Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2024.04.011
{"title":"Why do residents not choose General Surgery or surgical specialties?","authors":"","doi":"10.1016/j.cireng.2024.04.011","DOIUrl":"10.1016/j.cireng.2024.04.011","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141034053","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}
Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2024.04.010
In recent years, prehabilitation has generated high expectations as an innovative preoperative strategy to enhance clinical outcomes following surgery. Several studies have demonstrated that multimodal programs are effective in improving patients’ health status and cardiopulmonary reserve, allowing them to undergo surgery in better conditions and, consequently, reducing the incidence of postoperative complications.
Most publications describe proof-of-concept studies, and literature about their implementation is more limited. The implementation of these programs requires new resources and significant organizational effort.
In this paper, we share our experience implementing a multimodal prehabilitation program as a mainstream service at a tertiary hospital. Although there are still many unknowns regarding the optimal selection of patients, as well as the duration and components of the program, this article describes our journey in this field, aiming to provide insight for teams interested in developing a similar project.
{"title":"10 years of prehabilitation: From theory to clinical practice","authors":"","doi":"10.1016/j.cireng.2024.04.010","DOIUrl":"10.1016/j.cireng.2024.04.010","url":null,"abstract":"<div><p>In recent years, prehabilitation has generated high expectations as an innovative preoperative strategy to enhance clinical outcomes following surgery. Several studies have demonstrated that multimodal programs are effective in improving patients’ health status and cardiopulmonary reserve, allowing them to undergo surgery in better conditions and, consequently, reducing the incidence of postoperative complications.</p><p>Most publications describe proof-of-concept studies, and literature about their implementation is more limited. The implementation of these programs requires new resources and significant organizational effort.</p><p>In this paper, we share our experience implementing a multimodal prehabilitation program as a mainstream service at a tertiary hospital. Although there are still many unknowns regarding the optimal selection of patients, as well as the duration and components of the program, this article describes our journey in this field, aiming to provide insight for teams interested in developing a similar project.</p></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140893033","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}
Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2024.02.011
{"title":"A rare cause of acute abdominal pain: Perforation of a hepatic hydatid cyst into the peritoneum","authors":"","doi":"10.1016/j.cireng.2024.02.011","DOIUrl":"10.1016/j.cireng.2024.02.011","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140760845","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}
Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2024.05.015
Introduction
Peritoneal sarcomatosis is a rare disease, with multiple histological origins and poor overall prognosis. The option of radical cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The results of a surgical team experienced in these procedures are analyzed and discussed based on the available evidence.
Methods
Study on a prospective database of patients with peritoneal sarcomatosis who underwent CRS and HIPEC, from 2016 to 2022, in a national reference center for sarcomas and peritoneal oncological surgery, who met the established inclusion/exclusion criteria.
Results
23 patients were included in the study, with a median age of 53 years (6−68). Recurrent/persistent clinical presentation predominated (78.3%). Visceral origin (including GIST and non-GIST peritoneal) accounted for 47.8% of patients, compared to 43.5% uterine and 8.7% retroperitoneal. The median PCI was 17 (3−36), with CC0 cytoreduction of 87%. Postoperative morbidity (Dindo Clavien III–IV) of 13%, with no postoperative mortality in the series. Overall survival and disease-free survival at 5 years were 64% and 34%, respectively. Histological grade was the most influential prognostic factor for survival.
Conclusions
The results of the series, with low morbidity, support the benefit of radical peritoneal oncological surgery in patients with peritoneal sarcomatosis after adequate selection, as long as it is performed in high-volume centers, experienced surgeons and expert multidisciplinary teams. However, the role of HIPEC remains to be demonstrated and pending future studies.
{"title":"Radical cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal sarcomatosis: Results from a reference center and considerations based on current evidence","authors":"","doi":"10.1016/j.cireng.2024.05.015","DOIUrl":"10.1016/j.cireng.2024.05.015","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Peritoneal sarcomatosis is a rare disease, with multiple histological origins and poor overall prognosis. The option of radical cytoreductive surgery (CRS) with </span>hyperthermic intraperitoneal chemotherapy (HIPEC) is controversial. The results of a surgical team experienced in these procedures are analyzed and discussed based on the available evidence.</p></div><div><h3>Methods</h3><p>Study on a prospective database of patients with peritoneal sarcomatosis who underwent CRS and HIPEC, from 2016 to 2022, in a national reference center for sarcomas and peritoneal oncological surgery, who met the established inclusion/exclusion criteria.</p></div><div><h3>Results</h3><p><span><span>23 patients were included in the study, with a median age of 53 years (6−68). Recurrent/persistent clinical presentation predominated (78.3%). Visceral origin (including GIST and non-GIST peritoneal) accounted for 47.8% of patients, compared to 43.5% uterine and 8.7% retroperitoneal. The median PCI was 17 (3−36), with CC0 cytoreduction of 87%. Postoperative morbidity (Dindo Clavien III–IV) of 13%, with no </span>postoperative mortality in the series. Overall survival and disease-free survival at 5 years were 64% and 34%, respectively. Histological grade was the most influential </span>prognostic factor for survival.</p></div><div><h3>Conclusions</h3><p>The results of the series, with low morbidity, support the benefit of radical peritoneal oncological surgery in patients with peritoneal sarcomatosis after adequate selection, as long as it is performed in high-volume centers, experienced surgeons and expert multidisciplinary teams. However, the role of HIPEC remains to be demonstrated and pending future studies.</p></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141441249","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}
Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2024.05.001
Introduction
It is currently unknown which data sources from the clinical history, or combination thereof, should be evaluated to achieve the most complete calculation of postoperative complications (PC).
The objectives of this study were: to analyze the morbidity and mortality of 200 consecutive patients undergoing major surgery, to determine which data sources or combination collect the maximum morbidity, and to determine the accuracy of the morbidity reflected in the discharge report.
Methods
Observational and prospective cohort study.
The sum of all PC found in the combined review of medical notes, nursing notes, and a specific form was considered the gold standard. PC were classified according to the Clavien Dindo Classification and the Comprehensive Complication Index (CCI).
Results
The percentage of patients who presented PC according to the gold standard, medical notes, nursing notes and form were: 43.5%, 37.5%, 35% and 18.7% respectively.
The combination of sources improved CCI agreement by 8%–40% in the overall series and 39.1–89.7 % in patients with PC. The correct recording of PC was inversely proportional to the complexity of the surgery, and the combination of sources increased the degree of agreement with the gold standard by 35 %–67.5% in operations of greater complexity.
The CDC and CCI of the discharge report coincided with the gold-standard values in patients with PC by 46.8% and 18.2%, respectively.
Conclusions
The combination of data sources, particularly medical and nursing notes, considerably increases the quantification of PC in general, most notably in complex interventions.
导言:目前尚不清楚应评估临床病史中的哪些数据源或其组合,以实现最完整的术后并发症(PC)计算。本研究的目的是:分析连续接受大手术的 200 名患者的发病率和死亡率,确定哪些数据源或数据源组合收集的发病率最高,并确定出院报告中反映的发病率的准确性:方法:观察性和前瞻性队列研究。方法:观察性和前瞻性队列研究,将综合审查医疗记录、护理记录和特定表格中发现的所有 PC 的总和作为金标准。PC根据克拉维恩-丁多分类法和综合并发症指数(CCI)进行分类:根据金标准、医疗记录、护理记录和表格,出现 PC 的患者比例分别为:43.5%、37.5%、37.5%、43.5%、37.5%、37.5%:分别为 43.5%、37.5%、35% 和 18.7%。在整个系列中,综合使用各种来源的数据可将 CCI 的一致性提高 8%-40%,在 PC 患者中的一致性提高 39.1%-89.7%。PC 的正确记录与手术的复杂程度成反比,在复杂程度较高的手术中,联合使用数据源可将与金标准的一致性提高 35%-67.5%。出院报告中的CDC和CCI与PC患者黄金标准值的吻合度分别为46.8%和18.2%:结论:结合数据源,尤其是医疗和护理记录,可大大提高 PC 的量化程度,尤其是在复杂的介入手术中。
{"title":"Comparison and combination of three data sources from patient medical records to determine optimal quantification of postoperative morbidity according to the Clavien Dindo Classification and the Comprehensive Complication Index. A prospective study","authors":"","doi":"10.1016/j.cireng.2024.05.001","DOIUrl":"10.1016/j.cireng.2024.05.001","url":null,"abstract":"<div><h3>Introduction</h3><p>It is currently unknown which data sources from the clinical history, or combination thereof, should be evaluated to achieve the most complete calculation of postoperative complications (PC).</p><p>The objectives of this study were: to analyze the morbidity and mortality of 200 consecutive patients undergoing major surgery, to determine which data sources or combination collect the maximum morbidity, and to determine the accuracy of the morbidity reflected in the discharge report.</p></div><div><h3>Methods</h3><p>Observational and prospective cohort study.</p><p>The sum of all PC found in the combined review of medical notes, nursing notes, and a specific form was considered the gold standard. PC were classified according to the Clavien Dindo Classification and the Comprehensive Complication Index (CCI).</p></div><div><h3>Results</h3><p>The percentage of patients who presented PC according to the gold standard, medical notes, nursing notes and form were: 43.5%, 37.5%, 35% and 18.7% respectively.</p><p>The combination of sources improved CCI agreement by 8%–40% in the overall series and 39.1–89.7 % in patients with PC. The correct recording of PC was inversely proportional to the complexity of the surgery, and the combination of sources increased the degree of agreement with the gold standard by 35 %–67.5% in operations of greater complexity.</p><p>The CDC and CCI of the discharge report coincided with the gold-standard values in patients with PC by 46.8% and 18.2%, respectively.</p></div><div><h3>Conclusions</h3><p>The combination of data sources, particularly medical and nursing notes, considerably increases the quantification of PC in general, most notably in complex interventions.</p></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856254","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}
Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2024.05.008
{"title":"Intermittent gastroesophageal prolapse after a Nissen funduplication treated with Hill gastropexy","authors":"","doi":"10.1016/j.cireng.2024.05.008","DOIUrl":"10.1016/j.cireng.2024.05.008","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199926","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}
Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2023.08.006
Introduction
Every year hundreds of medical residents choose their specialization in various surgical fields. However, these numbers have been poorly analyzed. The objective of this study was to evaluate the selection of General and Digestive Surgery by medical residents and compare these results with the selection of other surgical specialties.
Methods
Cross-sectional observational study. The data from the selection of the medical residents from surgical specialties and the top 10 most demanded specialties between the years 2018 and 2022 were included. An analysis of adjusted ranking numbers based on the number of available positions was also conducted.
Results
The number of available positions in General and Digestive Surgery increased by 17.7% during the study period. However, the selection of our specialty has been delayed, with a median ranking number of 2419 (IQR: 1621–3284) in 2018, and 3484 (IQR: 2306–4156) in 2022 (p: .000). These differences remained significant after adjusting for the number of available positions (p: .000).
The choice of Urology, Thoracic Surgery, Cardiovascular Surgery, Gastroenterology, and Paediatrics also declined during this period, while Plastic Surgery, Dermatology, Ophthalmology, Anesthesiology, and Endocrinology improved their numbers.
Conclusion
The choice of General and Digestive Surgery has been delayed according to the data from the MIR selection of 2018–2022. The increase in the number of available positions has not been associated with a proportional increase in demand.
{"title":"Delay in the residents’ choice for General and Digestive Surgery: Analysis of the period 2018–2022","authors":"","doi":"10.1016/j.cireng.2023.08.006","DOIUrl":"10.1016/j.cireng.2023.08.006","url":null,"abstract":"<div><h3>Introduction</h3><p>Every year hundreds of medical residents choose their specialization in various surgical fields. However, these numbers have been poorly analyzed. The objective of this study was to evaluate the selection of General and Digestive Surgery by medical residents and compare these results with the selection of other surgical specialties.</p></div><div><h3>Methods</h3><p>Cross-sectional observational study. The data from the selection of the medical residents from surgical specialties and the top 10 most demanded specialties between the years 2018 and 2022 were included. An analysis of adjusted ranking numbers based on the number of available positions was also conducted.</p></div><div><h3>Results</h3><p>The number of available positions in General and Digestive Surgery increased by 17.7% during the study period. However, the selection of our specialty has been delayed, with a median ranking number of 2419 (IQR: 1621–3284) in 2018, and 3484 (IQR: 2306–4156) in 2022 (<em>p</em>: .000). These differences remained significant after adjusting for the number of available positions (<em>p</em>: .000).</p><p><span>The choice of Urology<span><span>, Thoracic Surgery<span>, Cardiovascular Surgery, </span></span>Gastroenterology, and </span></span>Paediatrics<span><span> also declined during this period, while Plastic Surgery, Dermatology, </span>Ophthalmology<span>, Anesthesiology<span>, and Endocrinology improved their numbers.</span></span></span></p></div><div><h3>Conclusion</h3><p>The choice of General and Digestive Surgery has been delayed according to the data from the MIR selection of 2018–2022. The increase in the number of available positions has not been associated with a proportional increase in demand.</p></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138296797","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}
Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2024.01.008
Introduction
The objective of the study is to compare 2 techniques for histological handling of rectal cancer specimens, namely whole-mount in a large block vs conventional sampling using small blocks, for mesorectal pathological assessment of circumferential resection margin status and depth of tumor invasion into the mesorectal fat.
Methods
This is a prospective study including 27 total mesorectal excision specimens of rectal cancer from patients treated for primary rectal carcinoma between 2020 and 2022 in a specialized multidisciplinary Colorectal Unit. For each total mesorectal excision specimen, 2 contiguous representative tumoral slices were selected and comparatively analyzed with whole-mount and small blocks macroscopic dissection techniques, enabling comparison between them in the same surgical specimen. The agreement between the 2 techniques to assess the distance of the tumor from the circumferential resection margin as well as the depth of tumor invasion was evaluated with the Student’s t-test for paired samples, Pearson’s correlation coefficient, and the Bland-Altman method comparison analysis.
Results
Complete mesorectal excision was observed in 8% of cases. Circumferential resection margin involvement was observed in only one case (4 %). The whole-mount and small block techniques obtained similar results when we assessed the distance to the circumferential resection margin (t-test P = 0.8, r = 0.92) and the depth of mesorectal infiltration (t-test P = 0.6, r = 0.95).
Conclusions
Both gross dissection techniques (whole-mount vs multiple small cassettes) are equivalent and reliable to assess the distance to circumferential resection margin and the depth of mesorectal infiltration in the mesorectal fat in rectal cancer staging.
简介该研究的目的是比较两种直肠癌标本组织学处理技术(即大块全切与传统的小块取样),以对直肠间质切除边缘状态和肿瘤侵犯直肠间质脂肪的深度进行病理评估:这是一项前瞻性研究,包括 27 份直肠癌直肠间质全切除标本,这些标本来自 2020 年至 2022 年期间在结直肠专科多学科病房接受治疗的原发性直肠癌患者。在每份直肠直肠间全切标本中,选择 2 个连续的有代表性的肿瘤切片,采用全切片和小块宏观解剖技术进行比较分析,以便在同一手术标本中进行比较。通过配对样本的学生 t 检验、皮尔逊相关系数和 Bland-Altman 方法对比分析,评估了两种技术在评估肿瘤与周缘切除边缘的距离以及肿瘤侵犯深度方面的一致性:结果:8%的病例可观察到完整的直肠系膜切除。仅有一例(4%)观察到环形切除边缘受累。当我们评估与周缘切除边缘的距离(t 检验 P = .8,r=0.92)和直肠系膜浸润深度(t 检验 P = .6,r=0.95)时,全层解剖技术和小块解剖技术获得了相似的结果:结论:在直肠癌分期中,两种大体解剖技术(整块解剖与多块小盒解剖)在评估直肠癌周缘切除边缘距离和直肠系膜脂肪浸润深度方面是等效和可靠的。
{"title":"A comparison of whole-mount and conventional sections for pathological mesorectal extension and circumferential resection margin assessment after total mesorectal excision","authors":"","doi":"10.1016/j.cireng.2024.01.008","DOIUrl":"10.1016/j.cireng.2024.01.008","url":null,"abstract":"<div><h3>Introduction</h3><p>The objective of the study is to compare 2 techniques for histological handling of rectal cancer specimens, namely whole-mount in a large block vs conventional sampling using small blocks, for mesorectal pathological assessment of circumferential resection margin status and depth of tumor invasion into the mesorectal fat.</p></div><div><h3>Methods</h3><p>This is a prospective study including 27 total mesorectal excision specimens of rectal cancer from patients treated for primary rectal carcinoma between 2020 and 2022 in a specialized multidisciplinary Colorectal Unit. For each total mesorectal excision specimen, 2 contiguous representative tumoral slices were selected and comparatively analyzed with whole-mount and small blocks macroscopic dissection techniques, enabling comparison between them in the same surgical specimen. The agreement between the 2 techniques to assess the distance of the tumor from the circumferential resection margin as well as the depth of tumor invasion was evaluated with the Student’s <em>t</em>-test for paired samples, Pearson’s correlation coefficient, and the Bland-Altman method comparison analysis.</p></div><div><h3>Results</h3><p>Complete mesorectal excision was observed in 8% of cases. Circumferential resection margin involvement was observed in only one case (4 %). The whole-mount and small block techniques obtained similar results when we assessed the distance to the circumferential resection margin (<em>t</em>-test <em>P</em> = 0.8, <em>r</em> = 0.92) and the depth of mesorectal infiltration (<em>t</em>-test <em>P</em> = 0.6, <em>r</em> = 0.95).</p></div><div><h3>Conclusions</h3><p>Both gross dissection techniques (whole-mount vs multiple small cassettes) are equivalent and reliable to assess the distance to circumferential resection margin and the depth of mesorectal infiltration in the mesorectal fat in rectal cancer staging.</p></div>","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2173507724000498/pdfft?md5=f41bccc446f3a1db19922647d908ae8a&pid=1-s2.0-S2173507724000498-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139907065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/j.cireng.2024.03.003
{"title":"Tools and resources for conducting systematic reviews and meta-analyses","authors":"","doi":"10.1016/j.cireng.2024.03.003","DOIUrl":"10.1016/j.cireng.2024.03.003","url":null,"abstract":"","PeriodicalId":93935,"journal":{"name":"Cirugia espanola","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140717073","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}