Pub Date : 2016-06-01DOI: 10.1097/01.sa.0000482336.21445.f4
J. Larsson, G. Bragadottir, Vitus Krumbholz, B. Redfors, J. Sellgren, S. Ricksten
{"title":"Effects of Acute Plasma Volume Expansion on Renal Perfusion, Filtration, and Oxygenation After Cardiac Surgery: A Randomized Study on Crystalloid vs Colloid","authors":"J. Larsson, G. Bragadottir, Vitus Krumbholz, B. Redfors, J. Sellgren, S. Ricksten","doi":"10.1097/01.sa.0000482336.21445.f4","DOIUrl":"https://doi.org/10.1097/01.sa.0000482336.21445.f4","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89130842","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 : 2016-06-01DOI: 10.1097/01.sa.0000482077.15788.94
John D. Santamaria, G. Duke, D. Pilcher, J. Moran, R. Bellomo
COMMENT An important function of the cardiovascular system is to provide adequate systemic blood flow and perfusion pressure to achieve and maintain organ homeostasis. This goal requires that vasoconstrictor and vasodilator influences be meticulously balanced. However, in “distributive shock,” a vasodilatory state predominates and can cause inadequate end-organ perfusion. Despite satisfactory or even high cardiac output, the lack of vascular tone results in unacceptable, dangerously low endorgan perfusion. Methylene blue is commonly used by clinicians as a dye in assorted medical procedures or, less frequently, to treat nitrateinduced methemoglobinemia. Importantly, the vasoconstrictive effect of MB is manifested only in circumstances of nitric oxide (NO) up-regulation. Hence, increases in blood pressure are not seen when MB is given as a dye during uncomplicated procedures involving nonvasoplegic patients. Nitric oxide binds to and activates the enzyme-soluble guanylate cyclase, forming cyclic guanosine monophosphate (cGMP), which, in turn, eventually produces vascular smooth muscle relaxation. Nitric oxide is continuously produced at low concentrations by the calcium-dependent enzyme NO synthase. Methylene blue directly inhibits NO synthase. It also inhibits the enzyme-soluble guanylate cyclase and prevents accumulation of cGMP. By competitively blocking the target enzyme of NO, MB reduces the responsiveness of vessels to cGMP-dependent vasodilators and restores vascular tone. Increases in intracellular cGMP relax both vascular smooth muscle and myocardial myocytes. This may explain why experimental animal studies have shown that, in addition to reduction in vasopressor requirements, inotropic support is reduced after administration of MB, probably owing to attenuation of ischemia/reperfusion injury. Although MB certainly improves blood pressure, enhanced oxygen delivery or reduced mortality secondary to MB has not yet been confirmed. Given these incomplete data, the authors believe that MB should be used to treat vasoplegia unresponsive to traditional vasopressors, rather than as a first-line agent, until more information becomes available. Clearly, large, randomized controlled trials are urgently required to establish the role of MB in treating vasoplegia.
{"title":"The Timing of Discharge From the Intensive Care Unit and Subsequent Mortality: A Prospective, Multicenter Study","authors":"John D. Santamaria, G. Duke, D. Pilcher, J. Moran, R. Bellomo","doi":"10.1097/01.sa.0000482077.15788.94","DOIUrl":"https://doi.org/10.1097/01.sa.0000482077.15788.94","url":null,"abstract":"COMMENT An important function of the cardiovascular system is to provide adequate systemic blood flow and perfusion pressure to achieve and maintain organ homeostasis. This goal requires that vasoconstrictor and vasodilator influences be meticulously balanced. However, in “distributive shock,” a vasodilatory state predominates and can cause inadequate end-organ perfusion. Despite satisfactory or even high cardiac output, the lack of vascular tone results in unacceptable, dangerously low endorgan perfusion. Methylene blue is commonly used by clinicians as a dye in assorted medical procedures or, less frequently, to treat nitrateinduced methemoglobinemia. Importantly, the vasoconstrictive effect of MB is manifested only in circumstances of nitric oxide (NO) up-regulation. Hence, increases in blood pressure are not seen when MB is given as a dye during uncomplicated procedures involving nonvasoplegic patients. Nitric oxide binds to and activates the enzyme-soluble guanylate cyclase, forming cyclic guanosine monophosphate (cGMP), which, in turn, eventually produces vascular smooth muscle relaxation. Nitric oxide is continuously produced at low concentrations by the calcium-dependent enzyme NO synthase. Methylene blue directly inhibits NO synthase. It also inhibits the enzyme-soluble guanylate cyclase and prevents accumulation of cGMP. By competitively blocking the target enzyme of NO, MB reduces the responsiveness of vessels to cGMP-dependent vasodilators and restores vascular tone. Increases in intracellular cGMP relax both vascular smooth muscle and myocardial myocytes. This may explain why experimental animal studies have shown that, in addition to reduction in vasopressor requirements, inotropic support is reduced after administration of MB, probably owing to attenuation of ischemia/reperfusion injury. Although MB certainly improves blood pressure, enhanced oxygen delivery or reduced mortality secondary to MB has not yet been confirmed. Given these incomplete data, the authors believe that MB should be used to treat vasoplegia unresponsive to traditional vasopressors, rather than as a first-line agent, until more information becomes available. Clearly, large, randomized controlled trials are urgently required to establish the role of MB in treating vasoplegia.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84019350","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 : 2016-04-01DOI: 10.1097/SA.0000000000000207
K. Johansson, O. Stephansson, M. Neovius
Maternal obesity is associated with increased risk of pregnancy complications such as gestational diabetes, stillbirth, preterm birth, and congenital malformations. While small studies have looked into the effect of prepregnancy bariatric surgery on gestational diabetes, these studies have been inconclusive and have not considered presurgery body mass index (BMI) as a confounder. Some systematic reviews have found a lower risk of neonatal complications after bariatric surgery but included heterogeneous studies with small sample sizes. Taking presurgery BMI into account, this study aims to investigate the risks of adverse perinatal outcomes including gestational diabetes in womenwho have had bariatric surgery versus women who have not. This population-based study used data from Swedish registries nationwide, which include prenatal, obstetric, and neonatal records. Of 627,693 singleton pregnancies between 2006 and 2011, 670 were in women who had undergone bariatric surgery with presurgery weight documented. Up to 5 control pregnancies in obese women were matched for BMI, age, level of education, years, and smoking history for each pregnancy in the intervention cohort. For controls, weight during early pregnancy was used to calculate BMI. For the study group, BMI was calculated with weight and height measurements at the time of surgery. Outcomes included gestational diabetes, low birth weight, macrosomia, stillbirth, largeand small-for-gestational-age, preterm birth, neonatal death, and major congenital malformations detected during the first year of life. Gestational diabetes was diagnosed by a 2-hour plasma glucose level of 10.0 mmol/L or higher during a glucose tolerance test (with a 75-g loading dose) or a fasting plasma glucose level of 7.0 mmol/L or higher. In the study, 1.9% of the postsurgery pregnancies versus 6.8% of the control pregnancies had gestational diabetes (odds ratio, 0.25; 95% confidence interval [CI], 0.13–0.47; P < 0.001; Table 2). The median gestation time of the diagnosis was 32 weeks for both groups, considering women for whom the diagnosis date was available. The surgery cohort, compared with controls, was associated with an increased risk of small-for-gestational-age infants (15.6% vs 7.6%; odds ratio, 2.20; 95% Health, Inc. All rights reserved. 376 Obstetrical and Gynecological Survey CI, 1.64–2.95;P < 0.001) and increased risk for low birth weight, although that was not statistically significant (6.8% vs 4.5%; odds ratio, 1.34; 95% CI, 0.88–2.04; P = 0.17). Alternatively, the surgery group had a lower risk for large-for-gestational-age infants compared with the control group (8.6% vs 22.4%; odds ratio, 0.33; 95% CI, 0.24–0.44; P < 0.001) and lower risk of macrosomia (1.2% vs 9.5%; odds ratio, 0.11; 95% CI, 0.05–0.24; P < 0.001). There was no significant difference between the 2 groups in terms of risk of preterm birth (10.0% vs 7.5%; odds ratio, 1.28; 95% CI, 0.92–1.78; P = 0.15), nor in terms of congenital malformation
产妇肥胖与妊娠并发症的风险增加有关，如妊娠糖尿病、死胎、早产和先天性畸形。虽然有小型研究调查了孕前减肥手术对妊娠糖尿病的影响，但这些研究都没有定论，也没有考虑手术前体重指数(BMI)作为混杂因素。一些系统综述发现，减肥手术后新生儿并发症的风险较低，但包括小样本量的异质性研究。考虑到手术前的体重指数，本研究旨在调查包括妊娠糖尿病在内的不良围产期结局的风险，包括接受过减肥手术的女性与未接受过减肥手术的女性。这项基于人群的研究使用了瑞典全国登记的数据，包括产前、产科和新生儿记录。在2006年至2011年间的627,693例单胎妊娠中，670例是接受了减肥手术并记录了手术前体重的女性。在干预队列中，最多5例肥胖妇女的对照妊娠与每次妊娠的BMI、年龄、教育水平、年龄和吸烟史相匹配。作为对照，怀孕早期的体重被用来计算BMI。对于研究组，BMI是通过手术时的体重和身高测量来计算的。结果包括妊娠期糖尿病、低出生体重、巨大儿、死产、大胎龄和小胎龄、早产、新生儿死亡和出生后第一年发现的主要先天性畸形。妊娠期糖尿病的诊断是在葡萄糖耐量试验(负荷剂量为75 g)时2小时血糖水平为10.0 mmol/L或更高，或空腹血糖水平为7.0 mmol/L或更高。在该研究中，1.9%的术后妊娠与6.8%的对照妊娠有妊娠糖尿病(优势比，0.25;95%置信区间[CI]， 0.13-0.47;P < 0.001;表2)。考虑到可获得诊断日期的妇女，两组诊断的中位妊娠时间为32周。与对照组相比，手术组与小胎龄儿的风险增加相关(15.6% vs 7.6%;优势比，2.20;健康公司版权所有。376产科和妇科调查CI, 1.64-2.95;P < 0.001)和低出生体重风险增加，尽管这没有统计学意义(6.8% vs 4.5%;优势比为1.34;95% ci, 0.88-2.04;P = 0.17)。另外，手术组与对照组相比，大胎龄婴儿的风险较低(8.6% vs 22.4%;优势比0.33;95% ci, 0.24-0.44;P < 0.001)，巨大儿的风险较低(1.2% vs 9.5%;优势比0.11;95% ci, 0.05-0.24;P < 0.001)。在早产风险方面，两组间无显著差异(10.0% vs 7.5%;优势比为1.28;95% ci, 0.92-1.78;P = 0.15)，先天畸形也不例外。本研究的一个局限性是，几乎所有(98%)的手术都是胃旁路手术，因此尚不清楚这些发现是否适用于其他类型的减肥手术。虽然研究发现，减肥手术与降低大胎龄婴儿和妊娠期糖尿病的风险有关，但减肥手术也与小胎龄婴儿的风险增加有关，因此建议在这些怀孕期间增加对这些婴儿的关注。
{"title":"Outcomes of pregnancy after bariatric surgery.","authors":"K. Johansson, O. Stephansson, M. Neovius","doi":"10.1097/SA.0000000000000207","DOIUrl":"https://doi.org/10.1097/SA.0000000000000207","url":null,"abstract":"Maternal obesity is associated with increased risk of pregnancy complications such as gestational diabetes, stillbirth, preterm birth, and congenital malformations. While small studies have looked into the effect of prepregnancy bariatric surgery on gestational diabetes, these studies have been inconclusive and have not considered presurgery body mass index (BMI) as a confounder. Some systematic reviews have found a lower risk of neonatal complications after bariatric surgery but included heterogeneous studies with small sample sizes. Taking presurgery BMI into account, this study aims to investigate the risks of adverse perinatal outcomes including gestational diabetes in womenwho have had bariatric surgery versus women who have not. This population-based study used data from Swedish registries nationwide, which include prenatal, obstetric, and neonatal records. Of 627,693 singleton pregnancies between 2006 and 2011, 670 were in women who had undergone bariatric surgery with presurgery weight documented. Up to 5 control pregnancies in obese women were matched for BMI, age, level of education, years, and smoking history for each pregnancy in the intervention cohort. For controls, weight during early pregnancy was used to calculate BMI. For the study group, BMI was calculated with weight and height measurements at the time of surgery. Outcomes included gestational diabetes, low birth weight, macrosomia, stillbirth, largeand small-for-gestational-age, preterm birth, neonatal death, and major congenital malformations detected during the first year of life. Gestational diabetes was diagnosed by a 2-hour plasma glucose level of 10.0 mmol/L or higher during a glucose tolerance test (with a 75-g loading dose) or a fasting plasma glucose level of 7.0 mmol/L or higher. In the study, 1.9% of the postsurgery pregnancies versus 6.8% of the control pregnancies had gestational diabetes (odds ratio, 0.25; 95% confidence interval [CI], 0.13–0.47; P < 0.001; Table 2). The median gestation time of the diagnosis was 32 weeks for both groups, considering women for whom the diagnosis date was available. The surgery cohort, compared with controls, was associated with an increased risk of small-for-gestational-age infants (15.6% vs 7.6%; odds ratio, 2.20; 95% Health, Inc. All rights reserved. 376 Obstetrical and Gynecological Survey CI, 1.64–2.95;P < 0.001) and increased risk for low birth weight, although that was not statistically significant (6.8% vs 4.5%; odds ratio, 1.34; 95% CI, 0.88–2.04; P = 0.17). Alternatively, the surgery group had a lower risk for large-for-gestational-age infants compared with the control group (8.6% vs 22.4%; odds ratio, 0.33; 95% CI, 0.24–0.44; P < 0.001) and lower risk of macrosomia (1.2% vs 9.5%; odds ratio, 0.11; 95% CI, 0.05–0.24; P < 0.001). There was no significant difference between the 2 groups in terms of risk of preterm birth (10.0% vs 7.5%; odds ratio, 1.28; 95% CI, 0.92–1.78; P = 0.15), nor in terms of congenital malformation","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75121977","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 : 2016-04-01DOI: 10.1097/01.SA.0000480631.30614.8C
M. Robinson, K. Morgensen, J. Casey, C. McKane, Takuhiro Moromizato, J. Rawn, K. Christopher
risk factors for the development of delirium. Numerous risk factors have been studied in the past, with conflicting results. Therefore, the authors of the current study took upon themselves to conduct a systematic review of the literature for proven risk factors. They found 33 articles that studied delirium in the ICU either in patient cohorts or in randomized controlled trials. The investigators evaluated the results of these studies to locate risk factors for delirium that were found in either univariate or multivariate analysis. Risk factors that were repeatedly shown by multivariate analysis to be associated with delirium are suggested to be the most important ones and should be evaluated in any future trial of delirium. Most of the risk factors having a strong association with delirium cannot be modified and include the following: age, dementia, hypertension, worse severity of illness, coma, emergency surgery, mechanical ventilation, and polytrauma. The only modifiable variables that predispose to delirium are metabolic acidosis and delirium during the previous day. Dexmedetomidine was found to protect against delirium. Although this is an important study, the data cannot be used to modify treatment. In order to prevent delirium, we have to better understand its development and thus find ways to prevent it. Although the list of risk factors appears extensive, the role of environmental conditions in the development of delirium in the ICU has not been sufficiently studied. Outside the ICU, delirium could be prevented by repeated orientation of the patients, reduction of noise, use of hearing aids and glasses, early mobilization, and better sleep patterns. All of these factors may play an important role in delirium in critical care patients. Our research into delirium at present is still limited to the descriptive and not to the analytical. We have to better understand the biological process of delirium in order to better study and control it.
{"title":"The Relationship Among Obesity, Nutritional Status, and Mortality in the Critically Ill","authors":"M. Robinson, K. Morgensen, J. Casey, C. McKane, Takuhiro Moromizato, J. Rawn, K. Christopher","doi":"10.1097/01.SA.0000480631.30614.8C","DOIUrl":"https://doi.org/10.1097/01.SA.0000480631.30614.8C","url":null,"abstract":"risk factors for the development of delirium. Numerous risk factors have been studied in the past, with conflicting results. Therefore, the authors of the current study took upon themselves to conduct a systematic review of the literature for proven risk factors. They found 33 articles that studied delirium in the ICU either in patient cohorts or in randomized controlled trials. The investigators evaluated the results of these studies to locate risk factors for delirium that were found in either univariate or multivariate analysis. Risk factors that were repeatedly shown by multivariate analysis to be associated with delirium are suggested to be the most important ones and should be evaluated in any future trial of delirium. Most of the risk factors having a strong association with delirium cannot be modified and include the following: age, dementia, hypertension, worse severity of illness, coma, emergency surgery, mechanical ventilation, and polytrauma. The only modifiable variables that predispose to delirium are metabolic acidosis and delirium during the previous day. Dexmedetomidine was found to protect against delirium. Although this is an important study, the data cannot be used to modify treatment. In order to prevent delirium, we have to better understand its development and thus find ways to prevent it. Although the list of risk factors appears extensive, the role of environmental conditions in the development of delirium in the ICU has not been sufficiently studied. Outside the ICU, delirium could be prevented by repeated orientation of the patients, reduction of noise, use of hearing aids and glasses, early mobilization, and better sleep patterns. All of these factors may play an important role in delirium in critical care patients. Our research into delirium at present is still limited to the descriptive and not to the analytical. We have to better understand the biological process of delirium in order to better study and control it.","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80691859","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 : 2016-04-01DOI: 10.1097/01.sa.0000480797.46135.b1
E. Card, P. Panharipande, C. Tomes, Cathy Lee, J. Wood, D. Nelson, A. Graves, A. Shintani, E. Ely, C. Hughes
{"title":"Emergence From General Anesthesia and Evolution of Delirium Signs in the Post-Anesthesia Care Unit","authors":"E. Card, P. Panharipande, C. Tomes, Cathy Lee, J. Wood, D. Nelson, A. Graves, A. Shintani, E. Ely, C. Hughes","doi":"10.1097/01.sa.0000480797.46135.b1","DOIUrl":"https://doi.org/10.1097/01.sa.0000480797.46135.b1","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91526828","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 : 2016-04-01DOI: 10.1097/01.SA.0000480633.15367.27
Yu-Ji Lee, Y. Wi, Y. J. Kwon, S. R. Kim, Se‐Ho Chang, S. Cho
{"title":"Association Between Colistin Dose and Development of Nephrotoxicity","authors":"Yu-Ji Lee, Y. Wi, Y. J. Kwon, S. R. Kim, Se‐Ho Chang, S. Cho","doi":"10.1097/01.SA.0000480633.15367.27","DOIUrl":"https://doi.org/10.1097/01.SA.0000480633.15367.27","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76381332","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 : 2016-04-01DOI: 10.1097/01.sa.0000480799.35833.11
I. Warnell, M. Chincholkar, M. Eccles
{"title":"Predicting Perioperative Mortality After Oesophagectomy: A Systematic Review of Performance and Methods of Multivariate Models","authors":"I. Warnell, M. Chincholkar, M. Eccles","doi":"10.1097/01.sa.0000480799.35833.11","DOIUrl":"https://doi.org/10.1097/01.sa.0000480799.35833.11","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88810593","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 : 2016-04-01DOI: 10.1097/01.SA.0000480632.07743.af
C. Horkan, S. Purtle, Mallika L Mendu, Takuhiro Moromizato, F. Gibbons, K. Christopher
{"title":"The Association of Acute Kidney Injury in the Critically Ill and Postdischarge Outcomes: A Cohort Study","authors":"C. Horkan, S. Purtle, Mallika L Mendu, Takuhiro Moromizato, F. Gibbons, K. Christopher","doi":"10.1097/01.SA.0000480632.07743.af","DOIUrl":"https://doi.org/10.1097/01.SA.0000480632.07743.af","url":null,"abstract":"","PeriodicalId":22104,"journal":{"name":"Survey of Anesthesiology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2016-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82381965","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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