Background: Although laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma, there is no clear consensus regarding its rate of recurrence and associated risk factors. Objectives: This study aimed to investigate the recurrence rate of myoma and its risk factors after laparoscopic myomectomy. Methods: In a historical cohort study, 172 patients who underwent laparoscopic myomectomy and had a minimum follow-up of 2 years were included. Myoma recurrence was checked semiannually by ultrasound imaging. The demographic, clinical, surgical, sonographic, and laboratory indices of the patients were compared between the recurrent and nonrecurrent groups, both in logistic regression models. Results: The mean age of the patients was 35 ± 5.7 years (range: 18 - 47 years). Their mean follow-up time was 26.3 ± 4.2 months (range: 24 - 28). The lesion recurred in 25 (14.5%) out of 172 patients. In the univariate analysis, higher age (OR:1.111, P = 0.015), higher body mass index (OR: 1.124, P = 0.024), gonadotropin-releasing hormone (GnRH) therapy (OR = 3.83, P = 0.027), and more than 1 myoma (OR: 2.60, P = 0.032) were associated with myoma recurrence. In the multiple analysis, a higher body mass index (OR: 1.222, P = 0.003) was a significant risk factor for myoma recurrence. Conclusions: Laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma and can be used as a uterus-preserving surgical alternative in patients of reproductive age. A more radical surgical procedure might be used for patients with multiple risk factors, as revealed in the present study.
背景:虽然腹腔镜子宫肌瘤切除术是治疗子宫肌瘤的有效方法，但对于其复发率和相关危险因素尚无明确的共识。目的:探讨腹腔镜子宫肌瘤切除术后子宫肌瘤的复发率及其危险因素。方法:在一项历史队列研究中，172例接受腹腔镜子宫肌瘤切除术的患者，随访时间至少为2年。每半年用超声检查一次肌瘤复发情况。在logistic回归模型中比较复发组和非复发组患者的人口学、临床、外科、超声和实验室指标。结果:患者平均年龄35±5.7岁(18 ~ 47岁)。平均随访时间为26.3±4.2个月(24 ~ 28个月)。172例患者中病变复发25例(14.5%)。在单因素分析中，较高的年龄(OR:1.111, P = 0.015)、较高的体重指数(OR: 1.124, P = 0.024)、促性腺激素释放激素(GnRH)治疗(OR = 3.83, P = 0.027)和超过1个肌瘤(OR: 2.60, P = 0.032)与肌瘤复发相关。在多重分析中，较高的体重指数(OR: 1.222, P = 0.003)是肌瘤复发的重要危险因素。结论:腹腔镜子宫肌瘤切除术是治疗子宫肌瘤的有效方法，可作为育龄患者保留子宫的手术选择。正如本研究所揭示的那样，对于具有多种危险因素的患者，可能会采用更彻底的外科手术。
{"title":"Short-Term Risk of Fibroid Recurrence After Laparoscopic Myomectomy and Its Associated Risk Factors","authors":"Zahra Asgari, Seyedeh Azam Pourhoseini, Reihaneh Hosseini, Behnaz Ghavami, Bahareh Meibodi, Ali Akbari","doi":"10.5812/semj-132683","DOIUrl":"https://doi.org/10.5812/semj-132683","url":null,"abstract":"Background: Although laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma, there is no clear consensus regarding its rate of recurrence and associated risk factors. Objectives: This study aimed to investigate the recurrence rate of myoma and its risk factors after laparoscopic myomectomy. Methods: In a historical cohort study, 172 patients who underwent laparoscopic myomectomy and had a minimum follow-up of 2 years were included. Myoma recurrence was checked semiannually by ultrasound imaging. The demographic, clinical, surgical, sonographic, and laboratory indices of the patients were compared between the recurrent and nonrecurrent groups, both in logistic regression models. Results: The mean age of the patients was 35 ± 5.7 years (range: 18 - 47 years). Their mean follow-up time was 26.3 ± 4.2 months (range: 24 - 28). The lesion recurred in 25 (14.5%) out of 172 patients. In the univariate analysis, higher age (OR:1.111, P = 0.015), higher body mass index (OR: 1.124, P = 0.024), gonadotropin-releasing hormone (GnRH) therapy (OR = 3.83, P = 0.027), and more than 1 myoma (OR: 2.60, P = 0.032) were associated with myoma recurrence. In the multiple analysis, a higher body mass index (OR: 1.222, P = 0.003) was a significant risk factor for myoma recurrence. Conclusions: Laparoscopic myomectomy is an effective procedure for the treatment of uterine myoma and can be used as a uterus-preserving surgical alternative in patients of reproductive age. A more radical surgical procedure might be used for patients with multiple risk factors, as revealed in the present study.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135833307","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}
Background: Diabetes management self-efficacy (DMSE) positively affects diabetes self-care behaviors and can lead to better glycemic control and improved disease outcomes in diabetes patients. Objectives: This study aimed to evaluate DMSE level and its relationship with medication adherence, glycemic control, and diabetes complications among type 2 diabetes (T2D) patients. Methods: A cross-sectional study was carried out from November 2019 to January 2020 on T2D patients who attended the Diabetes Center of the Kerman University of Medical Sciences. Data were collected using two validated questionnaires including the diabetes management self-efficacy scale (DMSES) to evaluate DMSE level and the eight-item Morisky medication adherence scale (MMAS) to assess adherence to medication. The SPSS statistical software version 22 was employed for data analysis. Results: Of 440 T2D patients entering the study, 72% were female with a mean (SD) age of 59.60 (10.48). The mean (SD) DMSE score of the respondents was 5.76 (1.87). A significant negative correlation was observed between DMSE with HbA1c (r = -0.289, P < 0.0001) and also with FBS (r = -0.229, P < 0.0001), but there was a significant positive correlation between DMSE and adherence to medication (r = 0.208, P < 0.0001). FBS level (β = -0.252, P < 0.0001), number of visits by specialty or subspecialty physicians (β = -0.139, P = 0.002), medication adherence score (β = 0.165, P < 0.0001), neuropathy (β = 0.142, P = 0.002), marital status β = 0.125, P = 0.004), household income (β = -0.126, P = 0.004), and blood glucose checks at home (β = 0.109, P = 0.013) were considered predictors of DMSE score. Conclusions: Diabetes management self-efficacy is considered suboptimal among T2D patients. Patients with higher DMSE have better adherence to medication, better blood glucose control, lower risk of neuropathy, and fewer visits by specialty and subspecialty physicians.
背景:糖尿病管理自我效能感(DMSE)对糖尿病患者的自我护理行为有积极影响，可导致糖尿病患者更好的血糖控制和改善疾病结局。目的:本研究旨在评估2型糖尿病(T2D)患者DMSE水平及其与药物依从性、血糖控制和糖尿病并发症的关系。方法:对2019年11月至2020年1月在克尔曼医学科学大学糖尿病中心就诊的T2D患者进行横断面研究。采用糖尿病管理自我效能量表(DMSES)评估DMSE水平，采用Morisky药物依从性量表(MMAS)评估药物依从性。采用SPSS统计软件22进行数据分析。结果:进入研究的440例T2D患者中，72%为女性，平均(SD)年龄为59.60(10.48)岁。被调查者的DMSE平均分(SD)为5.76分(1.87分)。DMSE与HbA1c呈显著负相关(r = -0.289, P <0.0001)和FBS (r = -0.229, P <0.0001)，但DMSE与药物依从性之间存在显著正相关(r = 0.208, P <0.0001)。FBS水平(β = -0.252, P <0.0001)、专科或亚专科医生就诊次数(β = -0.139, P = 0.002)、药物依从性评分(β = 0.165, P <0.0001)、神经病变(β = 0.142, P = 0.002)、婚姻状况(β = 0.125, P = 0.004)、家庭收入(β = -0.126, P = 0.004)和家庭血糖检查(β = 0.109, P = 0.013)被认为是DMSE评分的预测因素。结论:糖尿病管理自我效能在t2dm患者中被认为是次优的。DMSE较高的患者对药物的依从性较好，血糖控制较好，神经病变风险较低，专科和亚专科医生就诊次数较少。
{"title":"Association of Diabetes Management Self-efficacy with Adherence to Medication, Glycemic Control, and Disease Outcomes Among Type 2 Diabetes Patients","authors":"Ali Khalooei, Zohreh Hasheminejad","doi":"10.5812/semj-138227","DOIUrl":"https://doi.org/10.5812/semj-138227","url":null,"abstract":"Background: Diabetes management self-efficacy (DMSE) positively affects diabetes self-care behaviors and can lead to better glycemic control and improved disease outcomes in diabetes patients. Objectives: This study aimed to evaluate DMSE level and its relationship with medication adherence, glycemic control, and diabetes complications among type 2 diabetes (T2D) patients. Methods: A cross-sectional study was carried out from November 2019 to January 2020 on T2D patients who attended the Diabetes Center of the Kerman University of Medical Sciences. Data were collected using two validated questionnaires including the diabetes management self-efficacy scale (DMSES) to evaluate DMSE level and the eight-item Morisky medication adherence scale (MMAS) to assess adherence to medication. The SPSS statistical software version 22 was employed for data analysis. Results: Of 440 T2D patients entering the study, 72% were female with a mean (SD) age of 59.60 (10.48). The mean (SD) DMSE score of the respondents was 5.76 (1.87). A significant negative correlation was observed between DMSE with HbA1c (r = -0.289, P < 0.0001) and also with FBS (r = -0.229, P < 0.0001), but there was a significant positive correlation between DMSE and adherence to medication (r = 0.208, P < 0.0001). FBS level (β = -0.252, P < 0.0001), number of visits by specialty or subspecialty physicians (β = -0.139, P = 0.002), medication adherence score (β = 0.165, P < 0.0001), neuropathy (β = 0.142, P = 0.002), marital status β = 0.125, P = 0.004), household income (β = -0.126, P = 0.004), and blood glucose checks at home (β = 0.109, P = 0.013) were considered predictors of DMSE score. Conclusions: Diabetes management self-efficacy is considered suboptimal among T2D patients. Patients with higher DMSE have better adherence to medication, better blood glucose control, lower risk of neuropathy, and fewer visits by specialty and subspecialty physicians.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"40 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135406978","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}
Background: SARS-CoV-2, which emerged in China and spread globally, has been associated with adrenal insufficiency in numerous COVID-19 patients. The clinical evidence regarding adrenal involvement in COVID-19 patients is currently limited, primarily consisting of case reports and small patient series. Objectives: This study aimed to assess the variations in serum cortisol levels and evaluate the response of hospitalized COVID-19 patients to the adrenocorticotropic hormone (ACTH) test. Methods: This study was performed on patients with COVID-19 admitted to Valiasr Hospital, Birjand, Iran, in 2021. Sixty patients with COVID-19 were included in this study by simple random sampling. Patients' venous blood (5 mL) was collected in an EDTA anticoagulant tube. Blood samples were placed in a cool place, then 250 μg intramuscular cosyntropin was injected, and blood samples were taken again 60 minutes later. According to the kit protocol, cortisol levels were measured by a quantitative luminescence kit (Saluggia, Italy). Results: The study involved 60 participants, of which 32 were male (53.3%) and 28 were female (46.7%). The Mean participants' age was 63.1 ± 20.93. The median baseline cortisol serum levels were 28.075 µg /dL for men and 21.820 µg /dL for women. There was no significant difference between base cortisol serum levels (P-value = 0.248). After measuring the baseline cortisol levels in the studied patients, 21.7 % suffered from adrenal Insufficiency, 40 % were suspected of adrenal insufficiency and required cosyntropin injections, and 38.3 % did not have adrenal Insufficiency. Following the administration of cosyntropin injections, it was found that 33.3% of participants had adrenal insufficiency, while the remaining 66.7% did not exhibit any signs of adrenal insufficiency. Vital signs demonstrated that patients with adrenal insufficiency had notably lower mean systolic and diastolic blood pressures, and a statistically significant correlation was observed when comparing these two groups (P-value < 0.001 and P-value = 0.001, respectively). In assessing sodium and potassium serum levels between the two groups, individuals with adrenal insufficiency demonstrated lower average sodium levels (P-value < 0.001). At the same time, no noteworthy divergence was found in potassium levels between the groups (P-value = 0.587).Furthermore, no considerable discrepancy emerged in the in-hospital mortality rate during the patients' follow-up period (P-value = 0.322). Conclusions: As Adrenal insufficiency is life-threatening, early adrenal axis testing for COVID-19 patients with clinical suspicion of adrenal insufficiency should be carried out.
{"title":"Adrenal Insufficiency in Patients with COVID-19","authors":"Seyed Mojtaba Hosseini Dasht Bayaz, Seyyed Ebrahim Hosseini Zargaz, Masood Ziaee, Zahra Soroosh, Saeede Babaiyan","doi":"10.5812/semj-136950","DOIUrl":"https://doi.org/10.5812/semj-136950","url":null,"abstract":"Background: SARS-CoV-2, which emerged in China and spread globally, has been associated with adrenal insufficiency in numerous COVID-19 patients. The clinical evidence regarding adrenal involvement in COVID-19 patients is currently limited, primarily consisting of case reports and small patient series. Objectives: This study aimed to assess the variations in serum cortisol levels and evaluate the response of hospitalized COVID-19 patients to the adrenocorticotropic hormone (ACTH) test. Methods: This study was performed on patients with COVID-19 admitted to Valiasr Hospital, Birjand, Iran, in 2021. Sixty patients with COVID-19 were included in this study by simple random sampling. Patients' venous blood (5 mL) was collected in an EDTA anticoagulant tube. Blood samples were placed in a cool place, then 250 μg intramuscular cosyntropin was injected, and blood samples were taken again 60 minutes later. According to the kit protocol, cortisol levels were measured by a quantitative luminescence kit (Saluggia, Italy). Results: The study involved 60 participants, of which 32 were male (53.3%) and 28 were female (46.7%). The Mean participants' age was 63.1 ± 20.93. The median baseline cortisol serum levels were 28.075 µg /dL for men and 21.820 µg /dL for women. There was no significant difference between base cortisol serum levels (P-value = 0.248). After measuring the baseline cortisol levels in the studied patients, 21.7 % suffered from adrenal Insufficiency, 40 % were suspected of adrenal insufficiency and required cosyntropin injections, and 38.3 % did not have adrenal Insufficiency. Following the administration of cosyntropin injections, it was found that 33.3% of participants had adrenal insufficiency, while the remaining 66.7% did not exhibit any signs of adrenal insufficiency. Vital signs demonstrated that patients with adrenal insufficiency had notably lower mean systolic and diastolic blood pressures, and a statistically significant correlation was observed when comparing these two groups (P-value < 0.001 and P-value = 0.001, respectively). In assessing sodium and potassium serum levels between the two groups, individuals with adrenal insufficiency demonstrated lower average sodium levels (P-value < 0.001). At the same time, no noteworthy divergence was found in potassium levels between the groups (P-value = 0.587).Furthermore, no considerable discrepancy emerged in the in-hospital mortality rate during the patients' follow-up period (P-value = 0.322). Conclusions: As Adrenal insufficiency is life-threatening, early adrenal axis testing for COVID-19 patients with clinical suspicion of adrenal insufficiency should be carried out.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135372528","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}
Background: Faculties, as educational systems, comprise various educational groups, faculty members, researchers, students, and administrative staff. The management of data records related to the performance and activities of the faculty and its members leads to better monitoring, identification of weaknesses and strengths, and, ultimately, promotion of the faculty's performance. Dashboards are data management tools that can be used for monitoring and evaluating a faculty's performance. Objectives: This study aims to develop a protocol for the design of a faculty performance dashboard with a sequential mixed methods approach. Methods: This cross-sectional study will be conducted in the Faculty of Allied Medical Sciences, AJA University of Medical Sciences, in 2023. A mixed methods study with a sequential mixed (qualitative and then quantitative) design will be conducted in four phases. First, all the resources related to the functional dashboard are reviewed to identify its operational requirements. Second, the requirements and necessities of the software are determined by qualitative (interviews) and then quantitative (Delphi) methods. In this phase, 8 people will be interviewed during the qualitative phase, and thematic analysis will be used to analyze the data. For the quantitative step, the 2-round Delphi technique will be conducted by the purposive selection of 21 individuals. Data analysis for the quantitative step will be conducted in SPSS v. 22 by using descriptive statistics, including mode, median, mean, and percentage of agreement. Third, software coding will be performed in C# programming language in Visual Studio. Finally, 15 people among faculty members and managers will be selected by using purposive sampling to evaluate the software. In this phase, the qualitative method and then the quantitative method are used for software evaluation. In the qualitative method, the think-aloud protocol will be used to evaluate usability, and in the quantitative method, the users' satisfaction with the dashboard software will be assessed using a questionnaire. The validity and reliability of the questionnaire have been confirmed previously (Cronbach's alpha: 0.94). The data will be analyzed using descriptive statistics in SPSS v. 21. Results: The paper identifies four steps that should be followed when designing and adopting performance dashboards to support student agency and empowerment. Conclusions: The final product of this study is a dashboard for monitoring, evaluating performance, and managing resources at the faculty level.
背景:学院，作为教育系统，由不同的教育团体、教师、研究人员、学生和行政人员组成。管理与教师及其成员的表现和活动有关的数据记录，可以更好地监测、识别弱点和优势，并最终提高教师的表现。仪表板是数据管理工具，可用于监控和评估教师的表现。目的:本研究旨在开发一个协议的设计与顺序混合方法的教师绩效仪表板。方法:本横断面研究将于2023年在AJA医学科学大学联合医学科学学院进行。混合方法研究与连续混合(定性和定量)设计将在四个阶段进行。首先，审查与功能指示板相关的所有资源，以确定其操作需求。其次，通过定性(访谈)和定量(德尔菲)的方法确定软件的需求和必要性。在此阶段，定性阶段将对8人进行访谈，并采用专题分析的方法对数据进行分析。定量步骤采用两轮德尔菲法，有目的地选择21人。定量步骤的数据分析将在SPSS v. 22中进行，使用描述性统计，包括模式，中位数，平均值和同意的百分比。第三，在Visual Studio中使用c#编程语言进行软件编码。最后，采用有目的抽样的方法，从教师和管理人员中选出15人对软件进行评估。在这一阶段，先采用定性方法，再采用定量方法进行软件评价。在定性方法中，将使用think-aloud协议来评估可用性，在定量方法中，将使用问卷调查来评估用户对仪表板软件的满意度。问卷的效度和信度已被证实(Cronbach's alpha: 0.94)。数据将在SPSS v. 21中使用描述性统计进行分析。结果:本文确定了在设计和采用绩效仪表板以支持学生代理和授权时应遵循的四个步骤。结论:本研究的最终成果是一个用于监控、评估绩效和管理教员级资源的仪表板。
{"title":"Design and Evaluation of a Performance Dashboard for the Faculty of Allied Medical Sciences, AJA University of Medical Sciences: A Protocol for a Mixed Methods Study","authors":"Sohrab Almasi, Nahid Mehrabi, Mahdi Ghorbani","doi":"10.5812/semj-137592","DOIUrl":"https://doi.org/10.5812/semj-137592","url":null,"abstract":"Background: Faculties, as educational systems, comprise various educational groups, faculty members, researchers, students, and administrative staff. The management of data records related to the performance and activities of the faculty and its members leads to better monitoring, identification of weaknesses and strengths, and, ultimately, promotion of the faculty's performance. Dashboards are data management tools that can be used for monitoring and evaluating a faculty's performance. Objectives: This study aims to develop a protocol for the design of a faculty performance dashboard with a sequential mixed methods approach. Methods: This cross-sectional study will be conducted in the Faculty of Allied Medical Sciences, AJA University of Medical Sciences, in 2023. A mixed methods study with a sequential mixed (qualitative and then quantitative) design will be conducted in four phases. First, all the resources related to the functional dashboard are reviewed to identify its operational requirements. Second, the requirements and necessities of the software are determined by qualitative (interviews) and then quantitative (Delphi) methods. In this phase, 8 people will be interviewed during the qualitative phase, and thematic analysis will be used to analyze the data. For the quantitative step, the 2-round Delphi technique will be conducted by the purposive selection of 21 individuals. Data analysis for the quantitative step will be conducted in SPSS v. 22 by using descriptive statistics, including mode, median, mean, and percentage of agreement. Third, software coding will be performed in C# programming language in Visual Studio. Finally, 15 people among faculty members and managers will be selected by using purposive sampling to evaluate the software. In this phase, the qualitative method and then the quantitative method are used for software evaluation. In the qualitative method, the think-aloud protocol will be used to evaluate usability, and in the quantitative method, the users' satisfaction with the dashboard software will be assessed using a questionnaire. The validity and reliability of the questionnaire have been confirmed previously (Cronbach's alpha: 0.94). The data will be analyzed using descriptive statistics in SPSS v. 21. Results: The paper identifies four steps that should be followed when designing and adopting performance dashboards to support student agency and empowerment. Conclusions: The final product of this study is a dashboard for monitoring, evaluating performance, and managing resources at the faculty level.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"160 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136341573","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}
Introduction: Chronic granulomatous disease (CGD) is the most common inherited defect of phagocytes. Although most female carriers of X-linked CGD have been considered to be unaffected, they may have similar problems to those of CGD patients. This study suggests that the CGD carrier state might be more complex than it was previously appreciated. Case Presentation: A sixty-year-old woman visited our hospital in June 2021 due to pneumonia and pleural effusion. Chest computed tomography scan revealed left lower lobe pneumonia and mediastinal lymphadenopathies. In July 2021, her symptoms (high-grade fever, chills, and hemoptysis) were initially attributed to a hydatid cyst. Therefore, she underwent a lobectomy, resulting in purulent drainage on the excision site on the skin, refractory to local and systemic treatments. The refractory and recurrent nature of the lesions led to the immunological evaluation, which was completely normal with a 100% nitroblue tetrazolium (NBT) and a dihydrorhodamine (DHR) of 278 (normal > 100). Further DHR123 flow cytometry investigations with multiple stimulants revealed a carrier state of CGD, which was relevant to her history of chronic complications. Conclusions: Adult patients with unusual manifestations suggestive of neutrophil function defects in adulthood should be evaluated for the CGD carrier state. In these cases, NBT alone may miss the diagnosis of CGD. In such cases, DHR testing with multiple stimulants may establish a robust diagnosis.
{"title":"Carrier State of Chronic Granulomatous Disease Presented at Middle Age: A Case Report","authors":"Mahsa Rekabi, Mohammad Behgam Shadmehr, Esmaeil Mortaz, Vahab Rekabi, Maryam Heydarazad, Sepideh Darougar","doi":"10.5812/semj-139276","DOIUrl":"https://doi.org/10.5812/semj-139276","url":null,"abstract":"Introduction: Chronic granulomatous disease (CGD) is the most common inherited defect of phagocytes. Although most female carriers of X-linked CGD have been considered to be unaffected, they may have similar problems to those of CGD patients. This study suggests that the CGD carrier state might be more complex than it was previously appreciated. Case Presentation: A sixty-year-old woman visited our hospital in June 2021 due to pneumonia and pleural effusion. Chest computed tomography scan revealed left lower lobe pneumonia and mediastinal lymphadenopathies. In July 2021, her symptoms (high-grade fever, chills, and hemoptysis) were initially attributed to a hydatid cyst. Therefore, she underwent a lobectomy, resulting in purulent drainage on the excision site on the skin, refractory to local and systemic treatments. The refractory and recurrent nature of the lesions led to the immunological evaluation, which was completely normal with a 100% nitroblue tetrazolium (NBT) and a dihydrorhodamine (DHR) of 278 (normal > 100). Further DHR123 flow cytometry investigations with multiple stimulants revealed a carrier state of CGD, which was relevant to her history of chronic complications. Conclusions: Adult patients with unusual manifestations suggestive of neutrophil function defects in adulthood should be evaluated for the CGD carrier state. In these cases, NBT alone may miss the diagnosis of CGD. In such cases, DHR testing with multiple stimulants may establish a robust diagnosis.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135194117","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}
Zohreh Sohrabi, Atefeh Zabihi Zazoly, Ghobad Ramezani, Azam Norouzi, Mohammad Hasan Keshavarzi, Ghadir Pourbairamian, Leila Neisani Samani, Shahrzad Saravani
Background: Nowadays, creativity is emphasized in different aspects of teaching and learning. Different educational conditions, such as coronavirus disease 2019 (COVID-19), have directed attention to this issue. Objectives: The current study was an attempt to investigate creative teaching behaviors in medical classrooms and propose solutions for its promotion. Methods: This mixed-method study was conducted at the Iran University of Medical Sciences, Tehran, Iran (2020 - 2021). It was conducted in two phases, including quantitative (to determine the status quo) and qualitative (to provide solutions for its promotion). In the quantitative phase, 168 students were selected by simple random sampling. The data collection instrument was a standard creative teaching questionnaire. The qualitative phase included semi-structured interviews. The data were analyzed using qualitative content analysis and parametric tests. Results: The mean scores of creative teachings in higher-grade classes were significantly higher (P = 0.001). The highest mean score was reported for the fourth year (204.6 ± 0.58). The fourth-year students also had the highest mean scores in each component compared to other years. Except for the freedom component, the highest score was related to the third-year students (21.42 ± 0.89). In the qualitative phase, the strategies were classified into two categories: Developing software factors (3 subcategories) and upgrading and developing hardware factors (2 subcategories). Conclusions: According to the current study, a creative class will provide an appropriate environment for fostering creativity in students. Therefore, the use of appropriate instructional designs and motivational models that are compatible with the educational environment can be a suitable strategy.
{"title":"The Status of Creative Teaching in Medical Classes and Solutions for its Promotion","authors":"Zohreh Sohrabi, Atefeh Zabihi Zazoly, Ghobad Ramezani, Azam Norouzi, Mohammad Hasan Keshavarzi, Ghadir Pourbairamian, Leila Neisani Samani, Shahrzad Saravani","doi":"10.5812/semj-138760","DOIUrl":"https://doi.org/10.5812/semj-138760","url":null,"abstract":"Background: Nowadays, creativity is emphasized in different aspects of teaching and learning. Different educational conditions, such as coronavirus disease 2019 (COVID-19), have directed attention to this issue. Objectives: The current study was an attempt to investigate creative teaching behaviors in medical classrooms and propose solutions for its promotion. Methods: This mixed-method study was conducted at the Iran University of Medical Sciences, Tehran, Iran (2020 - 2021). It was conducted in two phases, including quantitative (to determine the status quo) and qualitative (to provide solutions for its promotion). In the quantitative phase, 168 students were selected by simple random sampling. The data collection instrument was a standard creative teaching questionnaire. The qualitative phase included semi-structured interviews. The data were analyzed using qualitative content analysis and parametric tests. Results: The mean scores of creative teachings in higher-grade classes were significantly higher (P = 0.001). The highest mean score was reported for the fourth year (204.6 ± 0.58). The fourth-year students also had the highest mean scores in each component compared to other years. Except for the freedom component, the highest score was related to the third-year students (21.42 ± 0.89). In the qualitative phase, the strategies were classified into two categories: Developing software factors (3 subcategories) and upgrading and developing hardware factors (2 subcategories). Conclusions: According to the current study, a creative class will provide an appropriate environment for fostering creativity in students. Therefore, the use of appropriate instructional designs and motivational models that are compatible with the educational environment can be a suitable strategy.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135388060","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}
Mansoureh Alipour-Anbarani, Mohtasham Ghaffari, Ali Montazeri, Amir Kavousi, ali ramezankhani
Background: Despite many studies on children’s physical literacy, less attention has been paid to adolescents’ physical literacy. Objectives: The objective of this study was to develop and assess the psychometric features of a questionnaire for measuring physical literacy in 16 - 18-year-old Iranian adolescents. Methods: This study was conducted in Tehran and employed a two-step mixed method. In the first part, the concept of adolescents’ physical literacy was identified using a content analysis approach. At this stage, 15 specialists and eleven 16 - 18-year-old adolescents were selected by the convenient sampling method. Data were collected through semi-structured interviews. In the Second part of the study, in order to describe the psychometric properties of the tool, its validity, reliability (internal consistency and test-retest), and factor analysis were assessed. Results: In the first stage, the analysis of the data obtained from the interviews emerged a definition for the concept of adolescents’ physical literacy as a set of skills to acquire, comprehend, and assess information and self-care skills to make the right decision and promote physical activities. In the second step, according to the qualitative analysis of the opinions of specialists and adolescents, as well as the review of the existing literature, the initial questionnaire was developed consisting of 62 questions in the dimension of physical literacy, which was subsequently abridged to 40 questions as some questions were omitted due to conceptual similarities. After the content was validated and the recommended corrections were made, the tool’s questions were further reduced to 34 items. In exploratory factor analysis, these 34 items were loaded into 5 factors, which, in total, represented 61.60% of the observed changes. However, based on the research team’s decision, the items of Factor 5 were transferred to Factor 2 due to conceptual similarities. Finally, a 34-item questionnaire with 4 factors was developed. The reliability of the tool was approved by α = 0.93, and the test-retest method with two-week intervals indicated appropriate reliability for the questionnaire (ICC = 0.97). Conclusions: The adolescents’ physical literacy questionnaire with 34 items and 4 dimensions was approved as a valid and reliable tool to measure adolescents’ physical literacy.
{"title":"Development and Psychometric of a Physical Literacy Questionnaire for Young Adolescents (16 - 18 Years of Age): A Mixed-Method Study","authors":"Mansoureh Alipour-Anbarani, Mohtasham Ghaffari, Ali Montazeri, Amir Kavousi, ali ramezankhani","doi":"10.5812/semj-138738","DOIUrl":"https://doi.org/10.5812/semj-138738","url":null,"abstract":"Background: Despite many studies on children’s physical literacy, less attention has been paid to adolescents’ physical literacy. Objectives: The objective of this study was to develop and assess the psychometric features of a questionnaire for measuring physical literacy in 16 - 18-year-old Iranian adolescents. Methods: This study was conducted in Tehran and employed a two-step mixed method. In the first part, the concept of adolescents’ physical literacy was identified using a content analysis approach. At this stage, 15 specialists and eleven 16 - 18-year-old adolescents were selected by the convenient sampling method. Data were collected through semi-structured interviews. In the Second part of the study, in order to describe the psychometric properties of the tool, its validity, reliability (internal consistency and test-retest), and factor analysis were assessed. Results: In the first stage, the analysis of the data obtained from the interviews emerged a definition for the concept of adolescents’ physical literacy as a set of skills to acquire, comprehend, and assess information and self-care skills to make the right decision and promote physical activities. In the second step, according to the qualitative analysis of the opinions of specialists and adolescents, as well as the review of the existing literature, the initial questionnaire was developed consisting of 62 questions in the dimension of physical literacy, which was subsequently abridged to 40 questions as some questions were omitted due to conceptual similarities. After the content was validated and the recommended corrections were made, the tool’s questions were further reduced to 34 items. In exploratory factor analysis, these 34 items were loaded into 5 factors, which, in total, represented 61.60% of the observed changes. However, based on the research team’s decision, the items of Factor 5 were transferred to Factor 2 due to conceptual similarities. Finally, a 34-item questionnaire with 4 factors was developed. The reliability of the tool was approved by α = 0.93, and the test-retest method with two-week intervals indicated appropriate reliability for the questionnaire (ICC = 0.97). Conclusions: The adolescents’ physical literacy questionnaire with 34 items and 4 dimensions was approved as a valid and reliable tool to measure adolescents’ physical literacy.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135537119","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}
Background: Early graft loss (EGL) is one of the rare complications of kidney transplantation. Several factors play a role in the occurrence of EGL in kidney transplant recipients, which must be identified and limited. Objectives: This ten-year retrospective study was conducted in a single center on 32 kidney transplant recipients with EGL to determine the reasons for and risk factors of kidney transplant rejection in Iran. Methods: This descriptive-analytical study’s population included 605 kidney transplant recipients receiving kidneys during the last ten years in our center. The diagnosis of EGL was based on renal allograft biopsy examination and primary clinical complications, including a rapid increase in serum creatinine. The age, gender, blood group, and rhesus (Rh) of both donors and recipients, as well as the kinship between the donor and recipient (relative and non-relative), right/left-sided living donor/recipient kidneys, primary kidney disease, the presence of underlying disease in the recipient, dialysis duration, the year of kidney transplantation, transplant survival time, patient survival time, and complications (surgery and others) were gathered. The data were analyzed using SPSS version 18. Results: In this study, 32 out of 605 kidney transplant recipients (5.28%) experienced EGL (53.1% male and 46.9% female, average age of 41.12 years). The duration of kidney function after transplantation was 5.56 ± 0.13 days. The transplanted kidneys were functional between 72 hours and one week after transplantation in 34.4% of the patients. The causes of EGL were found to be tissue rejection in 31.3% of the patients and vascular thrombosis and hyperacute rejection in 21.8%. Nephrectomy occurred in 41% of the patients, and 43.75% died because of a heart attack. Conclusions: Our findings supported previous studies' results, suggesting that EGL is associated with receiving an incompatible kidney transplant and surgery-related complications, including bleeding and thrombosis.
{"title":"Risk Factors and Causality of Early Graft Loss in Kidney Transplanted Patients in Northwestern Iran: A 10-Year Retrospective Study","authors":"Mohsen Mohammad Rahimi, Mahdi Hemmati, Afshar Zomorrodi, Reza Mosaddeghi-Heris, Behzad Lotfi","doi":"10.5812/semj-138566","DOIUrl":"https://doi.org/10.5812/semj-138566","url":null,"abstract":"Background: Early graft loss (EGL) is one of the rare complications of kidney transplantation. Several factors play a role in the occurrence of EGL in kidney transplant recipients, which must be identified and limited. Objectives: This ten-year retrospective study was conducted in a single center on 32 kidney transplant recipients with EGL to determine the reasons for and risk factors of kidney transplant rejection in Iran. Methods: This descriptive-analytical study’s population included 605 kidney transplant recipients receiving kidneys during the last ten years in our center. The diagnosis of EGL was based on renal allograft biopsy examination and primary clinical complications, including a rapid increase in serum creatinine. The age, gender, blood group, and rhesus (Rh) of both donors and recipients, as well as the kinship between the donor and recipient (relative and non-relative), right/left-sided living donor/recipient kidneys, primary kidney disease, the presence of underlying disease in the recipient, dialysis duration, the year of kidney transplantation, transplant survival time, patient survival time, and complications (surgery and others) were gathered. The data were analyzed using SPSS version 18. Results: In this study, 32 out of 605 kidney transplant recipients (5.28%) experienced EGL (53.1% male and 46.9% female, average age of 41.12 years). The duration of kidney function after transplantation was 5.56 ± 0.13 days. The transplanted kidneys were functional between 72 hours and one week after transplantation in 34.4% of the patients. The causes of EGL were found to be tissue rejection in 31.3% of the patients and vascular thrombosis and hyperacute rejection in 21.8%. Nephrectomy occurred in 41% of the patients, and 43.75% died because of a heart attack. Conclusions: Our findings supported previous studies' results, suggesting that EGL is associated with receiving an incompatible kidney transplant and surgery-related complications, including bleeding and thrombosis.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135816004","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}
Background: The neutrophil-to-lymphocyte ratio (NLR) is an inflammation biomarker in patients with liver cirrhosis. While increased NLR is linked to poor clinical outcomes and mortality in diseases like cancers, its association with cirrhosis complications has been sparsely examined. Objectives: This study aimed to evaluate the association between NLR and cirrhosis complications in patients with compensated liver cirrhosis. Methods: This retrospective cohort study was conducted on 256 patients with compensated liver cirrhosis visiting the Gastroenterology Clinic of Imam Khomeini Hospital, Ahvaz, Iran, in 2020. The peripheral blood lymphocyte and neutrophil counts were evaluated, and the NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Cirrhosis complications were assessed based on clinical and laboratory evaluation during 1 year of follow-up. Results: During the retrospective follow-up period, 59 patients (23.05%) experienced cirrhosis complications such as spontaneous bacterial peritonitis (n = 23), gastrointestinal bleeding (n = 22), and hepatic encephalopathy (n = 14). The baseline NLR, Model for End-Stage Liver Disease (MELD) score and Child-Pugh score were significantly higher in patients who later developed complications than in those who did not (P < 0.0001). The NLR with an optimal cut-off of > 1.95 had a sensitivity of 84.75% and specificity of 93.91% in predicting complications during the 1-year follow-up (AUC = 0.905, P < 0.0001). Conclusions: Our results indicated that the NLR is a simple, non-invasive, and cost-effective marker for predicting short-term complications in patients with compensated liver cirrhosis.
{"title":"The Association Between Peripheral Blood Neutrophil-to-Lymphocyte Ratio and Cirrhosis Complications in Adults with Compensated Liver Cirrhosis in Ahvaz, Iran","authors":"Seyed Jalal Hashemi, Mohsen Shokrian Tosi, Eskandar Hajiani, Abazar Parsi, Pezhman Alavinejad","doi":"10.5812/semj-138859","DOIUrl":"https://doi.org/10.5812/semj-138859","url":null,"abstract":"Background: The neutrophil-to-lymphocyte ratio (NLR) is an inflammation biomarker in patients with liver cirrhosis. While increased NLR is linked to poor clinical outcomes and mortality in diseases like cancers, its association with cirrhosis complications has been sparsely examined. Objectives: This study aimed to evaluate the association between NLR and cirrhosis complications in patients with compensated liver cirrhosis. Methods: This retrospective cohort study was conducted on 256 patients with compensated liver cirrhosis visiting the Gastroenterology Clinic of Imam Khomeini Hospital, Ahvaz, Iran, in 2020. The peripheral blood lymphocyte and neutrophil counts were evaluated, and the NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. Cirrhosis complications were assessed based on clinical and laboratory evaluation during 1 year of follow-up. Results: During the retrospective follow-up period, 59 patients (23.05%) experienced cirrhosis complications such as spontaneous bacterial peritonitis (n = 23), gastrointestinal bleeding (n = 22), and hepatic encephalopathy (n = 14). The baseline NLR, Model for End-Stage Liver Disease (MELD) score and Child-Pugh score were significantly higher in patients who later developed complications than in those who did not (P < 0.0001). The NLR with an optimal cut-off of > 1.95 had a sensitivity of 84.75% and specificity of 93.91% in predicting complications during the 1-year follow-up (AUC = 0.905, P < 0.0001). Conclusions: Our results indicated that the NLR is a simple, non-invasive, and cost-effective marker for predicting short-term complications in patients with compensated liver cirrhosis.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135925333","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}
Ahmad Dadmehrnia, Seyed Ali Akbar Faghihi, Hamid Reza Koohestani, Ghadir Pourbairamian, Mohammad Hasan Keshavarzi
Background: The identification of the strengths and weaknesses of pre-hospital emergency technicians, as the first providers of treatment services to critically ill patients, is of utmost importance. Objectives: This study was conducted to explain the challenges faced by emergency medical technicians in Shiraz, Iran, within 2021 - 2022. Methods: The present study was a qualitative study that was conducted using the traditional qualitative content analysis (Graneheim and Lundman, 2004). Sampling in this study was purposeful. A semi-structured interview was conducted with 17 emergency technicians in Shiraz. Lincoln and Guba’s standards were used to validate the data. Results: This study identified 3 categories and 12 subcategories. These three categories include management challenges, professional problems, and cultural barriers. Subcategories were “insufficient emergency medical services (EMS) stations”, “lack of human resources”, “role ambiguity”, “lack of organizational support”, lack of job prestige”, “high job stress”, “crowded missions”, “lack of psychotherapy and counseling”, “high-risk profession, “public’s false perception of EMS job”, “abuse of emergency call center services”, and “disrespectful behavior”. Conclusions: Considering that the provision of EMS is an inherently stressful and highly anxious job, some measures can be taken to reduce the mental effects of such pressure on the technicians. In addition, they should run public awareness campaigns to improve the cultural level of society to better understand the duties and activities of EMS workers at the community level.
背景:院前急救技术人员作为危重病人治疗服务的第一提供者，其优势和劣势的识别是至关重要的。目的:本研究旨在解释2021 - 2022年伊朗设拉子地区急诊医疗技术人员面临的挑战。方法:本研究采用传统的定性内容分析方法进行定性研究(Graneheim and Lundman, 2004)。本研究的抽样是有目的的。在设拉子对17名应急技术人员进行了半结构化访谈。使用Lincoln和Guba的标准来验证数据。结果:本研究确定了3个分类和12个亚分类。这三个类别包括管理挑战、专业问题和文化障碍。子类别为"紧急医疗服务(EMS)站不足"、"缺乏人力资源"、"角色模糊"、"缺乏组织支持"、"缺乏工作声望"、"工作压力大"、"任务拥挤"、"缺乏心理治疗和咨询"、"高风险职业"、"公众对EMS工作的错误认识"、"滥用紧急呼叫中心服务"和"不尊重行为"。结论:EMS的提供是一项固有的压力和高度焦虑的工作，可以采取一些措施来减少这种压力对技术人员的心理影响。此外，他们应该开展公众意识运动，以提高社会的文化水平，以便更好地了解急救人员在社区一级的职责和活动。
{"title":"An Elucidation on the Challenges of Pre-hospital Emergency Technicians: A Study on Emergency Medical Technicians in Shiraz, Iran","authors":"Ahmad Dadmehrnia, Seyed Ali Akbar Faghihi, Hamid Reza Koohestani, Ghadir Pourbairamian, Mohammad Hasan Keshavarzi","doi":"10.5812/semj-137606","DOIUrl":"https://doi.org/10.5812/semj-137606","url":null,"abstract":"Background: The identification of the strengths and weaknesses of pre-hospital emergency technicians, as the first providers of treatment services to critically ill patients, is of utmost importance. Objectives: This study was conducted to explain the challenges faced by emergency medical technicians in Shiraz, Iran, within 2021 - 2022. Methods: The present study was a qualitative study that was conducted using the traditional qualitative content analysis (Graneheim and Lundman, 2004). Sampling in this study was purposeful. A semi-structured interview was conducted with 17 emergency technicians in Shiraz. Lincoln and Guba’s standards were used to validate the data. Results: This study identified 3 categories and 12 subcategories. These three categories include management challenges, professional problems, and cultural barriers. Subcategories were “insufficient emergency medical services (EMS) stations”, “lack of human resources”, “role ambiguity”, “lack of organizational support”, lack of job prestige”, “high job stress”, “crowded missions”, “lack of psychotherapy and counseling”, “high-risk profession, “public’s false perception of EMS job”, “abuse of emergency call center services”, and “disrespectful behavior”. Conclusions: Considering that the provision of EMS is an inherently stressful and highly anxious job, some measures can be taken to reduce the mental effects of such pressure on the technicians. In addition, they should run public awareness campaigns to improve the cultural level of society to better understand the duties and activities of EMS workers at the community level.","PeriodicalId":39157,"journal":{"name":"Shiraz E Medical Journal","volume":"118 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966025","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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