Journal of the College of Physicians and Surgeons--Pakistan : JCPSP最新文献

{"title":"Team Objective Structured Bedside Assessment (TOSBA) in Paediatric Undergraduate Students.","authors":"Heena Rais, Azam Saeed Afzal, Amber Shamim Sultan, Farhana Zafar","doi":"10.29271/jcpsp.2025.07.897","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.07.897","url":null,"abstract":"<p><strong>Objective: </strong>To develop a team objective structured bedside assessment (TOSBA) tool for assessing the paediatric undergraduate students' clinical skills at the bedside.</p><p><strong>Study design: </strong>A validation, cross-sectional study. Place and Duration of the Study: Department of Paediatrics, Ziauddin Medical University Hospital, Karachi, Pakistan, from March to June, 2023.</p><p><strong>Methodology: </strong>Three groups of 4th-year students (n = 61) at Ziauddin Medical University underwent this formative assessment process 4-5 times during a 4-week rotation. Psychometric analysis for reliability was done by calculating the internal consistency and item-total correlation of TOSBA scores. At the same time, validity was determined by correlating TOSBA scores with the end-of-rotation objective structured clinical evaluation (OSCE) scores.</p><p><strong>Results: </strong>The TOSBA tool's overall reliability was good, with Cronbach's alpha values >0.7 for all clinical skills assessed. Spearman's correlation revealed r2 >0.4 (p <0.001) for history taking and clinical reasoning. Item-total correlation varied across stations, occasionally falling below 0.7. Strong correlations (0.46 to 0.73, p <0.001) were observed between similar constructs. The multi-trait-multi-method matrix highlighted divergent validity, showing no or negative correlations within the same method (TOSBA or OSCE), except for physical examination, which differed from OSCE.</p><p><strong>Conclusion: </strong>The TOSBA tool developed for formative assessment of undergraduate paediatric students is a reliable and moderately valid tool for formative assessment of undergraduate students.</p><p><strong>Key words: </strong>Objective structured clinical evaluation, Reliability, Team objective structured bedside assessment, Undergraduate students, Validity.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"897-903"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556273","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":"Treatment of Ossification or Sclerosis of the Posterior Longitudinal Ligament of the Cervical Spine Using New Techniques.","authors":"Wendong Xie, Xiudong Liu, Chao Zhang","doi":"10.29271/jcpsp.2025.07.939","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.07.939","url":null,"abstract":"<p><p>Null.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"939-940"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556275","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":"Balancing Benefits and Risks of the Use of Cage in Lumbar Spondylolisthesis Surgery: A Meta-Analysis.","authors":"Yunpeng Mao, Feng Yao, Chao Xu, Xinlin Wu, Yuhao Yang, Fuyong Zhang","doi":"10.29271/jcpsp.2025.07.892","DOIUrl":"10.29271/jcpsp.2025.07.892","url":null,"abstract":"<p><p>Lumbar spondylolisthesis is a prevalent spinal disorder for which the primary treatment approach involves surgical intervention, including reduction, decompression, internal fixation, and bone graft fusion. This systematic review evaluated and compared the clinical efficacy of posterior lumbar interbody fusion (PLIF)/transforaminal lumbar interbody fusion (TLIF) procedures using a cage, as opposed to posterolateral fusion (PLF) procedures without a cage, for the treatment of lumbar spondylolisthesis. The use of a cage has been shown to improve fusion rate and reduce functional disability. Patients who underwent inter-lumbar fusion with a cage experienced lower scores for postoperative lower back pain, with no significant difference in leg pain scores. Additionally, the use of a cage led to a decrease in postoperative complications, although there was no significant difference in operation time. The incorporation of a cage during lumbar spondylolisthesis surgery has been found to augment the efficacy of pedicle screw fixation through the simultaneous management of nerve decompression and pedicle screw fixation, resulting in significant enhancements in patient prognosis. Key Words: Spondylolisthesis, Pain, Fusion, Cage, Meta-analysis.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"892-896"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556244","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":"Cost-Effectiveness of Bariatric Surgery for the Treatment of Obesity: A Cost-Utility Analysis at International Metabolic and Bariatric Centre.","authors":"Mushtaq Ahmad, Maria Alamgir, Waqar Ahmad, Mah Noor Dad Khan, Abdul Haseeb Sahibzada","doi":"10.29271/jcpsp.2025.07.917","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.07.917","url":null,"abstract":"<p><strong>Objective: </strong>To determine the cost-effectiveness of bariatric surgery in comparison to conservative treatment options in managing obesity and its secondary complications.</p><p><strong>Study design: </strong>A cross-sectional survey. Place and Duration of the Study: Department of Bariatric Surgery, International Metabolic and Bariatric Centre, Afridi Medical Complex, Peshawar, Pakistan, from August 2019 to June 2024.</p><p><strong>Methodology: </strong>Patients undergoing bariatric surgeries including gastric bypass or sleeve gastrectomy were included in the surgical group; those getting routine medical care for obesity during the same time period were included in the non-surgical group. Data on preoperative and postoperative medical expenses for the surgery cohort was taken from medical records and hospital billing systems during a five-year period. Frequencies and percentages for categorical variables and mean ± standard deviation for continuous variables in both groups were calculated as part of the descriptive analysis.</p><p><strong>Results: </strong>A total of 5,743 patients who underwent bariatric surgery were included in the study. The average cost of bariatric surgery, including preoperative treatment and postoperative follow-up, was PKR 670,000 per person. Over a five-year period, this cost increased to PKR 904,290. On the other hand, the non-surgical group's average five-year total cost for managing obesity-related comorbidities was PKR 1,797,988.</p><p><strong>Conclusion: </strong>Bariatric surgery is a cost-effective intervention in managing obesity and its associated complications in the long term as compared to conventional treatment options and provides an increase in the healthcare cost reduction and enhances health status, higher quality of life, and increased QALYs.</p><p><strong>Key words: </strong>Bariatric surgery, Cost-effectiveness, Cost-utility analysis.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"917-921"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556252","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":"CPSP's Drive Towards Innovation - Advancing Assessment, Education, and Engagement.","authors":"Khalid Masud Gondal","doi":"10.29271/jcpsp.2025.07.813","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.07.813","url":null,"abstract":"<p><p>Null.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"813"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556253","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":"Safety and Efficacy of Low Molecular Weight Heparin <em>Vs</em>. Direct Oral Anticoagulants in Cancer-Associated Venous Thromboembolism.","authors":"Samar Minallah, Amer Rehman Farooqi, Kashif Sajjad, Zainab Shakeel, Manzoor Khan, Sajjad Ullah","doi":"10.29271/jcpsp.2025.07.875","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.07.875","url":null,"abstract":"<p><strong>Objective: </strong>To compare the safety and efficacy of low molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) in treating venous thromboembolism (VTE) among cancer patients.</p><p><strong>Study design: </strong>Descriptive study. Place and Duration of the Study: Department of General Medicine, Shaukat Khanum Memorial Cancer Hospital, Peshawar, Pakistan, from February to September 2023.</p><p><strong>Methodology: </strong>This retrospective study included 150 cancer patients treated with either LMWH or DOACs for at least one month. The safety and efficacy were measured in terms of occurrences of major bleeding (assessed through International Society of Thrombosis and Haemostasis (ISTH) score) and recurrent VTE within six months.</p><p><strong>Results: </strong>Among the 150 patients studied, 99 (66%) received LMWH, while 51 (34%) were treated with DOACs. The mean age in the LMWH group was 45.49 ± 13.48 years, compared to 54.00 ± 12.22 years in the DOAC group. Major bleeding events were more frequent 11 (11.1%) in the LMWH group than 3 (5.9%) in the DOAC group, though this difference was not statistically significant (p = 0.383). Recurrence rates of VTE were higher 8 (16%) in the DOAC group compared to the LMWH group 10 (10.1%), with no statistically significant difference (p = 0.300). The LMWH therapy was associated with a longer median treatment duration (170 days versus 166.5 days for DOACs; p = 0.290) and a statistically significant shorter hospital stay (0-25 days versus 0-30 days for LMWH; p = 0.038).</p><p><strong>Conclusion: </strong>Both DOACs and LMWH are equally effective for managing VTE. DOACs offer relatively shorter treatment durations and hospital stays, though they have a slightly higher recurrence rate and comparable or lower major bleeding risk.</p><p><strong>Key words: </strong>Venous thromboembolism, Low molecular weight heparin, Direct oral anticoagulants, Cancer, Thrombosis.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"875-880"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556271","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":"Comparison of Serum Prolidase Activity in Smokers and Non-Smokers.","authors":"Tahire Betul Kor, Basri Furkan Dagcioglu, Aygul Tikit, Salim Neselioglu","doi":"10.29271/jcpsp.2025.07.859","DOIUrl":"10.29271/jcpsp.2025.07.859","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effect of smoking on serum prolidase enzyme activity and proline/hydroxyproline levels.</p><p><strong>Study design: </strong>A case control study. Place and Duration of the Study: Department of Family Medicine, Ankara Bilkent City Hospital, Family Medicine, Ankara, Turkiye, from June 2022 to May 2023.</p><p><strong>Methodology: </strong>A total of 150 participants were included in the study, including 54 smokers, 43 ex-smokers, and 53 non-smokers. Proline and hydroxyproline concentrations were analysed using a liquid chromatography-mass spectrometre (Sciex QTrap 4500-Foster City-CA). Serum prolidase enzyme activity was determined with the Chinard reagent according to the spectrophotometric test. Multinomial logistic regression analysis compared prolidase activity and amino acid levels among smokers, ex-smokers, and non-smokers.</p><p><strong>Results: </strong>The median values of prolidase enzyme activity were statistically lower in the smoker group 734.2 (643.8-799.6) than in the non-smoker group 836.8 (755.2-884.2, β = 0.003, OR = 0.997, 95% CI = 0.994-1,000, p = 0.025. In multiple comparisons, the median values of hydroxyproline were significantly higher in the non-smoker group 8.99 (5.76-11.22) than in the ex-smoker 6.05 (4.37-8.21, p = 0.008). Still, no significant difference was found in the multinomial logistic regression analysis (β = -0.051, OR = 0.951, CI 95% = 0.848-1.066, p = 0.384).</p><p><strong>Conclusion: </strong>Serum prolidase enzyme activity was significantly lower in smokers than in non-smokers. The prolidase activity may be a fruitful area of ​​study to understand the pathophysiology of smoking-related diseases better.</p><p><strong>Key words: </strong>Smoking, Prolidase, Proline, Hydroxyproline, Collagen synthesis, COPD, Malignancy.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"859-865"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556250","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":"Predictive Value of the Naples Prognostic Score on New-Onset Atrial Fibrillation in ST-Segment Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention.","authors":"Yang Ling, Chen Liang, Renjie Wu, Jinfeng Wang","doi":"10.29271/jcpsp.2025.07.819","DOIUrl":"10.29271/jcpsp.2025.07.819","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the connection between Naples prognostic score (NPS) and new-onset atrial fibrillation (NOAF) in ST- segment elevation myocardial infarction (STEMI) cases following revascularisation.</p><p><strong>Study design: </strong>An observational study. Place and Duration of the Study: Department of Cardiology, Yijishan Hospital, Affiliated to Wannan Medical College, Wuhu, China, from December 2016 to February 2023.</p><p><strong>Methodology: </strong>The investigation recruited 683 consecutive STEMI patients after percutaneous coronary intervention (PCI), categorising them into two groups: NOAF group and sinus rhythm (SR) group. Analyses involving both multivariate logistic regression and receiver operating characteristic (ROC) curves were performed to evaluate the predictive capability of NPS for NOAF development. Additionally, the Kaplan-Meier method was employed to assess the differences in all-cause mortality between the two groups.</p><p><strong>Results: </strong>Fifty-one (7.5%) patients of the present study developed NOAF during hospitalisation. NPS was found to be independently predictive of NOAF (NPS as continuous variable, odds ratio [OR], 2.207; 95% confidence interval [CI], 1.305-3.732; p <0.05; NPS as categorical variable, OR, 5.616; 95% CI, 1.252-25.198; p <0.05). The optimal NPS threshold for predicting NOAF development in STEMI patients post-PCI was greater than 2 (p <0.001). Furthermore, the all-cause mortality rate among individuals complicated with NOAF is significantly elevated in comparison to that of the SR group over a median follow-up duration of 44 months (Log-rank p <0.001).</p><p><strong>Conclusion: </strong>NPS is independently predictive of NOAF among STEMI individuals who underwent PCI. Furthermore, NOAF is strongly linked to a poor prognosis after discharge.</p><p><strong>Key words: </strong>Naples prognostic score, New-onset atrial fibrillation, ST-segment elevation myocardial infarction, Prognosis.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"819-824"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556269","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":"MMP-8, IL-6, and IL-1β: The Most Promising Salivary Biomarkers for Early Diagnosis of Periodontitis.","authors":"Maria Ali, Yasmeen Taj, Farzeen Tanwir, Shaista Bakhat, Syed Adeel Ahmed","doi":"10.29271/jcpsp.2025.07.825","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.07.825","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the salivary levels of MMP-8, IL-1β, and IL-6 in patients with periodontitis and healthy controls, and to assess the association between these biomarkers and clinical parameters of periodontal disease.</p><p><strong>Study design: </strong>A case-control study. Place and Duration of the Study: Department of Pathology, Bahria University Health Sciences Campus, Karachi, Pakistan, from February to June 2024.</p><p><strong>Methodology: </strong>A total of 76 participants were selected using OpenEpi software. Ethical approval was obtained prior to the study. Clinical parameters such as plaque index (PI), calculus index (CI), periodontal probing depth (PPD), clinical attachment loss (CAL), and bleeding on probing (BOP) were measured. Salivary levels of IL-1β, IL-6, and MMP-8 were determined using a Sandwich ELISA kit (BT Lab). Data analysis was performed using IBM SPSS Statistics version 27, and independent t-test / Mann-Whitney U test was used to compare the biomarker levels, with significance set at p <0.05.</p><p><strong>Results: </strong>The study found significantly higher levels of IL-1β, MMP-8, and IL-6 in periodontitis patients compared to healthy controls. Significant associations were observed between biomarker levels and gender (p = 0.022), age groups (p <0.001), comorbidities (p = 0.012), plaque (p <0.001), CI (p <0.001), BOP (p <0.001), and CAL (p <0.001).</p><p><strong>Conclusion: </strong>This study demonstrated significant associations between salivary biomarkers (IL-1β, MMP-8, and IL-6) and clinical parameters of periodontitis. These biomarkers show promise as diagnostic tools for the early detection of periodontal disease.</p><p><strong>Key words: </strong>Periodontitis, Salivary biomarkers, Saliva, Interleukin 1beta, Interleukin 6, Matrix metalloproteinases 8.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"825-829"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556215","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":"Refeeding Syndrome in Children Aged 6 to 59 Months with Severe Acute Malnutrition.","authors":"Abdul Salam Memon, Muhammad Rafique, Amanullah Lail, Kulsoom Abdul Sattar, Zainab Khalid, Malik Sohail Danish","doi":"10.29271/jcpsp.2025.07.881","DOIUrl":"https://doi.org/10.29271/jcpsp.2025.07.881","url":null,"abstract":"<p><strong>Objective: </strong>To assess the frequency and factors of refeeding syndrome in children aged 6 to 59 months with severe acute malnutrition (SAM).</p><p><strong>Study design: </strong>Descriptive, cross-sectional study. Place and Duration of the Study: Department of Paediatric Medicine, Civil Hospital, Karachi, Pakistan, from April to September 2024.</p><p><strong>Methodology: </strong>All children aged 6 to 59 months diagnosed with SAM, initially presenting with normal serum phosphate, potassium, and magnesium concentration and underwent nutritional rehabilitation within the initial 72 hours of hospital admission. Refeeding syndrome was defined as the sudden lowering of serum phosphate, potassium, and magnesium concentrations within 72 hours of initiating nutritional rehabilitation. Chi-square/Fisher's exact test and paired t-test were applied to assess associations and mean differences, considering p ≤0.05 as significant.</p><p><strong>Results: </strong>The study included 185 children, with mean age of 23.94 ± 12.64 months, comprising of 104 (56.2%) boys and 81 (43.8%) girls. Refeeding syndrome was observed in 23 (12.4%) children. Children with refeeding syndrome showed significant declines in serum phosphate (3.68 ± 1.17 vs. 1.53 ± 0.49 mg/dL, p <0.001), potassium (3.92 ± 0.72 vs. 2.81 ± 0.66 mg/dL, p <0.001), and magnesium (2.02 ± 0.27 vs. 0.93 ± 0.22 mg/dL, p <0.001) levels from the baseline. Refeeding syndrome was significantly associated with younger age (p = 0.009), shorter height (p = 0.009), and the use of nasogastric or intravenous nutritional support (p = 0.012). Cardiac irregularities were more frequent in children with refeeding syndrome (p = 0.039).</p><p><strong>Conclusion: </strong>Refeeding syndrome occurred in 12.4% of SAM children and was linked to younger age, shorter height, and nasogastric or intravenous feeding.</p><p><strong>Key words: </strong>Refeeding syndrome, Severe acute malnutrition, Paediatrics, Electrolyte imbalance, Nutritional support.</p>","PeriodicalId":94116,"journal":{"name":"Journal of the College of Physicians and Surgeons--Pakistan : JCPSP","volume":"35 7","pages":"881-885"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556270","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}