Kurume Medical Journal最新文献

{"title":"Histological Improvement of Hepatic Fibrosis of Decompensated Liver Cirrhosis after Prednisolone and Azathioprine Treatment in a Patient with Autoimmune Hepatitis.","authors":"Hiroyuki Suzuki, Keisuke Amano, Kanji Yamaguchi, Tomoya Sano, Teruko Arinaga-Hino, Jun Akiba, Atsushi Takahashi, Hiromasa Ohira, Atsushi Tanaka, Yoshito Itoh, Takumi Kawaguchi","doi":"10.2739/kurumemedj.MS7112007","DOIUrl":"10.2739/kurumemedj.MS7112007","url":null,"abstract":"<p><p>The treatment of the underlying cause of liver disease may potentially reverse hepatic fibrosis. However, it remains uncertain whether improvement in fibrosis can be observed in decompensated liver cirrhosis (LC). Here, we present a case of autoimmune hepatitis (AIH)-related LC in which histological improvement of fibrosis was achieved despite the presence of decompensated LC. A Japanese female in her 20s was initially identified as having liver function impairments during her employment medical checkup. Following a laparoscopic liver biopsy, she was diagnosed with AIH-related decompensated LC (F4 and A3) with a Child-Pugh score of 10. The patient initially received treatment with prednisolone at a daily dose of 40 mg, followed by 20 mg/day of prednisolone plus 25 mg/day of azathioprine (subsequent increase of azathioprine to 100 mg/day). With this treatment, the abnormal serum marker levels returned to normal, thereby enabling the patient to avoid liver transplantation eight months after the initiation of treatment. Moreover, marked improvement was observed in non-invasive tests for hepatic fibrosis, including the FIB-4 index and FibroIndex, as well as liver stiffness evaluated by FibroScan®. Eleven months after diagnosis, the patient developed a cholestatic liver injury and was diagnosed with drug-induced cholestatic liver disease (azathioprine overcapacity as the causative agent). By percutaneous liver biopsy at this point, hepatic fibrosis (F2-3) was markedly improved compared with that at the diagnosis. Along with the improvement of hepatic fibrosis, notable improvements were also observed in patient-reported outcomes such as the SF-36® score and chronic liver disease questionnaire. In this report, we first described a case of AIH that showed a histological improvement of hepatic fibrosis even in decompensated LC by treatment with prednisolone and azathioprine.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"69-74"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740835","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":"Umbilical Cord Cysts from the Second Trimester of Pregnancy: Clinical Insights from 12 Cases of a 22-year Study in a Single Tertiary Center.","authors":"Aki Tetsuo, Megumi Muto, Masato Yokomine, Hironobu Kashiwada, Takashi Horinouchi, Toshiyuki Yoshizato, Naotake Tsuda","doi":"10.2739/kurumemedj.MS7112008","DOIUrl":"10.2739/kurumemedj.MS7112008","url":null,"abstract":"<p><p>This study aimed to explore the clinical characteristics of umbilical cord cysts (UCCs) detected from the second trimester onwards in a single tertiary center over a 22-year period. The subjects consisted of a total of 12 cases of UCCs among 11 pregnant women (10 singleton pregnancies and 1 twin pregnancy), diagnosed at ≥ 14 weeks of gestation, and managed at Kurume University Hospital from 2000 to 2021. The maternal backgrounds, characteristics of the cysts, including their location, numbers, sizes, associated fetal/neonatal findings, and outcomes, were analyzed retrospectively. The median maternal age was 28 years, with diagnosis at 18.5 gestational weeks. Cysts were found near the umbilical ring (8 cases), in a free loop (3 cases), and in both of these locations (1 case). Single cysts appeared in 8 cases, and multiple cysts in 4 cases, with the median diameter being 25.0 mm. Sizes varied by gestation, being larger near the umbilical ring without correlation to cyst number. Among the 9 cases with cysts located near the umbilical ring, 5 cases had fetal abnormalities, including trisomy 18 (2 cases), Beckwith-Wiedeman syndrome (1), and intrauterine fetal death (1). Urachal remnants were found in 4 cases and omphalomesenteric duct remnants in 1 case after birth. When UCC is observed, particularly a cyst located near the umbilical ring, comprehensive fetal ultrasound screening is necessary, and attention should be paid to fetal anomalies that may coexist. In cases where these are not identified prenatally, the presence of conditions such as urachal remnants needs to be considered.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":"43-49"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740878","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":"Investigating the Relationship between Pineal Calcification, Melatonin Secretion, Bone Mineral Density, and Arteriosclerotic lesions in Human Cadavers.","authors":"Kunimitsu Nooma, Tsuyoshi Saga, Joe Iwanaga, Yoko Tabira, Aya Han, Koichi Watanabe","doi":"10.2739/kurumemedj.MS7134012","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7134012","url":null,"abstract":"<p><p>In this study, we investigated the histological examination of the pineal gland, the degree of brain sand accumulation, and the state of pineal cells by immunohistochemistry using melatonin antibodies in 20 corpses aged between 59 and 98 years. We also investigated changes in the bone mineral density of the calcaneus and the degree of arteriosclerotic lesions of the ascending aorta and evaluated the relationship between them. In the cadavers examined in the present study, the size of the pineal gland did not differ from that described in previous studies. However, there was no statistically significant association between the degree of brain sand formation and age or sex, and a negative correlation was found between the degree of brain sand accumulation and the number of melatonin antibody-positive cells. The higher the degree of accumulation of brain sand in the pineal gland, the lower the bone density of the calcaneus. Furthermore, the higher the accumulations of cerebral sand in the pineal gland, the higher the aortic arteriosclerotic lesions. These results suggest that the pineal cell depletion that occurs with brain sand accumulation probably reduces bone density, which in turn affects calcium metabolism, possibly leading to arteriosclerotic lesions.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576593","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":"Psychological Distress among Japanese University Students after Parental Bereavement.","authors":"Teiko Yoshizuka, Shuichi Ozono, Ryuta Ishii, Hitoshi Obara, Kenta Murotani, Shinichiro Nagamitsu, Yushiro Yamashita, Tatsuki Mizuochi","doi":"10.2739/kurumemedj.MS7134011","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7134011","url":null,"abstract":"<p><p>Although parental bereavement during childhood or adolescence increases the risk of depression, few studies focus on young adult Japanese who have lost a parent. This study investigates the risk of psychological distress among Japanese young adults who experienced parental bereavement during childhood or adolescence (bereavement group), comparing their mental health with non-bereaved students (control group). A questionnaire survey was performed on 6385 students at A University, following the Japanese version of Kessler 6 (K6) to assess psychological distress. In total, 1508 students (42 in the bereavement group, 1185 in the control group) provided responses to the questionnaires, 1227 were analyzed, excluding those who did not respond the bereavement question. As a result, no statistically significant differences in the levels of psychological distress were observed between the bereavement and control groups. However, it can be confirmed that some factors influencing the total score of K6. Higher psychological distress in the bereavement group was significantly associated with medical faculty affiliation (β = 4.416, p = 0.050) and low caregiver income (β = 4.491, p = 0.042). Elevated distress levels in the control group were linked to non-medical faculty affiliation (β = -1.579, p < 0.001) and a history of psychiatric disorders (β = 7.094, p < 0.001). These findings emphasize the need for tailored psychological support targeting specific groups. Further research is required to validate the relationship between parental bereavement and mental health, and it is noteworthy that economic and psychological support is crucial for university students who have experienced parental bereavement.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576594","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":"Anatomical Variations of the Iliopsoas Muscle.","authors":"Yoko Tabira, Joe Iwanaga, Aya Han, Seiichi Inoue, Tatsuya Harano, Keigo Shimizu, Mitsuru Tanaka, R Shane Tubbs, Koichi Watanabe","doi":"10.2739/kurumemedj.MS7134010","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7134010","url":null,"abstract":"<p><p>Anatomical variations of the iliopsoas muscle are relatively uncommon but are clinically significant because of the muscle's relation to the femoral nerve (FN). Variants of the iliopsoas include accessory iliacus, iliacus minimus, psoas tertius, and psoas quartus muscles. This study describes anatomical findings of these variants. Dissections of the posterior abdominal wall in 95 Japanese cadavers at Kurume University School of Medicine (2015-2017) identified three cases of iliopsoas muscle variants. In the first case, a small variant muscle on the right side of a 91-year-old female cadaver originated from the iliolumbar ligament, pierced the FN, and joined the psoas major muscle (PMa). In the second case, a variant muscular slip was identified on the left side of a 78-year-old female cadaver. The slip originated from the anterior aspect of the middle part of the iliac crest and pierced the FN. The muscle joined the tendon of the PMa. Both cases were categorized as variations of the iliacus muscle (IM) and were called iliacus minimus muscles. In the third case, a bilateral variant muscle was noted in a 74-year-old male cadaver. The muscles mainly originated from the surface of the quadratus lumborum muscle. The variant muscle called the psoas quartus muscle, traveled posterior to the FN and united with the normal PMa and IM. This variation is seemingly very rare. A thorough understanding of these morphologic variations is essential for the accurate diagnosis and treatment of femoral nerve disorders and for safe lumbar and abdominal surgery.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303146","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":"Development of Thyrotoxicosis With Positive TSH Receptor Antibody and Transition to Hypothyroidism in a Patient With Unresectable Hepatocellular Carcinoma During Combined Atezolizumab and Bevacizumab Therapy: A Case Report and Review of the Literature.","authors":"Ryutaro Hidaka, Yuji Hiromatsu, Narihito Tatsumoto, Takahiro Fukuyama, Yoko Sagara, Aira Uchida, Hidekazu Tamai, Masayuki Tojikubo, Yuko Akehi, Eiji Kawasaki, Hiroki Nakamura","doi":"10.2739/kurumemedj.MS7134008","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7134008","url":null,"abstract":"<p><p>A 65-year-old male with multiple hepatocellular carcinomas underwent hepatic artery chemoembolization in March X and was administered lenvatinib. In July X, 2 weeks after the initiation of this treatment, he developed latent hypothyroidism. However, he showed no response to these treatments. Consequently, a combination therapy consisting of an anti-programmed cell death protein-ligand 1 (PD-L1) antibody (atezolizumab) plus bevacizumab, administered every 3 weeks, was initiated in March X+1. During three cycles of this combination therapy, the patient developed thyrotoxicosis. Graves' disease (GD) was suspected by TSH receptor antibody (TRAb) positivity and diffuse uptake in thyroid scintigraphy, although ^99mTcO₄^- uptake was normal. He was treated with methimazole. Notably, the hyperthyroidism was transient, rapidly transitioning to hypothyroidism. The emergence of GD during treatment with immune checkpoint inhibitors (ICPi) is a rare occurrence. To date, 26 cases of new-onset GD and/or thyroid eye disease (TED) have been reported. Approximately 71% of patients develop GD and/or TED within 3 months following the initiation of ICPi treatment. They quickly transition to a hypothyroid state, necessitating levothyroxine therapy. Furthermore, the presence of thyroid autoantibodies at baseline has been identified as a significant risk factor for thyroid immune-related adverse events (irAEs), highlighting the need for baseline measurements of these autoantibodies before treatment. Future prospective studies and further case report accumulations are essential to elucidate the role of thyroid irAEs during the combined therapy of ICPi and molecularly targeted drugs in advanced carcinoma cases.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303148","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":"Comparing Delirium Incidence and Length of Stay in Cardiovascular Procedures Before and After Coronavirus Disease 2019 Family Visitation Restrictions: A Single-Center Cohort Study.","authors":"Jun Kawabata, Kotaro Kuwaki, Tohru Takaseya, Naoki Itaya, Shinichi Tanihara","doi":"10.2739/kurumemedj.MS7134009","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7134009","url":null,"abstract":"<p><strong>Background: </strong>The impact of visitation restrictions due to the coronavirus disease (COVID-19) pandemic remains uncertain. This study examined delirium incidence and length of hospital stay of patients who underwent coronary artery bypass grafting, percutaneous coronary intervention, and transcatheter aortic valve implantation before and after visitation restrictions.</p><p><strong>Methods: </strong>The visitation restriction group (RG) included patients admitted and discharged between April 1, 2020, and March 31, 2022, whereas the non-restriction group (Non-RG) included those between April 1, 2018, and March 31, 2020. A chi-square test and sensitivity analysis were conducted to compare delirium incidence. The Mann-Whitney U test was used to compare the median length of stay. We conducted a multivariate logistic regression analysis to examine the association between delirium incidence and visitation restrictions and performed a subgroup analysis.</p><p><strong>Results: </strong>There was no significant difference in delirium incidence between Non-RG and RG (0.7% vs. 2.1%, P=0.083), as supported by the sensitivity analysis (3.3% vs. 2.1%, P=0.29). The length of stay significantly differed between Non-RG and RG (14 vs. 16 days, P=0.021). The odds ratios for delirium incidence, visitation restriction, emergency admission, and daily living level II were 2.46 (1.11-5.84), 3.65 (1.65-8.31), and 18.2 (3.45- 78.8), respectively. In the subgroup analysis, increase in sleep medications and discharge support were observed in high-risk patients.</p><p><strong>Conclusion: </strong>The analyses revealed no significant differences in delirium incidence between Non-RG and RG; however, the length of stay slightly increased. Delirium support and strategies for patient well-being during a pandemic are warranted.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303147","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":"Pulmonary Metastasis after Resection for Gastrointestinal Stromal Tumor in the Rectum.","authors":"Seiko Harada, Shinzo Takamori, Daigo Murakami, Yusuke Uchida, Masaki Kashihara, Fumihiko Fujita, Takefumi Yoshida, Kenichi Koushi, Toshihiro Hashiguchi, Masahiro Mitsuoka, Yoshito Akagi","doi":"10.2739/kurumemedj.MS7134003","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7134003","url":null,"abstract":"<p><p>A 71-year-old woman who had received resection for gastrointestinal stromal tumor (GIST) in the rectum after imatinib mesylate administration, revealed a pulmonary nodule measuring 11 × 10 mm in the right lung on chest computed tomography (CT), which was 26 months after the operation. The pulmonary nodule had gradually increased to 13 × 13 mm in diameter on follow-up chest CT. The standardized uptake value (SUV) of the pulmonary nodule on positron emission tomogram (PET) with 2-fluoro-2-deoxy-D-glucose (FDG) was 1.8. For diagnostic and therapeutic purposes, thoracoscopic partial resection of the lung, including the nodule, was performed. The pathological findings showed pulmonary metastasis from rectal GIST. On immunohistochemical examination, the tumor was diagnosed as the high-risk group, whereas the primary site in the rectum was the lowrisk group according to the Modified Fletcher classification. Imatinib mesylate was administered again, but her disease progressed. Although pulmonary metastasis from rectal GIST is a rare disease with a possible poor prognosis, pathological diagnosis should be essential to deciding treatment modality.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303150","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":"Rectal Metastasis from Early-Stage Endometrial Carcinoma Not Associated with Endometriosis: A Case Report and Literature Review.","authors":"Blagica Krsteska, Vladimir Risteski, Ana Jovceva, Svetozar Antovic","doi":"10.2739/kurumemedj.MS7134005","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7134005","url":null,"abstract":"<p><strong>Objective: </strong>Endometrial cancer (EC) is the third most common malignancy in woman with excellent prognosis when diagnosed in early-stage. Recurrences are extremely rare in Stage I EC especially in rectum when not associated with endometriosis. We present a case of rectal metastasis from endometrial carcinoma after 8 years of primary diagnosis. A review of the literature showed only 6 published cases.</p><p><strong>Case presentation: </strong>Herein we present a 59-year-old woman with a rectal tumor mass. The patient before 8 years was surgically treated for EC Stage IA with bilateral salpingo-oophorectomy and hysterectomy. After ultra-low anterior resection rectum was removed with the tumor. Histology revealed adenocarcinoma with positive immunohistochemistry for CK7, ER, PAX8, Vimentin which confirmed endometrial origin. Endometriosis was not found.</p><p><strong>Conclusion: </strong>Although rectum is a rare site of recurrence from endometrial cancer, rectal tumors should be sampled carefully. Previous patient history and positive immunohistochemistry for EC are in favor of recurrent disease. Screening of colorectal carcinoma should be performed in patients with previous gynecologic diagnosis. Further genetic analysis in bigger case series is needed in order to explain the time and the site of recurrence of early-stage endometrial carcinoma.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303151","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":"Painful Os Peroneum Syndrome: An Unusual Diagnosis.","authors":"Pedro Henrique Segatt, José Luiz Masson DE Almeida Prado, Márcio Luís Duarte","doi":"10.2739/kurumemedj.MS7134006","DOIUrl":"https://doi.org/10.2739/kurumemedj.MS7134006","url":null,"abstract":"<p><p>The painful Os peroneum syndrome is subdivided into acute and chronic cases. The acute presentation is usually caused by trauma, most commonly a supination or inversion of the ankle, which consequently can lead to a fracture of the Os peroneum or even a rupture of the peroneus longus tendon. Furthermore, its chronic presentation comes as a result of recurrent foot injuries or even recovery from a fracture with calcification remodeling of this sesamoid bone. The problem of underdiagnosing this disease lies in the consequences attached to the remodeling of the peroneus longus tendon with its calcification, or even leading to a picture of tenosynovitis and subsequent tendon rupture. We report a 55-year-old female patient who complains of pain in the lateral region of her right foot for ten days. The right foot X-ray detected the presence of \"Os peroneum.\" Magnetic resonance imaging (MRI) shows edematous ossification in the peroneus longus tendon compatible with Os peroneum and with swelling of the surrounding soft tissue and tendinopathy of the peroneus longus, precisely in the region indicated by the skin marker. The set of findings is compatible with painful Os peroneum syndrome. The patient was treated with a non-steroidal anti-inflammatory for five days with the resolution of symptoms.</p>","PeriodicalId":39559,"journal":{"name":"Kurume Medical Journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303149","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}