G. Vishnukanth, A. Ravindra, C. Selvaraja, V. Narenchandra
Azygous lobe is a normal congenital anatomic variant of the right upper lobe. The azygos lobe is not anatomically a separate lobe. Radiologically azygous lobe is noted in the apicomedial region of the right lung and is separated from the rest of upperlobe by azygous fissure. Though not a pathology, azygous lobe can be mistaken for a lung abscess or a bulla. Other complications include hemoptysis or azygous vein aneurysm.
{"title":"An unusual cause of right upper zone opacity − azygous fissure","authors":"G. Vishnukanth, A. Ravindra, C. Selvaraja, V. Narenchandra","doi":"10.4103/jacp.jacp_32_20","DOIUrl":"https://doi.org/10.4103/jacp.jacp_32_20","url":null,"abstract":"Azygous lobe is a normal congenital anatomic variant of the right upper lobe. The azygos lobe is not anatomically a separate lobe. Radiologically azygous lobe is noted in the apicomedial region of the right lung and is separated from the rest of upperlobe by azygous fissure. Though not a pathology, azygous lobe can be mistaken for a lung abscess or a bulla. Other complications include hemoptysis or azygous vein aneurysm.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45582667","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}
Context: The field walking tests like 6MWT and ISWT are commonly used indicators of functional capacity in patients with cardiopulmonary diseases. This study was designed to assess the correlation of six minute walk distance (6MWD) and incremental shuttle walk distance (ISWD) with the severity of airflow obstruction (FEV1%) in patients with chronic obstructive pulmonary disease. Aims: Comparison of correlation of six minute walk test and Incremental shuttle walk test with the severity of airflow obstruction in COPD patients.Settings and Design: Hospital-based prospective cross-sectional study in a tertiary care centre. Methods and Material: One hundred and twelve (112) spirometrically confirmed COPD patients underwent 6MWT and ISWT. The diagnosis of COPD and its severity was assessed by the GOLD criteria. 6MWT and ISWT were done on the same patient with a gap of 5–6 hours and the distance walked (6MWD and ISWD) was correlated with the severity of COPD (FEV1). Statistical Analysis Used: One way ANOVA to compare mean distance walked in 6MWT and ISWT with different grades of COPD. Pearson Correlation was done to correlate packyears of smoking and age with 6MWD and ISWD. Results: The mean distance walked in the 6MWT and ISWT was estimated and compared across the four categories of GOLD grading. There was no statistically significant difference between the study subjects of corresponding GOLD grades based on the distance walked in 6MWT and in ISWT. However, a linear correlation was depicted between ISWD and post-bronchodilator FEV1. A model of linear regression showed that ISWD was an independent contributor to post-bronchodilator FEV1 in our study. Conclusions: Incremental shuttle walk test, an externally paced near to standard test with its incremental nature, can be used as an appropriate surrogate for FEV1 in determining the severity of airflow obstruction in COPD patients.
{"title":"Correlation of six minute walk test and incremental shuttle walk test with severity of airflow obstruction in patients with chronic obstructive pulmonary disease","authors":"P. Tej, S. Kumar, G. Vishnukanth","doi":"10.4103/jacp.jacp_13_20","DOIUrl":"https://doi.org/10.4103/jacp.jacp_13_20","url":null,"abstract":"Context: The field walking tests like 6MWT and ISWT are commonly used indicators of functional capacity in patients with cardiopulmonary diseases. This study was designed to assess the correlation of six minute walk distance (6MWD) and incremental shuttle walk distance (ISWD) with the severity of airflow obstruction (FEV1%) in patients with chronic obstructive pulmonary disease. Aims: Comparison of correlation of six minute walk test and Incremental shuttle walk test with the severity of airflow obstruction in COPD patients.Settings and Design: Hospital-based prospective cross-sectional study in a tertiary care centre. Methods and Material: One hundred and twelve (112) spirometrically confirmed COPD patients underwent 6MWT and ISWT. The diagnosis of COPD and its severity was assessed by the GOLD criteria. 6MWT and ISWT were done on the same patient with a gap of 5–6 hours and the distance walked (6MWD and ISWD) was correlated with the severity of COPD (FEV1). Statistical Analysis Used: One way ANOVA to compare mean distance walked in 6MWT and ISWT with different grades of COPD. Pearson Correlation was done to correlate packyears of smoking and age with 6MWD and ISWD. Results: The mean distance walked in the 6MWT and ISWT was estimated and compared across the four categories of GOLD grading. There was no statistically significant difference between the study subjects of corresponding GOLD grades based on the distance walked in 6MWT and in ISWT. However, a linear correlation was depicted between ISWD and post-bronchodilator FEV1. A model of linear regression showed that ISWD was an independent contributor to post-bronchodilator FEV1 in our study. Conclusions: Incremental shuttle walk test, an externally paced near to standard test with its incremental nature, can be used as an appropriate surrogate for FEV1 in determining the severity of airflow obstruction in COPD patients.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48430425","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}
Anubhuti Singh, K. Kishore, A. Verma, Arpita Singh
Idiopathic pulmonary fibrosis (IPF) is a chronic disease associated with progressive deterioration of lung function and ultimately death. Until recent past, no drug therapy was approved for the management of IPF and patients either received symptomatic treatment or were enrolled in clinical trials. Since 2014, two new drugs with anti-fibrotic potential have been approved following positive outcomes in large-scale clinical trials. Nintedanib is the latest drug in this category and has recently been launched in India. Here we present a review about nintedanib, covering its mechanism of action, efficacy, adverse effect profile, cost effectiveness and implications in the Indian setting.
{"title":"Nintedanib for the treatment of idiopathic pulmonary fibrosis: An Indian perspective","authors":"Anubhuti Singh, K. Kishore, A. Verma, Arpita Singh","doi":"10.4103/jacp.jacp_35_19","DOIUrl":"https://doi.org/10.4103/jacp.jacp_35_19","url":null,"abstract":"Idiopathic pulmonary fibrosis (IPF) is a chronic disease associated with progressive deterioration of lung function and ultimately death. Until recent past, no drug therapy was approved for the management of IPF and patients either received symptomatic treatment or were enrolled in clinical trials. Since 2014, two new drugs with anti-fibrotic potential have been approved following positive outcomes in large-scale clinical trials. Nintedanib is the latest drug in this category and has recently been launched in India. Here we present a review about nintedanib, covering its mechanism of action, efficacy, adverse effect profile, cost effectiveness and implications in the Indian setting.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42867946","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}
The COVID 19 virus gains entry into body by docking to ACE2 receptors of lungs. Subsequently it deranges the balance in RAS and destabilizes oxidant-antioxidant systems. It leads to cytokine storm and endothelial dysfunction. Intially lung is compliant but patients may be hypoxic due to vasoplegia. Later typical full blown ARDS set in.
{"title":"COVID 19-lung interactions: the salient points for pulmonologist","authors":"A. Halder, A. Halder","doi":"10.4103/jacp.jacp_40_20","DOIUrl":"https://doi.org/10.4103/jacp.jacp_40_20","url":null,"abstract":"The COVID 19 virus gains entry into body by docking to ACE2 receptors of lungs. Subsequently it deranges the balance in RAS and destabilizes oxidant-antioxidant systems. It leads to cytokine storm and endothelial dysfunction. Intially lung is compliant but patients may be hypoxic due to vasoplegia. Later typical full blown ARDS set in.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43593266","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}
K. Kishore, Anubhuti Singh, M. Barthwal, D. Bhattacharyya, C. Katoch, R. Tyagi, S. Rana
Context: Although worldwide studies are available regarding the prevalence of COPD in CAD patients, data from India are sparse. Aims: The purpose of this study was to determine the prevalence of undiagnosed and therefore, untreated COPD in patients suffering from CAD. It would also attempt to establish the need for screening of patients diagnosed with CAD for COPD. Settings and Design: A cross-sectional, observational study carried out at the respiratory out patients department (OPD) of a tertiary care centre of armed forces over a period of one year. Methods and Material: 79 patients with angiographically proven CAD underwent spirometry to assess the prevalence of COPD. Statistical Analysis Used: Data analysis was done using SPSS (Statistical Package for Social Sciences) version 21.0. Results: The mean age of the patients was 62.49 years (±8.77). Mean smoking index was 235.88. Nine patients (11.39 %) were diagnosed to have COPD. All the patients diagnosed as COPD were male, >60 years old and had normal BMI. 88.9 % patients with COPD were smokers. On comparing the patients with and without COPD, a significant co-relation was found with LVEF (%) (P = 0.044). 44.4% patients had never been diagnosed with COPD. Conclusions: The prevalence of missed diagnosis of COPD is significant in our study. We recommend that at the time of diagnosis of CAD, the initial evaluation should include a detailed history, clinical examination and evaluation of lung function by spirometry.
{"title":"Is chronic obstructive pulmonary disease under-diagnosed in patients with coronary artery disease? A tertiary care centre experience from central India","authors":"K. Kishore, Anubhuti Singh, M. Barthwal, D. Bhattacharyya, C. Katoch, R. Tyagi, S. Rana","doi":"10.4103/jacp.jacp_43_19","DOIUrl":"https://doi.org/10.4103/jacp.jacp_43_19","url":null,"abstract":"Context: Although worldwide studies are available regarding the prevalence of COPD in CAD patients, data from India are sparse. Aims: The purpose of this study was to determine the prevalence of undiagnosed and therefore, untreated COPD in patients suffering from CAD. It would also attempt to establish the need for screening of patients diagnosed with CAD for COPD. Settings and Design: A cross-sectional, observational study carried out at the respiratory out patients department (OPD) of a tertiary care centre of armed forces over a period of one year. Methods and Material: 79 patients with angiographically proven CAD underwent spirometry to assess the prevalence of COPD. Statistical Analysis Used: Data analysis was done using SPSS (Statistical Package for Social Sciences) version 21.0. Results: The mean age of the patients was 62.49 years (±8.77). Mean smoking index was 235.88. Nine patients (11.39 %) were diagnosed to have COPD. All the patients diagnosed as COPD were male, >60 years old and had normal BMI. 88.9 % patients with COPD were smokers. On comparing the patients with and without COPD, a significant co-relation was found with LVEF (%) (P = 0.044). 44.4% patients had never been diagnosed with COPD. Conclusions: The prevalence of missed diagnosis of COPD is significant in our study. We recommend that at the time of diagnosis of CAD, the initial evaluation should include a detailed history, clinical examination and evaluation of lung function by spirometry.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41600393","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}
Pulmonary hamartomas are rare, benign tumours of lung and are composed of an abnormal mixture of epithelial and mesenchymal elements. They usually present as single, round nodules with distinct boundaries and are mostly asymptomatic. We present a case of 45 years old female who presented with cough, chest pain and dyspnea with few episodes of hemoptysis. Computed tomography (CT) scan of thorax showed a well-defined non enhancing mass lesion measuring 4 × 3.2 cm seen in the left lower lobe. Wedge resection was done. Histopathological examination confirmed the diagnosis of pulmonary hamartoma.
{"title":"Solitary pulmonary nodule − Pulmonary hamartoma","authors":"P. Khari, S. Mullick, Devesh Chauhan","doi":"10.4103/jacp.jacp_11_20","DOIUrl":"https://doi.org/10.4103/jacp.jacp_11_20","url":null,"abstract":"Pulmonary hamartomas are rare, benign tumours of lung and are composed of an abnormal mixture of epithelial and mesenchymal elements. They usually present as single, round nodules with distinct boundaries and are mostly asymptomatic. We present a case of 45 years old female who presented with cough, chest pain and dyspnea with few episodes of hemoptysis. Computed tomography (CT) scan of thorax showed a well-defined non enhancing mass lesion measuring 4 × 3.2 cm seen in the left lower lobe. Wedge resection was done. Histopathological examination confirmed the diagnosis of pulmonary hamartoma.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48966467","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}
Oxygen is a drug prescribed and administered for specific indications with different pathophysiological mechanism. Oxygen is administered to treat hypoxia not dyspnea. Furthermore, the management of hypoxia in patients with COVID-19 demands separate attention.
{"title":"Hypoxemia and oxygen therapy","authors":"A. Ghoshal","doi":"10.4103/jacp.jacp_44_20","DOIUrl":"https://doi.org/10.4103/jacp.jacp_44_20","url":null,"abstract":"Oxygen is a drug prescribed and administered for specific indications with different pathophysiological mechanism. Oxygen is administered to treat hypoxia not dyspnea. Furthermore, the management of hypoxia in patients with COVID-19 demands separate attention.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47100385","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}
The new version of guidelines of programmatic management of drug resistant tuberculosis in India 2019 by Revised National Tuberculosis Control Programme, Central TB Division, Directorate General of Health Services, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi, integrates use of the shorter MDR TB regimen and all oral longer MDR TB regimen with new drugs under RNTCP with opportunity to modify the regimen based on DST results. There are mammoth and comprehensive changes in the guidelines on programmatic management of drug resistant tuberculosis in India 2019.
{"title":"Recent changes in guidelines on programmatic management of drug resistant tuberculosis in India 2019: a paradigm shift in tuberculosis control","authors":"A. Chaudhuri","doi":"10.4103/jacp.jacp_47_20","DOIUrl":"https://doi.org/10.4103/jacp.jacp_47_20","url":null,"abstract":"The new version of guidelines of programmatic management of drug resistant tuberculosis in India 2019 by Revised National Tuberculosis Control Programme, Central TB Division, Directorate General of Health Services, Ministry of Health & Family Welfare, Nirman Bhawan, New Delhi, integrates use of the shorter MDR TB regimen and all oral longer MDR TB regimen with new drugs under RNTCP with opportunity to modify the regimen based on DST results. There are mammoth and comprehensive changes in the guidelines on programmatic management of drug resistant tuberculosis in India 2019.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49230951","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}
Pleural and pulmonary manifestations of Parvo virus infection are exceedingly rare. Here, we describe an immunocompetent patient with Parvo virus infection who presented with lymphocytic, exudative effusion. Though, this presentation is rare, it may be looked for, if a patient presents with rash and pleural effusion.
{"title":"Parvo virus infection − an unusual cause of pleural efusion in an immunocompetent patient","authors":"A. Khanna","doi":"10.4103/jacp.jacp_25_18","DOIUrl":"https://doi.org/10.4103/jacp.jacp_25_18","url":null,"abstract":"Pleural and pulmonary manifestations of Parvo virus infection are exceedingly rare. Here, we describe an immunocompetent patient with Parvo virus infection who presented with lymphocytic, exudative effusion. Though, this presentation is rare, it may be looked for, if a patient presents with rash and pleural effusion.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44835887","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}
Y. Rathore, Anshika Jindal, V. Joshi, Shubhra Jain, Shweta Bhati
Context: Acute exacerbation of COPD is very common disease and 20% of the COPD patients keep getting admitted with exacerbation. Serum procalcitonin (PCT) measurement is important to discriminate bacterial infection from other causes of AECOPD. Quick recognition along with prompt intervention may be the only action that prevents respiratory failure. Aims: To correlate serum PCT level with bacteriological profile and their need for ventilatory support in patients with AECOPD. Settings and Design: Hospital-based comparative type of cross-sectional study was conducted at the department of respiratory medicine in a tertiary care center of Rajasthan. Methods and Material: This comparative type of cross-sectional study was conducted between 45 AECOPD patients and 35 stable COPD patients. Serum PCT levels and sputum pyogenic culture were noted in all subjects. Statistical Analysis Used: Data collected were entered into excel spreadsheet and quantitative data were expressed as number and percentage. Results: There was a highly statistically significant difference of mean PCT value (P value < 0.003) between AECOPD patients (1.34 ± 2.53 ng/ml) and stable COPD patients (0.07 ± 0.05 ng/ml). Also, we found a statistically significant difference of mean PCT value (P value < 0.001) between AECOPD patients infected with Pseudomonas aeruginosa (3.64 ng/dl) and with other bacteria. A statistically significant difference (P value < 0.001) was present among AECOPD patients that needed invasive ventilation (5.41 ± 4.01 ng/ml), non-invasive ventilation (0.65 ± 0.81 ng/ml) and those did not need mechanical ventilation (0.27 ± 0.25 ng/ml) regarding the mean values of PCT. Conclusions: Our study found that higher PCT levels in severe AECOPD patients were associated more with bacterial infection and necessity of ventilatory support. Serum PCT can be used as good biomarker for intensive care unit admission.
{"title":"Serum procalcitonin in predicting bacterial exacerbation of COPD and need for ventilatory support","authors":"Y. Rathore, Anshika Jindal, V. Joshi, Shubhra Jain, Shweta Bhati","doi":"10.4103/jacp.jacp_1_20","DOIUrl":"https://doi.org/10.4103/jacp.jacp_1_20","url":null,"abstract":"Context: Acute exacerbation of COPD is very common disease and 20% of the COPD patients keep getting admitted with exacerbation. Serum procalcitonin (PCT) measurement is important to discriminate bacterial infection from other causes of AECOPD. Quick recognition along with prompt intervention may be the only action that prevents respiratory failure. Aims: To correlate serum PCT level with bacteriological profile and their need for ventilatory support in patients with AECOPD. Settings and Design: Hospital-based comparative type of cross-sectional study was conducted at the department of respiratory medicine in a tertiary care center of Rajasthan. Methods and Material: This comparative type of cross-sectional study was conducted between 45 AECOPD patients and 35 stable COPD patients. Serum PCT levels and sputum pyogenic culture were noted in all subjects. Statistical Analysis Used: Data collected were entered into excel spreadsheet and quantitative data were expressed as number and percentage. Results: There was a highly statistically significant difference of mean PCT value (P value < 0.003) between AECOPD patients (1.34 ± 2.53 ng/ml) and stable COPD patients (0.07 ± 0.05 ng/ml). Also, we found a statistically significant difference of mean PCT value (P value < 0.001) between AECOPD patients infected with Pseudomonas aeruginosa (3.64 ng/dl) and with other bacteria. A statistically significant difference (P value < 0.001) was present among AECOPD patients that needed invasive ventilation (5.41 ± 4.01 ng/ml), non-invasive ventilation (0.65 ± 0.81 ng/ml) and those did not need mechanical ventilation (0.27 ± 0.25 ng/ml) regarding the mean values of PCT. Conclusions: Our study found that higher PCT levels in severe AECOPD patients were associated more with bacterial infection and necessity of ventilatory support. Serum PCT can be used as good biomarker for intensive care unit admission.","PeriodicalId":30411,"journal":{"name":"The Journal of Association of Chest Physicians","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45249229","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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