Annals of African Medicine最新文献

{"title":"Evaluation of Changes in the Quadriceps Femoris Muscle in Critically Ill Children Using Ultrasound Compared with Controls.","authors":"K Y Bharath, Siddaroodha Sajjan, Mallanagouda M Patil","doi":"10.4103/aam.aam_194_26","DOIUrl":"https://doi.org/10.4103/aam.aam_194_26","url":null,"abstract":"<p><strong>Background: </strong>Critically ill children in the pediatric intensive care unit (PICU) are exposed to immobilization, mechanical ventilation, and systemic inflammation, which can lead to early skeletal muscle wasting. Ultrasound assessment of the quadriceps femoris provides a feasible bedside method to detect muscle changes during critical illness.</p><p><strong>Aim: </strong>To evaluate changes in quadriceps femoris muscle thickness and echogenicity in critically ill children using ultrasound and compare them with age-matched healthy controls.</p><p><strong>Materials and methods: </strong>This prospective observational study (January 2024-June 2025) included 348 children: 174 critically ill mechanically ventilated PICU patients and 174 age-matched controls. Quadriceps muscle thickness and echogenicity were assessed using standardized ultrasound measurements. Cases were evaluated on day 1, day 3, and day 5, while controls were assessed once.</p><p><strong>Results: </strong>Baseline muscle thickness was similar in cases and controls (1.60 cm). In cases, mean thickness declined to 1.54 cm by day 3 ( P = 0.031) and 1.48 cm by day 5 ( P < 0.001), representing a 7.5% reduction, while controls showed no significant change. Thickness reduction occurred in 59.2% of cases versus none of the controls ( P < 0.001). Increased muscle echogenicity was observed in 16.7% of cases and in no controls ( P < 0.001). Muscle changes showed no significant association with age or sex.</p><p><strong>Conclusion: </strong>Ultrasound detected early reductions in quadriceps muscle thickness and increased echogenicity in critically ill children. Serial bedside muscle ultrasound may be useful for monitoring early muscle changes in pediatric critical care.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759911","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":"Synovial Lipomatosis of Ankle with Sural Nerve Neuropathy: A Rare Case Report.","authors":"Prashant Pawar, Tuhina Singh, Sumit Jadhav, Selvi Khajanchi","doi":"10.4103/aam.aam_828_25","DOIUrl":"https://doi.org/10.4103/aam.aam_828_25","url":null,"abstract":"<p><strong>Abstract: </strong>Synovial lipomatosis, also known as lipoma arborescens, is a rare benign condition characterized by villous fatty proliferation of the synovium with replacement of the subsynovial tissue by mature adipocytes. Although it predominantly affects the knee joint, involvement of the ankle is distinctly uncommon. We report the case of a 52-year-old woman who presented with progressive left ankle pain and swelling of 1 year duration, associated with mechanical symptoms and restriction of motion. Physical examination revealed a posterolateral ankle swelling with mild limitation of range of motion, while laboratory parameters and rheumatologic markers were within normal limits. Plain radiography demonstrated a soft-tissue swelling with a calcified/bony mass, and magnetic resonance imaging revealed diffuse synovial proliferation with associated bone marrow edema. The patient underwent open ankle arthrotomy with excision of a loose calcified body and synovectomy. Histopathological examination confirmed synovial lipomatosis, showing fibrocollagenous tissue lined by hyperplastic synovial membrane with infiltration of mature adipocytes in a myxoid stroma, without evidence of malignancy. Postoperatively, the patient achieved complete symptomatic relief with restoration of normal ankle function at 6 months of follow-up, and no recurrence was noted at 1 year. This case highlights synovial lipomatosis as an important differential diagnosis for chronic ankle swelling and supports surgical synovectomy as an effective treatment with excellent clinical outcome and low recurrence.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760072","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":"Real-world Impact of Antivascular Endothelial Growth Factor Treatment on Visual and Anatomical Outcomes in Diabetic Macular Edema: A Prospective Observational Study.","authors":"Priya, Rupa Epil, Shubham Harsh","doi":"10.4103/aam.aam_751_25","DOIUrl":"https://doi.org/10.4103/aam.aam_751_25","url":null,"abstract":"<p><strong>Background: </strong>Diabetic macular edema (DME) is a major cause of visual impairment among individuals suffering from diabetic retinopathy. Anti-VEGF treatment continues to play an important role in improving both anatomical and functional outcomes in patients with DME. Aim: The aim was to evaluate the effect of anti-VEGF treatments on visual and anatomical outcomes in patients with diabetic macular edema (DME) and to identify treatment responders and non-responders.</p><p><strong>Methods: </strong>This was a prospective study of 92 eyes with DME that received treatment with intravitreal anti-VEGF injections and were followed for 12 months. The best-corrected visual acuity (BCVA) outcome metric was recorded in logMAR; central subfield thickness (CST) measured using optical coherence tomography (OCT) readings was recorded at baseline and 3, 6 and 12 months. Associations were evaluated with patient age, duration of diabetes, and severity of retinopathy.</p><p><strong>Results: </strong>This prospective study included 92 eyes diagnosed with DME who were treated with anti-VEGF intravitreal injections and followed for a year. The metric for best-corrected visual acuity (BCVA) was measured in logMAR; central subfield thickness (CST) was assessed by optical coherence tomography (OCT) at baseline and at 3, 6, and 12 months. Correlations were assessed with patient age, length of diabetes, and retinopathy grade.</p><p><strong>Conclusion: </strong>Anti-VEGF therapy led to significant changes in both BCVA and CST at 12 months (P < 0.001). Younger patients, shorter duration of diabetes and NPDR were associated with improved results. The visual and anatomic improvements were sustained over the full duration of the study.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760108","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":"Precision in Planning: Airway Battles in Pediatric Temporomandibular Joint Ankylosis.","authors":"Aishwarya Prasad, Sunil Rajan","doi":"10.4103/aam.aam_214_26","DOIUrl":"https://doi.org/10.4103/aam.aam_214_26","url":null,"abstract":"<p><strong>Background: </strong>Pediatric temporomandibular joint (TMJ) ankylosis produces severe trismus, mandibular hypoplasia, and retrognathia, creating an anticipated difficult airway with minimal apnea tolerance. Awake fiberoptic intubation is often impractical in children; therefore, airway strategies must prioritize continuous oxygenation and preservation of spontaneous ventilation.</p><p><strong>Methods: </strong>A consecutive case series of seven pediatric patients with TMJ ankylosis undergoing maxillofacial surgery was analyzed. All underwent inhalational induction with 8% sevoflurane in oxygen while maintaining spontaneous breathing. After nasal preparation, a nasopharyngeal airway connected to a Jackson-Rees circuit delivered anesthetic gases and stented the airway. Fiberoptic nasotracheal intubation was performed via the opposite nostril. Neuromuscular blockade was administered only after capnographic confirmation of tracheal intubation. Airway success and perioperative outcomes were recorded.</p><p><strong>Results: </strong>Patients aged 3 months-7 years had mouth opening ranging from nil to 1 cm. Fiberoptic intubation succeeded in all cases without desaturation, trauma, or failed airway events. Continuous ventilation through the nasopharyngeal airway maintained anesthetic depth and prevented airway collapse during instrumentation. Six patients were extubated awake with uneventful recovery. One infant with Pierre Robin sequence required postoperative ventilation and tracheostomy due to persistent anatomical obstruction rather than intubation failure.</p><p><strong>Conclusion: </strong>Nasopharyngeal airway-assisted inhalational anesthesia followed by fiberoptic nasal intubation is a safe, reproducible primary airway strategy in pediatric TMJ ankylosis. The technique preserves oxygenation, depth of anesthesia, minimizes repeated instrumentation, and is particularly useful in resource-limited settings. Postoperative airway planning remains essential in syndromic infants.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760083","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 Polishing and Finishing Techniques on Resin-based Restorative Materials Cytotoxicity Using Real-time Cell Analysis.","authors":"Prabu Mahin Syed Ismail","doi":"10.4103/aam.aam_132_26","DOIUrl":"https://doi.org/10.4103/aam.aam_132_26","url":null,"abstract":"<p><strong>Introduction: </strong>Resin-based restorative materials (RBRMs) are extensively used in contemporary dentistry; however, their biocompatibility remains a concern due to the release of residual monomers. Finishing-polishing procedures may significantly influence surface characteristics and subsequent cytotoxic behavior, yet dynamic evidence using the real-time cell analysis (RTCA) is limited. This research was done to evaluate the outcome of different finishing-polishing procedures on the cytotoxicity of RBRMs using RTCA.</p><p><strong>Materials and methods: </strong>This in vitro experimental study included 200 disc-shaped specimens fabricated from nanohybrid, bulk-fill, and microhybrid composite resins. Specimens were categorized into four groups depending upon surface treatment: Mylar strip (control), diamond bur finishing, disc polishing and multi-step polishing. Human gingival fibroblasts were exposed to material extracts and cellular responses were used with the xCELLigence RTCA system to monitor them constantly for 72 h. One-way ANOVA and Tukey's post hoc test (P < 0.05) were used for the statistical analysis.</p><p><strong>Results: </strong>RTCA demonstrated a significant time-dependent and surface-treatment dependent cellular response. Multi-step polishing exhibited the highest cell viability, followed by disc polishing and diamond bur finishing. While the control group showed the lowest cell index values (P < 0.05). Nanohybrid composites demonstrated significantly higher biocompatibility compared to bulk-fill and microhybrid materials.</p><p><strong>Conclusion: </strong>Finishing-polishing procedures and material composition significantly influence the cytotoxic behavior of RBRMs. Optimized polishing protocols enhance cellular viability and improve biological safety.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760066","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":"Incidence of Absent Dorsalis Pedis Artery in an Indian Population.","authors":"Prashant Pawar, Rohan Dilip Wable","doi":"10.4103/aam.aam_871_25","DOIUrl":"https://doi.org/10.4103/aam.aam_871_25","url":null,"abstract":"<p><strong>Background: </strong>The dorsalis pedis artery (DPA) is a key vessel in assessing peripheral arterial circulation. Its absence may mimic peripheral arterial disease (PAD) and lead to diagnostic errors.</p><p><strong>Aims and objectives: </strong>To determine the incidence of absent DPA in an Indian population using clinical examination and computed tomography angiography (CTA).</p><p><strong>Materials and methods: </strong>This study was conducted in two parts. Part 1 included clinical palpation of DPA in 2000 adult participants, confirmed using handheld Doppler. Part 2 involved retrospective analysis of 1000 lower limb CTA scans. Patients with vascular disease, trauma, or prior surgery were excluded.</p><p><strong>Results: </strong>Clinically, DPA was absent in 3.0% of limbs. CTA demonstrated anatomical absence in 2.5% of limbs, with substitution commonly by the peroneal artery. No significant association was found with age, sex, or laterality.</p><p><strong>Conclusion: </strong>Absence of DPA is an uncommon anatomical variant. Awareness is essential to avoid misdiagnosis of PAD and for appropriate surgical planning. Combined clinical and imaging evaluation improves diagnostic accuracy.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760137","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":"Case Series on Ectopic Pregnancy after Sterilization.","authors":"M S Priyanka, G Prema Priya, B Jeyamani","doi":"10.4103/aam.aam_80_26","DOIUrl":"https://doi.org/10.4103/aam.aam_80_26","url":null,"abstract":"<p><strong>Abstract: </strong>Female sterilization is one of the most commonly adopted permanent methods of contraception worldwide and is generally considered highly effective. Despite its low failure rate, pregnancy can occur following sterilization, and such pregnancies are associated with a disproportionately higher risk of ectopic implantation. Ectopic pregnancy after sterilization often presents diagnostic challenges, as prior sterilization may lead to a false sense of security and delayed clinical suspicion, thereby increasing the risk of tubal rupture and maternal morbidity. To describe the clinical presentation, diagnostic evaluation, management strategies, and maternal outcomes of ectopic pregnancies occurring after tubal sterilization. This case series includes four women with a previous history of tubal sterilization who were diagnosed with ectopic pregnancy at Vinayaka Mission's Kirupananda Variyar Medical College and Hospitals. Detailed clinical information, including age, parity, method and timing of sterilization, presenting symptoms, diagnostic findings, site of ectopic pregnancy, treatment approach, and outcomes, was collected and analyzed. Diagnosis was confirmed using urine pregnancy testing, serum beta human chorionic gonadotropin levels, and transvaginal ultrasonography. All cases were managed surgically and followed through the postoperative period. All four women presented with lower abdominal pain with or without amenorrhea. The interval between sterilization and occurrence of ectopic pregnancy ranged from 1 to 8 years. Tubal ectopic pregnancy was identified in all cases, with one patient presenting in a ruptured state requiring emergency surgical intervention. Timely diagnosis and appropriate surgical management resulted in favorable maternal outcomes in all cases, with no major postoperative complications. Ectopic pregnancy can occur even several years after tubal sterilization and should always be considered in women of reproductive age presenting with abdominal pain or menstrual irregularities, regardless of sterilization history. Maintaining a high index of clinical suspicion and ensuring early diagnostic evaluation are crucial for preventing maternal morbidity and achieving optimal outcomes.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759882","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":"Bisphosphonate-induced Esophagitis Dissecans Superficialis: A Rare Case Report.","authors":"Yogesh Bade, Junaid Ahmed, Vikas Bharti","doi":"10.4103/aam.aam_837_25","DOIUrl":"https://doi.org/10.4103/aam.aam_837_25","url":null,"abstract":"<p><strong>Abstract: </strong>Esophagitis dissecans superficialis (EDS), also referred to as \"sloughing esophagitis,\" is an uncommon benign condition characterized by the desquamation of the superficial layer of the esophageal squamous mucosa. It is often underdiagnosed due to its rarity and nonspecific clinical presentation. Although several factors such as caustic ingestion, thermal injury, autoimmune disorders, and mechanical trauma have been implicated, medication-induced mucosal injury remains one of the most significant causes. Among these, bisphosphonates - a class of drugs widely prescribed for osteoporosis and other bone-related disorders - have been identified as a potential offending agent. We report the case of a 66-year-old woman with no significant comorbidities who presented with persistent retrosternal burning and pain for 2 months. There was no associated dysphagia, odynophagia, vomiting, hematemesis, weight loss, or history of nonsteroidal anti-inflammatory drug use. Physical and systemic examinations were unremarkable. Despite treatment with double-dose esomeprazole for 8 weeks, her symptoms persisted. Upper gastrointestinal endoscopy revealed a large area of whitish sloughed-off mucosa overlying a superficial ulcer with regular margins, extending from 26 cm to just above the gastroesophageal junction. A detailed drug history subsequently revealed the use of bisphosphonate gel for osteoporosis. Histopathological analysis demonstrated sloughed squamous epithelium with the features of superficial mucosal necrosis, confirming the diagnosis of EDS secondary to bisphosphonate-induced chemical injury. Discontinuation of the bisphosphonate and continuation of proton-pump inhibitor therapy led to complete symptom resolution within 2 weeks. This case underscores the importance of considering drug-induced esophageal injury in patients with refractory retrosternal pain unresponsive to acid suppression therapy. Bisphosphonates, although highly effective in osteoporosis management, may cause significant mucosal damage when not used properly. Clinicians should maintain a high index of suspicion for bisphosphonate-induced EDS, as timely recognition and withdrawal of the offending agent usually result in rapid clinical and endoscopic improvement.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759877","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":"Artificial Intelligence for Public Health Surveillance: Promise, Inequities, and the Need for Transparent Global Adoption.","authors":"Victor N Oboli","doi":"10.4103/aam.aam_21_26","DOIUrl":"https://doi.org/10.4103/aam.aam_21_26","url":null,"abstract":"<p><strong>Abstract: </strong>Artificial intelligence (AI) has demonstrated a strong technical potential to enhance public health surveillance, but routine implementation remains limited. Most AI surveillance systems are developed in high-income settings, reducing generalizability and limiting usefulness in low- and middle-income countries. Barriers to adoption include data inequities, weak digital infrastructure, limited workforce capacity, and unclear governance frameworks. Equitable, transparent, and policy-aligned implementation is essential for AI to meaningfully strengthen global outbreak preparedness.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759908","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":"Enhancing Hospital Operations through the Annual Operational Plan: A 2-year Comparative Analysis in a Charitable Multispecialty Hospital in India.","authors":"Vinod Sawantwadkar, C Anuja, Satyajit Singh Gill, Shrikanth Muralidharan","doi":"10.4103/aam.aam_184_26","DOIUrl":"https://doi.org/10.4103/aam.aam_184_26","url":null,"abstract":"<p><strong>Background: </strong>In the evolving healthcare landscape, hospitals face multifaceted challenges, including rising patient demands, limited resources, and the need for sustained quality improvements. Traditional accreditation systems, such as those from the National Accreditation Board for Hospitals and the National Accreditation Board for Testing and Calibration Laboratories, primarily focus on clinical quality and patient safety but often overlook broader operational aspects such as billing accuracy, insurance processing, and interdepartmental coordination. The objective of this study was to address these gaps, the Annual Operational Plan (AOP) framework, adapted from corporate strategic planning models, that was introduced in a charitable multispecialty hospital to promote compliance, accountability, and efficiency across departments.</p><p><strong>Materials and methods: </strong>This study employed a comparative analysis of AOP compliance over 2 years in 39 departments. Compliance was categorized as completed, partial, or noncompliant for AOP items. The Plan-Do-Check-Act (PDCA) cycle was utilized for iterative monitoring, involving quarterly audits, feedback sessions, and targeted interventions. Statistical evaluations, including Chi-square tests, assessed changes in compliance rates and operational performance.</p><p><strong>Results: </strong>Total AOP items decreased from 334 in 2023-2024 to 279 in 2024-2025 due to refinements, but completed items rose from 119 (35.6%) to 160 (57.3%), while noncompliance fell from 43 (12.9%) to 5 (1.8%) (χ2 = 52.34, P < 0.00001). Departments such as blood bank, biomedical, and accident and emergency showed marked improvements, with blood bank achieving 100% completion. These gains were linked to enhanced departmental engagement and structured oversight.</p><p><strong>Conclusion: </strong>The AOP, integrated with PDCA, significantly boosted operational efficiency and accountability, filling voids in accreditation standards. While promising for resource-constrained settings, future research should explore patient outcomes, financial impacts, and long-term viability to validate its broader applicability.</p>","PeriodicalId":7938,"journal":{"name":"Annals of African Medicine","volume":" ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759894","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}