Circulation. Cardiovascular interventions最新文献

{"title":"Association Between Peripheral Versus Central Access for Alternative Access Transcatheter Aortic Valve Replacement and Mortality and Stroke: A Report From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.","authors":"Tsuyoshi Kaneko,&nbsp;Sameer A Hirji,&nbsp;Farhang Yazdchi,&nbsp;Yee-Ping Sun,&nbsp;Charles Nyman,&nbsp;Douglas Shook,&nbsp;David J Cohen,&nbsp;Amanda Stebbins,&nbsp;Michel Zeitouni,&nbsp;Sreekanth Vemulapalli,&nbsp;Vinod H Thourani,&nbsp;Pinak B Shah,&nbsp;Patrick O'Gara","doi":"10.1161/CIRCINTERVENTIONS.121.011756","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.121.011756","url":null,"abstract":"<p><strong>Background: </strong>In some patients, the alternative access route for transcatheter aortic valve replacement (TAVR) is utilized because the conventional transfemoral approach is not felt to be either feasible or optimal. However, accurate prognostication of patient risks is not well established. This study examines the associations between peripheral (transsubclavian/transaxillary, and transcarotid) versus central access (transapical and transaortic) in alternative access TAVR and 30-day and 1-year end points of mortality and stroke for all valve platforms.</p><p><strong>Methods: </strong>Using data from The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry with linkage to Medicare claims, patients who underwent alternative access TAVR from June 1, 2015 to June 30, 2018 were identified. Adjusted and unadjusted Cox proportional hazards modeling were performed to determine the association between alternate access TAVR site and 30-day and 1-year end points of mortality and stroke.</p><p><strong>Results: </strong>Of 7187 alternative access TAVR patients, 3725 (52%) had peripheral access and 3462 (48%) had central access. All-cause mortality was significantly lower in peripheral access versus central access group at in-hospital and 1 year (2.9% versus 6.3% and 20.3% versus 26.6%, respectively), but stroke rates were higher (5.0% versus 2.8% and 7.3% versus 5.5%, respectively; all <i>P</i><0.001). These results persisted after 1-year adjustment (death adjusted hazard ratio, 0.72 [95% CI, 0.62-0.85] and stroke adjusted hazard ratio, 2.92 [95% CI, 2.21-3.85]). When broken down by individual subtypes, compared with transaxillary/subclavian access patients, transapical, and transaortic access patients had higher all-cause mortality but less stroke (<i>P</i><0.05).</p><p><strong>Conclusions: </strong>In this real-world, contemporary, nationally representative benchmarking study of alternate access TAVR sites, peripheral access was associated with favorable mortality and morbidity outcomes compared with central access, at the expense of higher stroke. These findings may allow for accurate prognostication of risk for patient counseling and decision-making for the heart team with regard to alternative access TAVR.</p>","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e011756"},"PeriodicalIF":5.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40372521","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":"Prevalence and Impact of Neoatherosclerosis on Clinical Outcomes After Percutaneous Treatment of Second-Generation Drug-Eluting Stent Restenosis.","authors":"Zhaoyang Chen,&nbsp;Mitsuaki Matsumura,&nbsp;Gary S Mintz,&nbsp;Masahiko Noguchi,&nbsp;Tatsuhiro Fujimura,&nbsp;Eisuke Usui,&nbsp;Fumiyasu Seike,&nbsp;Xun Hu,&nbsp;Ge Jin,&nbsp;Chenguang Li,&nbsp;Hanan Salem,&nbsp;Khady N Fall,&nbsp;Evan Shlofmitz,&nbsp;Ajay J Kirtane,&nbsp;J Jane Cao,&nbsp;Jeffrey W Moses,&nbsp;Ziad A Ali,&nbsp;Allen Jeremias,&nbsp;Richard A Shlofmitz,&nbsp;Akiko Maehara","doi":"10.1161/CIRCINTERVENTIONS.121.011693","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.121.011693","url":null,"abstract":"<p><strong>Background: </strong>Clinical and morphological factors associated with lipidic versus calcified neoatherosclerosis within second-generation drug-eluting stents and the impact of lipidic versus calcified neoatherosclerosis on long-term outcomes after repeat intervention have not been well studied.</p><p><strong>Methods: </strong>A total of 512 patients undergoing optical coherence tomography before percutaneous coronary intervention for second-generation drug-eluting stents in-stent restenosis were included. Neoatherosclerosis was defined as lipidic or calcified neointimal hyperplasia in ≥3 consecutive frames or ruptured lipidic neointimal hyperplasia. The primary outcome was target lesion failure (cardiac death, target vessel myocardial infarction, definite stent thrombosis, or clinically driven target lesion revascularization).</p><p><strong>Results: </strong>The overall prevalence of neoatherosclerosis was 28.5% (146/512): 56.8% lipidic, 30.8% calcified, and 12.3% both lipidic and calcific. The prevalence increased as a function of time from stent implantation: 20% at 1 to 3 years, 30% at 3 to 7 years, and 75% >7 years. Renal insufficiency, poor lipid profile, and time from stent implantation were associated with lipidic neoatherosclerosis, whereas severe renal insufficiency, female sex, and time from stent implantation were associated with calcified neoatherosclerosis. Multivariable Cox regression revealed that female sex and lipidic neoatherosclerosis were associated with more target lesion failure, whereas stent age and final minimum lumen diameter after reintervention were related to lower target lesion failure. Calcified neoatherosclerosis was not related to adverse events after reintervention for in-stent restenosis given a large enough minimum lumen diameter was achieved.</p><p><strong>Conclusions: </strong>Lipidic but not calcified neoatherosclerosis was associated with poor subsequent outcomes after repeat revascularization if optimal stent expansion was achieved in lesions with calcified neoatherosclerosis.</p>","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e011693"},"PeriodicalIF":5.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40371984","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 Serial Coronary Stenoses on Various Coronary Physiologic Indices.","authors":"Jung-Min Ahn,&nbsp;Takaharu Nakayoshi,&nbsp;Takehiro Hashikata,&nbsp;Kuninobu Kashiyama,&nbsp;Hiroyuki Arashi,&nbsp;Jihoon Kweon,&nbsp;Marcel Van't Veer,&nbsp;Jennifer Lyons,&nbsp;William F Fearon","doi":"10.1161/CIRCINTERVENTIONS.122.012134","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.122.012134","url":null,"abstract":"<p><strong>Background: </strong>Determining the functional significance of each individual coronary lesion in patients with serial coronary stenoses is challenging. It has been proposed that nonhyperemic pressure ratios, such as the instantaneous wave free ratio (iFR) and the ratio of resting distal to proximal coronary pressure (Pd/Pa) are more accurate than fractional flow reserve (FFR) because autoregulation should maintain stable resting coronary flow and avoid hemodynamic interdependence (cross-talk) that occurs during hyperemia. This study aimed to measure the degree of hemodynamic interdependence of iFR, resting Pd/Pa, and FFR in a porcine model of serial coronary stenosis.</p><p><strong>Methods: </strong>In 6 anesthetized female swine, 381 serial coronary stenoses were created in the left anterior descending artery using 2 balloon catheters. The degree of hemodynamic interdependence was calculated by measuring the absolute changes in iFR, resting Pd/Pa, and FFR across the fixed stenosis as the severity of the other stenosis varied.</p><p><strong>Results: </strong>The hemodynamic interdependence of iFR, resting Pd/Pa, and FFR was 0.039±0.048, 0.021±0.026, and 0.034±0.034, respectively (all <i>P</i><0.001). When the functional significance of serial stenoses was less severe (0.70-0.90 for each index), the hemodynamic interdependence was 0.009±0.020, 0.007±0.013, and 0.017±0.022 for iFR, resting Pd/Pa, and FFR, respectively (all <i>P</i><0.001). However, in more severe serial coronary stenoses (<0.60 for each index), hemodynamic interdependence was 0.060±0.050, 0.037±0.030, and 0.051±0.037 for iFR, resting Pd/Pa, and FFR, respectively (all <i>P</i><0.001).</p><p><strong>Conclusions: </strong>When assessing serial coronary stenoses, nonhyperemic pressure ratios are affected by hemodynamic interdependence. When the functional significance of serial coronary stenoses is severe, the effect is similar to that which is seen with FFR.</p>","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e012134"},"PeriodicalIF":5.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40372523","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":"First in Human: Transcatheter Repair of Isolated Partial Anomalous Pulmonary Venous Return.","authors":"Khaled Tuwairqi,&nbsp;Ayesha Salahuddin,&nbsp;Gregory Judson,&nbsp;David Blusztein,&nbsp;Phillip Moore,&nbsp;Shafkat Anwar,&nbsp;Vaikom S Mahadevan","doi":"10.1161/CIRCINTERVENTIONS.122.012132","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.122.012132","url":null,"abstract":"","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e012132"},"PeriodicalIF":5.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40631137","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":"Balloon Interrogation of Intervening Tissue: A Novel Method to Decide Strategy for Closing Multiple Atrial Septal Defects.","authors":"Bharat Dalvi,&nbsp;Parag Bhalgat","doi":"10.1161/CIRCINTERVENTIONS.122.012048","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.122.012048","url":null,"abstract":"<p><strong>Background: </strong>Two separate ostium secundum atrial septal defects are a challenging substrate for device closure due to lack of a well-described strategy or an adequately evaluated protocol.</p><p><strong>Methods: </strong>This is a prospective study comprising 20 patients with 2 atrial septal defects who underwent device closure. All of them underwent balloon interrogation (BI) of the intervening tissue to decide 1- versus 2-device strategy. During BI, if the flow through both the defects could be stopped completely implying adequate mobility of the separating tissue, a single device strategy was used. The size of the device in this subset was determined by BI diameter. In case the flow persisted, 2 devices were used to close the defects separately.</p><p><strong>Results: </strong>The mean age was 24±17 years. The main defect size was (mean 14.5 mm±SD 2.69 mm), whereas the second defect measured (mean 8.5±SD 3.02 mm). The tissue separating the 2 defects was measured (mean 6.1±SD 2.6 mm). In 15 of them, based on the BI results, a single device was used successfully to close both the defects without a residual shunt. In the remaining 5 patients, 2 devices were used. There were no complications during the procedure or at follow-up period of 41.9±16.9 months.</p><p><strong>Conclusions: </strong>BI in patients with 2 atrial septal defects is helpful in defining 1- versus 2-device strategies and in choosing the size of the device to be used. Nearly 3/4 of the patients may get away with a single device for closing both the defects successfully thereby decreasing the cost and complexity of the procedure.</p>","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e012048"},"PeriodicalIF":5.6,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40372525","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":"Presence of Coronary Endothelial Dysfunction, Coronary Vasospasm, and Adenosine-Mediated Vasodilatory Disorders in Patients With Ischemia and Nonobstructive Coronary Arteries.","authors":"Rutger G T Feenstra,&nbsp;Coen K M Boerhout,&nbsp;Janneke Woudstra,&nbsp;Caitlin E M Vink,&nbsp;Marianne E Wittekoek,&nbsp;Guus A de Waard,&nbsp;Yolande Appelman,&nbsp;Etto C Eringa,&nbsp;Koen M J Marques,&nbsp;Robbert J de Winter,&nbsp;Marcel A M Beijk,&nbsp;Tim P van de Hoef,&nbsp;Jan J Piek","doi":"10.1161/CIRCINTERVENTIONS.122.012017","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.122.012017","url":null,"abstract":"<p><strong>Background: </strong>Coronary function testing in patients with ischemia and nonobstructive coronary arteries (INOCA) commonly includes assessment of adenosine-mediated vasodilation and acetylcholine spasm provocation. The purpose of this study was to evaluate the diagnostic value of additional endothelial function testing for the diagnosis of vasomotor dysfunction in patients with INOCA.</p><p><strong>Methods: </strong>In this retrospective cohort study, we included patients with INOCA who underwent clinically indicated comprehensive coronary function testing. Endothelial dysfunction was defined as a <50% increase in coronary blood flow, determined by Doppler flow, and/or epicardial vasoconstriction compared to baseline, in response to low-dose acetylcholine. Coronary artery spasm (CAS) was defined as vasospastic angina or microvascular angina in response to coronary high-dose acetylcholine. An impaired adenosine-mediated vasodilation was defined as a coronary flow reserve <2.5 and/or hyperemic microvascular resistance ≥2.5.</p><p><strong>Results: </strong>Among all 110 patients, 79% had endothelial dysfunction, 62% had CAS, and 29% had an impaired adenosine-mediated vasodilation. Endothelial dysfunction was present in 80% of patients who tested positively for CAS and/or an impaired adenosine-mediated vasodilation. Endothelial function testing increases the diagnostic yield of coronary function testing that only incorporates adenosine testing and spasm provocation by 17% to 92%. Of patients with normal adenosine-mediated vasodilation and no inducible CAS, 68% had endothelial dysfunction.</p><p><strong>Conclusions: </strong>Concomitant endothelial dysfunction was prevalent in the vast majority of patients with INOCA with inducible CAS and/or an impaired adenosine-mediated vasodilation. In patients with INOCA without inducible CAS and normal adenosine-mediated vasodilation, two-thirds had endothelial dysfunction. These results indicate the relevance to perform endothelial function testing in patients with INOCA in view of its therapeutic implication.</p>","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e012017"},"PeriodicalIF":5.6,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40558177","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 Unguided De-Escalation Versus Guided Selection of Dual Antiplatelet Therapy After Acute Coronary Syndrome: A Systematic Review and Network Meta-Analysis.","authors":"Toshiki Kuno, Tomohiro Fujisaki, Satoshi Shoji, Yuki Sahashi, Yusuke Tsugawa, Masao Iwagami, Hisato Takagi, Alexandros Briasoulis, Pierre Deharo, Thomas Cuisset, Azeem Latib, Shun Kohsaka, Deepak L Bhatt","doi":"10.1161/CIRCINTERVENTIONS.122.011990","DOIUrl":"10.1161/CIRCINTERVENTIONS.122.011990","url":null,"abstract":"<p><strong>Background: </strong>The benefit of dual antiplatelet therapy (DAPT) for reducing ischemic events is greatest in the early period of acute coronary syndrome, and recent randomized controlled trials have investigated the unguided de-escalation strategy of changing potent P2Y₁₂ inhibitors to less potent or reduced-dose P2Y₁₂ inhibitors 1 month after acute coronary syndrome. However, it remains unclear which strategy is more effective and safer: the uniform unguided de-escalation strategy versus the personalized guided selection of DAPT with genotype or platelet function tests.</p><p><strong>Methods: </strong>PubMed, EMBASE, and Cochrane Central were searched for articles published from database inception to September 10, 2021. Randomized controlled trials investigating DAPT using clopidogrel, low-dose prasugrel, standard-dose prasugrel, ticagrelor, unguided de-escalation strategy, and guided selection strategy for patients with acute coronary syndrome were included. Hazard ratios and relative risk estimates were extracted from each study. The estimates were pooled using a random-effects network meta-analysis. The primary efficacy outcome was major adverse cardiovascular events, defined as a composite of cardiovascular death, myocardial infarction, or stroke. The primary safety outcome was major or minor bleeding. Secondary outcomes were all-cause death, cardiovascular death, myocardial infarction, stroke, stent thrombosis, and major bleeding.</p><p><strong>Results: </strong>This study included 19 randomized controlled trials with 69 746 patients. Compared with guided selection of DAPT, unguided de-escalation of DAPT was associated with a decreased risk of the primary safety outcome (hazard ratio, 0.48 [95% CI, 0.33-0.72]) without increased risks of major adverse cardiovascular events (hazard ratio, 0.82 [95% CI, 0.53-1.28]) or any secondary outcomes. The results were similar when the guided selection strategy was divided into platelet function-guided and genotype-guided strategies.</p><p><strong>Conclusions: </strong>Compared with guided selection of DAPT, unguided de-escalation of DAPT decreased bleeding without increasing ischemic events in patients after acute coronary syndrome. If a strategy of de-escalation is chosen, these findings do not support the routine use of personalized guiding tests.</p><p><strong>Registration: </strong>URL: https://www.crd.york.ac.uk/PROSPERO/; Unique identifier: CRD42021273082.</p>","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e011990"},"PeriodicalIF":0.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40641069","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":"Rising Use of Percutaneous Ventricular Assist Devices: What Can Be Learned From the Data?","authors":"Zaid I Almarzooq,&nbsp;Robert W Yeh","doi":"10.1161/CIRCINTERVENTIONS.122.012266","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.122.012266","url":null,"abstract":"","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e012266"},"PeriodicalIF":5.6,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40558179","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":"Still a Long Way to the Precision Medicine of Antiplatelet Strategy After Percutaneous Coronary Intervention.","authors":"Young-Hoon Jeong,&nbsp;Yuki Obayashi,&nbsp;Haegeun Song,&nbsp;Takeshi Kimura","doi":"10.1161/CIRCINTERVENTIONS.122.012261","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.122.012261","url":null,"abstract":"","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e012261"},"PeriodicalIF":5.6,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40641068","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":"Neo-Commissural Alignment Technique for Transcatheter Aortic Valve Replacement Using the ACURATE Neo Valve.","authors":"Mohamed Abdel-Wahab,&nbsp;Mitsunobu Kitamura,&nbsp;Sean J Fitzgerald,&nbsp;Oliver Dumpies,&nbsp;Johannes Wilde,&nbsp;Robin F Gohmann,&nbsp;Nicolas Majunke,&nbsp;Matthias Gutberlet,&nbsp;Philipp Kiefer,&nbsp;Thilo Noack,&nbsp;Philipp Lurz,&nbsp;Steffen Desch,&nbsp;Christopher Frawley,&nbsp;Kevin Ward,&nbsp;Michael A Borger,&nbsp;David Holzhey,&nbsp;Holger Thiele","doi":"10.1161/CIRCINTERVENTIONS.122.011993","DOIUrl":"https://doi.org/10.1161/CIRCINTERVENTIONS.122.011993","url":null,"abstract":"","PeriodicalId":516631,"journal":{"name":"Circulation. Cardiovascular interventions","volume":" ","pages":"e011993"},"PeriodicalIF":5.6,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40462254","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}