GE Portuguese Journal of Gastroenterology最新文献

{"title":"Deep Learning and Minimally Invasive Endoscopy: Panendoscopic Detection of Pleomorphic Lesions.","authors":"Miguel Mascarenhas, Francisco Mendes, Tiago Ribeiro, João Afonso, Pedro Marílio Cardoso, Miguel Martins, Hélder Cardoso, Patrícia Andrade, João Ferreira, Miguel Mascarenhas Saraiva, Guilherme Macedo","doi":"10.1159/000539837","DOIUrl":"10.1159/000539837","url":null,"abstract":"<p><strong>Introduction: </strong>Capsule endoscopy (CE) is a minimally invasive exam suitable of panendoscopic evaluation of the gastrointestinal (GI) tract. Nevertheless, CE is time-consuming with suboptimal diagnostic yield in the upper GI tract. Convolutional neural networks (CNN) are human brain architecture-based models suitable for image analysis. However, there is no study about their role in capsule panendoscopy.</p><p><strong>Methods: </strong>Our group developed an artificial intelligence (AI) model for panendoscopic automatic detection of pleomorphic lesions (namely vascular lesions, protuberant lesions, hematic residues, ulcers, and erosions). 355,110 images (6,977 esophageal, 12,918 gastric, 258,443 small bowel, 76,772 colonic) from eight different CE and colon CE (CCE) devices were divided into a training and validation dataset in a patient split design. The model classification was compared to three CE experts' classification. The model's performance was evaluated by its sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the precision-recall curve.</p><p><strong>Results: </strong>The binary esophagus CNN had a diagnostic accuracy for pleomorphic lesions of 83.6%. The binary gastric CNN identified pleomorphic lesions with a 96.6% accuracy. The undenary small bowel CNN distinguished pleomorphic lesions with different hemorrhagic potentials with 97.6% accuracy. The trinary colonic CNN (detection and differentiation of normal mucosa, pleomorphic lesions, and hematic residues) had 94.9% global accuracy.</p><p><strong>Discussion/conclusion: </strong>We developed the first AI model for panendoscopic automatic detection of pleomorphic lesions in both CE and CCE from multiple brands, solving a critical interoperability technological challenge. Deep learning-based tools may change the landscape of minimally invasive capsule panendoscopy.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"31 6","pages":"408-418"},"PeriodicalIF":1.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781800","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":"Early-Stage Colon Cancer Surveillance: Pattern and Timing of Recurrence and the Role of 5-Year Surveillance.","authors":"Paula Ferreira Pinto, Mariana Peyroteo, Catarina Baía, Mariana Marques, Maria João Cardoso, José Flávio Videira, Joaquim Abreu de Sousa","doi":"10.1159/000540338","DOIUrl":"10.1159/000540338","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer is the third most prevalent cancer among both men and women with 80% of patients having localized disease enabling curative treatments. Given the low recurrence rate in early-stage disease, there is a growing interest in reviewing follow-up protocols. The aim of this study was to assess the frequency and timing of recurrence in early-stage colon cancer, as well as recurrence patterns.</p><p><strong>Methods: </strong>The data from all patients with colon adenocarcinoma consecutively treated with surgery at the Instituto Português de Oncologia do Porto, EPE, between January 2013 and December 2016, were retrospectively reviewed.</p><p><strong>Results: </strong>A total of 1,372 patients with colon cancer were submitted to surgery during the study period. From this group, 51.4% (<i>n</i> = 705) were early-stage colon cancers. Regarding the pathological stage, 3.5% were stage 0, 37.4% were stage I and 59.1% were stage II. The overall recurrence rate was 6.7%. When considering the group of patients without risk factors, the recurrence rate was 5.6%. The majority of recurrences occurred in the first 3 years of follow-up. The recurrence was diagnosed in the majority of patients through carcinoembryonic antigen elevation, followed by imaging exams. The presence of one or more risk factors (high nuclear grade, vascular invasion, extramural venous invasion, and perineural invasion) showed a statistically significant association with recurrence rate.</p><p><strong>Conclusion: </strong>The recurrence rate was low in early-stage colon cancer, with the majority of recurrences occurring in the first 3 years. Our study results show that surveillance should be tailored according to individual risk factors.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 2","pages":"109-117"},"PeriodicalIF":1.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765746","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":"Real-Time Gastric Juice Analysis to Rule Out the Presence of Autoimmune Gastritis: A Case-Control Study.","authors":"Emanuele Dilaghi, Gianluca Esposito, Irene Ligato, Alessandro Del Forno, Roberta Elisa Rossi, Cesare Hassan, Bruno Annibale, Angelo Zullo","doi":"10.1159/000540117","DOIUrl":"10.1159/000540117","url":null,"abstract":"<p><strong>Background: </strong>Autoimmune gastritis (AIG) is an infrequent disease predisposing to both neuroendocrine tumours and cancer. This study aimed to evaluate whether pH measurement of gastric juice allows accurate exclusion of the presence of AIG in real time so that gastric mucosa sampling on normal-appearing mucosa may be avoided.</p><p><strong>Methods: </strong>This study enrolled patients diagnosed with AIG and matched controls (ratio 1:5) who underwent upper endoscopy with standard gastric mucosa sampling and real-time, gastric juice pH assessment. A threshold of pH less than 4.5 was adopted as cut-off to rule out the presence of a feature of AIG. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated.</p><p><strong>Results: </strong>Data of 40 patients (M/F: 19/21; mean age: 58 years, range: 18-89) with AIG and 212 matched controls were evaluated. Among AIG patients, the feature of atrophy/metaplasia of the oxyntic mucosa was staged as mild in 9 cases, moderate in 9, and severe in the remaining 22 patients. Gastric juice analysis showed a pH value >4.5 in 29 (72.5%) patients and 12 (5.7%) controls. Sensitivity, specificity, accuracy, PPV, NPV, LR+, and LR- were 73% (95% CI = 0.57-0.84), 94% (95% CI = 0.90-0.97), 71% (95% CI = 0.64-0.74), 95% (95% CI = 0.93-0.97), 91% (95% CI = 0.87-0.95), 12.9 (95% CI = 7.19-23.03), and 0.29 (95% CI = 0.18-0.48), respectively. The histological assessment of false-negative cases showed the presence of only mild-moderate atrophy of oxyntic mucosa in 6 (54.5%) cases, and severe in the others.</p><p><strong>Conclusions: </strong>Our data found that real-time pH evaluation of gastric juice allows ruling out AIG with a very high NPV, but further studies are needed.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 1","pages":"37-42"},"PeriodicalIF":1.0,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191247","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":"Carbapenem-Resistant Enterobacteriaceae Colonization or Infection Was Not Associated with Post-Liver Transplant Graft Failure: An Observational Cohort Study.","authors":"João Caria, Ana C Gonçalves, Gonçalo Cristóvão, Maria Carlos, Sara Magalhães, Vasco Almeida, Fernanda Moreno, Élia Mateus, Hélder Pinheiro, Diana Póvoas, Fernando M T Maltez, Rui Perdigoto, Filipe S Cardoso, Hugo P Marques","doi":"10.1159/000539690","DOIUrl":"10.1159/000539690","url":null,"abstract":"<p><strong>Introduction: </strong>Carbapenem-resistant Enterobacteriaceae (CRE) epidemiology among liver transplant (LT) recipients is variable. We studied the impact of CRE colonization and infection on LT recipients' outcomes.</p><p><strong>Methods: </strong>This observational cohort study included consecutive adult LT recipients between January 2019 and December 2020 at Curry Cabral Hospital, Lisbon, Portugal. Primary exposures were CRE colonization (rectal swabs under a screening program) and infection within 1 year of index LT. Primary endpoint was graft failure within 1 year of the index LT.</p><p><strong>Results: </strong>Among 209 patients, the median (interquartile range [IQR]) age was 57 (47-64) years and 155 (74.2%) were male. CRE colonization was identified in 28 (13.4%) patients during the first year posttransplant (median [IQR] number of rectal swabs per patient of 4 [2-7]). CRE resistance genes identified were OXA48 in 8 (3.6%) patients, KPC in 19 (67.9%) patients, and VIM in 1 (3.6%) patient. Any bacterial/fungal and CRE infections were diagnosed in 88 (42.1%) and 6 (2.9%) patients, respectively, during the first year posttransplant. After adjusting for confounders, neither CRE colonization (aOR [95% CI] = 1.83 [0.71-4.70]; <i>p</i> = 0.21) nor infection (aOR [95% CI] = 1.35 [0.17-11.06]; <i>p</i> = 0.78) was associated with graft failure within 1 year of index LT.</p><p><strong>Discussion/conclusion: </strong>Under a screening program, CRE colonization and infection prevalence was low and neither was associated with graft failure.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 1","pages":"18-24"},"PeriodicalIF":1.0,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191236","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":"Navigating Challenges in a Case of Unusual Hepatic and Pulmonar Sarcoidosis: A Comprehensive Clinical Journey.","authors":"André Gonçalves, Diogo Simas, Plácido Gomes, Carinal Leal, Catarina Atalaia-Martins, Helena Vasconcelos","doi":"10.1159/000539226","DOIUrl":"10.1159/000539226","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcoidosis, a systemic granulomatous disorder with uncertain etiology, commonly involves the lungs and, to a lesser extent, the liver.</p><p><strong>Case presentation: </strong>A previously healthy 35-year-old Congolese female was admitted with a 7-month history of jaundice, itching, and weight loss. Despite markedly mixed hepatitis of a cholestatic pattern of liver injury, liver function tests remained normal in admission laboratory work. Enlarged ethiological study was negative for infections, autoimmunity, heavy metal poisoning, and metabolic diseases. Imaging aligned with compatible biopsy histology led to the diagnosis of hepatic and pulmonary sarcoidosis with vanishing bile duct syndrome. Despite initial treatment with ursodeoxycholic acid and corticosteroid therapy, the patient exhibited an unexpected exacerbation of liver enzymes, prompting a careful consideration of second-line interventions. Following discussion with a tertiary center and a comprehensive review of the literature, it was determined not to intensify therapy due to an inadequate response. Recognizing the persistent challenge of managing advanced cases and the potential progressive course of the disease, the patient was referred to a tertiary transplant center. Currently, she is under outpatient follow-up, clinical and analytically stable with no targeted therapy.</p><p><strong>Conclusion: </strong>This case report details a rare presentation of hepatic sarcoidosis with an unusual laboratory pattern, emphasizing diagnostic and management challenges in recognizing atypical presentations of hepatic sarcoidosis. The complexity of managing advanced cases warrants a multidisciplinary approach and the limited literature on this subject emphasizes the urgency for a more comprehensive understanding of sarcoidosis to improve diagnostic accuracy and refine therapeutic approaches.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 1","pages":"61-66"},"PeriodicalIF":1.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191239","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":"Abdominal Hypoperfusion and Acute Kidney Injury in the Critically Ill Patient with Liver Cirrhosis: A Prospective Cohort Study.","authors":"Rui Pereira, Diogo Lopes, Sara Brandão Machado, Luís Val-Flores, Fernando Caeiro, Rui Perdigoto, Paulo Alexandre Marcelino, Faouzi Saliba","doi":"10.1159/000538939","DOIUrl":"10.1159/000538939","url":null,"abstract":"<p><strong>Background: </strong>Reduced abdominal perfusion pressure (APP) is an underdiagnosed potential pathophysiological mechanism for acute kidney injury (AKI) in the patient with liver cirrhosis and ascites. This study aimed to analyze the prevalence of abdominal hypoperfusion (AhP) (APP <60 mm Hg) and the impact of APP on AKI in critically ill patients with liver cirrhosis.</p><p><strong>Methods: </strong>This was a post hoc analysis from a prospective cohort study set in a general ICU at a tertiary university hospital. Patients were recruited between October 2016 and December 2021. Acute renal failure (ARF) was defined by stage 3 AKI according to the International Club of Ascites.</p><p><strong>Results: </strong>Fifty-eight patients where included, with a mean age of 57 (±8.4) years, 79% were male, and 93% had acute-on-chronic liver failure at admission. The prevalence of AhP reached 75%, and 29% of cases had persisting AhP during the first week of ICU stay. Patients with baseline AhP had a higher 28-day mortality compared to those without AhP (respectively, 76% vs. 49%, <i>p</i> = 0.03). Acute renal failure developed in 48% of patients. Higher serum urea (aOR: 1.01, 95% CI: 1.00-1.02, <i>p</i> = 0.04) and white blood cell count (aOR: 1.1, 95% CI: 1.01-1.2, <i>p</i> = 0.02) at ICU admission, as well as low persisting APP (aOR: 0.9, 95% CI: 0.86-0.98, <i>p</i> = 0.02) were independent risk factors for ARF.</p><p><strong>Conclusion: </strong>Critically ill patients with liver cirrhosis presented a high prevalence of ARF, independently associated with higher baseline serum urea and WBC, and lower persisting APP. A structured clinical approach to optimize APP may reduce renal dysfunction in high-risk patients with cirrhosis.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"32 1","pages":"25-36"},"PeriodicalIF":1.0,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11790267/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191232","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":"Retraction Statement.","authors":"","doi":"10.1159/000538229","DOIUrl":"10.1159/000538229","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.1159/000533163.].</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"31 3","pages":"224"},"PeriodicalIF":0.6,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722535","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":"Portuguese Pancreatic Club Perspectives on Pancreatic Neuroendocrine Neoplasms: Diagnosis and Staging, Associated Genetic Syndromes and Particularities of Their Clinical Approach.","authors":"Joel Ferreira-Silva, Sara Meireles, Massimo Falconi, Alexandra Fernandes, Filipe Vilas-Boas, Miguel Bispo, Ricardo Rio-Tinto, Eduardo Rodrigues-Pinto","doi":"10.1159/000534641","DOIUrl":"10.1159/000534641","url":null,"abstract":"<p><p>Pancreatic neuroendocrine neoplasms (panNENs) have been historically regarded as rare, but their incidence has raised more than 6-fold over the last 3 decades, mostly owing to improvement in the detection of small asymptomatic tumours with imaging. Early detection and proper classification and staging are essential for the prognosis and management of panNENs. Histological evaluation is mandatory in all patients for the diagnosis of panNEN. Regarding localization and staging, multiphasic contrast-enhanced computer tomography is considered the imaging study of choice. Nevertheless, several other diagnostic modalities might present complementary information that can help in diagnosis and staging optimization: magnetic resonance imaging, somatostatin receptor imaging using positron emission tomography in combination with computed tomography (PET/CT), PET/CT with fluorodeoxyglucose (¹⁸F-FDG), and endoscopic ultrasound. Approximately 10% of panNENs are due to an inherited syndrome, which includes multiple endocrine neoplasia type 1, von Hippel-Lindau disease, neurofibromatosis type 1 (NF-1), tuberous sclerosis complex, and Mahvash disease. In this review, the Portuguese Pancreatic Club summarizes the classification, diagnosis, and staging of panNENs, with a focus on imaging studies. It also summarizes the characteristics and particularities of panNENs associated with inherited syndromes.</p>","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"31 3","pages":"153-164"},"PeriodicalIF":0.9,"publicationDate":"2023-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248671","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":"Lower Gastrointestinal Bleeding after Gynecological Surgery: An Atypical Endoscopic Diagnosis.","authors":"Vítor Macedo Silva, Tiago Lima Capela, Pedro Boal Carvalho, Bruno Rosa, José Cotter","doi":"10.1159/000535225","DOIUrl":"10.1159/000535225","url":null,"abstract":"","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"31 4","pages":"299-302"},"PeriodicalIF":1.0,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11305658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903593","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":"Portuguese Pancreatic Club Perspectives on Endoscopic Ultrasound-Guided and Surgical Treatment of Pancreatic Neuroendocrine Tumors","authors":"Tiago Ribeiro, Sara Castanheira-Rodrigues, Pedro Bastos, Humberto Cristino, Alexandra Fernandes, Eduardo Rodrigues-Pinto, Miguel Bispo, Ricardo Rio-Tinto, Filipe Vilas-Boas","doi":"10.1159/000534032","DOIUrl":"https://doi.org/10.1159/000534032","url":null,"abstract":"Pancreatic neuroendocrine tumors (panNETs) are a group of neoplasms with heterogenous biological and clinical phenotypes. Although historically regarded as rare, the incidence of these tumors has been increasing, mostly owing to improvements in the detection of small, asymptomatic tumors with imaging. The heterogeneity of these lesions creates significant challenges regarding diagnosis, staging, and treatment. Endoscopic ultrasound (EUS) has improved the characterization of pancreatic lesions. Furthermore, EUS nowadays has evolved from a purely diagnostic modality to allow the performance of minimally invasive locoregional therapy for pancreatic focal lesions. The choice of treatment as well as the treatment goals depend on several factors, including tumor secretory status, grading, staging, and patient performance status. Surgery has been the mainstay for the management of these patients, particularly for localized, low-grade, large panNETs &amp;gt;2 cm. Over the last decade, a significant body of evidence has been accumulated evaluating the role of EUS for the ablative therapy of panNETs, namely by the use of chemoablative agents and radiofrequency. Although endoscopic techniques are not routinely recommended by international guidelines, they may be considered for the treatment of smaller lesions in patients who are unwilling or unfit for pancreatic surgery. In this review, we summarize the existing evidence on the interventional techniques for the treatment of patients with panNETs, focusing on the EUS-guided and surgical approaches.","PeriodicalId":51838,"journal":{"name":"GE Portuguese Journal of Gastroenterology","volume":"9 9","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136105691","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}