 131 patients. The optimal cut off value of recurrence-free survival (RFS) to differentiate between ER (<i>n</i> = 55, 41.9%) and late recurrence (LR) (<i>n</i> = 76, 58.1%) was 8 mo. The median post-recurrence survival (PRS) of ER and LR was 1.4 mo and 2.9 mo, respectively (<i>P</i> = 0.008) but PRS was not strongly associated with RFS (<i>R</i>² = 0.04). Risk factors included age ≥ 70 years [hazard ratio (HR) = 1.752, <i>P</i> = 0.047], preoperative concurrent chemoradiotherapy (HR = 3.683, <i>P</i> < 0.001), colostomy creation (HR = 2.221, <i>P</i> = 0.036), and length of stay > 9 d (HR = 0.441, <i>P</i> = 0.006).</p><p><strong>Conclusion: </strong>RFS of 8 mo was the optimal cut-off value. Although ER was not associated with PRS, it was still related to prognosis; thus, intense surveillance is recommended.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.4240/wjgs.v16.i9.2860
Wen-Yu Huang, Sheng Zheng, Dan Zhu, Ying-Lang Zeng, Juan Yang, Xue-Li Zeng, Pei Liu, Shun-Ling Zhang, Ming Yuan, Zhi-Xia Wang
<p><strong>Background: </strong>Changes in alkaline phosphatase (ALP) and γ-glutamyltransferase (GGT) levels in patients with primary liver cancer (PLC) after radiofrequency ablation (RFA). Hepatocellular carcinoma is a malignant tumor with high incidence worldwide. As a common local treatment, RFA has attracted much attention for its efficacy and influence on liver function.</p><p><strong>Aim: </strong>To investigate the effect of serum ALP and GGT levels on the prognosis of patients with PLC treated by RFA.</p><p><strong>Methods: </strong>The preoperative clinical data of 165 patients who were pathologically or clinically diagnosed with PLC and who received RFA in our hospital between October 2018 and June 2023 were collected. The chi-square test was used to compare the data between groups. The Kaplan-Meier method and Cox regression were used to analyze the associations between serum ALP and GGT levels and overall survival, progression-free survival (PFS) and clinical characteristics of patients before treatment.</p><p><strong>Results: </strong>The 1-year survival rates of patients with normal (≤ 135 U/L) and abnormal (> 135 U/L) serum ALP before treatment were 91% and 79%, respectively; the 2-year survival rates were 90% and 68%, respectively; and the 5-year survival rates were 35% and 18%, respectively. The difference between the two groups was statistically significant (<i>P</i> = 0.01). Before treatment, the 1-year survival rates of patients with normal serum GGT levels (≤ 45 U/L) and abnormal serum GGT levels (> 45 U/L) were 95% and 87%, the 2-year survival rates were 85% and 71%, and the 5-year survival rates were 37% and 21%, respectively. The difference between the two groups was statistically significant (<i>P</i> < 0.001). Serum ALP [hazard ratio (HR) = 1.766, 95% confidence interval (95%CI): 1.068-2.921, <i>P</i> = 0.027] and GGT (HR = 2. 312, 95%CI: 1.367-3.912, <i>P</i> = 0.002) is closely related to the overall survival of PLC patients after RF ablation and is an independent prognostic factor. The 1-year PFS rates were 72% and 50%, the 2-year PFS rates were 52% and 21%, and the 5-year PFS rates were 14% and 3%, respectively. The difference between the two groups was statistically significant (<i>P</i> < 0001). The 1-year PFS rates were 81% and 56% in patients with normal and abnormal serum GGT levels before treatment, respectively; the 2-year PFS rates were 62% and 35%, respectively; and the 5-year PFS rates were 18% and 7%, respectively, with statistical significance between the two groups (<i>P</i> < 0.001). The serum ALP concentration (HR = 1. 653, 95%CI: 1.001-2.729, <i>P</i> = 0.049) and GGT (HR = 1.949, 95%CI: 1.296-2.930, <i>P</i> = 0.001) was closely associated with PFS after RFA in patients with PLC. The proportion of male patients with abnormal ALP levels is high, the Child-Pugh grade of liver function is poor, and the incidence of ascites is high. Among GGT-abnormal patients, the Child-Pugh grade of liver function was p
{"title":"Analysis of alkaline phosphatase and γ-glutamyltransferase after radiofrequency ablation of primary liver cancer: A retrospective study.","authors":"Wen-Yu Huang, Sheng Zheng, Dan Zhu, Ying-Lang Zeng, Juan Yang, Xue-Li Zeng, Pei Liu, Shun-Ling Zhang, Ming Yuan, Zhi-Xia Wang","doi":"10.4240/wjgs.v16.i9.2860","DOIUrl":"10.4240/wjgs.v16.i9.2860","url":null,"abstract":"<p><strong>Background: </strong>Changes in alkaline phosphatase (ALP) and γ-glutamyltransferase (GGT) levels in patients with primary liver cancer (PLC) after radiofrequency ablation (RFA). Hepatocellular carcinoma is a malignant tumor with high incidence worldwide. As a common local treatment, RFA has attracted much attention for its efficacy and influence on liver function.</p><p><strong>Aim: </strong>To investigate the effect of serum ALP and GGT levels on the prognosis of patients with PLC treated by RFA.</p><p><strong>Methods: </strong>The preoperative clinical data of 165 patients who were pathologically or clinically diagnosed with PLC and who received RFA in our hospital between October 2018 and June 2023 were collected. The chi-square test was used to compare the data between groups. The Kaplan-Meier method and Cox regression were used to analyze the associations between serum ALP and GGT levels and overall survival, progression-free survival (PFS) and clinical characteristics of patients before treatment.</p><p><strong>Results: </strong>The 1-year survival rates of patients with normal (≤ 135 U/L) and abnormal (> 135 U/L) serum ALP before treatment were 91% and 79%, respectively; the 2-year survival rates were 90% and 68%, respectively; and the 5-year survival rates were 35% and 18%, respectively. The difference between the two groups was statistically significant (<i>P</i> = 0.01). Before treatment, the 1-year survival rates of patients with normal serum GGT levels (≤ 45 U/L) and abnormal serum GGT levels (> 45 U/L) were 95% and 87%, the 2-year survival rates were 85% and 71%, and the 5-year survival rates were 37% and 21%, respectively. The difference between the two groups was statistically significant (<i>P</i> < 0.001). Serum ALP [hazard ratio (HR) = 1.766, 95% confidence interval (95%CI): 1.068-2.921, <i>P</i> = 0.027] and GGT (HR = 2. 312, 95%CI: 1.367-3.912, <i>P</i> = 0.002) is closely related to the overall survival of PLC patients after RF ablation and is an independent prognostic factor. The 1-year PFS rates were 72% and 50%, the 2-year PFS rates were 52% and 21%, and the 5-year PFS rates were 14% and 3%, respectively. The difference between the two groups was statistically significant (<i>P</i> < 0001). The 1-year PFS rates were 81% and 56% in patients with normal and abnormal serum GGT levels before treatment, respectively; the 2-year PFS rates were 62% and 35%, respectively; and the 5-year PFS rates were 18% and 7%, respectively, with statistical significance between the two groups (<i>P</i> < 0.001). The serum ALP concentration (HR = 1. 653, 95%CI: 1.001-2.729, <i>P</i> = 0.049) and GGT (HR = 1.949, 95%CI: 1.296-2.930, <i>P</i> = 0.001) was closely associated with PFS after RFA in patients with PLC. The proportion of male patients with abnormal ALP levels is high, the Child-Pugh grade of liver function is poor, and the incidence of ascites is high. Among GGT-abnormal patients, the Child-Pugh grade of liver function was p","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Endoscopic transpapillary gallbladder drainage is challenging because of the complexity of the procedure and high incidence of adverse events (AEs). To overcome these problems, endoscopic gallbladder stenting (EGBS) after percutaneous transhepatic gallbladder drainage (PTGBD) can be effective, as it mitigates inflammation and adhesion.
Aim: To examine the benefits of EGBS after PTGBD to assess its efficacy and impact on AEs.
Methods: We retrospectively analyzed data from 35 patients who underwent EGBS after PTGBD at a single center between January 2016 and December 2023. The primary outcomes were technical success and AEs, and the rate of recurrent cholecystitis was evaluated. In addition, the reasons for the failure of the procedure were identified.
Results: Among the 35 patients, the technical success rate was 77.1% and the final contrast of the cystic duct was successful in 97.1% of patients. The incidence of early AEs was relatively low (11.4%), with no instances of cystic duct perforation. The rate of recurrent cholecystitis was 3.7%, and no other biliary events were observed.
Conclusion: EGBS after PTGBD may be significantly beneficial, with a substantial success rate and minimal AEs in both short- and long-term follow-ups.
{"title":"Benefits of endoscopic gallbladder stenting following percutaneous transhepatic gallbladder drainage.","authors":"Fumitaka Niiya, Naoki Tamai, Masataka Yamawaki, Jun Noda, Tetsushi Azami, Yuichi Takano, Fumiya Nishimoto, Masatsugu Nagahama","doi":"10.4240/wjgs.v16.i9.2902","DOIUrl":"10.4240/wjgs.v16.i9.2902","url":null,"abstract":"<p><strong>Background: </strong>Endoscopic transpapillary gallbladder drainage is challenging because of the complexity of the procedure and high incidence of adverse events (AEs). To overcome these problems, endoscopic gallbladder stenting (EGBS) after percutaneous transhepatic gallbladder drainage (PTGBD) can be effective, as it mitigates inflammation and adhesion.</p><p><strong>Aim: </strong>To examine the benefits of EGBS after PTGBD to assess its efficacy and impact on AEs.</p><p><strong>Methods: </strong>We retrospectively analyzed data from 35 patients who underwent EGBS after PTGBD at a single center between January 2016 and December 2023. The primary outcomes were technical success and AEs, and the rate of recurrent cholecystitis was evaluated. In addition, the reasons for the failure of the procedure were identified.</p><p><strong>Results: </strong>Among the 35 patients, the technical success rate was 77.1% and the final contrast of the cystic duct was successful in 97.1% of patients. The incidence of early AEs was relatively low (11.4%), with no instances of cystic duct perforation. The rate of recurrent cholecystitis was 3.7%, and no other biliary events were observed.</p><p><strong>Conclusion: </strong>EGBS after PTGBD may be significantly beneficial, with a substantial success rate and minimal AEs in both short- and long-term follow-ups.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.4240/wjgs.v16.i9.2787
Yu-Hong Liu, Tzu-Chiao Lin, Chao-Yang Chen, Ta-Wei Pu
Background: Stapled hemorrhoidopexy (SH) is currently a widely accepted method for treating the prolapse of internal hemorrhoids. Postoperative anal stenosis is a critical complication of SH. A remedy for this involves the removal of the circumferential staples of the anastomosis, followed by the creation of a hand-sewn anastomosis. Numerous studies have reported modified SH procedures to improve outcomes. We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.
Aim: To compare outcomes of staple removal at the 3- and 9-o'clock positions during modified SH in patients with mixed hemorrhoids.
Methods: This was a single-center, retrospective, observational study. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included. The operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded.
Results: Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015 and January 1, 2020, were included. Operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH. In the modified SH group, 54% of patients had previously undergone surgical intervention for hemorrhoids, compared with the 40.3% of patients in the standard SH group. The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis. There was a significant relationship between the rate of postoperative anal stenosis and the modified SH: 0.251 (0.085-0.741) and 0.211 (0.069-0.641) in multiple regression analysis. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.
Conclusion: The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.
背景:缝合痔疮手术(SH)是目前广泛接受的治疗内痔脱垂的方法。术后肛门狭窄是痔疮缝合术的一个重要并发症。解决这一问题的方法是移除吻合口的环形订书钉,然后用手缝合吻合口。许多研究都报道了改良的 SH 手术,以改善手术效果。目的:比较混合痔患者在改良SH术中3点钟和9点钟位置取钉的效果:这是一项单中心、回顾性、观察性研究。研究纳入了2015年1月1日至2020年1月1日期间在本院结直肠中心接受标准或改良SH手术的III级或IV级痔疮患者。记录手术时间、失血量、住院时间以及轻微或严重并发症的发生率:结果:纳入了2015年1月1日至2020年1月1日期间在我院结直肠中心接受标准或改良SH手术的III级或IV级痔疮患者。记录了手术时间、失血量、住院时间、轻微或严重并发症的发生率。我们调查了接受改良SH手术的187名患者(平均年龄50.9岁)和接受标准SH手术的313名患者(平均年龄53.0岁)。在改良SH组中,54%的患者曾接受过痔疮手术治疗,而在标准SH组中,这一比例仅为40.3%。改良SH组中有5名(2.7%)患者有肛门狭窄,而标准SH组中有21名(6.7%)患者有肛门狭窄并发症。术后肛门狭窄率与改良SH有明显关系:多元回归分析中分别为0.251(0.085-0.741)和0.211(0.069-0.641)。改良SH技术是一种治疗晚期痔疮的安全手术方法,术后肛门狭窄率可能低于标准SH技术:结论:改良SH技术是一种治疗晚期痔疮的安全手术方法,术后肛门狭窄率可能低于标准SH技术。
{"title":"Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience.","authors":"Yu-Hong Liu, Tzu-Chiao Lin, Chao-Yang Chen, Ta-Wei Pu","doi":"10.4240/wjgs.v16.i9.2787","DOIUrl":"10.4240/wjgs.v16.i9.2787","url":null,"abstract":"<p><strong>Background: </strong>Stapled hemorrhoidopexy (SH) is currently a widely accepted method for treating the prolapse of internal hemorrhoids. Postoperative anal stenosis is a critical complication of SH. A remedy for this involves the removal of the circumferential staples of the anastomosis, followed by the creation of a hand-sewn anastomosis. Numerous studies have reported modified SH procedures to improve outcomes. We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH.</p><p><strong>Aim: </strong>To compare outcomes of staple removal at the 3- and 9-o'clock positions during modified SH in patients with mixed hemorrhoids.</p><p><strong>Methods: </strong>This was a single-center, retrospective, observational study. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included. The operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded.</p><p><strong>Results: </strong>Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015 and January 1, 2020, were included. Operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH. In the modified SH group, 54% of patients had previously undergone surgical intervention for hemorrhoids, compared with the 40.3% of patients in the standard SH group. The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis. There was a significant relationship between the rate of postoperative anal stenosis and the modified SH: 0.251 (0.085-0.741) and 0.211 (0.069-0.641) in multiple regression analysis. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.</p><p><strong>Conclusion: </strong>The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.4240/wjgs.v16.i9.3048
Feng Ke, Zhen-Hua Dong, Fan Bu, Cheng-Nan Li, Qi-Tong He, Zhi-Cheng Liu, Ji Lu, Kai Yu, Da-Guang Wang, He-Nan Xu, Chang-Tao Ye
Background: Clostridium difficile (C. difficile) infection (CDI) is a rare clinical disease caused by changes in the intestinal microenvironment, which has a variety of causes and a poor prognosis, and for which there is no standardized clinical treatment.
Case summary: A patient experienced recurrent difficulty in bowel movements over the past decade. Recently, symptoms worsened within the last ten days, leading to a clinic visit due to constipation. The patient was subsequently referred to our department. Preoperatively, the patient was diagnosed with obstructed colon accompanied by gallstones. Empirical antibiotics were administered both before and after surgery to prevent infection. On the fourth day post-surgery, symptoms of CDI emerged. Stool cultures confirmed the presence of C. difficile DNA. Treatment involved a combination of vancomycin and linezolid, resulting in the patient's successful recovery upon discharge. However, the patient failed to adhere to the prescribed medication after discharge and was discovered deceased during a follow-up two months later.
Conclusion: CDI is the leading cause of nosocomial post-operative care, with limited clinical cases and poor patient prognosis, and comprehensive clinical treatment guidelines are still lacking. This infection can be triggered by a variety of factors, including intestinal hypoxia, inappropriate antibiotic use, and bile acid circulation disorders. In patients with chronic bowel disease and related etiologies, prompt preoperative attention to possible CDI and preoperative bowel preparation is critical. Adequate and prolonged medication should be maintained in the treatment of CDI to prevent recurrence of the disease.
背景:艰难梭菌感染(CDI)是由肠道微环境变化引起的一种临床罕见疾病,病因多样,预后较差,目前尚无规范的临床治疗方法。最近十天内症状加重,因便秘就诊。患者随后被转诊至我科。术前,患者被诊断为结肠梗阻并伴有胆结石。为防止感染,手术前后均使用了经验性抗生素。术后第四天,出现了 CDI 症状。粪便培养证实了艰难梭菌 DNA 的存在。治疗包括万古霉素和利奈唑胺的联合用药,结果患者在出院时顺利康复。然而,患者出院后未能坚持按处方用药,两个月后的随访中发现其已经死亡:结论:CDI是术后护理中引起院内感染的主要原因,临床病例有限,患者预后较差,目前仍缺乏全面的临床治疗指南。引发这种感染的因素有很多,包括肠道缺氧、抗生素使用不当、胆汁酸循环障碍等。对于患有慢性肠道疾病及相关病因的患者,术前及时关注可能的 CDI 并做好术前肠道准备至关重要。在治疗 CDI 时应保持足够的长期用药,以防止疾病复发。
{"title":"Clostridium difficile infection following colon subtotal resection in a patient with gallstones: A case report and review of literature.","authors":"Feng Ke, Zhen-Hua Dong, Fan Bu, Cheng-Nan Li, Qi-Tong He, Zhi-Cheng Liu, Ji Lu, Kai Yu, Da-Guang Wang, He-Nan Xu, Chang-Tao Ye","doi":"10.4240/wjgs.v16.i9.3048","DOIUrl":"10.4240/wjgs.v16.i9.3048","url":null,"abstract":"<p><strong>Background: </strong><i>Clostridium difficile</i> (<i>C. difficile</i>) infection (CDI) is a rare clinical disease caused by changes in the intestinal microenvironment, which has a variety of causes and a poor prognosis, and for which there is no standardized clinical treatment.</p><p><strong>Case summary: </strong>A patient experienced recurrent difficulty in bowel movements over the past decade. Recently, symptoms worsened within the last ten days, leading to a clinic visit due to constipation. The patient was subsequently referred to our department. Preoperatively, the patient was diagnosed with obstructed colon accompanied by gallstones. Empirical antibiotics were administered both before and after surgery to prevent infection. On the fourth day post-surgery, symptoms of CDI emerged. Stool cultures confirmed the presence of <i>C. difficile</i> DNA. Treatment involved a combination of vancomycin and linezolid, resulting in the patient's successful recovery upon discharge. However, the patient failed to adhere to the prescribed medication after discharge and was discovered deceased during a follow-up two months later.</p><p><strong>Conclusion: </strong>CDI is the leading cause of nosocomial post-operative care, with limited clinical cases and poor patient prognosis, and comprehensive clinical treatment guidelines are still lacking. This infection can be triggered by a variety of factors, including intestinal hypoxia, inappropriate antibiotic use, and bile acid circulation disorders. In patients with chronic bowel disease and related etiologies, prompt preoperative attention to possible CDI and preoperative bowel preparation is critical. Adequate and prolonged medication should be maintained in the treatment of CDI to prevent recurrence of the disease.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11438826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142355153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}