The Journal of the Association of Physicians of India最新文献

{"title":"A Case Series of Dengue Fever with Unusual Presentation and Complications in a Rural Hospital.","authors":"P S Arthi, M Rajendran, Mohan Ramkumar M, Dinesh Ragav E","doi":"10.59556/japi.73.1071","DOIUrl":"10.59556/japi.73.1071","url":null,"abstract":"<p><strong>Background: </strong>One of the most dangerous arboviral infections in the world is dengue. There are four significant serotypes for epidemiology. Dengue hemorrhagic fever (DHF) and dengue fever (DF) are the two clinical spectrums indicated by the classification. The majority of cases are stereotyped and take well to fluid resuscitation. Strange clinical manifestations, however, were frequently overlooked and led to mortality. Six of these dengue cases were treated in a rural tertiary care facility for a year, and after receiving problem-based curative therapy, all of the cases recovered fully.</p><p><strong>Case description: </strong>During the midyear dengue epidemic in 2022, all six patients arrived at the rural tertiary care center located in southern India. There are two females and four males, with a mean age of 30 (range: 19-59). Three DHF, one DF, one dengue shock syndrome (DSS), and two original dengue infections were included in this investigation; most patients experienced significant gastrointestinal bleeding. Additional potentially fatal conditions included myocarditis, unpredictable rapid plasma leak, acute severe hepatitis, severe septic shock, cerebral hemorrhage, diarrhea, and decompensated dengue shock brought on by a third-space fluid leak. In addition to patient-specific proper fluid management, other empirical treatment approaches, such as blood transfusions, were employed. Early identification of the key phase was aided by bedside ultrasound screening. In all six cases, the patients fully recovered.</p><p><strong>Conclusion: </strong>Even now, treating dengue remains one of the world's most difficult infections. Given the extremely narrow treatment window, the aforementioned atypical presentations and consequences could be lethal if not identified early. These are not uncommon issues that go unreported and are frequently disregarded, so clinicians must be aware of them. To enhance medical research and improve care in rural areas, every patient's clinical management was documented for knowledge sharing.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"49-52"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070603","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":"Postural Instability in Idiopathic Parkinson's Disease: Determination of VEP, BAER, and SSEP Cutoff Values for an Early Screening of Fall.","authors":"Joydeep Mukherjee, Manoj K Roy, Jasodhara Chaudhuri, Amar K Misra, Kartik C Ghosh, Mrinal K Roy","doi":"10.59556/japi.73.1166","DOIUrl":"10.59556/japi.73.1166","url":null,"abstract":"<p><strong>Backgrounds and aims: </strong>Idiopathic Parkinson's disease (IPD) patients had progressively increased slowness, rest tremors, rigidity, and postural instability (PI). Postural stability depends on sensory inputs from visual, auditory, and somatosensory modalities. We tried to find important cutoff values of visual evoked potential (VEP), brainstem auditory evoked response (BAER), and short-latency somatosensory evoked potentials (SSEP) for determining postural stability in IPD patients.</p><p><strong>Methodology: </strong>About 50 IPD patients were recruited in a cross-sectional observational study. A pull test was used to determine postural stability. Patients were subgrouped into tremor dominant (TD variant) (<i>n</i> = 37) and PI and gait disorder (PIGD) (<i>n</i> = 13). We generated receiver operating characteristic (ROC) curves to classify patients into posturally stable and unstable and measured VEP, BAER, and SSEP cutoff values. The area under the curve (AUC) >0.8 was taken as significant.</p><p><strong>Results: </strong>Significant VEP N75, P100, and N145 cutoff values were noted bilaterally in IPD and its subgroups (TD and PIGD). Except for wave I, the latency of all other BAER waves showed significant cutoff values bilaterally in IPD and subgroups (TD and PIGD). Most BAER cutoff values in the IPD and TD subgroups reached 100% specificity. No significant SSEP values were noted.</p><p><strong>Discussion: </strong>Many significant VEP and BAER parameters with good sensitivity and specificity would guide clinicians in predicting PI and falls in IPD. The TD had lower BAER latency cutoff values than the PIGD. The postural stability of the TD subgroup was more dependent on the vestibular sensory input than that of the PIGD subgroup. Less vestibular compensatory support in PIGD led to a more severe phenotype than in TD.</p><p><strong>Conclusion: </strong>We found many evoked potential significant cutoff values determining postural stability in IPD and its subgroups (TD and PIGD). Lesser vestibular compensatory support in PIGD led to a more severe phenotype than in TD.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"28-36"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070561","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":"Splenic Abscess Complicating <i>Salmonella paratyphi</i> A Infection: A Case Report and Systematic Review of Literature (2001-2024).","authors":"Vithiya Ganesan, T Rajendran, Shunmuga Sundaram Ponnusamy","doi":"10.59556/japi.73.0998","DOIUrl":"10.59556/japi.73.0998","url":null,"abstract":"<p><strong>Introduction: </strong>Recently, there is an upsurge of splenic abscess due to typhoidal <i>Salmonella</i> in India.</p><p><strong>Methods: </strong>We present a case of splenic abscess caused by <i>Salmonella paratyphi</i> A in an immunocompetent male and conducted a systematic review of splenic abscess cases attributed to typhoidal <i>Salmonella</i> described between January 2001 and May 2024.</p><p><strong>Results: </strong>Of 33 cases reviewed, 26, 2, and 1 case each were reported from India, Sri Lanka, Turkey, Qatar, and Pakistan, respectively. <i>S. typhi</i> and <i>S. paratyphi</i> A were reported from 29 and 4 cases, respectively. Mean age was 21 years, with 13 children and 8 females. About 28 were immunocompetent and two had diabetes mellitus. Blood, pus, stool, and pleural fluid grew the isolate in 13, 20, 1, and 1 case, respectively. Ultrasonography (USG) abdomen was diagnostic in 28 cases and normal in two cases. Computed tomography (CT) abdomen was diagnostic in all the 27 cases tested. About 17, 12, and 1 patient showed multiple abscesses, solitary lesion, and multiloculated lesion, respectively. USG/CT-guided percutaneous drainage and splenectomy were performed in 25 and 7 cases, respectively. All 33 patients recovered from the infection.</p><p><strong>Conclusion: </strong>We aspire to raise acquaintance among health professionals regarding this uncommon entity and foresee it in pertinent contexts.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"66-72"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070566","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":"Cavernous Sinus Involvement in Rhino-orbital Cerebral Mucormycosis and Impact of Concurrent COVID-19 on Patient Outcome: A Retrospective Observational Study.","authors":"Harmeet Kaur, Madhur Verma, Punit Tiwari, Paramdeep Singh, Vaibhav Saini, Anuradha Raj","doi":"10.59556/japi.73.1102","DOIUrl":"10.59556/japi.73.1102","url":null,"abstract":"<p><strong>Background: </strong>Cavernous sinus thrombosis (CST) in rhino-orbital cerebral mucormycosis (ROCM) poses a challenge for clinicians in predicting outcomes and formulating management strategies, particularly with the concurrent coronavirus disease 2019 (COVID-19) infection.</p><p><strong>Purpose: </strong>This study was done to evaluate cavernous sinus (CS) involvement in ROCM. Additionally, we explored the association between CS thrombosis and COVID-19, exploring its potential impact on patient mortality.</p><p><strong>Materials and methods: </strong>A retrospective analysis was conducted on 106 ROCM patients, examining their COVID-19 status and reviewing imaging findings from contrast-enhanced computed tomography (CT) and magnetic resonance (MR). The imaging assessment focused on evaluating fungal sinusitis, identifying CS involvement qualitatively, and detecting extension to orbit or other intracranial areas. Findings were correlated with patient mortality.</p><p><strong>Results: </strong>CS involvement in ROCM was 48.1%, with a higher distribution (clinically insignificant) in COVID-positive patients (51.8%) compared to the COVID-negative group (34.8%). Most participants showed unilateral (78%) and diffuse pattern (71%) of CS involvement. A statistically significant association was observed between CS imaging parameters (filling defect, diffuse involvement pattern, convex shape of the lateral wall, and orbital cellulitis) and patient mortality, according to bivariate analysis (<i>p</i> < 0.05). Among 106 ROCM patients, 9.4% succumbed to the disease, with significantly higher mortality in those with CS thrombosis. However, subgroup analysis for the additional effect of COVID-19 on mortality yielded nonsignificant results.</p><p><strong>Conclusion: </strong>CS involvement in ROCM does not significantly impact mortality in both COVID-positive and negative patients. Imaging parameters such as filling defects, diffuse CS involvement, convex lateral wall, and orbital cellulitis may suggest the disease severity when observed.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9","pages":"15-21"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070565","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":"Takayasu Arteritis with Fistulizing Crohn's Disease: A Rare Presentation.","authors":"Ashish Joshi, Rishi Agarwal, Kriti Soni, Mohnish Bothra, Aditya Vyas, Harish Meel, Sushil Falodia","doi":"10.59556/japi.73.1007","DOIUrl":"10.59556/japi.73.1007","url":null,"abstract":"<p><p>Crohn's disease (CD) is a chronic, recurrent, transmural inflammatory disease with lesions anywhere in the gastrointestinal (GI) tract. Takayasu arteritis (TA) is an idiopathic, chronic, granulomatous inflammatory panarteritis that involves the aorta and its branches, known as \"pulseless disease.\" Crohn's disease and TA are both associated, as both are granulomatous disorders, and multiple cases of simultaneous occurrence of both diseases have been reported. Here we are reporting a rare case of simultaneous CD and TA in a young female who had a large enteroenteric fistula between the colon and jejunum and total occlusion of both subclavian arteries with reformed collaterals. The patient was managed with IV antibiotic, IV fluid, and steroid. This unique presentation underscores the importance of considering a potential association between the two conditions in patients presenting with GI symptoms and vascular symptoms.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"55-57"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070657","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":"Interesting Case of Celphos Poisoning with G6PD Deficiency: Is There a Correlation?","authors":"Nitin Wadaskar, Prafulla Doifode, Rahul Arora","doi":"10.59556/japi.73.1070","DOIUrl":"10.59556/japi.73.1070","url":null,"abstract":"<p><p>Celphos poisoning is one of the common poisonings in agricultural countries such as India, mainly in rural areas. Its clinical manifestations vary depending on the amount of poison consumed and the time since ingestion. It has a very high fatality rate. As of now, there is no specific antidote available for this poisoning. Its management includes intensive monitoring along with immediate initiation of supportive care. It is associated with multisystem involvement with multiorgan failure in severe cases, but hematological complications are not very common. Here, we present a successfully treated case of a young male with accidental consumption of Celphos poison with delayed presentation to a tertiary health care center. His clinical features were suggestive of hemolysis. On further evaluation, he was found to have glucose-6-phosphate dehydrogenase (G6PD) deficiency.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 9S","pages":"53-54"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070660","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":"Use of Ambulatory Glucose Profile in Monitoring and Improved Control of Gestational Diabetes Mellitus When Compared to Self-monitoring of Blood Glucose.","authors":"Mohammad Sabah Siddiqui, Superior Kawale, Rohini Rokkam, Sarita Agrawal, Amritava Ghosh","doi":"10.59556/japi.73.1064","DOIUrl":"10.59556/japi.73.1064","url":null,"abstract":"<p><strong>Introduction: </strong>Gestational diabetes mellitus (GDM) is hyperglycemia diagnosed for the first time during the second or third trimester of pregnancy. It often leads to neonatal complications. Effective management of GDM is crucial to mitigate such risks. This study evaluates the effectiveness of ambulatory glucose profile (AGP) vs self-monitoring of blood glucose (SMBG) in managing GDM.</p><p><strong>Methods: </strong>This 18-month observational study was conducted at All India Institute of Medical Sciences, Raipur, India, involving 65 pregnant women diagnosed with GDM. Thirty-two patients wore the flash glucose monitoring system (AGP group) and 33 performed SMBG (SMBG group). Blood glucose levels were monitored using AGP and SMBG, with data collected on fasting, postprandial glucose levels, and hypoglycemic events till 15 days after enrollment. Statistical analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) version 21.</p><p><strong>Results: </strong>The AGP group showed significant reductions in blood glucose levels across all measured times. Mean blood glucose concentrations decreased significantly in both groups from enrollment till 15 days, with no significant intergroup differences. The AGP group had a higher mean time in range (92 vs 90%) and lower time above range (4 vs 6%) compared to the SMBG group. Hypoglycemic events were fewer in the AGP group.</p><p><strong>Conclusion: </strong>AGP demonstrated superior effectiveness in managing GDM by providing continuous glucose monitoring, improving glycemic control, and reducing hypoglycemic events compared to SMBG. AGP is recommended for better glucose management in GDM patients.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"15-20"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070664","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":"Correlation of Glycemic Status with Angiographic Severity of Coronary Artery Disease in Acute Coronary Syndrome.","authors":"Varsha Rakshitha Prakash, Mohammed Omar Shariff, Vadagenalli Sathyanarayanarao Prakash","doi":"10.59556/japi.73.1034","DOIUrl":"10.59556/japi.73.1034","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Cardiovascular disease (CVD) remains the leading cause of illness and death worldwide, placing a significant strain on healthcare systems. Its development is influenced by multiple factors, with major risk contributors including hypertension, dyslipidemia, diabetes mellitus (DM), and lifestyle-related behaviors. Among these, DM notably increases the risk of coronary artery disease (CAD), particularly acute coronary syndrome (ACS). Chronic hyperglycemia in DM accelerates atherosclerosis, thereby heightening the risk of vascular complications. Given the intricate relationship between diabetes and CVD, assessing the influence of glycemic status on CAD severity is essential. This study aims to evaluate the severity of CAD in diabetic, prediabetic, and nondiabetic patients presenting with ACS using the Gensini score, a validated angiographic tool for measuring disease severity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To assess the severity of CAD in patients with ACS using the Gensini score, comparing disease severity among prediabetic, diabetic, and nondiabetic individuals.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A 6-month hospital-based cross-sectional study was conducted at a tertiary care center from July to December 2023, involving 150 patients diagnosed with ACS who underwent coronary angiography (CAG). Data collection was carried out retrospectively (July to September 2023) from inpatient records and prospectively (October to December 2023) from patients meeting the inclusion criteria. Clinical parameters, including patient history, comorbid conditions, cardiac biomarkers, HbA1c levels, electrocardiography (ECG), echocardiography (ECHO), and angiographic findings, were analyzed. The severity of CAD was assessed using the Gensini score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Statistical analysis: &lt;/strong&gt;Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 22. Categorical variables were expressed as frequencies and percentages, with statistical significance determined using the Chi-square or Fisher's exact test. Continuous variables were represented as mean ± standard deviation (SD) and compared using analysis of variance (ANOVA). Pearson's correlation was employed to examine associations between variables. Multivariate regression analysis was conducted to identify predictors of CAD severity (based on the Gensini score), adjusting for potential confounders such as diabetes duration (HbA1c ≥6.5%), age, and other cardiovascular risk factors. A &lt;i&gt;p&lt;/i&gt;-value of &lt;0.05 was considered statistically significant. Graphs were generated using Microsoft Excel and Word.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study analyzed 150 patients with ACS who underwent CAG, comprising 114 diabetic, 20 prediabetic, and 16 nondiabetic individuals. A male predominance was observed, with 100 male participants. Diabetic patients exhibited the highest severity of CAD, with a mean Gensini score of 49.08 ± 39.67, followed by prediabetic patients","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"60-66"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070546","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":"Caput Medusae Mimicking Umbilical Hernia.","authors":"Rahul Kumar, Tanvi Batra, Atul Kakar","doi":"10.59556/japi.73.1072","DOIUrl":"10.59556/japi.73.1072","url":null,"abstract":"<p><p>A 34-year-old female, a diagnosed case of chronic liver disease, presented to the emergency department with yellowish discoloration of the skin, abdominal distension, and bilateral lower limb swelling for 1 week. She also complained of painless swelling over her umbilicus for the last 6 months. On examination, she was conscious, oriented, and hemodynamically stable. General physical examination revealed icterus and bilateral pitting pedal edema up to the knees. On abdominal examination, the abdomen was distended and shifting dullness was present. A large swelling of approximately 7 × 5 cm was present over the anterior abdominal wall with a palpable thrill and an audible Cruveilhier-Baumgarten murmur (Figs 1A and B). The swelling was not reducible and had no signs of inflammation. The rest of the systemic examination was normal.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"102"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070514","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":"Anagen Effluvium as an Early Sign of Azathioprine Toxicity.","authors":"Sehtaj Kaur, Asit Kumar Mittal, Shaifali Jain, Laxman Kumar","doi":"10.59556/japi.73.1073","DOIUrl":"10.59556/japi.73.1073","url":null,"abstract":"<p><p>Azathioprine is a purine analog which is Food and Drug Administration (FDA) approved for organ transplant and severe rheumatoid arthritis (RA). Off-label use in dermatological diseases like immunobullous diseases, atopic dermatitis, autoimmune connective tissue disorders like systemic lupus erythematosus (SLE) and dermatomyositis, and other medical conditions like Crohn's disease, Churg-Strauss syndrome, and myasthenia gravis has long been in the picture.^1-3 The active metabolite of this prodrug is 6-thioguanine (6-TG), which gets incorporated into DNA/RNA structure, causing decreased purine metabolism resulting in its immunosuppressive effect. Thiopurine methyltransferase (TPMT) converts 6-mercaptopurine (6-MP) to an inactive metabolite. TPMT deficiency will cause increased conversion of 6-MP to active metabolite 6-TG, which increases the risk of myelosuppression, one of the life-threatening side effects of the drug.^1,2.</p>","PeriodicalId":22693,"journal":{"name":"The Journal of the Association of Physicians of India","volume":"73 8","pages":"104-105"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070590","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}