Introduction Compartment syndrome is a major factor contributing to limb loss and poor outcome following lower limb vascular injuries. Method This is a retrospective study done on patients with vascular injuries and undergone fasciotomy at the accident service operation theatre (ASOT) at the national hospital of Sri Lanka (NHSL), during a period of one year. Cases with Incomplete documentation were excluded. Data on patient demographics, time of injury, and time of fasciotomy, associated fractures, muscle viability and outcome were collected. Results A total of 30 cases were included. 26 (86%) were males. Nine (30%) were upper limb and 21(70%) were lower limb fasciotomy. The cause for limb injuries were road traffic accidents (RTA) in 18 (58.1%), trap gun injury in five (16.1%). All the fasciotomy were done prior to revascularization. 19 (63.3%) had fractures (12 (63%) were open and seven (36%) closed). six (20%) fasciotomy were done for compartment syndrome, 24 (80%) were done prophylactically. Three patients with compartment syndrome had open fractures (50%) and three had closed fractures (50%). On fasciotomy, in four cases all four leg compartment muscles were non-viable, two had non-viable three compartments and one patient had non-viable two compartments. The mean delay in patients who had all compartments viable was 3.7 hours (2-6.5) and the mean delay in patients with three or four non-viable compartments was 12.2hours (7-24). This difference was statistically significant (p-0.0001). The fasciotomy delay was also significant (p-0.0001) between the patients who had an amputation and limb salvage. Overall amputation rate was 20% in this series. Mean time of delay from admission to NHSL to the time of fasciotomy was 1.8 hours (1-3.5). Mean time of injury to time of fasciotomy was 5.42 hours (2-24). Discussion Number of non-viable compartments is significantly associated with the duration between time of injury to time of fasciotomy(P-0.0001). Therefore we suggest early fasciotomy before transfer
{"title":"Fasciotomy done for vascular trauma at a tertiary care centre in Sri Lanka","authors":"J. Arudchelvam","doi":"10.62474/uhxt2336","DOIUrl":"https://doi.org/10.62474/uhxt2336","url":null,"abstract":"Introduction Compartment syndrome is a major factor contributing to limb loss and poor outcome following lower limb vascular injuries. Method This is a retrospective study done on patients with vascular injuries and undergone fasciotomy at the accident service operation theatre (ASOT) at the national hospital of Sri Lanka (NHSL), during a period of one year. Cases with Incomplete documentation were excluded. Data on patient demographics, time of injury, and time of fasciotomy, associated fractures, muscle viability and outcome were collected. Results A total of 30 cases were included. 26 (86%) were males. Nine (30%) were upper limb and 21(70%) were lower limb fasciotomy. The cause for limb injuries were road traffic accidents (RTA) in 18 (58.1%), trap gun injury in five (16.1%). All the fasciotomy were done prior to revascularization. 19 (63.3%) had fractures (12 (63%) were open and seven (36%) closed). six (20%) fasciotomy were done for compartment syndrome, 24 (80%) were done prophylactically. Three patients with compartment syndrome had open fractures (50%) and three had closed fractures (50%). On fasciotomy, in four cases all four leg compartment muscles were non-viable, two had non-viable three compartments and one patient had non-viable two compartments. The mean delay in patients who had all compartments viable was 3.7 hours (2-6.5) and the mean delay in patients with three or four non-viable compartments was 12.2hours (7-24). This difference was statistically significant (p-0.0001). The fasciotomy delay was also significant (p-0.0001) between the patients who had an amputation and limb salvage. Overall amputation rate was 20% in this series. Mean time of delay from admission to NHSL to the time of fasciotomy was 1.8 hours (1-3.5). Mean time of injury to time of fasciotomy was 5.42 hours (2-24). Discussion Number of non-viable compartments is significantly associated with the duration between time of injury to time of fasciotomy(P-0.0001). Therefore we suggest early fasciotomy before transfer","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"54 S7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140401782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Management of penetrating cardiac trauma is a real time test of evaluating the integrity of a trauma care system.1 They have a low incidence of 0.16% as indicated by the trauma data bank of American College of Surgeons.2 Gunshot injuries, stab injuries and rarely accidental impalement are the main mechanisms of penetrating cardiac trauma. Knowledge and experience from high density trauma centers shows us that emergency transportation, quick response and proper diagnosis with urgent intervention is necessary to minimize fatalities.3 We present this rare case highlighting major challenges trauma care system in Sri Lanka faced with to deliver optimal care
{"title":"A patient with penetrating cardiac trauma: A real time test of integrity in the trauma care system in Sri Lanka","authors":"Mihira Bandara, D. Bandara","doi":"10.62474/ydfk5311","DOIUrl":"https://doi.org/10.62474/ydfk5311","url":null,"abstract":"Management of penetrating cardiac trauma is a real time test of evaluating the integrity of a trauma care system.1 They have a low incidence of 0.16% as indicated by the trauma data bank of American College of Surgeons.2 Gunshot injuries, stab injuries and rarely accidental impalement are the main mechanisms of penetrating cardiac trauma. Knowledge and experience from high density trauma centers shows us that emergency transportation, quick response and proper diagnosis with urgent intervention is necessary to minimize fatalities.3 We present this rare case highlighting major challenges trauma care system in Sri Lanka faced with to deliver optimal care","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"157 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140404721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Severe hepatic injuries are associated with high morbidity and mortality (30%) and are challenging to manage (1). Liver injuries occur frequently following abdominal trauma. For example in a series of 48 patients who underwent laparotomy following trauma at the National Hospital of Sri Lanka, Colombo (NHSL), 11 patients had liver injuries (22.9%). Most liver injuries can be managed non-operatively. In the case of surgical management, the focus is on damage control, packing, and vascular ligation and resection. Interventional radiological modalities are also used in the management (e.g. embolisation of the bleeding vessels). This report is on the outcome of patients who underwent liver resection following severe liver injuries.
{"title":"Severe liver injuries; a case series and review of the literature","authors":"J. Arudchelvam","doi":"10.62474/sljt-xyof6534","DOIUrl":"https://doi.org/10.62474/sljt-xyof6534","url":null,"abstract":"Severe hepatic injuries are associated with high morbidity and mortality (30%) and are challenging to manage (1). Liver injuries occur frequently following abdominal trauma. For example in a series of 48 patients who underwent laparotomy following trauma at the National Hospital of Sri Lanka, Colombo (NHSL), 11 patients had liver injuries (22.9%). Most liver injuries can be managed non-operatively. In the case of surgical management, the focus is on damage control, packing, and vascular ligation and resection. Interventional radiological modalities are also used in the management (e.g. embolisation of the bleeding vessels). This report is on the outcome of patients who underwent liver resection following severe liver injuries.","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"222 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
WHO has given a valuable tool for us to evaluate trauma system in a country with several defined domains. One of the most important domains is the prehospital trauma care(1). Sri Lanka is in a constant mechanism to upgrade itself in this area over several decades(2). Significant gains were made during the last decade in this aspect. The country has a mixed level of development in the subdomains under pre-hospital care(3). This editorial is focusing on a more constructive pathway to reach the high-income country type service(4).
{"title":"Editorial -01","authors":"gayan ekanayake","doi":"10.62474/sljt-kbix1314","DOIUrl":"https://doi.org/10.62474/sljt-kbix1314","url":null,"abstract":"WHO has given a valuable tool for us to evaluate trauma system in a country with several defined domains. One of the most important domains is the prehospital trauma care(1). Sri Lanka is in a constant mechanism to upgrade itself in this area over several decades(2). Significant gains were made during the last decade in this aspect. The country has a mixed level of development in the subdomains under pre-hospital care(3). This editorial is focusing on a more constructive pathway to reach the high-income country type service(4).","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"222 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Suicide bombing generates a significantly larger number of casualties per attack than other uses of force by terrorist groups. Acts of terrorism are evolving and becoming more complex. Health emergency trauma care systems should advance and be resilient to withstand shocks of terror mass casualty event while catering routine community care. Easter Sunday emergency and trauma care response at the Accident Services National Hospital Sri Lanka accrued invaluable lessons to be learned and shared with global emergency care fraternity.
{"title":"Resilience in terror and disaster medicine through consolidation of institutional memory - National Hospital Sri Lanka Easter Sunday 2019 experience","authors":"K. Abayajeewa, Amila Ratnayake ","doi":"10.62474/uufv1217","DOIUrl":"https://doi.org/10.62474/uufv1217","url":null,"abstract":"Suicide bombing generates a significantly larger number of casualties per attack than other uses of force by terrorist groups. Acts of terrorism are evolving and becoming more complex. Health emergency trauma care systems should advance and be resilient to withstand shocks of terror mass casualty event while catering routine community care. Easter Sunday emergency and trauma care response at the Accident Services National Hospital Sri Lanka accrued invaluable lessons to be learned and shared with global emergency care fraternity.","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"79 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140407098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mutilating upper limb injuries present complex challenges to both patients and surgeons, necessitating prompt and effective management strategies to achieve favorable outcomes. This retrospective study examines the cases of five consecutive patients with mangled upper limbs resulting from blunt trauma, evaluating demographics, injury mechanisms, injury patterns, and 60-day limb salvage outcomes. Among 2128 admissions between January and December 2022, five patients were identified with mangled upper limbs and open fractures, with an average age of 40.2 years and a notable male predominance (80%). The dominant hand was affected in 60% of cases, primarily due to blunt high-velocity road traffic accidents. The mean Mangled Extremity Severity Score (MESS) was 7.2, and the Ganga Hospital Open Injury Score averaged 16, indicating substantial injury severity without limb ischemia or compartment syndrome. All patients underwent definitive surgery within 48 hours, with various soft tissue reconstruction techniques employed, including free flaps, pedicle flaps, and local muscle mobilization, along with nerve grafting procedures. At the 60-day follow-up, successful limb salvage was achieved in all cases, with no instances of surgical site infection and excellent acceptance of skin grafted areas exceeding 95%. The findings underscore the importance of timely surgical intervention and comprehensive soft tissue coverage in achieving successful limb salvage outcomes in patients with mutilating upper limb injuries, emphasizing the critical role of early intervention and multidisciplinary collaboration.
{"title":"Salvaging mangled upper limbs with early soft tissue cover with flaps- A case series","authors":"O. Basnayake, G. Ekanayake","doi":"10.62474/gzpa7784","DOIUrl":"https://doi.org/10.62474/gzpa7784","url":null,"abstract":"Mutilating upper limb injuries present complex challenges to both patients and surgeons, necessitating prompt and effective management strategies to achieve favorable outcomes. This retrospective study examines the cases of five consecutive patients with mangled upper limbs resulting from blunt trauma, evaluating demographics, injury mechanisms, injury patterns, and 60-day limb salvage outcomes. Among 2128 admissions between January and December 2022, five patients were identified with mangled upper limbs and open fractures, with an average age of 40.2 years and a notable male predominance (80%). The dominant hand was affected in 60% of cases, primarily due to blunt high-velocity road traffic accidents. The mean Mangled Extremity Severity Score (MESS) was 7.2, and the Ganga Hospital Open Injury Score averaged 16, indicating substantial injury severity without limb ischemia or compartment syndrome. All patients underwent definitive surgery within 48 hours, with various soft tissue reconstruction techniques employed, including free flaps, pedicle flaps, and local muscle mobilization, along with nerve grafting procedures. At the 60-day follow-up, successful limb salvage was achieved in all cases, with no instances of surgical site infection and excellent acceptance of skin grafted areas exceeding 95%. The findings underscore the importance of timely surgical intervention and comprehensive soft tissue coverage in achieving successful limb salvage outcomes in patients with mutilating upper limb injuries, emphasizing the critical role of early intervention and multidisciplinary collaboration.","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"26 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140286529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vascular injuries can lead to life-threatening haemorrhage and limb-threatening ischemia if not addressed promptly. In Sri Lanka the number of limb vascular injuries are increasing due to the increase in road traffic accidents (RTA). This study describes the characteristics of patients who were operated on following vascular injuries at the Accident and Emergency department theatre of the National Hospital Sri Lanka (NHSL) from 2023 January to 2023 December.
{"title":"Vascular injury pattern and workload; A tertiary care center experience from Sri Lanka","authors":"Dulanjana Ranasinghe","doi":"10.62474/sljt-czfw6850","DOIUrl":"https://doi.org/10.62474/sljt-czfw6850","url":null,"abstract":"Vascular injuries can lead to life-threatening haemorrhage and limb-threatening ischemia if not addressed promptly. In Sri Lanka the number of limb vascular injuries are increasing due to the increase in road traffic accidents (RTA). This study describes the characteristics of patients who were operated on following vascular injuries at the Accident and Emergency department theatre of the National Hospital Sri Lanka (NHSL) from 2023 January to 2023 December.","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"133 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Ratnayake, Sanjeewa Munasinghe, Gamini Goonetilleke
Over the course of the 26-year civil war in Sri Lanka between the Liberation Tigers of Tamil Eelam (LTTE) and the government forces, LTTE’s ‘military’ capacity and strategy evolved from guerrilla-type ambushes using landmines to semi-conventional warfare with light arms and eventually to heavy artillery and improvised explosive devices. This evolution required both military and civil surgeons to enhance their knowledge and skills in managing high-energy war wounds to handle the large number of casualties admitted to health institutions. The Sri Lanka Medical Corps (SLMC) had been meticulously organized into echelons of care with graded capacity and capability to medivac battle injured personnel from point of injury to definitive care facilities. All injured personnel eventually found their way to Colombo Army Hospital and Ragama Rehabilitation Hospital for comprehensive rehabilitation. The civil war in Sri Lanka presented a significant influx of war-related injuries, demanding the creation of a comprehensive system seamlessly integrating both military and civilian elements. With a decade of peace, accompanied by shifts in injury epidemiology, the evolving landscape has mandated the exploration of innovative strategies to sustain and enhance the surgical skill-base for both military and civilian casualty care.
{"title":"Forging alliances: examining civil-military partnerships and their impact on war-time casualty care in Sri Lanka","authors":"A. Ratnayake, Sanjeewa Munasinghe, Gamini Goonetilleke","doi":"10.62474/dgjr2507","DOIUrl":"https://doi.org/10.62474/dgjr2507","url":null,"abstract":"Over the course of the 26-year civil war in Sri Lanka between the Liberation Tigers of Tamil Eelam (LTTE) and the government forces, LTTE’s ‘military’ capacity and strategy evolved from guerrilla-type ambushes using landmines to semi-conventional warfare with light arms and eventually to heavy artillery and improvised explosive devices. This evolution required both military and civil surgeons to enhance their knowledge and skills in managing high-energy war wounds to handle the large number of casualties admitted to health institutions. The Sri Lanka Medical Corps (SLMC) had been meticulously organized into echelons of care with graded capacity and capability to medivac battle injured personnel from point of injury to definitive care facilities. All injured personnel eventually found their way to Colombo Army Hospital and Ragama Rehabilitation Hospital for comprehensive rehabilitation. The civil war in Sri Lanka presented a significant influx of war-related injuries, demanding the creation of a comprehensive system seamlessly integrating both military and civilian elements. With a decade of peace, accompanied by shifts in injury epidemiology, the evolving landscape has mandated the exploration of innovative strategies to sustain and enhance the surgical skill-base for both military and civilian casualty care.","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"350 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blunt Thoracic trauma is one of the common presentations to accident and emergency departments in local settings. Life-threatening Tracheobronchial injury is uncommon and carries high mortality and morbidity if left untreated. This Article describes a case of major airway injury following blunt thoracic trauma in a young male.
{"title":"Life-threatening airway injury following blunt thoracic trauma.","authors":"Saman Pradeep","doi":"10.62474/sljt-txak2497","DOIUrl":"https://doi.org/10.62474/sljt-txak2497","url":null,"abstract":"Blunt Thoracic trauma is one of the common presentations to accident and emergency departments in local settings. Life-threatening Tracheobronchial injury is uncommon and carries high mortality and morbidity if left untreated. This Article describes a case of major airway injury following blunt thoracic trauma in a young male.","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"307 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140402329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elbow dislocations occur mostly in the young adult population and nearly 50% occur during sporting activities. Diagnosis and assessment of concentric reduction following manipulation are performed using plain radiography and fluoroscopy. Computed Tomography (CT) enable identifying subtle fractures that can otherwise lead to chronic instability. Simple dislocations by definition have no associated fractures and complex dislocations are associated with a variety of fractures, with the terrible triad injury and trans-humeral dislocations leading to surgical challenges. Assessment of the direction and the mechanics of elbow dislocation enable identify the structures that have been injured. Posterior and posterolateral dislocations are the most common patterns, where the lateral ligament complex is often compromised. Most simple dislocations are amenable to reduction, immobilization, and gradual rehabilitation resulting in good functional outcome. Ongoing instability can occur in 10% of the patients. Complex dislocations pose a surgical challenge and lead to joint stiffness, pain and ongoing instability if not managed properly. Identifying the individual component of a complex dislocation such as radial head fractures, coronoid fractures, proximal ulnar fractures, and ligament injures is important for satisfactory outcome.
{"title":"Traumatic elbow dislocations","authors":"M. Amarasooriya","doi":"10.62474/fgdb3996","DOIUrl":"https://doi.org/10.62474/fgdb3996","url":null,"abstract":"Elbow dislocations occur mostly in the young adult population and nearly 50% occur during sporting activities. Diagnosis and assessment of concentric reduction following manipulation are performed using plain radiography and fluoroscopy. Computed Tomography (CT) enable identifying subtle fractures that can otherwise lead to chronic instability. Simple dislocations by definition have no associated fractures and complex dislocations are associated with a variety of fractures, with the terrible triad injury and trans-humeral dislocations leading to surgical challenges. Assessment of the direction and the mechanics of elbow dislocation enable identify the structures that have been injured. Posterior and posterolateral dislocations are the most common patterns, where the lateral ligament complex is often compromised. Most simple dislocations are amenable to reduction, immobilization, and gradual rehabilitation resulting in good functional outcome. Ongoing instability can occur in 10% of the patients. Complex dislocations pose a surgical challenge and lead to joint stiffness, pain and ongoing instability if not managed properly. Identifying the individual component of a complex dislocation such as radial head fractures, coronoid fractures, proximal ulnar fractures, and ligament injures is important for satisfactory outcome.","PeriodicalId":517947,"journal":{"name":"Sri Lanka Journal of Trauma","volume":"1164 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140286428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：