Marila Gaste Martinez, Vanessa dos S Silva, Adriana P do Valle, Carmen R P R Amaro, José E Corrente, Luis Cuadrado Martin
{"title":"Comparison of different methods of erythrocyte dysmorphism analysis to determine the origin of hematuria.","authors":"Marila Gaste Martinez, Vanessa dos S Silva, Adriana P do Valle, Carmen R P R Amaro, José E Corrente, Luis Cuadrado Martin","doi":"10.1159/000367848","DOIUrl":"https://doi.org/10.1159/000367848","url":null,"abstract":"<p><strong>Background/aims: </strong>There is disagreement regarding the performance of conventional optical microscopy to assess the origin of hematuria. The aim of this study was to determine the optimal cutoff point for dysmorphic cells in order to detect glomerular hematuria by optical and phase-contrast microscopy.</p><p><strong>Methods: </strong>In total, 131 urine samples (66 from patients with glomerulopathies and 65 from nephrolithiasis patients) were evaluated in a blinded fashion. The percentages of doughnut cells and acanthocytes were verified by optical and phase-contrast microscopy. A total of 131 patients were randomly allocated to the derivation (n = 73) and validation (n = 58) groups. Receiver-operating characteristic (ROC) curves were plotted to check the discriminatory power of each group and the best cutoff points were determined by the Youden index in the derivation group and subsequently tested in the validation group.</p><p><strong>Results: </strong>All areas under the ROC curve (AUCs) were statistically significant using both methods (conventional optical and phase-contrast microscopy) and both groups (derivation and validation). AUCs did not differ between different glomerulopathies. The best cutoff point to determine the glomerular origin of hematuria by total dysmorphic cells was 22% using an optical conventional microscope and 40% by phase-contrast microscopy.</p><p><strong>Conclusion: </strong>We determined the best cutoff points to interpret erythrocyte dysmorphism and demonstrated that it is possible to discriminate the origin of hematuria by evaluating erythrocyte dysmorphism in urinalysis using either an optical or a phase-contrast microscope.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"128 1-2","pages":"88-94"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000367848","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32821324","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}
{"title":"Chronic kidney disease and the ageing population.","authors":"Marcello Tonelli, Miguel Riella","doi":"10.1159/000362458","DOIUrl":"https://doi.org/10.1159/000362458","url":null,"abstract":"<p><p>Due to improvements in socioeconomic development and increased life expectancy, the proportion of older people in the general population is increasing worldwide. While this trend is something to celebrate, it also brings with it challenges for health care systems. One particular challenge is an increase in chronic kidney disease, the prevalence of which is higher in older people. This article reviews the key links between kidney function, age, health and illness, and discusses the implications of the ageing population for the care of people with chronic kidney disease.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"128 3-4","pages":"319-22"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000362458","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32904709","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}
Dimitrios Poulikakos, Marek Malik, Debasish Banerjee
{"title":"Sex-dependent association between heart rate variability and pulse pressure in haemodialysis patients.","authors":"Dimitrios Poulikakos, Marek Malik, Debasish Banerjee","doi":"10.1159/000368436","DOIUrl":"https://doi.org/10.1159/000368436","url":null,"abstract":"<p><strong>Aims: </strong>Increased pulse pressure (PP) is associated with increased cardiovascular mortality in haemodialysis (HD) patients. Autonomic imbalance is common in HD patients and predisposes to sudden cardiac death, but its relationship to PP is unknown. We investigated the relationship between cardiac autonomic modulation assessed by heart rate variability (HRV) and PP in HD patients.</p><p><strong>Methods: </strong>Continuous electrocardiograms recorded during HD sessions were repeated 5 times at 2-week intervals in stable HD patients. The high-frequency (HF) and low-frequency (LF) components and the LF/HF ratio of HRV were calculated during the first and last hour of the recordings. These values and the corresponding systolic blood pressure (SBP), diastolic blood pressure (DBP) and PP measurements were averaged in repeated recordings of each patient.</p><p><strong>Results: </strong>Seventy-six patients were included in the final analysis (aged 61 ± 15 years, 32% females, 37% diabetics). In male patients, LF/HF correlated inversely with pre- and post-HD PP (r = -0.369, p = 0.007 and r = -0.546, p = 0.000, respectively), positively with pre- and post-HD DBP (r = 0.358, p = 0.009 and r = 0.306, p = 0.028, respectively) and inversely with post-HD SBP (r = -0.350, p = 0.011). In female patients, LF/HF correlated positively with post-HD SBP (r = 0.422, p = 0.040).</p><p><strong>Conclusion: </strong>We observed an association between PP and HRV in male HD patients. Sex differences may be important for cardiac risk assessment.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"128 3-4","pages":"361-6"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368436","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32905519","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}
Seon Ha Baek, Sejoong Kim, Dong Ki Kim, Jung Hwan Park, Sung Joon Shin, Sang Ho Lee, Bum Soon Choi, Ho Jun Chin, Suhnggwon Kim, Chun Soo Lim
{"title":"A low-salt diet increases the estimated net endogenous acid production in nondiabetic chronic kidney disease patients treated with angiotensin receptor blockade.","authors":"Seon Ha Baek, Sejoong Kim, Dong Ki Kim, Jung Hwan Park, Sung Joon Shin, Sang Ho Lee, Bum Soon Choi, Ho Jun Chin, Suhnggwon Kim, Chun Soo Lim","doi":"10.1159/000369558","DOIUrl":"https://doi.org/10.1159/000369558","url":null,"abstract":"<p><strong>Background/aims: </strong>An acid-base imbalance precedes renal disease progression in patients with chronic kidney disease (CKD). Little is known about the effects of a low-salt diet (LSD) on net endogenous acid production (NEAP) levels in CKD patients using angiotensin receptor blockade.</p><p><strong>Methods: </strong>We enrolled a total of 202 nondiabetic CKD patients who underwent an 8-week treatment with olmesartan from the original trial [Effects of Low Sodium Intake on the Antiproteinuric Efficacy of Olmesartan in Hypertensive Patients with Albuminuria (ESPECIAL) trial: NCT01552954]. The patients were divided into good- and poor-LSD-compliance groups.</p><p><strong>Results: </strong>During the interventional 8 weeks, the NEAP in the good-compliance group increased compared to the control group (12.9 ± 32.0 vs. -2.0 ± 35.0 mmol/day, p = 0.002). NEAP was positively associated with the good-LSD-compliance group in the fully adjusted analyses (r = 0.135, p = 0.016). The additional reduction of 2.39 g/day of protein intake with a reduction of 1 g/day of salt intake did not increase the NEAP under angiotensin II receptor blockade (ARB) treatment with an LSD (r = 0.546, p < 0.001).</p><p><strong>Conclusion: </strong>We found that an LSD may increase the NEAP in nondiabetic CKD patients using ARB, which suggests that additional acid producing-protein restriction should be required to prevent the NEAP from rising.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"128 3-4","pages":"407-13"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000369558","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32926404","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}
{"title":"Clinical potential of oral nicorandil to improve myocardial fatty acid metabolism after percutaneous coronary intervention in hemodialysis patients.","authors":"Masato Nishimura, Yu Okamoto, Toshiko Tokoro, Nodoka Sato, Masaya Nishida, Tetsuya Hashimoto, Hiroyuki Kobayashi, Satoru Yamazaki, Koji Okino, Noriyuki Iwamoto, Hakuo Takahashi, Toshihiko Ono","doi":"10.1159/000357579","DOIUrl":"https://doi.org/10.1159/000357579","url":null,"abstract":"<p><strong>Background/aims: </strong>The assessment of myocardial fatty acid metabolism impairment by single-photon emission computed tomography (SPECT) using (123)I-β-methyliodophenyl-pentadecanoic acid (BMIPP) might predict the risk of cardiac death in hemodialysis patients. We investigated the potential of oral nicorandil to improve myocardial fatty acid metabolism after percutaneous coronary intervention (PCI) in this population.</p><p><strong>Methods: </strong>We evaluated 128 hemodialysis patients who had obtained coronary revascularization by PCI (90 men and 38 women, 66 ± 9 years). Participants for the analysis were randomly assigned to either the nicorandil (n = 63) or control group (n = 65). BMIPP SPECT was performed every year after coronary revascularization by PCI. Uptake on SPECT was graded in 17 segments on a 5-point scale (0, normal; 4, absent) and assessed as BMIPP summed scores (SS).</p><p><strong>Results: </strong>The incidence of cardiac death was lower (p = 0.004) in the nicorandil group (7/63, 11.1%) than in the control group (21/65, 32.3%) during a mean follow-up of 2.7 ± 1.4 years. BMIPP SS reduction rates improved in the nicorandil group compared with the control group from 3 years of administration. In Kaplan-Meier analyses, free survival rate of cardiac death was higher in patients with a ≥20% BMIPP SS reduction rate as compared with those with a <20% BMIPP SS reduction rate (p = 0.0001). In multiple logistic analysis, oral administration of nicorandil was associated with ≥20% reduction rates of BMIPP SS (odds ratio 2.823, p = 0.011).</p><p><strong>Conclusion: </strong>Long-term oral administration of nicorandil may improve impaired myocardial fatty acid metabolism after coronary revascularization by PCI in hemodialysis patients.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"126 1","pages":"24-32"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000357579","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32037988","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}
Eric Chow, Hannah Wong, Shoshana Hahn-Goldberg, Christopher T Chan, Dante Morra
{"title":"Inpatient and emergent resource use of patients on dialysis at an academic medical center.","authors":"Eric Chow, Hannah Wong, Shoshana Hahn-Goldberg, Christopher T Chan, Dante Morra","doi":"10.1159/000360541","DOIUrl":"https://doi.org/10.1159/000360541","url":null,"abstract":"<p><strong>Background/aim: </strong>End-stage renal disease patients require resources for emergent and inpatient care in addition to ambulatory dialysis. There are two dialysis modalities and settings which patients switch between. Our aim was to characterize the patterns and reasons for switching, as well as the emergent and inpatient utilization of these patients at the University Health Network.</p><p><strong>Methods: </strong>Patients who received chronic dialysis between March 1, 2006, and April 30, 2011, were identified. Utilization was measured by emergency department (ED) visits, inpatient hospitalizations, and bed-days occupied per year.</p><p><strong>Results: </strong>Out of 576 patients identified, 18.6% switched modality and/or setting. The majority of switches occurred during the first year of dialysis. Patients who switched had increased utilization compared to those on a continuous modality/setting. Overall, patients had a median rate of 0.91 ED visits per patient-year, compared to 1.56 for patients who switched modality and setting. Median inpatient bed resource requirement was 4.46 bed-days/patient-year overall, compared to 8.91 for patients who switched modality and setting.</p><p><strong>Conclusions: </strong>Emergent and inpatient utilization is related to the setting and modality of dialysis, although differences are partly explained by comorbidities. Patients who switch modalities use more resources and may be a prime population for interventions.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"126 3","pages":"124-7"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000360541","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32263715","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}
K A Wlodzimirow, A Abu-Hanna, A A N M Royakkers, P E Spronk, L S Hofstra, M A Kuiper, M J Schultz, C S C Bouman
{"title":"Transient versus persistent acute kidney injury and the diagnostic performance of fractional excretion of urea in critically ill patients.","authors":"K A Wlodzimirow, A Abu-Hanna, A A N M Royakkers, P E Spronk, L S Hofstra, M A Kuiper, M J Schultz, C S C Bouman","doi":"10.1159/000357678","DOIUrl":"https://doi.org/10.1159/000357678","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the performance of fractional excretion of urea (FeU) for differentiating transient (T) from persistent (P) acute kidney injury (AKI) and to assess performance of FeU in predicting AKI in patients admitted to the ICU.</p><p><strong>Methods: </strong>We performed secondary analysis of a multicenter prospective observational cohort study on the predictive performance of biological markers for AKI in critically ill patients. AKI was diagnosed according to RIFLE staging.</p><p><strong>Results: </strong>Of 150 patients, 51 and 41 patients were classified as having T-AKI and P-AKI, respectively. The diagnostic performance for FeU to discriminate T-AKI from P-AKI on the day of AKI was poor (AUC-ROC = 0.61; 95% CI: 0.49-0.73). The diagnostic performance of FeU to predict AKI 1 and 2 days prior to AKI was poor as well (AUC-ROC = 0.61; 95% CI: 0.47-0.74, and 0.58; 95% CI: 0.43-0.73, respectively).</p><p><strong>Conclusions: </strong>FeU does not seem to be helpful in differentiating T- from P-AKI in critically ill patients and it is a poor predictor of AKI.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"126 1","pages":"8-13"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000357678","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32037969","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}
Shahed Ahmed, Sarah Curtis, Charlotte Hill, Trevor Hine
{"title":"Population-based estimated reference creatinine values: a novel method of a robust electronic acute kidney injury alert system.","authors":"Shahed Ahmed, Sarah Curtis, Charlotte Hill, Trevor Hine","doi":"10.1159/000368236","DOIUrl":"https://doi.org/10.1159/000368236","url":null,"abstract":"<p><strong>Background: </strong>Acute kidney injury (AKI) is common in hospitalized patients. Despite the progress that has been made in the last decade, early identification of AKI cases remains a challenge. In recent years, electronic AKI alert (e-AKI alert) systems have been tested and are usually based on changes in serum creatinine (Cr) values. However, these methods do not include one of the common scenarios, i.e. when there is no available preadmission Cr value available for a patient to compare and hence an e-AKI alert cannot be issued. Therefore, it is essential to have an alternative algorithm to produce e-AKI alerts in such scenarios.</p><p><strong>Method: </strong>We have developed e-AKI alert algorithms which compare serum Cr values at presentation with previous results, within KDIGO AKI guideline-specified classifications. However, where a comparator is not available, we have produced a 'population-based reference Cr value' age and sex matched from 137,000 serum Cr values extracted from blood tests in general practice from our Telepath system.</p><p><strong>Results: </strong>Cr results were split by gender, and then within each group the Cr were stratified according to year of age. The median Cr for each individual year of age was identified and plotted versus age to give separate graphs for males and females that gave excellent fits (R(2)) to cubic regressions.</p><p><strong>Conclusion: </strong>Population-based estimated reference Cr measurements from community blood test results is a more robust method of baseline Cr value estimation in generating potential e-AKI alerts to help early recognition and treatment of AKI cases leading to improved outcome.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"128 1-2","pages":"166-70"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368236","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32827090","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}
Peter Yam-Kau Poon, Cheuk-Chun Szeto, Bonnie Ching-Ha Kwan, Kai-Ming Chow, Philip Kam-Tao Li
{"title":"Relationship between HSP70-2 A+1267G Polymorphism and Cardiovascular Events of Chinese Peritoneal Dialysis Patients.","authors":"Peter Yam-Kau Poon, Cheuk-Chun Szeto, Bonnie Ching-Ha Kwan, Kai-Ming Chow, Philip Kam-Tao Li","doi":"10.1159/000368237","DOIUrl":"https://doi.org/10.1159/000368237","url":null,"abstract":"<p><strong>Background: </strong>Heat shock proteins (HSPs) are expressed by cells in response to various environmental stresses. A single-nucleotide polymorphism A+1267G of the HSPA1B gene affects the expression of HSP70-2, with the A allele being protective against inflammatory conditions. We investigated the relation between the HSP A+1267G polymorphism and the clinical outcomes of Chinese peritoneal dialysis (PD) patients.</p><p><strong>Methods: </strong>We studied 347 new PD cases (181 males, age 56.6 ± 13.7 years). Genotyping was done by standard methods. Patients were followed for 40.5 ± 20.7 months for survival analysis.</p><p><strong>Results: </strong>For the entire cohort, there was no difference in the 5-year survival between genotype groups. However, there was a significant interaction between HSP polymorphism and diabetic status on the cardiovascular event-free survival. In patients without pre-existing diabetes, 5-year cardiovascular event-free survival of the GG/AG genotype group was significantly better than that of the AA genotype group (57.2 vs. 32.1%, p = 0.011).</p><p><strong>Conclusion: </strong>The G allele of the HSP70-2 A+1267G polymorphism confers survival advantages in non-diabetic PD patients. The role of HSP in the pathogenesis of cardiovascular disease in renal failure patients needs further investigation.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"128 1-2","pages":"153-8"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000368237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32827500","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}
{"title":"JTT-751 for treatment of patients with hyperphosphatemia on peritoneal dialysis.","authors":"Keitaro Yokoyama, Takashi Akiba, Masafumi Fukagawa, Masaaki Nakayama, Hideki Hirakata","doi":"10.1159/000366482","DOIUrl":"https://doi.org/10.1159/000366482","url":null,"abstract":"<p><strong>Background/aims: </strong>JTT-751 (ferric citrate hydrate) is a novel iron-based phosphate approved in Japan for the treatment of hyperphosphatemia in dialysis and nondialysis patients with chronic kidney disease.</p><p><strong>Methods: </strong>In this phase 3, multicenter, open-label, dose-adjusted study, we investigated the efficacy and safety of JTT-751 in peritoneal dialysis patients. A total of 56 patients with serum phosphate ≥5.6 and <10.0 mg/dl were enrolled in the study. The dose of JTT-751 was adjusted to between 1.5 and 6.0 g/day, according to the target range of serum phosphate (3.5-5.5 mg/dl), for 12 weeks. The primary endpoint was change in serum phosphate from baseline to end of treatment. Secondary endpoints included the percentage of patients achieving target serum phosphate levels and changes in intact parathyroid hormone.</p><p><strong>Results: </strong>Serum phosphate was significantly reduced by 2.26 mg/dl (p < 0.001). The percentage of patients achieving target serum phosphate levels was 76.8%. Intact parathyroid hormone decreased significantly (p < 0.001). The most common adverse drug reactions were diarrhea and constipation. Most of the events were considered to be mild. Treatment with JTT-751 resulted in significant increases in serum ferritin and transferrin saturation (p < 0.001).</p><p><strong>Conclusion: </strong>In peritoneal dialysis patients with hyperphosphatemia, 12-week treatment with JTT-751 resulted in significant reductions in serum phosphate while simultaneously increasing serum iron parameters. JTT-751 was well tolerated.</p>","PeriodicalId":19094,"journal":{"name":"Nephron Clinical Practice","volume":"128 1-2","pages":"135-40"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000366482","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32819773","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}