Clinical toxicology (Philadelphia, Pa.)最新文献

{"title":"Once, twice, three times a bite victim: recidivism in snake envenomation.","authors":"Spencer Greene, Amber Anderson, George Warpinski, Sharan Campleman, Anne-Michelle Ruha","doi":"10.1080/15563650.2025.2516131","DOIUrl":"10.1080/15563650.2025.2516131","url":null,"abstract":"<p><strong>Introduction: </strong>We believe there are certain behaviors that may predispose people to being bitten by a snake. The purpose of this study was to describe cases reported to the North American Snakebite Registry in which the snakebite victim acknowledged multiple lifetime snakebites and to test the hypothesis that male sex, intentional handling of the snake, alcohol consumption, and maintaining snakes in captivity are associated with sustaining multiple snakebites in a lifetime.</p><p><strong>Methods: </strong>This was a retrospective review of de-identified patient information reported to the snakebite registry between January 1, 2013 and December 31, 2023. Data regarding the circumstances of the snake encounter, patient demographics, previous snakebites, antivenom administration, and clinical outcomes were reviewed.</p><p><strong>Results: </strong>Of the 2,140 snakebites reported during the study period, 94 (4.4%) involved patients with a history of one or more previous snakebites. Males accounted for 80 (85.1%) victims. Sixty-one (64.9%) bites followed intentional interaction with the snake. Alcohol use was reported in 15 (24.6%) of these cases. Captive snakes were responsible for 18 (29.5%) bites. Of the bites that resulted from unintentional snake interaction, alcohol was implicated in three (9.1%) cases. One (3%) bite was from a captive snake. Acute hypersensitivity reactions were observed in six (7.5%) patients who received antivenom.</p><p><strong>Discussion: </strong>Most patients with multiple lifetime snakebites were intentionally interacting with the snake just prior to being bitten. Maintaining snakes in captivity was reported more frequently in patients with previous bites than among the general snakebite population. Although alcohol use was more common among patients who intentionally interacted with snakes, most patients with multiple lifetime snakebites did not report preceding alcohol use.</p><p><strong>Conclusions: </strong>Male sex, intentionally handling snakes, and maintaining snakes in captivity are more common in patients with multiple lifetime snakebites than those who have experienced only one bite.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"619-625"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144577533","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":"Poison information centres are under pressure because of animal-related poison enquiries: a European survey.","authors":"Marieke A Dijkman, Joris H Robben, Dylan W de Lange, Nicola Bates","doi":"10.1080/15563650.2025.2522904","DOIUrl":"10.1080/15563650.2025.2522904","url":null,"abstract":"<p><strong>Introduction: </strong>As veterinary poison information centres are uncommon in Europe, many European poison information centres are confronted with veterinary-related enquiries. Here, we report the experience of poison information centres in handling enquiries related to poisoning in animals.</p><p><strong>Methods: </strong>A survey was sent to 59 poison information centres in 32 European countries and Israel. Data was collected from 2022 about the general demographics of the centre, with an emphasis on veterinary services and their experience handling animal-related enquiries.</p><p><strong>Results: </strong>Thirty-three poison information centres in 21 countries completed the survey. In France and the United Kingdom, centres refer animal-related enquiries to veterinary poison information centres. In six other countries, centres do not provide a veterinary service. In two of these six countries, the centres have terminated their veterinary service. Twenty-one of the 33 poison information centres in 13 countries provide veterinary services to the public and/or veterinary professionals. The percentage of enquiries relating to poisoning in animals to total enquiries ranged from 0.0-9.0% (median 2.4%) for enquiries from the public at 18 of 21 poison information centres and 0.1-20.1% (median 1.5%) for enquiries from veterinary professionals at 20 of 21 poison information centres. The enquiries predominantly involved companion animals, especially dogs and cats. Twelve poison information centres considered animal-related enquiries a burden. The nature of this burden varied from feeling uncomfortable answering these enquiries due to insufficient skills/experience/expertise (<i>n</i> = 10), lack of (sufficient) funding/finance (<i>n</i> = 6), too time-consuming (<i>n</i> = 5), and too many enquiries compared to human enquiries (<i>n</i> = 1). Two centres were considering terminating their veterinary service in the future.</p><p><strong>Discussion: </strong>Overall, 19 of 27 poison information centres in 19 countries without veterinary poison information centres consider a veterinary poison information centre a necessity. As the provision of a veterinary service is not their primary task, most poison information centres consider it a burden.</p><p><strong>Conclusion: </strong>Gaining insight into the volume of enquiries involving poisoning in animals, the burden they add to the workload of poison information centres, and the nature of this burden is important for the continuity of veterinary toxicological services by poison information centres.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"656-665"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586168","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":"Establishing a regional drug profile in Newfoundland and Labrador, Canada, using data from acute drug deaths.","authors":"Syed Z Raza, Cindy Whitten, Allyson Summers, Shane Randell, Nash Denic","doi":"10.1080/15563650.2025.2529017","DOIUrl":"10.1080/15563650.2025.2529017","url":null,"abstract":"<p><strong>Introduction: </strong>Drug deaths are rising in Canada and are driven by polydrug toxicity (that is toxicity resulting from multiple drugs belonging to different drug classes). Addressing polydrug toxicity requires the establishment of regional drug profiles so that appropriate harm reduction policies can be implemented.</p><p><strong>Methods: </strong>Using toxicology data from individuals who died from acute drug toxicity, we established regional drug profiles for the Canadian province of Newfoundland and Labrador. Medical examiners determined which drugs contributed to each acute death. Counts were described to establish the most common drugs and classes.</p><p><strong>Results: </strong>Between 2018 and 2023, 222 individuals died from unintentional acute drug toxicity, and a majority of deaths were from polydrug toxicity. Stimulants and opioids were the most frequent drug class combinations in the sample. Cocaine was the most frequent drug contributing to death and was involved in a majority of stimulant-related deaths. Opioid-related deaths involved many drugs, and deaths resulting from non-pharmaceutical opioids and opioid agonists used in opioid depen-dence treatment rose sharply in the later years of the study.</p><p><strong>Discussion: </strong>Stimulants, especially cocaine, disproportionately contributed to stimulant-related deaths, reinforcing the need for stimulant-specific harm reduction measures in the region. Among opioids, the sharp rise in deaths from opioid agonists used in opioid depen-dence treatment requires policy attention, and the emergence of non-pharmaceutical opioids presents an opportunity to implement policies that have shown success in other regions. Policy impacts and suggestions are discussed, including the need for drug-checking services so that drug profiles can be established more quickly and reflect drug use that is not specific to toxicity.</p><p><strong>Conclusions: </strong>A total of 222 individuals died from unintentional acute drug toxicity in Newfoundland and Labrador between 2018 and 2023, with polydrug toxicity comprising a majority (55.4%) of these fatalities. Stimulants and opioids were the most prevalent drug classes, with cocaine implicated in most stimulant-related deaths and various types of opioids involved in opioid-related deaths.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"640-647"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736603","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":"Post-injection delirium/sedation syndrome from long-acting olanzapine intramuscular injection is rapidly reversed with physostigmine and rivastigmine.","authors":"Sally Fotheringham, Nicholas A Buckley, Camilla Bradshaw, Andrew Dawson","doi":"10.1080/15563650.2025.2537806","DOIUrl":"10.1080/15563650.2025.2537806","url":null,"abstract":"<p><strong>Introduction: </strong>Post-injection delirium/sedation syndrome is a rare but serious adverse effect of depot olanzapine, typically managed with supportive care and benzodiazepines.</p><p><strong>Case reports: </strong>We report two cases of post-injection delirium/sedation syndrome following long-acting olanzapine intramuscular depot administration and describe the use of the acetylcholinesterase inhibitors, physostigmine and rivastigmine, in their management. Both patients showed rapid resolution of delirium within minutes of physostigmine administration, with no recurrence after rivastigmine maintenance therapy. The response was achieved with lower physostigmine doses than typically used in patients with pure antimuscarinic delirium. Olanzapine plasma concentrations were collected in one patient and were significantly elevated.</p><p><strong>Discussion: </strong>Intravenous physostigmine produced rapid and sustained resolution of delirium symptoms. Transdermal rivastigmine prevented recurrence. Benzodiazepines were ineffective prior to acetylcholinesterase inhibitor use.</p><p><strong>Conclusions: </strong>Our patients support the hypothesis that post-injection delirium/sedation syndrome includes an antimuscarinic mechanism responsive to acetylcholinesterase inhibitors. Early administration of physostigmine, followed by rivastigmine, may be an effective, targeted approach. We propose their use should be first-line when treating antimuscarinic delirium in post-injection delirium/sedation syndrome.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"684-686"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985265","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":"Isotocyanozene: detection of the 5-cyano analog of isotonitazene in human biological samples.","authors":"Ryan D McHenry, Lisa C Dunlop, Simon Hudson, Matthew Walters, James W Dear, David J Lowe","doi":"10.1080/15563650.2025.2528990","DOIUrl":"10.1080/15563650.2025.2528990","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"691-692"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586167","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":"Mass aconite poisoning from a mislabelled spice product.","authors":"Jessica T Kent, Abhinay Sathya, David N Juurlink, Emily Austin, Dorianna Simone, JoAnne Fernandes, Michael H Gollob, Margaret Thompson","doi":"10.1080/15563650.2025.2526115","DOIUrl":"10.1080/15563650.2025.2526115","url":null,"abstract":"<p><strong>Introduction: </strong>Aconitine is a potentially lethal alkaloid found in more than 200 plant species belonging to the genus <i>Aconitum</i> (aconite). Most cases of poisoning involve the improper processing of traditional Chinese medicine. We report a mass poisoning event caused by consumption of unprocessed aconite root powders mislabeled as sand ginger.</p><p><strong>Methods: </strong>We conducted a retrospective case series of patients who presented to two hospitals in the Greater Toronto area with aconite poisoning from a chicken dish eaten at a local restaurant. Demographic, management, and outcome data were collected by review of the electronic medical record.</p><p><strong>Results: </strong>Over an 8 h period, 11 patients presented to hospital with features of aconite poisoning. Symptoms began shortly after ingestion and included perioral paraesthesia (91%) and nausea, vomiting and abdominal pain (64%). In the hospital, the spectrum of illness varied from paraesthesia requiring no intervention (9%) to refractory ventricular dysrhythmias (73%) managed with infusions of sodium bicarbonate, amiodarone, and vasopressors. Two patients received mechanical ventilation for 48 h. No patients died. A public health investigation identified a mislabelled sand ginger spice product imported from China as the source of unprocessed aconite (aconitine 0.55%).</p><p><strong>Discussion: </strong>With the increasing availability of internationally sourced spice products, such events are likely to recur.</p><p><strong>Conclusions: </strong>This series demonstrates the potential for mass aconite poisoning through contaminated food and highlights the critical role of poison centers and public health systems in responding to such events.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"633-639"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602741","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":"Utility of non-specific symptoms in early detection of Russell's viper (<i>Daboia russelii</i>) envenoming following snakebite in rural Sri Lanka.","authors":"Supun Wedasingha, Anjana Silva, Sisira Siribaddana, Geoffrey K Isbister","doi":"10.1080/15563650.2025.2528994","DOIUrl":"10.1080/15563650.2025.2528994","url":null,"abstract":"<p><strong>Introduction: </strong>Early diagnosis of systemic snake envenoming is essential for prompt antivenom treatment. The commonly used 20-min whole blood clotting test has poor sensitivity. We investigated the diagnostic utility of non-specific systemic symptoms alone or with the 20-min whole blood clotting test in detecting Russell's viper (<i>Daboia russelli</i>) envenoming following a snakebite.</p><p><strong>Methods: </strong>We included snakebite patients admitted to a Sri Lankan hospital from July 2020 to June 2021. Snakebites were authenticated by snake identification or venom assays. Clinical assessments, whole blood clotting tests and an international normalized ratios were performed on admission. Non-specific systemic symptoms were vomiting, headache or abdominal pain. Systemic envenoming was defined as venom-induced consumption coagulopathy (international normalized ratio >1.5), neurotoxicity, or acute kidney injury.</p><p><strong>Results: </strong>There were 216 snakebites: 76 Russell's viper, 89 hump-nosed viper and 51 non-venomous snakebites. Sixty-three (29%) had non-specific systemic symptoms on admission, most commonly Russell's viper bites (53/76; 70%), compared to 10/89 (11%) hump-nosed viper bites and no non-venomous snakebites. The sensitivity of non-specific symptoms in diagnosing Russell's viper envenoming in all snakebites varied, with abdominal pain having the best sensitivity of 63% (95% CI: 51-74%) and the presence of any non-specific symptom had a sensitivity of 72% (95% CI: 60-81%). The 20-min whole blood clotting test had a sensitivity of 60% (95% CI: 48-71%). The combined test of abdominal pain OR a positive 20-min whole blood clotting test had a sensitivity of 82% (95% CI: 72-90%) and a specificity of 99% (95% CI: 95-100%) for Russell's viper envenoming in all snakebites, while any non-specific symptom OR a positive 20-min whole blood clotting test had a sensitivity of 88% (95% CI: 79-94%) and a specificity of 91% (95% CI: 85-94%).</p><p><strong>Discussion: </strong>Non-specific systemic symptoms were common in Russell's viper bites, but not in hump-nosed viper bites. Non-specific symptoms OR a positive 20-min whole blood clotting test had an excellent sensitivity and specificity for Russell's viper envenoming. Further studies are required for different snake species and geographical regions.</p><p><strong>Conclusion: </strong>In low-income settings with only access to a 20-min whole blood clotting test, the addition of non-specific symptoms, particularly abdominal pain, in snakebite diagnosis will improve early antivenom treatment.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"648-655"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985910","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":"Vasoplegic shock in felodipine, tadalafil, lisinopril, fluoxetine and ethanol poisoning responsive to methylthioninium chloride (methylene blue).","authors":"Jordan Jenrette, Benjamin Hatten, Mark William Simon","doi":"10.1080/15563650.2025.2527866","DOIUrl":"10.1080/15563650.2025.2527866","url":null,"abstract":"","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"693-694"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995108","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":"Hair straightening and acute kidney injury: a case series from a medical toxicology service.","authors":"Yuval Rabinovich, Dennis Scolnik, Ayelet Rimon, Julieta Weirthein, Orit Kliuk-Ben Bassat, Christopher O Hoyte, Miguel Glatstein","doi":"10.1080/15563650.2025.2541702","DOIUrl":"https://doi.org/10.1080/15563650.2025.2541702","url":null,"abstract":"<p><strong>Background: </strong>Formaldehyde-free, glyoxylic acid-containing hair-straightening treatments have gained popularity, but their safety is unproven. Since 2019, our medical toxicology service has identified multiple cases of acute kidney injury following exposure to these products. This study explores the association between glyoxylic acid-based hair-straightening treatments and nephrotoxicity.</p><p><strong>Methods: </strong>A retrospective study was conducted between April 2021 and March 2025 at Sourasky Medical Center, Tel Aviv, Israel. Thirteen female patients with symptoms such as nausea, vomiting, and abdominal pain that developed following exposure to glyoxylic acid-containing hair-straightening products were evaluated. Data on demographics, clinical presentation, laboratory results, and management were collected, including toxicological investigation of product ingredients.</p><p><strong>Results: </strong>The mean age of patients was 22 years. Twelve of 13 patients developed acute kidney injury. Urinalysis revealed calcium oxalate crystals in 27% of patients. All patients received intravenous fluids, and eight (61.5%) were treated with thiamine and pyridoxine; the patient who received early treatment did not develop kidney injury. None of the patients required hemodialysis, and there were no deaths. A common feature among the implicated products was the presence of glyoxylic acid, which was potentially linked to the formation of calcium oxalate crystals and subsequent kidney damage.</p><p><strong>Discussion: </strong>These findings highlight a potentially underrecognized risk of kidney toxicity associated with glyoxylic acid-containing hair products. The consistent clinical presentation, presence of urine calcium oxalate crystals, and temporal association with product use suggest a causal relationship. Prompt recognition and early treatment, particularly with thiamine and pyridoxine, may reduce the severity of kidney damage. Further studies and regulatory action are needed to better define the risk and prevent future cases.</p><p><strong>Conclusions: </strong>This case series suggests an association between glyoxylic acid hair-straightening products and acute kidney injury, and a potential role for thiamine and pyridoxine in mitigating toxicity. Early intervention may reduce the extent of kidney damage.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-6"},"PeriodicalIF":3.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986148","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":"Life-threatening anaphylaxis following antivenom administration in two patients with horse dander allergy.","authors":"Katherine Z Isoardi, Angela L Chiew, Atul Dhital, Geoffrey K Isbister","doi":"10.1080/15563650.2025.2545592","DOIUrl":"https://doi.org/10.1080/15563650.2025.2545592","url":null,"abstract":"<p><strong>Introduction: </strong>Antivenom is used to treat systemic envenomation and is immunoglobulin G raised from animals, mainly horses, inoculated by venom.</p><p><strong>Methods: </strong>We report two cases of life-threatening anaphylaxis following the administration of antivenom in patients with known horse dander allergy.</p><p><strong>Results: </strong>A 14-year-old boy presented with redback spider envenomation. He had a known horse dander allergy. He received antivenom to treat severe pain and developed immediate severe anaphylaxis requiring endotracheal intubation and inotropic support. A 52-year-old man with horse dander allergy presented with suspected snakebite and received antivenom. He developed immediate profound anaphylaxis and suffered a prolonged cardiac arrest. He later died from multiorgan failure secondary to hypoxia.</p><p><strong>Discussion: </strong>Severe anaphylaxis following antivenom administration in Australia is uncommon. In the setting of known horse dander allergy there is likely to be an increased risk of severe anaphylaxis due to probable cross-reactivity of shared allergens between horse dander and serum.</p><p><strong>Conclusion: </strong>Dander allergy to the same animal antivenom is raised from, likely confers an increased risk of life-threatening anaphylaxis. Asking someone specifically about the relevant animal dander allergy prior to antivenom administration is important to better weigh the risk-benefit analysis of antivenom administration.</p>","PeriodicalId":520593,"journal":{"name":"Clinical toxicology (Philadelphia, Pa.)","volume":" ","pages":"1-3"},"PeriodicalIF":3.3,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144986154","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}