The Journal of ExtraCorporeal Technology最新文献

{"title":"Standardized Therapies after ECMO Program (STEP); A Novel Approach to Pediatric post-ECMO Care","authors":"Rebekah KH Shappley, Christen M Holder, Constance E Poplos, Pilar Anton-MArtin, Thomas Spentzas, Toni M Whitaker, Swati Karmarkar, Samir H Shah, Hitesh Singh Sandhu","doi":"10.1051/ject/2024009","DOIUrl":"https://doi.org/10.1051/ject/2024009","url":null,"abstract":"Background: The study objective was to characterize compliance with Standardized Therapy after ECMO Program (STEP), an intentional discharge pathway for extracorporeal membrane oxygenation (ECMO) survivors in a US pediatric hospital. \u0000Methods: The program identified pediatric ECMO survivors before discharge, reviewed and requested appropriate consultations, educated families on ECMO sequelae, and sent ECMO summaries to pediatricians.Compliance with institutional post-ECMO guidelines was evaluated before and after STEP implementation. \u0000Results: We identified 77 ECMO survivors to hospital discharge (36 [46.8%] before and 41 [53.2%] after STEP implementation). There was a significant increase in complete (38.8% .vs 74.2%, p < 0.001) and time-appropriate neurodevelopmental testing (71.4% vs. 95.6%, p = 0.03). Significant increase in inpatient evaluations by neurology (52.7% vs. 75.6%, p = 0.03) and audiology (66.7% vs. 87.8%, p = 0.02), and in referrals for outpatient audiology (66.6 vs. 95.1%, p = 0.002), physical therapy (P.T.) (63.8% vs. 95.1%, p = 0.001), occupational therapy (O.T.) (63.8% vs. 95.1%, p = 0.001) and speech-language pathology (S.L.P.) (55.5% vs. 95.1%, p < 0.001) were noted. \u0000Conclusion: Implementing an intentional discharge pathway for pediatric ECMO survivors (STEP) successfully increases inpatient and outpatient compliance with hospital and Extracorporeal life support organization (ELSO) follow-up guidelines. It leads to timely and complete neurodevelopmental evaluation.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"18 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141107111","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 routine del Nido cardioplegia vs two types of modified del Nido cardioplegias for myocardial protection among patients undergoing coronary artery bypass grafting (CABG) surgeries: a randomized double-blind clinical trial.","authors":"Babar Ali, Salman Pervaiz Butt, Mohammad Ghazi Nour Ghazi Nour, Mohammad Bagher Khosravi, Naeimehossadat Asmarian, Ali Raza Shoul, Arun Kumar, Umer Darr, Gopal Bhatnagar","doi":"10.1051/ject/2024011","DOIUrl":"https://doi.org/10.1051/ject/2024011","url":null,"abstract":"Background: The del Nido Cardioplegia Solution is a widely used method for myocardial protection in various settings. However, there is limited evidence of its effectiveness in adult cardiac surgery, and the baseline solution, Plasma Lyte A, is not readily available, leading to the use of alternative baseline solutions. This study aims to investigate the effectiveness of routine del Nido cardioplegia in adult cardiac surgery and the impact of different baseline solutions on myocardial protection and other perioperative outcomes.\u0000Methods: This study was a prospective, double-blind randomized parallel group clinical trial conducted at a single tertiary care hospital in Iran. A total of 187 adult patients were evaluated for eligibility, of which 120 met the inclusion criteria for elective isolated CABG surgery. The patients were randomly assigned to three groups, with each group consisting of 40 patients. The control group received normal saline-based routine del Nido cardioplegia, Intervention Group A received ringer lactate-based del Nido cardioplegia, and Intervention Group B received plain ringer-based del Nido cardioplegia. The levels of CK-MB, Troponin T, Troponin I, and lactate were primarily assessed at four different times: after anesthesia induction (Baseline), 2 hours, 12 hours, and 24 hours.\u0000Results: Preoperative demographic and clinical characteristics were the same among groups with insignificant differences (p > 0.05). There was no significant difference among groups based on CK-MB, Troponin T, Troponin I, and lactate levels (p=0.078, 0.143, 0.311, and 0.129 respectively). However, there was a significant difference in the time effect of Troponin T and Lactate (p=0.034, p= < 0.001).\u0000Conclusion: Normal saline, Ringer lactate, and plain Ringer provide comparable myocardial protection in adult-isolated CABG surgery with modified del Nido cardioplegia. Larger studies are needed to identify the best alternative to Plasma Lyte A while maintaining del Nido Cardioplegia as the control.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"120 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140977456","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":"Traditional vs. modified Ringer lactate-based del Nido cardioplegia impacts on clinical outcomes in patients undergoing coronary artery bypass grafting: results from a clinical trial","authors":"Naser Kachoueian, Farhad Gorjipour, Salimeh Janghorban, Majid Torkashvand, Mohammad Parsa Mahjoob, Hossein Aslani, Mohamadjavad Mehrabanian, Fazel Gorjipour","doi":"10.1051/ject/2024010","DOIUrl":"https://doi.org/10.1051/ject/2024010","url":null,"abstract":"Introduction: myocardial protection with cardioplegia solution is one of the precautions during coronary bypass grafting surgery (CABG) with cardiopulmonary bypass (CPB) to reduce myocardial damage and ischemia/reperfusion injuries. Unfortunately, the major component of the del Nido cardioplegia solution, Plasma-Lyte A, is unreachable in Iran due to high cost. Therefore, we have utilized lactate Ringer's solution as the base solution for our modified del Nido solution (LR DN).\u0000Study design and methods: the present clinical trial was performed on 18-75 year old patients (EF>35%) undergoing CABG with CPB in Imam Hossein hospital Tehran-Iran in 2021. Patients were randomly allocated to LR DN (modified del Nido cardioplegia) and PL DN (standard del Nido cardioplegia solution) groups. Serum level of cardiac troponin I (cTnI) at baseline, declamp, ICU admission, and 24 hours after admission, the type and dosage of inotrope agents, EF, rate of arrhythmia after clamp removal and lactate level were measured and compared between groups.\u0000Results: 109 patients were recruited. There were no statistically significant differences between the PL DN cardioplegia and LR DN groups for cardiopulmonary bypass times, cardiac enzymes, transfusion requirements, and arterial blood gases. However, postoperative serum levels of cTnI among patients in the LR DN group was significantly higher than patients of the PL DN group after ICU admission and 24 hours postoperatively. Also, more patients needed epinephrine administration in the operating room in the LR DN group (29.8% vs. 11.5%; p: 0.019 vs. PL DN group).\u0000Conclusion: we concluded that standard del Nido cardioplegia solution offers better myocardial protection compared with Ringer's lactate-based del Nido cardioplegia in adult patients undergoing CABG with CPB. We recommend using standard del Nido cardioplegia with a base of Plasma-Lyte A for patients presenting for CABG surgery.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"20 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140976670","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":"Adapting and Applying Student-centered Learning in a Perfusion Clinical Rotation","authors":"James R Neal, Caitlin Blau, Clint Colby","doi":"10.1051/ject/2024001","DOIUrl":"https://doi.org/10.1051/ject/2024001","url":null,"abstract":"Abstract\u0000 \u0000While the process of teaching student perfusionists has been in development since the 1950s, the publication of the processes to improve perfusion clinical education has been largely lacking.  Publications regarding education from other allied health and medical fields have shown the value of student-centered learning.  The use of reflective practice to move perfusion students from thinking on actions after cardiopulmonary bypass (CPB) to reflecting and reacting on actions during CPB is better encouraged by moving from a teacher-centered to student-centered clinical model.   \u0000 \u0000Our institution’s teaching process has developed into a multi-point procedure with the goal of making our students into reflective practicing clinicians.  Student preceptor evaluations were reversed to allow the student to evaluate themselves first, with feedback from the preceptor given subsequently.  Additionally, a biweekly student educational session, where the student chooses a topic and reviews current evidence-based practice, was instituted.  The clinical program director serves as the moderator and clinical expert to facilitate problem-based learning during the sessions.  Students were also given 3 skill/experience levels with goals to reach and move through during the rotation.  These student levels were also helpful to our preceptors in knowing what each student’s skill level was throughout their rotation.\u0000Overall, moving from a teacher-centered to a student-centered clinical rotation has been helpful in making students familiar with reflective practice, self-evaluation, evidence-based practice, and problem-based learning.  The incorporation of these processes will hopefully lead students to becoming lifelong reflective perfusionists.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"62 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139836694","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":"Adapting and Applying Student-centered Learning in a Perfusion Clinical Rotation","authors":"James R Neal, Caitlin Blau, Clint Colby","doi":"10.1051/ject/2024001","DOIUrl":"https://doi.org/10.1051/ject/2024001","url":null,"abstract":"Abstract\u0000 \u0000While the process of teaching student perfusionists has been in development since the 1950s, the publication of the processes to improve perfusion clinical education has been largely lacking.  Publications regarding education from other allied health and medical fields have shown the value of student-centered learning.  The use of reflective practice to move perfusion students from thinking on actions after cardiopulmonary bypass (CPB) to reflecting and reacting on actions during CPB is better encouraged by moving from a teacher-centered to student-centered clinical model.   \u0000 \u0000Our institution’s teaching process has developed into a multi-point procedure with the goal of making our students into reflective practicing clinicians.  Student preceptor evaluations were reversed to allow the student to evaluate themselves first, with feedback from the preceptor given subsequently.  Additionally, a biweekly student educational session, where the student chooses a topic and reviews current evidence-based practice, was instituted.  The clinical program director serves as the moderator and clinical expert to facilitate problem-based learning during the sessions.  Students were also given 3 skill/experience levels with goals to reach and move through during the rotation.  These student levels were also helpful to our preceptors in knowing what each student’s skill level was throughout their rotation.\u0000Overall, moving from a teacher-centered to a student-centered clinical rotation has been helpful in making students familiar with reflective practice, self-evaluation, evidence-based practice, and problem-based learning.  The incorporation of these processes will hopefully lead students to becoming lifelong reflective perfusionists.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"22 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139777006","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 Checklist Checkup & Checklist fatigue- Say what? How does it impact clinical perfusion practice.","authors":"Bharat Datt","doi":"10.1051/ject/2023046","DOIUrl":"https://doi.org/10.1051/ject/2023046","url":null,"abstract":"","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"82 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138998659","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":"Preliminary report of extracorporeal blood purification therapy in patients receiving LVAD: Cytosorb or Jafron HA330","authors":"Z. Nurmykhametova, T. Lesbekov, R. Kaliyev, Bolat Bekishev, Nilufar Jabayeva, S. Novikova, L. Faizov, I. Vakhrushev, Yuriy Pya","doi":"10.1051/ject/2023048","DOIUrl":"https://doi.org/10.1051/ject/2023048","url":null,"abstract":"Background: Left ventricular assist device (LVAD) candidates are at increased risk of immune dysregulation and infectious complications. To attenuate the elevated proinflammatory cytokine levels and associated adverse clinical outcomes, it has been postulated that extracorporeal blood purification could improve the overall survival rate and morbidity of patients undergoing LVAD implantation.\u0000Methods: We retrospectively reviewed prospectively collected data of 15 patients who underwent LVAD implantation at our center between January 2021 and March 2022. Of these, 15 (100%) who received HeartMate 3™ (St. Jude Medical, Abbott, MN, USA) device were eligible. Intraoperatively, patients were single randomized 1:1:1 to three groups: group 1, patients who received Cytosorb therapy (n=5; installed in the CPB circuit); group 2, patients who received Jafron HA330 (n=5; installed in the CPB circuit); and control group 3, patients who did not receive filter (n=5; usual care, neither Cytosorb nor Jafron during CPB). Baseline patient characteristics and intraoperative data were compared between the groups. Blood sample analyses were performed to assess the levels of inflammatory markers (IL-1, 6, 8; CRP, Leukocyte, Lactate, PCT, NT-proBNP, TNF-α) in both preoperative and postoperative data.\u0000Results: Baseline patient characteristics were similar in all three groups. We found that IL1α; IL 6; IL8; Lactatedehydrogenase, PCT, pro-BNP, CRP; Leukocyte, and TNFα levels significantly increased with LVAD implantation and that neither Cytosorb nor Jafron influenced this response. In-hospital mortality and overall survival during follow-up were similar among the groups.\u0000Conclusion: Our preliminary results showed that hemoadsorption therapy using Cytosorb or Jafron hemoadsorption (HA) 330 may not be clinically beneficial for patients with advanced heart failure undergoing LVAD implantation. Large prospective studies are needed to evaluate the potential role of HA therapy in improving outcomes in patients undergoing LVAD implantation.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"98 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139005520","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 ECMO Therapy: Monitoring Oxygenator Functionality and Identifying Key Indicators, Factors, and Considerations for Changeout","authors":"Mr. Salman Pervaiz Butt, Nabeel Razzaq, Yasir Saleem, Bill Cook, Salman Abdulaziz","doi":"10.1051/ject/2023047","DOIUrl":"https://doi.org/10.1051/ject/2023047","url":null,"abstract":"Introduction:\u0000The optimal timing for extracorporeal membrane oxygenation (ECMO) circuit change-out is crucial for the successful management of patients with severe cardiopulmonary failure. This comprehensive review examines the various factors that influence the timing of oxygenator replacement in the ECMO circuit. By considering these factors, clinicians can make informed decisions to ensure timely and effective change-out, enhancing patient outcomes and optimizing the delivery of ECMO therapy.\u0000 \u0000Methodology:\u0000A thorough search of relevant studies on ECMO circuit and oxygenator change-out was conducted using multiple scholarly databases and relevant keywords. Studies published between 2017 and 2023 were included, resulting in 40 studies that met the inclusion criteria.\u0000 \u0000Discussion:\u0000Thrombosis within the membrane oxygenator and its impact on dysfunction were identified as significant contributors, highlighting the importance of monitoring coagulation parameters and gas exchange. Several factors, including fibrinogen levels, pre and post-membrane blood gases, plasma free hemoglobin, D-dimers, platelet function, flows and pressures, and anticoagulation strategy, were found to be important considerations when determining the need for an oxygenator or circuit change-out. The involvement of a multidisciplinary team and thorough preparation were also highlighted as crucial aspects in this process.\u0000 \u0000Conclusion:\u0000In conclusion, managing circuit change-outs in ECMO therapy requires considering factors such as fibrinogen levels, blood gases, plasma free hemoglobin, D-dimers, platelet function, flows, pressures, and anticoagulation strategy. Monitoring these parameters allows for early detection of issues, timely interventions, and optimized ECMO therapy. Standardized protocols, personalized anticoagulation approaches, and non-invasive monitoring techniques can improve safety and effectiveness of circuit change-outs. Further research and collaboration are needed to advance ECMO management and enhance patient outcomes.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"33 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139006624","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":"Perfusion techniques for an 800g premature neonate undergoing Arterial Switch Procedure for Transposition of the Great Arteries","authors":"Richard Owens, Madeline Loftin, Kellen Rosten, Douglas Fisher, Blake Denison, Erin Gottlieb, Charles Fraser","doi":"10.1051/ject/2023045","DOIUrl":"https://doi.org/10.1051/ject/2023045","url":null,"abstract":"Early cardiac surgery in neonates and infants with congenital heart disease has been performed since the middle to late years of the twentieth century. To date there are very few reports of successful congenital heart surgery using cardiopulmonary bypass (CPB) in premature babies less than 1000grams with serious congenital heart disease. Limited information is available in the literature describing perfusion techniques for this extremely fragile patient population. Miniaturization of the CPB circuit contributes multiple factors that affect this population significantly. These factors include the reduction of patient to circuit ratios, volume of distribution of pharmacological agents, management of pressure gradients within the CPB system and increased tactile control by the attending perfusionist. Careful management of the physiological environment of the patient is of utmost importance and can mitigate risks during CPB, including volume shifts into the interstitial space, electrolyte, and acid-base imbalance, and intracranial hemorrhage. We report perfusion techniques successfully utilized during the surgical repair of transposition of the great arteries for an 800g, 28-week-old neonate. CPB techniques for the smallest and youngest patients may be executed safely when proper physical, chemical and perfusion process adjustments are made and managed meticulously.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":" 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610127","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":"An in Vitro Comparison of Intra-Operative Isohemagglutinin and Human Leukocyte Antigen Removal Techniques in Pediatric Heart Transplant","authors":"Emily A Hayes, Ashley B Walczak, Erin Goodhue Meyer, Kathleen K Nichol, Matthew A Deitemyer, V. Duffy, Michelle Moore Padilla, Robert J Gajarski, D. Nandi","doi":"10.1051/ject/2023034","DOIUrl":"https://doi.org/10.1051/ject/2023034","url":null,"abstract":"Background: Highly sensitized pediatric patients awaiting heart transplantation experience longer wait times and higher waitlist mortality. To improve the likelihood of successful transplantation, various strategies have been utilized, including peri-operative plasmapheresis, to broaden potential donor pools.\u0000Methods: This in vitro study utilized two membrane-based plasmapheresis (MP, Prismaflex) and two centrifuge-based plasmapheresis (CP, Spectra Optia, Terumo BCT) circuits incorporated into four separate extracorporeal (EC) circuits primed with high titer, highly sensitized type O donor whole blood. Assays were performed to determine baseline anti-A and B isohemagglutinin titers (IT) and anti-human leukocyte antigen (HLA) antibodies and then at 30-minute increments until completion of the run at two hours.\u0000Results:  There was a decrease in anti-A and anti-B IgM and IgG titers with both MP and CP.  Mean anti-A and anti-B titer reduction was by 4.625 titers (93.7% change) and 4.375 titers (93.8% change) using MP and CP, respectively.  At two hours of apheresis, CP reduced mean fluorescence intensity (MFI) by 2-3.5 fold and MP reduced MFI by 1.7-2.5 fold.\u0000Conclusions: In this in vitro plasmapheresis model of IT and anti-HLA antibody reduction, both MP and CP can be used quickly and effectively to reduce circulating antibodies, and CP may have some greater degree of efficiency. Further in vivo research on incorporating CP or MP into EC circuits at the time of transplant is needed. However, with further clinical research, there is potential to broaden potential donors and improve patient safety in sensistized patients.","PeriodicalId":309024,"journal":{"name":"The Journal of ExtraCorporeal Technology","volume":"220 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134555740","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}