Annals of Medicine and Surgery最新文献

{"title":"Bardet-Biedl syndrome in a Syrian adolescent: a rare case report.","authors":"Ammer Alabed, Shaghaf Alhallak, Tala Dakkak, Ahmad Jamal Alhaj Ali, Noel Beiruty, Kamal Alwannous","doi":"10.1097/MS9.0000000000003077","DOIUrl":"10.1097/MS9.0000000000003077","url":null,"abstract":"<p><strong>Introduction: </strong>Bardet-Biedl Syndrome (BBS) is a rare genetic disorder that affects multiple organs and presents with a variety of characteristics. It was found that a dysfunction in the cilia causes it, in addition to mutations in the genes involved in the composition of these cilia. We present a unique case of BBS in a 13-year-old male from Syria, characterized by a significant family history of scleroderma and a distinct clinical presentation.</p><p><strong>Case presentation: </strong>The patient presented with intellectual disabilities, post-axial polydactyly, and a history of delayed developmental milestones. The patient's BMI was within the normal range. Laboratory investigations revealed increased TSH and positive calcium oxalate, without evidence of central obesity or blindness. The diagnosis of BBS was made with a moderate level of confidence. The patient was undergoing treatment with thyroxine, showing improvement in thyroid function and communication skills.</p><p><strong>Clinical discussion: </strong>This case highlights the manifestations of BBS and the importance of recognizing atypical presentations. Diagnostic criteria traditionally emphasize a combination of primary and secondary features. We discuss the challenges of diagnosing BBS without genetic testing and the implications for treatment in resource-limited settings. Additionally, we explore therapeutics in managing the patient's condition.</p><p><strong>Conclusion: </strong>This case represents a unique presentation of BBS, expanding the understanding of its clinical variability in different populations. The findings underscore the necessity for individualized diagnostic approaches and comprehensive management strategies in patients with limited access to genetic testing. By documenting this case, we contribute to the growing body of literature on BBS, particularly in the Syrian context, highlighting the need for increased awareness and research into this challenging disorder.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3833-3836"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245975","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":"Outcomes and prognostic factors of tonsillar Kaposi sarcoma in the United States SEER Database.","authors":"Akef Obeidat, Tarek Ziad Arabi, Abdul-Rahman Elhassan, Safia Elhassan, Marwan Alaswad, Belal Nedal Sabbah","doi":"10.1097/MS9.0000000000003294","DOIUrl":"10.1097/MS9.0000000000003294","url":null,"abstract":"<p><p>Tonsillar Kaposi sarcoma (KS) is an extremely rare manifestation of KS, a neoplasm associated with human herpesvirus-8 and often linked to immunocompromised individuals. This study aims to analyze the outcomes and prognostic factors of tonsillar KS using data from the SEER (Surveillance, Epidemiology, and End Results) database, covering cases from 2000 to 2020. A total of 42 patients were identified, with the vast majority being male (97.6%) and a mean age of 40.1 years. Tumors were primarily localized (42.9%), and treatment modalities varied, with radiation therapy being the most common (38.1%), followed by chemotherapy (21.4%) and surgery (19.0%). Survival analysis showed that 21.4% of patients had died by the last follow-up, but the median survival time was not reached, indicating a relatively favorable prognosis. No statistically significant survival differences were observed based on treatment modality or other demographic factors, though there were trends towards worse outcomes for patients with regional disease and longer delays in treatment initiation. The study highlights the rarity of tonsillar KS, its demographic profile, and suggests a generally positive prognosis, although further research is needed to optimize treatment strategies for this rare form of KS.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3102-3106"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245983","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":"Risk factors and outcomes of inadequate empirical antibiotic therapy in ventilator-associated pneumonia: a systematic review and meta-analysis.","authors":"Alina Tariq, Theodosios Kantas, Bundhoo Beebee Shabneeze, Shaikh H Fawwad, Norah Aung, F N U Adnan, Kapil Khanal, Anushka Agrawal, Pratik Lamichhane","doi":"10.1097/MS9.0000000000003289","DOIUrl":"10.1097/MS9.0000000000003289","url":null,"abstract":"<p><strong>Objectives: </strong>Inadequate empirical antibiotic therapy for ventilator-associated pneumonia (VAP) is defined as at least one bacterial isolate not covered by initial antibiotics, or when the bacteria were resistant to all empiric antibiotics. The aim of our study is to identify the associated risk factors and outcomes of inadequately treated VAP in critically ill adults.</p><p><strong>Methods: </strong>PubMed, Embase, and Google Scholar databases were systematically searched until March 2024. Any observational study reporting on inadequate antibiotic therapy of adult patients (≥18 years) admitted to the intensive care unit (ICU) with a diagnosis of VAP was included in the analysis. The risk factors studied in this meta-analysis were isolation of multi-drug resistant (MDR) bacteria, prior use of antibiotics, admission in surgical units, polymicrobial infection, and late-onset VAP. Likewise, outcomes like in-hospital mortality, length of stay in the ICU and hospital, and duration of intubation were also studied.</p><p><strong>Results: </strong>Isolation of MDR bacteria from the patient significantly increased the risk of inadequate empirical antibiotic treatment (OR = 2.50, 95% C.I. = 1.57-3.97, <i>P</i> < 0.016). Prior use of antibiotics, admission in surgical units, polymicrobial infection, and late-onset VAP were not associated with the inadequate treatment. Likewise, inadequately treated VAP had significantly higher in-hospital mortality (RR = 1.66, 95% C.I. = 1.23-2.23, <i>P</i> < 0.001) and intubation duration (HG = 0.31, 95% C.I. = 0.03-0.59, <i>P</i> = 0.03) as compared to patients who received adequate treatment.</p><p><strong>Conclusions: </strong>VAP caused by MDR pathogens were highly likely to receive inadequate empirical antibiotic therapy. The mortality rate and intubation duration were significantly longer in inadequately treated VAP as compared to adequately treated VAP.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3786-3793"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246057","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":"Acute stroke as the initial manifestation of neuropsychiatric lupus erythematosus and anti-phospholipid syndrome in a child patient.","authors":"Saif Sadeh, Mariam Thalji, Hakam Shrouf, Sharif Basal, Saed I Y Attawna","doi":"10.1097/MS9.0000000000003317","DOIUrl":"10.1097/MS9.0000000000003317","url":null,"abstract":"<p><strong>Introduction and importance: </strong>Neurologic disorders are among the most significant clinical symptoms of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), primarily affecting the central nervous system. Both SLE and APS increase the risk of cerebrovascular events, and stroke is one of the most serious and late consequences that often occur years after diagnosis. Stroke as an initial symptom is uncommon in its early stages and frequently misinterpreted as ischemic cerebrovascular illness, posing diagnostic challenges.</p><p><strong>Case report: </strong>A 15-year-old female patient presented to the emergency department with a history of right-sided body weakness, mouth deviation, and dysarthria. A brain MRI revealed a complete occlusion of the left MCA with multiple acute left periventricular ischemia. She was referred for urgent brain catheterization, where complete recanalization of the MCA was performed. Extensive investigations were performed, including serological laboratory studies, which led to a subsequent diagnosis of SLE and APS.</p><p><strong>Clinical discussion: </strong>Ischemic stroke is a serious and late consequence of SLE and APS that often occurs years after diagnosis. Ischemic stroke as an initial symptom is uncommon in its early stages and frequently misinterpreted.</p><p><strong>Conclusion: </strong>This case exemplifies a sudden and possibly fatal presentation of SLE and APS in pediatric patients, emphasizing the need of early recognition and tailored treatment in influencing the disease's progression and outcomes.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3935-3939"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245933","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":"Aural myiasis in a healthy adult laborer from Nepal: a case report.","authors":"Anupam Koirala, Tek Nath Yogi, Sujan Dhamel, Jagat Kiran Oli, Anju Darai, Amrit Bhusal, Bibek Ojha, Rijan Kafle","doi":"10.1097/MS9.0000000000003281","DOIUrl":"10.1097/MS9.0000000000003281","url":null,"abstract":"<p><strong>Introduction: </strong>Aural myiasis, the infestation of the ear by fly larvae, is rare. It typically affects individuals with risk factors like poor hygiene, chronic ear conditions, or mental disabilities. This report highlights a case of a healthy adult and addresses its etiology, diagnosis, treatment, and prevention.</p><p><strong>Case presentation: </strong>A 45-year-old male laborer presented with aural fullness and bleeding from the left ear. Endoscopic examination revealed two maggots within the middle ear cavity, along with a pars tensa perforation. Treatment included turpentine oil instillation, antibiotics, antipyretics, and ear drops. The patient's hearing improved post-treatment, underscoring the rarity of this condition in healthy individuals.</p><p><strong>Discussion: </strong>This case underlines the clinical significance of early detection in preventing severe complications, such as brain penetration, which can be fatal. While otomyiasis is uncommon in healthy individuals, it requires prompt intervention, including maggot removal and addressing underlying factors. The scarcity of reported cases may reflect underdiagnosis or mismanagement of common ear complaints.</p><p><strong>Conclusion: </strong>Aural myiasis is rarely seen in healthy adults but highlights the importance of early diagnosis and treatment to prevent complications. Preventive measures include improving hygiene and addressing predisposing factors such as chronic ear conditions, socioeconomic barriers, and environmental exposures. Early eradication of larvae is vital to avoid severe outcomes, emphasizing the need for awareness among clinicians and the general population individuals.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3889-3893"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245974","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":"Efficacy and safety of pemafibrate administration in patients with dyslipidemia: a systematic review and updated meta-analysis of randomized controlled trials.","authors":"Mohammed A Elbahloul, Ammar Elgadi, Mohamed Ramadan, Houssaini Mohamed Amine, Hossam Fayed, Mohamed E Kasser, Ahmed Hussein, Fatma Labieb","doi":"10.1097/MS9.0000000000003264","DOIUrl":"10.1097/MS9.0000000000003264","url":null,"abstract":"<p><strong>Background: </strong>Patients with dyslipidemia are at risk for cardiovascular diseases. Lowering levels of lipid decrease morbidity. Pemafibrate is a selective peroxisome proliferator-activated receptor α modulator (SPPARMα) that works better at lowering serum triglycerides.</p><p><strong>Methods: </strong>Clinical trials investigating the effect of pemafibrate on lipid biomarkers in patients with dyslipidemia were searched in PubMed, Ovid Medline, SCOPUS, Web of Science (WOS), and the Cochrane Library from inception till 31 December 2023. The data were pooled as mean difference, odds ratio (OR), and 95% confidence interval (CI).</p><p><strong>Results: </strong>14 clinical trials were eligible, involving 12 451 patients, and showed favorable triglyceride level change (MD: -49.60 [-62.64, -36.55] <i>P</i> < 0.00001) for pemafibrate compared to placebo. Pemafibrate showed a significant increase in HDL-C levels (MD: 14.57 [10.14, 19.01] <i>P</i> < 0.00001) but showed a concurrent increase in LDL-C levels (MD: 10.99 [6.10, 15.88] <i>P</i> < 0.00001). It also showed non-HDL-C, total cholesterol level, Apo B, Apo C-II, and Apo C-III to be significantly reduced in pemafibrate groups. Also, in pemafibrate groups, hepatic adverse events were reported less frequently than in placebo groups. No significant difference was found in the frequency of total adverse effects, adverse drug reactions, or serious adverse events between the pemafibrate and placebo groups.</p><p><strong>Conclusion: </strong>Pemafibrate improved the overall lipid biomarkers compared to placebo groups, demonstrating a significant reduction in triglycerides, non-HDL-C, and total cholesterol while increasing HDL-C. Moreover, there was no significant difference in adverse effects.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3756-3767"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246018","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":"A comparative analysis of ARMS (anti-reflux mucosectomy) and TIF (transoral incisionless fundoplication) in the treatment of gastroesophageal reflux disease (GERD).","authors":"Anmol Mohan, Faryal Sohail, Namra Asif Saeed, Maryam Jameel, Mazen W Assal, Zim Warda Hasan, Arfah Zafar, Hasibullah Aminpoor, Vikash Kumar","doi":"10.1097/MS9.0000000000003311","DOIUrl":"10.1097/MS9.0000000000003311","url":null,"abstract":"<p><p>Gastroesophageal reflux disease (GERD) is a prevalent condition impacting physical and mental health, characterized by symptoms like heartburn and acid regurgitation. GERD affects 18.1-27.8% of North Americans, rising to ~ 50% under less strict criteria. Effective management of GERD is critical to improving patients' quality of life. Traditional treatments range from lifestyle modifications and pharmacological interventions to surgical approaches like laparoscopic anti-reflux surgery (LARS). Patients with erosive esophagitis receive a near 70-80% rate of \"complete\" symptom relief by 4 weeks using PPIs, in contrast to patients with non-erosive reflux disease (NERD), who demonstrate an intermediate response on the order of 50-60%. However, the invasiveness and associated side effects of surgical options have spurred the development of endoscopic techniques, including anti-reflux mucosectomy (ARMS) and transoral incisionless fundoplication (TIF). This review evaluates ARMS and TIF as therapeutic interventions for GERD, focusing on their risks, benefits, outcomes, and complications. ARMS is noted for shorter procedure times and fewer complications, particularly dysphagia and bleeding, making it an efficient choice for symptom control. TIF, while associated with a higher recurrence and reoperation rate, demonstrates superior long-term efficacy in medication reduction and sustained quality-of-life improvements, especially in patients without prior anti-reflux surgeries. Emerging advancements in endoscopic technologies, such as improved suturing techniques and refinements in mucosal resection, hold promise for reducing recurrence rates and enhancing procedural durability. The choice between ARMS and TIF should be tailored to individual patient needs, taking into account GERD severity, comorbidities, and surgical history. Both procedures exemplify significant advancements in minimally invasive GERD management, and ongoing innovations in endoscopic technologies are expected to further refine their safety and effectiveness. This comparative analysis provides insights into optimizing treatment selection and underscores the importance of personalized care in managing GERD.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3596-3609"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245969","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":"Cobenfy (xanomeline-trospium): a breakthrough FDA-approved therapy redefining schizophrenia treatment.","authors":"Syed Mohsin Raza Bukhari, Suhayya Btool, Jalil Abbas, Arif Hussain, Hassan Mehdi, Mohsin Raza","doi":"10.1097/MS9.0000000000003309","DOIUrl":"10.1097/MS9.0000000000003309","url":null,"abstract":"","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3065-3067"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246005","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":"Commentary on \"A case of necrotizing fasciitis secondary to cutaneous tuberculosis in a patient with systemic lupus erythematosus (SLE)\".","authors":"Ali Beheshti Namdar, Masoud Keikha","doi":"10.1097/MS9.0000000000003299","DOIUrl":"10.1097/MS9.0000000000003299","url":null,"abstract":"","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3999-4000"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246007","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":"Investigating the association between initial blood product transfusion with a higher plasma-to-red blood cell ratio and mortality in adults with severe bleeding following trauma.","authors":"Parham Khoshdani Farahani, Mohammad Kazem Shahmoradi, Masoud Sharifian, Haleh Pak","doi":"10.1097/MS9.0000000000003314","DOIUrl":"10.1097/MS9.0000000000003314","url":null,"abstract":"<p><strong>Objective: </strong>Trauma patients presenting with massive bleeding require significant blood transfusions to restore circulation and achieve hemostasis. The ratio of fresh-frozen plasma (FFP) to packed red blood cells (PRBC) is critical in determining immediate outcomes and mortality in these patients. This study aims to evaluate the impact of a high FFP:PRBC ratio on 24-hour and 30-day mortality among trauma patients with massive bleeding.</p><p><strong>Methods: </strong>In this retrospective descriptive study, inclusion criteria involved adults aged 18 or older presenting with massive trauma-related bleeding within 6 hours after trauma. Patients were categorized into two groups based on the FFP:PRBC ratio: high ratio (>1:1.5) or low ratio (<1:1.5) for damage control resuscitation. Data on demographic characteristics, mortality, intensive care unit (ICU) admission, length of hospital stay, and need for mechanical ventilation were collected. The primary outcomes were 24-hour and 30-day mortality, while secondary outcomes included ICU admission, mechanical ventilation duration, and hospital stay length. A Chi-square test was used to evaluate the association betweena high FFP:PRBC ratio and 24-hour and 30-day mortality. The Mann-Whitney test was used to analyze secondary outcomes.</p><p><strong>Results: </strong>Among 300 patients with a mean age of 40.5 years, 231 (76.7%) were male, and 69 (22.9%) were female. The high FFP:PRBC ratio group showed significantly higher rates of 24-hour mortality (11.5%), 30-day mortality (45.9%), and ICU admission (<i>P</i> < 0.001). However, the mean duration of mechanical ventilation in the high ratio group was 3.36 ± 2.85 days, indicating that some patients in this group still required ventilatory support.</p><p><strong>Conclusion: </strong>This study demonstrates that a high FFP:PRBC ratio (>1:1.5) is associated with reduced 24-hour and 30-day mortality rates among trauma patients with massive hemorrhage. However, the need for mechanical ventilation in some high-ratio patients suggests potential trade-offs that warrant further investigation. Additional research is needed to explore the potential adverse effects of high FFP:PRBC ratios and to optimize transfusion strategies in trauma care.</p>","PeriodicalId":8025,"journal":{"name":"Annals of Medicine and Surgery","volume":"87 6","pages":"3183-3188"},"PeriodicalIF":1.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246032","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}