Cardiovascular Revascularization Medicine最新文献

{"title":"Subendocardial ischemia: does CMD really exist?","authors":"Nils P Johnson, K Lance Gould","doi":"10.1016/j.carrev.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.01.008","url":null,"abstract":"<p><p>Patients with angina but without obstructive epicardial coronary disease still require a specific mechanistic diagnosis to enable targeted treatment. The overarching term \"coronary microvascular dysfunction\" (CMD) has been applied broadly - but is it correct? We present a series of case examples culminating a systematic exploration of our large clinical database to distinguish among four categories of coronary pathophysiology. First, by far the largest group of \"no stenosis angina\" patients exhibits subendocardial ischemia during intact flow through diffuse epicardial disease during dipyridamole vasodilator stress. Second, rare patients indeed have ischemic signs or symptoms due solely to reduced flow attributable to microvascular dysfunction but without subendocardial hypoperfusion. Third, a previously unrecognized group of patients displays significant ST-segment changes and rare angina but normal high dipyridamole induced coronary flow and intact normal subendocardial uptake, perhaps due to a stretch mechanism from hyperemia. Fourth, ischemia due to reduced flow plus a subendocardial defect can arise as a secondary effect of a variety of global cardiac pathology, for example severe diffuse atherosclerosis, severe aortic stenosis, or a primary cardiomyopathy. Because subendocardial ischemia dominates the pathophysiologic epidemiology of these patient categories, understanding its mechanisms and therefore potential treatment targets will bring the largest clinical benefits to the largest number of patients. However, its diagnosis requires meticulous attention to exclude caffeine that can lead to a \"false positive\" diagnosis of CMD, absolute flow quantification to avoid confusing high resting flow with normal stress flow from reduced flow capacity, and quantification of subendocardial blood flow.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048260","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":"Temporary mechanical circulatory support utilization and outcomes in cardiogenic shock phenotypes: A comparative analysis of heart failure and acute myocardial infarction.","authors":"Laith Alhuneafat, Fares Ghanem, Ahmad Jabri, Abdallah Naser, Muhammed Ibraiz Bilal, Mohannad Al Akeel, Andrea Elliott, Tamas Alexy, Mohammad Alqarqaz, Pedro Villablanca, Mir Babar Basir","doi":"10.1016/j.carrev.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.01.007","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiogenic shock (CS) is marked by substantial morbidity and mortality. The two major CS etiologies include heart failure (HF) and acute myocardial infarction (AMI). The utilization trends of mechanical circulatory support (MCS) and their clinical outcomes are not well described.</p><p><strong>Methods: </strong>This study compares the rates of MCS utilization, factors associated with utilization, and clinical outcomes in patients who present with HF-CS and AMI-CS, using 2016-2020 National Inpatient Sample data.</p><p><strong>Results: </strong>The study included 329,280 patients, comprising 204,660 cases of AMI-CS and 124,620 of HF-CS. MCS utilization increased over the study period with variable degree among devices, and CS-phenotype. AMI-CS had higher intraaortic balloon pump (32.4 % vs. 8.9 %), extracorporeal membrane oxygenation (2.8 % vs. 2.4 %), and percutaneous ventricular assist device use (14.5 % vs. 8.1 %) compared to HF-CS (p < 0.01). Factors linked to lower MCS use were female sex, age over 60 years, Black race, atrial fibrillation, chronic obstructive lung disease, diabetes mellitus, cirrhosis, previous stroke, or myocardial infarction. After adjusting for various factors, patients with HF-CS vs. AMI-CS had significantly fewer adverse outcomes, including inpatient death, stroke, tracheostomy, mechanical ventilation, and blood transfusion. However, HF-CS had higher odds of acute renal failure requiring dialysis. AMI-CS was associated with shorter hospital stays (8.8 vs. 15.0 days, p < 0.001), lower charges ($251,580 vs. $294,792, p < 0.001), and were less likely to discharge home.</p><p><strong>Conclusion: </strong>Despite the evolving trends in MCS utilization over time, CS patients still face high morbidity and mortality rates. The underlying shock etiology has a substantial impact on outcomes, with AMI cases demonstrating worse complications. This highlights the need for a standardized approach that also takes into consideration etiology, patient-specific factors, care availability, and equitable access.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068859","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":"Effects of aortic valve calcification on transcatheter aortic valve replacement for low-flow, low-gradient aortic stenosis.","authors":"Ranbir Singh, Yash Prakash, Lakshay Chopra, Akarsh Sharma, Samuel Maidman, Dylan Sperling, Esha Vaish, Sahil Khera, Parasuram Melarcode-Krishnamoorthy, Samin Sharma, Annapoorna Kini, Stamatios Lerakis","doi":"10.1016/j.carrev.2025.01.005","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.01.005","url":null,"abstract":"<p><strong>Background: </strong>Patients with low-flow, low-gradient (LFLG) aortic stenosis (AS) have precarious hemodynamics and are a fragile population for intervention. Quantification of aortic valve calcification (AVC) severity is a critical component of the evaluation for transcatheter aortic valve replacement (TAVR); this study aims to further clarify its utility for risk stratification in LFLG AS.</p><p><strong>Methods: </strong>This retrospective study evaluated 467 patients with LFLG AS undergoing TAVR at a large quaternary-care hospital from January 2019 to December 2021. AVC was quantified with Agatston scores using pre-operative computed tomography angiograms. Primary endpoint was a composite of all-cause mortality and heart failure rehospitalization rates.</p><p><strong>Results: </strong>51 patients (10.9 %) had mild calcification, 137 (29.3 %) had moderate, and 279 (59.7 %) had severe. Increased AVC severity correlated with increased AS severity by aortic valve area (0.69cm² for mild AVC vs. 0.63cm² for severe; p ≤0.001), peak velocity (3.1 m/s vs. 3.9 m/s; p ≤0.001), and mean gradient (21 mmHg vs. 36 mmHg; p ≤0.001). Kaplan-Meier analysis showed increased reductions in the primary composite endpoint (p = 0.023) and heart failure rehospitalization rates (p = 0.005) for patients with greater AVC severity undergoing TAVR. Multivariate adjustments confirmed a significant reduction in heart failure rehospitalizations when comparing TAVR outcomes between mild and severe AVC (HR 0.40, 95 % CI 0.18-0.91; p = 0.028). Between the 3 groups, there were no significant differences in adjusted rates of paravalvular leak or other periprocedural complications.</p><p><strong>Conclusions: </strong>Increased AVC in LFLG AS does not correlate clinically with more severe AS by echocardiography. Patients with more severe AVC have less heart failure rehospitalizations and derive greater benefit from TAVR.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029963","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":"Awareness for the risk of adverse outcomes of female patients after ST-segment elevation acute coronary syndrome.","authors":"Mariana Martinho, Rita Calé, Alexandra Briosa, Ernesto Pereira, Ana Rita Pereira, Bárbara Ferreira, Sílvia Vitorino, Pedro Santos, João Morgado, Cátia Eusébio, Patrícia Araújo, Gonçalo Morgado, Cristina Martins, Hélder Pereira","doi":"10.1016/j.carrev.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.01.006","url":null,"abstract":"<p><strong>Introduction: </strong>Women increased risk of early mortality following ST-segment elevation myocardial infarction (STEMI) has been attributed to older age, more comorbidities, and less primary revascularization (PCI). Data on long-term outcomes is conflicting, and younger patients' specific evidence is limited.</p><p><strong>Purpose: </strong>Compare gender outcomes following STEMI within a cohort of younger (≤55 years) and older (>55 years) individuals.</p><p><strong>Methods: </strong>Retrospective analysis of consecutive patients with STEMI who underwent PCI within 48 h of symptom onset, between 2010 and 2015. Adverse outcomes were defined as 30-day, 1-year and 5-year all-cause mortality, and 5-year MACE. Propensity score matching for age, CV risk factors, and prior CV disease aimed to establish a well-balanced subset of male and female individuals.</p><p><strong>Results: </strong>Among 882 patients, 26.8 % were females. Women were older and had higher clinical severity. Although clinical and PCI success were similar, over a mean follow-up of 91 months, women demonstrated nearly three times the risk of 30-day mortality (10.4 % vs 3.7 %, HR 2.88; p ≤0.001) and double the risk of 5-year death (31.9 % vs 17.0 %, HR 2.07; p < 0.001) and MACE (39.0 % vs 17.6 %, HR 1.95; p < 0.001). Sex differences in the younger subgroup were seen for 1-year (HR 3.74, p < 0.001), and long-term outcomes: HR 2.20 (p = 0.05) for 5-year mortality; HR 2.10 (p = 0.027) for 5-year MACE. After propensity matching, sex remained an independent predictor of adverse outcomes.</p><p><strong>Conclusions: </strong>Females showed more CV events following STEMI, even after adjusting for potential confounders. These findings raise awareness for women risk and the need for strict post-STEMI surveillance.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025285","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":"Examining the relationship between monocytes and monocyte-derived ratios in post-percutaneous coronary intervention patients and their impact on coronary artery disease progression.","authors":"Ilan Merdler, Kalyan R Chitturi, Abhishek Chaturvedi, Lior Lupu, Ryan Wallace, Matteo Cellamare, Cheng Zhang, Vaishnavi Sawant, Itsik Ben-Dor, Brian C Case, Ron Waksman","doi":"10.1016/j.carrev.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.01.009","url":null,"abstract":"<p><strong>Background: </strong>Inflammation plays a key role in the progression and instability of coronary atherosclerosis. Monocytes and their ratios with eosinophils and lymphocytes serve as valuable markers for assessing inflammation. We explored blood monocyte levels and their related ratios in patients undergoing percutaneous coronary intervention (PCI) for in-stent restenosis (ISR) or significant de novo lesions (DNL).</p><p><strong>Methods and results: </strong>A total of 3912 PCI procedures were identified from a single-center retrospective registry (2013-2022) and categorized into three groups: single PCI and no subsequent intervention (control group, n = 3342), significant ISR requiring repeat PCI (ISR-PCI group, n = 219), and significant de novo lesions requiring repeat PCI (DNL-PCI group, n = 351). Monocyte counts and monocyte-related ratios were evaluated at the index procedure and follow-up (clinical or repeat PCI procedures). Comorbidities were more prevalent in the ISR-PCI and DNL-PCI groups than those in the control group. In comparison to the control group, both ISR-PCI (15.6 ± 26.7 vs. 24.4 ± 37.8, P < 0.001) and DNL-PCI groups (16.2 ± 28.5 vs. 24.4 ± 37.8, P < 0.001) exhibited a significantly lower baseline monocyte-to-eosinophil ratio. In the adjusted regression models, a lower baseline monocyte-to-eosinophil ratio (P = 0.001) and monocyte-to-lymphocyte ratio (P = 0.04) were associated with DNL, whereas no such association was observed in ISR-PCI cases (P = 0.4 for both ratios).</p><p><strong>Conclusion: </strong>Our findings reinforce the role of inflammatory markers, such as monocytes and monocyte-related ratios, in identifying individuals at risk for the progression of coronary disease post-PCI.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081748","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":"Impact of pulmonary artery catheterization in patients with acute myocardial infarction cardiogenic shock.","authors":"Mohit Pahuja, Kalyan R Chitturi, Aakash Tuli, Abhinav Saxena, Adam Johnson, Akhil S Kallur, Cheng Zhang, Hank Rappaport, Corey Shea, Jason P Wermers, Hayder D Hashim, Nelson L Bernardo, Lowell F Satler, Itsik Ben-Dor, Samer S Najjar, Farooq H Sheikh, Ron Waksman","doi":"10.1016/j.carrev.2024.12.010","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.12.010","url":null,"abstract":"<p><p>Acute myocardial infarction (AMI) remains one of the most common causes for cardiogenic shock (CS), with high inpatient mortality (40-50 %). Studies have reported the use of pulmonary artery catheters (PACs) in decompensated heart failure, but contemporary data on their use to guide management of AMI-CS and in different SCAI stages of CS are lacking. We investigated the association of PACs and clinical outcomes in AMI-CS. In this retrospective study from a large healthcare system (MedStar Health, 10 hospitals) from 2014 to 2021, patients were grouped according to presentation as ST-elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) and on the basis of SCAI classification. In-hospital mortality was assessed among patients with and without PACs using propensity-matched analysis. A total of 2585 patients were included, of whom 797 had STEMI and 1788 had NSTEMI. Overall, 517 patients underwent PAC placement; PAC utilization rates were 19.7 % in the STEMI group and 20.4 % in the NSTEMI group. Overall, among patients with AMI-CS, we observed that in-hospital mortality was higher in patients who did not receive PACs during hospitalization (35.9 % vs 25.9 %, p < 0.001). After propensity-matching 484 patients in the PAC group to 484 in the no-PAC group, the no-PAC group still showed higher mortality (34.9 % vs 26.7 %, p = 0.005). Utilization of MCS devices was higher in patients with PAC. In conclusion, our results suggest an advantage in utilizing PACs in AMI-CS patients to identify early CS stages and offer appropriate therapies. Therefore, PACs should be routinely used in for this population.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068857","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 and efficacy of a light antithrombotic regimen after left atrial appendage occlusion: Insights from the LOGIC (left atrial appendage occlusion in patients with gastrointestinal or IntraCranial bleeding) international multicenter registry.","authors":"Francesco Gallo, Matteo D'Addazio, Gianpiero D'Amico, Domenico G Della Rocca, Patrizio Mazzone, Stefano Bordignon, Gavino Casu, Francesco Giannini, Sergio Berti, Rodney P Horton, Giuseppe D'Angelo, Lukas Urbanek, Pierluigi Merella, Rossella Ruggiero, Francesco Bosica, Boris Schmidt, Enrico Atzori, Marco Barbierato, Andrea Natale, Sakis Themistoclakis, Federico Ronco","doi":"10.1016/j.carrev.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>Antithrombotic therapy (AT) after left atrial appendage occlusion (LAAO) in patients with non-valvular atrial fibrillation (NVAF) has the purpose of preventing device related thrombosis (DRT), avoiding embolic events; nevertheless, the correct antithrombotic regimen after LAAO is still under debate.</p><p><strong>Aims: </strong>Aim of this substudy of the observational LOGIC registry was to describe the efficacy and safety of a light antithrombotic regimen, comprising single antiplatelet therapy or none, compared to a standard antithrombotic regimen, after a successful LAAO.</p><p><strong>Methods: </strong>Patients with NVAF that underwent LAAO were previously included in the LOGIC registry. Patients receiving single or no AT were considered as light therapy group, while other regimen were considered as standard regimen group. Outcomes of interest were death from any causes and cardiovascular death, ischemic stroke, transient ischemic attack and systemic embolization, any bleeding and major bleeding at 12 months.</p><p><strong>Results: </strong>Six hundred and twenty-eight patients were considered in the analysis, 31.4 % received a light antithrombotic regimen. There were no differences in overall and cardiovascular mortality (5.1 % Vs 6.7 %, p = 0.426 and 2.0 % Vs 1.4 %, p = 0.553 respectively). Cerebrovascular stroke and transient ischemic attack were similar between the two groups (1.5 % Vs 1.4 %, p = 0.898 and 1.5 % Vs 1.3 %, p = 0.847). Light regimen was not associated with an increased rate of systemic embolism (1.0 % Vs 0.7 %, p = 0.447 and HR 0.88 [95 % CI: 0.34-2.27; p = 0.79]). A light AT regimen did not affect bleeding events being not different between the two groups (HR 0.71; 95 % CI: 0.33-1.59; p = 0.41).</p><p><strong>Conclusions: </strong>An AT regimen based on single or no antithrombotic therapy after LAAO seems to be safe in patients with high-bleeding risk, without increasing cerebrovascular or peripheral ischemic events.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985059","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":"Finding the balance: Advancing strategies for managing severely calcified coronary lesions.","authors":"Ricardo Fonseca Oliveira Suruagy Motta, Anderson Matheus Pereira da Silva","doi":"10.1016/j.carrev.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.01.004","url":null,"abstract":"<p><p>This letter to the editor provides a critical and constructive analysis of the article \"Intravascular Lithotripsy Compared with Rotational Atherectomy for Calcified Coronary Lesions: A Meta-analysis of Outcomes\", highlighting key methodological limitations and the exclusion of relevant contemporary studies. It emphasizes the clinical importance of addressing severely calcified coronary lesions, a significant challenge in interventional cardiology, and advocates for future research to prioritize randomized clinical trials, subgroup analyses, and cost-effectiveness evaluations to improve the applicability of findings across healthcare settings. By promoting dialogue within the scientific community and encouraging the integration of evolving data, the letter aims to refine clinical strategies and align them with evidence-based public health approaches, particularly in resource-limited environments.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967010","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":"Trends and disparities in cardiovascular disease-related mortality among adults with peripheral arterial disease in the United States.","authors":"Usama Qamar, Maaz Asif, Waleed Qamar, Siddharth Agarwal","doi":"10.1016/j.carrev.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.carrev.2025.01.003","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967011","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: Improving outcomes with standardized care in high-risk patients supported with a percutaneous microaxial flow pump","authors":"Ezequiel J. Molina","doi":"10.1016/j.carrev.2024.08.015","DOIUrl":"10.1016/j.carrev.2024.08.015","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 69-70"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056904","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}