Pub Date : 2024-12-01DOI: 10.1016/j.igie.2024.11.001
{"title":"On behalf of our editors, authors, and readers: A tribute to our reviewers","authors":"","doi":"10.1016/j.igie.2024.11.001","DOIUrl":"10.1016/j.igie.2024.11.001","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Page 567"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139966","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}
In this study, we assessed our machine learning (ML)-based model's impact on reducing annual surveillance endoscopy costs for detecting gastric cancer (GC).
Methods
We analyzed 1099 patients with chronic gastritis undergoing annual EGD and randomly divided them into training and test sets (4:1). Using gradient-boosting decision trees and incorporating patient characteristics, we developed the ML model. In the test sets, we compared the EGD number needed to screen (NNS) for 1 GC, cost, and GC detection rate across different risk stratification strategies.
Results
The ML-selected high-risk cohort demonstrated low NNS values, low total cost, low cost per 1 GC, and high GC detection rates compared with alternative risk stratification approaches, including operative link for gastric atrophy assessment and operative link for gastric intestinal metaplasia assessment.
Conclusions
Our ML model holds promise in reducing endoscopy surveillance costs while maintaining a robust GC detection rate.
{"title":"Impact of a machine learning–based prediction model on annual surveillance endoscopy costs for detecting gastric cancer","authors":"Junya Arai MD, PhD , Atsushi Miyawaki MD, PhD , Yoku Hayakawa MD, PhD , Tomonori Aoki MD, PhD , Ryota Niikura MD, PhD , Hiroaki Fujiwara MD, PhD , Tetsuo Ushiku MD, PhD , Masato Kasuga MD, PhD , Mitsuhiro Fujishiro MD, PhD","doi":"10.1016/j.igie.2024.09.003","DOIUrl":"10.1016/j.igie.2024.09.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>In this study, we assessed our machine learning (ML)-based model's impact on reducing annual surveillance endoscopy costs for detecting gastric cancer (GC).</div></div><div><h3>Methods</h3><div>We analyzed 1099 patients with chronic gastritis undergoing annual EGD and randomly divided them into training and test sets (4:1). Using gradient-boosting decision trees and incorporating patient characteristics, we developed the ML model. In the test sets, we compared the EGD number needed to screen (NNS) for 1 GC, cost, and GC detection rate across different risk stratification strategies.</div></div><div><h3>Results</h3><div>The ML-selected high-risk cohort demonstrated low NNS values, low total cost, low cost per 1 GC, and high GC detection rates compared with alternative risk stratification approaches, including operative link for gastric atrophy assessment and operative link for gastric intestinal metaplasia assessment.</div></div><div><h3>Conclusions</h3><div>Our ML model holds promise in reducing endoscopy surveillance costs while maintaining a robust GC detection rate.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 463-467"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140070","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}
Pub Date : 2024-12-01DOI: 10.1016/j.igie.2024.08.001
Isabella C. Wiest MD, MSc , Dyke Ferber MD , Stefan Wittlinger MSc , Matthias P. Ebert MD , Sebastian Belle MD , Jakob Nikolas Kather MD, MSc
Background and Aims
The assessment of adverse events from endoscopic procedures is essential for successful interventions, ensuring accurate follow-up, adverse event management, and processing for quality control. Despite the critical need for structured documentation, the current practice often relies on free-text recordings, which poses challenges for scalable intervention analysis; however, the introduction of large language models (LLMs) offers a promising solution by enabling the automatic extraction of adverse event details from procedural reports without altering existing documentation practices.
Methods
We analyzed 672 endoscopy reports, using OpenAI’s GPT-4 and Llama-2–based models to structure the data in JavaScript Object Notation for efficient analysis. We used an automated LLM pipeline to extract adverse events such as bleeding, perforation, and aspiration. The dataset was divided into a proof-of-concept set (PoC-S) with n = 171 reports, on which we explored prompt engineering to improve the performance of the models. The final analysis was run on an additional external test set of 501 reports.
Results
GPT-4 showed high accuracy, with a sensitivity of 97% and specificity of 92% in the PoC-S and 91% and 96%, respectively, in the test set. GPT-4 use in real-world settings is limited by privacy concerns. Conversely, Llama-2–based models, especially the Llama-2 variants fine-tuned for German language, demonstrated comparable performance (PoC-S: sensitivity of 94%; specificity of 92%, in the test set (TS): sensitivity of 89%; specificity of 93%) and offered a viable privacy-compliant alternative. The model effectiveness was further influenced by the method of prompt engineering, with experiments showing that the specificity and sensitivity could vary substantially based on the inclusion of specific prompt features, underscoring the importance of tailored prompt design.
Conclusions
Applying LLMs to extract structured medical information, particularly from endoscopy reports, offers an efficient, scalable, and adaptable documentation method that captures adverse events accurately with a low error rate. It facilitates immediate quality reporting and reduces manual documentation efforts.
{"title":"Deep sight: enhancing periprocedural adverse event recording in endoscopy by structuring text documentation with privacy-preserving large language models","authors":"Isabella C. Wiest MD, MSc , Dyke Ferber MD , Stefan Wittlinger MSc , Matthias P. Ebert MD , Sebastian Belle MD , Jakob Nikolas Kather MD, MSc","doi":"10.1016/j.igie.2024.08.001","DOIUrl":"10.1016/j.igie.2024.08.001","url":null,"abstract":"<div><h3>Background and Aims</h3><div>The assessment of adverse events from endoscopic procedures is essential for successful interventions, ensuring accurate follow-up, adverse event management, and processing for quality control. Despite the critical need for structured documentation, the current practice often relies on free-text recordings, which poses challenges for scalable intervention analysis; however, the introduction of large language models (LLMs) offers a promising solution by enabling the automatic extraction of adverse event details from procedural reports without altering existing documentation practices.</div></div><div><h3>Methods</h3><div>We analyzed 672 endoscopy reports, using OpenAI’s GPT-4 and Llama-2–based models to structure the data in JavaScript Object Notation for efficient analysis. We used an automated LLM pipeline to extract adverse events such as bleeding, perforation, and aspiration. The dataset was divided into a proof-of-concept set (PoC-S) with n = 171 reports, on which we explored prompt engineering to improve the performance of the models. The final analysis was run on an additional external test set of 501 reports.</div></div><div><h3>Results</h3><div>GPT-4 showed high accuracy, with a sensitivity of 97% and specificity of 92% in the PoC-S and 91% and 96%, respectively, in the test set. GPT-4 use in real-world settings is limited by privacy concerns. Conversely, Llama-2–based models, especially the Llama-2 variants fine-tuned for German language, demonstrated comparable performance (PoC-S: sensitivity of 94%; specificity of 92%, in the test set (TS): sensitivity of 89%; specificity of 93%) and offered a viable privacy-compliant alternative. The model effectiveness was further influenced by the method of prompt engineering, with experiments showing that the specificity and sensitivity could vary substantially based on the inclusion of specific prompt features, underscoring the importance of tailored prompt design.</div></div><div><h3>Conclusions</h3><div>Applying LLMs to extract structured medical information, particularly from endoscopy reports, offers an efficient, scalable, and adaptable documentation method that captures adverse events accurately with a low error rate. It facilitates immediate quality reporting and reduces manual documentation efforts.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 447-452.e5"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140071","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}
Pub Date : 2024-12-01DOI: 10.1016/j.igie.2024.09.007
Tahne Vongsavath DO , Kyaw Min Tun DO , Syed Mohsin Saghir MD , Jay Bapaye MD , Renuka Verma MD , Chun-Han Lo MD , Ahmad Gill MD , Banreet Singh Dhindsa MD , Saurabh Chandan MD , Douglas G. Adler MD, FACG, AGAF, FASGE
Background and Aims
Endoscopic submucosal dissection (ESD) is used for closure of GI lesions after endoscopic resection techniques such as EMR. Generally, a large defect is left that can increase the risk of postprocedural bleeding or perforation, and it has been managed by techniques such as endoscopic placement of clips to reapproximate the defect edges. An over-the-scope suturing system (OSS), OverStitch created by Apollo Endosurgery, has been designed for similar utility in ESD closure. The goal of its design is to achieve full-thickness closure and exchange of suture without endoscopic removal. The goal of this study was to evaluate the technical success and efficacy of using OSS in the closure of ESD.
Methods
A comprehensive literature review across multiple databases was performed. Studies including OverStitch and ESD information were evaluated, with 7 articles meeting predetermined eligibility of quality for inclusion. Statistical analysis was completed by using CMA version 3.0 software (Biostat, Englewood, NJ, USA). The primary evaluated end point was technical success and efficacy of instrument use in patients undergoing ESD closure with OSS. The secondary evaluated end point was the overall rate of adverse events related to the use of OSS.
Results
Overall, the pooled rates for instrumental efficacy and technical success were 95.8% (95% CI [confidence interval], 80.6%-99.2%; P = .04) and 99.2% (95% CI, 79.8%-100.0%; P = 1.00), respectively. The pooled rate of adverse events was .9% (95% CI, 0%-24.8%; P = .99) with pain reported as the most common adverse event.
Conclusions
OSS seems to be an effective and safe tool in the closure of defects after ESD. However, its design also makes it large and difficult to maneuver. Although it allows for replacement of the suture kit without endoscopic removal, there have been multiple reported episodes of device failure. Further randomized controlled trials are warranted as OSS becomes more widely used.
{"title":"Efficacy and safety of over-the-scope endoscopic suturing device for closure of defects after endoscopic submucosal dissection: a systematic review and meta-analysis","authors":"Tahne Vongsavath DO , Kyaw Min Tun DO , Syed Mohsin Saghir MD , Jay Bapaye MD , Renuka Verma MD , Chun-Han Lo MD , Ahmad Gill MD , Banreet Singh Dhindsa MD , Saurabh Chandan MD , Douglas G. Adler MD, FACG, AGAF, FASGE","doi":"10.1016/j.igie.2024.09.007","DOIUrl":"10.1016/j.igie.2024.09.007","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Endoscopic submucosal dissection (ESD) is used for closure of GI lesions after endoscopic resection techniques such as EMR. Generally, a large defect is left that can increase the risk of postprocedural bleeding or perforation, and it has been managed by techniques such as endoscopic placement of clips to reapproximate the defect edges. An over-the-scope suturing system (OSS), OverStitch created by Apollo Endosurgery, has been designed for similar utility in ESD closure. The goal of its design is to achieve full-thickness closure and exchange of suture without endoscopic removal. The goal of this study was to evaluate the technical success and efficacy of using OSS in the closure of ESD.</div></div><div><h3>Methods</h3><div>A comprehensive literature review across multiple databases was performed. Studies including OverStitch and ESD information were evaluated, with 7 articles meeting predetermined eligibility of quality for inclusion. Statistical analysis was completed by using CMA version 3.0 software (Biostat, Englewood, NJ, USA). The primary evaluated end point was technical success and efficacy of instrument use in patients undergoing ESD closure with OSS. The secondary evaluated end point was the overall rate of adverse events related to the use of OSS.</div></div><div><h3>Results</h3><div>Overall, the pooled rates for instrumental efficacy and technical success were 95.8% (95% CI [confidence interval], 80.6%-99.2%; <em>P</em> = .04) and 99.2% (95% CI, 79.8%-100.0%; <em>P</em> = 1.00), respectively. The pooled rate of adverse events was .9% (95% CI, 0%-24.8%; <em>P</em> = .99) with pain reported as the most common adverse event.</div></div><div><h3>Conclusions</h3><div>OSS seems to be an effective and safe tool in the closure of defects after ESD. However, its design also makes it large and difficult to maneuver. Although it allows for replacement of the suture kit without endoscopic removal, there have been multiple reported episodes of device failure. Further randomized controlled trials are warranted as OSS becomes more widely used.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 527-532.e2"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139963","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}
Pub Date : 2024-12-01DOI: 10.1016/j.igie.2024.10.004
Jun Hee Lee MD , Ji Yoon Kim MD , Taebin Kwon MS , Hyuk Soon Choi MD, PhD , Bora Keum MD, PhD , Hoon Jai Chun MD, PhD , Daehie Hong PhD , Hyunsoo Chung MD, PhD
{"title":"A novel endoscopic suturing device: comparison with endoclips and hand-sewn techniques for gastrostomy closure in an ex vivo porcine model","authors":"Jun Hee Lee MD , Ji Yoon Kim MD , Taebin Kwon MS , Hyuk Soon Choi MD, PhD , Bora Keum MD, PhD , Hoon Jai Chun MD, PhD , Daehie Hong PhD , Hyunsoo Chung MD, PhD","doi":"10.1016/j.igie.2024.10.004","DOIUrl":"10.1016/j.igie.2024.10.004","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 487-489"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140067","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}
Pub Date : 2024-12-01DOI: 10.1016/j.igie.2024.10.006
Taisuke Fujita BA , Linda S. Lee MD
{"title":"From obscurity to prominence in the scope world","authors":"Taisuke Fujita BA , Linda S. Lee MD","doi":"10.1016/j.igie.2024.10.006","DOIUrl":"10.1016/j.igie.2024.10.006","url":null,"abstract":"","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 533-538"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139964","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}
Pub Date : 2024-12-01DOI: 10.1016/j.igie.2024.09.002
Jad P. AbiMansour MD , Jerry Yung-Lun Chin MBBS , Eric J. Vargas MD , Jyotroop Kaur MBBS , Barham K. Abu Dayyeh MD, MPH , Ryan J. Law DO , Vishal Garimella MBBS , Michael J. Levy MD , Andrew C. Storm MD , Ross Dierkhising MS , Alina Allen MD , Vinay Chandrasekhara MD
Background and Aims
A measurement of spleen stiffness has been demonstrated to improve the detection of clinically significant portal hypertension (CSPH). In this study, we evaluated the performance of EUS-guided shear wave elastography (EUS-SWE) for detecting CSPH.
Methods
EUS-SWE measurements of the spleen were compared between patients with and without CSPH. Receiver-operating characteristic curve analysis was performed and quantified by the area under the receiver-operating characteristic curve (AUROC).
Results
Of 142 patients with EUS-SWE spleen measurements, 13 (9.2%) had CSPH and 129 (90.8%) did not. Patients with CSPH had a significantly higher mean spleen stiffness (37.6 ± 8.5 kPA vs 29.1 ± 9.9 kPA, P = .003). The AUROC was .74.
Conclusions
SWE is a promising technology that can readily be incorporated into standard EUS examination for assessment of portal hypertension.
{"title":"EUS-based shear wave elastography of the spleen for detection of clinically significant portal hypertension","authors":"Jad P. AbiMansour MD , Jerry Yung-Lun Chin MBBS , Eric J. Vargas MD , Jyotroop Kaur MBBS , Barham K. Abu Dayyeh MD, MPH , Ryan J. Law DO , Vishal Garimella MBBS , Michael J. Levy MD , Andrew C. Storm MD , Ross Dierkhising MS , Alina Allen MD , Vinay Chandrasekhara MD","doi":"10.1016/j.igie.2024.09.002","DOIUrl":"10.1016/j.igie.2024.09.002","url":null,"abstract":"<div><h3>Background and Aims</h3><div>A measurement of spleen stiffness has been demonstrated to improve the detection of clinically significant portal hypertension (CSPH). In this study, we evaluated the performance of EUS-guided shear wave elastography (EUS-SWE) for detecting CSPH.</div></div><div><h3>Methods</h3><div>EUS-SWE measurements of the spleen were compared between patients with and without CSPH. Receiver-operating characteristic curve analysis was performed and quantified by the area under the receiver-operating characteristic curve (AUROC).</div></div><div><h3>Results</h3><div>Of 142 patients with EUS-SWE spleen measurements, 13 (9.2%) had CSPH and 129 (90.8%) did not. Patients with CSPH had a significantly higher mean spleen stiffness (37.6 ± 8.5 kPA vs 29.1 ± 9.9 kPA, <em>P</em> = .003). The AUROC was .74.</div></div><div><h3>Conclusions</h3><div>SWE is a promising technology that can readily be incorporated into standard EUS examination for assessment of portal hypertension.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 507-511"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143140005","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}
Technique-related factors of EUS-guided liver biopsy sampling (EUS-LB) as a determinant of specimen yield have not been studied. We used a modified technique to study adequacy, safety, and technical determinants in patients with or without cirrhosis.
Methods
EUS-LB was performed with a 19-gauge Franseen-tip needle by wet heparinized suction. One or 2 passes with a variable number of actuations were taken, with an endpoint of the aspiration of blood. Primary outcomes were tissue core adequacy and definitive histologic diagnosis. Secondary outcomes were a correlation between the number and depth of actuations with total specimen length (TSL), longest specimen length (LSL), and adverse events (AEs). Early and late AEs were also accessed.
Results
Adequate samples were seen in 48 of 50 patients, and a histologic diagnosis could be achieved in 49 of 50 patients. Mean TSL, LSL, and depth of actuation were 7.98 ± 3.74 cm, 1.89 ± .80 cm, and 4.29 ± .98 cm, respectively. The median number of complete portal tracts was 23 (range, 7-50) and number of actuations was 7 (range, 4-12). The correlation between TSL with number and depth of actuation was r = .71 versus r = .53 and r = .55 versus r = .51 and for LSL was r = .28 versus r = .11 and r = .74 versus r = .55 in noncirrhotic and cirrhotic patients, respectively. No major and 7 (14%) minor AEs were observed.
Conclusions
This modified EUS-LB technique resulted in adequate tissue acquisition and is safe in noncirrhotic and cirrhotic patients. Technical factors like the number and depth of actuations determine specimen yield.
{"title":"Adequacy, safety, and technical determinants of a modified EUS-guided liver biopsy sampling technique in patients with or without cirrhosis: a pilot study","authors":"Biswa Ranjan Patra MD, DM, Shashank Pujalwar MD, DM, Sidharth Harindranath MD, DM, Shubham Gupta MD, DM, Arun Vaidya MD, DM, Prajakta Mane BSc, PGDMLT, Akash Shukla MD, DM","doi":"10.1016/j.igie.2024.10.003","DOIUrl":"10.1016/j.igie.2024.10.003","url":null,"abstract":"<div><h3>Background and Aims</h3><div>Technique-related factors of EUS-guided liver biopsy sampling (EUS-LB) as a determinant of specimen yield have not been studied. We used a modified technique to study adequacy, safety, and technical determinants in patients with or without cirrhosis.</div></div><div><h3>Methods</h3><div>EUS-LB was performed with a 19-gauge Franseen-tip needle by wet heparinized suction. One or 2 passes with a variable number of actuations were taken, with an endpoint of the aspiration of blood. Primary outcomes were tissue core adequacy and definitive histologic diagnosis. Secondary outcomes were a correlation between the number and depth of actuations with total specimen length (TSL), longest specimen length (LSL), and adverse events (AEs). Early and late AEs were also accessed.</div></div><div><h3>Results</h3><div>Adequate samples were seen in 48 of 50 patients, and a histologic diagnosis could be achieved in 49 of 50 patients. Mean TSL, LSL, and depth of actuation were 7.98 ± 3.74 cm, 1.89 ± .80 cm, and 4.29 ± .98 cm, respectively. The median number of complete portal tracts was 23 (range, 7-50) and number of actuations was 7 (range, 4-12). The correlation between TSL with number and depth of actuation was r = .71 versus r = .53 and r = .55 versus r = .51 and for LSL was r = .28 versus r = .11 and r = .74 versus r = .55 in noncirrhotic and cirrhotic patients, respectively. No major and 7 (14%) minor AEs were observed.</div></div><div><h3>Conclusions</h3><div>This modified EUS-LB technique resulted in adequate tissue acquisition and is safe in noncirrhotic and cirrhotic patients. Technical factors like the number and depth of actuations determine specimen yield.</div></div>","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 4","pages":"Pages 512-520"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143139961","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}
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