Journal of Obstetrics and Gynecology of India最新文献

{"title":"Pregnancy Outcome in Women Aged 40 Years and Above: A Cross Sectional Study.","authors":"Natasha Gupta, Anubhuti Rana, Vatsala Dadhwal, Aparna K Sharma, Sunesh Kumar, Vanamail Perumal, Nitesh Kumar","doi":"10.1007/s13224-025-02214-5","DOIUrl":"10.1007/s13224-025-02214-5","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective was to evaluate maternal and neonatal outcomes in pregnant women aged 40 years or older, compared to those aged 35-39 and 20-34 years. The secondary objective was to assess caesarean section rates and indications in the same age groups.</p><p><strong>Methodology: </strong>This retrospective case-control study was conducted at the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, from January 2014 to July 2020.After taking ethical clearance, pregnant women who delivered after 24 weeks of gestation from January 2014 to July 2020 were recruited in this study and divided into three groups: 40 years and above (group A), 35-39 years (group B), and controls aged 20-34 years (group C). Multiple pregnancies were excluded. 43 pregnant women aged 40 years & above and 99 pregnant women aged 35-39 years who delivered during the study period were included in groups A and B respectively, while 100 control cases were randomly allocated to group C. Their case records were analysed Statistical analyses included t-tests/ANOVA for continuous variables and Chisquare/Fisher's exact tests for categorical data, with <i>p</i> < 0.05 considered statistically significant.</p><p><strong>Results: </strong>Infertility was highest in women aged ≥ 40 years (30.23%, <i>p</i> < 0.05), and ART conception rates were elevated in women aged 35-39 years as compared to other two groups (16.27%). Gestational diabetes mellitus (GDM) was significantly more common in women aged ≥ 40 years (44.18%, <i>p</i> < 0.001), while preeclampsia, though more frequent in women aged 35-39, was not statistically significant across groups. Intrahepatic cholestasis of pregnancy was most prevalent in Group B (17.17%, <i>p</i> < 0.05). There were no significant differences in anemia rates or fetal growth restriction (FGR) among groups, though FGR was highest in women aged ≥ 40 years. Preterm birth rates also did not differ significantly. NICU admissions were highest in Group B (18.18%) but were not statistically significant. Vaginal delivery rates were highest in Group C (41%), with significantly lower rates in Group A (16.27%, <i>p</i> < 0.05). Group A had no instrumental deliveries, while Groups B and C had similar rates (3.30% and 3%, <i>p</i> = 0.514). Elective caesarean sections were significantly more common in women aged 35-39 (68.18%) than in those ≥ 40 years (51.16%) or aged 20-34 years (33.33%, <i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Maternal age significantly influences obstetric outcomes, with higher risks of GDM, infertility, and lower vaginal delivery rates in older women. These findings highlight the need for age-specific management to improve maternal and neonatal outcomes.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 4","pages":"325-331"},"PeriodicalIF":0.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unrepaired Total Anomalous Pulmonary Venous Connections Complicating Adult Pregnancy.","authors":"Kamal Patil, Simran Pachnanda, Shivaraj Patil, M C Metgud, Veeresh Manvi, Madhav Prabhu","doi":"10.1007/s13224-025-02132-6","DOIUrl":"10.1007/s13224-025-02132-6","url":null,"abstract":"<p><p>Incidentally, diagnosed unrepaired cyanotic complex congenital heart disease in adult pregnancy is rare. We report a case of asymptomatic total anomalous pulmonary venous connection in a 23-year-old primigravida who had an abnormal cardiac examination and electrocardiogram on presentation. She underwent an echocardiogram which revealed the underlying cardiac anomaly. The pregnancy course was complicated by the preterm onset of labor requiring urgent lower segment cesarean section with successful delivery of the fetus.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 4","pages":"361-363"},"PeriodicalIF":0.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges in Prenatal Diagnosis and Therapy of Congenital Adrenal Hyperplasia in India: Balancing the Act.","authors":"Satish Choudhury, Avantika Gupta, Chetan Khare","doi":"10.1007/s13224-025-02294-3","DOIUrl":"10.1007/s13224-025-02294-3","url":null,"abstract":"<p><p>Congenital adrenal hyperplasia (CAH) is a serious autosomal recessive disorder that can lead to virilization in female fetuses, salt-wasting crises, and long-term health complications. Prenatal diagnosis using CYP21A2 gene testing and fetal sex determination enables early initiation of dexamethasone therapy to prevent irreversible genital ambiguity in affected female fetuses. However, in India, the PCPNDT Act prohibits prenatal sex determination for autosomal disorders like CAH, resulting in unnecessary steroid exposure to the majority of unaffected or male fetuses. While developed countries permit sex determination under ethical oversight for such conditions, India continues to face ethical and clinical dilemmas. We highlight the urgent need for policy reform to allow medically justified fetal sex determination in genetically at-risk pregnancies to ensure safer, more targeted treatment and prevent avoidable fetomaternal harm.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 4","pages":"368-369"},"PeriodicalIF":0.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<b>Di</b>agnostic Accuracy of an Erythrocyte Index-Based Protocol for Screening Beta Thalassemia Trait Among Antenatal Women in India.","authors":"Neha Singh, Tulika Seth, Shashi Kant, Ravneet Kaur, Sanjay K Rai","doi":"10.1007/s13224-025-02195-5","DOIUrl":"10.1007/s13224-025-02195-5","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of beta thalassemia trait (BTT) in India ranges from 1 to17%. Antenatal screening for BTT is the most acceptable screening strategy. Complete blood count (CBC) is a part of the routine antenatal checkup, and no extra resource would be required for BTT screening among antenatal women.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the hematological laboratory reports of anemic antenatal women. Data were extracted from the laboratory reports of CBC and the HPLC (high-performance liquid chromatography) test. The diagnostic performance parameters that were assessed included accuracy, sensitivity, specificity, and predictive values (positive and negative) with 95% CI. We compared mean corpuscular volume (MCV), the mean corpuscular hemoglobin (MCH) level, and the Shine and Lal (SNL) index with HPLC (gold standard) for detecting BTT. An exploratory analysis was performed to derive the best combination of tests for screening BTT.</p><p><strong>Results: </strong>Five hundred antenatal women participated in the study, of which 132 were positive for BTT by HPLC. Women with HbA2 value in the range of 3.5% to 9% were taken as positive for BTT. MCH was the most specific (89.9%), and the Shine and Lal index was the most sensitive test (90.9%) for detecting BTT. The MCH and the Shine and Lal index, when used in parallel, had the highest area under the curve for detecting BTT.</p><p><strong>Conclusion: </strong>The CBC-based indices are effective screening tools for BTT. Two tests, i.e., the MCH and the Shine and Lal index, when used in parallel, had high sensitivity for detecting BTT among antenatal women.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 4","pages":"346-351"},"PeriodicalIF":0.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smooth Muscle Tumor of Uncertain Malignant Potential Masquerading as Sarcoma.","authors":"Naren Boleneni, Sridhar Dasu","doi":"10.1007/s13224-026-02413-8","DOIUrl":"10.1007/s13224-026-02413-8","url":null,"abstract":"<p><strong>Background: </strong>Smooth muscle tumor of uncertain malignant potential (STUMP) is a rare uterine neoplasm with histopathological features intermediate between benign leiomyoma and leiomyosarcoma, posing significant diagnostic and management challenges.</p><p><strong>Case presentation: </strong>A 41-year-old woman presented with abdominal pain and distension. Examination revealed a large abdominal mass occupying all quadrants. MRI demonstrated a 20 × 18 × 16 cm exophytic sub-serosal fundal mass extending to the epigastrium, with extensive cystic degeneration suggestive of sarcomatous change. She underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Intraoperatively, a large uterine fundal mass with extensive neovascularization was identified. Final histopathological examination and immunohistochemistry confirmed the diagnosis of STUMP.</p><p><strong>Conclusion: </strong>This case highlights the difficulty in preoperative differentiation between benign leiomyomas and premalignant or malignant uterine smooth muscle tumors. Definitive diagnosis relies on histopathological and immune-histochemical assessment, underscoring the importance of appropriate surgical management and long-term surveillance in patients diagnosed with STUMP.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 4","pages":"364-365"},"PeriodicalIF":0.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Non-responders to LNG-IUS in Cases of Heavy Menstrual Bleeding.","authors":"Gayatri Savani, Saroj Kumari, Shruti Ravinarayan, Nigamananda Mishra","doi":"10.1007/s13224-025-02141-5","DOIUrl":"10.1007/s13224-025-02141-5","url":null,"abstract":"<p><strong>Introduction: </strong>Heavy menstrual bleeding (HMB) or menorrhagia, a common complaint among women during their reproductive years, significantly impacts women's quality of life, productivity, and healthcare costs. The treatment options range from conservative medical management to minimally invasive procedures and hysterectomy. While levonorgestrel-intrauterine system (LNG-IUS) is established as an effective treatment for HMB, there is a lack of significant research on factors determining non-response in women with HMB. This study aims to analyse the factors behind non-response to LNG-IUS in women with HMB.</p><p><strong>Material and methods: </strong>A retrospective observational study was conducted at BARC Hospital, Mumbai, from January 2017 to March 2020, including 88 patients with HMB who received LNG-IUS. Non-responders to LNG-IUS were analysed for reasons of failure, including endometrial thickness, hysteroscopy, and biopsy reports. Patients were contacted one year later to assess treatment outcomes, and alternative treatments or surgery was offered to non-responders, with final histopathological findings documented.</p><p><strong>Results and discussion: </strong>In this study, 29.5% of patients were non-responders, with the majority aged 40-44 years, and most experiencing persistent heavy bleeding, dysmenorrhea, device expulsion, or misplacement. Half of the non-responders had an endometrial thickness of less than 10 mm and proliferative endometrium on biopsy. Nine patients underwent hysterectomy, with adenomyosis found in seven of them.</p><p><strong>Conclusion: </strong>LNG-IUS is effective in treating HMB, but factors, such as age, endometrial thickness, and certain underlying structural and non-structural pathologies, may contribute to non-response.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 4","pages":"310-313"},"PeriodicalIF":0.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ovarian Hyper Stimulation Syndrome (OHSS) Type III in Severe Primary Hypothyroidism: A Rare and Interesting Case Report.","authors":"J Deepika, Urvi Mistry, Dhwani Desai, Ragini Nimesh Verma","doi":"10.1007/s13224-025-02179-5","DOIUrl":"10.1007/s13224-025-02179-5","url":null,"abstract":"<p><strong>Background: </strong>Ovarian hyperstimulation syndrome (OHSS) usually occurs after induction of ovulation for in-vitro fertilization. It is rarely seen spontaneously in pregnant females. This syndrome is life threatening complication with a range of symptoms, including abdominal distention and discomfort, dyspnea, enlarged ovaries, ascites, hemoconcentration, hypercoagulability, electrolyte imbalances and oliguria.</p><p><strong>Case report: </strong>This case report presents a unique case of spontaneous OHSS in a 13-year-old premenarchal female with primary hypothyroidism. The patient presented with abdominal pain, ascites, and a significant ovarian mass, along with laboratory findings including severe anemia, kidney dysfunction, and elevated thyroid-stimulating hormone levels and estradiol. Imaging revealed enlarged, multicystic ovaries. Following diagnosis, the patient was managed with thyroid replacement therapy, broad-spectrum antibiotics, and hemodialysis for acute kidney injury. Despite initial improvements, she developed cerebral venous sinus thrombosis, which was treated with anticoagulation. Over one month of treatment, her ovarian cysts reduced significantly with thyroxine therapy.</p><p><strong>Conclusion: </strong>Therefore, it is essential for clinicians and radiologists to familiarize themselves with the clinical symptoms and imaging findings associated with spontaneous OHSS in the context of primary hypothyroidism. Understanding these aspects will enhance their ability to diagnose and manage this condition effectively and avoid life threatening complications and unnecessary surgery.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 4","pages":"358-360"},"PeriodicalIF":0.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148801279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Intraovarian Platelet-Rich Plasma Injection on Ovarian Function and Reproductive Outcomes in Patients with Poor Ovarian Response.","authors":"Maryam Azizi Kutenaei, Pegah Ranjbari, Mohammadreza Zeighami, Ensieh Salehi","doi":"10.1007/s13224-025-02204-7","DOIUrl":"10.1007/s13224-025-02204-7","url":null,"abstract":"<p><strong>Background: </strong>Platelet-rich plasma (PRP), derived from peripheral blood, contains bioactive mediators that support cellular repair and tissue regeneration. PRP is thought to play a key role in the repair of ovarian tissue post-ovulation and may positively impact ovarian reserve. This study aims to investigate the potential of platelets and their derivatives in enhancing ovarian function in patients with poor ovarian response (POR) to ovulation stimulation.</p><p><strong>Methods: </strong>This randomized controlled trial was conducted on infertile patients with POR undergoing intracytoplasmic sperm injection (ICSI) and frozen embryo transfer (FET) cycles. Eligible patients were randomly assigned to either the control group (<i>n</i> = 29) or the intervention group (<i>n</i> = 29), with the intervention group receiving bilateral intraovarian PRP injections during their first ovum pick-up. PRP efficacy was evaluated by comparing hormone levels, the number of retrieved oocytes and embryos in the subsequent ovum pick-up after PRP treatment, as well as pregnancy outcomes between the two groups.</p><p><strong>Results: </strong>Data showed that the PRP-treated group had significantly higher levels of anti-Müllerian hormone (AMH) and estradiol, along with a greater number of retrieved oocytes, mature (MII) oocytes, embryos, and high- quality embryos compared to controls (<i>P</i> < 0.05). Biochemical pregnancy, clinical pregnancy, and live birth rates were also markedly higher in the PRP group (<i>P</i> < 0.05), while miscarriage rate did not differ significantly between groups (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>These findings suggest that intraovarian PRP injections may enhance ovarian response and improve reproductive outcomes in patients with POR. However, it recommends further research to confirm PRP's effectiveness before considering it as a standard adjuvant therapy for POR.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 4","pages":"303-309"},"PeriodicalIF":0.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13493685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148800609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and Psychosocial Characteristics of Women with Vaginismus: A Retrospective Descriptive Study from a Sexual Health Clinic in India.","authors":"Aishwarya Rao, Nikunj Gokani, Ashima Sahore, Abhishek Mensegere, Sandip Deshpande","doi":"10.1007/s13224-025-02230-5","DOIUrl":"10.1007/s13224-025-02230-5","url":null,"abstract":"<p><strong>Background/introduction: </strong>Vaginismus, classified as genito-pelvic pain/penetration disorder in DSM-5, is characterized by involuntary pelvic floor muscle contraction, fear of penetration, and anxiety. Despite its impact on sexual health, it remains underreported, particularly in conservative societies like India. Limited data exist on its prevalence and psychosocial correlates in Indian settings. This study examines the clinical and psychosocial characteristics of women diagnosed with vaginismus at a sexual health clinic in India.</p><p><strong>Methods: </strong>A retrospective descriptive study analyzed chart data from a sexual health clinic in India (May 2023-May 2024). Women aged ≥ 18 years, diagnosed with vaginismus per DSM-5 criteria, were included. Socio-demographic, clinical, psychiatric, and psychosocial data were extracted and analyzed using descriptive statistics.</p><p><strong>Results: </strong>Of 692 women with sexual dysfunction, 313 (45.23%) had vaginismus. The mean age was 29.4 years (SD = 4.73). Most were from Tier 1 cities (72.8%) and had attempted but not succeeded in intercourse (58.8%). Anxiety and depression were common psychiatric comorbidities, while thyroid disorders and polycystic ovarian syndrome were frequent medical conditions. Partner-related sexual dysfunction occurred in 8.6% of cases. Fear of penetration (57%) and sexual myths (9.2%) were prevalent.</p><p><strong>Conclusions: </strong>Vaginismus has significant psychosocial and cultural implications. The findings underscore the need for multidisciplinary interventions, including psychotherapy, sexual education, and couple therapy, to improve outcomes and reduce stigma surrounding female sexual health.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 3","pages":"200-205"},"PeriodicalIF":0.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful perinatal outcome of DCDA twin pregnancy in a bicorporeal uterus.","authors":"Chinmayee Ratha, Sasikala Kola","doi":"10.1007/s13224-025-02322-2","DOIUrl":"10.1007/s13224-025-02322-2","url":null,"abstract":"<p><p>Diagnosis of Mullerian anomalies in any woman leads to great distress, and the associated uncertainty of pregnancy outcomes is a cause of apprehension for both the woman and her treating clinician. With the advent of modern imaging techniques, we are able to diagnose many Mullerian anomalies. Despite the possibility of complications, few cases may have a favorable perinatal outcome when managed with meticulous planning and monitoring based on clinical judgment. We are reporting one such case of successful perinatal outcome of DCDA twin pregnancy in a bicorporeal uterus with information about preconceptional workup, planning and antenatal follow-up till the birth of viable twin babies at term.</p>","PeriodicalId":51563,"journal":{"name":"Journal of Obstetrics and Gynecology of India","volume":"76 3","pages":"267-271"},"PeriodicalIF":0.5,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13294398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148347227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}