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Influence of medical didactic training on the self-efficacy and motivation of clinical teachers. 医学教学培训对临床教师自我效能感和动力的影响。
IF 1.7 Q2 SURGERY Pub Date : 2024-06-21 eCollection Date: 2024-06-01 DOI: 10.1515/iss-2023-0073
Franziska Schydlo, Jasmina Sterz, Maria-Christina Stefanescu, Martina Kadmon, Sarah König, Miriam Rüsseler, Felix Walcher, Farzin Adili

Objectives: Due to increasing workload and rising expectations for both undergraduate and speciality training in medicine, teaching in a clinical environment can be challenging. The "Train the Trainer" course, developed by CAL (Chirurgische Arbeitsgemeinschaft Lehre, Deutsche Gesellschaft für Chirurgie (DGCH)), aims to assist clinical teachers in their task. This study investigates the effect the course has on participants' self-efficacy and teaching motivation.

Methods: Prior to attending the course, participants anonymously completed a 50-question pre-course questionnaire using standardised questions to gather information on biographical data teaching experience, and validated tools measuring teaching motivation and self-efficacy (PRE). Directly after completing the course, participants evaluated it using a 25-question post-course questionnaire (POST1). At least 12 months after the course, participants received a follow-up questionnaire (POST2) by mail. This 44-question form aimed to gather biographical data, review the teaching methods participants had used since their training, and reassess their teaching motivation and self-efficacy.

Results: Between June 2016 and October 2019, 20 TTT courses were held across six German medical faculties. Data were gathered from 241 participants. After the course, 182 POST2 questionnaires were mailed, 61 of which were returned (equals a 39 % return rate). The findings revealed significant increases in teacher self-efficacy (p=0.0025), identified regulation (p=0.0000), and career motivation (p=0.0044). In contrast, there was a significant decrease in introjected regulation (p=0.0048). When comparing the participants to a reference sample selected from literature, significant differences emerged in intrinsic motivation (p=0.0000) and amotivation (p=0.0025).

Conclusions: Course participants already showed strong intrinsic motivation and self-efficacy before taking the course. After completing it, their confidence to meet specific teaching demands based on their abilities had increased. Notably, changes in motivational dimensions identified and introjected regulation point towards a shift in motivational sources, indicating a more self-regulated approach towards participants' teaching activities. Further research is needed to determine how much of this change was due to course participation.

目的:由于工作量不断增加,人们对医学本科生和专科生培训的期望值不断提高,在临床环境中开展教学工作具有挑战性。由 CAL(Chirurgische Arbeitsgemeinschaft Lehre,Deutsche Gesellschaft für Chirurgie (DGCH))开发的 "培训培训师 "课程旨在帮助临床教师完成任务。本研究调查了该课程对学员自我效能感和教学动力的影响:在参加课程之前,学员匿名填写了一份包含 50 个问题的课前问卷,问卷中使用了标准化的问题来收集学员的个人履历、教学经验以及衡量教学动力和自我效能的有效工具(PRE)。课程结束后,学员们直接使用 25 个问题的课后问卷(POST1)对课程进行评估。课程结束至少 12 个月后,学员们会收到一份邮寄的后续问卷(POST2)。这份包含 44 个问题的问卷旨在收集学员的履历数据,回顾学员自培训以来所使用的教学方法,并重新评估他们的教学动机和自我效能:结果:2016 年 6 月至 2019 年 10 月期间,德国六所医学院共举办了 20 期 TTT 课程。共收集了 241 名学员的数据。课程结束后,邮寄了 182 份 POST2 调查问卷,其中 61 份被收回(回收率为 39%)。调查结果显示,教师的自我效能感(p=0.0025)、识别调节(p=0.0000)和职业动机(p=0.0044)均有明显提高。与此相反,内省式调节却有明显下降(p=0.0048)。在将学员与从文献中选取的参考样本进行比较时,内在动机(p=0.0000)和非内在动机(p=0.0025)出现了显著差异:课程参与者在参加课程之前就已经表现出强烈的内在动机和自我效能感。结业后,他们根据自身能力满足具体教学要求的信心有所增强。值得注意的是,所发现的动机维度和引入调节的变化指向了动机来源的转变,表明学员在教学活动中采用了更加自我调节的方法。要确定这种变化在多大程度上归因于课程的参与,还需要进一步的研究。
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引用次数: 0
Lost in transition? Loss of follow-up and quality of life in adults after resection of choledochal malformation in childhood 过渡时期的失落?儿童期胆总管畸形切除术后成人的随访损失和生活质量
IF 1.3 Q1 Medicine Pub Date : 2024-06-14 DOI: 10.1515/iss-2023-0061
Reem Abo-Namous, J. Kuebler, Andrej Potthoff, Omid Madadi-Sanjani, Marie Uecker, J. Dingemann, Claus Petersen, Benno M. Ure, N. Schukfeh
Abstract Objectives Choledochal malformation (CM) is a rare disease that can lead to malignancy and potential long-term sequelae despite surgical resection. There is no long-term follow-up data on patients after CM resection in Germany. We aimed to determine the long-term outcome of our patients with a duration of follow-up >10 years and focused on long-term sequelae and health-related quality of life (HRQOL). Methods All patients who had undergone CM-resection in our department from 01/1978 to 06/2009 were contacted. Patients were interviewed about postoperative complications and their present medical attendance. HRQOL was determined using Pediatric Quality of Life Inventory 4.0 (PedsQL), version for adults. The PedsQL scales the HRQOL from 0 to 100, with higher scores indicating a better HRQOL. Scores were compared to those published for a healthy population. Results Out of 56 patients who were contacted, 23 (41 %) participated. The median age at time of surgery was 3.1 years (6 days–16.1 years) and at time of the survey 24.3 years (11.1–53.8 years). Eighteen patients (78 %) had ceased their gastroenterologic follow-up at a median time of 4.3 years after surgery. Five (22 %) were still in gastroenterologic follow-up, two of these had an uneventful clinical course, and three (13 %) had ongoing complications attributed to the CM. One of these had undergone hemihepatectomy 34 years postoperatively due to bile duct stenosis, one had undergone removal of bile duct stones 14 years postoperatively, and one suffered from portal vein thrombosis with esophageal and jejunal varices. There was no mortality in our series. Median total HRQOL score was 89. There was no significant difference in the median total health, physical health, and psychosocial health scores of our patients in comparison to the healthy population. Conclusions We confirmed that the majority of patients after CM resection are lost to follow-up. Those who answered our questionnaire showed a good HRQOL. Given the high rate of severe long-term complications and the life-long risk of malignancy, we recommend a transition program for all patients.
摘要 目的 胆总管畸形(CM)是一种罕见疾病,尽管可以通过手术切除,但可能导致恶性肿瘤和潜在的长期后遗症。在德国,没有关于胆总管畸形切除术后患者的长期随访数据。我们旨在确定随访时间超过 10 年的患者的长期预后,重点关注长期后遗症和与健康相关的生活质量(HRQOL)。方法 我们联系了 1978 年 1 月至 2009 年 6 月期间在本部门接受过 CM 切除术的所有患者。患者接受了关于术后并发症和目前就医情况的访谈。使用成人版儿科生活质量量表 4.0 (PedsQL) 测定患者的 HRQOL。PedsQL 对 HRQOL 的评分范围为 0 到 100 分,分数越高表示 HRQOL 越好。得分与健康人群的得分进行比较。结果 在联系到的 56 名患者中,有 23 人(41%)参与。手术时的中位年龄为 3.1 岁(6 天-16.1 岁),调查时的中位年龄为 24.3 岁(11.1-53.8 岁)。有 18 名患者(78%)在术后 4.3 年的中位时间内停止了胃肠道随访。五名患者(22%)仍在接受胃肠病学随访,其中两名患者的临床病程并不顺利,三名患者(13%)仍有 CM 引起的并发症。其中一人因胆管狭窄在术后34年接受了半肝切除术,一人在术后14年接受了胆管结石切除术,还有一人患有门静脉血栓并伴有食管和空肠静脉曲张。我们的系列病例中没有死亡病例。HRQOL 总分中位数为 89 分。与健康人群相比,我们的患者在总健康、身体健康和社会心理健康的中位数得分上没有明显差异。结论 我们证实,大部分肿瘤切除术后的患者都失去了随访机会。那些回答了我们问卷的患者显示出良好的 HRQOL。鉴于严重长期并发症的高发率和终身恶性肿瘤的风险,我们建议为所有患者制定过渡计划。
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引用次数: 0
Depth of intact vascular plexus – visualized with optical coherence tomography – correlates to burn depth in thoracic thermic injuries in children 用光学相干断层扫描观察到的完整血管丛深度与儿童胸腔热损伤的烧伤深度有关
IF 1.3 Q1 Medicine Pub Date : 2024-06-12 DOI: 10.1515/iss-2023-0066
Valerie Dalicho, Tina Straube, Kathrin Kelly, Beke Larsen, Lutz Wünsch, Judith Lindert
Abstract Objectives Deep thermal injuries are among the most serious injuries in childhood, often resulting in scarring and functional impairment. However, accurate assessment of burn depth by clinical judgment is challenging. Optical coherence tomography (OCT) provides structural images of the skin and can detect blood flow within the papillary plexus. In this study, we determined the depth of the capillary network in healthy and thermally injured skin and compared it with clinical assessment. Methods In 25 children between 7 months and 15 years of age (mean age 3.5 years (SD±4.14)) with thermal injuries of the ventral thoracic wall, we determined the depth of the capillary network using OCT. Measurements were performed on healthy skin and at the center of the thermal injury (16 grade IIa, 9 grade IIb). Comparisons were made between healthy skin and thermal injury. Results The capillary network of the papillary plexus in healthy skin was detected at 0.33 mm (SD±0.06) from the surface. In grade IIb injuries, the depth of the capillary network was 0.36 mm (SD±0.06) and in grade IIa injuries 0.23 mm (SD±0.04) (Mann–Whitney U test: p<0.001). The overall prediction accuracy is 84 %. Conclusions OCT can reliably detect and differentiate the depth of the capillary network in both healthy and burned skin. In clinical IIa wounds, the capillary network appears more superficial due to the loss of the epidermis, but it is still present in the upper layer, indicating a good prognosis for spontaneous healing. In clinical grade IIb wounds, the papillary plexus was visualized deeper, which is a sign of impaired blood flow.
摘要 目的 深度热损伤是儿童期最严重的损伤之一,通常会造成疤痕和功能障碍。然而,通过临床判断来准确评估烧伤深度是一项挑战。光学相干断层扫描(OCT)可提供皮肤结构图像,并能检测乳头丛内的血流。在这项研究中,我们测定了健康皮肤和热损伤皮肤的毛细血管网深度,并将其与临床评估进行了比较。方法 我们对 25 名 7 个月至 15 岁(平均年龄 3.5 岁(SD±4.14))胸腹壁热损伤的儿童使用 OCT 测定毛细血管网的深度。测量在健康皮肤和热损伤中心进行(16 例 IIa 级,9 例 IIb 级)。对健康皮肤和热损伤进行比较。结果 健康皮肤的乳头丛毛细血管网在距离表面 0.33 毫米(SD±0.06)处被检测到。在 IIb 级损伤中,毛细血管网的深度为 0.36 毫米(SD±0.06),在 IIa 级损伤中为 0.23 毫米(SD±0.04)(曼-惠特尼 U 检验:P<0.001)。总体预测准确率为 84%。结论 OCT 可以可靠地检测和区分健康皮肤和烧伤皮肤的毛细血管网深度。在临床 IIa 级伤口中,由于表皮脱落,毛细血管网看起来更表层,但仍存在于上层,这表明伤口自愈的预后良好。在临床 IIb 级伤口中,乳头状神经丛的位置较深,这是血流受损的迹象。
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引用次数: 0
Virtual tumor mapping and margin control with 3-D planning and navigation 利用三维规划和导航进行虚拟肿瘤绘图和边缘控制
IF 1.3 Q1 Medicine Pub Date : 2024-04-25 DOI: 10.1515/iss-2021-0009
David Steybe, P. Voss, M. Metzger, Rainer Schmelzeisen, P. Poxleitner
Computer technology–based treatment approaches like intraoperative navigation and intensity-modulated radiation therapy have become important components of state of the art head and neck cancer treatment. Multidirectional exchange of virtual three-dimensional patient data via an interdisciplinary platform allows all medical specialists involved in the patients treatment to take full advantage of these technologies. This review article gives an overview of current technologies and future directions regarding treatment approaches that are based on a virtual, three-dimensional patient specific dataset: storage and exchange of spatial information acquired via intraoperative navigation allow for a highly precise frozen section procedure. In the postoperative setting, virtual reconstruction of the tumor resection surface provides the basis for improved radiation therapy planning and virtual reconstruction of the tumor with integration of molecular findings creates a valuable tool for postoperative treatment and follow-up. These refinements of established treatment components and novel approaches have the potential to make a major contribution to improving the outcome in head and neck cancer patients.
基于计算机技术的治疗方法,如术中导航和调强放射治疗,已成为最先进的头颈部癌症治疗方法的重要组成部分。通过跨学科平台多向交换患者的虚拟三维数据,可以让参与患者治疗的所有医疗专家充分利用这些技术。这篇综述文章概述了基于虚拟三维患者特定数据集的治疗方法的现有技术和未来发展方向:通过术中导航获取的空间信息的存储和交换可实现高度精确的冷冻切片手术。在术后环境中,肿瘤切除面的虚拟重建为改进放射治疗计划提供了基础,而结合分子研究结果的肿瘤虚拟重建则为术后治疗和随访提供了宝贵的工具。这些对既有治疗方法和新方法的改进有可能为改善头颈部癌症患者的治疗效果做出重大贡献。
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引用次数: 0
Proximal humerus fracture and acromioclavicular joint dislocation 肱骨近端骨折和肩锁关节脱位
IF 1.3 Q1 Medicine Pub Date : 2024-04-11 DOI: 10.1515/iss-2023-0049
Maren Bieling, Alexander Ellwein, H. Lill, S. Sehmisch, F. M. Reeh
Proximal humerus fractures and injuries to the acromioclavicular joint are among the most common traumatic diseases of the upper extremity. Fractures of the proximal humerus occur most frequently in older people and are an indicator fracture of osteoporosis. While a large proportion of only slightly displaced fractures can be treated non-operatively, more complex fractures require surgical treatment. The choice of optimal treatment and the decision between joint-preserving surgery by means of osteosynthesis or endoprosthetic treatment is often a difficult decision in which both fracture morphology factors and individual factors should be taken into account. If endoprosthetic treatment is indicated, satisfactory long-term functional and clinical results have been achieved with a reverse shoulder arthroplasty. Injuries to the acromioclavicular joint occur primarily in young, athletic individuals. The common classification according to Rockwood divides the injury into 6 degrees of severity depending on the dislocation. This classification forms the basis for the decision on non-operative or surgical treatment. The indication for surgical treatment for higher-grade injuries is the subject of controversial debate in the latest literature. In chronic injuries, an autologous tendon transplant is also performed. Whereas in the past, treatment was often carried out using a hook plate, which was associated with complications, the gold standard today is minimally invasive treatment using Endobutton systems. This review provides an overview of the two injury patterns and discusses the various treatment options.
肱骨近端骨折和肩锁关节损伤是上肢最常见的创伤性疾病之一。肱骨近端骨折多发于老年人,是骨质疏松症的标志性骨折。虽然大部分仅有轻微移位的骨折可以通过非手术治疗,但更复杂的骨折则需要手术治疗。如何选择最佳治疗方法,是通过骨合成术还是假体内固定治疗来保留关节,往往是一个难以抉择的问题,其中既要考虑骨折形态因素,也要考虑个体因素。如果需要进行假体内固定治疗,反向肩关节置换术已取得了令人满意的长期功能和临床效果。肩锁关节损伤主要发生在年轻运动员身上。根据洛克伍德(Rockwood)的常用分类法,根据脱位情况将损伤分为 6 种严重程度。这一分类是决定非手术治疗还是手术治疗的依据。在最新的文献中,对较高级别损伤的手术治疗指征存在争议。对于慢性损伤,还可以进行自体肌腱移植。过去通常使用钩板进行治疗,这种方法容易引起并发症,而现在的金标准是使用 Endobutton 系统进行微创治疗。本综述概述了这两种损伤模式,并讨论了各种治疗方案。
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引用次数: 0
Spontaneous duodenocutaneous fistula: a rare presentation of perforated duodenal ulcer 自发性十二指肠皮肤瘘:十二指肠溃疡穿孔的罕见表现形式
IF 1.3 Q1 Medicine Pub Date : 2024-04-09 DOI: 10.1515/iss-2023-0051
Isabel Barreto, Arnold Kohler, René Fahrner
Fistula formation between the duodenum and the skin of the anterior abdominal wall is a rare complication and reported most often following surgery. To the best of our knowledge, the development of a spontaneous duodenocutaneous fistula in association with duodenal ulcer has only been reported once. A 52-year-old female patient presented at the emergency department with a painful ulcer and erythema on the right abdominal wall. On admission, she was in extremely poor general and nutritional condition. Laboratory analysis revealed inflammation. An empiric antibiotic therapy was initiated; parenteral nutrition, fluid, and electrolyte resuscitation were started. An enterocutaneous fistula was postulated and confirmed by endoscopy identifying a perforated duodenal ulcer. Surgery was not a valuable option and a Foley catheter was inserted through the fistula. During further endoscopic interventions, the Foley catheter was first replaced by a jejunal tube and later by a percutaneous endoscopic gastrostomy with a jejunal limb for enteral nutrition. The fistula output decreased, the local infection was controlled and the nutritional status improved. Three months later the fistula was closed and the gastrostomy tube was removed. After 2 years the patient was in good general and nutritional condition.
十二指肠与前腹壁皮肤之间形成瘘管是一种罕见的并发症,多在手术后发生。据我们所知,十二指肠溃疡并发自发性十二指肠皮肤瘘的报道仅有一次。 一名 52 岁的女性患者因右腹壁出现疼痛性溃疡和红斑而到急诊科就诊。入院时,她的全身状况和营养状况极差。实验室分析显示她患有炎症。患者开始接受经验性抗生素治疗,并开始肠外营养、输液和电解质复苏。内镜检查发现十二指肠溃疡穿孔,推测并确认了肠皮瘘。手术治疗没有价值,于是通过瘘管插入了福里导管。在进一步的内镜干预中,福里导管先是被空肠管取代,后来又被经皮内镜胃造瘘术和空肠肢体肠内营养取代。瘘管输出量减少,局部感染得到控制,营养状况得到改善。 三个月后,瘘管闭合,胃造瘘管被拔除。两年后,患者的全身状况和营养状况良好。
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引用次数: 0
Abstracts DGCH 摘要 DGCH
IF 1.3 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1515/iss-2024-2006
Jan-Philipp Happe, Karen Fischhuber, Josef Stolberg-Stolberg, Dr. Janette Iking, Ursula Marschall, Michael J Raschke, Jeanette Köppe, J. C. Katthagen, Julia Sussiek, Z. Qi, Jiashu Zhang, Haitao Jin, Ch. Nimsky, Xiaolei Chen, Xinghua Xu, Qun Wang, Z. Gan, R. Xiong, Shiyu Zhang, Jingyue Wang, Minghang Liu, M. Bauer
were classified as geriatric according to the "Delineation Criteria of Geriatrics" version V1.3 (4). The endpoints were defined as overall survival (OS), major adverse events (MAE), thromboembolic events (TE) and injury/surgical complications. Event rates were determined using Kaplan-Meier estimates and cumulative incidence functions using Aalen-Johansen estimates. Multivariable analyses were performed using Cox regressions and Fine-Gray models.
根据 "老年病学划分标准 "V1.3 版(4),这些患者被划分为老年病患者。终点定义为总生存期(OS)、主要不良事件(MAE)、血栓栓塞事件(TE)和损伤/手术并发症。事件发生率采用 Kaplan-Meier 估计法确定,累积发生率函数采用 Aalen-Johansen 估计法确定。采用 Cox 回归和 Fine-Gray 模型进行多变量分析。
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引用次数: 0
Abstracts DGT 摘要 DGT
IF 1.3 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1515/iss-2024-2001
Lisann Rheinhold, Thomas Galetin, Rachel Klamer, Ahmed Alkhatam, Aris Koryllos, Romina Rösch, Laura V. Klotz, Lena Brendel, R. Griffo, P. Christopoulos, Thomas Muley, Hauke Winter, Raffella Griffo, Henrike Deissner, Peter Reimer, Martin Eichhorn
The number of inductive immunochemotherapy (IO+CTx) in patients with lung cancer and higher-grade tumor stages is increasing. Actually the impact of IO+CTx on extended lung resections is unclear. The goal of this study was to analyze the short-term outcomes after extended lung cancer resections.
在肺癌患者和肿瘤分期较高的患者中,采用诱导免疫化学疗法(IO+CTx)的人数正在增加。事实上,IO+CTx 对肺癌扩大切除术的影响尚不明确。本研究旨在分析肺癌扩大切除术后的短期疗效。
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引用次数: 0
Abstracts DGKCH 摘要 DGKCH
IF 1.3 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1515/iss-2024-2005
Nariman Mokhaberi, Michalis Aftzoglou, Philipp Schneider, Daniel Biermann, Rainer Gerhard Kozlik-Feldmann, Christian Tomuschat, Christine Drießler, Armin-Johannes Michel, Andrea Schmedding, Florentine Weise, Niklas Dressler, N. Peukert, Johannes Düß, S. Mayer, M. Lacher, Jan Riedel, Yuqing Lu, Julia Elrod, S. Turial, Maciej Pech, Volker Aumann, A. Nyiredi, Lena Bode, Jan-Hendrik Gosemann, Gabriel Götz, Robin Wachowiak, Peter Zimmermann, Tomasz Baranski, Matthias Nissen, Ralf-Bodo Tröbs, I. Martynov, Monika Sparber-Sauer, Amadeus T Heinz, C. Vokuhl, Martin Ebinger, J. Gesche, Marc Münter, E. Koscielniak, Jörg Fuchs, Guido Seitz, Mark Schneider, Ruben Visschers, U. Kontny, Ulf Neumann, Wilhelmus van Gemert
Impaired intestinal endotoxin tolerance is seen in human preterms suffering from necrotizing enterocolitis (NEC), but the underlying mechanism remains unknown. Activation of the TLR4/p65 pathway deregulates β-catenin abundance in intestinal epithelial cells (IECs) from human NEC patients. The cell adhesion molecule β-catenin plays a crucial role in transcriptional activation of proliferation and cell growth in intestinal epithelial cells (IECs). It has been shown that β-catenin acts either as a pro-or anti-inflammatory mediator in a cell and tissue specific behavior. This study aims to elucidate the effects of stabilized β-catenin upon lipopolysaccharide (LPS) induced inflammatory signaling in IECs.
患有坏死性小肠结肠炎(NEC)的人类早产儿肠道内毒素耐受性受损,但其根本机制仍不清楚。TLR4/p65通路的激活会降低人类NEC患者肠上皮细胞(IECs)中β-catenin的丰度。细胞粘附分子β-catenin在肠上皮细胞(IECs)增殖和细胞生长的转录激活过程中起着至关重要的作用。研究表明,β-catenin 可作为一种促炎或抗炎介质,具有细胞和组织特异性。本研究旨在阐明稳定的β-catenin对IECs中脂多糖(LPS)诱导的炎症信号转导的影响。
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引用次数: 0
Abstracts DGPRÄC 摘要 DGPRÄC
IF 1.3 Q1 Medicine Pub Date : 2024-04-01 DOI: 10.1515/iss-2024-2002
Alexander Dermietzel, Philipp Wiebringhaus, Tobias Hirsch, Maximilian Kückelhaus, Sonja Dahmann
,
,
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引用次数: 0
期刊
Innovative Surgical Sciences
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