Pub Date : 2020-12-31DOI: 10.24966/ETS-8798/100056
Xin-long Chen
In this work we investigated whether a joint treatment with insulin instillation and negative pressure wound therapy (NPWT) would reduce insulin resistance (IR) in diabetic patients with infected diabetic foot ulcers (DFUs) and improve their healing. We also studied the effects of insulin+NPWT treatment on the inflammatory response coupled with wound healing. Seventy-five diabetic patients with infected DFUs were recruited and randomly divided into equal (n=25) groups treated respectively with NPWT alone, NPWT+insulin, and conventional dressings (controls). Thereafter, the ulcers’ healing progress was assessed. The serum levels of Tumor Necrosis Factor-α (TNF-α), Interleukin-2 (IL-2), and Interleukin-6 (IL-6) were measured at 1 day before and at 7, 14, and 21 days after each treatment using specific double-antibody sandwich enzyme-linked immunosorbent assays (ELISA). Serum glucose was measured via a glucose-oxidase method, and serum insulin via radioimmunoassay. In each patient, IR was appraised via the Homeostasis Model Assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). Our results showed that at 7, 14 and 21 days post-treatment, with respect to the control group the two NPWT-treated groups had (i) significantly (p < 0.05) lower serum levels of TNF-α, IL-2 and IL-6; (ii) a significantly (p < 0.01) greater reduction in IR; and (iii) significantly (p < 0.05) higher wound healing rates. Moreover, at 14- and 21-days post-treatment, the NPWT+insulin-treated group had a significantly (p < 0.05) higher wound healing rate than the NPWT alone-treated group. In conclusion, the combined NPWT+insulin instillation treatment gave superior results by improving wound healing, decreasing inflammation at the wounds surface, and reducing IR in diabetic patients with infected DFUs.
{"title":"Associating Insulin Instillation with Negative Pressure Wound Therapy Reduces Insulin Resistance in Diabetic Patients with Infected Foot Wounds","authors":"Xin-long Chen","doi":"10.24966/ETS-8798/100056","DOIUrl":"https://doi.org/10.24966/ETS-8798/100056","url":null,"abstract":"In this work we investigated whether a joint treatment with insulin instillation and negative pressure wound therapy (NPWT) would reduce insulin resistance (IR) in diabetic patients with infected diabetic foot ulcers (DFUs) and improve their healing. We also studied the effects of insulin+NPWT treatment on the inflammatory response coupled with wound healing. Seventy-five diabetic patients with infected DFUs were recruited and randomly divided into equal (n=25) groups treated respectively with NPWT alone, NPWT+insulin, and conventional dressings (controls). Thereafter, the ulcers’ healing progress was assessed. The serum levels of Tumor Necrosis Factor-α (TNF-α), Interleukin-2 (IL-2), and Interleukin-6 (IL-6) were measured at 1 day before and at 7, 14, and 21 days after each treatment using specific double-antibody sandwich enzyme-linked immunosorbent assays (ELISA). Serum glucose was measured via a glucose-oxidase method, and serum insulin via radioimmunoassay. In each patient, IR was appraised via the Homeostasis Model Assessment (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI). Our results showed that at 7, 14 and 21 days post-treatment, with respect to the control group the two NPWT-treated groups had (i) significantly (p < 0.05) lower serum levels of TNF-α, IL-2 and IL-6; (ii) a significantly (p < 0.01) greater reduction in IR; and (iii) significantly (p < 0.05) higher wound healing rates. Moreover, at 14- and 21-days post-treatment, the NPWT+insulin-treated group had a significantly (p < 0.05) higher wound healing rate than the NPWT alone-treated group. In conclusion, the combined NPWT+insulin instillation treatment gave superior results by improving wound healing, decreasing inflammation at the wounds surface, and reducing IR in diabetic patients with infected DFUs.","PeriodicalId":51381,"journal":{"name":"Educational Technology & Society","volume":"7 1","pages":"1-8"},"PeriodicalIF":4.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42962483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urgent public health interventions to mitigate the spread of Covid-19 curtailed most social activities and work. Meanwhile, maintaining social distancing and lockdown will cause substantial economic loss and social damage. Now the critical question is how to reopen the economy while containing the COVID-19 pandemic without social distancing restrictions? The solution is mass testing. Alternative public health intervention strategies such as shelter-in-place and social distancing policies that may halt economic activities may be curtailed if virus testing which is an effective way to contain Covid-19 is expanded. Although the U.S. still has a longer path ahead, we have estimated that if the number of daily tests is 581,000 per day, i.e., the current number of daily tests would need to be doubled in order for Covid-19 to be contained and social distancing measures to be lifted.
{"title":"Mass testing and containment of Covid-19","authors":"M. Xiong","doi":"10.24966/ETS-8798/S1001","DOIUrl":"https://doi.org/10.24966/ETS-8798/S1001","url":null,"abstract":"Urgent public health interventions to mitigate the spread of Covid-19 curtailed most social activities and work. Meanwhile, maintaining social distancing and lockdown will cause substantial economic loss and social damage. Now the critical question is how to reopen the economy while containing the COVID-19 pandemic without social distancing restrictions? The solution is mass testing. Alternative public health intervention strategies such as shelter-in-place and social distancing policies that may halt economic activities may be curtailed if virus testing which is an effective way to contain Covid-19 is expanded. Although the U.S. still has a longer path ahead, we have estimated that if the number of daily tests is 581,000 per day, i.e., the current number of daily tests would need to be doubled in order for Covid-19 to be contained and social distancing measures to be lifted.","PeriodicalId":51381,"journal":{"name":"Educational Technology & Society","volume":"7 1","pages":""},"PeriodicalIF":4.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42408699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-31DOI: 10.24966/ets-8798/100051
M. Kukučka
Solid pseudopapillary neoplasm of the pancreas is a rare pancreatic tumor with low malignant potential, typically affecting young women. In literature this tumor may be referred to as Frantz tumor, solid tumor, cystic tumor, papillary-cystic tumor or solid pseudopapillary tumor. According to the current WHO classification from 2010 these tumors are considered low-grade malignant epithelial tumors of pancreas. In this case report we present a case of 19-years old women with cystic lesion located in left hypogastrium. After thorough evaluation and subsequent multidisciplinary consultation, the patient was indicated to radical resection of the lesion. Final histological evaluation of the surgical specimen revealed the diagnosis of solid-pseudopapillary neoplasm.
{"title":"Solid Pseudopapillary Neoplasm of the Pancreas: Case Report","authors":"M. Kukučka","doi":"10.24966/ets-8798/100051","DOIUrl":"https://doi.org/10.24966/ets-8798/100051","url":null,"abstract":"Solid pseudopapillary neoplasm of the pancreas is a rare pancreatic tumor with low malignant potential, typically affecting young women. In literature this tumor may be referred to as Frantz tumor, solid tumor, cystic tumor, papillary-cystic tumor or solid pseudopapillary tumor. According to the current WHO classification from 2010 these tumors are considered low-grade malignant epithelial tumors of pancreas. In this case report we present a case of 19-years old women with cystic lesion located in left hypogastrium. After thorough evaluation and subsequent multidisciplinary consultation, the patient was indicated to radical resection of the lesion. Final histological evaluation of the surgical specimen revealed the diagnosis of solid-pseudopapillary neoplasm.","PeriodicalId":51381,"journal":{"name":"Educational Technology & Society","volume":"7 1","pages":"1-3"},"PeriodicalIF":4.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41711255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-31DOI: 10.24966/ets-8798/100050
V. Ameh
Objective: To determine the clinical and imaging diagnostic accuracy in adult patients presenting to the Emergency Department with groin abscess. Method: Retrospective chart review of all adult patients presenting to a district general hospital with a provisional diagnosis of groin abscess was undertaken from January 2019 to December 2019. A proforma was used to capture data such as the age, sex, co-morbidities, grade of assessing clinician and imaging profile. Results: 39 patients with a provisional diagnosis of groin abscess were identified; representing approximately 1% of all ED attendances. There were 21 males and 18 females. The age range was from 23 to 73 years (mean age 42). The abscess was located on the left side in 19 patients (49%), 18 (46%) on the right and 2 (5%) were bilateral. The overall rate of correct diagnosis of the ED clinicians compared to CT diagnosis is indicated by a sensitivity of 82%, positive predictive value of 90% and an accuracy of 75%. 22 patients had CT scan which confirmed an abscess in 18 (83%). Conclusion: Groin abscess is a rare presentation to the Emergency department. Most patients were seen by clinicians below the consultant grade. Diagnostic accuracy was highest amongst physicians.
{"title":"Groin Abscess: Assessing The Diagnostic Accuracy Of Emergency Department Clinicians And Imaging Modalities","authors":"V. Ameh","doi":"10.24966/ets-8798/100050","DOIUrl":"https://doi.org/10.24966/ets-8798/100050","url":null,"abstract":"Objective: To determine the clinical and imaging diagnostic accuracy in adult patients presenting to the Emergency Department with groin abscess. Method: Retrospective chart review of all adult patients presenting to a district general hospital with a provisional diagnosis of groin abscess was undertaken from January 2019 to December 2019. A proforma was used to capture data such as the age, sex, co-morbidities, grade of assessing clinician and imaging profile. Results: 39 patients with a provisional diagnosis of groin abscess were identified; representing approximately 1% of all ED attendances. There were 21 males and 18 females. The age range was from 23 to 73 years (mean age 42). The abscess was located on the left side in 19 patients (49%), 18 (46%) on the right and 2 (5%) were bilateral. The overall rate of correct diagnosis of the ED clinicians compared to CT diagnosis is indicated by a sensitivity of 82%, positive predictive value of 90% and an accuracy of 75%. 22 patients had CT scan which confirmed an abscess in 18 (83%). Conclusion: Groin abscess is a rare presentation to the Emergency department. Most patients were seen by clinicians below the consultant grade. Diagnostic accuracy was highest amongst physicians.","PeriodicalId":51381,"journal":{"name":"Educational Technology & Society","volume":"7 1","pages":"1-4"},"PeriodicalIF":4.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42715553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-31DOI: 10.24966/ets-8798/100049
M. Sugrue
Introduction: Optimizing delivery of care to patients with appendicitis as part of an emergency general surgery care program is important. Appendicitis is one of commonest emergency surgical presentations and has significant potential morbidity and occasional mortality. Meta-analysis of reinterventions following appendicectomy has not been published. This meta-analysis evaluated the prevalence and potential predictors of reoperation and interventional radiological (IR) procedures post appendicectomy. Methods: A PROSPERO-registered (ID CRD42017069040) meta-analysis following PRISMA guidelines using databases PubMed and Scopus for studies between June 2012 to May 2017 was undertaken. Headings included “reoperation”, “return to operation theatre”, “complication”, “appendicectomy”, “outcome”, “abscess drainage”. Articles scoring ≥16 for comparative and ≥10 for non-comparative using MINORS criteria were included. Results: 2810 articles reviewed were reduced to 52 qualifying studies for a final analysis of 319,053 appendicectomies. Overall, 0.9% (range 0.0% to 14.2%) underwent some form of reintervention. The reoperation rate was 0.6% (range 0.0 to 14.2%) and radiologic drainage rate 1.5% (range 0.0% to 11.1%). Reoperations were significantly associated with a laparoscopic approach, earlier grade of appendicitis and not using drains. Laparoscopy conversion to open and the grade of surgeon performing the appendicectomy did not affect reintervention. Conclusion: This meta-analysis identified a small but notable reoperation and IR rate, significantly increased by complexity of appendicitis and open surgery. Strategies promoting for earlier presentation and diagnosis with laparoscopic approaches may improve overall outcomes.
{"title":"Unplanned Reoperation And Interventional Radiology Post Appendicectomy: A Meta-Analysis","authors":"M. Sugrue","doi":"10.24966/ets-8798/100049","DOIUrl":"https://doi.org/10.24966/ets-8798/100049","url":null,"abstract":"Introduction: Optimizing delivery of care to patients with appendicitis as part of an emergency general surgery care program is important. Appendicitis is one of commonest emergency surgical presentations and has significant potential morbidity and occasional mortality. Meta-analysis of reinterventions following appendicectomy has not been published. This meta-analysis evaluated the prevalence and potential predictors of reoperation and interventional radiological (IR) procedures post appendicectomy. Methods: A PROSPERO-registered (ID CRD42017069040) meta-analysis following PRISMA guidelines using databases PubMed and Scopus for studies between June 2012 to May 2017 was undertaken. Headings included “reoperation”, “return to operation theatre”, “complication”, “appendicectomy”, “outcome”, “abscess drainage”. Articles scoring ≥16 for comparative and ≥10 for non-comparative using MINORS criteria were included. Results: 2810 articles reviewed were reduced to 52 qualifying studies for a final analysis of 319,053 appendicectomies. Overall, 0.9% (range 0.0% to 14.2%) underwent some form of reintervention. The reoperation rate was 0.6% (range 0.0 to 14.2%) and radiologic drainage rate 1.5% (range 0.0% to 11.1%). Reoperations were significantly associated with a laparoscopic approach, earlier grade of appendicitis and not using drains. Laparoscopy conversion to open and the grade of surgeon performing the appendicectomy did not affect reintervention. Conclusion: This meta-analysis identified a small but notable reoperation and IR rate, significantly increased by complexity of appendicitis and open surgery. Strategies promoting for earlier presentation and diagnosis with laparoscopic approaches may improve overall outcomes.","PeriodicalId":51381,"journal":{"name":"Educational Technology & Society","volume":"7 1","pages":"1-10"},"PeriodicalIF":4.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46512939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-31DOI: 10.24966/ets-8798/100053
A. Ammar
A 47 years old male presented to emergency department with history of pain abdomen after road traffic accident 6 hours back. He had deceleration injury while driving a minivan when he hit a truck parked on road side. On presentation, his Airway and breathing was intact with GCS 15/15.Pulse was 110/min and blood pressure was 100/70 mmHg. His abdomen was generalized tender, mostly in the hypogastrium. Digital rectal examination was normal. Ultrasound abdomen showed free fluid in the peritoneal cavity and chest and abdominal X-rays were unremarkable. On opening the abdomen there was 7×7 cm isolated perforation in sigmoid colon 5 cm proximal to recto sigmoid junction. Repair of perforation was done and proximal double barrel sigmoid colostomy was made. Patient was discharged on 3rd post-operative day. Later after 4 months reversal of sigmoid colostomy was done and patient was discharged.
{"title":"A Rare Case of Isolated Sigmoid Colon Perforation in Patient with Blunt Trauma Abdomen","authors":"A. Ammar","doi":"10.24966/ets-8798/100053","DOIUrl":"https://doi.org/10.24966/ets-8798/100053","url":null,"abstract":"A 47 years old male presented to emergency department with history of pain abdomen after road traffic accident 6 hours back. He had deceleration injury while driving a minivan when he hit a truck parked on road side. On presentation, his Airway and breathing was intact with GCS 15/15.Pulse was 110/min and blood pressure was 100/70 mmHg. His abdomen was generalized tender, mostly in the hypogastrium. Digital rectal examination was normal. Ultrasound abdomen showed free fluid in the peritoneal cavity and chest and abdominal X-rays were unremarkable. On opening the abdomen there was 7×7 cm isolated perforation in sigmoid colon 5 cm proximal to recto sigmoid junction. Repair of perforation was done and proximal double barrel sigmoid colostomy was made. Patient was discharged on 3rd post-operative day. Later after 4 months reversal of sigmoid colostomy was done and patient was discharged.","PeriodicalId":51381,"journal":{"name":"Educational Technology & Society","volume":" ","pages":"1-4"},"PeriodicalIF":4.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46068828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-31DOI: 10.24966/ets-8798/100052
Oana Antal
Introduction: We present the case of a 44-year man with a fulminant necrotizing myositis and fasciitis and streptococcal toxic shock syndrome, the patient being under treatment with tocilizumab and methotrexate for rheumatoid arthritis. Case presentation: He presented to the emergency department with diarrhea, flu-like symptoms and intense progressive pain in the right thigh after having shoveled while doing building work at home. His condition deteriorated within hours, he developed severe rhabdomyolysis, multiple organ dysfunction syndrome, disseminated intravascular coagulopathy and died, despite early treatment. Discussion: A great index of suspicion for severe necrotizing soft tissue infections is necessary in patients on tocilizumab or other biologic immunosuppressive agents. The possible mechanisms in this setting include lowering CRP involved in innate immune responses, decrement of neutrophil count and function, increasing iron availability for infection, as well as high expression of vimentin, the streptococcal binding protein, by regenerating muscle fibers after trauma. Diarrhea due to endotoxins and flu-like symptoms may be early and sometimes they may be the only presenting signs of severe group A streptococcal infection in patients with blunt trauma on biologics. Low initial CRP and white blood cell count may be misleading. A rapid streptococcal strip test may help anticipate and possibly prevent a deleterious evolution in such patients. Conclusion: Biologics may modify the clinical presentation of NF, the LRINEC score, and the pathology decision algorithm. A great index of suspicion for severe soft tissue infections is required in patients on biologics with blunt trauma, especially when presenting with flu-like symptoms, diarrhea, or vomiting.
{"title":"Fulminant Necrotizing Fasciitis And Myositis With Streptococcal Toxic Shock Syndrome In A Patient With Rheumatoid Arthritis On Tocilizumab: A Case Report","authors":"Oana Antal","doi":"10.24966/ets-8798/100052","DOIUrl":"https://doi.org/10.24966/ets-8798/100052","url":null,"abstract":"Introduction: We present the case of a 44-year man with a fulminant necrotizing myositis and fasciitis and streptococcal toxic shock syndrome, the patient being under treatment with tocilizumab and methotrexate for rheumatoid arthritis. Case presentation: He presented to the emergency department with diarrhea, flu-like symptoms and intense progressive pain in the right thigh after having shoveled while doing building work at home. His condition deteriorated within hours, he developed severe rhabdomyolysis, multiple organ dysfunction syndrome, disseminated intravascular coagulopathy and died, despite early treatment. Discussion: A great index of suspicion for severe necrotizing soft tissue infections is necessary in patients on tocilizumab or other biologic immunosuppressive agents. The possible mechanisms in this setting include lowering CRP involved in innate immune responses, decrement of neutrophil count and function, increasing iron availability for infection, as well as high expression of vimentin, the streptococcal binding protein, by regenerating muscle fibers after trauma. Diarrhea due to endotoxins and flu-like symptoms may be early and sometimes they may be the only presenting signs of severe group A streptococcal infection in patients with blunt trauma on biologics. Low initial CRP and white blood cell count may be misleading. A rapid streptococcal strip test may help anticipate and possibly prevent a deleterious evolution in such patients. Conclusion: Biologics may modify the clinical presentation of NF, the LRINEC score, and the pathology decision algorithm. A great index of suspicion for severe soft tissue infections is required in patients on biologics with blunt trauma, especially when presenting with flu-like symptoms, diarrhea, or vomiting.","PeriodicalId":51381,"journal":{"name":"Educational Technology & Society","volume":" ","pages":"1-4"},"PeriodicalIF":4.0,"publicationDate":"2020-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42837743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.24966/ets-8798/100039
Pshenisnov Konstantin Viktorovich
{"title":"Acetaminophen Poisoning: A Cause Of Acute Liver Failure In Pediatrics (Clinical Case)","authors":"Pshenisnov Konstantin Viktorovich","doi":"10.24966/ets-8798/100039","DOIUrl":"https://doi.org/10.24966/ets-8798/100039","url":null,"abstract":"","PeriodicalId":51381,"journal":{"name":"Educational Technology & Society","volume":"7 1","pages":"1-5"},"PeriodicalIF":4.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46159976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-30DOI: 10.24966/ets-8798/100044
A. Perez
{"title":"Laparoscopic Inguinal Hernia Repair Can Be Judiciously Used In The Acute Setting","authors":"A. Perez","doi":"10.24966/ets-8798/100044","DOIUrl":"https://doi.org/10.24966/ets-8798/100044","url":null,"abstract":"","PeriodicalId":51381,"journal":{"name":"Educational Technology & Society","volume":" ","pages":"1-2"},"PeriodicalIF":4.0,"publicationDate":"2020-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42885102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"教育学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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