Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery最新文献

{"title":"Comparison of food tolerance among bariatric surgery procedures: a systematic review.","authors":"Silvia Leite, Mary O'Kane","doi":"10.1016/j.soard.2024.11.018","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.018","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901346","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":"Bariatric surgery targeting opioid prescribing: a national model for effectively reducing opioid use after bariatric surgery.","authors":"Anthony T Petrick, Tejen A Shah, Dominick Gadaleta, Jon Gould, John Morton, April Smith, Kimberly Evans-Labok, Leandra Knapp, Clifford Y Ko, Stacy A Brethauer","doi":"10.1016/j.soard.2024.11.011","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.011","url":null,"abstract":"<p><strong>Background: </strong>Prescription opioids are responsible for a significant proportion of opioid-related deaths in the United States. Approximately 6% of opioid-naïve patients who receive opioid prescriptions after surgery become chronic opioid users. However, chronic opioid use after bariatric surgery may be twice as common.</p><p><strong>Objectives: </strong>This study aimed to report the feasibility and efficacy of implementing a national opioid-reducing protocol and to determine the impact of this protocol on opioid use after bariatric surgery.</p><p><strong>Setting: </strong>Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-accredited hospitals.</p><p><strong>Methods: </strong>Bariatric surgery targeting opioid prescription (BSTOP) was a national project sponsored by the MBSAQIP. It was executed in 3 phases: baseline, pilot, and implementation. A total of 271 MBSAQIP-accredited centers implemented the BSTOP protocol and reported data for all 3 phases. Protocol adherence, inpatient opioid use, opioids discharge prescribing, and outpatient opioid use were analyzed. Hospital-level opioid prescription habits were also assessed.</p><p><strong>Results: </strong>Compliance with 6 of 9 process measures improved significantly (P < .001). Median morphine milligram equivalents (MMEs) prescribed during inpatient stay decreased from 35 MMEs during data collection to 23 MMEs during the implementation phase (Dwass-Steel-Critchlow-Fligner, P < .001). Opioids prescribed at discharge decreased by 9.5% (P < .001). Low inpatient MME prescriptions were achieved by 14.2% of hospitals, while 15.7% of hospitals became low-discharge opioid prescribers.</p><p><strong>Conclusions: </strong>Implementation of a national opioid-reducing protocol in bariatric surgery is feasible and effective in reducing opioid prescribing and use. However, the adoption of postdischarge prescription guidelines remains low. Opportunities to reduce the impact of prescription opioids on overdose deaths persist.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928868","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":"10-Year outcomes of marginal ulcer formation and impact of gastrojejunostomy technique in Roux-en-Y gastric bypass.","authors":"James W Feimster, Leslie Okorji, B Amy Paul, Kyle J Thompson, Selwan Barbat, Timothy S Kuwada, Keith S Gersin, Roc Bauman, Iain H Mckillop, Abdelrahman Nimeri","doi":"10.1016/j.soard.2024.10.039","DOIUrl":"https://doi.org/10.1016/j.soard.2024.10.039","url":null,"abstract":"<p><strong>Background: </strong>Marginal ulcers (MUs) are potential complications following Roux-en-Y gastric bypass (RYGB) surgery. Our institution performs 3 different laparoscopic gastrojejunal anastomosis (GJA) techniques. The aim of this study was to analyze the incidence of MUs between 25-mm circular stapler (CS), linear stapler (LS), and hand-sewn (HS) GJA techniques using data collected over a 10-year period.</p><p><strong>Methods: </strong>A retrospective single-institutional review of patients who underwent upper endoscopy after RYGB was queried (2010-2019). The type of GJA performed, complications, endoscopic interventions, smoking, and nonsteroidal anti-inflammatory drug (NSAID) use were analyzed.</p><p><strong>Results: </strong>Overall, 2683 RYGBs were performed (1564 CS, 883 LS, and 236 HS) and an upper endoscopy was performed in 12.4% of these patients (15.4% of CS, 8.1% of LS, and 8.1% of HS patients). The incidence of MU was 6.7% (9.2% of CS, 3.3% of LS, 3.4% of HS patients). Rates of endoscopy were higher after CS versus LS and HS GJA, and incidence of MU was higher in the CS cohort versus LS and HS. Incidence of strictures was higher after CS GJA versus LS and HS, and revision of the GJA due to MU was higher following use of a CS versus LS and HS.</p><p><strong>Conclusion: </strong>Comparing 3 common GJA techniques for RYGB, the incidence of upper endoscopy after RYGB was higher following CS GJA, and incidence of MU, stricture, and revisional surgery for MU after RYGB were high in the CS cohort.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative survival of sleeve gastrectomy versus Roux-en-Y gastric bypass in adults with obesity: a systematic review and meta-analysis.","authors":"Yosuke Sakurai, Pranav Balakrishnan, Toshiki Kuno, Yujiro Yokoyama, Madison Bowles, Hisato Takagi, David A Denning, D Blaine Nease, Tammy L Kindel, Semeret Munie","doi":"10.1016/j.soard.2024.11.016","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.016","url":null,"abstract":"<p><strong>Background: </strong>The difference in survival between sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) remains controversial.</p><p><strong>Objective: </strong>To investigate the comparative survival difference between SG and RYGB in adults with morbid obesity.</p><p><strong>Setting: </strong>A meta-analysis.</p><p><strong>Methods: </strong>MEDLINE, EMBASE, and Cochrane Library Central Register of Controlled Trial were searched through June 30th, 2023 to identify studies comparing SG and RYGB. To minimize confounding, only adjusted outcomes were used from observational studies. The primary outcome was all-cause mortality during follow-up. Secondary outcomes were revision, reoperation, reintervention, hospitalization, endoscopic procedure, and emergency department visit.</p><p><strong>Results: </strong>Twenty-two studies (10 randomized controlled trials [RCTs] and 12 observational studies) met the inclusion criteria. Three RCTs and seven observational studies with 333,713 patients (SG, n = 172,909; RYGB, n = 160,804) were analyzed for all-cause mortality, with a weighted median follow-up of 34.4 months. SG was associated with decreased risks of all-cause mortality during follow-up (hazard ratio [HR]: .85; 95% confidence interval [CI]: .79 to .92), reoperation (HR: .69; 95% CI: .59 to .80), reintervention (HR: .74; 95% CI: .66 to .81), hospitalization (HR: .86; 95% CI: .77 to .97), and endoscopic procedure (HR: .55; 95% CI: 0.40-.76), whereas SG was associated with a higher risk of revision (HR: 2.18, 95% CI: 1.52 to 3.14). Meta-regression suggested consistent survival advantages of SG regardless of the proportion of patients with diabetes or follow-up duration.</p><p><strong>Conclusion: </strong>In adults with morbid obesity undergoing bariatric surgery, SG was associated with a decreased risk of all-cause mortality during follow-up compared with RYGB. A large-scale randomized trial with long-term follow-up is still necessary for validation.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901341","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 same-day sleeve gastrectomy surgery on postoperative emergency department visits: analysis from the Michigan Bariatric Surgery Collaborative.","authors":"Oliver A Varban, Sarah Petersen, Amanda Stricklen, Tammy Kindel, Sabrena Noria, Michael A Edwards, Anthony Petrick, Nabeel Obeid, Jonathan F Finks, Arthur M Carlin","doi":"10.1016/j.soard.2024.11.013","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.013","url":null,"abstract":"<p><strong>Background: </strong>Same-day discharge after sleeve gastrectomy (SDDSG) is being performed in select patient populations with increased regularity since 2020.</p><p><strong>Objectives: </strong>To evaluate the impact of SDDSG on emergency department (ED) visits.</p><p><strong>Setting: </strong>Academic and private practice bariatric surgery programs participating in a statewide quality improvement collaborative.</p><p><strong>Methods: </strong>Using a statewide bariatric specific data registry, all patients undergoing SDDSG between 2020 and 2023 were identified (n = 984). Rates of 30-day ED visits and complications were compared between SDDSG and a 2:1 propensity-matched cohort with a 1-2-day hospital length of stay (n = 1968).</p><p><strong>Results: </strong>The mean age and body mass index of SDDSG patients were 41.7 years and 45.9, respectively. When compared to the matched cohort, SDDSG patients had higher rates of ED visits (9.2% versus 6.2%, P = .0029), were more likely to present to ED earlier (10.3 days versus 12.9 days, P = .0118), and were less likely to require hospital admission (87.8% versus 71.1%, P < .0037), even though the overall complication rates were similar (4.7% versus 3.7%, P = .2087). The most common reason for an ED visit after SDDSG was nausea, vomiting, and dehydration (58.9% versus 66.9%, P = .2294), and the most common day to present to the ED was Friday (20.0% versus 20.7%, P = .9061), which was similar between groups.</p><p><strong>Conclusions: </strong>Despite having similar complication rates, patients undergoing SDDSG were more likely to present to the ED after surgery when compared to a matched cohort of patients with a 1-2-day hospital stay.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901364","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":"Weight and shape overvaluation and its relation to anxiety, depression, and maladaptive eating symptoms for patients up to 4 years after bariatric surgery.","authors":"Elise S Pearl, Matthew F Murray, Erin N Haley, Maunda Snodgrass, Jordan M Braciszewski, Arthur M Carlin, Lisa R Miller-Matero","doi":"10.1016/j.soard.2024.11.019","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.019","url":null,"abstract":"<p><strong>Background: </strong>Weight and shape overvaluation (WSO; undue influence of weight and shape on self-evaluation) is common among individuals undergoing bariatric surgery. Little is known about how WSO relates to poorer outcomes for patients remote from surgery.</p><p><strong>Objectives: </strong>To examine associations between WSO with anxiety and depression symptoms and various maladaptive eating behaviors in patients up to 4 years post-bariatric surgery.</p><p><strong>Setting: </strong>Henry Ford Health, United States.</p><p><strong>Methods: </strong>Patients who underwent surgery between 2018 and 2021 were invited to complete the study between 2021 and 2022. Participants (N = 765) completed anxiety and depression symptom and eating behavior measures.</p><p><strong>Results: </strong>Participants endorsed moderate WSO (M = 3.62, standard deviation = 1.87), which was positively related to anxiety (r = .37) and depression (r = .20) symptoms; eating in response to anger/frustration (r = .26), anxiety (r = .28), and depression (r = .31); and addictive eating behaviors (r = .26); and was significantly associated with the presence of loss-of-control (odds ratio [OR] = 1.39), binge (OR = 1.39), and graze (OR = 1.24) eating. WSO also was related to more frequent grazing (r = .23) but not loss-of-control or binge eating frequency for participants who endorsed behavior presence.</p><p><strong>Conclusions: </strong>Findings underscore that links between WSO, psychiatric distress, and maladaptive eating behaviors persist up to 4 years after bariatric surgery. These domains should be assessed at bariatric follow-ups, and assessment of WSO may help providers identify patients at risk for poorer outcomes. Findings should be used to inform temporal modeling of how WSO may predispose patients to poorer bariatric outcomes.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A population based study of bariatric surgery in Illinois.","authors":"Catherine S Valukas, Joseph Sanchez, Dominic Vitello, Eric P Hungness, Ezra N Teitelbaum, Joe Feinglass","doi":"10.1016/j.soard.2024.11.022","DOIUrl":"10.1016/j.soard.2024.11.022","url":null,"abstract":"<p><strong>Background: </strong>Utilization of metabolic and bariatric surgery has increased significantly over the last 2decades, yet barriers to access remain.</p><p><strong>Objectives: </strong>This study aimed to 1) define rates of metabolic and bariatric surgery utilization for qualifying adults in Illinois and 2) describe patient characteristics associated with undergoing surgery at Illinois hospitals with low metabolic and bariatric surgery volume.</p><p><strong>Setting: </strong>Metabolic and bariatric surgery at all nonfederal Illinois hospitals was included.</p><p><strong>Methods: </strong>Illinois hospital administrative data for 2016-2022 metabolic and bariatric surgery procedures (numerators) and Illinois Behavioral Risk Factor Surveillance System population estimates (denominators) were used to compute metabolic and bariatric surgery rates per estimated 100,000 Illinois residents ages 18-69 who qualified for metabolic and bariatric surgery based on National Institutes of Health Guidelines. Zip code median income was obtained from census data. Multivariable logistic regression was used to identify patient characteristics associated with receiving metabolic and bariatric surgery at low volume hospitals (LVHs), defined as less than 50 annual bariatric procedures.</p><p><strong>Results: </strong>The average annual metabolic and bariatric surgery rate was 702 per 100,000 qualifying Illinois adults. Rates were highest among non-Hispanic Black patients (890/100,000) and lowest for Hispanic patients (396/100,000) and patients from zip codes with median household income <$75,000. Lower median household income was the only characteristic associated with use of LVHs.</p><p><strong>Conclusions: </strong>Metabolic and bariatric surgery procedures almost doubled over the study period in Illinois, increasing the most for non-Hispanic Black and Medicaid patients. However, Hispanic and low-income patients still have rates well below the state average.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142974181","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":"Robotic sleeve gastrectomy has higher complication rates compared to laparoscopic: 8-year analysis of robotic versus laparoscopic primary bariatric surgery.","authors":"Graham J Spurzem, Ryan C Broderick, Emily K Kunkel, Hannah M Hollandsworth, Bryan J Sandler, Garth R Jacobsen, Santiago Horgan","doi":"10.1016/j.soard.2024.11.014","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.014","url":null,"abstract":"<p><strong>Background: </strong>Robotic-assisted bariatric surgery is growing rapidly. The optimal approach to minimize complications remains unclear.</p><p><strong>Objective: </strong>Assess robot utilization and compare 30-day outcomes for laparoscopic and robotic primary sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.</p><p><strong>Setting: </strong>United States.</p><p><strong>Methods: </strong>A retrospective analysis of the MBSAQIP database identified primary SG and RYGB cases from 2015 to 2022. Revisions/conversions, cases converted to another approach, and combined cases other than esophagogastroduodenoscopy were excluded. Outcomes were compared with logistic regression following 1:1 propensity-score matching to adjust for differences in patient demographics/comorbidities and operative variables.</p><p><strong>Results: </strong>A total of 823,902 cases (591,118 SG; 232,784 RYGB) were included. From 2015 to 2022, the percentage of SG and RYGB performed robotically increased from 6.7% and 6.9% to 29.5% and 31.8%, respectively. Compared to laparoscopic, robotic SG had significantly higher overall morbidity (odds ratio 1.14 [1.07-1.21], P < .001), leak (1.24 [1.05-1.46], P = .03), and bleeding rates (1.34 [1.13-1.58], P < .001). Robotic RYGB had significantly lower overall morbidity (.75 [.70-.81], P < .001) and bleeding (.80 [.68-.94], P < .01) with similar leak rates (.87 [.71-1.07], P = .18). Combined robotic SG and RYGB outcomes were similar to laparoscopic for 2020-2022 cases, except for higher rates of organ/space infection, readmission, and septic shock in the robotic group.</p><p><strong>Conclusion: </strong>Robotic SG has higher complication rates compared to laparoscopic, while robotic RYGB is protective against bleeding complications. Short-term outcomes for robotic surgery have become more similar to laparoscopic, but remain inferior. Further studies are warranted to elucidate the factors driving these findings.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901371","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":"Breastfeeding in metabolic and bariatric patients: a comprehensive guide for surgeons, patients, and the multidisciplinary team.","authors":"Priya Suri, Alyssa Bellini, Miaoli Emilie Bloemhard, Justin Yoon Choi, Adrienne Hoyt-Austin, Randi Janene McCreary, Colleen Kennedy, Benjamin Clapp, Farah Husain, Pearl Ma, Lisa Renee Hilton-Rowe, Victoria Lyo","doi":"10.1016/j.soard.2024.11.017","DOIUrl":"10.1016/j.soard.2024.11.017","url":null,"abstract":"<p><p>Since nearly 40% of metabolic and bariatric surgery (MBS) patients are individuals with the ability to bear children, many may seek to become pregnant or may be currently lactating when seeking surgery. While many patients plan to breastfeed, MBS patients are at high risk for premature cessation of breastfeeding. Limited literature exists on the impact of MBS on lactation and there are no established guidelines to help clinicians support and educate MBS patients about breastfeeding. Herein, we aim to fill that gap by providing a comprehensive guide for bariatric surgeons, obstetricians, women's health providers, lactation consultants, registered dietitians, bariatric nurse coordinators, and advanced practice providers to support breastfeeding in patients with a history of MBS or who are considering MBS. We review physician-patient discussion points on how MBS impacts lactation, the micronutrient and caloric needs for this unique population, and data to support successful breastfeeding in post-MBS patients who are lactating regarding practical, anesthetic, and imaging considerations.</p>","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142960806","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":"Comment on: Statin use trajectories post-bariatric surgery: a matched cohort analysis.","authors":"Athanasios Sevdalis, Megan Jenkins","doi":"10.1016/j.soard.2024.11.015","DOIUrl":"https://doi.org/10.1016/j.soard.2024.11.015","url":null,"abstract":"","PeriodicalId":94216,"journal":{"name":"Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901338","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}