A Rare Case of Cerulean Cataract in a Child with Cushing's Syndrome and Juvenile Idiopathic Arthritis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report A Rare Case of Cerulean Cataract in a Child with Cushing's Syndrome and Juvenile Idiopathic Arthritis Meera Pohane, Vishwajit Suryawanshi, Ranjana sharma, Archana Dhengare This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6508847/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cerulean cataracts are uncommon congenital lens opacities that often manifest as bluish-white opacities in the lens throughout infancy. It is pretty uncommon for it to co-occur with both Cushing's disease and juvenile idiopathic arthritis (JIA), even though it may manifest alone. This instance emphasizes how important it is to diagnose and treat uncommon pediatric presentations using a multidisciplinary approach. Case Presentation: A 9-year-old child with Cushing's disease and previously diagnosed JIA presents with a complaint of progressive eyesight loss, arthralgias, and morning stiffness. His ophthalmologic evaluation revealed that he could only see light in each eye. A dense posterior subcapsular Cataract was observed by slit-lamp examination, with the characteristic cerulean Cataract presentation of tiny white opacities in concentric rings. Additionally, he developed oedema in his hands and legs. The patient's visual acuity fully recovered after having both cataracts removed. Conclusions: The significance of early and regular ophthalmologic screening in children with chronic systemic disorders is underscored by the peculiar correlation seen between cerulean cataracts, JIA, and Cushing's syndrome. It also shows that early surgery may be linked to acceptable visual outcomes, even in the face of perplexing clinical presentations. Cerulean Cataract Juvenile Idiopathic Arthritis (JIA) Cushing’s Syndrome Pediatric Ophthalmology Figures Figure 1 Background Cerulean cataract is a rare type of congenital cataract, typically marked by small, bluish-white opacities arranged in concentric layers within the lens. While it’s often detected in childhood, it may go unnoticed until vision becomes significantly impaired. On the other hand, Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease that can lead to various systemic complications, including eye involvement, particularly uveitis. Cushing’s syndrome, though less common in children, is known to affect multiple systems and can also contribute to cataract development, especially in cases involving long-term steroid use. Although there is some literature on cataracts in patients with either JIA or Cushing’s syndrome, reports of cerulean cataracts occurring alongside both conditions are extremely scarce. This case brings attention to a unique combination of diagnoses in a young child and emphasizes the need for early and regular eye screening in patients with systemic autoimmune or endocrine disorders. The rarity of this triad makes it an important case to share with the clinical community. Case Presentation A 9-year-old boy arrived in the pediatric unit complaining of stiffness, joint discomfort, and rapidly declining vision. He had been diagnosed with Cushing's syndrome and juvenile idiopathic arthritis (JIA) at the age of four. Over the last six months, his parents noticed his vision slowly declining, particularly in low light. In addition, he had glare sensitivity, was frequently squinting, and occasionally experienced double vision and fading colours. Upon examination, the tiny joints in both wrists and ankles were palpably swollen, and the discomfort prevented them from moving freely. According to ophthalmologic evaluation, each eye's visual acuity was limited to light perception. A slit-lamp examination revealed thick posterior subcapsular cataracts, typical signs of cerulean cataracts, and many tiny, white opacities arranged in concentric rings within the lens. The patient required Cataract extractions in both eyes due to the severity of their visual impairment. The postoperative period was uneventful, and the operations were straightforward. Excellent visual recovery was seen during the postoperative followup assessment, with complete restoration of visual acuity and no signs of recurrence or postoperative inflammation. There was no notable family history of autoimmune illness or cataracts. Paediatricians, ophthalmologists, and rheumatologists worked closely together to handle the case, enabling a thorough and well-coordinated treatment procedure. Primary history collection and manifestation A 9-year-old male patient with a medical history of Cushing’s syndrome and Juvenile Idiopathic Arthritis was brought to the hospital by his relatives and admitted to the pediatric ward. He presented with symptoms including joint pain, joint swelling, stiffness, blurry vision, faded color perception, difficulty seeing at night, light sensitivity, double vision, and reduced visual acuity during childhood. Medical, family and psychosocial history: - Cushing's syndrome and Juvenile Idiopathic Arthritis had previously been diagnosed. There are four people in the home as per household history. Relevant past interventions with outcomes: - Relevant past interventions with outcomes: - Cerulean cataract with Cushing's syndrome and Juvenile Idiopathic Arthritis on diagnosed in the last 5 years Clinical Findings: On examination, visual acuity in both eyes was limited to following light. A slit lamp examination of both eyes showed small white opacities arranged in concentric layers, along with a dense posterior subcapsular cataract. Timeline: A 9-year-old male patient with a medical history of Cushing's syndrome and Juvenile Idiopathic Arthritis was brought to the hospital by his relatives and admitted to the pediatric ward. He presented with symptoms including joint pain, joint swelling, stiffness, blurry vision, faded color perception, difficulty seeing at night, light sensitivity, double vision, and reduced visual acuity during childhood. On examination, visual acuity in both eyes was limited to following light. A slit lamp examination of both eyes showed small white opacities arranged in concentric layers, along with a dense posterior subcapsular cataractand on physical examination joint swelling both hand and leg. The patient successfully underwent cataract surgery on both eyes, with each procedure completed without complications, resulting in normal final visual acuity in both eyes. Investigation: Genera Physical Assessment – On examination, visual acuity in both eyes was limited to following light. A slit lamp examination of both eyes showed small white opacities arranged in concentric layers, along with a dense posterior subcapsular cataractand on physical examination joint swelling both hand and leg. Declarations Ethics approval and consent to participate Not applicable. Consent for publication Written informed consent was taken from the patient’s parents for publication of data and images. Consent for study Written informed consent was taken from patient’s parents for this study. Availability of data and materials All data generated or analyzed during this study has taken from patients file and other literature. Competing interests The authors declare that they have no competing interests. Funding This study was supported by the Datta Meghe Institute of Higher Education and Research. Authors' contributions Meera Pohane: Conceptualization, manuscript drafting. Vishwajit Suryawanshi: Clinical management, data acquisition. Ranjana Sharma: Ophthalmologic diagnosis and interpretation. Archana Dhengare: Literature review, critical manuscript revision. All authors read and approved the final manuscript. Acknowledgements We thank the patient and his family for their support and cooperation. References Angeles-Han S, Yeh S. Prevention and Management of Cataracts in Children with Juvenile Idiopathic Arthritis–Associated Uveitis. Curr Rheumatol Rep. 2012;14(2):142–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6508847","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":460290988,"identity":"88ec4fbd-3c23-444f-8bb1-3d78a67ae4da","order_by":0,"name":"Meera Pohane","email":"","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Meera","middleName":"","lastName":"Pohane","suffix":""},{"id":460290989,"identity":"670c90c3-1d5a-4f81-89e9-68ace8917053","order_by":1,"name":"Vishwajit Suryawanshi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYDACZgY2KIux8YFEBUiEuYFYLczNBhZnQDQjAS0McC3sbRKVbWDr8GsxOM7+7DHPn8P5BscPNkjcnFcbzd8O1PKjYhtuLYd5zI152w5bbjiT2GA4c9vx3BmHGRsYe87cxqlFspmHTZq34bCBwYHEhmTJbcdyG4BamBnb8GlhfyYNdJiBwfmHDYf/zjmWO5+QFn5mBjNpHjaglhuJjQ2SDTW5Gwhr4TGTnNuWbiB542Ezg8SxA7kbgVoO4vMLG//xZxJv/lgb8J1Pf/5DoqYud975wwcf/KjArQUOFA6AqcNg8gBh9UAg3wCm6ohSPApGwSgYBSMLAACHhlzwHDP/vgAAAABJRU5ErkJggg==","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Vishwajit","middleName":"","lastName":"Suryawanshi","suffix":""},{"id":460290990,"identity":"cedc0ff2-e581-412a-8fde-81fcc8001bbe","order_by":2,"name":"Ranjana sharma","email":"","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ranjana","middleName":"","lastName":"sharma","suffix":""},{"id":460290991,"identity":"e47ec1ea-0d6a-4b0d-9baa-fe9b58319949","order_by":3,"name":"Archana Dhengare","email":"","orcid":"","institution":"Datta Meghe Institute of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Archana","middleName":"","lastName":"Dhengare","suffix":""}],"badges":[],"createdAt":"2025-04-23 04:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6508847/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6508847/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83420819,"identity":"6bf97692-4156-478d-87f5-9bc8cea274ea","added_by":"auto","created_at":"2025-05-26 01:54:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":827050,"visible":true,"origin":"","legend":"\u003cp\u003eClinical imaging using a slit lamp revealed cerulean cataracts in both the right and left eyes. Physical examination showed joint swelling in both hands and legs.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6508847/v1/ff8118117f27d10d252f6ad3.png"},{"id":84683531,"identity":"e436d616-45bb-47e3-91f2-9e629234f780","added_by":"auto","created_at":"2025-06-16 08:39:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1546747,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6508847/v1/cb0c6cf2-e490-411e-a43c-949f09db0c34.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Rare Case of Cerulean Cataract in a Child with Cushing's Syndrome and Juvenile Idiopathic Arthritis","fulltext":[{"header":"Background","content":"\u003cp\u003eCerulean cataract is a rare type of congenital cataract, typically marked by small, bluish-white opacities arranged in concentric layers within the lens. While it\u0026rsquo;s often detected in childhood, it may go unnoticed until vision becomes significantly impaired. On the other hand, Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease that can lead to various systemic complications, including eye involvement, particularly uveitis. Cushing\u0026rsquo;s syndrome, though less common in children, is known to affect multiple systems and can also contribute to cataract development, especially in cases involving long-term steroid use. Although there is some literature on cataracts in patients with either JIA or Cushing\u0026rsquo;s syndrome, reports of cerulean cataracts occurring alongside both conditions are extremely scarce. This case brings attention to a unique combination of diagnoses in a young child and emphasizes the need for early and regular eye screening in patients with systemic autoimmune or endocrine disorders. The rarity of this triad makes it an important case to share with the clinical community.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 9-year-old boy arrived in the pediatric unit complaining of stiffness, joint discomfort, and rapidly declining vision. He had been diagnosed with Cushing's syndrome and juvenile idiopathic arthritis (JIA) at the age of four. Over the last six months, his parents noticed his vision slowly declining, particularly in low light. In addition, he had glare sensitivity, was frequently squinting, and occasionally experienced double vision and fading colours.\u003c/p\u003e \u003cp\u003eUpon examination, the tiny joints in both wrists and ankles were palpably swollen, and the discomfort prevented them from moving freely. According to ophthalmologic evaluation, each eye's visual acuity was limited to light perception. A slit-lamp examination revealed thick posterior subcapsular cataracts, typical signs of cerulean cataracts, and many tiny, white opacities arranged in concentric rings within the lens.\u003c/p\u003e \u003cp\u003eThe patient required Cataract extractions in both eyes due to the severity of their visual impairment. The postoperative period was uneventful, and the operations were straightforward. Excellent visual recovery was seen during the postoperative followup assessment, with complete restoration of visual acuity and no signs of recurrence or postoperative inflammation.\u003c/p\u003e \u003cp\u003eThere was no notable family history of autoimmune illness or cataracts. Paediatricians, ophthalmologists, and rheumatologists worked closely together to handle the case, enabling a thorough and well-coordinated treatment procedure.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePrimary history collection and manifestation\u003c/h2\u003e \u003cp\u003eA 9-year-old male patient with a medical history of Cushing\u0026rsquo;s syndrome and Juvenile Idiopathic Arthritis was brought to the hospital by his relatives and admitted to the pediatric ward. He presented with symptoms including joint pain, joint swelling, stiffness, blurry vision, faded color perception, difficulty seeing at night, light sensitivity, double vision, and reduced visual acuity during childhood.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMedical, family and psychosocial history: -\u003c/h3\u003e\n\u003cp\u003eCushing's syndrome and Juvenile Idiopathic Arthritis had previously been diagnosed. There are four people in the home as per household history.\u003c/p\u003e\n\u003ch3\u003eRelevant past interventions with outcomes: -\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eRelevant past interventions with outcomes: -\u003c/div\u003e \u003cp\u003eCerulean cataract with Cushing's syndrome and Juvenile Idiopathic Arthritis on diagnosed in the last 5 years\u003c/p\u003e\n\u003ch3\u003eClinical Findings:\u003c/h3\u003e\n\u003cp\u003eOn examination, visual acuity in both eyes was limited to following light. A slit lamp examination of both eyes showed small white opacities arranged in concentric layers, along with a dense posterior subcapsular cataract.\u003c/p\u003e\n\u003ch3\u003eTimeline:\u003c/h3\u003e\n\u003cp\u003eA 9-year-old male patient with a medical history of Cushing's syndrome and Juvenile Idiopathic Arthritis was brought to the hospital by his relatives and admitted to the pediatric ward. He presented with symptoms including joint pain, joint swelling, stiffness, blurry vision, faded color perception, difficulty seeing at night, light sensitivity, double vision, and reduced visual acuity during childhood. On examination, visual acuity in both eyes was limited to following light. A slit lamp examination of both eyes showed small white opacities arranged in concentric layers, along with a dense posterior subcapsular cataractand on physical examination joint swelling both hand and leg. The patient successfully underwent cataract surgery on both eyes, with each procedure completed without complications, resulting in normal final visual acuity in both eyes.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInvestigation:\u003c/h2\u003e \u003cp\u003eGenera Physical Assessment \u0026ndash; On examination, visual acuity in both eyes was limited to following light. A slit lamp examination of both eyes showed small white opacities arranged in concentric layers, along with a dense posterior subcapsular cataractand on physical examination joint swelling both hand and leg.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003cbr\u003e\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003cbr\u003e\u003c/strong\u003eWritten informed consent was taken from the patient’s parents for publication of data and images.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was taken from patient’s parents for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003cbr\u003e\u003c/strong\u003eAll data generated or analyzed during this study has taken from patients file and other literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003cbr\u003e\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003cbr\u003e\u003c/strong\u003eThis study was supported by the Datta Meghe Institute of Higher Education and Research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eMeera Pohane: Conceptualization, manuscript drafting.\u003c/li\u003e\n \u003cli\u003eVishwajit Suryawanshi: Clinical management, data acquisition.\u003c/li\u003e\n \u003cli\u003eRanjana Sharma: Ophthalmologic diagnosis and interpretation.\u003c/li\u003e\n \u003cli\u003eArchana Dhengare: Literature review, critical manuscript revision.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eAll authors read and approved the final manuscript.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003cbr\u003e\u0026nbsp;We thank the patient and his family for their support and cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAngeles-Han S, Yeh S. Prevention and Management of Cataracts in Children with Juvenile Idiopathic Arthritis\u0026ndash;Associated Uveitis. Curr Rheumatol Rep. 2012;14(2):142\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"
[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cerulean Cataract, Juvenile Idiopathic Arthritis (JIA), Cushing’s Syndrome, Pediatric Ophthalmology","lastPublishedDoi":"10.21203/rs.3.rs-6508847/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6508847/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Cerulean cataracts are uncommon congenital lens opacities that often manifest as bluish-white opacities in the lens throughout infancy. It is pretty uncommon for it to co-occur with both Cushing's disease and juvenile idiopathic arthritis (JIA), even though it may manifest alone. This instance emphasizes how important it is to diagnose and treat uncommon pediatric presentations using a multidisciplinary approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation: \u003c/strong\u003eA 9-year-old child with Cushing's disease and previously diagnosed JIA presents with a complaint of progressive eyesight loss, arthralgias, and morning stiffness. His ophthalmologic evaluation revealed that he could only see light in each eye. A dense posterior subcapsular Cataract was observed by slit-lamp examination, with the characteristic cerulean Cataract presentation of tiny white opacities in concentric rings. Additionally, he developed oedema in his hands and legs. The patient's visual acuity fully recovered after having both cataracts removed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThe significance of early and regular ophthalmologic screening in children with chronic systemic disorders is underscored by the peculiar correlation seen between cerulean cataracts, JIA, and Cushing's syndrome. It also shows that early surgery may be linked to acceptable visual outcomes, even in the face of perplexing clinical presentations.\u003c/p\u003e","manuscriptTitle":"A Rare Case of Cerulean Cataract in a Child with Cushing's Syndrome and Juvenile Idiopathic Arthritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-26 01:54:09","doi":"10.21203/rs.3.rs-6508847/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"
[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4b440f83-0f19-4eb1-aa59-28ca02e1f2cf","owner":[],"postedDate":"May 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-16T08:39:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-26 01:54:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6508847","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6508847","identity":"rs-6508847","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
Text is read by the "Ask this paper" AI Q&A widget below.
Extraction quality varies by source — PMC NXML preserves structure
cleanly, OA-HTML may include some navigation residue, and OA-PDF can
have broken hyphenation. The publisher copy
(via DOI)
is the canonical version.