Case Reports in Obstetrics and Gynecology最新文献

{"title":"Fertility-Sparing Management of Grade 2 Endometrioid Endometrial Adenocarcinoma Without Progesterone Receptor Expression: A Case Report.","authors":"Luiz Felipe Lessa Ortiz, Rafael Dyer Rodrigues de Moraes, Renan Ribeiro E Ribeiro, Caio Bosquê Hidalgo Ribeiro, Amanda Lino De Faria Lessa, Bárbara Bomfim Muniz Moraes, Henrique Cunha Vieira, Giorgio Bogani","doi":"10.1155/crog/5582003","DOIUrl":"10.1155/crog/5582003","url":null,"abstract":"<p><p>Managing G2 endometrioid endometrial adenocarcinoma without progesterone receptor (PR) expression presents significant challenges, particularly when considering fertility preservation. Grade 2 tumors fall into an area of uncertainty within fertility-sparing strategies, making treatment decisions complex and requiring careful individualization. This case report describes a 41-year-old patient who, despite PR and PE negativity, responded to conservative management with hysteroscopic resection, a levonorgestrel-releasing intrauterine device, metformin, and later megestrol, achieving complete histological remission in 15 months. The difficulty in managing G2 tumors lies in their variable behavior, necessitating a multidisciplinary approach, strict monitoring, and adaptability based on treatment response. This case underscores that, although fertility preservation in PR-negative G2 tumors remains challenging, it is feasible in highly selected cases. The evolving literature suggests that alternative strategies, such as immune modulation and aromatase inhibitors, may further expand options. Individualized management remains crucial, balancing oncological safety with reproductive goals through continuous reassessment and engagement with emerging therapeutic evidence.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"5582003"},"PeriodicalIF":0.8,"publicationDate":"2026-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147763496","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":"DICER1 Syndrome With Embryonal Rhabdomyosarcoma of the Uterine Cervix and Retroperitoneal Metastasis: A Case Report and Literature Review.","authors":"Xiao-Qiang Wei, Qiu-Yang Wang, Tian Li, You-Bin Hu","doi":"10.1155/crog/9718758","DOIUrl":"10.1155/crog/9718758","url":null,"abstract":"<p><strong>Background: </strong>DICER1 syndrome is a rare autosomal dominant genetic disorder and presents a variety of manifestations.</p><p><strong>Case: </strong>A 15-year-old adolescent presented cervical embryonal rhabdomyosarcoma, retroperitoneal tumor and multinodular goiter. Genetic analysis demonstrated a mutation in Exon 25 of DICER1 gene, a mutation in Intron 19 of NF1 gene, and a mutation in Exon 7 of TP53 gene. The patient received surgical treatment and six courses of combination chemotherapy. After 7 months of initial diagnosis, the patient occurred a pleural and mediastinal metastasis and eventually died of respiratory failure.</p><p><strong>Conclusion: </strong>Multiple gene mutations, in addition to DICER1 gene mutation, may influence the behavior and prognosis of DICER1 syndrome. We detail the necessity of instituting personalized, multidisciplinary monitoring plans, including regular clinical evaluations and targeted imaging of high-risk organs, to enable early detection and intervention.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"9718758"},"PeriodicalIF":0.8,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12978575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147442839","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":"Hidden in the Scar: A Rare Case of Vulvar Endometriosis Mimicking Bartholin's Cyst at an Episiotomy Site.","authors":"Swati Kumari, Anna Zaradna, Valmiki Vijay Seeraj","doi":"10.1155/crog/7202665","DOIUrl":"10.1155/crog/7202665","url":null,"abstract":"<p><strong>Background: </strong>Vulvar endometriosis is an exceptionally rare manifestation of extrapelvic endometriosis, particularly when located at the site of a prior episiotomy. Often misdiagnosed as more common vulvar pathologies, these lesions may present with cyclical pain and swelling, mimicking Bartholin's gland cysts or infected epidermal inclusion cysts.</p><p><strong>Case: </strong>We report the case of a 25-year-old gravida 3 para 2 woman with long-standing dysmenorrhea, dyspareunia, and a right vulvar mass that fluctuated with her menstrual cycle. Initially presumed to be a Bartholin's cyst, the lesion failed to respond to antibiotics and sitz baths. MRI revealed a complex vaginal wall cyst without classic signs of pelvic endometriosis. Examination under anesthesia and aspiration of chocolate-colored fluid raised suspicion for an endometriotic lesion. Surgical excision confirmed endometrial glands and stroma with hemosiderin-laden macrophages-consistent with vulvar endometriosis at the site of a right mediolateral episiotomy scar. Postoperative recovery was uneventful, and the patient experienced complete resolution of symptoms.</p><p><strong>Conclusion: </strong>This case highlights the diagnostic challenge of vulvar endometriosis in women with prior perineal trauma. Clinicians should maintain a high index of suspicion for endometriosis in cyclical vulvar masses-especially when located along episiotomy scars and unresponsive to conventional treatment. Early recognition and surgical excision can be curative and significantly improve quality of life.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"7202665"},"PeriodicalIF":0.8,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12972205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431074","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":"Advanced Management of Severe Adenomyosis in IVF: A Personalized Approach With Extended GnRH Agonist and Letrozole Therapy.","authors":"Charline Fatemi, Jonalyn Edades, Ibrahim ElKhatib, Francisco Ruiz, Laura Marqueta Marques, Laura Melado","doi":"10.1155/crog/4150637","DOIUrl":"10.1155/crog/4150637","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study is to evaluate the effectiveness of prolonged GnRH agonist (GnRH-a) suppression combined with letrozole and intensive luteal phase support in a patient with severe adenomyosis undergoing frozen-thawed embryo transfer (FET).</p><p><strong>Design: </strong>The study design was a case report.</p><p><strong>Setting: </strong>The setting was a tertiary referral in vitro fertilization (IVF) clinic.</p><p><strong>Subjects: </strong>The subject was a 41-year-old woman with a history of primary infertility with severe adenomyosis and endometriosis. Her partner presented with nonobstructive azoospermia.</p><p><strong>Exposure: </strong>Following micro-TESE, ovarian stimulation, and ICSI, the patient received prolonged combined GnRH-a and letrozole suppression before two attempts of single euploid frozen embryo transfer (eFET).</p><p><strong>Main outcome measures: </strong>The main outcome measure was pregnancy outcome.</p><p><strong>Results: </strong>The first eFET cycle with 3 months of suppression resulted in an early miscarriage at 7 weeks. In the second cycle, a prolonged 5-month suppression led to a significant reduction of the uterine size, lower serum estradiol levels, and optimal endometrial preparation, achieving an ongoing pregnancy and delivery of a healthy baby at 36 weeks of gestation.</p><p><strong>Conclusion: </strong>This case supports the potential benefit of extended GnRH-a and letrozole suppression with intensive luteal phase support for patients with severe adenomyosis, suggesting that individualized protocols may be beneficial and warrant further investigation in similar complex cases.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"4150637"},"PeriodicalIF":0.8,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431071","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":"Combined Management of a Rare Case of an Incarcerated Intrauterine Device: Case Report and Review of the Literature.","authors":"Stefano Restaino, Federico Paparcura, Elisa Rizzante, Silvia Zermano, Annalisa Graziano, Antonio Ferraro, Margherita Cuman, Alice Poli, Martina Arcieri, Lorenza Driul, Giuseppe Vizzielli","doi":"10.1155/crog/7806325","DOIUrl":"10.1155/crog/7806325","url":null,"abstract":"<p><strong>Background: </strong>Hormonal intrauterine systems are widely used for long-acting reversible contraception and for managing gynecological conditions such as heavy menstrual bleeding and endometrial hyperplasia. Although rare, complications such as uterine embedment and perforation can occur, potentially leading to device malfunction or injury displacement. This is the first reported case describing the removal of a fully incarcerated hormonal intrauterine system using a combined hysteroscopic and laparoscopic approach. Our findings suggest that this technique may offer a safe and effective alternative for managing cases of embedded intrauterine devices where conventional hysteroscopic removal is unsuccessful.</p><p><strong>Case presentation: </strong>We report the case of a 35-year-old asymptomatic woman with a hormonal intrauterine system fully embedded in the posterior myometrial wall, positioned 4.3 mm from the uterine serosa. The device was initially confirmed to be intracavitary upon insertion but was later found to have migrated into the myometrium during a routine 30-day follow-up ultrasound. Initial attempts at hysteroscopic removal failed due to poor visualization and a broken retrieval string. Given the high risk of iatrogenic injury, a combined laparoscopic-hysteroscopic approach was planned. Under laparoscopic visualization and transrectal ultrasound guidance, a careful myometrial excision using a hysteroscopic-angled loop was performed, successfully freeing and removing the intrauterine device. A bilateral salpingectomy was also conducted at the patient's request.</p><p><strong>Conclusion: </strong>A combined laparoscopic-hysteroscopic approach under ultrasound guidance may be regarded as a viable technique for complex cases of intrauterine device incarceration within the myometrium, minimizing the risk of uterine perforation and adjacent organ injury.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"7806325"},"PeriodicalIF":0.8,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12972590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431079","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":"Severe Cord Entanglement in a Monochorionic-Monoamniotic Twin Pregnancy: Highlighting Perinatal Risks and Management Challenges-A Case Report.","authors":"Michel Alagha, Karmen Saroufine, Hassan Aji, Ghassan Nabbout","doi":"10.1155/crog/5549397","DOIUrl":"10.1155/crog/5549397","url":null,"abstract":"<p><p>Monochorionic-monoamniotic (MCMA) twin pregnancies represent the rarest and highest risk form of twin gestation, largely due to complications such as umbilical cord entanglement (UCE). We report a case of a 27-year-old woman with a spontaneously conceived MCMA twin pregnancy complicated by an extreme intraoperative finding of 17 loops of UCE, yet with a favorable neonatal outcome. MCMA gestation was diagnosed antenatally by ultrasound demonstrating a single placenta without an intertwin membrane. The patient was admitted at 31 weeks' gestation for planned inpatient monitoring and administration of antenatal corticosteroids, followed by elective cesarean delivery at 32 weeks' gestation. Both female neonates were delivered in vertex presentation and admitted to the neonatal intensive care unit (NICU) due to prematurity. Birthweights, Apgar scores, and short-term neonatal outcomes were reassuring, with no major complications noted prior to discharge. This case underscores the importance of early diagnosis, close fetal surveillance, and appropriately timed delivery in MCMA pregnancies. Despite the high risk associated with UCE, favorable outcomes can be achieved through vigilant prenatal care and multidisciplinary management.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"5549397"},"PeriodicalIF":0.8,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431103","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":"Choriocarcinoma in the Cervix: Case Report of a Challenging Differential Diagnosis.","authors":"Kristin Pfister, Rok Satler, Dieter Erdin, Andreas Müller, Gesine Meili, Peter Bode","doi":"10.1155/crog/3427582","DOIUrl":"10.1155/crog/3427582","url":null,"abstract":"<p><strong>Background: </strong>Primary cervical choriocarcinoma in abortion curettage tissue is extremely rare and represents a diagnostic challenge. It is a serious condition that requires prompt and targeted therapeutic management. This case report describes the diagnostic evaluation, taking into account relevant differential diagnoses and highlighting the importance of a comprehensive diagnostic work-up to resolve these complex cases.</p><p><strong>Case report: </strong>A 43-year-old woman presented with recurrent vaginal bleeding, an elevated <i>β</i>-HCG of 1165 mU/mL, and sonographic suspicion of an incomplete abortion with an ectopic pregnancy in the cervix. Dilation and curettage were performed. Histological analysis raised the suspicion of a gestational choriocarcinoma of the cervix. In contrast, an external specialist referral suggested a somatic carcinoma with germ cell differentiation due to an abnormal p53 pattern, which subsequently led to a change in the management. The patient underwent a total hysterectomy and bilateral salpingo-oophorectomy together with bilateral iliac lymphadenectomy. In the final molecular workup, nonmaternal DNA was identified in the tumor tissue. A <i>TP53</i> mutation could not be detected. In summary, these findings confirmed a gestational choriocarcinoma of the cervix. Follow-up 28 months after completion of chemotherapy revealed no evidence of recurrence.</p><p><strong>Conclusion: </strong>Cervical gestational choriocarcinoma requires thorough molecular investigation, as accurate diagnosis is pivotal for optimal management.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"3427582"},"PeriodicalIF":0.8,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431107","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":"Case Report of a Large Ovarian Cyst in a Multiparous Woman: A Challenging Surgical Management.","authors":"Ibrahim Talat Kasar, Atheer Hameed Alqarni, Elhadi Miskeen, Anwar Ali Alshehri, Naif Abdulaziz Alqarni, Mirnan Adel Alghamdi, Amal Fayez Hamuman, Amal Ahmed Alotaibi, Tagwa Idris, Laila Yahya Alhubaishi","doi":"10.1155/crog/2109088","DOIUrl":"10.1155/crog/2109088","url":null,"abstract":"<p><p>This case report details the surgical management of a large (15 × 9 cm) symptomatic right ovarian cyst in a 42-year-old multiparous woman, highlighting the decision-making process for definitive treatment. The patient presented with chronic pelvic pain and a palpable mass, significantly reducing her quality of life. Imaging revealed a large, multilocular, benign-appearing cystic lesion. Given the patient's age, completion of childbearing, and the cyst's size and complexity, a right salpingo-oophorectomy was performed instead of a cystectomy to achieve definitive symptom resolution and mitigate recurrence risk. The decision to proceed with a definitive right salpingo-oophorectomy, rather than an ovarian cystectomy, was based on a confluence of factors: the patient's age (42), her status as a multiparous woman who had completed childbearing, and the cyst's size and complex multilocular morphology which increased the technical difficulty and potential morbidity of cystectomy while raising a low-grade concern for underlying neoplasia. The surgery was uncomplicated, and histopathology confirmed a benign cystadenoma. This case underscores the importance of tailoring surgical intervention, specifically the choice between cystectomy and salpingo-oophorectomy, to individual patient factors such as parity, fertility goals, and cyst characteristics to optimize clinical outcomes.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"2109088"},"PeriodicalIF":0.8,"publicationDate":"2026-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12968067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147431066","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 Rare Case Report on Holoprosencephaly With Cyclopia: Jimma University Medical Center, Ethiopia.","authors":"Dejene Tolossa Debela, Fanta Asefa Disasa, Anberbir Girma, Sagni Jelkeba Seto","doi":"10.1155/crog/2602471","DOIUrl":"10.1155/crog/2602471","url":null,"abstract":"<p><strong>Background: </strong>Holoprosencephaly is a congenital brain malformation resulting from incomplete division of the forebrain (prosencephalon) into two hemispheres during early embryonic development, typically during the 4th-6th week of gestation. Cyclopia is a rare and fatal form of holoprosencephaly characterized by severe craniofacial abnormalities resulting from incomplete cleavage of the embryonic prosencephalon, leading to the failure of separation of the orbital cavities. The prevalence is 1.31 per 10,000 for live births and 1:250 for spontaneous abortions.</p><p><strong>Case presentation: </strong>This is a case report of a 33-year-old Gravida 5, Para 4 woman with no history of abortion and a prior history of normal vaginal deliveries, who presented to the obstetric triage with a 7-day history of absent fetal movements. After a detailed history was taken, a physical examination and ultrasound scan confirmed an intrauterine fetal death. Termination of the pregnancy was decided after the mother was counseled on the possible outcome of the pregnancy. Induction with misoprostol per the hospital protocol was given to deliver an 1800-g, Grade 3 macerated male fetus with a diagnosis of a severe form of holoprosencephaly with cyclopia and proboscis.</p><p><strong>Conclusion: </strong>Although holoprosencephaly is rare, early first-trimester anatomical ultrasound conducted by an experienced clinician is critical for accurate diagnosis, and evaluation of severity is pivotal for counseling families regarding expected outcomes and pregnancy termination decisions.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"2602471"},"PeriodicalIF":0.8,"publicationDate":"2026-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375946","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":"Life-Threatening Ectopic Pregnancy Implanted on the Uterosacral Ligament in a LNG-IUS User: A Maternal Near-Miss Event.","authors":"Annalisa Di Cello, Jessica Sovereto, Maria Patrizia Muzzi, Carmelina Donatella Ermio","doi":"10.1155/crog/1602324","DOIUrl":"10.1155/crog/1602324","url":null,"abstract":"<p><strong>Background: </strong>Ectopic pregnancy is a major cause of first-trimester maternal morbidity and mortality. Implantation on the uterosacral ligament is exceptionally rare and may lead to catastrophic intraperitoneal bleeding.</p><p><strong>Case presentation: </strong>A 38-year-old woman using a levonorgestrel-releasing intrauterine system (LNG-IUS) presented in hemodynamic preshock with severe anemia and positive <i>β</i>-hCG. Imaging revealed a large-volume hemoperitoneum without identifiable intrauterine or adnexal gestation. Emergency diagnostic laparoscopy demonstrated approximately 5 L of hemoperitoneum and active bleeding from the right uterosacral ligament. The bleeding lesion was excised, and histopathology confirmed ectopic gestation. The patient recovered uneventfully and was discharged on postoperative Day 6.</p><p><strong>Conclusion: </strong>Uterosacral ligament ectopic pregnancy is an extremely rare but potentially fatal condition. This case constitutes a maternal near-miss and underscores the importance of maintaining high suspicion and rapidly proceeding with surgical exploration when hemoperitoneum is present and diagnosis is unclear.</p>","PeriodicalId":9610,"journal":{"name":"Case Reports in Obstetrics and Gynecology","volume":"2026 ","pages":"1602324"},"PeriodicalIF":0.8,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12966615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147375971","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}