Breast diseasePub Date : 2023-01-01DOI: 10.3233/BD-230012
Fadoua El Battioui, Fatima El Malki, Said Barrijal
{"title":"Quality of life assessment of breast cancer survivors in Northern Morocco: Rural-urban disparity.","authors":"Fadoua El Battioui, Fatima El Malki, Said Barrijal","doi":"10.3233/BD-230012","DOIUrl":"https://doi.org/10.3233/BD-230012","url":null,"abstract":"<p><p>This article is a cross-sectional study of 216 women undergoing adjuvant hormone therapy for breast cancer in two oncology centers in northern Morocco. Quality of life (QoL) was assessed using the Functional Assessment of Cancer Therapy (FACT) questionnaire and its endocrine subscale (ES). The relationship between rural-urban status in our sample and QoL was assessed by linear regression analysis using sociodemographic and clinical variables as covariates. Our results show that physical and functional well-being are significantly (p < 0.001) higher in rural areas (24 and 29, respectively) than in urban areas (16 and 19, respectively), while social and emotional well-being are significantly (p < 0.001) higher in urban areas (22 and 21, respectively) than in rural areas (15 and 16, respectively). However, there was no significant difference (p = 0.097) between rural and urban breast cancer survivors regarding endocrine symptom burden. Regarding the effect of sociodemographic and clinical factors on overall HRQOL of breast cancer survivors, hormone type was shown to have a significant effect on overall HRQOL (FACT-ES) of rural and urban breast cancer survivors (𝛽 = +0.849 and 𝛽 = +0.678, respectively). A similar effect was observed for ES (𝛽 = +0.896 and 𝛽 = +0.180, respectively).In contrast, other factors (age, marital status, economic status, menopausal status, type of surgery) did not have a significant effect on HRQOL (FACT-ES) or ES.The study highlighted the need for increased psychosocial supportive care efforts for rural breast cancer survivors to improve their QoL.</p>","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"42 1","pages":"291-298"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41102381","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}
Breast diseasePub Date : 2023-01-01DOI: 10.3233/BD-220066
Ahmed Abdallah, Omar Hamdy, Mohammad Zuhdy, Saleh S Elbalka, Mohamed Abdelkhalek, Amir M Zaid, Ahmed Atef, Mohamed G Elmadawy, Basel Refky, Khaled Abdel Wahab, Dalia Bayoumi, Khadiga M Ali, Islam H Metwally, Mosab Shetiwy
{"title":"The epidemiological and clinicopathological characteristics of multifocal/multicentric breast cancer in the Egyptian Delta and its impact on management strategies.","authors":"Ahmed Abdallah, Omar Hamdy, Mohammad Zuhdy, Saleh S Elbalka, Mohamed Abdelkhalek, Amir M Zaid, Ahmed Atef, Mohamed G Elmadawy, Basel Refky, Khaled Abdel Wahab, Dalia Bayoumi, Khadiga M Ali, Islam H Metwally, Mosab Shetiwy","doi":"10.3233/BD-220066","DOIUrl":"https://doi.org/10.3233/BD-220066","url":null,"abstract":"<p><strong>Background: </strong>Multifocal (MFBC)/multicentric (MCBC) breast cancer is being more recognized due to the improved imaging modalities and the greater orientation with this form of breast cancer, however, optimal surgical treatment, still poses a challenge. The standard surgical treatment is mastectomy, however, breast-conserving surgeries (BCS) may be appropriate in certain situations.</p><p><strong>Methods: </strong>A total of 464 cases of MF/MCBC out of 4798 cases of breast cancer were retrospectively analyzed from the database of the Oncology Center, Mansoura University (OCMU), between January 2008 and December 2019.</p><p><strong>Results: </strong>Radiologic involvement of multiple quadrants was reported in 27.9% by ultrasonography, 19% by mammography, and 59.1% by magnetic resonance imaging. BCS was performed in 32 cases (6.9%) while 432 cases underwent a mastectomy. Postoperative pathology revealed infiltration of other quadrants grossly in 23.5%, and under the microscope in 63.6% of the examined cases. Mean disease-free and overall survival were 95.5 and 164.6 months, respectively. When compared with MFBC, MCBC showed higher pathologic tumor size (p < 0.001), higher stages (p < 0.001), higher recurrence rates (p = 0.006), and lower DFS (P = 0.009) but with similar OS (P = 0.8).</p><p><strong>Conclusion: </strong>Mastectomy is still the primary treatment option for MCBC with higher recurrence rates compared with MFBC. However, BCS for properly selected MFBC is considered oncologically safe, following the same rules of breast conservation for unifocal disease.</p>","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"42 1","pages":"101-114"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9311113","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}
Breast diseasePub Date : 2023-01-01DOI: 10.3233/BD-239004
Shafa Nadia, Fridawaty Rivai, Indahwaty Sidin, Syahrir A Pasinringi
{"title":"What is known about patient-centered care application in post-surgical breast cancer patients?","authors":"Shafa Nadia, Fridawaty Rivai, Indahwaty Sidin, Syahrir A Pasinringi","doi":"10.3233/BD-239004","DOIUrl":"https://doi.org/10.3233/BD-239004","url":null,"abstract":"<p><strong>Background: </strong>Over the past two decades, patient-centered care has become internationally recognized as a dimension of high-quality health care. Recent research has shown that patient-centered care has many benefits, which are broadly categorized as patient experience and clinical and operational benefits.</p><p><strong>Objective: </strong>The study aimed at analyzing the correlation between the application of patient-centered care (PCC) and length of stay, patient satisfaction, and clinical outcome of post-surgical breast cancer patients.</p><p><strong>Methods: </strong>The study design was cross-sectional. A sample of 100 patients was determined and selected with the inclusion criteria. Data were collected using measuring tools comprising patient-centered care and patient satisfaction questionnaires as well as medical records to evaluate the length of stay and clinical outcomes. Bivariate analysis was conducted to analyze the correlation between patient-centered-care and length of stay (LOS), patient satisfaction, and the clinical outcomes of inpatients.</p><p><strong>Results: </strong>A correlation was found between patient-centered care (PCC) application and patient satisfaction (p = 0.005), but no correlation was observed between PCC application and length of stay (LOS) (p = 0.176) as well as clinical outcome (p = 0.128).</p><p><strong>Conclusions: </strong>The application of patient-centered care can be attributed to patient satisfaction but is not correlated to length of stay and clinical outcome of post-surgical breast cancer patients. The hospital should create an accepted definition and commonly agreed set of dimensions used for the concept of operationalization and its measurement to implement PCC and improve overall patient satisfaction and clinical outcome and reduce the length of stay as expected.</p>","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"42 1","pages":"233-243"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9952373","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}
Breast diseasePub Date : 2022-06-01DOI: 10.1177/01945998221083834
Andrew Morel, Jason E Cohn
{"title":"In Reference to \"Rural Otolaryngology Care Disparities: A Scoping Review\".","authors":"Andrew Morel, Jason E Cohn","doi":"10.1177/01945998221083834","DOIUrl":"10.1177/01945998221083834","url":null,"abstract":"","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"42 1 1","pages":"1228"},"PeriodicalIF":2.6,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89411165","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}
Breast diseasePub Date : 2022-05-26DOI: 10.3233/bd-210037
Khadijeh Kalan Farmanfarma, N. Mahdavifar, Somayeh Heidarpour Kiasara, Soheil Hassanipour, H. Salehiniya
{"title":"Determinants of mammography screening in Iranian women: A systematic review and meta-analysis.","authors":"Khadijeh Kalan Farmanfarma, N. Mahdavifar, Somayeh Heidarpour Kiasara, Soheil Hassanipour, H. Salehiniya","doi":"10.3233/bd-210037","DOIUrl":"https://doi.org/10.3233/bd-210037","url":null,"abstract":"BACKGROUND\u0000Mammography is the most effective method for early detection of breast cancer (BC), however, it has performed in low-level. The aim of this study was to investigate the determinants of mammography in Iran.\u0000\u0000\u0000METHODS\u0000This study was a systematic review which was performed based on articles published in both Persian and English languages among Iranian patients in the period of 2000 to 2020 by using keywords of \"Iran and mammography\". Papers were selected from national databases including (SID, Magiran) and international database including (Scopus, PubMed and web of science), finally related articles to mammography were reviewed.\u0000\u0000\u0000RESULTS\u0000Findings indicated that 35-50% of breast cancer can be detected in the early stages by mammography, however, it is in low rate of performance among Iranian women. Age, age of menarche, occupation, family history, marital status, family support, number of pregnancies, physician recommendations, perceived sensibility and severity, self-efficacy and perceived benefits are the most important predictors of performing mammography in Iran.\u0000\u0000\u0000CONCLUSION\u0000Due to the growing trend of breast cancer cases in the country and low mammography rates in Iranian population, high risk groups such as women with BC family history, low income level, low education level, older age and people with history of breast complications were more emphasized for performing mammography through health centers. Therefore, appropriate planning to reduce the barriers of mammography could be helpful.","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"41 1 1","pages":"279-294"},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42578561","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}
Breast diseasePub Date : 2022-05-20DOI: 10.3233/bd-210080
Vincent Vakaet, Hans Van Hulle, Viktor Quataert, P. Deseyne, Max Schoepen, L. Paelinck, G. Post, A. V. Van Greveling, B. Speleers, M. Mareel, W. De Neve, C. Monten, L. Veldeman
{"title":"Accelerated radiotherapy in patients over sixty years old after mastectomy: Acute and one-year physician-assessed toxicity and health-related quality of life.","authors":"Vincent Vakaet, Hans Van Hulle, Viktor Quataert, P. Deseyne, Max Schoepen, L. Paelinck, G. Post, A. V. Van Greveling, B. Speleers, M. Mareel, W. De Neve, C. Monten, L. Veldeman","doi":"10.3233/bd-210080","DOIUrl":"https://doi.org/10.3233/bd-210080","url":null,"abstract":"INTRODUCTION\u0000Postmastectomy radiotherapy reduces the risk of locoregional recurrence in breast cancer patients. The first results on accelerated radiotherapy in five fractions after breast conserving surgery are promising. The data on postmastectomy radiotherapy in five or six fractions is limited. We now present the data on acute and one-year toxicity and health related quality of life (HRQoL) after postmastectomy radiotherapy in patients of sixty years or older.\u0000\u0000\u0000METHODOLOGY\u0000119 patients received five fractions of 5.7 Gy to the chest wall and five fractions of 5.4 Gy to the lymph nodes over ten to twelve days. Physician-assessed toxicity were scored using the Common Terminology Criteria for Adverse Events version 4.03 toxicity scoring system and the LENT-SOMA scale. Fatigue was measured by the Multidimensional Fatigue Inventory (MFI-206). HRQoL was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire the breast cancer specific module and the BREAST-Q questionnaire.\u0000\u0000\u0000RESULTS\u0000Fatigue and edema were the most frequently observed physician-assessed toxicities. One year after radiotherapy only 12.9% experienced a clinically important deterioration in chest wall symptoms and in 22.9% of the patients were improved. Future perspective at one year after radiotherapy was improved in 40.0% of the patients. Patient-reported fatigue showed the greatest improvement.\u0000\u0000\u0000CONCLUSION\u0000Accelerated radiotherapy should be considered to minimize the burden of breast cancer treatment, especially in older patients.","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"41 1 1","pages":"261-266"},"PeriodicalIF":0.0,"publicationDate":"2022-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44868896","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}
Breast diseasePub Date : 2022-05-17DOI: 10.3233/bd-210041
Zeni Kharel, Omar P Nemer, Wang Xi, Bimala Upadhayaya, C. Falkson, Ruth M O'Regan, Ajay Dhakal
{"title":"Inflammatory breast cancer with excellent response to pembrolizumab-chemotherapy combination: A case report.","authors":"Zeni Kharel, Omar P Nemer, Wang Xi, Bimala Upadhayaya, C. Falkson, Ruth M O'Regan, Ajay Dhakal","doi":"10.3233/bd-210041","DOIUrl":"https://doi.org/10.3233/bd-210041","url":null,"abstract":"Inflammatory breast cancer (IBC) is a rare variety of breast cancer accounting for two percent of breast cancer diagnoses in the United States. It is characterized by peau d'orange, breast edema and erythema on physical examination and dermal lymphatic invasion by tumor emboli on histological examination. Micrometastases to lymphatics and bone marrow at the time of diagnosis and angiogenic properties of IBC explain the high propensity of this cancer to relapse and metastasize, its aggressiveness and poor prognosis. Preoperative sequential anthracycline and taxane (plus trastuzumab and pertuzumab if HER2-positive) based chemotherapy is the current standard of care for IBC. We herein report a case of stage IIIC triple-negative IBC treated with pembrolizumab plus chemotherapy based neoadjuvant therapy with a complete clinical and complete pathological response. This is the first case of triple-negative IBC treated with this regimen reported in the literature, thereby providing clinical data on the tolerability and efficacy of pembrolizumab plus chemotherapy based neoadjuvant regimen for the treatment of IBC.","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"41 1 1","pages":"255-260"},"PeriodicalIF":0.0,"publicationDate":"2022-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45132645","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}
Breast diseasePub Date : 2022-04-11DOI: 10.3233/bd-210066
S. Kumar, S. Bhattacharyya, A. Das, Gurpreet Singh, A. Bal
{"title":"In vitro effect of PIK3CA/mTOR inhibition in triple-negative breast cancer subtype cell lines.","authors":"S. Kumar, S. Bhattacharyya, A. Das, Gurpreet Singh, A. Bal","doi":"10.3233/bd-210066","DOIUrl":"https://doi.org/10.3233/bd-210066","url":null,"abstract":"BACKGROUND\u0000Agents targeting the PI3K pathway in triple negative breast cancer did not show any significant efficacy so far mostly because of the complex nature of these targeted inhibitors. Targeting the cancer cells with the combination of inhibitors may help in decelerating the regulatory pathways further achieving optimum clinical benefit. In this study, we investigated the effect of PIK3CA and mTOR inhibition in-vitro in triple-negative breast cancer (TNBC) cell lines.\u0000\u0000\u0000OBJECTIVE AND METHODS\u0000Three TNBC cell lines; MDA MB231, MDA MB468, and MDA MB453 were subtyped using immunohistochemistry and were screened for hotspot mutations in PIK3CA and AKT1. All cell lines were treated with different concentrations of inhibitors; PI3K inhibitor (BKM 120), mTOR inhibitor (AZD 8055), and dual PI3K/mTOR inhibitor (BEZ 235), and cell viability was assessed by MTT (3-(4, 5-Dimethylthiazol-2-yl)-2, 5-Diphenyltetrazolium Bromide), Trypan blue and Annexin-V/PI Assays.\u0000\u0000\u0000RESULTS\u0000Using immunohistochemistry, TNBC cell lines were subtyped as; mesenchymal subtype-specific cell line (MDA MB231), basal subtype-specific cell line (MDA MD468), and Luminal androgen receptor (LAR) subtype-specific cell line (MDA MB453). PIK3CA hot spot mutation (p.H1047R) in exon 20 was identified in the Luminal androgen receptor subtype (MDA MB453 cells) cell line. Cell viability assays showed that the Mesenchymal subtype-specific cell line (MDA MB231) was the most resistant to all inhibitors and the Luminal Androgen subtype (MDA MB453 cells) cell line was more sensitive to BKM120 (PI3K inhibitor) inhibition compared to other subtypes.\u0000\u0000\u0000CONCLUSIONS\u0000This study identified that the Luminal androgen receptor subtype of triple-negative breast cancer with PIK3CA mutation may be targeted with PIK3CA inhibitors with a favorable outcome.","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"41 1 1","pages":"241-247"},"PeriodicalIF":0.0,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46400007","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}
Breast diseasePub Date : 2022-04-05DOI: 10.3233/bd-210060
S. Youssry, A. Hussein, R. Ramadan, Ahmad Alkarmouty, Amel Elsheredy
{"title":"The association of human cytomegalovirus with biomarkers of inflammation and immune activation in breast cancer.","authors":"S. Youssry, A. Hussein, R. Ramadan, Ahmad Alkarmouty, Amel Elsheredy","doi":"10.3233/bd-210060","DOIUrl":"https://doi.org/10.3233/bd-210060","url":null,"abstract":"BACKGROUND\u0000The presence of human cytomegalovirus (HCMV) in breast cancer has been reported, suggesting a potential association between HCMV infection and breast carcinogenesis.\u0000\u0000\u0000OBJECTIVE\u0000To evaluate the association between HCMV infection and immune activation and inflammatory markers in breast cancer.\u0000\u0000\u0000METHODS\u0000HCMV DNA was detected from all patients using real-time PCR, Anti HCMV IgM and IgG antibodies were measured. IL-17 and IL-22 concentrations were detected by ELISA. Assessment of NLR and PLR was done, and cell proliferation was assessed using MTT assay.\u0000\u0000\u0000RESULTS\u0000The results revealed a significantly increased prevalence of anti-HCMV IgG and HCMV DNA in patients compared to both benign and control groups where positive HCMV prevalence was significantly associated with vascular invasion, proliferation rate, high neutrophil-to-lymphocyte ratio (NLR), and elevated IL-17 serum level. Furthermore, we demonstrated that increased serum IL-17 in patients was markedly associated with tumor stage, vascular invasion, and high NLR.\u0000\u0000\u0000CONCLUSION\u0000It can be concluded that HCMV infection may have vital roles in breast cancer pathogenesis. Moreover, altered peripheral blood cells and cytokines may result in disordered immune response in breast cancer patients.","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"41 1 1","pages":"229-239"},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45098663","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}
Breast diseasePub Date : 2022-04-04DOI: 10.3233/bd-210025
Paola Locicero, N. Weingertner, V. Noblet, M. Mondino, C. Mathelin, S. Molière
{"title":"An integrative ultrasound-pathology approach to improve preoperative phyllodes tumor classification: A pilot study.","authors":"Paola Locicero, N. Weingertner, V. Noblet, M. Mondino, C. Mathelin, S. Molière","doi":"10.3233/bd-210025","DOIUrl":"https://doi.org/10.3233/bd-210025","url":null,"abstract":"OBJECTIVE\u0000Preoperative diagnosis of phyllodes tumor (PT) is challenging, core-needle biopsy (CNB) has a significant rate of understaging, resulting in suboptimal surgical planification. We hypothesized that the association of imaging data to CNB would improve preoperative diagnostic accuracy compared to biopsy alone.\u0000\u0000\u0000METHODS\u0000In this retrospective pilot study, we included 59 phyllodes tumor with available preoperative imaging, CNB and surgical specimen pathology.\u0000\u0000\u0000RESULTS\u0000Two ultrasound features: tumor heterogeneity and tumor shape were associated with tumor grade, independently of CNB results. Using a machine learning classifier, the association of ultrasound features with CNB results improved accuracy of preoperative tumor classification up to 84%.\u0000\u0000\u0000CONCLUSION\u0000An integrative approach of preoperative diagnosis, associating ultrasound features and CNB, improves preoperative diagnosis and could thus optimize surgical planification.","PeriodicalId":9224,"journal":{"name":"Breast disease","volume":"41 1 1","pages":"221-228"},"PeriodicalIF":0.0,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46472176","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}