Cardiovascular Revascularization Medicine最新文献

{"title":"Renin-angiotensin system inhibitors use and outcomes of aortic valve replacement: A systematic review and meta-analysis.","authors":"Muhammad Rafay Shahzad Cheema, Anfal Arshad, Sabahat Ul Ain Munir Abbasi, Muhammad Umar, Moiza Hamid, Muhammad Kashif, Raees Riaz Chattha, Areej Babar, Muhammad Sohaib Khan, Saadullah Javed, Sehar Fatima, Zainab Ismail, Hritvik Jain, Abdul Mannan Khan Minhas, Andrew M Goldsweig","doi":"10.1016/j.carrev.2026.04.021","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.04.021","url":null,"abstract":"<p><strong>Background: </strong>Aortic stenosis leads to adverse left ventricular remodeling; aortic valve replacement (AVR) remains the cornerstone of management. We evaluated clinical and echocardiographic outcomes with renin-angiotensin system inhibitor (RASi) use in patients undergoing AVR.</p><p><strong>Methods: </strong>Five electronic databases were systematically queried for studies comparing outcomes with and without RASi post-AVR. Outcomes were pooled using random-effects models to calculate risk ratios (RRs), mean differences, and standardized mean differences with 95% confidence intervals. Outcomes of interest included all-cause and cardiovascular mortality, heart failure, myocardial infarction, stroke/TIA, arrhythmias, pacemaker requirement, acute kidney injury, and echocardiographic parameters.</p><p><strong>Results: </strong>Seventeen studies (16 observational, 1 RCT) including 44,935 patients [RASi: 20,723; no RASi: 24,212] were included. RASi use was associated with significantly reduced all-cause mortality (RR: 0.74; 95% CI: 0.65-0.83; p < 0.0001) and cardiovascular mortality (RR: 0.65; 95% CI: 0.49-0.85; p = 0.002), consistent across TAVR and SAVR subgroups. No significant differences were observed for heart failure, myocardial infarction, stroke, or pacemaker requirement. RASi did not increase acute kidney injury (p = 0.08) or major bleeding (p = 0.67). Echocardiographic outcomes, including peak aortic valve velocity and LV mass index, showed no significant differences between groups.</p><p><strong>Conclusions: </strong>In predominantly observational studies, RASi use following AVR is associated with lower all-cause and cardiovascular mortality without increasing major adverse clinical events. Survival benefits were not accompanied by consistent echocardiographic improvements. Given substantial heterogeneity and residual confounding inherent to observational data, prospective randomized trials are needed to confirm these associations.</p><p><strong>Social media abstract: </strong>Meta-analysis of 17 studies shows survival benefit with ACEI/ARB in the patients undergoing TAVR/SAVR, with no significant differences in HF, MI, stroke/TIA, AF, pacemaker, or echo outcomes.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857431","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":"Saline optical coherence tomography in percutaneous coronary intervention: Practical considerations and technical guidance.","authors":"Bernard Wong, Bharat Khialani, James Xu, Cuneyt Ada, Eugene B Wu, Scott Harding","doi":"10.1016/j.carrev.2026.04.024","DOIUrl":"https://doi.org/10.1016/j.carrev.2026.04.024","url":null,"abstract":"<p><p>Optical coherence tomography (OCT) is a high-resolution intravascular imaging modality that provides detailed assessment of plaque morphology, stent optimization and procedural complications during percutaneous coronary intervention (PCI). Conventional OCT requires injection of contrast for blood clearance during image acquisition, which can increase the risk of contrast-induced nephropathy particularly in patients with renal dysfunction. Saline-based OCT has emerged as an alternative strategy to reduce contrast exposure, with available data supporting its safety and diagnostic quality in a substantial proportion of cases. However, its adoption remains limited, largely due to technical challenges in achieving adequate blood clearance with saline. This review article aims to outline the differences in physical properties between saline and contrast, highlights practical technical considerations for saline-based OCT acquisition, and proposes strategies for workflow integration in contemporary PCI practice.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147844603","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":"Editorial: Impact of elevated lipoprotein(a) on epicardial coronary flow conductance and endoluminal atherosclerotic disease distribution","authors":"Ori Waksman,&nbsp;Hector M. Garcia-Garcia","doi":"10.1016/j.carrev.2025.11.004","DOIUrl":"10.1016/j.carrev.2025.11.004","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"86 ","pages":"Pages 78-80"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514925","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":"Editorial: Left atrial appendage occlusion, antiplatelets and anticoagulants","authors":"David Hildick-Smith","doi":"10.1016/j.carrev.2025.09.007","DOIUrl":"10.1016/j.carrev.2025.09.007","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"86 ","pages":"Pages 10-11"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151257","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 Houston Methodist CTO-PCI Registry: Contemporary risk profile, procedural characteristics, and outcomes of patients undergoing percutaneous coronary intervention for chronic total occlusion","authors":"Chloe Kharsa ,&nbsp;Gal Sella ,&nbsp;Mangesh Kritya ,&nbsp;Yasser M. Sammour ,&nbsp;Rody G. Bou Chaaya ,&nbsp;Jerrin Philip ,&nbsp;Muhammad Haisum Maqsood ,&nbsp;William A. Zoghbi ,&nbsp;Neal S. Kleiman ,&nbsp;Alpesh R. Shah","doi":"10.1016/j.carrev.2025.08.014","DOIUrl":"10.1016/j.carrev.2025.08.014","url":null,"abstract":"<div><h3>Background</h3><div>Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) remains technically challenging, with ongoing debate about procedural success predictors and long-term outcomes. We report real-world data from the Houston Methodist CTO PCI Registry to characterize procedural success, safety, and mid- to long-term outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 507 patients undergoing CTO PCI between 2018 and 2023. Baseline clinical characteristics, procedural details, and outcomes including procedural success, in-hospital complications, and follow-up events were evaluated. Multivariable logistic regression identified predictors of procedural success.</div></div><div><h3>Results</h3><div>The cohort had a mean age of 65.3 ± 10.0 years, 20.9 % women, and a high prevalence of comorbidities (hypertension 96.1 %, diabetes 49.7 %). The mean J-CTO score was 1.8 ± 1.1. Procedural success was achieved in 81.2 % of cases, with low in-hospital mortality (0.4 %) and complication rates. Annual success rates improved from 72.7 % in 2018 to a peak of 86.7 % in 2020, reflecting growing operator experience and evolving techniques. Multivariable analysis showed that age (OR 0.97, 95 % CI [0.95–1.00]; <em>p</em> = 0.03), cumulative air kerma (OR 1.00, 95 % CI [1.00–1.00]; <em>p</em> = 0.003) and lesion length (OR 1.05, 95 % CI [1.03–1.07], <em>p</em> &lt; 0.001) were independent predictors of success. KM analysis revealed a 2-year overall survival of 91.4 %, freedom from clinically driven target lesion revascularization (TLR) of 93.6 % at 2 years, and event-free survival from target lesion failure (TLF) of approximately 85 % at 2 years. At a median follow-up of 745 days, all-cause mortality was 9.2 %, and TLR occurred in 2.4 % of patients.</div></div><div><h3>Conclusion</h3><div>CTO PCI can be performed safely with high success rates and favorable mid- to long-term outcomes in a complex population. Procedural success is primarily driven by lesion-specific factors rather than clinical comorbidities. These findings support the continued evolution and application of CTO PCI in appropriately selected patients.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"86 ","pages":"Pages 51-59"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144974194","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":"Bayesian insights into fractional flow reserve-guided complete revascularization versus culprit-only percutaneous coronary intervention: The authors reply","authors":"Chidubem Ezenna ,&nbsp;Mrinal Murali Krishna ,&nbsp;Meghna Joseph ,&nbsp;Andrew M. Goldsweig","doi":"10.1016/j.carrev.2026.04.006","DOIUrl":"10.1016/j.carrev.2026.04.006","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"86 ","pages":"Pages 97-98"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147677824","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":"Machine learning enhanced prediction of deep sternal wound infection after surgical myocardial revascularization","authors":"Jurij M. Kalisnik ,&nbsp;Janez Zibert ,&nbsp;Tina Kamensek ,&nbsp;Maja Hanuna ,&nbsp;Giuseppe Santarpino ,&nbsp;Theodor Fischlein","doi":"10.1016/j.carrev.2025.07.016","DOIUrl":"10.1016/j.carrev.2025.07.016","url":null,"abstract":"<div><h3>Background</h3><div>Deep sternal wound infection following surgical myocardial revascularization is a potentially devastating complication. This study aims to improve risk prediction of deep sternal wound infection with machine learning algorithms.</div></div><div><h3>Methods</h3><div>This single-center retrospective study contains data from 5221 consecutive patients who underwent surgical myocardial revascularization between 2007 and 2022. Two machine learning algorithms (Extreme Gradient Boosting and Deep Neural Network) were trained with perioperative parameters and validated to detect deep sternal wound infection. Their predictive accuracy was then compared to conventional statistical modelling in terms of multivariable logistic regression. Shapley Additive Explanations was applied to the Extreme Gradient Boosting model to determine the importance of each contributing feature to the occurrence of deep sternal wound infection.</div></div><div><h3>Results</h3><div>The overall incidence of deep sternal wound infection was 3.4 % and 54.7 % occurred within 15 days after surgery. The predictive accuracy of the applied machine learning models was identical (AUC: 0.851, <em>p</em> = 0.982) whereas both, Extreme Gradient Boosting (AUC: 0.851, <em>p</em> = 0.031) and Deep Neural Network (AUC: 0.851, <em>p</em> = 0.017), outperformed the multivariable logistic regression model (AUC: 0.796). According to the Shapley Additive Explanations, the five most important predictive features were body mass index, red blood cell transfusions, pleural effusion requiring pleurocentesis, lower preoperative hemoglobin levels and concomitant peripheral artery disease.</div></div><div><h3>Conclusion</h3><div>Machine learning algorithms significantly improved risk prediction of deep sternal wound infection after surgical myocardial revascularization with the best predictive accuracy presented so far.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"86 ","pages":"Pages 81-87"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144769191","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":"Safety of pre-procedure fasting versus non-fasting protocols before cardiac catheterization – a Bayesian meta-analysis of randomized clinical trials","authors":"Abhishek Chaturvedi ,&nbsp;Abdullah K. Al Qaraghuli ,&nbsp;Beni R. Verma ,&nbsp;Dan Haberman ,&nbsp;Matteo Cellamare ,&nbsp;Cheng Zhang ,&nbsp;Jason Galo ,&nbsp;Waiel Abusnina ,&nbsp;Lior Lupu ,&nbsp;Hayder D. Hashim ,&nbsp;Toby Rogers ,&nbsp;Itsik Ben-Dor ,&nbsp;Lowell F. Satler ,&nbsp;Ron Waksman","doi":"10.1016/j.carrev.2025.08.019","DOIUrl":"10.1016/j.carrev.2025.08.019","url":null,"abstract":"<div><h3>Background</h3><div>Fasting prior to cardiac catheterization is a routine practice to minimize the risk of complications. Recent studies suggest that non-fasting protocols may be equally safe and increase patient satisfaction. We performed a meta-analysis of randomized controlled trials (RCTs) to examine the safety of fasting versus non-fasting prior to cardiac catheterization.</div></div><div><h3>Methods</h3><div>We searched for eligible RCTs comparing fasting versus non-fasting protocols prior to cardiac catheterization from inception through December 21, 2024. Studies were included if they reported at least one of the outcomes of interest– nausea/vomiting, aspiration event, new ventilation/oxygen requirements, hypotension, hypoglycemia, and acute kidney injury. The treatment effect of each outcome was measured using the logarithmic odds ratios (logOR) and estimated under the Bayesian paradigm. Under the hierarchical Bayesian random effect model, we elicited an informative prior for the logOR ∼ (0, 0.1), representing the null hypothesis of no treatment effect. Between-study heterogeneity was elicited with a weakly informative half-Cauchy prior of a 0.5 scale. All analyses were conducted using R version 4.0.</div></div><div><h3>Results</h3><div>9 studies met the inclusion criteria with a total of 3567 patients (1805 in fasting and 1762 in non-fasting). The Bayesian meta-analysis yielded a posterior mean OR of 0.99 [95 % credible interval (CrI): 0.82–1.20] for nausea and vomiting, 0.99 (95 % CrI: 0.82–1.21) for aspiration event, 1.003 (95 % CrI: 0.83–1.22) for new ventilation and oxygen requirements, 1.04 (95 % CrI: 0.87–1.25) for hypotension, 1.02 (95 % CrI: 0.85–1.24) for hypoglycemia, and 0.97 (95 % CrI: 0.81–1.18) for acute kidney injury. All CrI include 1 and the point estimates are very close to 1, indicating a lack of evidence to drive away from the prior assumption of no average effect size. Sensitivity analyses using three distinct prior scenarios (non-informative, optimistic informative, and skeptical informative) and a subset of studies conducted in 2023–2024 yielded similar findings.</div></div><div><h3>Conclusion</h3><div>Our study demonstrates that a non-fasting strategy prior to cardiac catheterization is as safe as the usual fasting strategy. Pre-procedural fasting should be individualized based on patient and procedure-related factors, and guidelines should be updated with regard to pre-cardiac procedure protocols that minimize fasting and improve patient satisfaction.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"86 ","pages":"Pages 34-43"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066084","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":"Intracardiac echocardiography via the transesophageal route versus transesophageal echocardiography for guiding left atrial appendage occlusion","authors":"Giulia Laterra ,&nbsp;Giorgio Sacchetta ,&nbsp;Giombattista Barrano ,&nbsp;Claudia Artale ,&nbsp;Silvia Motta ,&nbsp;Paolo Mazzone ,&nbsp;Giovanni Ruscica ,&nbsp;Serena Costa ,&nbsp;Marco Barbanti ,&nbsp;Marco Contarini","doi":"10.1016/j.carrev.2025.09.006","DOIUrl":"10.1016/j.carrev.2025.09.006","url":null,"abstract":"<div><h3>Objectives</h3><div>This study sought to compare intracardiac echocardiography (ICE) probe via the esophageal route (TE-ICE) and transesophageal echocardiography (TEE) guidance for the LAAO procedure.</div></div><div><h3>Background</h3><div>Intraprocedural imaging guidance is recommended for all LAAO procedures. Currently, both femoral-ICE-guided and TEE-guided LAAO demonstrated similar outcomes. TE-ICE may serve as a potential alternative imaging modality in LAAO. This approach avoids general anesthesia and its potential complications, while maintaining a favorable learning curve, as it is highly similar to standard transesophageal echocardiography, with whose imaging operators are generally more familiar.</div></div><div><h3>Methods</h3><div>A pooled analysis of the FLXiEST and DIONISIO registries was conducted. For the purposes of this study, TE-ICE patients were compared to TEE patients. All TE-ICE procedures were performed using a 2D ICE catheter introduced via the transesophageal route. One-to-one propensity score matching was applied to compare the TE-ICE technique with the gold standard TEE in guiding LAAO. Technical success and procedural success were defined as the primary outcomes of the study.</div></div><div><h3>Results</h3><div>A total of 282 patients were included in the present study. After adjustment for clinical and echocardiographic characteristics, 99 matched-pair treated with LAAO using TE-ICE and TEE were compared. The technical success did not differ between TE-ICE and TEE patients (98 % vs 96 %; <em>p</em> = 0.6827). The procedural success, defined as technical success in the absence of in- hospital device or procedure-related clinical events, was comparable between the two groups (93 % vs 92 %; <em>p</em> = 0.7673). No statistically significant differences were found for all procedural complications assessed: death, stroke, TIA, pericardial effusion, device embolization, systemic arteria embolization and major bleeding.</div></div><div><h3>Conclusions</h3><div>The present pooled analysis of the DIONISO and the FLXiEST demonstrated that LAAO procedure guidance can be performed with equivalent outcomes using either TE-ICE and TEE. Indeed, the use of TE-ICE technique could be particularly advantageous in high-volume centers to reduce the need for anesthesia, especially in fragile and elderly patients. This approach offers significant organizational benefits by potentially eliminating the requirement for an anesthesiologist in the cath lab, thereby streamlining workflow and improving resource allocation.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"86 ","pages":"Pages 19-25"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151314","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":"Seven years of follow-up of first-in-human percutaneous epicardial-only left atrial appendage closure using Sierra device","authors":"Michał Piotrowski ,&nbsp;Julia Izabela Karpierz ,&nbsp;Radosław Litwinowicz ,&nbsp;Bogusław Kapelak ,&nbsp;Krzysztof Bartuś","doi":"10.1016/j.carrev.2025.08.001","DOIUrl":"10.1016/j.carrev.2025.08.001","url":null,"abstract":"<div><h3>Background</h3><div>It is estimated that at least one third of the population will suffer from atrial fibrillation in their lifetime. In order to prevent strokes and thromboembolism, anticoagulation treatment should be administered. In addition, exclusion of the left atrial appendage should be considered in certain cases to prevent fatal ischemic complications. In patients at high risk of intervention, the devices available to close the left atrial appendage are not suitable. In addition, their use is limited by the anatomy of the left atrial appendage, which may not be suitable for any of the available exclusion devices. The aim of this study is to present the long-term results of the Sierra Aegis Left Atrial Appendage Ligation System – a new, exclusively epicardial system for closure of the left atrial appendage - for the first time in a human study.</div></div><div><h3>Methods</h3><div>This was a prospective, first-in-human study investigating the efficacy and safety of the Sierra Aegis Left Atrial Appendage Ligation System for epicardial closure of the left atrial appendage. 7 patients (mean age: 57.3 ± 10.6 years, 71.4 % male) who underwent left atrial appendage exclusion with the Sierra system were followed for up to 7 years.</div></div><div><h3>Results</h3><div>No strokes, leaks, or other complications were observed in the study group during the 7-year follow-up period.</div></div><div><h3>Conclusions</h3><div>This 7-year follow-up of the first-in-human study of the Sierra Aegis Ligation System for left atrial appendage closure shows very good long-term results in terms of the efficacy and safety of this device when used in humans.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"86 ","pages":"Pages 12-16"},"PeriodicalIF":1.9,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800618","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}