Annals of African Medicine最新文献

{"title":"To Investigate the Laboratory Sample Criteria of Ammonia Measurement in Saudi Arabia.","authors":"Mohammed Abdullah Jeraiby","doi":"10.4103/aam.aam_80_24","DOIUrl":"10.4103/aam.aam_80_24","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the laboratory sample acceptance criteria, ammonia analysis, and the reporting of ammonia results and raise awareness of the new guidelines.</p><p><strong>Methods: </strong>It is a descriptive cross-sectional study. The study was conducted in the clinical laboratories of the hospital, KSA. Furthermore, the study used electronic questionnaires. A questionnaire was distributed to clinical biochemistry laboratories in Saudi Arabia. The results were collected and compared to updated best practice guidelines on hyperammonemia issued by the Metabolic Biochemistry Network (MetBio.net).</p><p><strong>Results: </strong>This study examined laboratory practices in ammonia analysis. EDTA tubes are widely used (78.0%) for blood/plasma ammonia measurement. Most laboratories prioritize sample delivery on ice (100%) and fast-track samples for ammonia analysis (95.1%). Awareness of ammonia analysis criteria includes automated methods for hemolysis assessment (61.0%) and rejection of grossly hemolyzed samples (92.7%). The enzymatic method is predominant (97.6%). Concerns about icterus and lipemia impact (80.5% and 85.4%, respectively) are noted. Reporting practices vary, with 65.9% setting specific thresholds for critical limits.</p><p><strong>Conclusion: </strong>This study offers insights into current ammonia analysis practices, identifying areas for improvement. Aligning with literature, it emphasizes the need for ongoing education and guideline updates for consistent and accurate severe hyperammonemia diagnosis and management.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"573-578"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186329","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":"To Study the Correlation of Methylenetetrahydrofolate Reductase C677T and MTR (A2756G) Gene Polymorphism in Endometriosis in Women of Reproductive Age Group.","authors":"Suman Singh, Sujata Deo, Vandana Solanki, Nitu Nigam","doi":"10.4103/aam.aam_119_24","DOIUrl":"10.4103/aam.aam_119_24","url":null,"abstract":"<p><strong>Background: </strong>One of the typical benign gynecologic conditions in women of childbearing age is endometriosis, which can almost always lead to pelvic pain, infertility, and menstrual irregularities. The biochemical features of endometriosis focus on the folic acid and one-carbon cycle. Endometriosis cannot be diagnosed by a blood test. An important enzyme in the folate cycle is methylenetetrahydrofolate reductase (MTHFR). There are a number of variants in the MTHFR gene, but the C677T polymorphism has received the most attention and is associated with a number of diseases and problems.</p><p><strong>Purpose: </strong>To investigate the association between MTHFR (C677T) and MTR (A2756G) gene polymorphisms and the pathogenesis of endometriosis.</p><p><strong>Materials and methods: </strong>A total of 51 endometriosis cases and 51 healthy volunteers were genotyped for MTHFR (C677T) and MTR (A2756G) gene polymorphisms. Genotypes were determined by the polymerase chain reaction restriction fragment length polymorphism. The frequency of genotypes was analyzed by the Chi-square test and odds ratio for relative risk.</p><p><strong>Results: </strong>The frequencies of CC, CT, and TT genotypes of MTHFR C677T were 17.65%, 54.90%, and 27.45% in cases and 64.71%, 15.69%, and 19.61% in controls, respectively. In addition, the frequencies of the C and T alleles were 46.92% and 53.08% in cases and 72.55% and 27.45% in controls, respectively. The T-allele and the CT and TT genotypes of the MTHFR C677T gene polymorphism were significantly associated with cases. No significant association with cases was observed for the MTR A2756G gene polymorphism.</p><p><strong>Conclusion: </strong>We conclude that the MTHFR C677T polymorphism was significantly associated with endometriosis, but the MTR A2756G polymorphism was not associated with endometriosis patients.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"579-585"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Patient with Marburg's Variant of Multiple Sclerosis Responded Well to Cyclophosphamide.","authors":"Foziah Jabbar Alshamrani, Rawan Salim Alyami","doi":"10.4103/aam.aam_30_24","DOIUrl":"10.4103/aam.aam_30_24","url":null,"abstract":"<p><p>Marburg's disease is a fatal variant of multiple sclerosis (MS), distinguished by its fulminant, rapidly progressive monophasic course that often leads to patients' mortality within weeks of onset. Owing to its rarity, there are no established treatment guidelines. We present a 34 year-old male who was diagnosed with MS, and magnetic resonance imaging revealed numerous supra- and infratentorial white matter plaques. Steroid pulse therapy, intravenous immunoglobulin, and plasma exchange were ineffective. After excluding other differential diagnoses, Marburg's variant MS was considered, and intravenous cyclophosphamide with methylprednisolone was administered. The patient showed significant and fast clinical improvement adding to the evidence that cyclophosphamide is an effective therapeutic modality for treating this MS variant.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"686-690"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186274","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":"Validation of Peripheral Perfusion Index as a Noninvasive Screening Tool in Predicting Adverse Neonatal Outcome.","authors":"Rizwana Abdul Nasser, Shiji Joseph, Anila Arangassery Poulose, Ramaraj Subbiah","doi":"10.4103/aam.aam_101_24","DOIUrl":"10.4103/aam.aam_101_24","url":null,"abstract":"<p><strong>Introduction: </strong>Timely identification of suboptimal organ perfusion is crucial to detect adverse outcomes early and to prevent its long-term motor and cognitive effects. Peripheral perfusion index (PI) is a noninvasive screening tool which can identify babies at risk for hemodynamic compromise.</p><p><strong>Aim: </strong>We aimed to study the validity of peripheral PI as an early predictor of adverse neonatal outcome in comparison with other commonly used noninvasive screening modalities such as heart rate (HR), respiratory rate, temperature, capillary refill time (CRT), and blood pressure.</p><p><strong>Materials and methods: </strong>This prospective observational study was carried out between January 2021 and May 2022. All infants born beyond 32 weeks of pregnancy who are admitted to the neonatal intensive care unit and needed hemodynamic were included in the study. Peripheral PI was monitored along with other noninvasive parameters at specific intervals and compared with those parameters for the degree of variation in each at specified time intervals and with the changing hemodynamic status of these babies including adverse outcomes.</p><p><strong>Results: </strong>A cohort of 93 neonates was enrolled in the study. Our study found lower PI values among newborns with adverse outcomes. This study also revealed negative correlations between HR and PI, suggesting that low PI could indicate early neonatal compromise and circulatory inadequacy. We also established positive correlations between PI and CRT, systolic blood pressure, mean arterial blood pressure, and pulse pressure.</p><p><strong>Conclusion: </strong>PI can serve as a noninvasive screening tool which can identify babies at risk for hemodynamic compromise, especially in resource-poor settings.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"598-603"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Trial Comparing the Outcome of Proximal Femoral Nailing and Proximal Femoral Nailing Antirotation 2 for Unstable Intertrochanteric Femur Fracture.","authors":"Vinay Prabhat, Thanchuingam Jingua, Govind Kumar Gupta, Rohit Topno, Sabyasachi Kundu, Abhishek Guria","doi":"10.4103/aam.aam_144_24","DOIUrl":"10.4103/aam.aam_144_24","url":null,"abstract":"<p><strong>Background: </strong>Proximal Femoral Nailing (PFN) and Proximal Femoral Nailing Anti-rotation (PFNA 2) are both intra-medullary implants having 6 degrees of proximal valgus angulation. The helical blade compact the cancellous bone in femoral head when it is driven inside.</p><p><strong>Aims and objectives: </strong>The aim of our study is to compare radiological and functional outcome and superiority over other in management of unstable intertrochanteric fracture by PFN and PFNA 2.</p><p><strong>Materials and methods: </strong>The study was conducted from October 2021 to September 2022 which included 76 patients of unstable intertrochanteric fractures of femur.</p><p><strong>Results: </strong>In PFN group, Harris hip score was Excellent in 23 cases (60.52%), Good in 12 cases (31.57%), Fair in 2 cases (5.26%) and poor in1 case (2.63%). In PFNA 2 group, Harris hip score was excellent in 24cases (63.15%), Good in13 cases (34.21 %), Fair in 1 case (2.63%) and Poor in none of the cases.</p><p><strong>Conclusion: </strong>PFNA 2 significantly reduces the operative time and blood loss compared to PFN. However Both PFN and PFNA 2 implants offers no statistically significant advantages over each other in terms of fracture unions, functional and radiological outcomes, post-operative complications and recovery outcomes.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"621-627"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186301","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":"Emerging Trend of Multidrug-resistant Organisms Causing Sepsis in Ventilated Newborns.","authors":"Sudesh Kumar, Prajna Ray, Ranita Sahana","doi":"10.4103/aam.aam_96_24","DOIUrl":"10.4103/aam.aam_96_24","url":null,"abstract":"<p><strong>Introduction: </strong>Increasing trend of antibiotic and multidrug resistance (MDR) organism are significant public health risks and major issues in intensive care unit (ICU). We aimed to identify, determine the prevalence, and to evaluate their antibiotic resistance pattern in sepsis-positive ventilated newborns.</p><p><strong>Materials and methods: </strong>The observational cross-sectional study was conducted in a neonatal ICU. One hundred and sixty-eight neonates were included.</p><p><strong>Results: </strong>One hundred and sixty-eight ventilated newborns were enrolled, of which 79 (47.02%) cases were culture positive. Of the isolated organisms, 53 (67.08%) were MDR, in which 32 (60.03%) with early-onset neonatal sepsis (EONS) and 21 (39.6%) with late-onset neonatal sepsis. Twenty-three (43.39%) isolated organisms were Gram-positive MDR and 30 (56.6%) were Gram-negative MDR. The most common isolated MDR organisms were Pseudomonas aeruginosa and coagulase-negative staphylococci (CONS). The culture positivity of the MDR organism was significantly higher to non-MDR ( P < 0.000017). Among gram negative MDR organism Pseudomonas and Klebsiella was highly resistant against ciprofloxacin and piperacillin with tazobactam respectively. Among MDR Gram-positive bacteria CONS and Enterococcus faecalis was most common. CONS were highly resistant to clindamycin, penicillin, and ciprofloxacin.</p><p><strong>Conclusions: </strong>This study showed an alarmingly high prevalence of MDR organisms and Gram-negative strains which were more isolated from EONS. This can limit the initial therapeutic choice regarding antibiotics, leading to increased mortality, morbidity with risk of spreading resistant organisms.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"604-609"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186308","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":"Recent Scenario of Diagnostic and Prognostic Biomarkers of Sepsis in Clinical Practice and the Role of Multi-marker Approach: An Update.","authors":"Arun Sinha, Shrimanjunath Sankanagoudar, Ankur Sharma, Nikhil Kothari, Neeraj Gupta, Praveen Sharma","doi":"10.4103/aam.aam_50_24","DOIUrl":"10.4103/aam.aam_50_24","url":null,"abstract":"<p><p>Despite extensive work done in the field of sepsis biomarkers; still, there is no consensus on which parameter could be considered as an ideal biomarker for sepsis diagnosis. This review aims to look into the existing biomarkers of clinical utility which are currently being used for sepsis diagnostics along with their advantages and disadvantages. We also provide an insight into the usefulness of a multi-marker approach to diagnosing sepsis and what could be the future direction. A literature review was conducted and four search engines such as PubMed, Scopus, Google Scholar, and Research Gate were used for data mining. Three clinically relevant markers for sepsis diagnosis such as procalcitonin (PCT), prespsin, and pentraxin-3 reviewed critically. Articles were also reviewed for the assessment of a multi-marker approach. Overall more than 100 research papers were found to be eligible for this review. Currently, most of the studies are using a chemiluminescent immunoassay-based PCT as a diagnostic method for sepsis. This method has been standardized all over the world, along with traditional markers such as C-reactive protein (CRP) and highly sensitive-CRP. But now, studies are also being conducted on presepsin and pentraxin-3 which are more sensitive and specific for early diagnosis of sepsis. Despite there being literature on presepsin and pentraxin-3, but due to a lack of standardization for assay methods and the costs involved, both parameters are still a long way in finding space in the routine clinical practice. More efforts should be made to combine several markers and develop an algorithm which can overcome the shortcomings of these markers.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"522-531"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770919","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":"Management of Unique Complex Long Bone Fractures by Gunshot Injuries with Linear Rail System.","authors":"Lukman Olalekan Ajiboye, Abdullahi Bello Galadima, Abdulkadir Muhammad Usman, Olanrewaju Olatunji Sulaimon, Chukwuebuka Kingsley Okezie","doi":"10.4103/aam.aam_143_23","DOIUrl":"10.4103/aam.aam_143_23","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The insurgence of banditry, kidnapping and farmer-herdsmen clashes has presented a unique etiological factor of complex long bone (fracture) and soft tissue gunshot injuries to orthopaedic Surgeons in North West Nigeria. These complex fractures and soft tissues injuries are of very challenging and with high risks of bone loss being open fracture, infected gap nonunion and soft tissue defects which are individually and/or collectively difficult situation to manage to salvage the affected limbs. The management include but not limited to resuscitation using Advanced Trauma Life Support Protocols, often staged management of the injury which entails: wound debridement with external fixation, soft tissue cover or grafting, bone grafting including vascularized bone grafting and bone transport.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this retrospective study is to share our experience of the outcome of Linear Rail System (LRS) in salvaging long bone complex fractures from gunshot injuries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Twenty-seven patients who had limb salvage procedures with LRS on account of complex fractures from gunshot injuries between January 1, 2019 and December 30, 2022 and were recruited into this retrospective study. The clinical details of the patients were retrieved from the medical record department and analyzed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study involved 27 patients (male-female ratio of 5.75:1) aged 22-49 years with a mean age of 30.5 years. All patients suffered Gustilo type III injuries associated with varying bone loss resulting from debridement of devitalized bone or bone loss at the scene of the injury. There were 17 cases of tibia, 7 femurs, and 3 humerus. All patients presented at the accident and emergency room. The surgical treatment included debridement, docking, corticotomy at an appropriate level and distraction/compression by LRS respectively. All cases had antibiotics, achieved union and limb length equalization/bone transport. Primary docking was done in 59% with subsequent limb lengthening while 41% had bone transport from the osteotomy sites. The average bone gap regenerated was 8.92 cm (range 3.23-16.90 cm) over a period of 19 months (ranging between 7 and 19 months). At the end of fracture union, 78% of the patients had normal range of motion in nearby joints and with satisfactory limb function in 93% of the cases according to patients' report.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The uniqueness of complex long bone fractures by gunshot injuries with extensive soft tissue and fractures especially with cases of bone loss due to the injury or from the debridement required a faster, simpler and more acceptable device that will achieve the desired result. The use of LRS in this study was a good option to achieve soft tissue care, infection control, fracture union, restore limb length and rehabilitation to restore function with satisfactory outcome. However, ap","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"562-566"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186325","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":"Only Diagnose the Pharyngeal-cervical-brachial Subtype of Guillain-Barré Syndrome if the Defined Diagnostic Criteria Are Met.","authors":"Josef Finsterer","doi":"10.4103/aam.aam_157_24","DOIUrl":"10.4103/aam.aam_157_24","url":null,"abstract":"","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"704-705"},"PeriodicalIF":0.6,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186326","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":"Comparative Evaluation of the Antimicrobial Efficacy of Stabilized Chlorine Dioxide, Botanical Oral Rinse, and Kidodent Mouthwash as Preprocedural Mouthrinse: A Randomized Clinical Trial.","authors":"Tanuja Pericherla, Jayalakshmi Pandranki, Narsimha Rao V Vanga","doi":"10.4103/aam.aam_83_24","DOIUrl":"10.4103/aam.aam_83_24","url":null,"abstract":"<p><strong>Context: </strong>Aerosols composed of airborne biological material, present significant biohazard risks during dental procedures due to their potential pathogenicity. Effective infection control measures are essential to mitigate these risks during oral prophylaxis and other dental activities.</p><p><strong>Aim: </strong>The study seeks to evaluate the efficacy of two commercially available mouthwashes - one with stabilized chlorine dioxide (ClO 2 ) and the other herbal based - as preprocedural rinses and their acceptance in children, offering alternative options to Kidodent mouthwash.</p><p><strong>Subjects and methods: </strong>The study included 60 individuals aged 9-14 years, with 15 participants allocated to each group based on specific inclusion criteria. After obtaining informed consent, participants rinsed with either with fluoride-triclosan-based mouthwash (Kidodent), stabilized ClO 2 mouthwash (Freshclor), botanical oral rinse (BOR) (Oralife), or saline before ultrasonic scaling. Blood agar plates were used to capture airborne bacteria during oral prophylaxis, and colony-forming units (CFUs) were counted after incubation. Sensory analysis assessed mouthwash acceptability using a postoperative hedonic scale.</p><p><strong>Statistical analysis used: </strong>SPSS software analyzed the data, computing mean ± standard deviation for each variable. One-way ANOVA tested group differences in CFUs, followed by post hoc Tukey's testing. Sensory responses were assessed using the Kruskal-Wallis test.</p><p><strong>Results: </strong>The study found that BOR, Freshclor, and Kidodent significantly reduced bacterial CFUs compared to normal saline rinse ( P < 0.001). Stabilized ClO 2 and BOR were as effective as Kidodent ( P > 0.05). Children favored stabilized ClO 2 ( n = 15; 100%) and then Kidodent ( n = 13; 86.67%), with BOR being the least favored ( n = 6; 40%).</p><p><strong>Conclusions: </strong>The research underscores the significance of preprocedural mouthrinses in reducing contamination risks during dental procedures ( P < 0.001). Oralife and Freshclor exhibit efficacy similar to Kidodent mouthwash for children ( P > 0.05), offering safer alternatives containing botanical extracts and stabilized ClO 2 , respectively.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":"662-670"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144186306","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}