Keta D. Thakkar, J. Thomas, A. Hrishi, M. Sethuraman
Abstract Multimodal monitoring can be a useful tool to design an appropriate anesthesia technique in the intraoperative period during the surgical excision of an intracerebral arteriovenous malformation (AVM). Intraoperatively, hyperperfusion syndrome can be attributed to causes like insufficient blood pressure control, occlusion of venous drainage before complete resection of arterial feeders, or inadequate hemostatic control of distended capillaries receiving arterial flow. We would like to highlight the potential role of near-infrared spectroscopy and jugular venous oxygen saturation catheter in detection of intraoperative normal perfusion pressure breakthrough and take necessary measures to prevent further insult with the help of this case report.
{"title":"Decoding the Onset of Intraoperative Normal Pressure Perfusion Breakthrough with Near-Infrared Spectroscopy and Jugular Venous Oxygen Saturation Catheter in a Case of Arteriovenous Malformation Surgery","authors":"Keta D. Thakkar, J. Thomas, A. Hrishi, M. Sethuraman","doi":"10.1055/s-0041-1732831","DOIUrl":"https://doi.org/10.1055/s-0041-1732831","url":null,"abstract":"Abstract Multimodal monitoring can be a useful tool to design an appropriate anesthesia technique in the intraoperative period during the surgical excision of an intracerebral arteriovenous malformation (AVM). Intraoperatively, hyperperfusion syndrome can be attributed to causes like insufficient blood pressure control, occlusion of venous drainage before complete resection of arterial feeders, or inadequate hemostatic control of distended capillaries receiving arterial flow. We would like to highlight the potential role of near-infrared spectroscopy and jugular venous oxygen saturation catheter in detection of intraoperative normal perfusion pressure breakthrough and take necessary measures to prevent further insult with the help of this case report.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48996416","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}
Jennifer H. Kang, Michael L. James, A. Gibson, Ovais Inamullah, G. C. Sherrill, M. Lutz, Christa B. Swisher
Aim Patients with mechanical heart valves and coexisting atrial fibrillation (AFib-MHV) who suffer an intraparenchymal hemorrhage (IPH, defined as bleeding solely within the brain parenchyma and/or ventricle) are at a high risk of thromboembolism without anticoagulation. Data are lacking regarding the safety of early re-initiation of anticoagulation in these patients. Patients and Methods We performed a descriptive, single-institution retrospective analysis of patients with AFib-MHV who suffered a non-traumatic, supratentorial IPH between July 2013 and June 2017. We analyzed the patients and IPH characteristics, anticoagulation and antiplatelet use, the occurrence of thrombotic and hemorrhage complications, and discharge disposition. We described the timing of initiation of anticoagulation and outcomes after IPH while in-patient. Results Six patients with AFib-MHV suffered a spontaneous IPH. Four were initiated on anticoagulation prior to discharge, of whom two were initiated within 3 days post-hemorrhage. These patients suffered no bleeding complications and were discharged home with a modified Rankin Scale of 1. Conclusion Patients with AFib-MHV who suffer a spontaneous IPH are a rare population to study. Further studies to guide the management of restarting anticoagulation in this select population are warranted.
{"title":"Anticoagulation after Spontaneous Intraparenchymal Hemorrhage in Patients with Mechanical Heart Valves and Concomitant Atrial Fibrillation","authors":"Jennifer H. Kang, Michael L. James, A. Gibson, Ovais Inamullah, G. C. Sherrill, M. Lutz, Christa B. Swisher","doi":"10.1055/s-0041-1735653","DOIUrl":"https://doi.org/10.1055/s-0041-1735653","url":null,"abstract":"\u0000 Aim Patients with mechanical heart valves and coexisting atrial fibrillation (AFib-MHV) who suffer an intraparenchymal hemorrhage (IPH, defined as bleeding solely within the brain parenchyma and/or ventricle) are at a high risk of thromboembolism without anticoagulation. Data are lacking regarding the safety of early re-initiation of anticoagulation in these patients.\u0000 Patients and Methods We performed a descriptive, single-institution retrospective analysis of patients with AFib-MHV who suffered a non-traumatic, supratentorial IPH between July 2013 and June 2017. We analyzed the patients and IPH characteristics, anticoagulation and antiplatelet use, the occurrence of thrombotic and hemorrhage complications, and discharge disposition. We described the timing of initiation of anticoagulation and outcomes after IPH while in-patient.\u0000 Results Six patients with AFib-MHV suffered a spontaneous IPH. Four were initiated on anticoagulation prior to discharge, of whom two were initiated within 3 days post-hemorrhage. These patients suffered no bleeding complications and were discharged home with a modified Rankin Scale of 1.\u0000 Conclusion Patients with AFib-MHV who suffer a spontaneous IPH are a rare population to study. Further studies to guide the management of restarting anticoagulation in this select population are warranted.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41625479","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}
M. Arasu, Srinivasan Swaminathan, Balaji Kannamani, L. Elakkumanan
Postoperative vision loss (POVL) is devastating not only for the patient but also for the anesthesiologist. Posterior reversible encephalopathy syndrome (PRES) is an infrequent and treatable cause of POVL, which is reported predominantly in rapid hemodynamic perturbations, endothelial dysfunction, and massive volume resuscitation. 1,2 To our knowledge, there are no reported cases of PRES following acute hypertension for a brief duration of 3 minutes and massive transfusion. A
{"title":"Posterior Reversible Encephalopathy Syndrome Causing Transient Postoperative Blindness Following Spine Surgery","authors":"M. Arasu, Srinivasan Swaminathan, Balaji Kannamani, L. Elakkumanan","doi":"10.1055/s-0041-1731919","DOIUrl":"https://doi.org/10.1055/s-0041-1731919","url":null,"abstract":"Postoperative vision loss (POVL) is devastating not only for the patient but also for the anesthesiologist. Posterior reversible encephalopathy syndrome (PRES) is an infrequent and treatable cause of POVL, which is reported predominantly in rapid hemodynamic perturbations, endothelial dysfunction, and massive volume resuscitation. 1,2 To our knowledge, there are no reported cases of PRES following acute hypertension for a brief duration of 3 minutes and massive transfusion. A","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47319338","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}
Nidhi Singh, K. Jangra, S. Soni, R. Virk, Apinderpreet Singh
Airway assessment is occasionally difficult and challenging in neurosurgical situations, such as in unconscious and uncooperative patients, patients with a spinal fracture on traction, and patients with stereotactic frames in situ. An incomplete assessment may bring a surprise during laryngoscopy and intubation. Here, we present a case of posterior fossa space-occupying lesion (SOL) with hoarseness of voice where intubation of trachea became extremely challenging. We report a case of 56 years old male with no known comorbidities who presented with chief complaints of sway-ing
{"title":"Hoarseness of Voice in a Patient with Posterior Fossa Tumor: A Diagnostic Error","authors":"Nidhi Singh, K. Jangra, S. Soni, R. Virk, Apinderpreet Singh","doi":"10.1055/s-0041-1734420","DOIUrl":"https://doi.org/10.1055/s-0041-1734420","url":null,"abstract":"Airway assessment is occasionally difficult and challenging in neurosurgical situations, such as in unconscious and uncooperative patients, patients with a spinal fracture on traction, and patients with stereotactic frames in situ. An incomplete assessment may bring a surprise during laryngoscopy and intubation. Here, we present a case of posterior fossa space-occupying lesion (SOL) with hoarseness of voice where intubation of trachea became extremely challenging. We report a case of 56 years old male with no known comorbidities who presented with chief complaints of sway-ing","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47746626","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}
infection, malnutrition, dehydration, tracheostomy, longer hospitalization longer intensive care unit (ICU) stays, contractures, and heterotopic ossification. PSH remains an under-recognized condition that is difficult to diagnose. A high index of suspicion is key to early diagnosis. The first step in diagnosis is to exclude conditions with similar symptoms, such as infection, sedation withdrawal, seizures, and pulmonary embolism. Clinical diagnostic tools (PSH assessment measure) have been proposed to assist clinicians in the reliable identification of PSH.8 Such tools incorporate a clinical feature scale that categorizes the severity of sympathetic signs during episodes and a diagnostic tool that gauges the likelihood of diagnosis of PSH based on the presence of characteristic features. These two components are combined in a score that reflects the degree of confidence in diagnosis of PSH. The feasibility and reliability of these tools have been recently validated by van Eijck et al.9 There is evidence that they may reduce the chances of misdiagnosis and favorably impact hospital length of stay and costs of hospitalization.10 The pathophysiology of PSH is poorly understood and the dominant theory suggests the failure of the central autonomic network. Disruption of descending pathways releases sympathetic responses from their normal inhibitory modulation. The consequence is that sympathetic responses to internal or external stimuli become exaggerated.11 The interruption of descending inhibitory modulation might also produce maladaptive changes in the spinal cord leading to excitatory interneuronal activity.12 These changes could help explain how non-noxious stimuli are perceived as noxious by brain.12 While formal evidence on treatment is scant and lacks methodological quality, PSH is a disorder that can be treated.13 Can episodes be prevented with pharmacological intervention? There is at least one retrospective study that claims so. Tang et al asserted that dexmedetomidine infusion has Paroxysmal sympathetic hyperactivity (PSH) is a syndrome of excessive and pathological adrenergic output to nociceptive or non-nociceptive (including environmental) stimuli. It is observed as a complication of various acute brain insults such as traumatic brain injury (TBI), stroke, anoxic brain injury, tumors, infections, autoimmune encephalitis, and acute hydrocephalus. It can manifest as a constellation of episodic, simultaneous symptoms such as tachycardia, hyperthermia, hypertension, tachypnea, and diaphoresis, often accompanied by dystonia and even motor posturing.1 Onset of these symptoms is usually fast, but resolution is slow, unless terminated by medication. Since the first description of this syndrome by Penfield,2 many names have been ascribed to it which has created puzzlement in its diagnosis as well as understanding of its pathophysiology. Some of the names associated with this condition over the years are “autonomic storm,” “sympathetic storm,” “
{"title":"Paroxysmal Sympathetic Hyperactivity: Ignoring the Presence of an Elephant in the Room","authors":"P. Bithal, Siddharth Chavali","doi":"10.1055/s-0041-1740206","DOIUrl":"https://doi.org/10.1055/s-0041-1740206","url":null,"abstract":"infection, malnutrition, dehydration, tracheostomy, longer hospitalization longer intensive care unit (ICU) stays, contractures, and heterotopic ossification. PSH remains an under-recognized condition that is difficult to diagnose. A high index of suspicion is key to early diagnosis. The first step in diagnosis is to exclude conditions with similar symptoms, such as infection, sedation withdrawal, seizures, and pulmonary embolism. Clinical diagnostic tools (PSH assessment measure) have been proposed to assist clinicians in the reliable identification of PSH.8 Such tools incorporate a clinical feature scale that categorizes the severity of sympathetic signs during episodes and a diagnostic tool that gauges the likelihood of diagnosis of PSH based on the presence of characteristic features. These two components are combined in a score that reflects the degree of confidence in diagnosis of PSH. The feasibility and reliability of these tools have been recently validated by van Eijck et al.9 There is evidence that they may reduce the chances of misdiagnosis and favorably impact hospital length of stay and costs of hospitalization.10 The pathophysiology of PSH is poorly understood and the dominant theory suggests the failure of the central autonomic network. Disruption of descending pathways releases sympathetic responses from their normal inhibitory modulation. The consequence is that sympathetic responses to internal or external stimuli become exaggerated.11 The interruption of descending inhibitory modulation might also produce maladaptive changes in the spinal cord leading to excitatory interneuronal activity.12 These changes could help explain how non-noxious stimuli are perceived as noxious by brain.12 While formal evidence on treatment is scant and lacks methodological quality, PSH is a disorder that can be treated.13 Can episodes be prevented with pharmacological intervention? There is at least one retrospective study that claims so. Tang et al asserted that dexmedetomidine infusion has Paroxysmal sympathetic hyperactivity (PSH) is a syndrome of excessive and pathological adrenergic output to nociceptive or non-nociceptive (including environmental) stimuli. It is observed as a complication of various acute brain insults such as traumatic brain injury (TBI), stroke, anoxic brain injury, tumors, infections, autoimmune encephalitis, and acute hydrocephalus. It can manifest as a constellation of episodic, simultaneous symptoms such as tachycardia, hyperthermia, hypertension, tachypnea, and diaphoresis, often accompanied by dystonia and even motor posturing.1 Onset of these symptoms is usually fast, but resolution is slow, unless terminated by medication. Since the first description of this syndrome by Penfield,2 many names have been ascribed to it which has created puzzlement in its diagnosis as well as understanding of its pathophysiology. Some of the names associated with this condition over the years are “autonomic storm,” “sympathetic storm,” “","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46616823","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}
T. Vijayashree, D. Masapu, D. Rajappa, S. Rudrappa, N. Chandrashekar
Surgical procedures involving the spine require prone positioning and are not devoid of complications. Perioperative peripheral nerve injury (PPNI) is an important complication with an incidence of 0.03 to 0.1% and with 0.02% incidence of brachial plexopathy in noncardiac surgery. 1 Intraoperative neuromonitoring (IONM)
{"title":"What Can a False-Negative Transcranial Motor Evoked Potential Envisage the Outcome in Isolated Position-Related Praxis?","authors":"T. Vijayashree, D. Masapu, D. Rajappa, S. Rudrappa, N. Chandrashekar","doi":"10.1055/s-0041-1730097","DOIUrl":"https://doi.org/10.1055/s-0041-1730097","url":null,"abstract":"Surgical procedures involving the spine require prone positioning and are not devoid of complications. Perioperative peripheral nerve injury (PPNI) is an important complication with an incidence of 0.03 to 0.1% and with 0.02% incidence of brachial plexopathy in noncardiac surgery. 1 Intraoperative neuromonitoring (IONM)","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42248724","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}
Ramesh J. Venkatapura, S. Jena, R. Christopher, D. Bhat
Background The incidence of hyponatremia is high in supratentorial tumors. However, most studies of supratentorial tumors have included patients with sellar/suprasellar tumors. It is common knowledge that sellar tumors have higher incidence and severity of hyponatremia. Incidence of hyponatremia is not known if we exclude sellar/suprasellar tumors. Therefore, this study was designed to evaluate the incidence of hyponatremia in supratentorial tumors after excluding sellar/suprasellar tumors. Methods After institutional ethics committee approval and written informed consent, adult patients with supratentorial tumors (nonsellar/suprasellar) were recruited, and data were collected prospectively. In all patients, serum electrolytes were measured every 2 to 3 days. Hyponatremia was defined as serum sodium of <135 mEq/L. All the patients were followed up till death or discharge from the hospital. Results A total of 61 patients’ data were analyzed. There were 31 male and 30 female patients with an average age of 44 years. There were 23 meningiomas, 36 gliomas, and 2 other tumors. Forty patients (66%) developed hyponatremia during hospital stay. There were 29 mild cases (serum sodium 131–134 mEq/L), 7 were moderate (serum sodium 126–130 mEq/L), and 4 were severe (serum sodium <126 mEq/L). Three hyponatremic meningioma patients died, of which two had mild hyponatremia and one had severe hyponatremia. Duration of hospital stay was longer in hyponatremic patients. Conclusion The incidence of hyponatremia is high in supratentorial tumor patients after excluding sellar/suprasellar lesions. In the majority of patients, the disturbance is mild. Hyponatremic patients has a longer hospital stay and higher mortality.
{"title":"High Incidence of Hyponatremia in Patients Operated for Nonsellar/Suprasellar Supratentorial Tumors—A Prospective Observational Study","authors":"Ramesh J. Venkatapura, S. Jena, R. Christopher, D. Bhat","doi":"10.1055/s-0041-1730043","DOIUrl":"https://doi.org/10.1055/s-0041-1730043","url":null,"abstract":"\u0000Background The incidence of hyponatremia is high in supratentorial tumors. However, most studies of supratentorial tumors have included patients with sellar/suprasellar tumors. It is common knowledge that sellar tumors have higher incidence and severity of hyponatremia. Incidence of hyponatremia is not known if we exclude sellar/suprasellar tumors. Therefore, this study was designed to evaluate the incidence of hyponatremia in supratentorial tumors after excluding sellar/suprasellar tumors.\u0000Methods After institutional ethics committee approval and written informed consent, adult patients with supratentorial tumors (nonsellar/suprasellar) were recruited, and data were collected prospectively. In all patients, serum electrolytes were measured every 2 to 3 days. Hyponatremia was defined as serum sodium of <135 mEq/L. All the patients were followed up till death or discharge from the hospital.\u0000Results A total of 61 patients’ data were analyzed. There were 31 male and 30 female patients with an average age of 44 years. There were 23 meningiomas, 36 gliomas, and 2 other tumors. Forty patients (66%) developed hyponatremia during hospital stay. There were 29 mild cases (serum sodium 131–134 mEq/L), 7 were moderate (serum sodium 126–130 mEq/L), and 4 were severe (serum sodium <126 mEq/L). Three hyponatremic meningioma patients died, of which two had mild hyponatremia and one had severe hyponatremia. Duration of hospital stay was longer in hyponatremic patients.\u0000Conclusion The incidence of hyponatremia is high in supratentorial tumor patients after excluding sellar/suprasellar lesions. In the majority of patients, the disturbance is mild. Hyponatremic patients has a longer hospital stay and higher mortality.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1730043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41845933","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}
Shraya Banerjee, N. Gupta, D. Sarkar, Kalyanpury J. Choudhury
Abstract We report a case of hydrocephalus with Dandy–Walker malformation in a 2-month-old girl child recently recovered from COVID-19. The child was detected to have acyanotic heart disease with left-to-right shunt and severe pulmonary arterial hypertension during the preoperative evaluation process for ventriculoperitoneal (VP) shunt placement. We share our experience of the perioperative management for pulmonary artery banding (PAB) and patent ductus arteriosus ligation as a part of staged cardiac corrective surgery, followed by VP shunt to relieve hydrocephalus in the single setting. Our management was focused on the preservation of the normal cerebral and cardiac physiology to prevent rise in intracranial pressure and pulmonary artery pressure. A multidisciplinary team, consisting of cardiac- and neuroanesthesiologists and cardiac and neurosurgeons, was involved in management of the case. Diligent maintenance of airway, stable hemodynamics, meticulous ventilation, along with postoperative ICU management helped in the successful outcome of this unique case.
{"title":"Anesthetic Management in an Infant with Dandy–Walker Syndrome Presenting with Acyanotic Heart Disease and Hydrocephalous Post-COVID-19 Recovery: A Rare Experience","authors":"Shraya Banerjee, N. Gupta, D. Sarkar, Kalyanpury J. Choudhury","doi":"10.1055/s-0041-1731601","DOIUrl":"https://doi.org/10.1055/s-0041-1731601","url":null,"abstract":"Abstract We report a case of hydrocephalus with Dandy–Walker malformation in a 2-month-old girl child recently recovered from COVID-19. The child was detected to have acyanotic heart disease with left-to-right shunt and severe pulmonary arterial hypertension during the preoperative evaluation process for ventriculoperitoneal (VP) shunt placement. We share our experience of the perioperative management for pulmonary artery banding (PAB) and patent ductus arteriosus ligation as a part of staged cardiac corrective surgery, followed by VP shunt to relieve hydrocephalus in the single setting. Our management was focused on the preservation of the normal cerebral and cardiac physiology to prevent rise in intracranial pressure and pulmonary artery pressure. A multidisciplinary team, consisting of cardiac- and neuroanesthesiologists and cardiac and neurosurgeons, was involved in management of the case. Diligent maintenance of airway, stable hemodynamics, meticulous ventilation, along with postoperative ICU management helped in the successful outcome of this unique case.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1731601","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42447824","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：