Monaldi Archives for Chest Disease最新文献

{"title":"Infective endocarditis and oral health: a long-known threat, still a challenge.","authors":"Mohamed Alsergani, Renad Hatim Zaini, Naji Al Kholaif, Mohammed Al Admawi, Maria Teresa Savo, Dan Alexandru Cozac, Donatella Tansella, Basil Ali Aladani, Sara Di Michele, Valeria Pergola","doi":"10.4081/monaldi.2025.3497","DOIUrl":"10.4081/monaldi.2025.3497","url":null,"abstract":"<p><p>Infective endocarditis (IE) remains a life-threatening condition associated with high morbidity and mortality, often influenced by the complex interplay between systemic and oral health. The increasing recognition of oral health as a risk modifier has led to greater focus on the oral microbiome, dental procedures, and periodontal disease as potential contributors to bacteremia and IE. This review critically examines the relationship between oral health and IE, exploring pathophysiological mechanisms, risk factors, and the evolving epidemiology of the disease. The discussion includes diagnostic challenges, particularly in culture-negative cases, and the emerging role of advanced imaging and molecular diagnostics in improving early detection. A central focus is placed on preventive strategies, highlighting the debate surrounding antibiotic prophylaxis (AP) in high-risk individuals and the potential role of periodontal therapy in reducing systemic inflammation and transient bacteremia. The review also addresses the growing concern of antimicrobial resistance and the necessity of balancing AP recommendations with antimicrobial stewardship. Additionally, this review identifies critical research gaps, including the need for longitudinal studies on the impact of oral health interventions on IE incidence and the importance of interdisciplinary collaboration between dental and medical professionals in optimizing patient care. By synthesizing current guidelines and emerging evidence, this review underscores the necessity of an integrated, multidisciplinary approach to mitigate the burden of IE and establish oral health as a key pillar of infection prevention.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175804","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":"Unveiling atrial electromechanical delay in chronic obstructive pulmonary disease: an observational cohort study from north India.","authors":"Ratesh Buhlan, Arjun Tandon, Mohit Bhatia, Atul Tiwari, Soumik Ghosh, J K Mishra","doi":"10.4081/monaldi.2025.3306","DOIUrl":"10.4081/monaldi.2025.3306","url":null,"abstract":"<p><p>Chronic obstructive pulmonary disease (COPD) is often associated with cardiovascular complications such as atrial fibrillation (AF), heart failure, and myocardial infarction. AF is highly prevalent in COPD, yet the mechanisms linking them remain unclear. This study investigates the role of atrial electromechanical delay (AEMD) in predicting cardiovascular outcomes in COPD patients. This prospective cohort study included 60 COPD patients (forced expiratory volume in 1 second/forced vital capacity <0.7) from August 2022 to March 2024. Patients with pre-existing heart disease and other major comorbidities were excluded. Participants underwent spirometry, electrocardiogram (ECG), echocardiography, and N-terminal pro type natriuretic peptide (NT-proBNP) testing. AEMD was measured at the lateral and medial mitral annuli and tricuspid annulus. Primary endpoints included AF incidence, heart failure, stroke, and COPD exacerbations, while secondary endpoints were hospitalization and mortality. AEMD values were significantly higher in patients with AF (75.4±5.9 ms vs. 70.4±4.1 ms, p=0.004), heart failure, and COPD exacerbations, particularly at the lateral and medial mitral annuli. AEMD at the tricuspid annulus was strongly associated with mortality (p=0.04). P-wave dispersion (41.2±6.4 ms vs. 36.1±4.2 ms, p=0.001) and QT dispersion (49.3±8.9 ms vs. 42.1±6.8 ms, p=0.002) were significantly elevated in patients with adverse outcomes. Elevated NT-proBNP levels (>1000 pg/mL) correlated with prolonged AEMD, suggesting cardiac stress. AEMD, particularly at the mitral and tricuspid annuli, is a strong predictor of AF, heart failure, and COPD exacerbations. P-wave and QT dispersion are associated with increased hospitalization and mortality, highlighting their role in risk stratification. These findings support the use of AEMD and ECG parameters as early markers for cardiovascular complications in COPD. Further validation in larger cohorts is needed.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656319","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":"How to escape from sudden death: a challenging case of a rare cardiomyopathy with an unexpected twist.","authors":"Luísa Pinheiro, Margarida De Castro, Filipa Cordeiro, Tamara Pereira, Francisco Ferreira, Víctor Sanfins, António Lourenço, Olga Azevedo","doi":"10.4081/monaldi.2025.3526","DOIUrl":"10.4081/monaldi.2025.3526","url":null,"abstract":"<p><p>A 59-year-old man presented with recurrent syncope and was found to have bifascicular block and severe concentric left ventricular hypertrophy. A permanent double-chamber pacemaker was implanted. Initial investigations revealed elevated transferrin saturation and homozygosity for the HFE gene p.C282Y variant, indicating hereditary hemochromatosis. However, cardiac magnetic resonance imaging showed inferolateral intramyocardial late gadolinium enhancement (LGE) without evidence of iron deposition, raising suspicion for Fabry disease (FD). This was confirmed by low α-galactosidase A activity and detection of the pathogenic GLA p.F113L variant. Multisystemic evaluation revealed additional FD manifestations, and enzyme replacement therapy was initiated, later switched to oral migalastat. The patient subsequently developed left ventricular systolic dysfunction and apical thrombus, attributed to high ventricular pacing burden, and was scheduled for cardiac resynchronization therapy (CRT) device implantation. Before the upgrade, he suffered a cardiac arrest due to ventricular fibrillation, associated with coronary artery stenosis, requiring CRT-D implantation. Despite device therapy and amiodarone initiation, recurrent ventricular tachycardias (VTs) persisted, leading to percutaneous coronary intervention and electrical stability. This case highlights the diagnostic complexity of overlapping cardiac diseases, the significance of inferolateral LGE and conduction abnormalities in suspecting FD, and the crucial role of family screening. The p.F113L variant is associated with late-onset, cardiac-predominant FD, where bradyarrhythmias are more prognostically relevant, but concurrent pathologies like coronary artery disease must be considered in VT presentations.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477841","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":"Biomarkers in atypical pneumonia: a systematic review of diagnostic and prognostic utility.","authors":"Debashis Priyadarshan Sahoo, Bikash Ranjan Rout","doi":"10.4081/monaldi.2025.3564","DOIUrl":"10.4081/monaldi.2025.3564","url":null,"abstract":"<p><p>Atypical pneumonia, driven by pathogens like Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila, is challenging to diagnose due to non-specific symptoms. This systematic review assessed the diagnostic accuracy and prognostic value of biomarkers in atypical pneumonia. A comprehensive search of PubMed, Scopus, Web of Science, and Google Scholar (2000-2024) identified 27 studies, including observational, cohort, case-control, and review designs. Studies focused on biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), ferritin, D-dimer, and pathogen-specific antibodies, with quality evaluated using the Newcastle-Ottawa Scale and AMSTAR 2. CRP was elevated in 85% of cases, with a pooled sensitivity of 82.3% [95% confidence interval (CI) 76.5-88.1, I2=78%] but moderate specificity (65.2%, 95% CI 58.0-72.4). PCT exhibited high specificity (88.7%, 95% CI 83.2-94.2, I2=65%) for bacterial etiologies, making it valuable for distinguishing bacterial from viral infections. Anti-Mycoplasma pneumoniae immunoglobulin M (IgM) showed excellent diagnostic accuracy (sensitivity 90.1%, 95% CI 85.0-95.2). Ferritin levels >400 ng/mL were strongly associated with severe outcomes [odds ratio (OR) 3.15, 95% CI 2.10-4.72, I2=70%]. Elevated biomarkers correlated with increased hospitalization (OR 2.78, 95% CI 1.95-3.96) and mortality (OR 3.42, 95% CI 2.30-5.08). Heterogeneity was significant (I2=65-78%), reflecting variability in study populations and methods. PCT and anti-Mycoplasma pneumoniae IgM enhance diagnostic precision, while ferritin and CRP are robust prognostic markers. Standardized biomarker thresholds are essential to optimize their clinical utility and improve patient outcomes in atypical pneumonia management.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546103","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":"Prevalence of tuberculosis infection among patients undergoing regular hemodialysis: a multicenter study in Egypt.","authors":"Wagdy Amin, Nehal Nafea, Salah Abdel Sattar, Mohamed El Adawy, Nadia Ragab, Amal Tohamy, Lara Refaat, Ghada Ahmed Fouad, Gehan Abdel Samad, Yousra A El-Maradny, Rasha Ashmawy","doi":"10.4081/monaldi.2025.3442","DOIUrl":"10.4081/monaldi.2025.3442","url":null,"abstract":"<p><p>Dear Editor, About one-third of the human population is presently infected by Mycobacterium tuberculosis, and about 10% during their life develop active tuberculosis (5% during the first 2 years following infection)...</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546104","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":"Impact of antifibrotics on post-COVID-19 lung sequelae.","authors":"Yosri Mohamed Kamel Akl, Youssef Amin Soliman, Sabah Ahmed Mohamed, Afnan Nabil Fatehi Abdelghaffar, Aml Ibrahim Bayoumi","doi":"10.4081/monaldi.2025.3301","DOIUrl":"10.4081/monaldi.2025.3301","url":null,"abstract":"<p><p>Respiratory problems in acute COVID-19 and post-acute COVID-19 syndrome vary greatly, potentially leading to long-term functional difficulties. Off-label usage of antifibrotics, such as pirfenidone, has emerged as a promising treatment for post-COVID interstitial lung problems. Our study aims to assess clinical and radiological lung abnormalities post-COVID-19 and the effect of antifibrotics on the outcome. A retrospective observational study examined data from 90 COVID-19 patients who completed the follow-up period in the post-COVID clinic at the Chest Department, Kasr El Ainy Hospital, from August 2020 to August 2022. Demographic data, comorbidities, exercise tolerance, and chest computed tomography (CT) results were collected 1 and 6 months after the diagnosis. Initial CT scans (1 month following hospital admission) revealed diffuse ground-glass opacities (87.8%) and reticulations (43.3%). After 6 months, 33.3% were back to normal, 41% had persistent reticulations, 22.2% had ground glass opacities, and 3.3% had bronchiectasis. CT scores improved dramatically after 6 months. No significant link was detected between CT score change and off-label use of pirfenidone. Antifibrotic therapy has a modest effect on post-COVID lung problems. One-third of patients showed reticulations as persistent radiological abnormalities, which could guide future treatment choices.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276572","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":"Ultrasound-guided diaphragm evaluation and outcomes in severe acute exacerbation of chronic obstructive pulmonary disease (uDISCO Study): an observational study.","authors":"Nipun Malhotra, Dipti Gothi, Rahul Kumar, Mahismita Patro, Sunil Kumar, Anshul Jain, Mohit Agarwal","doi":"10.4081/monaldi.2025.3483","DOIUrl":"10.4081/monaldi.2025.3483","url":null,"abstract":"<p><p>Acute exacerbations of chronic obstructive pulmonary disease (COPD) are associated with compromised diaphragmatic function. This can be evaluated using point-of-care ultrasound. The association of diaphragm function with hospital length of stay or mortality has not been assessed earlier. This study aimed to evaluate the correlation of diaphragmatic function with length of hospital stay, mortality, and non-invasive ventilation (NIV) failure in severe acute exacerbation of COPD. Diaphragmatic excursion and thickening index (Tdi) were evaluated with ultrasound-guided assessment in individuals with severe acute exacerbation of COPD at the time of hospitalization. The individuals were evaluated for length of stay in survivors, NIV ventilation failure in those requiring NIV therapy, and mortality in non-survivors. A total of 110 individuals were screened, and 60 of these were enrolled. A total of 55 individuals survived, and 5 died. The length of stay had a negative correlation with excursion (R: -0.78, p<0.001) and Tdi (R: -0.96, p<0.001). The excursion and Tdi were smaller by 30% and 50%, respectively, in the event of NIV failure compared to NIV success. Excursion ≤1.96 cm [area under receiver operating characteristic curve (AUROC): 0.958] or Tdi≤92% (AUROC: 0.974) were associated with length of stay ≥8 days. Excursion ≤1.48 cm (AUROC: 0.75) or Tdi≤51.2% (AUROC: 0.8) were associated with NIV failure. Tdi≤40% was associated with a high risk of mortality (RR: 22.67, p=0.035). Smaller diaphragmatic excursion, or Tdi, correlated with prolonged LoS, mortality, and NIV failure.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102907","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":"Relationship between fractional exhaled nitric oxide, asthma control test, and spirometry measurement in individuals with asthma receiving treatment.","authors":"Arthana Kanagaraj, Santhiya Ramachandran, Pajanivel Ranganadin, Akila Mohan","doi":"10.4081/monaldi.2025.3300","DOIUrl":"10.4081/monaldi.2025.3300","url":null,"abstract":"<p><p>To evaluate the relationship between fractional exhaled nitric oxide (FeNO), asthma control test (ACT), and spirometry measurements in individuals with asthma receiving treatment, a cross-sectional study was conducted involving 47 diagnosed asthmatic patients. FeNO levels were measured using Eversens Evernoa FeNO, ACT scores were recorded, and spirometry (pre- and post-bronchodilator) was conducted. Correlations between these parameters were analyzed using Pearson's correlation and t-tests. The study found no statistically significant correlation between FeNO and spirometry parameters [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and FEV1/FVC] or ACT scores. While FeNO was higher in individuals without a family history of asthma and nonsmokers, these differences were not statistically significant. Additionally, spirometry parameters showed significant improvement after bronchodilator use, but FeNO did not strongly predict lung function improvement. The findings suggest that while FeNO is useful as an indicator of airway inflammation, it may not consistently correlate with functional lung measurements or asthma control as assessed by spirometry and ACT. This highlights the need for a multidimensional approach to asthma management that combines these tools for more comprehensive disease assessment.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676449","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":"Potential novel role of asthma biologics as rescue therapy in the intensive care unit for life-threatening asthma exacerbations: a systematic review.","authors":"Lorenzo Carriera, Pier Valerio Mari, Roberto Barone, Simone Ielo, Emanuele Cataldo, Michela Di Tomasso, Michela Bezzi, Andrea Smargiassi, Riccardo Inchingolo, Angelo Coppola","doi":"10.4081/monaldi.2025.3319","DOIUrl":"10.4081/monaldi.2025.3319","url":null,"abstract":"<p><p>Severe asthma exacerbations have high morbidity and mortality. The management can be challenging, and the optimal strategy for patients admitted to the intensive care unit (ICU) with life-threatening and near-fatal asthma has not been fully defined. An interesting area of research is represented by the rescue or compassionate use of biological drugs when all treatments fail, including advanced interventions such as extracorporeal membrane oxygenation. This systematic review analyzes the cases described in the literature and discusses characteristics, treatments, and outcomes of patients who received asthma-approved monoclonal antibodies as rescue therapy following admission to the ICU due to near-fatal asthma exacerbations or status asthmaticus refractory to conventional treatments. A total of 14 studies (13 case reports and 1 case series) were included according to the prespecified inclusion and exclusion criteria. Various monoclonal antibodies were administered, most commonly benralizumab and omalizumab. Treatment was generally initiated within the first week of ICU admission, with nearly half of the patients receiving therapy within 5 days. Further research, including randomized controlled trials, is required to assess if this therapeutic option impacts ICU outcomes, which specific biologics could be used, and their eventual optimal timing and dosage.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561888","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":"Relationship of fractional exhaled nitric oxide with blood eosinophilia in characterizing type-2 airway inflammation in treatment-naïve patients with chronic obstructive pulmonary disease.","authors":"Riksoam Chatterjee, Mansi Gupta, Zia Hashim, Ajmal Khan, Alok Nath, Vikas Aggarwal","doi":"10.4081/monaldi.2025.3315","DOIUrl":"10.4081/monaldi.2025.3315","url":null,"abstract":"<p><p>Fractional exhaled nitric oxide (FeNO), a sensitive and reproducible, non-invasive biomarker for type-2 (T2) inflammation in asthma, remains underutilized in chronic obstructive pulmonary disease (COPD). We investigated the potential role of FeNO and its relationship with blood eosinophilia in characterizing T2 airway inflammation in COPD. A single-center prospective observational study was conducted in 75 treatment-naïve adult patients with stable COPD and 75 age-sex-matched controls. The Global Initiative for Chronic Obstructive Lung Disease criteria were used for the diagnosis of COPD. FeNO levels were compared with clinico-radiological features, pulmonary functions, and other markers of T2 inflammation in COPD. Participants in the COPD subgroup had a median age of 62 (55.0, 69.0) years with a male predominance (77.3%). The median FeNO value was 27.0 ppb (19.0, 39.0) in COPD and 14.0 ppb (10.0, 20.0) in controls (p<0.001). FeNO values were categorized as low (≤25 ppb), intermediate (25-50 ppb), and high (≥50 ppb), with 57.3% of COPD patients having intermediate to high FeNO. In contrast, 46.7% of these patients had an absolute eosinophil count (AEC) ≥300/mm3. Higher values of FeNO in COPD were associated with the history of atopy (p<0.001), a positive bronchodilator reversibility on spirometry (p<0.05), and high-resolution computed tomography findings such as emphysema, bronchial wall thickening, bronchiectasis/bronchiolectasis, and mosaic attenuation (p<0.05). In addition, FeNO levels showed a strong positive linear correlation with serum immunoglobulin E (IgE) levels (r2=0.66, p<0.001) and AEC (r2=0.56, p<0.001). FeNO's best diagnostic cut-off level to detect T2 inflammation was 31 ppb (sensitivity: 65.9%, specificity: 86.5%; area under the receiver operating characteristic curve: 0.79). FeNO measurement, besides blood eosinophilia, is an effective, direct, airway-specific, non-invasive tool for detecting T2 airway inflammation in stable patients with COPD. Atopy (IgE sensitization) is a crucial factor in explaining higher FeNO values in COPD patients. FeNO correlates well with blood eosinophilia in COPD patients with an eosinophilic phenotype as a surrogate biomarker with good sensitivity and specificity.</p>","PeriodicalId":51593,"journal":{"name":"Monaldi Archives for Chest Disease","volume":" ","pages":""},"PeriodicalIF":0.8,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692384","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}