Klinicist最新文献

{"title":"Cellular and molecular aspects of degenerative disc disease and potential strategies of biological therapy","authors":"A. V. Novikova, N. Pravdyuk, N. Shostak","doi":"10.17650/1818-8338-2020-14-1-2-42-54","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-42-54","url":null,"abstract":"Back pain is one of the main global health problems with a high level of prevalence and patients’ disability. In most cases, it is associated with degenerative spine damage (degenerative disc disease), dorsopathy, discopathy (M51 and M53 according to the International Classification of Diseases, 10th revision), affecting all levels of the intervertebral disc (IVD) (cytological, chemical and biochemical) as a whole as well as biological molecules that regulate homeostasis of the disc intercellular substance (growth factors, pro-inflammatory cytokines, enzymes). A key point in IVD dehydration is that catabolic processes predominate over anabolic ones due to changed gene expression in the corresponding biologically active molecules, disc angiogenesis and neoinnervation of the structures of the fibrous ring and pulpous nucleus. The latter is responsible for chronic pain in patients.Cells supporting homeostasis in nucleus pulpous, chondrocytes, continuously synthesize and restore proteoglycans and hyaluronic acid in nucleus pulpous, restoring shock-absorbing functions of the vertebral-motor segment. Decreased activity and death of chondrocytes in the avascular disc structure is a serious problem for reparative medicine. In accordance with IVD molecular-cellular mechanisms, numerous approaches to treat degenerative disc disease are being developed, each of which, influencing one of the links in the pathogenesis, has a direct or indirect effect on IVD repair.The article describes morphology, pathogenesis and genetics of degenerative disc disease, as well as main modern strategies of biological therapy: tissue engineering, biologically active substances locally used in IVD matrix, including PRP therapy (Platelet Rich Plasma therapy), methods of gene (using the viral vector) and cell therapy, as well as experience in the local use of genetically engineered biological products. Most successful studies are a combination of cell and gene therapy with the use of synthesized matrices.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67773002","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":"Interleukin 6 in aging and age-related diseases","authors":"S. V. Topolyanskaya","doi":"10.17650/1818-8338-2020-14-3-4-k-633","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-3-4-k-633","url":null,"abstract":"Modern concepts about the importance of subclinical inflammation in various age-associated pathology are described in the review. The term “inflammaging” (inflammation due to aging) refers to the special role of inflammation in the aging processes. This type of inflammation is low-grade, controlled, asymptomatic, chronic and systemic. Inflammaging determines the rate of aging and life expectancy. The balance of pro-inflammatory and anti-inflammatory cytokines plays a significant role in aging processes. The increased levels of pro-inflammatory cytokines such as interleukin-6 and tumor necrosis factor-α in the elderly are associated with different diseases, disability and mortality. Interleukin-6 is a multifunctional cytokine involved in the regulation of acute phase response and other immunological reactions, in the hematopoiesis and in chronic inflammation. This cytokine is important in the pathogenesis of chronic inflammation diseases, as well as different oncological disorders. Interleukin-6 is often called the “cytokine of gerontologists”, since it is one of the main signaling pathways associated with aging and age-related diseases. This cytokine also plays an important role in the pathogenesis of atherosclerosis, coronary artery disease, chronic heart failure and increases the risk of death from cardiovascular diseases and overall mortality. Interleukin-6 is a key proinflammatory cytokine responsible for the “metabolic inflammation”, obesity, insulin resistance and diabetes mellitus. This cytokine has a significant impact on the development of sarcopenia and frailty. The serum levels of interleukin-6 negatively correlate with muscle mass and skeletal muscle function in the elderly, so it is considered as a biomarker of sarcopenia and functional decline. Interleukin-6 may contribute to the development of osteoporosis by stimulating osteoclastogenesis and bone resorption. The modern data indicate the diverse effects of interleukin-6 and confirm the significant role of this cytokine in aging and in different age-associated pathology.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"14 1","pages":"10-17"},"PeriodicalIF":0.0,"publicationDate":"2020-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49000538","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":"Specificity of using botulinic toxin type A for blepharospasm treatment","authors":"A. Artemenko, O. A. Shavlovskaya, E. R. Mkhitaryan","doi":"10.17650/1818-8338-2019-13-3-4-43-52","DOIUrl":"https://doi.org/10.17650/1818-8338-2019-13-3-4-43-52","url":null,"abstract":"Blepharospasm (BS) is one of the diseases characterized exclusively by involuntary face movements (facial hyperkinesis). Typical clinical manifestations include squinting or increased blinking. Among frequent patients’ complains at the disease onset are unpleasant irritations, a foreign body sensation, itching, dry eyes, and frequent blinking. Dynamism is a typical BS feature: 1) it increases during emotional stress, in stressful situations, during fatigue, eye strain (reading), in bright light; 2) disappears while sleeping; 3) decreases after waking up; 4) «corrective gestures», such as touching skin of the eyelids, paraorbital regions and glabellar region, wearing glasses, chewing or absorbing sweets, other arbitrary movements, affect BS. Botulinum therapy (botulinum toxin type A (BtA) injections, in particular using Relatox, the effectiveness of which has been demonstrated in clinical studies) is considered the «gold standard» in BS treatment. BtA is injected mainly into the orbicular muscle of eye, superficially, into the upper, lower eyelids and outer eye corner. The clinical effect occurs quickly, already in the first week after injection and lasts 3 months or more. Cases of botulinum therapy inefficiency in treating BS and other facial hyperkinesis are extremely rare.The article describes BS main clinical aspects, BtA injection schemes as well as adverse events during the therapy. Electromyography is not mandatory to assess BtA effectiveness in BS treatment, but it is necessary in cases of inefficient therapy, adverse events or the therapy complications. It is particularly important to strictly comply with recommended BtA doses, and that the drug is injected by a certified specialist only. Botulinum therapy for BS patients is a highly effective and, in most cases, the only treatment with a good safety profile.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67771819","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":"СОВРЕМЕННЫЕ МЕТОДЫ АМБУЛАТОРНОГО МОНИТОРИРОВАНИЯ ЭЛЕКТРОКАРДИОГРАММЫ. КЛИНИЧЕСКОЕ ПРИМЕНЕНИЕ","authors":"Е. В. Первова","doi":"10.17650/1818-8338-2017-11-2-58-73","DOIUrl":"https://doi.org/10.17650/1818-8338-2017-11-2-58-73","url":null,"abstract":"The review presents the clinical characteristics and comparative data of application of modern non-invasive and invasive methods of ambulatory electrocardiographic monitoring in the diagnosis of arrhythmias and cardiac conduction. The properties of each of the methods  of extended electrocardiographic monitoring, the effectiveness of their application and tactics for improving the diagnosis of arrhythmias and syncope during the process of diagnosis are presented.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"58-73"},"PeriodicalIF":0.0,"publicationDate":"2017-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42426284","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":"НОВЫЕ ВОЗМОЖНОСТИ ЛОКАЛЬНОЙ ТЕРАПИИ БОЛЕВОГО СИНДРОМА В СПИНЕ","authors":"Надежда Александровна Шостак, А. А. Клименко, Д. Ю. Андрияшкина","doi":"10.17650/1818-8338-2017-11-2-74-79","DOIUrl":"https://doi.org/10.17650/1818-8338-2017-11-2-74-79","url":null,"abstract":"Purpose of study – to examine effectiveness and tolerability of therapy рatch NANOPLAST forte in comparison with “placebo” patch in patients with back pain syndrome in conditions of prospective comparative randomized study, approved by the local ethics committee. Materials and methods. The study included 60 patients with acute/ recrudescence of chronic primary back pain syndrome, there were 30 patients in each group, which were comparable in main clinical parameters. A primary effectiveness criterion was reduction of back pain syndrome intensity at rest and during movements by no less than 50% from initial level according to visual analogue scale (mm). Overall effectiveness of NANOPLAST forte patch was evaluated separately by doctor and patient on the 10th day according to the following grading: significant improvement; improvement; absence of effect. A need for administration of non-steroidal anti-inflammatory drugs (NSAID) was assessed during the study. A patch was applied once a day for 12 h (from 9 to 21 h). Tolerability of NANOPLAST forte patch and “Placebo” patch was evaluated according to frequency and severity of local and/or systemic adverse events, and to tolerability grading: very good effect, good effect, satisfactory effect, absence of effect. Frequency of achievement of not less than 50% of back pain reduction at rest was significantly higher in NANOPLAST forte group than in “placebo” group (96,6% versus 23.3% respectively; р=0.001, Pearson’s chi-squared test), as well as during movements (93,3% versus 40% respectively; р=0.001, Pearson’s chi-squared test). Evaluation of treatment effectiveness was higher in NANOPLAST forte group in comparison with “Placebo” group in the opinion of both patient and doctor. Pain intensity during walking and at rest statistically significantly decreased according to visual analogue scale (p<0.05, Wilcoxon test) by the 10th day  in NANOPLAST forte group. A need for additional administration of non-steroidal anti-inflammatory drugs was statistically significantly lower in NANOPLAST forte group in comparison with “Placebo” group (р<0.05, Pearson’s chi-squared test). All patients completed the study. Adverse events related to use of NANOPLAST forte patch were not detected. Conclusion. NANOPLAST forte can be recommended as an effective and safe method of local therapy in case of back pains.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"74-79"},"PeriodicalIF":0.0,"publicationDate":"2017-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47132839","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":"ГЕНДЕРНЫЕ ОСОБЕННОСТИ АФФЕКТИВНЫХ РАССТРОЙСТВ У БОЛЬНЫХ ОСТРЫМ ИНФАРКТОМ МИОКАРДА","authors":"С. Ю. Мухтаренко, Т. М. Мураталиев, Ю. Н. Неклюдова, З. Т. Раджапова, В. К. Звенцова","doi":"10.17650/1818-8338-2017-11-2-49-57","DOIUrl":"https://doi.org/10.17650/1818-8338-2017-11-2-49-57","url":null,"abstract":"The study objective is to investigate characteristics of mixed anxiety-depressive disorders (MADD) and the level of subjective self-control  in relation to health (SSCh), as well as the effect of affective disorder severity on clinical course and prognosis of the disease in men and women with acute myocardial infarction (AMI). Materials and methods. The study included 124 patients with AMI aged between 30 and 85 years (mean age 58.6  ±  12.1 years), who were divided into 2 groups: the 1st group contained 88 (71 %) men, the 2nd group – 36 (29 %) women. Results. Per the screening test, MADD was more frequently diagnosed in the female group (91.7 %) compared to the male group (56.8 %),  р 0.05) mortality, respectively.  Conclusion. Psychometric tests have shown higher rate and severity of MADD in the female group compared to the male group. In the female group, left ventricular ejection fraction was significantly lower than in the male group, and overall and hospital mortality was higher.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"49-57"},"PeriodicalIF":0.0,"publicationDate":"2017-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48626214","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":"ФАКТОРЫ ПРИВЕРЖЕННОСТИ К ТЕРАПИИ СЕРДЕЧНО-СОСУДИСТЫХ ЗАБОЛЕВАНИЙ ПО ДАННЫМ СОВРЕМЕННЫХ ИССЛЕДОВАНИЙ","authors":"М. С. Соболева","doi":"10.17650/1818-8338-2017-11-2-33-39","DOIUrl":"https://doi.org/10.17650/1818-8338-2017-11-2-33-39","url":null,"abstract":"In article the review of modern foreign and Russian researches about value of adherence of patients to medicinal therapy of сardiovascular diseases is carried out. Relevance of a problem of non-compliance with appointments of the doctor is described. Factors of adherence which are associated with drug (the price, quantity, reception frequency, amount of drugs), with personal qualities and medical characteristics  of the patient (forgetfulness, age, sex, the diagnosis and the accompanying pathologies, existence of complications in the anamnesis, education, quality of life), with insufficient knowledge of a disease and/or of medicines, side effects, fears and doubts of patients are defined. The review of various methods and ways of rise of adherence, their use in medical practice is provided.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"33-39"},"PeriodicalIF":0.0,"publicationDate":"2017-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48986859","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":"Прокальцитониновый тест в ревматологии","authors":"Д. В. Буханова, Борис Сергеевич Белов, Г. М. Тарасова, А. Г. Дилбарян","doi":"10.17650/1818-8338-2017-11-2-16-23","DOIUrl":"https://doi.org/10.17650/1818-8338-2017-11-2-16-23","url":null,"abstract":"Currently, differential diagnosis of systemic bacterial infection and active rheumatic process remains a challenging problem in rheumatology. In the review, current data on the role of procalcitonin biomarker in diagnosis and differential diagnosis of rheumatic diseases (RD) and infectious pathology are presented. In particular, some authors recommend procalcitonin (PCT) test as a marker of bacterial infection in bones and joints at levels above 0.5 ng/ml; at PCT level below 0.3 ng/ml, infection can be ruled out. In patients with microcrystalline arthritis, data on the significance of PCT for differential diagnosis are contradictory. PCT level doesn’t correlate with systemic lupus erythematosus activity and is elevated only during bacterial infection proportionally to its systematicity. In some studies, elevated PCT level was observed in ANCA-associated vasculitis with high activity without bacterial infection. It was shown that in 80 % of adults with Still’s disease, PCT level was higher than the threshold value even without infection. For patients with RD hospitalized in intensive care units, PCT clearance is a more informative predictive characteristic than its level, regardless of the cause of PCT elevation (infection, injury, severe organ damage, etc.); slowdown of its decrease is a factor of poor prognosis and is associated with higher mortality. At the same time, PCT level positively correlates with the SOFA score in presence of bacterial infection. For some rheumatic diseases, the threshold PCT value at which the test has optimal sensitivity and specificity is yet to be established. Nonetheless, PCT should be evaluated in relation to the clinical picture and data of additional examinations. The effect of various therapy methods used in rheumatology on PCT level requires further research.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"16-23"},"PeriodicalIF":0.0,"publicationDate":"2017-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45966580","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":"ИССЛЕДОВАНИЕ ЭЛЕКТРОФИЗИОЛОГИЧЕСКИХ ПАРАМЕТРОВ ПРЕДСЕРДИЙ У ПАЦИЕНТОВ С ДЛИТЕЛЬНО ПЕРСИСТИРУЮЩЕЙ ФОРМОЙ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ И КЛАПАННОЙ ПАТОЛОГИЕЙ","authors":"А. А. Куликов, Лео Антонович Бокерия","doi":"10.17650/1818-8338-2017-11-2-40-48","DOIUrl":"https://doi.org/10.17650/1818-8338-2017-11-2-40-48","url":null,"abstract":"The study objective is to examine electrophysiological parameters of atrial myocardium, characteristics of atrioventricular conduction, and potential factors affecting recurrent atrial fibrillation (AF) in patients with persistent and long-term persistent forms of AF prior to the Labirynth IIIB surgery with single-step correction of valvular heart disease. Materials and methods . The study included 100 adults (48 men, 52 women) with persistent and long-term persistent forms of AF and different valvular heart diseases. Mean patient age was 59 years. Mean AF duration was 4 years. All patients were prescribed antiarrhythmic therapy but it proved ineffective. In 15 % of patients, restoration of the sinus rhythm was attempted through electrical cardioversion but long-term control of the sinus rhythm wasn’t achieved. All patients were diagnosed with organic pathology of the mitral valve. Also, in 80 % of patients, relative insufficiency of the tricuspid valve was detected. Chronic heart failure functional class per NYHA was III. Size of the left atrium was 5 cm, mean left ventricular ejection fraction was 61 %. All patients underwent electrical cardioversion. After successful restoration of the sinus rhythm, endocardial electrophysiology study (EES) of the heart was performed. Then, correction of valvular pathologies and the Labyrinth IIIB surgery were performed. Results. Examination of refractoriness of different parts of the atriums has shown that effective refractory period (ERP) of the atrioventricular node was minimal compared to other parts of the atriums. Maximal ERP duration was observed in the upper part of the right atrium. Therefore, in patients with long history of AF, heterogeneity of atrial myocardium ERP duration is observed. In 17 % of patients, atrial vulnerability was detected. The area of atrial vulnerability was always associated with ERP. Its duration in patients with atrial vulnerability was significantly higher. Conclusion. Long-term mitral valve incompetence and persistent AF lead to anatomical and electrophysiological remodeling of the atriums, which manifests through increased volume of the left atrium, as well as increased duration of intra-atrial conduction and heterogeneity  of refractory periods. EES allows to evaluate these functions of the atrioventricular conduction system and atrial electrophysiological parameters: detect aberrations in conduction through atrial myocardium, dispersion of its refractoriness, and the area of atrial vulnerability. These factors can serve as predictors of AF recurrence.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"40-48"},"PeriodicalIF":0.0,"publicationDate":"2017-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47476617","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":"Значимость лабораторных показателей в прогнозировании исходов острого инфаркта миокарда","authors":"И. Е. Белая, В. И. Коломиец, Э. К. Мусаева","doi":"10.17650/1818-8338-2016-10-4-29-35","DOIUrl":"https://doi.org/10.17650/1818-8338-2016-10-4-29-35","url":null,"abstract":"The study objective is to validate a mathematical model for prognosis of progression of the acute period of myocardial infarction. Materials and methods . We examined 135 patients with acute Q-wave myocardial infarction of the left ventricle aged between 34 and 88 years (mean age 66, standard deviation 12 years), among them 64 women and 71 men. For prognosis of the outcome of the acute period of myocardial infarction we used an approach based on intellectual data analysis (data mining) in combination with mathematical methods based on decision trees. Results. Using decision tree algorithms, we singled out laboratory parameters (attributes) which were subsequently used as input. Adequacy of classification of these attributes was determined by a contingency table. Accuracy of the obtained calculation results was 95.56 % demonstrating good agreement between the model and observed data. In a decision tree visualization, the most significant 8 laboratory parameters were determined. Significance of NO 2 metabolite was 24.9 %, triglycerides – 16.7 %, urea – 14.8 %, erythrocytes – 11.2 %, alanine aminotransferase – 9.4 %, very low density lipoproteins – 9.4 %, creatinine – 8.5 %, prothrombin index – 5.1 %. In the Rules tab, only rules 4 and 9 can be used with confidence, because their confidence level approaches 100 %, and effect cost for the fact of death was 33.59 % and 32.03 %, respectively. Conclusion. Using a decision tree algorithm, we determined prognostically significant factors for progression of acute myocardial infarction. The following set of parameters predicts unfavorable outcome (death) with 95.56 % accuracy: NO 2 < level 22.755 mmol/l, triglycerides ≥ 1.565 mmol/l, erythrocytes < 4.91 M/uL, alanine aminotransferase < 1.23 mmol/l, urea < 7.05 mmol/l, very low-density lipoproteins < 0.965 mmol/l, creatinine ≥ 91.55 µmol/l, NO 2 level ≥ 22.755 mmol/l predicts a favorable outcome with 95.56 % accuracy.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"11 1","pages":"29-35"},"PeriodicalIF":0.0,"publicationDate":"2017-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44970023","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}