Pub Date : 2025-03-12DOI: 10.1016/j.amjsurg.2025.116297
Lavina Malhotra, Andrew H Stephen, Madeline Goosman, Adam R Aluisio, Mohammed Arafeh, Charles A Adams, Stephanie N Leuckel, Brent Emigh, Benjamin M Hall, Daithi S Heffernan
Background: Abdominal sepsis frequently causes neurologic and pulmonary dysfunction among geriatric patients, We hypothesize that patients with abdominal sepsis who undergo extra-abdominal imaging have a greater burden of illness.
Methods: Patients 65 years and older that underwent emergency abdominal surgery for sepsis were divided into those with abdominal only(AbdCT) versus abdominal and extra-abdominal(ExtraCT) imaging.
Results: ExtraCT patients(N = 30) compared to AbdCT(N = 97) had higher rates of dementia(13.3 % versus 3.3 %; p = 0.03), diabetes(93.3 % versus 60.1 %; p < 0.01 and COPD(70 % versus 29.9 %; p < 0.01) but lower rates of abdominal pain as chief complaint (23.3 % versus 81.4 %; p < 0.01) and higher rates of being qSOFA positive (33.3 % vs 7.2 %; p < 0.05). Importantly, time to OR was not different between groups. ExtraCT patients had higher rates of 30-day mortality (33.3 % vs 5.2 %; p < 0.01). Extra-abdominal CT imaging was associated with increased risk of mortality (OR = 5.4; 95 %CI = 1.4-20.1).
Conclusions: ExtraCT among geriatric patients with abdominal emergencies is a marker of severity of illness and should guide end-of-life decision making.
{"title":"Extra-abdominal CT imaging indicates increased severity of illness in advanced age patients requiring emergency abdominal surgery.","authors":"Lavina Malhotra, Andrew H Stephen, Madeline Goosman, Adam R Aluisio, Mohammed Arafeh, Charles A Adams, Stephanie N Leuckel, Brent Emigh, Benjamin M Hall, Daithi S Heffernan","doi":"10.1016/j.amjsurg.2025.116297","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116297","url":null,"abstract":"<p><strong>Background: </strong>Abdominal sepsis frequently causes neurologic and pulmonary dysfunction among geriatric patients, We hypothesize that patients with abdominal sepsis who undergo extra-abdominal imaging have a greater burden of illness.</p><p><strong>Methods: </strong>Patients 65 years and older that underwent emergency abdominal surgery for sepsis were divided into those with abdominal only(AbdCT) versus abdominal and extra-abdominal(ExtraCT) imaging.</p><p><strong>Results: </strong>ExtraCT patients(N = 30) compared to AbdCT(N = 97) had higher rates of dementia(13.3 % versus 3.3 %; p = 0.03), diabetes(93.3 % versus 60.1 %; p < 0.01 and COPD(70 % versus 29.9 %; p < 0.01) but lower rates of abdominal pain as chief complaint (23.3 % versus 81.4 %; p < 0.01) and higher rates of being qSOFA positive (33.3 % vs 7.2 %; p < 0.05). Importantly, time to OR was not different between groups. ExtraCT patients had higher rates of 30-day mortality (33.3 % vs 5.2 %; p < 0.01). Extra-abdominal CT imaging was associated with increased risk of mortality (OR = 5.4; 95 %CI = 1.4-20.1).</p><p><strong>Conclusions: </strong>ExtraCT among geriatric patients with abdominal emergencies is a marker of severity of illness and should guide end-of-life decision making.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"116297"},"PeriodicalIF":2.7,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-11DOI: 10.1016/j.amjsurg.2025.116295
Nicole McLellan, Jessica J Lie, Josie Geller, Heather Stuart
Background: Surgical residents experience higher levels of negative stress and helplessness compared to the general population. Studies have linked stress to negative eating habits. Despite the high stress and burnout among surgical residents, studies on their disordered eating behaviors remain limited. Understanding the factors contributing to these findings will help optimize mental health during residency training.
Methods: This study is a mixed-methods cross-sectional survey of all general surgery residents in Canada. The survey assessed disordered eating, quality of life, and self-compassion using the Eating Attitudes Test (EAT-26), Kessler Psychological Distress Scale (KPDS), and Self-Compassion short-form scale (SCSF). A qualitative component examined factors influencing eating habits in residency. Logistic regression was performed to identify factors associated with at-risk disordered eating behaviors.
Results: Out of 450 surgical residents, 128 residents completed the survey (28 %). Respondents were 23 % male and split evenly across all postgraduate levels. There were 68 % of respondents who identified as having psychological distress and 34 % exhibited high risk behaviors for disordered eating. High levels of psychological distress (OR 3.29; 95 % CI [1.39-7.76]) and elevated BMI (OR 3.99; 95 % CI [1.63-9.77]) were significantly associated with exhibiting at-risk disordered eating behaviors Positive factors influencing eating were having a partner at home and having non-residency related extracurriculars. Negative factors were overnight call shift frequency, call shift length, and volume of pages.
Conclusion: This is the first nationwide survey examining eating behaviors among general surgery residents. This population was found to have elevated rates of high-risk behavior for disordered eating.
{"title":"Disordered eating behaviours, self-compassion, and psychological distress in Canadian general surgery residents.","authors":"Nicole McLellan, Jessica J Lie, Josie Geller, Heather Stuart","doi":"10.1016/j.amjsurg.2025.116295","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116295","url":null,"abstract":"<p><strong>Background: </strong>Surgical residents experience higher levels of negative stress and helplessness compared to the general population. Studies have linked stress to negative eating habits. Despite the high stress and burnout among surgical residents, studies on their disordered eating behaviors remain limited. Understanding the factors contributing to these findings will help optimize mental health during residency training.</p><p><strong>Methods: </strong>This study is a mixed-methods cross-sectional survey of all general surgery residents in Canada. The survey assessed disordered eating, quality of life, and self-compassion using the Eating Attitudes Test (EAT-26), Kessler Psychological Distress Scale (KPDS), and Self-Compassion short-form scale (SCSF). A qualitative component examined factors influencing eating habits in residency. Logistic regression was performed to identify factors associated with at-risk disordered eating behaviors.</p><p><strong>Results: </strong>Out of 450 surgical residents, 128 residents completed the survey (28 %). Respondents were 23 % male and split evenly across all postgraduate levels. There were 68 % of respondents who identified as having psychological distress and 34 % exhibited high risk behaviors for disordered eating. High levels of psychological distress (OR 3.29; 95 % CI [1.39-7.76]) and elevated BMI (OR 3.99; 95 % CI [1.63-9.77]) were significantly associated with exhibiting at-risk disordered eating behaviors Positive factors influencing eating were having a partner at home and having non-residency related extracurriculars. Negative factors were overnight call shift frequency, call shift length, and volume of pages.</p><p><strong>Conclusion: </strong>This is the first nationwide survey examining eating behaviors among general surgery residents. This population was found to have elevated rates of high-risk behavior for disordered eating.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"116295"},"PeriodicalIF":2.7,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-10DOI: 10.1016/j.amjsurg.2025.116296
SaeRam Oh , Annmarie Butare , William Irish , Mark A. Newell , Kenji Leonard , Michael D. Honaker
Background
Surgical site infections (SSI) following colon surgery continue to pose a significant clinical and financial impact on a healthcare system. The National Healthcare Safety Network (NHSN) utilizes the Complex 30-day SSI model to report the predictive number of infections for a hospital, which is submitted to the Centers for Medicare and Medicaid Services. However, this model does not account for patient acuity. The primary aim of the study was to determine the predictive accuracy of the model for predicting colon SSI in patients undergoing urgent and emergent general surgical procedures.
Methods
The National Surgery Quality Improvement Program (NSQIP) database was queried for variables used in the NHSN Complex 30-day SSI model from 2016 to 2022. Patients ≥18 years old who underwent an urgent/emergent general surgery colon operation were included. Utilizing model variables and coefficients, the predicted number of infections was calculated. A receiver-operating characteristic (ROC) curve was generated and the area under the curve (AUC) calculated to evaluate the model's predictive accuracy.
Results
Of the 476,178 patients included, 51 % were female with a mean age of 58 (±24), 15.7 % had diabetes, 35.2 % had body mass index (BMI) ≥ 30mg/kg2 and 61.1 % has ASA classification of 3/4/5. The overall infection rate was 4.3 %. In patients sustaining an SSI, 16.6 % had diabetes, 36.7 % had BMI ≥30mg/kg2, and 68.0 % had an ASA class of 3/4/5. The ROC curve revealed an AUC of 0.554 (95 % CI: 0.5498, 0.5577.)
Conclusions
Our findings demonstrate the Complex 30-day SSI model currently has a predictive accuracy only slightly better than chance in patients undergoing urgent or emergent general surgical colon operations. This may have significant impact on hospitals caring for patients with a higher acuity. Future models should take into consideration the acuity of the operation in efforts to improve the predictive accuracy in this patient population.
{"title":"Predictive accuracy of the complex 30-day model for colon surgical site infections in emergent operations","authors":"SaeRam Oh , Annmarie Butare , William Irish , Mark A. Newell , Kenji Leonard , Michael D. Honaker","doi":"10.1016/j.amjsurg.2025.116296","DOIUrl":"10.1016/j.amjsurg.2025.116296","url":null,"abstract":"<div><h3>Background</h3><div>Surgical site infections (SSI) following colon surgery continue to pose a significant clinical and financial impact on a healthcare system. The National Healthcare Safety Network (NHSN) utilizes the Complex 30-day SSI model to report the predictive number of infections for a hospital, which is submitted to the Centers for Medicare and Medicaid Services. However, this model does not account for patient acuity. The primary aim of the study was to determine the predictive accuracy of the model for predicting colon SSI in patients undergoing urgent and emergent general surgical procedures.</div></div><div><h3>Methods</h3><div>The National Surgery Quality Improvement Program (NSQIP) database was queried for variables used in the NHSN Complex 30-day SSI model from 2016 to 2022. Patients ≥18 years old who underwent an urgent/emergent general surgery colon operation were included. Utilizing model variables and coefficients, the predicted number of infections was calculated. A receiver-operating characteristic (ROC) curve was generated and the area under the curve (AUC) calculated to evaluate the model's predictive accuracy.</div></div><div><h3>Results</h3><div>Of the 476,178 patients included, 51 % were female with a mean age of 58 (±24), 15.7 % had diabetes, 35.2 % had body mass index (BMI) ≥ 30mg/kg2 and 61.1 % has ASA classification of 3/4/5. The overall infection rate was 4.3 %. In patients sustaining an SSI, 16.6 % had diabetes, 36.7 % had BMI ≥30mg/kg2, and 68.0 % had an ASA class of 3/4/5. The ROC curve revealed an AUC of 0.554 (95 % CI: 0.5498, 0.5577.)</div></div><div><h3>Conclusions</h3><div>Our findings demonstrate the Complex 30-day SSI model currently has a predictive accuracy only slightly better than chance in patients undergoing urgent or emergent general surgical colon operations. This may have significant impact on hospitals caring for patients with a higher acuity. Future models should take into consideration the acuity of the operation in efforts to improve the predictive accuracy in this patient population.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116296"},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-10DOI: 10.1016/j.amjsurg.2025.116285
Ali Schroeder, Tamir Bresler, Philip Bohlmann, Anjali S Kumar
Background: This study evaluated a structured case-log assignment to assess experiences in third-year surgical clerkships, focusing on student-preceptor interactions allowing entrustability of the student with surgical instruments.
Methods: Case-logs from 74 students across multiple clinical sites in a community-based medical school were reviewed. Assignments detailed operation type, hands-on-instrument time, and personal growth reflections.
Results: Students logged 1396 operations (65.43 %; 31.07 ± 23.85 surgeries/student), 382 clinic sessions (17.91 %), and 355 rounds/consultations (16.65 %). Common surgeries included intrabdominal (49.78 %) and abdominal wall (15.25 %). Fiberoptic-assisted (45.45 %) and open surgeries (36.82 %) predominated. Most (77.94 %) operations occurred without residents, with limited hands-on time (27.51 % reporting 1 %-24 %). Weekend logs (46 students) captured fewer surgeries (2.22 ± 1.31/student), though intrabdominal surgeries and hands-on time were higher. Reflections highlighted key experiences and learning opportunities.
Conclusion: Structured case-logs effectively capture surgical exposure and student experiences. Integrating digital logbooks could enhance real-time data collection and streamline assessment.
{"title":"Is surgery a spectator sport? Third-year surgical clerkship case-log analysis at a community-based medical college.","authors":"Ali Schroeder, Tamir Bresler, Philip Bohlmann, Anjali S Kumar","doi":"10.1016/j.amjsurg.2025.116285","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116285","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated a structured case-log assignment to assess experiences in third-year surgical clerkships, focusing on student-preceptor interactions allowing entrustability of the student with surgical instruments.</p><p><strong>Methods: </strong>Case-logs from 74 students across multiple clinical sites in a community-based medical school were reviewed. Assignments detailed operation type, hands-on-instrument time, and personal growth reflections.</p><p><strong>Results: </strong>Students logged 1396 operations (65.43 %; 31.07 ± 23.85 surgeries/student), 382 clinic sessions (17.91 %), and 355 rounds/consultations (16.65 %). Common surgeries included intrabdominal (49.78 %) and abdominal wall (15.25 %). Fiberoptic-assisted (45.45 %) and open surgeries (36.82 %) predominated. Most (77.94 %) operations occurred without residents, with limited hands-on time (27.51 % reporting 1 %-24 %). Weekend logs (46 students) captured fewer surgeries (2.22 ± 1.31/student), though intrabdominal surgeries and hands-on time were higher. Reflections highlighted key experiences and learning opportunities.</p><p><strong>Conclusion: </strong>Structured case-logs effectively capture surgical exposure and student experiences. Integrating digital logbooks could enhance real-time data collection and streamline assessment.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"244 ","pages":"116285"},"PeriodicalIF":2.7,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-07DOI: 10.1016/j.amjsurg.2025.116294
Tobi Somorin, Ju Hyung An, David Berger, Panos Kougias, Sherene Sharath
{"title":"Healthcare disparities and fiscal challenges Medicaid payor proportions' role in academic medical center profit margins.","authors":"Tobi Somorin, Ju Hyung An, David Berger, Panos Kougias, Sherene Sharath","doi":"10.1016/j.amjsurg.2025.116294","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116294","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116294"},"PeriodicalIF":2.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-07DOI: 10.1016/j.amjsurg.2025.116293
Jiyun Hu, Shucai Xie, Ya Liao, Tao Chen, Zhaoxin Qian, Lina Zhang
The role of gender in sepsis outcomes remains controversial. Numerous epidemiological studies investigating gender-dependent clinical outcomes in sepsis have yielded conflicting evidence. While the literature varies, most studies indicate that male gender is associated with worse sepsis outcomes and survival. Understanding the gender's role in these processes provides valuable insights into potential therapeutic targets for sepsis.
{"title":"The gender paradox in sepsis: Exploring male vulnerability and female resilience.","authors":"Jiyun Hu, Shucai Xie, Ya Liao, Tao Chen, Zhaoxin Qian, Lina Zhang","doi":"10.1016/j.amjsurg.2025.116293","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116293","url":null,"abstract":"<p><p>The role of gender in sepsis outcomes remains controversial. Numerous epidemiological studies investigating gender-dependent clinical outcomes in sepsis have yielded conflicting evidence. While the literature varies, most studies indicate that male gender is associated with worse sepsis outcomes and survival. Understanding the gender's role in these processes provides valuable insights into potential therapeutic targets for sepsis.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116293"},"PeriodicalIF":2.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-07DOI: 10.1016/j.amjsurg.2025.116292
Aymen H. Sadaka , William J. O'Brien , Kamal M.F. Itani
Background
Since 2011, the New England VA Hernia Registry (NEVAHR) prospectively collected operative details of ventral hernia repairs (VHRs) from 5 VA medical centers. This study aims to determine factors associated with recurrence.
Methods
Recurrence and surgical site occurrences (SSO) were directly identified via clinical and operative notes and/or imaging. Analysis was conducted via logistical regression.
Results
There were 681 VHRs. Mesh was used in 589 (86.5 %) repairs and was associated with larger average defect sizes (p < 0.001) and incisional hernias (p = 0.007). There were 117 (19.9 %) recurrences among mesh repairs and 22 (23.9 %) among suture repairs (p = 0.033). Among mesh repairs, recurrence was associated with higher BMI (p = 0.009), smoking (p = 0.012), parastomal and subcostal hernias (p = 0.003; p = 0.042), SSOs (p = 0.009), laparoscopy (p = 0.042), and smaller mesh-fascia overlap (p = 0.039). No factors associated with recurrence among suture repairs.
Conclusion
Despite proper decision-making by NEVAHR surgeons, suture repair underperforms for hernias >2 cm. Utility of suture repair for defects <2 cm requires more investigation.
{"title":"The interplay of surgeon judgment and available evidence in the long-term outcome of ventral hernia repair","authors":"Aymen H. Sadaka , William J. O'Brien , Kamal M.F. Itani","doi":"10.1016/j.amjsurg.2025.116292","DOIUrl":"10.1016/j.amjsurg.2025.116292","url":null,"abstract":"<div><h3>Background</h3><div>Since 2011, the New England VA Hernia Registry (NEVAHR) prospectively collected operative details of ventral hernia repairs (VHRs) from 5 VA medical centers. This study aims to determine factors associated with recurrence.</div></div><div><h3>Methods</h3><div>Recurrence and surgical site occurrences (SSO) were directly identified via clinical and operative notes and/or imaging. Analysis was conducted via logistical regression.</div></div><div><h3>Results</h3><div>There were 681 VHRs. Mesh was used in 589 (86.5 %) repairs and was associated with larger average defect sizes (p < 0.001) and incisional hernias (p = 0.007). There were 117 (19.9 %) recurrences among mesh repairs and 22 (23.9 %) among suture repairs (p = 0.033). Among mesh repairs, recurrence was associated with higher BMI (p = 0.009), smoking (p = 0.012), parastomal and subcostal hernias (p = 0.003; p = 0.042), SSOs (p = 0.009), laparoscopy (p = 0.042), and smaller mesh-fascia overlap (p = 0.039). No factors associated with recurrence among suture repairs.</div></div><div><h3>Conclusion</h3><div>Despite proper decision-making by NEVAHR surgeons, suture repair underperforms for hernias >2 cm. Utility of suture repair for defects <2 cm requires more investigation.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116292"},"PeriodicalIF":2.7,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143621310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-05DOI: 10.1016/j.amjsurg.2025.116290
Mytien Nguyen, Alizeh Abbas, Lamario J Williams, Wendelyn M Oslock, Ranganath G Kathawate, Paula A Ferrada
{"title":"Roses & thorns of academic surgery: Paving the way for others with Dr. Paula Ferrada.","authors":"Mytien Nguyen, Alizeh Abbas, Lamario J Williams, Wendelyn M Oslock, Ranganath G Kathawate, Paula A Ferrada","doi":"10.1016/j.amjsurg.2025.116290","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116290","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116290"},"PeriodicalIF":2.7,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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