To assess the impact of perioperative prognostic nutritional index (PNI) changes on prognosis and recurrence after colorectal cancer surgery.
Methods
A total of 475 patients who underwent curative resection for primary colorectal adenocarcinoma and were diagnosed with pathological stage (pStage) II/III were retrospectively reviewed. The patients were divided into two groups: the high group (preoperative PNI ≤ postoperative PNI, n = 290) and the low group (preoperative PNI > postoperative PNI, n = 185).
Results
The low group exhibited significantly higher recurrence and mortality rates (all p < 0.001). Kaplan–Meier analysis showed worse overall and recurrence-free survival in the low group (all p < 0.001). Perioperative PNI changes predicted prognosis and recurrence independent of preoperative nutritional conditions. Subgroup analyses showed better overall survival and recurrence-free survival in the high group across various parameters, such as patient background, surgical outcomes, adjuvant chemotherapy, and pathological characteristics. Multivariate analysis revealed that the low group based on perioperative PNI changes (hazard ratio [HR]: 5.809, 95% confidence interval [CI]: 3.451–9.779, p < 0.001), pathological T stage (HR: 1.962, 95% CI: 1.184–3.253, p = 0.009), and pathological N stage (HR: 3.434, 95% CI: 1.964–6.004, p < 0.001) were identified as independent predictors of worse overall survival.
Conclusions
Patients with pStage II/III colorectal cancer who demonstrate a lower postoperative PNI levels compared to preoperative had poorer overall survival and recurrence-free survival. Perioperative PNI changes can serve as useful biomarkers for predicting survival and recurrence.
{"title":"Impact of perioperative prognostic nutritional index changes on the survival of patients with stage II/III colorectal cancer","authors":"Kyota Tatsuta, Mayu Sakata, Tadahiro Kojima, Toshiya Akai, Mikihiro Shimizu, Yoshifumi Morita, Hirotoshi Kikuchi, Yoshihiro Hiramatsu, Kiyotaka Kurachi, Hiroya Takeuchi","doi":"10.1002/ags3.12826","DOIUrl":"10.1002/ags3.12826","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To assess the impact of perioperative prognostic nutritional index (PNI) changes on prognosis and recurrence after colorectal cancer surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 475 patients who underwent curative resection for primary colorectal adenocarcinoma and were diagnosed with pathological stage (pStage) II/III were retrospectively reviewed. The patients were divided into two groups: the high group (preoperative PNI ≤ postoperative PNI, <i>n</i> = 290) and the low group (preoperative PNI > postoperative PNI, <i>n</i> = 185).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The low group exhibited significantly higher recurrence and mortality rates (all <i>p</i> < 0.001). Kaplan–Meier analysis showed worse overall and recurrence-free survival in the low group (all <i>p</i> < 0.001). Perioperative PNI changes predicted prognosis and recurrence independent of preoperative nutritional conditions. Subgroup analyses showed better overall survival and recurrence-free survival in the high group across various parameters, such as patient background, surgical outcomes, adjuvant chemotherapy, and pathological characteristics. Multivariate analysis revealed that the low group based on perioperative PNI changes (hazard ratio [HR]: 5.809, 95% confidence interval [CI]: 3.451–9.779, <i>p</i> < 0.001), pathological T stage (HR: 1.962, 95% CI: 1.184–3.253, <i>p</i> = 0.009), and pathological N stage (HR: 3.434, 95% CI: 1.964–6.004, <i>p</i> < 0.001) were identified as independent predictors of worse overall survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with pStage II/III colorectal cancer who demonstrate a lower postoperative PNI levels compared to preoperative had poorer overall survival and recurrence-free survival. Perioperative PNI changes can serve as useful biomarkers for predicting survival and recurrence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 5","pages":"817-825"},"PeriodicalIF":2.9,"publicationDate":"2024-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124625","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}
The prognosis of colorectal cancer (CRC) has been historically reliant on the Tumor Node Metastasis (TNM) staging system, but there is variability in outcomes among patients at similar stages. Therefore, there is an urgent need for more robust biomarkers. The aim of this study was to assess the clinical feasibility of the recently reported Inflammatory Burden Index (IBI) for predicting short- and long-term outcomes in patients with CRC.
Methods
This was a retrospective observational study of 555 CRC patients undergoing surgery for primary tumor resection. We determined the prognostic value of preoperative IBI for disease-free and overall survival, and its predictive value for perioperative risk of infectious complications, including surgical site infection.
Results
Increased preoperative IBI was significantly associated with advanced disease stage and poor oncological outcome in CRC patients. Higher IBI was independently linked to poorer disease-free and overall survival. Similar outcomes were observed in a subanalysis focused on high-risk stage II and stage III CRC patients. Elevated preoperative IBI was significantly correlated with an increased risk of surgical site infection and other postoperative infectious complications. Propensity score-matching analysis validated the impact of IBI on the prognosis in CRC patients.
Conclusion
We established preoperative IBI as a valuable predictive biomarker for perioperative risks and oncological outcomes in CRC patients. Preoperative IBI is useful for designing effective perioperative management and postoperative oncological follow-up.
目的：结直肠癌（CRC）的预后历来依赖于肿瘤结节转移（TNM）分期系统，但处于类似分期的患者的预后存在差异。因此，迫切需要更可靠的生物标志物。本研究旨在评估最近报道的炎症负担指数（IBI）在预测 CRC 患者短期和长期预后方面的临床可行性：这是一项回顾性观察研究，研究对象是接受原发肿瘤切除手术的 555 例 CRC 患者。我们确定了术前 IBI 对无病生存率和总生存率的预后价值，以及对围手术期感染并发症（包括手术部位感染）风险的预测价值：结果：术前 IBI 增加与 CRC 患者的晚期疾病分期和不良肿瘤预后显著相关。较高的IBI与较差的无病生存率和总生存率有独立联系。在一项针对高危 II 期和 III 期 CRC 患者的子分析中也观察到了类似的结果。术前 IBI 升高与手术部位感染和其他术后感染并发症的风险增加有显著相关性。倾向评分匹配分析验证了IBI对CRC患者预后的影响：我们将术前 IBI 确立为预测 CRC 患者围手术期风险和肿瘤预后的重要生物标记物。术前IBI有助于设计有效的围手术期管理和术后肿瘤学随访。
{"title":"Inflammatory Burden Index as a promising new marker for predicting surgical and oncological outcomes in colorectal cancer","authors":"Shinji Yamashita, Yoshinaga Okugawa, Naru Mizuno, Hiroki Imaoka, Tadanobu Shimura, Takahito Kitajima, Mikio Kawamura, Yoshiki Okita, Masaki Ohi, Yuji Toiyama","doi":"10.1002/ags3.12829","DOIUrl":"10.1002/ags3.12829","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>The prognosis of colorectal cancer (CRC) has been historically reliant on the Tumor Node Metastasis (TNM) staging system, but there is variability in outcomes among patients at similar stages. Therefore, there is an urgent need for more robust biomarkers. The aim of this study was to assess the clinical feasibility of the recently reported Inflammatory Burden Index (IBI) for predicting short- and long-term outcomes in patients with CRC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective observational study of 555 CRC patients undergoing surgery for primary tumor resection. We determined the prognostic value of preoperative IBI for disease-free and overall survival, and its predictive value for perioperative risk of infectious complications, including surgical site infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Increased preoperative IBI was significantly associated with advanced disease stage and poor oncological outcome in CRC patients. Higher IBI was independently linked to poorer disease-free and overall survival. Similar outcomes were observed in a subanalysis focused on high-risk stage II and stage III CRC patients. Elevated preoperative IBI was significantly correlated with an increased risk of surgical site infection and other postoperative infectious complications. Propensity score-matching analysis validated the impact of IBI on the prognosis in CRC patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We established preoperative IBI as a valuable predictive biomarker for perioperative risks and oncological outcomes in CRC patients. Preoperative IBI is useful for designing effective perioperative management and postoperative oncological follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 5","pages":"826-835"},"PeriodicalIF":2.9,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124626","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}
<p>Dr. Takeuchi and Kitagawa<span><sup>1</sup></span> described the importance of artificial intelligence (AI) in surgical innovation. AI is rapidly gaining ground in various surgical fields worldwide. The current trajectory indicates that harnessing AI technologies can significantly improve patient care by reinforcing established practices and accelerating surgical innovation, offering a distinctive chance to explore potential advantages in providing health services to low- and middle-income countries (LMICs) globally.</p><p>Large language models hold immense promise in revolutionizing medical education and emerging as indispensable assets in surgical practice. Medical students and surgeons could easily access a wealth of educational materials and clinical insights presented intuitively, enriching their understanding and proficiency.<span><sup>2</sup></span> AI technologies have demonstrated their effectiveness in tailoring surgical training, streamlining administrative duties, and creating practical and affordable simulation training programs tailored to the specific needs of diverse individuals.<span><sup>3</sup></span></p><p>Integrating machine learning algorithms in areas like big data analysis, computer vision, and operative robotics promises to revolutionize surgical patient risk assessment, surgical treatment, and postoperative monitoring, potentially enhancing patient outcomes through reductions in morbidity and mortality.<span><sup>4</sup></span> More importantly, immediate intra-operative suggestions can assist surgeons in providing better evidence-based treatment to surgical patients. As the key players in this transformation, surgeons have the power to grasp the basic principles of AI, understand its implications in healthcare, and explore avenues for integrating this technology. Collaboration with data scientists to capture comprehensive data and provide clinical context is pivotal to optimizing surgical care quality.</p><p>In the upcoming AI-driven era, it is crucial to prioritize AI's conscientious and ethical utilization. This should be underscored by vigilant monitoring of data governance and potential patient safety risks during deployment. The implementation process must also address usability, pathway feasibility, and the crucial need for thorough evaluation of healthcare technology and evidence generation. When these may be perceived as obstacles to AI adoption, holistic implementation strategies promise to establish a robust framework for the widespread integration of AI across healthcare systems, ensuring its responsible and ethical use.</p><p>Global surgery encompasses a swiftly growing interdisciplinary domain dedicated to enhancing and ensuring fair access to quality surgical care within global healthcare frameworks. Initiatives within global surgery predominantly concentrate on bolstering capabilities, advocating for equitable access, facilitating educational programs, conducting research, and crafting policies tailore
{"title":"Artificial intelligence-driven surgical innovation: A catalyst for medical equity","authors":"Si-Wai Vivian Chiu, Chung-Feng Liu, Kuang-Ming Liao, Chong-Chi Chiu","doi":"10.1002/ags3.12827","DOIUrl":"10.1002/ags3.12827","url":null,"abstract":"<p>Dr. Takeuchi and Kitagawa<span><sup>1</sup></span> described the importance of artificial intelligence (AI) in surgical innovation. AI is rapidly gaining ground in various surgical fields worldwide. The current trajectory indicates that harnessing AI technologies can significantly improve patient care by reinforcing established practices and accelerating surgical innovation, offering a distinctive chance to explore potential advantages in providing health services to low- and middle-income countries (LMICs) globally.</p><p>Large language models hold immense promise in revolutionizing medical education and emerging as indispensable assets in surgical practice. Medical students and surgeons could easily access a wealth of educational materials and clinical insights presented intuitively, enriching their understanding and proficiency.<span><sup>2</sup></span> AI technologies have demonstrated their effectiveness in tailoring surgical training, streamlining administrative duties, and creating practical and affordable simulation training programs tailored to the specific needs of diverse individuals.<span><sup>3</sup></span></p><p>Integrating machine learning algorithms in areas like big data analysis, computer vision, and operative robotics promises to revolutionize surgical patient risk assessment, surgical treatment, and postoperative monitoring, potentially enhancing patient outcomes through reductions in morbidity and mortality.<span><sup>4</sup></span> More importantly, immediate intra-operative suggestions can assist surgeons in providing better evidence-based treatment to surgical patients. As the key players in this transformation, surgeons have the power to grasp the basic principles of AI, understand its implications in healthcare, and explore avenues for integrating this technology. Collaboration with data scientists to capture comprehensive data and provide clinical context is pivotal to optimizing surgical care quality.</p><p>In the upcoming AI-driven era, it is crucial to prioritize AI's conscientious and ethical utilization. This should be underscored by vigilant monitoring of data governance and potential patient safety risks during deployment. The implementation process must also address usability, pathway feasibility, and the crucial need for thorough evaluation of healthcare technology and evidence generation. When these may be perceived as obstacles to AI adoption, holistic implementation strategies promise to establish a robust framework for the widespread integration of AI across healthcare systems, ensuring its responsible and ethical use.</p><p>Global surgery encompasses a swiftly growing interdisciplinary domain dedicated to enhancing and ensuring fair access to quality surgical care within global healthcare frameworks. Initiatives within global surgery predominantly concentrate on bolstering capabilities, advocating for equitable access, facilitating educational programs, conducting research, and crafting policies tailore","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 5","pages":"952-953"},"PeriodicalIF":2.9,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124609","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}
To clarify the usefulness of intraoperative lavage cytology in patients undergoing curative resection for pStage II-III colorectal cancer in a prospective multicenter study.
Methods
Patients preoperatively diagnosed with stage II-III colorectal cancer between 2013 and 2017 from 20 hospitals were enrolled. Lavage cytology was performed twice during the surgery. The primary endpoint was the effect of lavage cytology on the 5-year relapse-free survival (RFS) in patients with pStage II-III colorectal cancer. The secondary endpoint was the effect of lavage cytology on the 5-year overall survival (OS) and peritoneal recurrence.
Results
A total of 1378 patients were eligible for analysis. The number of patients with pStage II-III colorectal cancer was 670 and 708, respectively. Fifty-four patients (3.9%) had positive cytological results. In pStage II patients, the 5-year RFS rates with positive and negative cytology were 61.1% and 81.6%, respectively (p = 0.023). The 5-year OS rates were 67.1% and 91.7%, respectively (p = 0.0083). However, there was no difference in RFS or OS between pStage III patients with positive and negative cytology results. The peritoneal recurrence rates were 11.8% and 1.5% in pStage II patients with positive and negative cytology results, respectively (p = 0.032). These rates were 10.5% and 2.5% in patients with stage III disease, respectively (p = 0.022).
Conclusion
Stage II colorectal cancer patients with negative cytology had better outcomes than those with positive cytology. Peritoneal lavage cytology is useful for predicting peritoneal recurrence after curative resection of stage II-III colorectal cancer.
{"title":"Peritoneal lavage cytology in patients with curative resection for stage II and III colorectal cancer: A multi-institutional prospective study","authors":"Hirotoshi Kobayashi, Kenjiro Kotake, Kotaro Maeda, Takeshi Suto, Masayasu Kawasaki, Hideki Ueno, Koji Komori, Heita Ozawa, Keiji Koda, Masayuki Ohue, Kimihiko Funahashi, Ichiro Takemasa, Hideyuki Ishida, Shinsuke Kazama, Yoshifumi Shimada, Hajime Morohashi, Yusuke Kinugasa, Yukihide Kanemitsu, Hiroki Ochiai, Soichiro Ishihara, Michio Itabashi, Kenichi Sugihara, Yoichi Ajioka","doi":"10.1002/ags3.12825","DOIUrl":"10.1002/ags3.12825","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To clarify the usefulness of intraoperative lavage cytology in patients undergoing curative resection for pStage II-III colorectal cancer in a prospective multicenter study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients preoperatively diagnosed with stage II-III colorectal cancer between 2013 and 2017 from 20 hospitals were enrolled. Lavage cytology was performed twice during the surgery. The primary endpoint was the effect of lavage cytology on the 5-year relapse-free survival (RFS) in patients with pStage II-III colorectal cancer. The secondary endpoint was the effect of lavage cytology on the 5-year overall survival (OS) and peritoneal recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1378 patients were eligible for analysis. The number of patients with pStage II-III colorectal cancer was 670 and 708, respectively. Fifty-four patients (3.9%) had positive cytological results. In pStage II patients, the 5-year RFS rates with positive and negative cytology were 61.1% and 81.6%, respectively (<i>p</i> = 0.023). The 5-year OS rates were 67.1% and 91.7%, respectively (<i>p</i> = 0.0083). However, there was no difference in RFS or OS between pStage III patients with positive and negative cytology results. The peritoneal recurrence rates were 11.8% and 1.5% in pStage II patients with positive and negative cytology results, respectively (<i>p</i> = 0.032). These rates were 10.5% and 2.5% in patients with stage III disease, respectively (<i>p</i> = 0.022).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Stage II colorectal cancer patients with negative cytology had better outcomes than those with positive cytology. Peritoneal lavage cytology is useful for predicting peritoneal recurrence after curative resection of stage II-III colorectal cancer.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 5","pages":"807-816"},"PeriodicalIF":2.9,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11368490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124628","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}
Aberrant TGF-β signaling pathway can lead to invasive phenotype of colorectal cancer (CRC), resulting in poor prognosis. It is pivotal to develop an effective prognostic factor on the basis of TGF-β-related genes to accurately identify risk of CRC patients.
Methods
We performed differential analysis of TGF-β-related genes in CRC patients from databases and previous literature to obtain TGF-β-related differentially expressed genes (TRDEGs). LASSO-Cox regression was utilized to build a CRC prognostic feature model based on TRDEGs. The model was validated using two GEO validation sets. Wilcoxon rank-sum test was utilized to test correlation of model with clinical factors. ESTIMATE algorithm and ssGSEA and tumor mutation burden (TMB) analysis were used to analyze immune landscape and mutation burden of high-risk (HR) and low-risk (LR) groups. CellMiner database was utilized to identify therapeutic drugs with high sensitivity to the feature genes.
Results
We established a six-gene risk prognostic model with good predictive accuracy, which independently predicted CRC patients' prognoses. The HR group was more likely to experience immunotherapy benefits due to higher immune infiltration and TMB. The feature gene TGFB2 could inhibit the efficacy of drugs such as XAV-939, Staurosporine, and Dasatinib, but promote the efficacy of drugs such as CUDC-305 and by-product of CUDC-305. Similarly, RBL1 could inhibit the drug action of Fluphenazine and Imiquimod but promote that of Irofulven.
Conclusion
A CRC risk prognostic signature was developed on basis of TGF-β-related genes, which provides a reference for risk and further therapeutic selection of CRC patients.
{"title":"A new TGF-β risk score predicts clinical and immune landscape in colorectal cancer patients","authors":"Bing Tang, Binggang Liu, Zhiyao Zeng","doi":"10.1002/ags3.12802","DOIUrl":"10.1002/ags3.12802","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Aberrant TGF-β signaling pathway can lead to invasive phenotype of colorectal cancer (CRC), resulting in poor prognosis. It is pivotal to develop an effective prognostic factor on the basis of TGF-β-related genes to accurately identify risk of CRC patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed differential analysis of TGF-β-related genes in CRC patients from databases and previous literature to obtain TGF-β-related differentially expressed genes (TRDEGs). LASSO-Cox regression was utilized to build a CRC prognostic feature model based on TRDEGs. The model was validated using two GEO validation sets. Wilcoxon rank-sum test was utilized to test correlation of model with clinical factors. ESTIMATE algorithm and ssGSEA and tumor mutation burden (TMB) analysis were used to analyze immune landscape and mutation burden of high-risk (HR) and low-risk (LR) groups. CellMiner database was utilized to identify therapeutic drugs with high sensitivity to the feature genes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We established a six-gene risk prognostic model with good predictive accuracy, which independently predicted CRC patients' prognoses. The HR group was more likely to experience immunotherapy benefits due to higher immune infiltration and TMB. The feature gene TGFB2 could inhibit the efficacy of drugs such as XAV-939, Staurosporine, and Dasatinib, but promote the efficacy of drugs such as CUDC-305 and by-product of CUDC-305. Similarly, RBL1 could inhibit the drug action of Fluphenazine and Imiquimod but promote that of Irofulven.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A CRC risk prognostic signature was developed on basis of TGF-β-related genes, which provides a reference for risk and further therapeutic selection of CRC patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 5","pages":"927-941"},"PeriodicalIF":2.9,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12802","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141115572","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}
Methods of predicting severe postoperative complications after anatomical resection for hepatocellular carcinoma are yet to be established. We aimed to clarify the relationship between inflammation-based prognostic scores and liver fibrosis markers and the incidence of postoperative complications after anatomical resection for hepatocellular carcinoma as well as the usefulness of these markers in surgical procedure selection.
Methods
We included 374 patients with hepatocellular carcinoma who had undergone initial hepatectomy between January 2007 and December 2021. The association between inflammation-based prognostic scores or liver fibrosis markers and postoperative complications was evaluated, and severe postoperative complication rates in the high-risk group defined by these markers were compared in terms of surgical procedure.
Results
The advanced lung cancer inflammation index and nonalcoholic fatty liver disease fibrosis score correlated significantly with severe postoperative complications after anatomical resection, with areas under the curve of 0.67 and 0.61, respectively. The combined advanced lung cancer inflammation index and nonalcoholic fatty liver disease fibrosis score resulted in a larger area under the curve (0.69). Furthermore, in the high-risk group determined by the combined score, the anatomical resection group had a significantly higher incidence of severe complications than the partial resection group (P < 0.01). There were no significant differences in prognosis among the surgical procedures in the high-risk group.
Conclusion
The combined advanced lung cancer inflammation index and nonalcoholic fatty liver disease fibrosis score serves as a predictive marker for severe postoperative complications after anatomical resection. This combined marker may contribute to appropriate surgical procedure selection.
{"title":"Combination of advanced lung cancer inflammation index and nonalcoholic fatty liver disease fibrosis score as a promising marker for surgical procedure selection for hepatocellular carcinoma","authors":"Kiyotaka Hosoda, Akira Shimizu, Koji Kubota, Tsuyoshi Notake, Noriyuki Kitagawa, Takahiro Yoshizawa, Hiroki Sakai, Hikaru Hayashi, Koya Yasukawa, Yuji Soejima","doi":"10.1002/ags3.12815","DOIUrl":"10.1002/ags3.12815","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Methods of predicting severe postoperative complications after anatomical resection for hepatocellular carcinoma are yet to be established. We aimed to clarify the relationship between inflammation-based prognostic scores and liver fibrosis markers and the incidence of postoperative complications after anatomical resection for hepatocellular carcinoma as well as the usefulness of these markers in surgical procedure selection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included 374 patients with hepatocellular carcinoma who had undergone initial hepatectomy between January 2007 and December 2021. The association between inflammation-based prognostic scores or liver fibrosis markers and postoperative complications was evaluated, and severe postoperative complication rates in the high-risk group defined by these markers were compared in terms of surgical procedure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The advanced lung cancer inflammation index and nonalcoholic fatty liver disease fibrosis score correlated significantly with severe postoperative complications after anatomical resection, with areas under the curve of 0.67 and 0.61, respectively. The combined advanced lung cancer inflammation index and nonalcoholic fatty liver disease fibrosis score resulted in a larger area under the curve (0.69). Furthermore, in the high-risk group determined by the combined score, the anatomical resection group had a significantly higher incidence of severe complications than the partial resection group (<i>P <</i> 0.01). There were no significant differences in prognosis among the surgical procedures in the high-risk group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combined advanced lung cancer inflammation index and nonalcoholic fatty liver disease fibrosis score serves as a predictive marker for severe postoperative complications after anatomical resection. This combined marker may contribute to appropriate surgical procedure selection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 6","pages":"1096-1106"},"PeriodicalIF":2.9,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12815","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141120144","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}
The interactions between cancer cells and tumor-associated macrophages (TAMs) via microRNAs (miRNAs) play crucial roles in malignant potential and drug resistance. However, it remains unclear how lenvatinib-resistant hepatocellular carcinoma (LR HCC) promotes TAM tumor biology. Here we investigated the crosstalk between LR HCC cells and TAMs for cancer progression and lenvatinib resistance, focusing on an exosomal miRNA.
Methods
We used two bioinformatics software programs to identify miRNAs that target PTEN in gastrointestinal cancers, then investigated exosomal miRNA expression in LR HCC conditioned medium (CM). After modifying TAMs with LR HCC CM (LR TAM), macrophage phenotype and PTEN-Nrf2 signaling pathway component expression were analyzed in LR TAMs. The malignant potential and drug resistance were investigated in naïve HCC cells cultured with LR TAM CM.
Results
LR HCC cells highly induced M2-like properties in macrophages compared with naïve HCC cells. Exosomal miR-301a-3p expression was increased in LR HCC CM, with higher activation of the PTEN/PI3K/GSK3β/Nrf2 signaling pathway in LR TAMs. Naïve HCC cells were educated with LR TAM CM to promote malignant potential and lenvatinib resistance. Inhibition of exosomal miR-301a-3p prevented the malignant potential of LR TAMs. Activation of Nrf2 signaling by LR HCC cell-derived exosomal miR-301a-3p skewed the transformation of macrophages to the M2 phenotype.
Conclusion
Our study provides new findings on the role of miR-301a-3p, suggesting it is a promising therapeutic target to improve HCC lenvatinib resistance.
{"title":"Lenvatinib-resistant hepatocellular carcinoma promotes malignant potential of tumor-associated macrophages via exosomal miR-301a-3p","authors":"Yuhei Waki, Yuji Morine, Yu Saito, Hiroki Teraoku, Shinichiro Yamada, Tetsuya Ikemoto, Tatsuya Tominaga, Mitsuo Shimada","doi":"10.1002/ags3.12814","DOIUrl":"10.1002/ags3.12814","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The interactions between cancer cells and tumor-associated macrophages (TAMs) via microRNAs (miRNAs) play crucial roles in malignant potential and drug resistance. However, it remains unclear how lenvatinib-resistant hepatocellular carcinoma (LR HCC) promotes TAM tumor biology. Here we investigated the crosstalk between LR HCC cells and TAMs for cancer progression and lenvatinib resistance, focusing on an exosomal miRNA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used two bioinformatics software programs to identify miRNAs that target PTEN in gastrointestinal cancers, then investigated exosomal miRNA expression in LR HCC conditioned medium (CM). After modifying TAMs with LR HCC CM (LR TAM), macrophage phenotype and PTEN-Nrf2 signaling pathway component expression were analyzed in LR TAMs. The malignant potential and drug resistance were investigated in naïve HCC cells cultured with LR TAM CM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LR HCC cells highly induced M2-like properties in macrophages compared with naïve HCC cells. Exosomal miR-301a-3p expression was increased in LR HCC CM, with higher activation of the PTEN/PI3K/GSK3β/Nrf2 signaling pathway in LR TAMs. Naïve HCC cells were educated with LR TAM CM to promote malignant potential and lenvatinib resistance. Inhibition of exosomal miR-301a-3p prevented the malignant potential of LR TAMs. Activation of Nrf2 signaling by LR HCC cell-derived exosomal miR-301a-3p skewed the transformation of macrophages to the M2 phenotype.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study provides new findings on the role of miR-301a-3p, suggesting it is a promising therapeutic target to improve HCC lenvatinib resistance.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 6","pages":"1084-1095"},"PeriodicalIF":2.9,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12814","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140983821","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}
This study aimed to investigate the regional disparities in gastric cancer surgery in Japan.
Methods
The annual incidence of gastric cancer and number of gastrectomies, board-certified surgeons in gastroenterology by the Japanese Society of Gastroenterological Surgery, and board-certified surgeons by the Japan Society for Endoscopic Surgery were evaluated by prefecture in Japan during 2014–2019. Medium-sized regional disparities were assessed using the Gini coefficient. Gastrectomies were further broken down by site (distal; proximal; total) and approach (open vs laparoscopic). Moreover, we compared the urban and rural regional disparities in all study variables.
Results
The annual national average incidence of gastric cancer was 127 466 and the number of gastrectomies was 49 128. Gini coefficients for almost all variables, except for board-certified surgeons by the Japan Society of Endoscopic Surgery, were <0.2, indicating low inequality. The incidence of gastric cancer, the number of gastrectomies, and the aging rate were significantly higher in rural prefectures than in urban prefectures.
Conclusion
Inter-prefectural regional disparities in gastric cancer surgery were generally small; however, both the incidence of gastric cancer and number of gastrectomies were higher in rural prefectures, where the aging rate was also increased. This study provides an overview of the landscape of gastric cancer care in Japan.
{"title":"Inter-prefectural regional disparities in gastric cancer surgery: A Japanese nationwide population-based cohort study from 2014 to 2019","authors":"Masamitsu Kido, Katsutoshi Shoda, Luying Yan, Kazuya Ikoma, Daisuke Ichikawa","doi":"10.1002/ags3.12813","DOIUrl":"10.1002/ags3.12813","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to investigate the regional disparities in gastric cancer surgery in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The annual incidence of gastric cancer and number of gastrectomies, board-certified surgeons in gastroenterology by the Japanese Society of Gastroenterological Surgery, and board-certified surgeons by the Japan Society for Endoscopic Surgery were evaluated by prefecture in Japan during 2014–2019. Medium-sized regional disparities were assessed using the Gini coefficient. Gastrectomies were further broken down by site (distal; proximal; total) and approach (open vs laparoscopic). Moreover, we compared the urban and rural regional disparities in all study variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The annual national average incidence of gastric cancer was 127 466 and the number of gastrectomies was 49 128. Gini coefficients for almost all variables, except for board-certified surgeons by the Japan Society of Endoscopic Surgery, were <0.2, indicating low inequality. The incidence of gastric cancer, the number of gastrectomies, and the aging rate were significantly higher in rural prefectures than in urban prefectures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Inter-prefectural regional disparities in gastric cancer surgery were generally small; however, both the incidence of gastric cancer and number of gastrectomies were higher in rural prefectures, where the aging rate was also increased. This study provides an overview of the landscape of gastric cancer care in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 6","pages":"1017-1025"},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12813","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141029742","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}
Due to the coronavirus disease 2019 (COVID-19) pandemic, cancer screening, diagnosis, and treatment have changed. This study aimed to investigate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prior to gastroenterological cancer surgeries on postoperative complications using data from a nationwide database in Japan.
Methods
Data on patients who underwent surgery for cancer including esophageal, gastric, colon, rectal, liver, and pancreatic cancer between July 1, 2019, and September 300, 2022, from real-world sources in Japan were analyzed. The association between preoperative SARS-CoV-2 infection and short-term postoperative outcomes was evaluated. A similar analysis stratified according to the interval from SARS-CoV-2 infection to surgery (<4 vs. >4 weeks) was conducted.
Results
In total, 60 604 patients were analyzed, and 227 (0.4%) patients were diagnosed with SARS-CoV-2 infection preoperatively. The median interval from SARS-CoV-2 infection to surgery was 25 days. Patients diagnosed with SARS-CoV-2 infection preoperatively had a significantly higher incidence of pneumonia (odds ratio: 2.05; 95% confidence interval: 1.05–3.74; p = 0.036) than those not diagnosed with SARS-CoV-2 infection based on the exact logistic regression analysis adjusted for the characteristics of the patients. A similar finding was observed in patients who had SARS-CoV-2 infection <4 weeks before surgery.
Conclusions
Patients with a history of SARS-CoV-2 infection had a significantly higher incidence of pneumonia. This finding can be particularly valuable for countries that have implemented strict regulations in response to the COVID-19 pandemic and have lower SARS-CoV-2 infection-related mortality rates.
{"title":"Impact of SARS-CoV-2 infection on short-term postoperative outcomes after gastroenterological cancer surgery using data from a nationwide database in Japan","authors":"Masashi Takeuchi, Taizo Hibi, Ryo Seishima, Yusuke Takemura, Hiromichi Maeda, Genta Toshima, Noriyuki Ishida, Naoki Miyazaki, Akinobu Taketomi, Yoshihiro Kakeji, Yasuyuki Seto, Hideki Ueno, Masaki Mori, Ken Shirabe, Yuko Kitagawa","doi":"10.1002/ags3.12812","DOIUrl":"10.1002/ags3.12812","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Due to the coronavirus disease 2019 (COVID-19) pandemic, cancer screening, diagnosis, and treatment have changed. This study aimed to investigate the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prior to gastroenterological cancer surgeries on postoperative complications using data from a nationwide database in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data on patients who underwent surgery for cancer including esophageal, gastric, colon, rectal, liver, and pancreatic cancer between July 1, 2019, and September 300, 2022, from real-world sources in Japan were analyzed. The association between preoperative SARS-CoV-2 infection and short-term postoperative outcomes was evaluated. A similar analysis stratified according to the interval from SARS-CoV-2 infection to surgery (<4 vs. >4 weeks) was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 60 604 patients were analyzed, and 227 (0.4%) patients were diagnosed with SARS-CoV-2 infection preoperatively. The median interval from SARS-CoV-2 infection to surgery was 25 days. Patients diagnosed with SARS-CoV-2 infection preoperatively had a significantly higher incidence of pneumonia (odds ratio: 2.05; 95% confidence interval: 1.05–3.74; <i>p</i> = 0.036) than those not diagnosed with SARS-CoV-2 infection based on the exact logistic regression analysis adjusted for the characteristics of the patients. A similar finding was observed in patients who had SARS-CoV-2 infection <4 weeks before surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with a history of SARS-CoV-2 infection had a significantly higher incidence of pneumonia. This finding can be particularly valuable for countries that have implemented strict regulations in response to the COVID-19 pandemic and have lower SARS-CoV-2 infection-related mortality rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 5","pages":"942-951"},"PeriodicalIF":2.9,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ags3.12812","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141054193","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}
Little information is available from prospective clinical trials on the influences of surgical approaches on postoperative quality of life (QOL). We aimed to prospectively compare chronological changes in postoperative body weight and QOL between laparoscopic and open total gastrectomy for stage I gastric cancer (GC).
Methods
We conducted a multi-institutional prospective study (CCOG1504) of patients who undergo laparoscopic or open total gastrectomy. Body weight was measured at the baseline and at the 1st, 2nd, and 3rd postoperative years (POY). QOL using the European Organization for Research and Treatment of Cancer quality of life questionnaire-C30 (EORTC QLQ-C30) and the Post-Gastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaires were measured at the baseline and at the 1st, 3rd, 6th, 12th, and 36th postoperative months (POM).
Results
We enrolled 84 patients from 15 institutions, and finally 43 patients for the laparoscopic group and 16 for the open group were eligible for data analysis. There were no significant differences in body weight change between the two groups. The role functioning score among the EORTC QLQ-C30 tended to be higher (i.e., better QOL) in the laparoscopic group at POM 1 and 12 after surgery compared to the open group. The dissatisfaction at working score among the PGSAS-37 at 1 month after surgery was lower (i.e. better QOL) in the laparoscopic group compared to the open group.
Conclusions
The results of CCOG1504 indicated that laparoscopic approach for total gastrectomy was associated with a more favorable dissatisfaction at working score (PGSAS-37).
{"title":"Long-term quality of life after open and laparoscopic total gastrectomy for stage I gastric cancer: A prospective multi-institutional study (CCOG1504)","authors":"Chie Tanaka, Mitsuro Kanda, Kazunari Misawa, Yoshinari Mochizuki, Masashi Hattori, Satoshi Sueoka, Takuya Watanabe, Takanobu Yamada, Kenta Murotani, Yasuhiro Kodera","doi":"10.1002/ags3.12808","DOIUrl":"10.1002/ags3.12808","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Little information is available from prospective clinical trials on the influences of surgical approaches on postoperative quality of life (QOL). We aimed to prospectively compare chronological changes in postoperative body weight and QOL between laparoscopic and open total gastrectomy for stage I gastric cancer (GC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a multi-institutional prospective study (CCOG1504) of patients who undergo laparoscopic or open total gastrectomy. Body weight was measured at the baseline and at the 1st, 2nd, and 3rd postoperative years (POY). QOL using the European Organization for Research and Treatment of Cancer quality of life questionnaire-C30 <b>(</b>EORTC QLQ-C30) and the Post-Gastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaires were measured at the baseline and at the 1st, 3rd, 6th, 12th, and 36th postoperative months (POM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 84 patients from 15 institutions, and finally 43 patients for the laparoscopic group and 16 for the open group were eligible for data analysis. There were no significant differences in body weight change between the two groups. The role functioning score among the EORTC QLQ-C30 tended to be higher (i.e., better QOL) in the laparoscopic group at POM 1 and 12 after surgery compared to the open group. The dissatisfaction at working score among the PGSAS-37 at 1 month after surgery was lower (i.e. better QOL) in the laparoscopic group compared to the open group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results of CCOG1504 indicated that laparoscopic approach for total gastrectomy was associated with a more favorable dissatisfaction at working score (PGSAS-37).</p>\u0000 </section>\u0000 </div>","PeriodicalId":8030,"journal":{"name":"Annals of Gastroenterological Surgery","volume":"8 6","pages":"999-1007"},"PeriodicalIF":2.9,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142581067","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}
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