Dhruv Verma, J. Yum, Kyra LeRoy, T. McDaniel, S. Saab
Background: Platelet transfusion is the standard of care for managing thrombocytopenia in patients with advanced liver disease undergoing procedures. Randomized control trials have demonstrated the safety and efficacy of avatrombopag in the management of thrombocytopenia in this population. However, real-world data is limited. Methods: Retrospective cohort study performed in patients 18 and older with thrombocytopenia and liver disease who were prescribed avatrombopag before invasive procedure. Patients were stratified by platelet count into high (>40.0×10 9 /L) and low baseline (<40.0×10 9 /L) cohorts. Demographic, clinical data, changes in platelet count, use of platelet transfusion, rescue therapy, and incidence of portal vein thrombosis were recorded. Results: Of the 29 study patients, 59% were male and the mean age was 62 years. Hepatitis C virus infection was the most common etiology of liver disease (28%) and esophagogastroduodenoscopy was the most common procedure performed (86%). Mean baseline platelet count was 39.3×10 9 /L and 16 patients had platelet counts below 40.0×10 9 /L. Platelet count increased 2.2 folds, from 37.4×10 9 /L to 76.9×10 9 /L in 20 patients who had peri-procedure platelet counts. No patients required rescue therapy or platelet transfusion and there were no adverse effects. There was no new portal vein thrombosis. Conclusions: Results from this real-world study are consistent with the results of the clinical trials for avatrombopag. Avatrombopag is a safe and effective alternative to platelet transfusion to treat thrombocytopenia in patients with chronic liver disease scheduled to undergo a procedure. Our primary outcome assessed efficacy as defined as the proportion of patients who did not require a platelet transfusion or rescue procedure for bleeding up to 7 days after a procedure. Secondary end points assessed adverse events as defined as the proportion of patients with adverse events and proportion of patients who developed portal vein thrombosis after receiving avatrombopag. Sensitivity analysis was performed on platelet response to avatrombopag.
{"title":"Real-life experience with avatrombopag","authors":"Dhruv Verma, J. Yum, Kyra LeRoy, T. McDaniel, S. Saab","doi":"10.21037/DMR-21-10","DOIUrl":"https://doi.org/10.21037/DMR-21-10","url":null,"abstract":"Background: Platelet transfusion is the standard of care for managing thrombocytopenia in patients with advanced liver disease undergoing procedures. Randomized control trials have demonstrated the safety and efficacy of avatrombopag in the management of thrombocytopenia in this population. However, real-world data is limited. Methods: Retrospective cohort study performed in patients 18 and older with thrombocytopenia and liver disease who were prescribed avatrombopag before invasive procedure. Patients were stratified by platelet count into high (>40.0×10 9 /L) and low baseline (<40.0×10 9 /L) cohorts. Demographic, clinical data, changes in platelet count, use of platelet transfusion, rescue therapy, and incidence of portal vein thrombosis were recorded. Results: Of the 29 study patients, 59% were male and the mean age was 62 years. Hepatitis C virus infection was the most common etiology of liver disease (28%) and esophagogastroduodenoscopy was the most common procedure performed (86%). Mean baseline platelet count was 39.3×10 9 /L and 16 patients had platelet counts below 40.0×10 9 /L. Platelet count increased 2.2 folds, from 37.4×10 9 /L to 76.9×10 9 /L in 20 patients who had peri-procedure platelet counts. No patients required rescue therapy or platelet transfusion and there were no adverse effects. There was no new portal vein thrombosis. Conclusions: Results from this real-world study are consistent with the results of the clinical trials for avatrombopag. Avatrombopag is a safe and effective alternative to platelet transfusion to treat thrombocytopenia in patients with chronic liver disease scheduled to undergo a procedure. Our primary outcome assessed efficacy as defined as the proportion of patients who did not require a platelet transfusion or rescue procedure for bleeding up to 7 days after a procedure. Secondary end points assessed adverse events as defined as the proportion of patients with adverse events and proportion of patients who developed portal vein thrombosis after receiving avatrombopag. Sensitivity analysis was performed on platelet response to avatrombopag.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41536704","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}
As more bariatric procedures are performed every year in the United States, the number of revisions has increased concomitantly. Most commonly indicated due to weight regain or insufficient weight loss, these operations are usually more challenging and tend to be associated with higher morbidity rates than primary surgery. Although technically demanding, revisional surgery offers additional weight management and improvement of obesity-related comorbidities. Enhanced visualization, improved range of motion and ergonomics, multi quadrant access, and motion scaling are all features that make robotic platforms potentially promising for complex operations such as revisional bariatric surgery. A robotic approach also reduces mechanical strain from thick abdominal walls and allows for easier hand-sewn anastomoses when the field of vision is limited. Benefits need to be contrasted by the known limitations of longer operative times (OTs), including docking, lack of haptic feedback, equipment costs, and the training needed to acquire expertise. So far, most studies do not show significant differences in outcomes between robot-assisted and laparoscopic approaches. Further advancement in the field and widespread use could likely bring costs down and improve patient outcomes when chosen judiciously. Overall, robot-assisted revisional bariatric surgery appears to be a safe and feasible alternative to laparoscopic revisional bariatric surgery (LRBS) for complex
{"title":"Robot-assisted revisional bariatric surgery","authors":"Cristina J. Ponce, A. Guerron, R. Sudan","doi":"10.21037/DMR-21-6","DOIUrl":"https://doi.org/10.21037/DMR-21-6","url":null,"abstract":"As more bariatric procedures are performed every year in the United States, the number of revisions has increased concomitantly. Most commonly indicated due to weight regain or insufficient weight loss, these operations are usually more challenging and tend to be associated with higher morbidity rates than primary surgery. Although technically demanding, revisional surgery offers additional weight management and improvement of obesity-related comorbidities. Enhanced visualization, improved range of motion and ergonomics, multi quadrant access, and motion scaling are all features that make robotic platforms potentially promising for complex operations such as revisional bariatric surgery. A robotic approach also reduces mechanical strain from thick abdominal walls and allows for easier hand-sewn anastomoses when the field of vision is limited. Benefits need to be contrasted by the known limitations of longer operative times (OTs), including docking, lack of haptic feedback, equipment costs, and the training needed to acquire expertise. So far, most studies do not show significant differences in outcomes between robot-assisted and laparoscopic approaches. Further advancement in the field and widespread use could likely bring costs down and improve patient outcomes when chosen judiciously. Overall, robot-assisted revisional bariatric surgery appears to be a safe and feasible alternative to laparoscopic revisional bariatric surgery (LRBS) for complex","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46798866","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}
We are grateful for the opportunity to review the role of stenting in colorectal cancer. This technique is an important tool in the armamentarium of the clinician treating colorectal cancer and emergency presentations of malignant large bowel obstruction. Large bowel obstruction due to colorectal cancer is a common condition, traditionally treated by open surgery and creation of a colostomy (Hartmann procedure). There are now numerous options for treating this condition of which stenting is but one. We will discuss in this review how to assess patients for potential stenting. We will review stenting both as a means to palliate large bowel obstruction but also consider whether there is a role for using this as ‘bridging treatment’ to more definite surgical intervention and when this may be appropriate. Indications for the procedure, as well as a guide to correct technique for safe and effective insertion are presented. Details around the design principles and commercially available products are reviewed. Timing of such procedures, their safety profile and potential associated pitfalls are all discussed. Some controversies around the use of stenting are also described. Finally, a series of cases illustrating the utility of colonic stenting are presented to provide clinical context to the topic.
{"title":"Role and timing of colonic stenting in colorectal cancer","authors":"K. Buxey, Hanumant Chouhan","doi":"10.21037/DMR-20-133","DOIUrl":"https://doi.org/10.21037/DMR-20-133","url":null,"abstract":"We are grateful for the opportunity to review the role of stenting in colorectal cancer. This technique is an important tool in the armamentarium of the clinician treating colorectal cancer and emergency presentations of malignant large bowel obstruction. Large bowel obstruction due to colorectal cancer is a common condition, traditionally treated by open surgery and creation of a colostomy (Hartmann procedure). There are now numerous options for treating this condition of which stenting is but one. We will discuss in this review how to assess patients for potential stenting. We will review stenting both as a means to palliate large bowel obstruction but also consider whether there is a role for using this as ‘bridging treatment’ to more definite surgical intervention and when this may be appropriate. Indications for the procedure, as well as a guide to correct technique for safe and effective insertion are presented. Details around the design principles and commercially available products are reviewed. Timing of such procedures, their safety profile and potential associated pitfalls are all discussed. Some controversies around the use of stenting are also described. Finally, a series of cases illustrating the utility of colonic stenting are presented to provide clinical context to the topic.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41991488","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}
N. Méndez-Sánchez, Alejandro Valencia-Rodríguez, C. Coronel-Castillo, X. Qi
: Hepatocellular carcinoma (HCC) is considered a serious health problem worldwide as it is one of the most prevalent malignancies in the world and with devastating outcomes. According to the 2020 estimation of global burden cancer by the International Agency for Research on Cancer (IARC), HCC ranks third in mortality among cancer deaths despite the incidence rate ranks sixth. In most cases, a history of preexisting chronic liver disease (CLD) is mandatory, usually established in the stage of cirrhosis. Globally, hepatitis B virus (HBV) continues to be the main cause of cirrhosis and HCC, especially in countries of East Asia and Sub-Saharan Africa where there are no universal vaccination programs against this virus. Other CLD include alcoholic liver disease (ALD), hepatitis C virus, nonalcoholic fatty liver disease, and in more infrequent cases, chronic aflatoxins exposure. Due to this large clinical spectrum that encompasses HCC, it is necessary to systematically review each CLD associated with the development of this cancer by studying its prevalence, molecular pathogenesis, risk factors associated with the progression of HCC, and specially prevention strategies. Finally, regarding the treatment of HCC, great advances have been made in the last decade. Surgical resection, transplantation, and in some cases ablation, are the only curative treatment for HCC, although tumor recurrence is commonly seeing in the follow-up process. Locoregional therapies are still controversial, whether they really provide an overall survival benefit or not, as well as in what type of patients would benefit most from this therapy. Regarding systemic therapies, a recently published phase 3 clinical trial demonstrated greater superiority in the overall survival of atezolizumab plus bevacizumab compared to Sorafenib as a first-line treatment in unresectable HCC patients. This finding will definitely bring a new perspective in the management of these kind of patients.
{"title":"Narrative review of hepatocellular carcinoma: from molecular bases to therapeutic approach","authors":"N. Méndez-Sánchez, Alejandro Valencia-Rodríguez, C. Coronel-Castillo, X. Qi","doi":"10.21037/DMR-20-116","DOIUrl":"https://doi.org/10.21037/DMR-20-116","url":null,"abstract":": Hepatocellular carcinoma (HCC) is considered a serious health problem worldwide as it is one of the most prevalent malignancies in the world and with devastating outcomes. According to the 2020 estimation of global burden cancer by the International Agency for Research on Cancer (IARC), HCC ranks third in mortality among cancer deaths despite the incidence rate ranks sixth. In most cases, a history of preexisting chronic liver disease (CLD) is mandatory, usually established in the stage of cirrhosis. Globally, hepatitis B virus (HBV) continues to be the main cause of cirrhosis and HCC, especially in countries of East Asia and Sub-Saharan Africa where there are no universal vaccination programs against this virus. Other CLD include alcoholic liver disease (ALD), hepatitis C virus, nonalcoholic fatty liver disease, and in more infrequent cases, chronic aflatoxins exposure. Due to this large clinical spectrum that encompasses HCC, it is necessary to systematically review each CLD associated with the development of this cancer by studying its prevalence, molecular pathogenesis, risk factors associated with the progression of HCC, and specially prevention strategies. Finally, regarding the treatment of HCC, great advances have been made in the last decade. Surgical resection, transplantation, and in some cases ablation, are the only curative treatment for HCC, although tumor recurrence is commonly seeing in the follow-up process. Locoregional therapies are still controversial, whether they really provide an overall survival benefit or not, as well as in what type of patients would benefit most from this therapy. Regarding systemic therapies, a recently published phase 3 clinical trial demonstrated greater superiority in the overall survival of atezolizumab plus bevacizumab compared to Sorafenib as a first-line treatment in unresectable HCC patients. This finding will definitely bring a new perspective in the management of these kind of patients.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48179641","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}
A. Body, S. Latham, J. Kong, Ajay Raghunath, E. Segelov
The current standard of care for stage III colon cancer has been adjuvant chemotherapy since this was first shown to be beneficial three decades ago. Despite the improvement in outcomes after introduction of oxaliplatin a decade ago, relapse rates are still significant with associated high morbidity and mortality related to metastatic colon cancer worldwide. Discovery of novel agents for use in colon cancer has been slow and disappointing. Repurposing currently available drugs with known activity in colon cancer into a neoadjuvant chemotherapy regimen has the potential to improve outcomes in colon cancer even while we await development of new drugs. Clinical trials of neoadjuvant chemotherapy for colon cancer to date have been encouraging, demonstrating lower pathologic stage amongst treated patients, and higher rates of R0 resection. However, only early data is available and long term survival outcomes are eagerly awaited. Challenges include optimal staging and patient selection for neoadjuvant therapy, with current methods of radiologic staging lacking specificity to exclude low risk patients (who might not require chemotherapy) from trials. Novel approaches, a notable example being the use of immunotherapy for mismatch repair (MMR) deficient tumours, hold promise of higher response rates without increasing toxicity. Neoadjuvant chemotherapy for this disease still requires further data to be available before it is ready for widespread use, however shows great promise. This review article will discuss the available data regarding rationale and evidence for neoadjuvant chemotherapy for colon cancer.
{"title":"Stage III colon cancer: is neoadjuvant chemotherapy ready for prime time?—A narrative review of neoadjuvant chemotherapy for colon cancer","authors":"A. Body, S. Latham, J. Kong, Ajay Raghunath, E. Segelov","doi":"10.21037/DMR-20-159","DOIUrl":"https://doi.org/10.21037/DMR-20-159","url":null,"abstract":"The current standard of care for stage III colon cancer has been adjuvant chemotherapy since this was first shown to be beneficial three decades ago. Despite the improvement in outcomes after introduction of oxaliplatin a decade ago, relapse rates are still significant with associated high morbidity and mortality related to metastatic colon cancer worldwide. Discovery of novel agents for use in colon cancer has been slow and disappointing. Repurposing currently available drugs with known activity in colon cancer into a neoadjuvant chemotherapy regimen has the potential to improve outcomes in colon cancer even while we await development of new drugs. Clinical trials of neoadjuvant chemotherapy for colon cancer to date have been encouraging, demonstrating lower pathologic stage amongst treated patients, and higher rates of R0 resection. However, only early data is available and long term survival outcomes are eagerly awaited. Challenges include optimal staging and patient selection for neoadjuvant therapy, with current methods of radiologic staging lacking specificity to exclude low risk patients (who might not require chemotherapy) from trials. Novel approaches, a notable example being the use of immunotherapy for mismatch repair (MMR) deficient tumours, hold promise of higher response rates without increasing toxicity. Neoadjuvant chemotherapy for this disease still requires further data to be available before it is ready for widespread use, however shows great promise. This review article will discuss the available data regarding rationale and evidence for neoadjuvant chemotherapy for colon cancer.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42251006","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}
Optimal management of inflammatory bowel disease (IBD) requires a multidisciplinary team approach, including specialists in the fields of gastroenterology, surgery, radiology and pathology. The histological examination of endoscopic biopsies or resection specimens after surgery aids in establishing the diagnosis of IBD and plays a central part in distinguishing between the two main entities of IBD, that is ulcerative colitis (UC) and Crohn’s disease (CD). The histopathological features that are characteristic for either UC or CD, have been well-described for decades. Though, the fact that no single finding is truly disease specific can introduce diagnostic doubt and mix-up of the diagnoses. Recent progress in the usage of proper validated histological indexes to measure and grade the histological activity in endoscopic biopsies, and the systematical evaluation of resection margins in ileal resections specimens in CD, suggest that histological assessment can be utilized as a predictive factor that can guide disease management, also after the diagnosis has been established. For now, systematic assessment of histological activity with an appropriate histological index is a well-established endpoint for evaluation of treatment responses in clinical trials. Given the growing amount of valid data, it might also be beneficial to systematically include use of histological scoring in daily clinical practice to improve the future management of IBD.
{"title":"A close view on histopathological changes in inflammatory bowel disease, a narrative review","authors":"L. Kellermann, L. Riis","doi":"10.21037/DMR-21-1","DOIUrl":"https://doi.org/10.21037/DMR-21-1","url":null,"abstract":"Optimal management of inflammatory bowel disease (IBD) requires a multidisciplinary team approach, including specialists in the fields of gastroenterology, surgery, radiology and pathology. The histological examination of endoscopic biopsies or resection specimens after surgery aids in establishing the diagnosis of IBD and plays a central part in distinguishing between the two main entities of IBD, that is ulcerative colitis (UC) and Crohn’s disease (CD). The histopathological features that are characteristic for either UC or CD, have been well-described for decades. Though, the fact that no single finding is truly disease specific can introduce diagnostic doubt and mix-up of the diagnoses. Recent progress in the usage of proper validated histological indexes to measure and grade the histological activity in endoscopic biopsies, and the systematical evaluation of resection margins in ileal resections specimens in CD, suggest that histological assessment can be utilized as a predictive factor that can guide disease management, also after the diagnosis has been established. For now, systematic assessment of histological activity with an appropriate histological index is a well-established endpoint for evaluation of treatment responses in clinical trials. Given the growing amount of valid data, it might also be beneficial to systematically include use of histological scoring in daily clinical practice to improve the future management of IBD.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49347888","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 Bowel preparation has long been considered as the standard preoperative management for colorectal surgery. However, there are still controversies about bowel preparation and the importance of bowel preparation gradually declined. The purpose of this study is to describe the current attitudes and practice patterns of preoperative bowel preparation among Chinese surgeons. Methods An online 11-question anonymous survey was randomly assigned to Chinese surgeons. The questionnaire sought information on each surgeon’s current practice of preoperative bowel preparation. Results 384 Chinese surgeons from 26 provincial administrative regions took part in this survey. The most common reason for choosing bowel preparation was preventing surgical site infection (SSI). Meanwhile, 74% Chinese surgeons believed bowel preparation could avoid anastomotic leakage. Only 34% thought that bowel preparation was considered to reduce risk of postoperative bleeding. In terms of bowel preparation methods, 57% Chinese surgeons preferred to choose laxatives alone. Regarding the choices of agents, Chinese surgeons were more likely to choose polyethylene glycol-electrolyte lavage solution (PEG-ELS). Conclusions Surgeons choose bowel preparation mostly to avoid SSI and anastomotic leakage, and they prefer using laxatives alone. Our study shows that surgeons do not have clear guidelines that can govern their clinical practice and there are still controversies about bowel preparation. Further study is required to provide strong evidences to inform clinical and policy decisions.
{"title":"A Chinese Survey of Current Practice Patterns of Preoperative Bowel Preparation in Colorectal Surgery","authors":"Hongfeng Yu, Li Xu, Shuhao Liu, Songcheng Yin, Chunhong Hong, Shaohua Yang, Jingyao Chen, Jianfeng Li, Changhua Zhang","doi":"10.21203/rs.3.rs-625927/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-625927/v1","url":null,"abstract":"\u0000 Background\u0000\u0000Bowel preparation has long been considered as the standard preoperative management for colorectal surgery. However, there are still controversies about bowel preparation and the importance of bowel preparation gradually declined. The purpose of this study is to describe the current attitudes and practice patterns of preoperative bowel preparation among Chinese surgeons.\u0000Methods\u0000\u0000An online 11-question anonymous survey was randomly assigned to Chinese surgeons. The questionnaire sought information on each surgeon’s current practice of preoperative bowel preparation.\u0000Results\u0000\u0000384 Chinese surgeons from 26 provincial administrative regions took part in this survey. The most common reason for choosing bowel preparation was preventing surgical site infection (SSI). Meanwhile, 74% Chinese surgeons believed bowel preparation could avoid anastomotic leakage. Only 34% thought that bowel preparation was considered to reduce risk of postoperative bleeding. In terms of bowel preparation methods, 57% Chinese surgeons preferred to choose laxatives alone. Regarding the choices of agents, Chinese surgeons were more likely to choose polyethylene glycol-electrolyte lavage solution (PEG-ELS).\u0000Conclusions\u0000\u0000Surgeons choose bowel preparation mostly to avoid SSI and anastomotic leakage, and they prefer using laxatives alone. Our study shows that surgeons do not have clear guidelines that can govern their clinical practice and there are still controversies about bowel preparation. Further study is required to provide strong evidences to inform clinical and policy decisions.","PeriodicalId":72814,"journal":{"name":"Digestive medicine research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45518177","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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