East and Central African Journal of Surgery最新文献

{"title":"Radiological diagnosis of pneumoperitoneum in children with typhoid intestinal perforation","authors":"L. Anyanwu, A. Mohammad, M. Saleh, Lawal B. Abdullahi, A. Farinyaro, S. Obaro","doi":"10.4314/ECAJS.V22I2.7","DOIUrl":"https://doi.org/10.4314/ECAJS.V22I2.7","url":null,"abstract":"Background: Typhoid fever is a severe systemic illness caused by the gram-negative bacillus Salmonella typhi and transmitted by the faecal-oral route. This study sought to determine the value of plain abdominal and chest radiographs in detecting pneumoperitoneum in children with typhoid intestinal perforation (TIP). Methods: A retrospective review of plain abdominal and chest radiographs of children who had surgery for TIP between June 2009 and December 2011 in our unit. All the films were reviewed by the same radiologist who was blinded to the intraoperative findings, for the presence or absence of various signs of pneumoperitoneum. Data were collected on a structured questionnaire and analysed using SPSS version 15.0. Results: Radiographs of 54 children were reviewed. Their ages ranged from 3 years to 13 years (median 7 years). Thirty-three of them were boys and 21 were girls (male-to-female ratio 1.57:1). Pneumoperitoneum was detected in 47 patients (87%). In the erect abdominothoracic films, air under the right hemidiaphragm was detected in 16 of 41 cases (39%), and extraluminal or intraperitoneal air-fluid levels in 31 of 41 cases (75.6%). In the supine abdominal films, the commonest sign of pneumoperitoneum was the right upper quadrant gas sign (23 of 50 cases; 46%). Conclusions: A careful interpretation of plain abdominal and chest radiographs in the child suspected to have TIP, would lead to more accurate diagnosis of pneumoperitoneum. Keywords: pneumoperitoneum; typhoid intestinal perforation; radiographs; children; air–fluid levels","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124922349","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":"Total hip replacement surgery in Ethiopia","authors":"E. Gokcen, B. Wamisho","doi":"10.4314/ECAJS.V22I2.5","DOIUrl":"https://doi.org/10.4314/ECAJS.V22I2.5","url":null,"abstract":"Background: Total hip replacement (THR) surgery has evolved over years to the point that it has been considered as \"the operation of the century\". For developed countries, arthroplasty is well established for the management of various joint disorders and has completely revolutionised the treatment of the arthritic hip. The story is different in developing nations. Expensive implant costs and lack of trained orthopaedic surgeons are the main constraints; poverty has caused African countries to remain behind from enjoying the benefits of this medical breakthrough. In this study, we report our first and largest series of 50 such surgeries performed at the CURE Hospital in Addis Ababa. We believe that this is the first consecutive case series from Ethiopia and wanted to share our experience. Methods: Prospectively, all consecutive patients that underwent THR at CURE Hospital from October 2009 to October 2013 were followed for over 3 years using clinical assessments and hip scores. The hip implant used was a Stryker Omnfit Uncemented HA-coated prosthesis. The Visual Analog Scale (VAS) for pain and the Modified Oxford Hip Score were used to assess outcomes. Variables recorded for each patient included sociodemographic information, diagnosis, comorbidity, surgical approach, duration of surgery, estimated blood loss, implant sizes for Ethiopian hips, complications, sequelae, hip scores, and final patient satisfaction. These were analysed using SPSS version 16. Patterns and learning points were observed. Results: Of the 50 consecutive THR patients, 26 were male. Mean age was 48 years (range 14-85). In 30 hips, the right side was operated on, and 2 were bilaterally treated. Primary osteoarthritis (OA) and avascular necrosis (AVN) were the leading diagnoses requiring THR. Previous partial hip replacement (PHR, hemiarthroplasty) was converted to THR in 6 patients. The commonest comorbidities were dibetes mellitus and hypertension. There were 4 hips that dislocated after THR and 1 needed revision surgery. There was 1 persistent infection, 1 case of deep vein thrombosis (DVT), and 1 death. Mean EBL was approximately 1 L and only 5 patients needed transfusion. The most common sizes for Ethiopian hips were a 28 mm+0 head, 52 mm acetabular shell, and 140 mm #8 stem. The VAS and Modified Oxford Hip scores both improved significantly, and the results were comparable with international standards. Conclusions: THR is a viable, safe, and effective option in Ethiopia. Appropriate staff training, careful patient selection, continuous supply chain of implants, and establishing a dedicated joint replacement centre will reliably sustain THR surgery. Keywords: THR; total hip arthroplasty; osteoarthritis; hip surgery; implants; arthritis; hip prosthesis","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"86 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115880479","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":"Iatrogenic tube jejunostomy complicating suprapubic cystostomy: A case report","authors":"A. Muhammad, A. Bello, Muhammed Ahmed, M. Yusuf","doi":"10.4314/ECAJS.V22I2.8","DOIUrl":"https://doi.org/10.4314/ECAJS.V22I2.8","url":null,"abstract":"Suprapubic cystostomy (SPC) can be done by open or percutaneous technique. The procedure is considered simple and generally safe even in less experienced hands. However, some complications may arise occasionally, including bowel injury. We report a 60-year-old man who presented with acute-on-chronic urinary retention 6 months after a SPC in a peripheral hospital for chronic urinary retention. The catheter was draining scanty turbid fluid and was changed regularly. Abdominal exploration revealed an intact full bladder with the supposed suprapubic catheter passing through a small perforation into the jejunum. He had repair of the perforation and proper SPC was inserted. The recovery was uneventful, and he was discharged home after a week. Keywords: suprapubic cystostomy; complications; bowel injury; tube jejunostomy","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122512995","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":"Clinicopathological guide to malignant bone tumours: A retrospective analysis of the cancer registry at Kilimanjaro Christian Medical Centre in northern Tanzania","authors":"Pamela T.K. Samoyo, Gilbert Z Nkya, F. Minja, R. Temu","doi":"10.4314/ECAJS.V22I2.4","DOIUrl":"https://doi.org/10.4314/ECAJS.V22I2.4","url":null,"abstract":"Background: Primary neoplasms of the skeleton are rare. This study aimed at determining the spectrum of different malignant bone tumours at a tertiary hospital cancer registry in the Northern Zone of Tanzania, along with related symptoms, clinical presentations, and clinical diagnosis accuracy (using histology as the standard). \u0000Methods: This retrospective study reviewed bone specimen records in the cancer registry at Kilimanjaro Christian Medical Centre (KCMC) in Tanzania, for the period from 1 January 1998-31 December 2012. Patient information for corresponding cancer registry records was traced from hospital files and x-ray reports. Data were analysed using a mixed quantitative and qualitative approach. \u0000Results: Two hundred twenty-five malignant bone tumours were recorded at KCMC Cancer Registry over a period of 14 years. Seventy-five with adequate records were analysed. Forty-seven patients (62.7%) were male. Mean age was 34.1 (standard deviation 20) years. The femur was affected in 26 cases (34.7%). Osteosarcoma (22 cases; 29.3%) was the most common malignant bone tumour. Clinicians correctly preliminarily diagnosed multiple myeloma, osteosarcoma, and ameloblastoma, but had inexperience with carcinomas and other types of sarcomas. Chronic osteomyelitis and metastatic lesions were mentioned frequently by radiologists as the diagnosis of some malignant bone tumours that turned out to be carcinomas or sarcomas on histology. \u0000Conclusions: Clinician and radiologist training of other types of malignant bone tumours other than multiple myeloma, osteosarcoma, and ameloblastoma is required. An Orthopaedic Biopsy Form (OBF) was developed to address high loss to follow-up (66.7%). \u0000https://dx.doi.org/10.4314/ecajs.v22i2.4 \u0000  \u0000This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130781044","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":"Review of adult head injury admissions into the intensive care unit of a tertiary hospital in Nigeria","authors":"A. Owojuyigbe, E. Komolafe, O. A. Dada, Olufunke F Dada, A. Adenekan, A. Faponle, Ibironke O. Ogunbameru, O. Owagbemi, Fred S. Ige-Orhionkpaibima, Chiazor Udochukwu Onyia, Oluseun A. Olanrewaju","doi":"10.4314/ECAJS.V22I2.2","DOIUrl":"https://doi.org/10.4314/ECAJS.V22I2.2","url":null,"abstract":"Background: Head injury is frequently associated with death and disability and imposes considerable demands on health services. Outcome after head injury is closely related to prompt management, including prevention of secondary brain injury and intensive care unit (ICU) management. This study aimed at determining the aetiological spectrum, injury characteristics, ICU admission patterns, and treatment outcomes of adult head-injured patients at a sub-Saharan tertiary hospital. Methods: A retrospective study on adult head-injured patients admitted to the ICU of a sub-Saharan tertiary hospital between July 2000 and June 2010. Results: A total of 198 head-injured adult patients were managed in the ICU during the study period. This included 128 males and 70 females with a male-to-female ratio of 1.8:1. The most common mode of injury was road traffic accident. All the patients admitted to ICU had either moderate or severe head injury, with 73.7% having severe head injury. About 26.3% of the patients had associated cervical spine injuries and 50% had various musculoskeletal and soft tissue injuries. Cranial computed tomography findings included brain contusions and intracranial haematomas. Mean duration of ICU stay was 18 days (range 24 hours-42 days), with 89.9% discharged out of ICU care. The overall mortality was 10.1%, although only 36.9% had satisfactory outcomes, as determined by the Glasgow Outcome Scale. Outcome had statistically significant (P < 0.05) relationship with severity of head injury and surgical intervention. Conclusions: Head injury management in the ICU requires an approach to ensure prevention of secondary brain injury; appropriate and early neuroimaging to diagnose lesions that would benefit from timely surgical intervention; as well as management of fluid, electrolyte and haematological derangements. Keywords: head injury; admissions; ICU","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"135 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124347913","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":"Mini-craniotomy under local anaesthesia and sedation as a less invasive procedure for spontaneous intracerebral haemorrhage in a developing country","authors":"A. Adeleye","doi":"10.4314/ecajs.v22i2.1","DOIUrl":"https://doi.org/10.4314/ecajs.v22i2.1","url":null,"abstract":"Background: Minimally invasive surgery (MINS) is being viewed as the more practical alternative to the traditional craniotomy for the evacuation of spontaneous intracerebral haemorrhage (sICH). Most such sICH arises as complications of systemic hypertension. The techniques of MINS described are not currently affordable in most developing countries. Methods: An annotated technique of mini-craniotomy under local anaesthesia (LA) is here described as a stop-gap solution to this problem. An outcome study of this surgical technique in a prospective consecutive patient population is also presented. Results: Twenty-one patients, 13 males, mean age 41.1 years, underwent this surgical procedure. Clinical presentation of the sICH was generally severe: 48% in coma, 81% critically ill, and many of these cases were complicated with high fever, meningism, and chest morbidity. The Glasgow Coma Scale score was 3/15 to 8/15 and 9/15 to 12/15, respectively, in 9 of 21 cases (42.9%) each. The ICH showed evidence of significant mass effect on brain computed tomography (CT) scan in 95% and was associated with intraventricular haemorrhage in 43%. The bleed was deep-seated in the white matter and basal ganglia in 16 of 21 cases, and superficial-cortical in the rest. The midline shift was at least 5 mm in all of these. The surgical procedure was successfully completed in all cases. The in-hospital results were: mortality of 62% and postoperative survival of 38%, which is well within the range of global outcome statistics related to sICH. Conclusions: In well-selected patient groups mini-craniotomy under LA appears effectual in the surgical evacuation of sICH. It has a particular attraction as a low-cost treatment option for developing countries. Keywords: spontaneous ICH; surgical evacuation; minimally invasive surgery; surgical technique; mini-craniotomy; local anaesthesia; low-cost procedure; developing country","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122094549","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":"Epidemiology and clinical profile of common musculoskeletal diseases in patients with diabetes mellitus at Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia","authors":"B. Wamisho, Y. Feleke","doi":"10.4314/ECAJS.V22I2.6","DOIUrl":"https://doi.org/10.4314/ECAJS.V22I2.6","url":null,"abstract":"Background: Diabetes mellitus (DM) affects connective tissues in many ways and causes different alterations in periarticular and skeletal systems. Methods: A cross-sectional study was conducted by interviewing and examining 402 consecutive diabetic patients followed at Tikur Anbessa Hospital OPD. Evaluation was performed according to the Short Musculoskeletal Function Assessment Questionnaire (SMFA). The diagnoses were established by Consultant Orthopedic Surgeon. Results: Average duration of diabetes is 143 months (12 Years) and majority, 66.7% (268/402) of them are currently on insulin therapy. Mean current FBS is 245mg%. Excluding OA (47, 11.7%) and CLBP (78, 19.4%), overall prevalence of 1 or more of musculoskeletal Diseases (MSD) is 41.5 %. Hands were the most affected (74, 18.5 %). Five had amputation. Hand involvement and sex of the patient and Type of diabetes is significantly associated, Duration of DM and shoulder involvement are significantly related. Conclusions: Musculoskeletal manifestations are very high in adult diabetic patients at the centre and need multidisciplinary clinical attention. Physicians should always consider examining the periarticular region of the joints in the hands feet. Duration of diabetes is associated to development of shoulder complications. Recommendations: Routine MSD screening, establishing a foot care clinic and strengthening diabetic education may prevent development or worsening of MSD Keywords: musculoskeletal complications; diabetic foot; foot care; trigger finger; Dupuytren's contracture; stiff frozen shoulder","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114163188","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":"Management of gangrenous sigmoid volvulus at Tenwek Hospital in western Kenya","authors":"P. B. Ooko, Russell E. White","doi":"10.4314/ECAJS.V22I2.3","DOIUrl":"https://doi.org/10.4314/ECAJS.V22I2.3","url":null,"abstract":"Background: Bowel gangrene has a negative impact on outcomes of patients with sigmoid volvulus (SV). This study aimed at evaluating the management and outcomes of patients with gangrenous sigmoid volvulus and assessing the utility of primary anastomosis as a management option. Methods: An 11-year (January 2006-December 2016) descriptive retrospective chart review of patients managed for SV at Tenwek Hospital in Bomet, Kenya. Results: A total of 46 cases were identified, representing 25.4% of all cases of SV noted during the study period. The group had a mean age of 47.3 years (range 15-81), mean symptom duration of 2.2 days (range 2 hours-7 days) and a male predominance of 87%. Primary anastomosis (PA) without a proximal diverting colostomy was performed in 24 cases and a Hartmann's procedure (HP) was performed in 22 cases. Patients who had a HP were noted to have had a longer duration of symptoms and a higher incidence of peritonitis than those who had a PA (2.7 vs 1.8 days, P = 0.02; and 72% vs 42%, P = 0.04). All patients with concurrent colonic perforation (n = 3) had a HP. Seven patients died, giving an overall mortality of 15.2%. There was an anastomotic leak rate of 4.2% and a mortality rate of 8.3% among the subset of patients who had a PA. Conclusions: Primary anastomosis can be safely performed with good outcomes in patients with gangrenous SV, and the presence of bowel gangrene does not mandate a diverting colostomy. Keywords: sigmoid volvulus; bowel gangrene; primary anastomosis; colostomy; bowel obstruction","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122404868","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":"Pattern and management of priapism in a tertiary hospital of North-Western Nigeria","authors":"A. Muhammad, N. Agwu, A. Abdulwahab-Ahmed, S. Abubakar, A. Musa, I. Mungadi","doi":"10.4314/ECAJS.V22I1.9","DOIUrl":"https://doi.org/10.4314/ECAJS.V22I1.9","url":null,"abstract":"Background: Priapism is a persistent penile erection that continues for more than four hours beyond sexual stimulation and orgasm or unrelated to sexual stimulation 1 . The objective is to document the pattern and management of priapism in our hospital. Methods: This is a retrospective study of patients managed for Priapism by Urology Unit of our hospital, from January 2009 to December 2015. Results: Thirty patients were managed for managed for priapism within the study period. The mean age at presentation was 23.9 ± 12.2 years with a range of 8- 55 years. Fifteen patients (57.7 %) presented beyond 72 hours of the onset of priapism. All the patients had ischaemic priapism. Half of the patients had sickle cell disease, two (7.7 %) had chronic myeloid leukaemia, five (19.2%) used aphrodisiacs and cause was not established in six (23.1%). The most effective forms of treatments were corporal aspiration and glanulocavernosal shunt. Hydroxyurea was used for the patients with leukaemia. Thirteen (50.0%) of the patients were loss to follow-up after their first visits. Three patients (11.5%) developed erectile dysfunction. Conclusion: Sickle cell disease is the commonest cause of ischaemic priapism in our practice. Late presentation is common and is usually associated with the development of erectile dysfunction. Keywords: priapism, sickle cell disease, aphrodisiacs, erectile dysfunction, treatments of ischaemic priapism","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"116 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133507722","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":"Strengthening surgical and anaesthetic services at district level in the African region: issues, challenges and proposed actions","authors":"J. Ndihokubwayo, S. Coulibaly, M. Cherian, M. M. Ekeke, J. Nabyonga, L. Musango, T. Nkurunziza, C. King, I. Premaratne, W. Johnson","doi":"10.4314/ECAJS.V22I1.3","DOIUrl":"https://doi.org/10.4314/ECAJS.V22I1.3","url":null,"abstract":"Health care delivery systems are organized at several levels with the district hospital serving as the first referral for comprehensive care in the majority of countries worldwide. The provision of comprehensive surgical services requires several inputs and tools to be in place, among which are an adequately trained surgical, anaesthesia and obstetric healthcare workforce, infrastructure and functioning equipment, and essential medicines and supplies. These, however, are not in place in the majority of commonly received surgical cases, such as trauma, obstetric, abdominal and orthopedic emergencies, thus limiting the capacity of district hospitals to address them. Global and regional public health initiatives have traditionally neglected the necessity of the provision of surgical services despite the fact that these constitute an essential component of comprehensive primary healthcare (PHC) 1 . In fact, because surgery so frequently cannot be safely postponed, this deficiency prevents the transfer of patients to a secondary or tertiarylevel hospital where further care can be provided. 2","PeriodicalId":302666,"journal":{"name":"East and Central African Journal of Surgery","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116284332","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}