Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0053
M. Teo, O. Choudhri, M. Lawton
Giant aneurysms are among the most challenging neurovascular lesions with poor natural history. Therefore, treatment to minimize morbidity and mortality is paramount. With development in skull base approaches, microsurgical techniques, endovascular technology, and neuroanaesthesia, a proportion of giant aneurysms can be clipped primarily, clip reconstructed, or treated endovascularly. With the ongoing development in endovascular techniques, more of these lesions can be treated successfully without open surgery. However, without long-term data on endovascular reconstruction, aneurysm recurrence after coiling, and poor outcomes with the use of flow diverters for dolichoectatic basilar aneurysms, surgical treatment remains a viable option for patients with these complex lesions. This chapter discusses the use of complex revascularization and flow reversal techniques including high-flow extracranial to intracranial bypass for these patients.
{"title":"Giant aneurysms and bypass surgery","authors":"M. Teo, O. Choudhri, M. Lawton","doi":"10.1093/med/9780198746706.003.0053","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0053","url":null,"abstract":"Giant aneurysms are among the most challenging neurovascular lesions with poor natural history. Therefore, treatment to minimize morbidity and mortality is paramount. With development in skull base approaches, microsurgical techniques, endovascular technology, and neuroanaesthesia, a proportion of giant aneurysms can be clipped primarily, clip reconstructed, or treated endovascularly. With the ongoing development in endovascular techniques, more of these lesions can be treated successfully without open surgery. However, without long-term data on endovascular reconstruction, aneurysm recurrence after coiling, and poor outcomes with the use of flow diverters for dolichoectatic basilar aneurysms, surgical treatment remains a viable option for patients with these complex lesions. This chapter discusses the use of complex revascularization and flow reversal techniques including high-flow extracranial to intracranial bypass for these patients.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"122 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123341115","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}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0094
N. Keong
This chapter is on normal pressure hydrocephalus (NPH) and deals with aspects from theories of pathogenesis, clinical presentation, and management, surgical management, and complications, as well as the assessment of outcome. It provides a concise overview of a challenging topic; many theories have been advanced to explain the underlying mechanisms by which the NPH syndrome develops. However, the basic pathophysiological processes still remain unclear. The major theory streams proposed for the pathogenesis of NPH can be loosely organized into structural, cerebral blood flow, and cerebrospinal fluid flow subgroups. The components of each theory stream are expanded in this chapter, although the list of studies supporting each section is by no means exhaustive.
{"title":"Normal pressure hydrocephalus","authors":"N. Keong","doi":"10.1093/med/9780198746706.003.0094","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0094","url":null,"abstract":"This chapter is on normal pressure hydrocephalus (NPH) and deals with aspects from theories of pathogenesis, clinical presentation, and management, surgical management, and complications, as well as the assessment of outcome. It provides a concise overview of a challenging topic; many theories have been advanced to explain the underlying mechanisms by which the NPH syndrome develops. However, the basic pathophysiological processes still remain unclear. The major theory streams proposed for the pathogenesis of NPH can be loosely organized into structural, cerebral blood flow, and cerebrospinal fluid flow subgroups. The components of each theory stream are expanded in this chapter, although the list of studies supporting each section is by no means exhaustive.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122800676","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}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0030
Donald McArthur, A. Natalwala
Haemangioblastomas are rare and benign tumours which favour the infratentorial structures in the central nervous system. Around 30% of these tumours are associated with Von Hippel-Lindau syndrome, which if the diagnosis is missed can lead to rapid disease progression and significant morbidity and mortality. Complete surgical resection is the main treatment but other techniques including stereotactic radiosurgery are described in this chapter. Screening for Von Hippel-Lindau (VHL), the optimal timing, and mode of treatment remain controversial due to the diversity of clinical presentation in these patients. This chapter also outlines the general principles of managing patients with haemangioblastomas and the factors which impact on prognosis.
{"title":"Haemangioblastoma","authors":"Donald McArthur, A. Natalwala","doi":"10.1093/med/9780198746706.003.0030","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0030","url":null,"abstract":"Haemangioblastomas are rare and benign tumours which favour the infratentorial structures in the central nervous system. Around 30% of these tumours are associated with Von Hippel-Lindau syndrome, which if the diagnosis is missed can lead to rapid disease progression and significant morbidity and mortality. Complete surgical resection is the main treatment but other techniques including stereotactic radiosurgery are described in this chapter. Screening for Von Hippel-Lindau (VHL), the optimal timing, and mode of treatment remain controversial due to the diversity of clinical presentation in these patients. This chapter also outlines the general principles of managing patients with haemangioblastomas and the factors which impact on prognosis.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134475477","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}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0090
H. Mccullagh, T. Patankar, T. Goddard, A. Tyagi
The spectrum of paediatric neurovascular disorders includes several conditions like arteriovenous malformation (AVM), aneurysm, and cavernous malformations that occur in adults. Despite the similarity in pathology there are differences in presentation, location, and management of vascular disorders in children as compared to adults. There are disorders that are peculiar to the paediatric population like vein of Galen malformations or intraventricular haemorrhage in premature infants and others that occur predominantly in children though are seen in adults such as moya disorder. Recent advances in endovascular therapy, radiosurgery, and multimodality management of vascular lesions have increased the options available to manage these lesions in children. Identification of underlying gene abnormalities in cavernomas and moya moya disease promises to shed new light on the pathogenesis of these disorders. The common neurovascular disorders seen in the paediatric population are discussed in this chapter with the focus on those seen predominantly in children.
{"title":"Paediatric neurovascular disorders","authors":"H. Mccullagh, T. Patankar, T. Goddard, A. Tyagi","doi":"10.1093/med/9780198746706.003.0090","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0090","url":null,"abstract":"The spectrum of paediatric neurovascular disorders includes several conditions like arteriovenous malformation (AVM), aneurysm, and cavernous malformations that occur in adults. Despite the similarity in pathology there are differences in presentation, location, and management of vascular disorders in children as compared to adults. There are disorders that are peculiar to the paediatric population like vein of Galen malformations or intraventricular haemorrhage in premature infants and others that occur predominantly in children though are seen in adults such as moya disorder. Recent advances in endovascular therapy, radiosurgery, and multimodality management of vascular lesions have increased the options available to manage these lesions in children. Identification of underlying gene abnormalities in cavernomas and moya moya disease promises to shed new light on the pathogenesis of these disorders. The common neurovascular disorders seen in the paediatric population are discussed in this chapter with the focus on those seen predominantly in children.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"11 suppl_1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129052706","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}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0048
J. McMillen
Aneurysm rupture with subarachnoid haemorrhage is the most devastating complication of intracerebral aneurysms. Grading the severity of the haemorrhage assists with prognostication and assists with decision-making for patient management. Both radiological and clinical grading systems can be predictive of outcomes following subarachnoid haemorrhage. The pathophysiology of, and risk factors for, intracerebral aneurysm formation, growth, and rupture are complicated and poorly understood. In order to make an informed judgement about which patients to treat, it is important to balance the natural history of the condition against each patient’s risks of treatment. Numerous risk factors for aneurysm rupture have been identified, and this quantification of risk continues to be refined. Cerebral vasospasm is a common complication after subarachnoid haemorrhage. The pathological mechanisms of vasospasm involve numerous changes acting in concert to result in ischaemic neurological deficits. Clinical and radiological monitoring allows early detection and treatment to prevent ischaemic neurological deficits.
{"title":"The pathophysiology of subarachnoid haemorrhage","authors":"J. McMillen","doi":"10.1093/med/9780198746706.003.0048","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0048","url":null,"abstract":"Aneurysm rupture with subarachnoid haemorrhage is the most devastating complication of intracerebral aneurysms. Grading the severity of the haemorrhage assists with prognostication and assists with decision-making for patient management. Both radiological and clinical grading systems can be predictive of outcomes following subarachnoid haemorrhage. The pathophysiology of, and risk factors for, intracerebral aneurysm formation, growth, and rupture are complicated and poorly understood. In order to make an informed judgement about which patients to treat, it is important to balance the natural history of the condition against each patient’s risks of treatment. Numerous risk factors for aneurysm rupture have been identified, and this quantification of risk continues to be refined. Cerebral vasospasm is a common complication after subarachnoid haemorrhage. The pathological mechanisms of vasospasm involve numerous changes acting in concert to result in ischaemic neurological deficits. Clinical and radiological monitoring allows early detection and treatment to prevent ischaemic neurological deficits.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114704873","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}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0059
C. McGuigan, K. O'Connell, E. McGovern, I. McGurgan
Spinal cord presentations commonly seen by neurosurgeons suggestive of surgical pathology can be mimicked by many medical conditions. The most common presentations of medical, neurological conditions seen by neurosurgeons include conditions causing acute spastic paraparesis, such as transverse myelitis, and acute flaccid paralysis, such as Guillain–Barré syndrome. Other medical conditions such as motor neuron disease, neuropathy pain syndromes can also mimic radiculopathies and may be referred for a neurosurgical outpatient review. Therefore, a knowledge of these conditions and recognition of some of the key questions to ask during a history is beneficial. Key findings to look for on examination will also help with a timely diagnosis and involvement of the relevant specialist without unnecessary investigations or interventions.
{"title":"Medical pathologies of the spinal cord","authors":"C. McGuigan, K. O'Connell, E. McGovern, I. McGurgan","doi":"10.1093/med/9780198746706.003.0059","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0059","url":null,"abstract":"Spinal cord presentations commonly seen by neurosurgeons suggestive of surgical pathology can be mimicked by many medical conditions. The most common presentations of medical, neurological conditions seen by neurosurgeons include conditions causing acute spastic paraparesis, such as transverse myelitis, and acute flaccid paralysis, such as Guillain–Barré syndrome. Other medical conditions such as motor neuron disease, neuropathy pain syndromes can also mimic radiculopathies and may be referred for a neurosurgical outpatient review. Therefore, a knowledge of these conditions and recognition of some of the key questions to ask during a history is beneficial. Key findings to look for on examination will also help with a timely diagnosis and involvement of the relevant specialist without unnecessary investigations or interventions.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124328414","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}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0081
A. McEvoy, Tim Wehner, V. Wykes
Epileptic seizures are transient neurologic alterations due to abnormal excessive or synchronous neuronal cerebral activity. They may cause subjective symptoms (aura), and objective autonomic, behavioural, or cognitive alterations in any combination. Focal seizures are initially generated in one circumscribed area in the brain, whereas generalized seizures involve bihemispheric neuronal networks from the seizure onset. Epilepsy is a brain disease defined by the occurrence of two unprovoked seizures more than 24 h apart or one unprovoked seizure with underlying pathological or genetic factors resulting in a similar recurrence risk. Focal epilepsy syndromes are best classified by aetiology or anatomical area of origin. A seizure that does not self-terminate results in status epilepticus, and constitutes a medical emergency that requires immediate treatment. Focal cortical dysplasia and hippocampal sclerosis are the commonest aetiologies of epilepsy amenable to surgical treatment and are reviewed here. The limbic pathway may be involved in seizure propagation, and the anatomy is described.
{"title":"Classification of seizures and epilepsy","authors":"A. McEvoy, Tim Wehner, V. Wykes","doi":"10.1093/med/9780198746706.003.0081","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0081","url":null,"abstract":"Epileptic seizures are transient neurologic alterations due to abnormal excessive or synchronous neuronal cerebral activity. They may cause subjective symptoms (aura), and objective autonomic, behavioural, or cognitive alterations in any combination. Focal seizures are initially generated in one circumscribed area in the brain, whereas generalized seizures involve bihemispheric neuronal networks from the seizure onset. Epilepsy is a brain disease defined by the occurrence of two unprovoked seizures more than 24 h apart or one unprovoked seizure with underlying pathological or genetic factors resulting in a similar recurrence risk. Focal epilepsy syndromes are best classified by aetiology or anatomical area of origin. A seizure that does not self-terminate results in status epilepticus, and constitutes a medical emergency that requires immediate treatment. Focal cortical dysplasia and hippocampal sclerosis are the commonest aetiologies of epilepsy amenable to surgical treatment and are reviewed here. The limbic pathway may be involved in seizure propagation, and the anatomy is described.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127192208","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}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0043
Hadie Adams, A. Kolias, A. Helmy, P. Hutchinson, R. Chesnut
Traumatic brain injury (TBI) is a significant cause of preventable morbidity and mortality in the United Kingdom and across the world, leading to disability and loss of productivity. The estimated incidence of TBI in Europe is on average 235 per 100 000, ranging of 150–300/100 000 per year. The Glasgow Coma Scale (GCS) is often used to classify the severity of TBI, with patients scoring 8 or less being classified as severe, 9–12 as moderate, and scores of 13–15 as mild. Mild TBI is the most common form of head injury, and the incidence of TBI is the highest in young adult males. In Western countries the major causes of TBI-related hospitalizations are falls, assaults, and motor vehicle traffic collisions.
{"title":"Surgical management of head injury","authors":"Hadie Adams, A. Kolias, A. Helmy, P. Hutchinson, R. Chesnut","doi":"10.1093/med/9780198746706.003.0043","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0043","url":null,"abstract":"Traumatic brain injury (TBI) is a significant cause of preventable morbidity and mortality in the United Kingdom and across the world, leading to disability and loss of productivity. The estimated incidence of TBI in Europe is on average 235 per 100 000, ranging of 150–300/100 000 per year. The Glasgow Coma Scale (GCS) is often used to classify the severity of TBI, with patients scoring 8 or less being classified as severe, 9–12 as moderate, and scores of 13–15 as mild. Mild TBI is the most common form of head injury, and the incidence of TBI is the highest in young adult males. In Western countries the major causes of TBI-related hospitalizations are falls, assaults, and motor vehicle traffic collisions.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"282 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127493424","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}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0045
Mark Wilson
Interest in concussion and sports-related injury has intensified in recent years for three main reasons: (1) it is a preventable form of brain injury; (2) there is increasing evidence that repeated injury can result in long-term neurocognitive loss; and (3) as a result there are potential medicolegal costs to organizations that, possibly inadvertently, allow this form of brain injury to occur within their sport. The long-term effects of boxing resulting in dementia pugilistica have been appreciated for some time, however the results of repeated mild head injury in other sports is now under focus. Concussion, increasingly termed mild traumatic brain injury, should be graded. Imaging, removal from, and return to sport are all discussed in this chapter.
{"title":"Concussion and sports-related head injury","authors":"Mark Wilson","doi":"10.1093/med/9780198746706.003.0045","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0045","url":null,"abstract":"Interest in concussion and sports-related injury has intensified in recent years for three main reasons: (1) it is a preventable form of brain injury; (2) there is increasing evidence that repeated injury can result in long-term neurocognitive loss; and (3) as a result there are potential medicolegal costs to organizations that, possibly inadvertently, allow this form of brain injury to occur within their sport. The long-term effects of boxing resulting in dementia pugilistica have been appreciated for some time, however the results of repeated mild head injury in other sports is now under focus. Concussion, increasingly termed mild traumatic brain injury, should be graded. Imaging, removal from, and return to sport are all discussed in this chapter.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127694211","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}
Pub Date : 2019-09-01DOI: 10.1093/med/9780198746706.003.0067
S. Smithason, Bryan S. Lee, E. Benzel
Spinal cord injury (SCI), either traumatic or non-traumatic in aetiology, leads to temporary or permanent damage to the spinal cord function. Significant efforts have been directed towards the elucidation of the underlying pathophysiology of SCI. Both primary and secondary mechanisms of SCI exist, leading to immediate and often irreversible cell damage. Immediate treatment and adequate management in the setting of acute SCI are essential, preservation of even a small amount of functional neuronal tissue can permit ambulation. SCI is associated with a prolonged hospital stay, rehabilitation stay, and often associated with enormous monetary costs. Neurological recovery after SCI is largely dependent on the extent of injury. The management of SCI and the determination of the role and timing of surgical decompression remain crucial and yet controversial. Further epidemiological research and studies are warranted in order to enhance healthcare planning and cost-effectiveness.
{"title":"Managing spinal cord trauma","authors":"S. Smithason, Bryan S. Lee, E. Benzel","doi":"10.1093/med/9780198746706.003.0067","DOIUrl":"https://doi.org/10.1093/med/9780198746706.003.0067","url":null,"abstract":"Spinal cord injury (SCI), either traumatic or non-traumatic in aetiology, leads to temporary or permanent damage to the spinal cord function. Significant efforts have been directed towards the elucidation of the underlying pathophysiology of SCI. Both primary and secondary mechanisms of SCI exist, leading to immediate and often irreversible cell damage. Immediate treatment and adequate management in the setting of acute SCI are essential, preservation of even a small amount of functional neuronal tissue can permit ambulation. SCI is associated with a prolonged hospital stay, rehabilitation stay, and often associated with enormous monetary costs. Neurological recovery after SCI is largely dependent on the extent of injury. The management of SCI and the determination of the role and timing of surgical decompression remain crucial and yet controversial. Further epidemiological research and studies are warranted in order to enhance healthcare planning and cost-effectiveness.","PeriodicalId":115670,"journal":{"name":"Oxford Textbook of Neurological Surgery","volume":"181 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132775564","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}
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