Transplant Research and Risk Management最新文献

{"title":"Tacrolimus Trough Level Variation and Its Correlation to Clinical Outcomes and Consequences in Solid Organ Transplantation","authors":"Sarah Albilal, M. Shawaqfeh, Salwa Albusaysi, Lolwa Fetyani, Fai Alnashmi, Shaden D Alshehri, Nataleen A Albekairy, Amal Akhulaif, L. Alzahrani, Mariah Alwuhayde, A. Obaidat, Abdulkareem M. Al Bekairy","doi":"10.2147/trrm.s415385","DOIUrl":"https://doi.org/10.2147/trrm.s415385","url":null,"abstract":"","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45318662","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":"Kidney Transplant Recipients with JC Virus Infection Have Decreased Function of the Transplanted Kidney","authors":"Ho Trung Hieu, B. T. Sy","doi":"10.2147/trrm.s384595","DOIUrl":"https://doi.org/10.2147/trrm.s384595","url":null,"abstract":"Purpose: We conducted a survey on the status of patients after kidney transplantation infected with JC virus (JCV), at 108 Military Central Hospital (108MCH), Vietnam, combining research on the effects of JCV infection on transplanted kidney function and understanding the risk factors for JCV infection in kidney transplant recipients. Patients and Methods: A single-center cohort study was conducted in the period from March 2021 to July 2022, using a combination of retrospective and prospective methods, with longitudinal follow-up of 94 eligible kidney transplant patients who agreed to participate, at the Department of Nephrology and Dialysis, 108MCH, Vietnam. Patients undergo monthly health checks and have their blood and urine tested by a real-time PCR method, with TaqMan probes (BioRad, USA). If at least one of the two specimens (blood or urine sample) is positive for JCV (when JCV is quantified in blood or urine samples at >250 copies/mL), the patient is confirmed to have JCV infection in any part or tissue of the body. Factors of JCV infection, such as age, gender, donor source, and immunosuppressive therapy, along with demographic and clinical data and JCV infection status, were analyzed using multivariable Cox-regression analysis. The estimated glomerular filtration rate (eGFR) was selected as an indicator of kidney function, and the difference in eGFR between JCV-infected patients and non-infected patients was compared using the t -test. This study was approved by the Research Ethics Committee. Results: JCV was detected in 71.3% of kidney transplant patients. Differences in eGFR were observed between the JCV-infected and non-infected patient groups (64.47±25.70 and 70.89±28.80 mL/min/1.73 m 2 for each group; independent t -test; t =−6.079; p =0.00). Factors such as kidney donor (HR=0.086; 95% confidence interval [CI]: 0.008–0.936; p =0.04), tacrolimus trough level (HR=1.083; 95% CI: 1.069–1.097; p =0.00), mycophenolate dose (HR=1.002; 95% CI: 1.002–1.001; p =0.00) and prednisone dose (HR=1.001; 95% CI: 1.000–1.001; p =0.00) in the trio of immunosuppressants tacrolimus + mycophenolate mofetil (MMF) + prednisone (multivariable Cox-regression analysis) are potential risk factors for JCV infection in renal transplantation. JCV infection in kidney transplant patients lowers the eGFR, leading to decreased transplant kidney function (independent t -test, p =0.00). Conclusion: The level of JCV infection in kidney transplant patients in our study is quite high (71.3%). Using an immunosuppressive regimen that uses the trio of immunosuppressants tacrolimus + MMF + prednisone, and having a donor source element are potential risk factors for JCV infection in renal transplantation. The function of the transplanted kidney is reduced by JCV infection in kidney transplant patients in the short term. The timely diagnosis and treatment of JCV can ensure the stable and long-term function of transplanted kidneys in kidney transplant patients. initially to dete","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42605483","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":"A Unique Case of Tacrolimus-Induced Dysphagia and Dysarthria in the Absence of Diagnostic Findings","authors":"Skyler L Kanegi, George D Crane, K. Scott, E. Thomas","doi":"10.2147/trrm.s378778","DOIUrl":"https://doi.org/10.2147/trrm.s378778","url":null,"abstract":": Tacrolimus is a cornerstone immunosuppressant with high efficacy in preventing graft rejection in liver recipients. However, neurotoxic side effects such as posterior reversible encephalopathy syndrome (PRES) may occur. Patients often exhibit seizures, encephalopathy, headache, and hypertension. This case describes a 68-year-old female who received deceased donor liver transplantation and was started on an immunosuppressive regiment of tacrolimus which was adjusted to therapeutic trough. Graft function was preserved throughout post-operative course. The patient experienced a prolonged intubation period complicated by failed spontaneous breathing tests until post-operative day (POD) 8. From POD 8–16, the patient experienced dysphagia. From POD 13–16, the patient exhibited altered mental status and dysarthria. Throughout presentation of these symptoms, the patient had no radiographic findings, lab findings, or hypertension. On POD 15, tacrolimus was discontinued in favor of cyclosporine. By POD 17, the patient experienced complete resolution of her encephalopathy, dysphagia, and dysarthria. The patient was discharged on POD 24. This is the first known case of dysphagia and dysarthria as major presenting symptoms of tacrolimus toxicity. Discontinuing tacrolimus in favor of cyclosporine can successfully resolve a constellation of neurotoxic symptoms that do not fit a classic picture of PRES.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44135002","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":"Predictive Value of Delayed Graft Function Definitions Following Donation After Circulatory Death Renal Transplantation in the United Kingdom","authors":"H. Stirnadel-Farrant, G. Mu, Selin Cooper-Blenkinsopp, R. Schroyer, K. Thorneloe, E. Harrison, S. M. Andrews","doi":"10.2147/trrm.s320221","DOIUrl":"https://doi.org/10.2147/trrm.s320221","url":null,"abstract":"Purpose: A variety of definitions for delayed graft function (DGF) have been proposed, but none has consistently been shown to be superior for predicting long-term graft outcomes for kidney donation after circulatory death (DCD) transplantation. In this study, real-world clinical outcome data following DCD transplantation were explored to determine the value of various DGF definitions for predicting graft survival. Patients and Methods: Data from 4 centers registered in the UK-based National Health Service Blood and Transplant registry (2010 to mid-2015) were used to assess 4 definitions of DGF in this retrospective chart review study. Results: Depending on the definition used, the frequency of DGF ranged from 119/362 (32.9%) when DGF was determined with available registry data and based on a requirement for dialysis within 7 days post-transplantation, to 224/315 (71.1%) when based on failure to achieve a 10% fall in serum creatinine (SCr) versus baseline per 24 hours averaged over the first 72 hours. Patients without clinical DGF as determined by a physician upon chart review, or when defined as <30% reduction in baseline SCr within 7 days post-transplantation with or without dialysis, had significantly better graft survival probability 1 year (hazard ratio 2.08 and 4.48, respectively) and 5 years post-transplant, whereas serum creatinine level over the first 72 hours post-transplant was not predictive of graft survival at 1 year. Patients with clinical DGF upon physician chart review also had higher SCr, lower estimated glomerular filtration rate levels, and were dialyzed more (2.3 days) versus patients without (0.2 days). Conclusion: Delayed graft function, determined clinically or using a functional definition, is associated with poorer renal function and remains a useful predictor of graft survival at 1 year after DCD kidney transplantation. not have DGF by these definitions had better kidney function at 30 days and at 1 year following their transplant. In conclusion, DGF using these definitions may help to predict long-term outcomes after DCD kidney transplantation.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45443717","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":"Prophylaxis of Cytomegalovirus Infection in Solid Organ Transplantation, Retrospective Evaluation","authors":"Abdulkareem M. Albekairy, M. Shawaqfeh, Shroug H Alharbi, Faisal Almuqbil, Mesfer A Alghamdi, Nataleen A Albekairy, S. Muflih, Abdulmalik A Alkatheri","doi":"10.2147/trrm.s366213","DOIUrl":"https://doi.org/10.2147/trrm.s366213","url":null,"abstract":"Introduction: Cytomegalovirus infection is one of the opportunistic infections that occur within the first year of solid organ transplantation (SOT). Antiviral prophylaxis like valganciclovir is recommended for organ transplant recipients if the donors are seropositive. The study aims to assess the association between compliance with CMV prevention guidelines and the incidence of CMV infection post kidney and liver transplantation. Methods: A single-center, cross-sectional chart review study was conducted at a tertiary care facility. The study included patients with liver and/or kidney transplantation and received valganciclovir for CMV prevention. The primary endpoint is to determine the incidence of CMV post SOT. The secondary endpoint is to assess the association between compliance with the CMV prevention guidelines and the incidence of CMV infection. Descriptive statistics were used to report the incidence of CMVand logistic regression for risk factor comparisons. The study was approved by the Institutional Review Board. Results: A total of 493 patients had a mean age of 48.6 ± 15.3 years were included. For the primary endpoint, there were a total of 257 patients with CMV occurrence (52.1%). For the secondary endpoint, there was no statistically significant association between CMV incidence and starting CMV prophylaxis agent post-transplantation within 10 days post-transplant (p < 0.75) and duration of CMV prophylactic medications (p < 0.47). In this study, the cases of CMV disease that occurred within 3–6 months following completion of antiviral prophylaxis were in 28% of the patients. Other factors associated with increased risk of CMV infection were evaluated. Conclusion: We found about 28% of CMV infection cases occurred within 3–6 months following completion of antiviral prophylaxis. This was attributed to non-adherence to prophylaxis guidelines. The study has shown that there is a need for improvement in clinical practice. Future studies should address the optimal duration of the CMV prophylaxis. to identify the factors associated with the development of CMV among transplant patients. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were established. The statistical significance was set as α=0.05. All statistical analyses were performed using Statistical Package for Social Sciences version 24.0 (SPSS 24.0).","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47227709","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":"Amniotic Membrane Transplantation an Experience of a Locally Prepared Tissue","authors":"N. Al-Yousuf, Hasan Alsetri, E. Farid, S. George","doi":"10.2147/trrm.s336917","DOIUrl":"https://doi.org/10.2147/trrm.s336917","url":null,"abstract":"Purpose: To describe the method used locally in amniotic membrane preparation and preservation for ocular surface reconstruction. To report the indications, surgical techniques, outcome and complications of amniotic membrane transplant using the locally prepared tissue. To examine the safety and efficacy of this less commonly studied method in amniotic membrane banking technique. Patients and Methods: Dimethylsulphoxide (DMSO) was used for the preparation and preservation of the amniotic membrane. A retrospective study was done from 2005 to 2017 to examine the indications of amniotic membrane transplant. The surgical techniques used for different indications are described. Surgical outcome and complications are reported. Results: The prepared tissue was used for the surgical management of a variety of disorders related to the ocular surface. Over the 12 years period from 2005 to 2017, a total of 135 cases were done. The most common indications for amniotic membrane transplant were pterygium surgery (41%), non-healing corneal ulcer (24%), others (13%), corneal perforation (10%), chemical burn (7%), bullous keratopathy (3%) and conjunctival-corneal scarring (2%). The most common surgical procedures used were inlay, overlay and combination (sandwich) techniques. Success rates for this ocular structure restoration procedure were the highest when treating corneal ulcers (81%), followed by pseudophakic bullous keratopathy (75%), then corneal perforations (70%). The recurrence rate for pterygium with amniotic membrane transplant was 14%. The most common complication was repeat amniotic membrane transplant. There were no complications related to the banking technique. Conclusion: This method of preparation and preservation of amniotic membranes is safe and effective for ocular surface disorders. Amniotic membrane transplants have high success rates when treating, corneal ulcers, corneal perforations, pseudophakic bullous and epidermolysis bullosa.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45542948","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":"Assessment of Risk Factors Associated with Bone and Mineral Disease Post-Renal Transplantation: “The Experiences of Two Centers”","authors":"Nouf E AL-Otaibi, Abdulmalik S. Alotaibi, Nataleen A Albekairy, M. Shawaqfeh, Moawad Alotaibi, Shmeylan Alharbi, Abdulmalik A Alkatheri, Abdulkreem M Albekairy","doi":"10.2147/trrm.s338844","DOIUrl":"https://doi.org/10.2147/trrm.s338844","url":null,"abstract":"","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45838027","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":"Changes in the Composition and Function of the Human Salivary Microbiome After Heart Transplantation: A Pilot Study","authors":"Heidi Joyce, M. R. Taylor, Andrew Moffat, Miao Hong, D. Isaac, N. Fine, S. Greenway","doi":"10.2147/trrm.s328467","DOIUrl":"https://doi.org/10.2147/trrm.s328467","url":null,"abstract":"Introduction: Interactions between our commensal microbes and immune system are well recognized but the impact of immunosuppression on this relationship is less well character-ized, particularly outside of the gastrointestinal tract. In this pilot case-control study, we examined microbial composition and inferred function in the saliva of patients after heart transplantation. Methods: Saliva samples were collected from 26 healthy adolescent and adult heart transplant patients and 27 healthy non-transplant controls. Bacterial DNA was isolated and the V3 and V4 regions of the 16S rRNA gene were sequenced. Measures of bacterial diversity and inferred function were calculated using the software packages DADA2, Phyloseq, QIIME, PICRUSt and STAMP. Results: Transplant patients were on average 51.6 ± 18.2 years of age and 8.6 ± 5.3 years post-transplant. Both alpha (p = 0.0009) and beta (p = 0.001) diversity differed significantly between the groups, and there were statistically significant changes (p < 0.01) in 101 individual functional pathways. Discussion: We conclude that the effects of chronic immunosuppression on bacterial composition and function in the oropharynx appear relatively subtle with no obvious ill effects on patient health. Full interpretation is limited by our lack of knowledge for many of the bacterial functional pathways. tract. We studied microbial composition and inferred function in the saliva of patients after heart transplantation compared to healthy non-transplant controls. Bacterial diversity differed significantly between the groups and there were statistically significant changes in multiple individual functional pathways. We conclude that immune suppression has broad but subtle effects on the oral microbiome.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41534463","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":"Characteristics and Outcomes of Cytomegalovirus Infection in Seropositive Kidney Transplant Recipients in the Era of Antiviral Prophylaxis with Valacyclovir: A Single-Center Study in Morocco","authors":"Bouchra Rezzouk, T. Bouattar, B. Belkadi, R. Razine, R. Bayahia, N. Ouzeddoun, L. Benamar, H. Rhou, N. Bouihat, A. Ibrahimi, M. Seffar, H. Kabbaj","doi":"10.2147/TRRM.S278655","DOIUrl":"https://doi.org/10.2147/TRRM.S278655","url":null,"abstract":"Purpose: Despite the use of antiviral prophylaxis with valacyclovir, cytomegalovirus infection (CMV) can still occur in seropositive kidney transplant recipients. In this study, we aimed to assess the incidence of CMV DNAemia and its risk factors in Moroccan transplant recipients. Patients and Methods: Sixty kidney recipients with positive cytomegalovirus serostatus, receiving post-transplant prophylaxis were enrolled between 2013 and 2017. In total, 455 plasma samples were collected and tested for CMV DNAemia using PCR-based Abbott RealTime assays. Results: The incidence of CMV infection in seropositive patients was 63%. In patients with quantifiable DNAemia, the duration of CMV infection was significantly shorter than in those with detectable DNAemia (141.5 ± 96.9 vs 294.1 ± 112.6 days, P < 0.001). During prophylactic treatment, 14 of 30 patients (47.0%) experienced active replication with quantifiable DNAemia, whereas none of eight patients with detectable DNAemia did ( P = 0.017). Patients with symptomatic DNAemia were significantly younger than those without symptoms (28.8 ± 5.12 vs 38.1 ± 12.34 years, P = 0.007). The peak viral loads were significantly associated with viral disease (odds ratio: 3.39, 95% confidence interval: 1.21–9.53, P = 0.02). The duration of DNAemia (21.2 vs 13.4 days, P = 0.028) was significantly longer in symptomatic patients. Significantly higher rates of acute rejection were exclusively observed in recipients with disease (4/8, 50% vs 0/22, 0%, P = 0.003). Conclusion: Patients with high-level DNAemia were at an increased risk of progression to disease and acute rejection. Monitoring the viral load during the first year post-transplantation is essential, to support current preventive strategies. was statistically significant. Abbreviations: SD, standard deviation; HLA, human leukocyte antigen.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47304581","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":"Risk Factors of Pleural Effusion Following Pediatric Liver Transplantation and the Perioperative Outcomes","authors":"Chollasak Thirapattaraphan, Prapatsorn Srina, Ampaipan Boonthai, N. Arpornsujaritkun, B. Sakulchairungrueng, W. Apinyachon, S. Treepongkaruna","doi":"10.2147/trrm.s276511","DOIUrl":"https://doi.org/10.2147/trrm.s276511","url":null,"abstract":"Background: Pediatric liver transplantation (LT) has been accepted as a definitive treatment for end-stage liver disease. Pleural effusion is a common pulmonary complication following LT in children. The objectives of the study were to identify prevalence of post-LT pleural effusion, risk factors, and the impact on patients’ outcomes. Methods: A retrospective study was conducted in 107 pediatric patients who underwent LT at our center between March 2001 and June 2018. They were categorized into pleural effusion and non-pleural effusion groups. Preoperative and perioperative data, intraoperative findings, liver graft characteristics, and perioperative outcomes were compared between the two groups. Results: Post-LT pleural effusion occurred in 64 (59.8%) patients. There were more patients with PELD score ≥ 18 in the pleural effusion group (68.8 vs 48.8%, P =0.039). Other preoperative and perioperative data were not significantly different. The pleural effusion group had a higher rate of reoperation than non-pleural effusion group (55.6 vs 30.9%, P =0.013). Median oxygen dependence time, length of ICU and hospital stay were significantly longer in the pleural effusion group (18.5 vs 7.0, 10 vs 7 and 48 vs 34 days, respectively, P <0.05). However, mortality was not significantly different. Among the patients with pleural effusion, median time to extubation, oxygen dependence time, length of ICU and hospital stay were significantly longer in those who required therapeutic interventions than those without interventions (12 vs 3, 31 vs 10, 17 vs 8, and 60 vs 43 days, respectively, P <0.05). Conclusion: Pleural effusion following pediatric LT is common and its potential risk factor is PELD score at LT ≥ 18. Post-LT pleural effusion is associated with prolonged oxygen dependence time, ICU stay and hospital stay, particularly those who required therapeutic interventions.","PeriodicalId":41597,"journal":{"name":"Transplant Research and Risk Management","volume":"1 1","pages":""},"PeriodicalIF":0.9,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41729460","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}