Journal of Liver Transplantation最新文献

{"title":"The impact of donor anemia on post-liver transplant outcomes: A stratified analysis by cold ischemia time","authors":"David Uihwan Lee ,&nbsp;Mohammed Rifat Shaik ,&nbsp;Kuntal Bhowmick ,&nbsp;Youngjae Cha ,&nbsp;Ki Jung Lee ,&nbsp;Nishat Anjum Shaik ,&nbsp;Gregory Hongyuan Fan ,&nbsp;Miranda Tsang ,&nbsp;Eddie Kwon ,&nbsp;Hannah Chou ,&nbsp;Harrison Chou ,&nbsp;Raza Malik","doi":"10.1016/j.liver.2025.100270","DOIUrl":"10.1016/j.liver.2025.100270","url":null,"abstract":"<div><h3>Background &amp; Aims</h3><div>Cold ischemia time (CIT) has long been correlated with liver transplant (LT) graft viability. Donor anemia, leading to suboptimal oxygen delivery to the liver, may theoretically worsen the ischemia-reperfusion injury associated with CIT. In this study, we stratify CIT by tertiles and investigate the potential relationship between donor anemia, CIT, and LT-recipient prognosis by varying donor hematocrit (Hct) thresholds.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing (UNOS) Standard Transplant Analysis and Research (STAR) Database was used to study LT patients between 2005 and 2019. Patients were categorized into tertiles by donor Hct thresholds of &lt; 27.6, 27.6-32.3, and &gt; 32.3, and compared amongst all CIT and set thresholds. Primary outcomes assessed were all-cause mortality and graft failure.</div></div><div><h3>Results</h3><div>All study results are reported in comparison to LT recipients with donor Hct below 27.6. In the composite population encompassing all CIT thresholds, LT recipients experienced higher all-cause mortality (aHR 1.04; 95% CI 1.00-1.08, p=0.05), as well as graft failure (aHR 1.10; 95% CI 1.01-1.20, p=0.02) with donor Hct above 32.3. There were no significant differences in primary outcomes within the first CIT tertile. Recipients within the 2nd CIT tertile experienced higher rates of graft failure with Hct above 32.3 (aHR 1.17; 95% CI 1.01-1.37, p=0.04). Higher all-cause mortality was observed in recipients with donor Hct above 32.3 (aHR 1.07; 95% CI 1.00-1.14, p=0.04) within the 3rd tertile of CIT.</div></div><div><h3>Conclusion</h3><div>Normal donor Hct and mild donor anemia were associated with worse LT-recipient outcomes when compared to moderate-to-severe donor anemia. This may potentially represent a local adaptation in the donor graft from chronic anemia or a multifactorial, organization-based process. These associations warrant further investigation.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100270"},"PeriodicalIF":0.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776722","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}

{"title":"Dual hypothermic oxygenated machine perfusion (DHOPE) improves extended allocation graft function in liver transplantation","authors":"J Arend,&nbsp;A Bollensdorf,&nbsp;F Stelter,&nbsp;M Rahimli,&nbsp;RS Croner,&nbsp;M Franz","doi":"10.1016/j.liver.2025.100271","DOIUrl":"10.1016/j.liver.2025.100271","url":null,"abstract":"<div><h3>Background</h3><div>Patients with end-stage liver disease or liver tumours can only be treated curatively with liver transplantation (LTx). The glaring organ shortage and the increasing allocation of marginal donor organs is an international challenge. These organs can be accepted and transplanted with good results through preconditioning using machine perfusion (MP). This makes it possible to shorten the waiting list time and thus reduce the dropout rate from the waiting list, especially for patients with hepatocellular carcinoma.</div></div><div><h3>Materials and Methods</h3><div>The Magdeburg Liver Surgery Register/ Study was screened for the last 132 liver transplant patients. Of these, 18 were transplanted with Dual Hypothermic Oxygenated Machine (DHOPE) perfusion and 114 without (non-MP). Recipient demographic, perioperative and follow-up data were retrospectively collected and analysed. Donor data and risk factors were evaluated.</div></div><div><h3>Results</h3><div>The mean recipient age with DHOPE was 57.4 years vs. non-MP 55.9 years. The mean donor age was higher in the DHOPE Group (64.5 vs. 58.3 years, <em>p</em> = 0.073). The mean DHOPE time was 371.0 (57–945) minutes. The DHOPE reduced the cold ischemic time significant (7.1 vs. 8.4 h, <em>p</em> = 0.010). The Donor Risk Index was higher with DHOPE (1.903 vs. 1.889, <em>p</em> = 0.869). The rate of <em>Re</em>-LTx was 0 % vs 7.0 % with and without DHOPE (<em>p</em> = 0.299). The rate of EAD and primary non-function DHOPE vs. non-MP was 23.5 % vs. 27.8 % (<em>p</em> = 0.485) and 0.0 % vs. 5.3 % (<em>p</em> = 0.427). DHOPE significantly increased the rate of extended or rescue allocation from 26.3 % to 61.1 % (<em>p</em> = 0.003). With DHOPE, the donor age was higher (64.5 vs. 58.3 years, <em>p</em> = 0.0.073). The postoperative ICU time was significantly shorter after DHOPE (7.2 vs. 13.6 days, <em>p</em> = 0.044). The hospitalisation time after LTx was not significant, but it tended to be shorter at 28.7 vs 39.3 days (<em>p</em> = 0.097). The 1-year survival rate with and without DHOPE was 88,9 % vs. 80,3 % (<em>p</em> = 0593).</div></div><div><h3>Conclusion</h3><div>The increasing proportion of marginal donor organs requires optimisation of organ reconditioning, as is possible with Dual Hypothermic Oxygenated Machine Perfusion. Reduction of reperfusion damage leads to better postoperative graft function and thus faster convalescence. As the data show, marginal organs can be transplanted safely and with a good result using DHOPE.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100271"},"PeriodicalIF":0.0,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747777","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}

{"title":"The role of recipient sex in the post-liver transplant prognosis of acute-on-chronic liver failure","authors":"David Uihwan Lee ,&nbsp;Mohammed Rifat Shaik ,&nbsp;Sharmitha Yerneni ,&nbsp;Ashton Harmacinski ,&nbsp;Nishat Anjum Shaik ,&nbsp;Katie Evey ,&nbsp;Kuntal Bhowmick ,&nbsp;Zainab Mujahid ,&nbsp;Youngjae Cha ,&nbsp;Hannah Chou ,&nbsp;Andrew Yi ,&nbsp;Kijung Lee ,&nbsp;Gregory Hongyuan Fan ,&nbsp;Raza Malik","doi":"10.1016/j.liver.2025.100267","DOIUrl":"10.1016/j.liver.2025.100267","url":null,"abstract":"<div><h3>Background &amp; aims</h3><div>Limited data exists on the impact of recipient sex on the post-liver transplant (LT) outcomes in patients with acute-on-chronic liver failure (ACLF). This study aims to utilize a national transplant registry to evaluate the relationship between recipient sex and post-transplant outcomes, stratified by ACLF severity.</div></div><div><h3>Methods</h3><div>The United Network for Organ Sharing Standard Transplant Analysis and Research (UNOS-STAR) database was queried to collect health information on 47,447 patients who underwent liver transplantation between 1987 and 2019. The cohort was stratified by biological sex, and further subdivided into groups based on ACLF severity: Grade 0 (without ACLF) and Grade 1–3 in increasing severity. The primary outcomes assessed were all-cause mortality and graft failure while secondary outcomes included specific causes of death.</div></div><div><h3>Results</h3><div>No sex-based disparities were observed in the primary outcomes of all-cause mortality and graft failure across all grades of ACLF. However, females without ACLF exhibited a higher risk of mortality from recurrent graft disease compared to males. Time-point analyses revealed higher 180-day and 360-day mortality rates in females without ACLF. Among patients with ACLF Grade 1, females demonstrated higher 30-day mortality, but no significant differences were found at 90-, 180- or 360-days. Among patients with ACLF Grades 2 and 3, however, no sex-based differences in 30-day to 360-day mortality were identified.</div></div><div><h3>Conclusion</h3><div>Factors other than sex appear to play a more critical role in determining the long-term transplant outcomes in ACLF. The increased short-term mortality observed in females with ACLF grade 1 warrants further investigation to elucidate potential contributing factors.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100267"},"PeriodicalIF":0.0,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738369","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}

{"title":"De novo shrimp allergy in an adult liver transplant recipient","authors":"Jaimie Chang,&nbsp;Aryanna Sousa,&nbsp;Steven Flamm,&nbsp;Lloyd Brown,&nbsp;Edie Chan,&nbsp;Nathalie Sela","doi":"10.1016/j.liver.2025.100269","DOIUrl":"10.1016/j.liver.2025.100269","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100269"},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143686988","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}

{"title":"Preliminary experience in anesthetic management of patients undergoing auxiliary liver transplant according to the RAPID procedure","authors":"Marie-Hélène Lagios ,&nbsp;Audrey Dieu ,&nbsp;Loïc Benoit ,&nbsp;Arnaud Steyaert ,&nbsp;Virginie Montiel ,&nbsp;Aude Vanbuggenhout ,&nbsp;Lancelot Marique ,&nbsp;Laurent Coubeau","doi":"10.1016/j.liver.2025.100268","DOIUrl":"10.1016/j.liver.2025.100268","url":null,"abstract":"<div><h3>Background</h3><div>RAPID (Resection And Partial Liver Transplantation With Delayed Total Hepatectomy) is a novel two-stage surgical procedure, with only 23 reported cases, involving partial liver resection and transplantation of a left lobe (stage 1) followed by a delayed total hepatectomy (stage 2). The perioperative anesthetic management of these recipients presents unique challenges and has never been described so far.</div></div><div><h3>Materials and methods</h3><div>We report on ten patients with unresectable liver metastases who underwent this procedure from a living donor in our center between May 2020 and April 2024. Retrospectively, we collected preoperative, graft-related, and intraoperative management data during stage 1 (S1) and stage 2 (S2), and postoperative outcomes.</div></div><div><h3>Results and discussion</h3><div>Recipients’ median age was 53 (50–57), median graft-to-recipient weight ratio 0.43 % (0.41–0.45), total ischemia time 82 min (75–105). No patients experienced postreperfusion syndrome. Median intensive care unit (ICU) stay was 36 h (27–48) after S1, 24 h (24–48) after S2. Median INR on POD 3 was 1.20 (1.13–1.29) after S1, 1.29 (1.16–1.70) after S2. Complications after S1 included portal thrombosis in one patient, and three required revision surgery. After S2, one patient required revision for hemostasis, and another developed acute kidney injury. This patient died on day 12 from bleeding post-thoracocentesis for pleural effusion. Six-month survival rate was 90 %.</div></div><div><h3>Conclusions</h3><div>These preliminary data, as a first step in developing perioperative management protocols for this innovative surgery, show good hemodynamic tolerance, no postreperfusion syndrome, and preserved liver function throughout the process. These results highlight the RAPID procedure's safety during surgery and postoperative course.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100268"},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143509120","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}

{"title":"Molecular evidence of solitary lung metastasis as the initial recurrence of hepatocellular carcinoma a decade more after liver transplantation","authors":"Cheng-Maw Ho ,&nbsp;Hsao-Hsun Hsu ,&nbsp;Hui-Ling Chen ,&nbsp;Po-Huang Lee ,&nbsp;Rey-Heng Hu","doi":"10.1016/j.liver.2025.100266","DOIUrl":"10.1016/j.liver.2025.100266","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100266"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143465449","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}

{"title":"Tacrolimus-induced psychosis in liver transplant recipients: A systematic review of all published cases","authors":"Pooja Belur ,&nbsp;Komal Dani ,&nbsp;Stephanie H. Cho","doi":"10.1016/j.liver.2025.100265","DOIUrl":"10.1016/j.liver.2025.100265","url":null,"abstract":"<div><h3>Objective</h3><div>This systematic review aims to better characterize the clinical patterns, potential protective and risk factors, prognosis, and management of tacrolimus-induced psychosis in liver transplant recipients.</div></div><div><h3>Method</h3><div>We reviewed all published cases of severe psychiatric complications associated with tacrolimus in liver transplant recipients from 1998 to 2024. In total, 17 case reports, 1 case-control study, 3 retrospective studies, and 2 prospective studies were identified.</div></div><div><h3>Results</h3><div>Tacrolimus-induced psychosis presented with a wide range of symptoms, including tremor, speech difficulties, seizures, delusions, and paranoia. Of the 17 case reports, only 10 documented symptoms aligning with a clinical, DSM-based definition of psychosis. Affected patients varied in age, and a significant proportion had no prior psychiatric history. Symptom onset after tacrolimus initiation varied, though 15 of 17 cases developed psychosis within the first 6 months of treatment. Of these cases, 13 saw resolution of symptoms within one month of stopping tacrolimus. We differentiated cases by a strict, DSM-based definition of psychosis versus a broader categorization. The 10 cases fitting the classic definition showed a higher rate of symptom resolution within the first month.</div></div><div><h3>Conclusion</h3><div>Presentation of tacrolimus-induced psychosis varied considerably across reviewed studies, with rapid resolution upon drug discontinuation in most cases. However, a standardized approach to balancing risks of drug withdrawal against the need for immunosuppression remains absent. This review underscores the need for standardized diagnostic criteria.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100265"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474677","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}

{"title":"Incidental hepatocellular carcinoma in explanted livers: Prevalence, prognosis and features","authors":"Emilie Kerstens ,&nbsp;Samuele Iesari ,&nbsp;Eliano Bonaccorsi ,&nbsp;Laurent Coubeau ,&nbsp;Géraldine Dahlqvist ,&nbsp;Coralie Hamoir ,&nbsp;Olga Ciccarelli ,&nbsp;Bénédicte Delire","doi":"10.1016/j.liver.2025.100264","DOIUrl":"10.1016/j.liver.2025.100264","url":null,"abstract":"<div><h3>Background and aims</h3><div>Incidental hepatocellular carcinoma (iHCC) on cirrhotic liver specimens is not rare. The aim of this study was to evaluate prevalence and outcomes of liver transplant recipients (LTRs) with iHCC. We compared this group to cirrhotic patients who underwent liver transplantation (LT) for previously known hepatocellular carcinoma (pkHCC) or tumor-free end-stage liver disease (ESLD).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 268 cirrhotic patients who underwent LT at our center between 2010 and 2020<em>.</em> Patient selection was made according to the indication for LT and histopathological analyses of surgical specimens (tumor-free ESLD, hepatocellular carcinoma (HCC)). Results were compared using Fisher's exact or Mann-Whitney U tests as appropriate. We used the Kaplan-Meier method to analyze the rate of death and log-rank tests to compare survival curves.</div></div><div><h3>Results</h3><div>The prevalence of iHCC was 12 %. Alcohol-related liver disease was more frequent in iHCC LTRs than in the other groups (<em>p</em> = 0.046). iHCC patients spent more time on the waiting list than patients with tumor-free ESLD cirrhosis (Ci) (12.2 months vs. 3.5 months; <em>p</em> = 0.04). Five-year overall survival of iHCC LTRs was significantly reduced compared to the survival of Ci LTRs (44 % vs. 87 %, <em>p</em> = 0.028).</div></div><div><h3>Conclusions</h3><div>The prevalence of iHCC within LT candidates is significant. iHCC LTRs show a lower survival rate than Ci LTRs, but a reduced rate of tumor recurrence compared to pkHCC LTRs. HCC screening protocol of ESLD LT candidates might include a larger use of high-resolution imaging techniques and iHCC LTRs should be approached as pkHCC LTRs with regards to postoperative imaging follow-up.</div></div><div><h3>Summary</h3><div>Prevalence of incidental hepatocellular carcinoma is considerable among LT candidates. These patients have a lower survival rate than recipients with tumor-free ESLD cirrhosis. Optimizing screening methods for hepatocellular carcinoma in cirrhotic patients awaiting liver transplantation could improve their prognosis.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"18 ","pages":"Article 100264"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386321","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}

{"title":"From severe acute cholangitis to aggressive intrahepatic cholangiocarcinoma: Causal or coincidental association?","authors":"Victoria Ramdour ,&nbsp;Thomas Lévi-Strauss ,&nbsp;Patrick Chevallier ,&nbsp;Delphine Ouvrier ,&nbsp;Antonio Iannelli ,&nbsp;Albert Tran ,&nbsp;Rodolphe Anty","doi":"10.1016/j.liver.2024.100250","DOIUrl":"10.1016/j.liver.2024.100250","url":null,"abstract":"","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100250"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177333","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}

{"title":"Worse clinical outcomes of TACE when liver function is decompensated in a cohort of patients with cirrhosis and HCC waiting for liver transplantation","authors":"Elizaveta Makarova ,&nbsp;Xuanjia Fan ,&nbsp;Iman Farooqi ,&nbsp;Katrina Bakhl ,&nbsp;Terrence E. Murphy ,&nbsp;Elizabeth S. Stonesifer ,&nbsp;Alison Faust","doi":"10.1016/j.liver.2024.100257","DOIUrl":"10.1016/j.liver.2024.100257","url":null,"abstract":"<div><div>Trans arterial chemoembolization (TACE) is the most frequently utilized locoregional therapy for patients with hepatocellular carcinoma (HCC). The reported evidence has been mixed regarding outcomes in patients with decompensated cirrhosis who undergo TACE. The aim of our study was to evaluate the clinical outcomes of patients with cirrhosis and HCC that underwent TACE procedures while awaiting liver transplantation. This was a retrospective cohort study of patients listed for transplant between February 2018 and April 2022. We analyzed 74 patients that had a total of 171 TACE procedures, and defined outcomes within 90 days of TACE in four categorical levels as follows: clinical stability/improvement (1), worsening of liver functioning (2), hospitalization (3), and death or delisting (4). The primary statistical analysis was based on multinomial modeling of this categorical outcome. Patients with decompensated liver function at the time of TACE had odds of being hospitalized within 90 days of the TACE procedure that were 8 times higher than those with compensated liver function (p=0.007). Patients with albumin &lt;3 g/dL or bilirubin &gt;3mg/dL were more likely to experience poor outcomes within 90 days following TACE. There was no statistically significant difference in death and delisting after TACE between patients with compensated and decompensated liver function, though the sample size in this outcome was small.</div></div>","PeriodicalId":100799,"journal":{"name":"Journal of Liver Transplantation","volume":"17 ","pages":"Article 100257"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143177366","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}