K. Kaur, Vishal Mangal, D. Paul, Kapil S. Kulkarni
Oral cancer is among the top three cancers in India. Surgery is the recommended treatment option for early-stage and locally advanced resectable cases. The incidence of perioperative stroke in patients undergoing neck dissection for head and neck cancer is only 0.2%. In the following article, we report the first case of perioperative malignant infarct in a patient undergoing mandibular reconstruction with free fibula flap surgery for oral cancer. An eighty-year-old male diagnosed with locally advanced carcinoma of the oral cavity underwent mandibular reconstruction with free fibula flap surgery. In the perioperative period, he developed malignant infarction involving the right middle and posterior cerebral artery in the immediate postoperative period, however, it was diagnosed after 36 hours of surgery. He was managed conservatively and discharged with a favorable outcome. This case highlights the importance of clinical examination in such a case, along with the difficulties faced in examining the patient in the perioperative period.
{"title":"Perioperative Malignant Infarct in a Patient undergoing Mandibular Reconstruction with Free Fibular Flap Surgery for Oral Cancer: A Case Report","authors":"K. Kaur, Vishal Mangal, D. Paul, Kapil S. Kulkarni","doi":"10.4038/SLJA.V29I1.8611","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8611","url":null,"abstract":"Oral cancer is among the top three cancers in India. Surgery is the recommended treatment option for early-stage and locally advanced resectable cases. The incidence of perioperative stroke in patients undergoing neck dissection for head and neck cancer is only 0.2%. In the following article, we report the first case of perioperative malignant infarct in a patient undergoing mandibular reconstruction with free fibula flap surgery for oral cancer. An eighty-year-old male diagnosed with locally advanced carcinoma of the oral cavity underwent mandibular reconstruction with free fibula flap surgery. In the perioperative period, he developed malignant infarction involving the right middle and posterior cerebral artery in the immediate postoperative period, however, it was diagnosed after 36 hours of surgery. He was managed conservatively and discharged with a favorable outcome. This case highlights the importance of clinical examination in such a case, along with the difficulties faced in examining the patient in the perioperative period.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"29 1","pages":"45"},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41465397","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}
In a recent article in this journal Saad et al described the combined use of interscalene and supraclavicular brachial plexus block for brachioaxillary graft in patients with chronic renal failure. The article included a figure showing the ultrasonic appearance seen during supraclavicular brachial plexus block (Figure 1A). I wish to draw attention to the incorrect labelling of the pleura in that image. The pleura is an important structure to identify and avoid with the needle when performing a supraclavicular block and a clear understanding of the relevant ultrasound anatomy is vital.
{"title":"The Importance of Correctly Labelling Ultrasound Images","authors":"D. L. Hamilton","doi":"10.4038/SLJA.V29I1.8657","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8657","url":null,"abstract":"In a recent article in this journal Saad et al described the combined use of interscalene and supraclavicular brachial plexus block for brachioaxillary graft in patients with chronic renal failure. The article included a figure showing the ultrasonic appearance seen during supraclavicular brachial plexus block (Figure 1A). I wish to draw attention to the incorrect labelling of the pleura in that image. The pleura is an important structure to identify and avoid with the needle when performing a supraclavicular block and a clear understanding of the relevant ultrasound anatomy is vital.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"29 1","pages":"79"},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47938939","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}
S. Nanayakkara, I. Nanayakkara, P. Wijekoon, Yamuna R. Athukorala, P. Nakandala, Sithara Rathnayake
Background Post-operative pain relief in cleft surgery should be efficient and effective. The Face, Leg, Activity, Cry and Consolability (FLACC) scale is a validated tool for post-operative pain assessment in patients who cannot express themselves verbally. The objective of this study was to assess the effectiveness of the analgesic protocol practiced at the Dental Hospital Peradeniya, using FLACC scale during the first 24 hours following cleft surgery. Methods and material Sample included 193 patients who underwent primary repair of cleft lip and palate. They were given paracetamol two hours before surgery and 0.1mg/kg intravenous morphine during surgery. Infra-orbital nerve blocks for cleft lip surgeries, greater palatine nerve blocks for cleft palate surgeries and rectal diclofenac suppository (1.5 mg/kg) if above six months of age were added. The surgical site was infiltrated with 1% lignocaine in adrenaline. Oral paracetamol was used post-operatively. Cuddling, carrying, lullaby singing and nursing by mother was used as non-pharmacological strategies in the ward. Pain assessment was done at 5 min after recovery from anaesthesia and then at 30 minutes, 1 hour, 1.5 hours, 2 hours, 2.5 hours, 3 hours, 3.5 hours, 4 hours, 5 hours and 6 hours after recovery, and then at 8 am and 12 noon on the day following surgery using the FLACC scale. Results The number of patients with severe to profound pain reduced gradually following recovery, except for a minor resurgence of pain at 2.5 hours. At the end of first 24 hours, 92.7% of patients had no pain according to the FLACC scale while only less than 1% had severe pain. Conclusion The combined protocol of pharmacological and non-pharmacological strategies used at the Cleft Centre was highly effective for relief of post-operative pain in cleft surgeries.
{"title":"Efficiency of Post-Operative Pain Management in Infants undergoing Cleft Lip and Plate Repairs: A Study using the FLACC Scale","authors":"S. Nanayakkara, I. Nanayakkara, P. Wijekoon, Yamuna R. Athukorala, P. Nakandala, Sithara Rathnayake","doi":"10.4038/SLJA.V29I1.8646","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8646","url":null,"abstract":"Background Post-operative pain relief in cleft surgery should be efficient and effective. The Face, Leg, Activity, Cry and Consolability (FLACC) scale is a validated tool for post-operative pain assessment in patients who cannot express themselves verbally. The objective of this study was to assess the effectiveness of the analgesic protocol practiced at the Dental Hospital Peradeniya, using FLACC scale during the first 24 hours following cleft surgery. Methods and material Sample included 193 patients who underwent primary repair of cleft lip and palate. They were given paracetamol two hours before surgery and 0.1mg/kg intravenous morphine during surgery. Infra-orbital nerve blocks for cleft lip surgeries, greater palatine nerve blocks for cleft palate surgeries and rectal diclofenac suppository (1.5 mg/kg) if above six months of age were added. The surgical site was infiltrated with 1% lignocaine in adrenaline. Oral paracetamol was used post-operatively. Cuddling, carrying, lullaby singing and nursing by mother was used as non-pharmacological strategies in the ward. Pain assessment was done at 5 min after recovery from anaesthesia and then at 30 minutes, 1 hour, 1.5 hours, 2 hours, 2.5 hours, 3 hours, 3.5 hours, 4 hours, 5 hours and 6 hours after recovery, and then at 8 am and 12 noon on the day following surgery using the FLACC scale. Results The number of patients with severe to profound pain reduced gradually following recovery, except for a minor resurgence of pain at 2.5 hours. At the end of first 24 hours, 92.7% of patients had no pain according to the FLACC scale while only less than 1% had severe pain. Conclusion The combined protocol of pharmacological and non-pharmacological strategies used at the Cleft Centre was highly effective for relief of post-operative pain in cleft surgeries.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"29 1","pages":"24"},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45242748","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 The protective ocular mechanisms are disrupted due to sedation and neuromuscular relaxants. This increases the risk of developing ocular surface disease (OSD) leading to increased post critical care morbidity. The risks are further increased in patients who are nursed prone as access to eyes is limited. Our aim was to determine whether eye care met the standard of the Ophthalmic Services Guidance and to improve the quality of care provided if found to be deficient. Methodology and Results A prospective audit of the eye care provided to ventilated patients in critical care was done in April, 2020. An ophthalmological examination including fluoresce in staining was done to ascertain the prevalence of ocular morbidity present. Twenty-seven patients met the inclusion criteria and 88% patients were ventilated secondary to COVID-19 pneumonia. 35% of them were nursed prone at time of assessment; 81% had lagophthalmos (incomplete eye closure) while 53% of patients had a variant of OSD, including 23% with swollen conjunctival prolapse, 18% with conjunctivitis and 12% with corneal abrasions. None of the patients with lagophthalmos had received eye lubricants. Of the proned patients 50% had their eyes taped closed but only 33% had eye lubrication applied. We introduced local best practice guidance adapted from the Ophthalmic Services guidance. Education of critical care staff was undertaken and simplified guidance was exhibited in clinical areas. Post-intervention audit was carried out against the standard after a one-month interval and 24 patients were included (80% COVID-19 pneumonia); 67% had eye lubrication and 50% had eyes taped as per guidance in supine position. 100% of proned patients had eye lubricants with micropore taping. Conclusion During the COVID-19 pandemic, staffs were recruited from diverse backgrounds including theatre scrub nurses, recovery practitioners and operation department practitioners, to work alongside critical care nurses caring for ventilated patients. Education on the best ophthalmic practice guidance enabled holistic care to be provided to many ventilated patients by staff with limited prior experience in eye care in critical care.
{"title":"Audit of Eye Care for Ventilated Patients in Intensive Treatment Unit During COVID-19 Pandemic","authors":"Muditha Dhanapala, S. Sabaretnam","doi":"10.4038/SLJA.V29I1.8755","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8755","url":null,"abstract":"Introduction The protective ocular mechanisms are disrupted due to sedation and neuromuscular relaxants. This increases the risk of developing ocular surface disease (OSD) leading to increased post critical care morbidity. The risks are further increased in patients who are nursed prone as access to eyes is limited. Our aim was to determine whether eye care met the standard of the Ophthalmic Services Guidance and to improve the quality of care provided if found to be deficient. Methodology and Results A prospective audit of the eye care provided to ventilated patients in critical care was done in April, 2020. An ophthalmological examination including fluoresce in staining was done to ascertain the prevalence of ocular morbidity present. Twenty-seven patients met the inclusion criteria and 88% patients were ventilated secondary to COVID-19 pneumonia. 35% of them were nursed prone at time of assessment; 81% had lagophthalmos (incomplete eye closure) while 53% of patients had a variant of OSD, including 23% with swollen conjunctival prolapse, 18% with conjunctivitis and 12% with corneal abrasions. None of the patients with lagophthalmos had received eye lubricants. Of the proned patients 50% had their eyes taped closed but only 33% had eye lubrication applied. We introduced local best practice guidance adapted from the Ophthalmic Services guidance. Education of critical care staff was undertaken and simplified guidance was exhibited in clinical areas. Post-intervention audit was carried out against the standard after a one-month interval and 24 patients were included (80% COVID-19 pneumonia); 67% had eye lubrication and 50% had eyes taped as per guidance in supine position. 100% of proned patients had eye lubricants with micropore taping. Conclusion During the COVID-19 pandemic, staffs were recruited from diverse backgrounds including theatre scrub nurses, recovery practitioners and operation department practitioners, to work alongside critical care nurses caring for ventilated patients. Education on the best ophthalmic practice guidance enabled holistic care to be provided to many ventilated patients by staff with limited prior experience in eye care in critical care.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"29 1","pages":"34"},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45885759","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}
B.M Munasinghe, N. Subramaniam, N. Srisothinathan, B. Ranatunga, Kasun Ranaweera, C. Rathuwithana, A. Appuhamy
Goldenhar Syndrome is a rare congenital entity which comprises of facial dysmorphism, oral cavity malformations and vertebral anomalies any of which could lead to difficult airway during anaesthesia. Here, we report a case of a 5-month-old infant who underwent a congenital talipes equino varies (CTEV) correction under general anaesthesia with caudal block. We experienced difficulty in mask ventilation, failed endotracheal intubation and transient desaturation which was anticipated thus managed successfully without serious morbidity to the patient.
{"title":"Difficult airway management in a child with Goldenhar Syndrome- A case report","authors":"B.M Munasinghe, N. Subramaniam, N. Srisothinathan, B. Ranatunga, Kasun Ranaweera, C. Rathuwithana, A. Appuhamy","doi":"10.4038/SLJA.V29I1.8648","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8648","url":null,"abstract":"Goldenhar Syndrome is a rare congenital entity which comprises of facial dysmorphism, oral cavity malformations and vertebral anomalies any of which could lead to difficult airway during anaesthesia. Here, we report a case of a 5-month-old infant who underwent a congenital talipes equino varies (CTEV) correction under general anaesthesia with caudal block. We experienced difficulty in mask ventilation, failed endotracheal intubation and transient desaturation which was anticipated thus managed successfully without serious morbidity to the patient.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46278489","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}
B. Gupta, Mohit Kumar, Talawar Praveen, Lucy Ittoop Amanta
Whilst a double lumen tube (DLT) is the gold standard for one lung ventilation, its double curvatures and increased diameter can make intubation difficult, potentially compounded by a challenging airway. We describe the successful placement of DLT in a difficult airway, and confirmation of the appropriate placement of DLT by using flexible paediatric video-ureteroscope (digital Olympus URF-V2/V2R), without which the purpose of achieving lung isolation was not possible.
{"title":"Novel Use of Flexible Paediatric Video-Ureteroscope to Confirm Double Lumen Tube Placement as an Alternative to the Conventional Bronchoscope","authors":"B. Gupta, Mohit Kumar, Talawar Praveen, Lucy Ittoop Amanta","doi":"10.4038/SLJA.V29I1.8642","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8642","url":null,"abstract":"Whilst a double lumen tube (DLT) is the gold standard for one lung ventilation, its double curvatures and increased diameter can make intubation difficult, potentially compounded by a challenging airway. We describe the successful placement of DLT in a difficult airway, and confirmation of the appropriate placement of DLT by using flexible paediatric video-ureteroscope (digital Olympus URF-V2/V2R), without which the purpose of achieving lung isolation was not possible.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"29 1","pages":"52"},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43447504","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 ongoing COVID-19 pandemic has thrown a dual challenge before health care workers to treat patients and as well protect themselves. The aerosol generating procedures (AGPs) such as nebulization, bag and mask ventilation, endotracheal intubation carries a maximum risk of viral spread. Most of the above procedures are performed by anaesthesiologists, hence they are recommended to wear highest level of protection.
{"title":"COVID - 19 Intubation Box: Is it the New Normal???","authors":"Chashamjot Bawa, R. Sarna, Rajeev Chauhan","doi":"10.4038/SLJA.V29I1.8682","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8682","url":null,"abstract":"The ongoing COVID-19 pandemic has thrown a dual challenge before health care workers to treat patients and as well protect themselves. The aerosol generating procedures (AGPs) such as nebulization, bag and mask ventilation, endotracheal intubation carries a maximum risk of viral spread. Most of the above procedures are performed by anaesthesiologists, hence they are recommended to wear highest level of protection.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"29 1","pages":"80"},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70153982","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}
{"title":"Transportation Pods for Transport of COVID - 19 Patients","authors":"S. Vijayaraghavan, N. Puthenveettil","doi":"10.4038/SLJA.V29I1.8620","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8620","url":null,"abstract":"","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"29 1","pages":"75"},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44222269","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 Delayed discharges and transfers from PACU result in congestion and bottleneck at various stages along perioperative care. We did this retrospective cross-sectional study to evaluate the incidence and risk factors for prolonged length of stay (LOS) in PACU. This study was conducted at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. Materials and methods We included patients who stayed postoperatively in PACU for more than 2 hours. We collected the data of patients having surgical procedures in main operation room from April 2019 to February 2020. We collected preoperative, operative and postoperative variables of all included patients. The reasons for prolonged LOS in PACU were recorded as documented in patient notes. Results There was a total of 206 prolonged stays in PACU of our hospital. Perioperative cardiovascular and respiratory adverse events accounted for most of cases of prolonged PACU stays followed by surgical reasons like bleeding and extended surgery. Conclusion The main reasons for prolonged stay in PACU were cardiovascular and respiratory adverse events in perioperative period.
{"title":"Evaluation of Risk Factors for Prolonged Stay in Post Anaesthesia Care Unit (PACU) in a Tertiary Care Hospital of Saudia Arabia","authors":"A. Huda, Nasrullah Sheikh","doi":"10.4038/SLJA.V29I1.8631","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8631","url":null,"abstract":"Background Delayed discharges and transfers from PACU result in congestion and bottleneck at various stages along perioperative care. We did this retrospective cross-sectional study to evaluate the incidence and risk factors for prolonged length of stay (LOS) in PACU. This study was conducted at Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia. Materials and methods We included patients who stayed postoperatively in PACU for more than 2 hours. We collected the data of patients having surgical procedures in main operation room from April 2019 to February 2020. We collected preoperative, operative and postoperative variables of all included patients. The reasons for prolonged LOS in PACU were recorded as documented in patient notes. Results There was a total of 206 prolonged stays in PACU of our hospital. Perioperative cardiovascular and respiratory adverse events accounted for most of cases of prolonged PACU stays followed by surgical reasons like bleeding and extended surgery. Conclusion The main reasons for prolonged stay in PACU were cardiovascular and respiratory adverse events in perioperative period.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":" ","pages":""},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46933248","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}
Antrochoanal polyps (ACP) are benign lesions that arise from the mucosa of the maxillary sinus. Large antrochoanal polyps may extend in to the nasopharynx and beyond hyoid bone and reach almost up to the epiglottis. We present our experience of airway management for FESS in an 11-year child with a giant atypical antrochoanal polyp extending in to the oral cavity.
{"title":"Giant Antrochoanal Polyp: Anaesthetic Considerations","authors":"R. Surana, A. Bharadwaj","doi":"10.4038/SLJA.V29I1.8654","DOIUrl":"https://doi.org/10.4038/SLJA.V29I1.8654","url":null,"abstract":"Antrochoanal polyps (ACP) are benign lesions that arise from the mucosa of the maxillary sinus. Large antrochoanal polyps may extend in to the nasopharynx and beyond hyoid bone and reach almost up to the epiglottis. We present our experience of airway management for FESS in an 11-year child with a giant atypical antrochoanal polyp extending in to the oral cavity.","PeriodicalId":41531,"journal":{"name":"Sri Lankan Journal of Anaesthesiology","volume":"29 1","pages":"64"},"PeriodicalIF":0.2,"publicationDate":"2021-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45188416","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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