Surgery in practice and science最新文献

{"title":"Perceptions, practices, and barriers in surgical informed consent: A cross-sectional study from Sudan","authors":"Ibrahim Nagmeldin Hassan ,&nbsp;Mohamed Ibrahim ,&nbsp;Siddig Yaqub ,&nbsp;Muhsin Ibrahim ,&nbsp;Haythem Abdalla ,&nbsp;Ghada Aljaili ,&nbsp;Wafa Osman ,&nbsp;Nagmeldin Abuassa","doi":"10.1016/j.sipas.2025.100309","DOIUrl":"10.1016/j.sipas.2025.100309","url":null,"abstract":"<div><h3>Background</h3><div>Informed consent is a cornerstone of ethical surgical practice, yet significant challenges persist in ensuring patients' comprehension, particularly in low-resource settings. Cultural norms, literacy barriers, and limited institutional support often hinder truly informed decision-making.</div></div><div><h3>Methods</h3><div>A hospital-based cross-sectional study was conducted from September to December 2024 at a rural surgical center in Omdurman, Sudan. A total of 422 adult patients undergoing elective surgery were interviewed postoperatively using a validated, culturally adapted questionnaire. Descriptive and inferential statistics were applied to assess patient demographics, perceptions of the informed consent process, and associated barriers.</div></div><div><h3>Results</h3><div>The mean age of participants was 42.0 ± 14.3 years, with a near-equal gender distribution. Only 17.1% of patients signed their own surgical consent forms, with 80.6% of these self-signers being male. Among those whose consent was signed by relatives (82.9%), females were overrepresented (56.6%). While 91.5% recognized the importance of informed consent, only 33.6% understood its medico-legal significance. Consent explanations were predominantly delivered by residents or house officers (62.1%), and just 20.1% of patients felt that the discussion influenced their surgical decision. Self-signers were more likely to recall discussion of surgical complications (75.0% vs. 51.4%; <em>p</em> &lt; 0.001), less likely to recall expected benefits (61.1% vs. 78.9%; <em>p</em> = 0.001), and showed no significant difference for consequences if surgery was not performed (80.6% vs. 82.9%; <em>p</em> = 1.0). Overall satisfaction with the consent process was high (87.7%), though this did not correlate with comprehension. Educational status significantly influenced autonomy, with illiterate participants disproportionately less likely to sign their own forms and more likely to cite language barriers and lack of information (<em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Despite high reported satisfaction, substantial deficiencies exist in patients’ comprehension and autonomy in the informed consent process in Sudan. Gender disparities, literacy limitations, and systemic reliance on junior staff compromise the ethical validity of consent. Interventions tailored to cultural and educational contexts—such as provider training, simplified materials, and patient-centered communication—are urgently needed to enhance informed surgical decision-making in low-resource environments.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100309"},"PeriodicalIF":0.8,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159829","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":"Improving consenting practice in trauma and orthopaedics: A single centre original mixed methods study","authors":"Kevin Joseph Jacob,&nbsp;Mohammad Naeem Mangal,&nbsp;Jack W M Lamb,&nbsp;Ahmad Abdallatif,&nbsp;Keshav Mathur,&nbsp;Mohammed Elmajee","doi":"10.1016/j.sipas.2025.100310","DOIUrl":"10.1016/j.sipas.2025.100310","url":null,"abstract":"<div><h3>Introduction</h3><div>Informed consent represents a cornerstone of ethical and legal surgical practice across numerous healthcare systems, including that of the United Kingdom. Despite its recognised importance, achieving consistency and comprehensiveness in the consent process remains a persistent challenge, particularly within busy and time-constrained clinical environments. This study critically evaluates existing consenting practices in the Department of Trauma and Orthopaedics at Worcestershire Acute Hospitals. It also presents the department’s experience with implementing electronic consent (e-consent) forms as a replacement for traditional handwritten documentation.</div></div><div><h3>Methodology</h3><div>A two-phase study was conducted at a single National Health Service (NHS) trust. In the first phase, 102 handwritten surgical consent forms were retrospectively audited against national guidelines to assess compliance in areas such as timing of consent, legibility, provision of information, and documentation of risks and alternatives. The second phase involved a structured survey of clinicians within the orthopaedic department to explore their experiences with the current process and their perceptions of electronic alternatives.</div></div><div><h3>Results</h3><div>The audit revealed major shortcomings in the handwritten consent process: only 21 % of forms were completed well in advance of surgery, fewer than half provided adequate procedural information, and just 17 % documented all available treatment options. Over 60 % were poorly legible, and most lacked complete documentation of risks and benefits. Survey results indicated widespread clinician dissatisfaction and a strong preference for e-consent systems to improve legibility, clarity, and patient engagement.</div></div><div><h3>Conclusion</h3><div>The study highlights significant deficiencies in handwritten consent practices and supports adopting standardised e-consent systems to enhance communication, patient comprehension, and medico-legal protection.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100310"},"PeriodicalIF":0.8,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121160","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":"Does calibration technique for distal locking screw insertion reduce radiation exposure and operative time during intramedullary nailing of humeral shaft fractures in comparison with freehand technique?","authors":"Mirza Sivro,&nbsp;Tarik Branković","doi":"10.1016/j.sipas.2025.100307","DOIUrl":"10.1016/j.sipas.2025.100307","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to compare the influence of two different methods of distal screw insertion during intramedullary nailing of humeral shaft fractures on radiation exposure and operative time.</div></div><div><h3>Methods</h3><div>A single-center retrospective study, which included 44 patients, was conducted. Patients were divided into the Freehand and Calibration groups according to the technique used for distal screw insertion. Medical records were used to collect baseline characteristics of patients and complications, and operative reports were used to collect data for outcomes which included number of expositions, dose area product (DAP), fluoroscopy time and operation time. Operation time was defined as time from skin incision to final suture.</div></div><div><h3>Results</h3><div>There were no significant differences noted between the groups in gender, age, fracture side and fracture type distribution. The mean DAP in the Calibration group measured 232.8 ± 130.1 μGy·m2, and was lower than in the Freehand group where measured value was 305.4 ± 141.6 μGy·m2, without significant difference between the groups (<em>p</em> = 0.084). Mean fluoroscopy time was also lower in the Calibration group of patients (32.3 ± 12.7 s) than in the Freehand group (39.4 ± 14.6 s), with <em>p</em> = 0.094. Mean operative time was shorter in the Calibration group (68.8 ± 27.1 min) in comparison with the Freehand group (76.5 ± 17.7 min), but without statistically significant difference (<em>p</em> = 0.272).</div></div><div><h3>Conclusion</h3><div>The usage of calibration technique for distal locking screw insertion has similar operative time and intraoperative radiation exposure during intramedullary nailing of humeral shaft fractures compared with the freehand technique.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100307"},"PeriodicalIF":0.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050533","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":"The prevalence of weight regain after sleeve gastrectomy in the middle east","authors":"Raad Dowais ,&nbsp;Nour Shatnawe,&nbsp;Sondos Ahmad,&nbsp;Alaa Hayajneh,&nbsp;Amneh Abu-Asbeh,&nbsp;Dania Odat,&nbsp;Batool Jaradat","doi":"10.1016/j.sipas.2025.100306","DOIUrl":"10.1016/j.sipas.2025.100306","url":null,"abstract":"<div><h3>Background</h3><div>Sleeve gastrectomy is one of the most commonly performed bariatric procedures worldwide, particularly in the Middle East, where obesity rates are among the highest globally. However, despite being effective for initial weight loss, a significant proportion of patients experiences weight regain after some time<strong>.</strong> We analyzed the prevalence of weight regain after sleeve gastrectomy in the Middle East and its association with patients' demographic characteristics, preoperative body mass index (BMI), and comorbidities.</div></div><div><h3>Methods</h3><div>A quantitative cross-sectional study conducted between 2023 and 2024 using an online questionnaire distributed via social media platforms, and through personal networks, targeted adults from Arabic-speaking Middle Eastern countries who had undergone sleeve gastrectomy 12+ months ago. Data collected included sociodemographics, medical conditions, country of residency, highest and lowest weight before and after surgery, current weight, and time required to reach lowest weight after surgery.</div></div><div><h3>Result</h3><div>Among 225 participants, mean BMI dropped in 1 year from 43.8 to 28.7. Younger patients achieved higher excess weight loss compared to those &gt;45 years old (74.1% vs 61.2 %). the average was 72.9 % at 12 months after the surgery, but declined to 66.6 % as time progressed. While 22.7 % were still losing weight and 31.8 % maintained their weight 12 months postoperatively, weight regain was observed in 45.5 % and was higher in those &gt;45 years old.</div></div><div><h3>Conclusion</h3><div>Despite favorable short-term outcomes, around half of the patients experienced weight regain within the first year, which was shown to be correlated with older age group, while preoperative BMI and gender showed no significant impact. These findings highlight the multifactorial nature of weight regain and emphasize the need for long-term follow-up. Conducting future studies with a larger population and longer follow up periods is expected to gain more accurate results.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100306"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145026350","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":"Major Milestones for Surgery in Practice and Science","authors":"Jorg Kleeff,&nbsp;Artur Rebelo","doi":"10.1016/j.sipas.2025.100291","DOIUrl":"10.1016/j.sipas.2025.100291","url":null,"abstract":"","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100291"},"PeriodicalIF":0.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145094732","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":"Severe morbidity following pancreatectomy with vascular reconstruction: impact of intraoperative vascular events and grafted venous reconstructions","authors":"Ramiro Fernández-Placencia ,&nbsp;Francisco Berrospi ,&nbsp;Carlos Luque-Vásquez ,&nbsp;Eduarda Bustamante ,&nbsp;Néstor Sánchez ,&nbsp;Eloy Ruiz ,&nbsp;Vanesa Huamán ,&nbsp;Eduardo Payet ,&nbsp;Juan Celis","doi":"10.1016/j.sipas.2025.100305","DOIUrl":"10.1016/j.sipas.2025.100305","url":null,"abstract":"<div><h3>Background</h3><div>Vascular resection and reconstruction during pancreatic surgery has become increasingly common in high-volume centers. However, the impact of intraoperative vascular events and complex venous reconstructions on severe morbidity remains understudied.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study including 77 patients who underwent pancreatic resection with vascular reconstruction at a high-volume tertiary care center between January 2010 and December 2024. Perioperative factors were evaluated through univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>Intraoperative events occurred in 25 % of the patients; severe morbidity (≥ IIIb according to the Clavien–Dindo classification) was observed in 31 %, and the mortality rate was 3.9 %. Severe morbidity was significantly influenced by intraoperative events (OR=4.3, 95 % CI 1.3–14.6, <em>p</em> = 0.016) and type 4 venous reconstruction (OR=12.7, 95 % CI 1.5–280, <em>p</em> = 0.037). Despite the increasing proportion of type 3 and type 4 venous reconstructions performed over the years, the rates of severe morbidity have remained stable. A notable improvement in the R0 resection rate for pancreatic ductal adenocarcinoma was observed after 2019, with a significant shift toward more complex venous reconstructions.</div></div><div><h3>Conclusion</h3><div>Intraoperative events and type 4 venous reconstruction significantly increase the risk of severe morbidity in pancreatic surgery. These findings underscore the importance of surgical planning, expertise in vascular procedures, and multidisciplinary care to improve outcomes.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100305"},"PeriodicalIF":0.8,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050532","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":"Letter to Editor on “Functional and radiological outcomes following sacroiliac screw fixation of posterior pelvic ring injuries: A retrospective study”","authors":"Dr․Parth Aphale ,&nbsp;Himanshu Shekhar ,&nbsp;Shashank Dokania","doi":"10.1016/j.sipas.2025.100304","DOIUrl":"10.1016/j.sipas.2025.100304","url":null,"abstract":"","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100304"},"PeriodicalIF":0.8,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144885609","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":"Comparison of the effects of bariatric surgery and pelvic floor muscle training on urinary incontinence in elderly women with obesity","authors":"Hui Peng ,&nbsp;Yunxian Xian ,&nbsp;Jie Zhang","doi":"10.1016/j.sipas.2025.100303","DOIUrl":"10.1016/j.sipas.2025.100303","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the effectiveness of BS in improving UI among elderly obese women and compare it to pelvic floor muscle exercises (PFME).</div></div><div><h3>Methods</h3><div>This retrospective case-control study included 46 women diagnosed with UI, all patients underwent laparoscopic sleeve gastrectomy. These patients were compared to a matched cohort of 46 women who performed PFME and 92 control women who received no intervention. The primary outcome was assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes included UI rehabilitation and sleep quality, measured by the Pittsburgh Sleep Quality Index (PSQI). Statistical analyses included univariate and multivariate logistic regression.</div></div><div><h3>Results</h3><div>Both the BS and PFME groups showed significant improvements in UI and sleep quality compared to the control group. The PFME group had the best UI outcomes, with most participants reporting ICIQ-SF scores between 1 and 7 at 12 months. The BS group reported scores between 7.1 and 14, while the control group had scores mostly above 14.1. Postoperative complications, particularly diarrhea, significantly impacted the effectiveness of UI improvement in the BS group.</div></div><div><h3>Conclusion</h3><div>Bariatric surgery can effectively improve UI in elderly obese women, although its impact is not as significant as PFME. Postoperative diarrhea is a risk factor that reduces the effectiveness of UI improvement after BS. Further research through multicenter, long-term, large-scale randomized controlled trials is recommended to validate these findings and explore the relationship between mental and physical conditions and UI improvement post-BS.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100303"},"PeriodicalIF":0.8,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892231","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":"The influence of antibiotic and mechanical bowel preparation on the microbiome in colorectal cancer surgery: A pilot study","authors":"Undine Gabriele Lange ,&nbsp;Konrad Lehr ,&nbsp;René Thieme ,&nbsp;Albrecht Hoffmeister ,&nbsp;Jürgen Feisthammel ,&nbsp;Ines Gockel ,&nbsp;Alexander Link ,&nbsp;Boris Jansen-Winkeln","doi":"10.1016/j.sipas.2025.100302","DOIUrl":"10.1016/j.sipas.2025.100302","url":null,"abstract":"<div><h3>Backround</h3><div>The extent to which bowel preparation mechanical (MBP) or oral antibiotic (OA) or in combination (MBP/OA)) should be performed prior to elective colorectal surgery is the subject of ongoing debate. The aim of our study was to investigate the effect of MPB/OA [with single-shot intravenous antibiotic administration before incision (MPB/OA+ivAB)] on the microbiome of patients with colorectal carcinoma (CRC) operated minimally-invasive.</div></div><div><h3>Methods</h3><div>We were studying 16 consecutive patients who underwent elective resection surgery for CRC at our centre in a prospective panel study. MBP was performed and 1 g parmomomycin/500 mg metronidazole was administered orally one day preoperatively; 1 g ertapenem was administered intravenously 30 min prior incision. Three mucosal samples were taken preoperatively during colonoscopy and intraoperatively and analysed by 16S rRNA V1-V2 gene sequencing.</div></div><div><h3>Results</h3><div>Before MPB/OA+ivOA, the genera <em>Phocaeicola</em> (10 %), <em>Bacteroides</em> (7 %) and <em>unclassified Ruminococcaceae</em> (6 %) were predominant. After preparation, all bacteria were reduced except <em>Enterococcus</em> (7 %) and <em>Escherichia/Shigella</em> (6 %), which had increased. Significant reductions were seen for <em>Bacteroides</em> (<em>p</em> = 0.01), <em>Haemophilus</em> (<em>p</em> = 0.047), <em>Holdemanella</em> (<em>p</em> = 0.004), <em>Neisseria</em> (<em>p</em> = 0.004), <em>Odoribacter</em> (<em>p</em> = 0.027), <em>unclassified Clostridiales</em> (<em>p</em> = 0.008) and <em>unclassified Ruminococcacaeae</em> (<em>p</em> = 0.009). Large effect sizes (Cohens’d) were seen for <em>Bacteroidetes</em> (<em>d</em> = 0.864) and <em>unclassified Ruminococcacaeae</em> (<em>d</em> = 0.909).</div></div><div><h3>Conclusions</h3><div>In our pilot study, we observed a significant reduction in seven bacterial genera after MBP/OA+ivAB in patients with CRC. Some of these bacterial genera have been associated with anastomotic insufficiency. Further, large in-depth analyses are needed to evaluate perioperative microbial drift with postoperative complications.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100302"},"PeriodicalIF":0.8,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827128","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":"Trauma Care in Angola: Highlights and Strategic Insights from the 2nd Angolan Trauma Surgery Congress","authors":"Márcio Teodoro da Costa Gaspar ,&nbsp;Paulo Campos ,&nbsp;Nuno Sevivas ,&nbsp;João Maia Teixeira ,&nbsp;Rodrigues Leonardo ,&nbsp;Agostinho Matamba ,&nbsp;Pedro Henrique Ferreira Alves ,&nbsp;Matchecane Tlhomulo ,&nbsp;Adilson Oliveira ,&nbsp;João Abreu ,&nbsp;Maricê Castro ,&nbsp;Roseny Rodrigues ,&nbsp;Lina Antunes ,&nbsp;Eduardo Catoquessa ,&nbsp;Filomena Amaral ,&nbsp;Gade Miguel ,&nbsp;Valdano Manuel ,&nbsp;Tania Monteiro ,&nbsp;Jéssica Campos ,&nbsp;Bruno Sinedino ,&nbsp;Belmiro Rosa","doi":"10.1016/j.sipas.2025.100300","DOIUrl":"10.1016/j.sipas.2025.100300","url":null,"abstract":"<div><div>The 2nd Angolan Trauma Surgery Congress, held in Luanda, brought together healthcare professionals, surgeons, and policymakers to address the pressing challenges in trauma care across Angola. This article summarizes the congress’s key themes, clinical insights, and policy discussions, with an emphasis on improving trauma systems, multidisciplinary coordination, and evidence-based surgical practices. The sessions underscored the urgent need for capacity building, trauma registries, and the standardization of pre-hospital and hospital-based trauma care protocols. The discussions also provided a platform for evaluating Angola’s current surgical response to polytrauma, highlighting advances, limitations, and future directions.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"22 ","pages":"Article 100300"},"PeriodicalIF":0.8,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144810419","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}