Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.008
Katherine Maguire, Tom Y. Pettigrew
In contrast to adult practice, the majority of paediatric eye surgery is performed under general anaesthesia. Most patients presenting on a paediatric ophthalmology operating list will be otherwise healthy children who are suitable for day surgery. However, some children may present with eye pathology as part of a congenital disorder. The perioperative plan should be formulated after assessment of the child’s behaviour and medical comorbidities, taking into account the surgical conditions required for the intended procedure. Factors influencing intraocular pressure (IOP) may require careful manipulation, and anaesthetists should be vigilant of the oculocardiac reflex (OCR). Postoperative nausea and vomiting (PONV) is more common in ocular surgery, particularly following strabismus correction. In most cases, simple analgesics and intraoperative application of topical local anaesthesia are sufficient to provide effective postoperative pain relief.
{"title":"Anaesthesia for eye surgery in paediatrics","authors":"Katherine Maguire, Tom Y. Pettigrew","doi":"10.1016/j.mpaic.2025.07.008","DOIUrl":"10.1016/j.mpaic.2025.07.008","url":null,"abstract":"<div><div>In contrast to adult practice, the majority of paediatric eye surgery is performed under general anaesthesia. Most patients presenting on a paediatric ophthalmology operating list will be otherwise healthy children who are suitable for day surgery. However, some children may present with eye pathology as part of a congenital disorder. The perioperative plan should be formulated after assessment of the child’s behaviour and medical comorbidities, taking into account the surgical conditions required for the intended procedure. Factors influencing intraocular pressure (IOP) may require careful manipulation, and anaesthetists should be vigilant of the oculocardiac reflex (OCR). Postoperative nausea and vomiting (PONV) is more common in ocular surgery, particularly following strabismus correction. In most cases, simple analgesics and intraoperative application of topical local anaesthesia are sufficient to provide effective postoperative pain relief.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 585-588"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.012
Richard R. Ribchester, Thomas H. Gillingwater
Understanding the biological processes and mechanisms underlying neuromuscular function in anaesthetized or sedated patients depends on adequate knowledge of the anatomy, physiology, and pathology of the connections between motor neurons and muscle fibres at neuromuscular junctions. Neuromuscular synaptic integrity depends on: maintenance of Ca2+-dependent release of acetylcholine by exocytosis from synaptic vesicles that fuse with active zones in motor nerve terminal membranes; the subsequent depolarizing action of acetylcholine on postsynaptic receptors at motor endplates; and termination of neuromuscular transmission by enzymic action of acetylcholinesterase located in the synaptic basal lamina. Homeostatic mechanisms sustain the magnitude of endplate potentials and the safety factor for neuromuscular transmission; but dysfunction of neuromuscular junctions occurs following administration of neuromuscular blockers or in diseases and other conditions affecting release, action and inactivation of acetylcholine.
{"title":"Neuromuscular function and transmission","authors":"Richard R. Ribchester, Thomas H. Gillingwater","doi":"10.1016/j.mpaic.2025.07.012","DOIUrl":"10.1016/j.mpaic.2025.07.012","url":null,"abstract":"<div><div>Understanding the biological processes and mechanisms underlying neuromuscular function in anaesthetized or sedated patients depends on adequate knowledge of the anatomy, physiology, and pathology of the connections between motor neurons and muscle fibres at neuromuscular junctions. Neuromuscular synaptic integrity depends on: maintenance of Ca<sup>2+</sup>-dependent release of acetylcholine by exocytosis from synaptic vesicles that fuse with active zones in motor nerve terminal membranes; the subsequent depolarizing action of acetylcholine on postsynaptic receptors at motor endplates; and termination of neuromuscular transmission by enzymic action of acetylcholinesterase located in the synaptic basal lamina. Homeostatic mechanisms sustain the magnitude of endplate potentials and the safety factor for neuromuscular transmission; but dysfunction of neuromuscular junctions occurs following administration of neuromuscular blockers or in diseases and other conditions affecting release, action and inactivation of acetylcholine.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 605-615"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.010
Jhalini Jawaheer, Emily Robertson
This article describes care of the eye and the clinical signs that may indicate injury to the eye, relevant to the operating theatre and intensive care environments. Risk factors, mechanisms of injury, recognition and management of common and important eye injuries are discussed, as are good practice points and preventative measures pertinent to anaesthetists. Signs of ocular infection, that intensivists should be vigilant for, are highlighted. Ocular injury in the trauma patient, that requires prompt evaluation and management of sight-threatening conditions, is also discussed.
{"title":"Care of the eye in anaesthesia","authors":"Jhalini Jawaheer, Emily Robertson","doi":"10.1016/j.mpaic.2025.07.010","DOIUrl":"10.1016/j.mpaic.2025.07.010","url":null,"abstract":"<div><div>This article describes care of the eye and the clinical signs that may indicate injury to the eye, relevant to the operating theatre and intensive care environments. Risk factors, mechanisms of injury, recognition and management of common and important eye injuries are discussed, as are good practice points and preventative measures pertinent to anaesthetists. Signs of ocular infection, that intensivists should be vigilant for, are highlighted. Ocular injury in the trauma patient, that requires prompt evaluation and management of sight-threatening conditions, is also discussed.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 593-598"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.013
Jonathan E Dickerson
The digital age commenced in the mid-20th century and since we have seen approximately exponential growth in information. This period has also seen the rapid growth of computer technology that has facilitated, for instance, the derivation of whole genomes and automated drug discovery. Data, information, knowledge and wisdom lay the foundations for understanding how experience is formed from evidence and observations. When data are put into context, the resultant information can drive growth and further contribute to increased knowledge. Appreciating the source of data enables us to recognize and hopefully correct for inherent error and bias. Ultimately knowledge discovery can be automated to gain information from data and so on, enhancing our understanding of a given subject and expanding collective wisdom.
{"title":"Data, information, knowledge, wisdom, and understanding","authors":"Jonathan E Dickerson","doi":"10.1016/j.mpaic.2025.07.013","DOIUrl":"10.1016/j.mpaic.2025.07.013","url":null,"abstract":"<div><div>The digital age commenced in the mid-20th century and since we have seen approximately exponential growth in information. This period has also seen the rapid growth of computer technology that has facilitated, for instance, the derivation of whole genomes and automated drug discovery. Data, information, knowledge and wisdom lay the foundations for understanding how experience is formed from evidence and observations. When data are put into context, the resultant information can drive growth and further contribute to increased knowledge. Appreciating the source of data enables us to recognize and hopefully correct for inherent error and bias. Ultimately knowledge discovery can be automated to gain information from data and so on, enhancing our understanding of a given subject and expanding collective wisdom.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 616-618"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.007
Stuart Young, Aravind Basavaraju
The majority of ophthalmic surgeries are performed as day cases under topical or regional anaesthesia with or without intravenous sedation. However, general anaesthesia is necessary in certain circumstances e.g. local anaesthetic allergy or patients who are unable to cooperate or to lie flat or still. Patients for ophthalmic surgery are frequently elderly with multiple comorbidities, such as diabetes and hypertension. Patients with rare genetic syndromes may present for eye surgery. Therefore adequate preoperative evaluation and preparation will minimize perioperative complications. The goals of general anaesthesia are smooth induction and emergence, with stable intra-ocular pressure (IOP) and akinesia of the globe. These can be achieved with a combination of intravenous and inhalational agents with or without muscle relaxants and opiates. Use of the laryngeal mask airway has the advantage of causing a smaller rise in IOP on insertion and less coughing on emergence. Total intravenous anaesthesia with propofol and remifentanil has the advantages of causing less postoperative nausea and vomiting (PONV), reduced stress response to airway intervention, rapid recovery and smooth emergence. Some eye procedures require special consideration, for example, strabismus and vitreoretinal surgery involves traction of the rectus muscles producing a higher incidence of oculocardiac reflex and PONV. Most ophthalmic surgery produces mild to moderate pain amenable to non-opioid analgesics. Intraoperative topical and regional anaesthesia reduce postoperative pain and opiate requirement. Open globe injury and a full stomach present unique challenges to prevent increase in IOP as well as protecting the airway.
{"title":"General anaesthesia for ophthalmic surgery","authors":"Stuart Young, Aravind Basavaraju","doi":"10.1016/j.mpaic.2025.07.007","DOIUrl":"10.1016/j.mpaic.2025.07.007","url":null,"abstract":"<div><div>The majority of ophthalmic surgeries are performed as day cases under topical or regional anaesthesia with or without intravenous sedation. However, general anaesthesia is necessary in certain circumstances e.g. local anaesthetic allergy or patients who are unable to cooperate or to lie flat or still. Patients for ophthalmic surgery are frequently elderly with multiple comorbidities, such as diabetes and hypertension. Patients with rare genetic syndromes may present for eye surgery. Therefore adequate preoperative evaluation and preparation will minimize perioperative complications. The goals of general anaesthesia are smooth induction and emergence, with stable intra-ocular pressure (IOP) and akinesia of the globe. These can be achieved with a combination of intravenous and inhalational agents with or without muscle relaxants and opiates. Use of the laryngeal mask airway has the advantage of causing a smaller rise in IOP on insertion and less coughing on emergence. Total intravenous anaesthesia with propofol and remifentanil has the advantages of causing less postoperative nausea and vomiting (PONV), reduced stress response to airway intervention, rapid recovery and smooth emergence. Some eye procedures require special consideration, for example, strabismus and vitreoretinal surgery involves traction of the rectus muscles producing a higher incidence of oculocardiac reflex and PONV. Most ophthalmic surgery produces mild to moderate pain amenable to non-opioid analgesics. Intraoperative topical and regional anaesthesia reduce postoperative pain and opiate requirement. Open globe injury and a full stomach present unique challenges to prevent increase in IOP as well as protecting the airway.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 580-584"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.014
Jonathan E Dickerson
Patients must trust doctors, their decisions and actions; this confidence extends to how we treat patients’ information. Healthcare information should be accurate and securely stored in a readily accessible format. With the digital revolution it is increasingly simple to do this, but it is important to be mindful of just how easy it is to breach confidentiality. There is extensive legislation governing the use of healthcare information and the Caldicott principles describe good practice. All healthcare professions have a moral, ethical, regulatory and legal duty to be familiar with these and ensure adherence in daily practice.
{"title":"Privacy, confidentiality, and security of healthcare information","authors":"Jonathan E Dickerson","doi":"10.1016/j.mpaic.2025.07.014","DOIUrl":"10.1016/j.mpaic.2025.07.014","url":null,"abstract":"<div><div>Patients must trust doctors, their decisions and actions; this confidence extends to how we treat patients’ information. Healthcare information should be accurate and securely stored in a readily accessible format. With the digital revolution it is increasingly simple to do this, but it is important to be mindful of just how easy it is to breach confidentiality. There is extensive legislation governing the use of healthcare information and the Caldicott principles describe good practice. All healthcare professions have a moral, ethical, regulatory and legal duty to be familiar with these and ensure adherence in daily practice.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 619-622"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.015
Vijayanand Nadella
{"title":"Self-assessment","authors":"Vijayanand Nadella","doi":"10.1016/j.mpaic.2025.07.015","DOIUrl":"10.1016/j.mpaic.2025.07.015","url":null,"abstract":"","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 623-624"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.003
Denis Chung Man Kwong, David Wai Tsan Ng
The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed significant global challenges since 2019. Despite the subsequent emergence of the milder Omicron variant in November 2021, COVID-19 continues to cause significant morbidities and mortality, especially among the elderly and those with medical comorbidities. Its global impact necessitates a comprehensive understanding of its pathophysiology and management, particularly in perioperative settings. This review provides a comprehensive analysis of the pathophysiology and clinical features of acute COVID-19 and long COVID, current evidence-based treatment strategies and perioperative consideration. This review, tailored for anaesthetists and intensivists, emphasizes individualized care and multidisciplinary collaboration to improve outcomes of COVID-19 patients undergoing surgery.
{"title":"Pathophysiology and treatment of COVID and its perioperative management","authors":"Denis Chung Man Kwong, David Wai Tsan Ng","doi":"10.1016/j.mpaic.2025.07.003","DOIUrl":"10.1016/j.mpaic.2025.07.003","url":null,"abstract":"<div><div>The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed significant global challenges since 2019. Despite the subsequent emergence of the milder Omicron variant in November 2021, COVID-19 continues to cause significant morbidities and mortality, especially among the elderly and those with medical comorbidities. Its global impact necessitates a comprehensive understanding of its pathophysiology and management, particularly in perioperative settings. This review provides a comprehensive analysis of the pathophysiology and clinical features of acute COVID-19 and long COVID, current evidence-based treatment strategies and perioperative consideration. This review, tailored for anaesthetists and intensivists, emphasizes individualized care and multidisciplinary collaboration to improve outcomes of COVID-19 patients undergoing surgery.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 548-558"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.004
Chris KH Li, Jane C Ko
Hypersensitivity reactions are rare yet significant perioperative complications. Prompt referral of patients with previous perioperative hypersensitivity to the immunology service aids in the identification of the culprit agent and safe alternatives for future anaesthetics. Both in-vivo and in-vitro tests exist for the evaluation of perioperative hypersensitivity. Serum tryptase sampling is utilized to confirm the diagnosis of perioperative hypersensitivity reactions together with clinical history. Skin testing is the first-line investigation due to its well established profile. In-vitro tests such as specific immunoglobulin E quantification and basophil activation test have the advantage of sparing the patient from re-exposure. Drug provocation tests remain to be the gold standard yet require careful patient selection and closely collaborated anaesthetist–immunologist care in the perioperative setting.
{"title":"Perioperative allergy testing","authors":"Chris KH Li, Jane C Ko","doi":"10.1016/j.mpaic.2025.07.004","DOIUrl":"10.1016/j.mpaic.2025.07.004","url":null,"abstract":"<div><div>Hypersensitivity reactions are rare yet significant perioperative complications. Prompt referral of patients with previous perioperative hypersensitivity to the immunology service aids in the identification of the culprit agent and safe alternatives for future anaesthetics. Both in-vivo and in-vitro tests exist for the evaluation of perioperative hypersensitivity. Serum tryptase sampling is utilized to confirm the diagnosis of perioperative hypersensitivity reactions together with clinical history. Skin testing is the first-line investigation due to its well established profile. In-vitro tests such as specific immunoglobulin E quantification and basophil activation test have the advantage of sparing the patient from re-exposure. Drug provocation tests remain to be the gold standard yet require careful patient selection and closely collaborated anaesthetist–immunologist care in the perioperative setting.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 559-565"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.mpaic.2025.07.005
Christina T.Y. Cheung, Eva Y.F. Chan
Postoperative pulmonary complications are common. Despite advances in perioperative care for patients undergoing major surgery, they are associated with increased morbidity, mortality and healthcare costs. Strategies to reduce postoperative pulmonary complications include identification of patients at risk for respiratory complications, followed by risk stratification and perioperative optimization. This article evaluates current literature on the definition of postoperative pulmonary complications, their underlying biological mechanisms, contributing risk factors and preventative measures. Of note, the wide variability in the definition of postoperative pulmonary complications highlights the importance of identifying outcome measures and standardized end points as they affect the validity of clinical trials. Validated risk prediction models are useful tools for clinicians to stratify patients at risk, however there is still a lack of consensus over which model is the best one to use. Evidence for preventative measures including smoking cessation, correction of anaemia, perioperative respiratory physiotherapy and intraoperative management including lung-protective ventilation and goal-directed haemodynamic therapy are discussed. Most importantly, perioperative care bundles demonstrate the importance of multidisciplinary involvement during different time points when a patient undergoes surgery, and a combination of interventions are found to be more beneficial than individual interventions alone.
{"title":"Postoperative pulmonary complications and their prevention","authors":"Christina T.Y. Cheung, Eva Y.F. Chan","doi":"10.1016/j.mpaic.2025.07.005","DOIUrl":"10.1016/j.mpaic.2025.07.005","url":null,"abstract":"<div><div>Postoperative pulmonary complications are common. Despite advances in perioperative care for patients undergoing major surgery, they are associated with increased morbidity, mortality and healthcare costs. Strategies to reduce postoperative pulmonary complications include identification of patients at risk for respiratory complications, followed by risk stratification and perioperative optimization. This article evaluates current literature on the definition of postoperative pulmonary complications, their underlying biological mechanisms, contributing risk factors and preventative measures. Of note, the wide variability in the definition of postoperative pulmonary complications highlights the importance of identifying outcome measures and standardized end points as they affect the validity of clinical trials. Validated risk prediction models are useful tools for clinicians to stratify patients at risk, however there is still a lack of consensus over which model is the best one to use. Evidence for preventative measures including smoking cessation, correction of anaemia, perioperative respiratory physiotherapy and intraoperative management including lung-protective ventilation and goal-directed haemodynamic therapy are discussed. Most importantly, perioperative care bundles demonstrate the importance of multidisciplinary involvement during different time points when a patient undergoes surgery, and a combination of interventions are found to be more beneficial than individual interventions alone.</div></div>","PeriodicalId":45856,"journal":{"name":"Anaesthesia and Intensive Care Medicine","volume":"26 9","pages":"Pages 566-573"},"PeriodicalIF":0.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050247","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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