Journal of investigative medicine : the official publication of the American Federation for Clinical Research最新文献

{"title":"Impact of GLP-1 receptor agonists on cardiovascular outcomes in patients with peripheral artery disease without diabetes: A propensity score-matched analysis.","authors":"Emmanuel Daniel, Mohammed El-Nayir, Kayode Ogunniyi, Yash Patel, Paul Olayiwola, Omotola Oredipe, Henry Nwankwo, Karldon Nwaezeapu, Tioluwani Ojo","doi":"10.1177/10815589251393978","DOIUrl":"10.1177/10815589251393978","url":null,"abstract":"<p><p>Peripheral artery disease (PAD) is associated with a high risk of cardiovascular events. While glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated cardiovascular benefit in patients with diabetes, their role in patients with PAD without diabetes is not well understood. This study aimed to assess the impact of GLP-1RA therapy on cardiovascular outcomes in nondiabetic PAD patients. We conducted a retrospective cohort study using the TriNetX U.S. collaborative network, identifying adults aged 18-89 with PAD and no history of diabetes from January 2014 to January 2024. Patients treated with GLP-1RAs were compared with untreated counterparts. A 1:1 greedy nearest neighbor propensity score matching was performed to balance baseline characteristics. The primary outcomes were 3-point major adverse cardiovascular events (MACE) defined as nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death, all-cause mortality; major adverse limb events (MALE) defined as limb-threatening ischemia, revascularization procedures, or major amputation. Cox regression and Kaplan-Meier analysis were used to assess outcomes over a 5-year follow-up period. After matching, 13,555 patients remained in each group with well-balanced covariates. GLP-1RA use was associated with lower risk of MACE (hazard ratio (HR): 0.61; 95% confidence interval (CI): 0.57-0.66; <i>p</i> < 0.001), all-cause mortality (HR: 0.40; 95% CI: 0.35-0.46; <i>p</i> < 0.001), and MALE (HR: 0.22; 95% CI: 0.17-0.28; <i>p</i> < 0.001). In a sensitivity analysis focusing on semaglutide use initiated post-2021, the benefits remained robust for both MACE (HR: 0.55; 95% CI: 0.50-0.60) and all-cause mortality (HR: 0.303; 95% CI: 0.25-0.36). In this large real-world cohort, GLP-1RA therapy was associated with significantly reduced cardiovascular and limb-related events in nondiabetic patients with PAD. These findings support the potential role of GLP-1RAs in cardiovascular risk reduction beyond diabetes and highlight the need for prospective randomized trials in this population.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"641-653"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369454","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":"Effectiveness of a social justice curriculum intervention on cultural competency among internal medicine residents.","authors":"Bhavi Trivedi, Adriana Mares, Lakshmi Kattamuri, Sukhila Baddam Reddy, Debabrata Mukherjee, Priya Harindranathan, Aimee Hechanova, Brian Edwards, Alok Dwivedi, Abhizith Deoker","doi":"10.1177/10815589251406266","DOIUrl":"10.1177/10815589251406266","url":null,"abstract":"<p><p>There is a nationwide need to include social justice topics in medical education to reduce health disparities of culturally diverse patients. Cultural competence and humility act as a link between historically marginalized racial and ethnic groups and social justice to foster health equity among patients. We implemented a Social Justice in Medicine curriculum in the Internal Medicine residency program to prepare cultural competencies for social justice among residents. We sought to investigate the impact of curriculum implementation on residents' cultural competency. The social justice in medicine included a variety of educational strategies including online curriculum modules, immersive clinical experiences in continuity clinics, community engagement, a lecture series (Social Determinants of Health, social injustices, resident activism, etc.), and the use of reflective practices (bias assessments, group discussions). We conducted a pre-post quasi-experimental study (July 2023-June 2024) to evaluate the effect of implementation of an educational intervention on competency as measured by the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Revised, a 25-item four-point Likert scale. This instrument assesses cultural awareness, knowledge, skill, encounters, and desire. The effect size was summarized with mean difference (MD) and 95% confidence interval (CI). A total of 40 residents participated in the study. Overall 11.7% relative improvement in cultural competency was observed following the intervention (MD = 7.7; 95% CI: 4.72-10.68, <i>p</i> < 0.001). The intervention improved all the domains of competency including awareness (MD = 0.93; 95% CI: -0.02-1.87, <i>p</i> = 0.05), knowledge (MD = 2.20; 95% CI: 1.33-3.07, <i>p</i> < 0.001), skill (MD = 1.90; 95% CI: 1.12-2.68, <i>p</i> < 0.001), encounters (MD = 1.10; 95% CI: 0.23-1.97, <i>p</i> = 0.014), and desire (MD = 1.58; 95% CI: 0.80-2.35, <i>p</i> < 0.001). The implementation of social justice in the medicine curriculum improved the cultural competencies among internal medicine residents in our study. Future longitudinal studies are required to investigate challenges, barriers, and modes of implementation strategies in a larger setting.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"691-697"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656807","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":"HCAR2 inhibits prostate cancer invasion and metastasis by regulating cAMP signaling pathway.","authors":"Yanmin Li, Hanmin Chen, Ruohui Huang","doi":"10.1177/10815589251406272","DOIUrl":"10.1177/10815589251406272","url":null,"abstract":"<p><p>Prostate cancer (PCa) is one of the most prevalent malignancies affecting men and a significant contributor to the rising global cancer-related mortality rate. Nevertheless, intricate processes underlying invasion and metastasis remain largely unclear. The objective of our research was to explore the function and underlying mechanisms of hydroxycarboxylic acid receptor 2 (HCAR2) in the invasion and metastasis of PCa. We analyzed differentially expressed genes in PCa through transcriptome sequencing. Then, we conducted bioinformatics analyses to investigate the correlation between HCAR2 and PCa. Furthermore, we overexpressed HCAR2 both in vitro and in vivo to investigate its role in regulating the proliferation and invasion of PCa cells as well as the tumorigenic ability of PCa cells. Finally, we treated PC3 cells with the signaling pathway inhibitor H89 on the basis of HCAR2 overexpression to explore the role of the cAMP signaling pathway in PCa. HCAR2 was significantly downregulated in PCa patients. HCAR2 had diagnostic significance for the survival prognosis of PCa patients, with a high diagnostic accuracy rate over a five-year period. The core targets of HCAR2 in PCa were involved in the cAMP signaling pathway. Furthermore, overexpression of HCAR2 repressed the proliferation, migration, and invasion abilities of PC3 and DU145 cells, as well as the tumorigenic ability of PCa cells in vivo. Finally, H89 treatment reversed the effects of HCAR2 overexpression on cAMP signaling pathway-related proteins, as well as on the proliferation, migration, and invasion abilities of PC3 cells. HCAR2 inhibited the proliferation and invasion of PCa cells through the cyclic adenosine monophosphate signaling pathway.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"670-690"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644355","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":"A case of Kabuki syndrome with congenital pulmonary airway malformation.","authors":"Lan Yang, Qinghui Chen, Weifang Zhou, Jianping Deng, Jianmei Tian","doi":"10.1177/10815589261425966","DOIUrl":"10.1177/10815589261425966","url":null,"abstract":"<p><p>This study reports one case of Kabuki syndrome (KS) accompanied by a new mutation in the KMT2D gene and concurrent congenital pulmonary airway malformation (CPAM). After birth, the child demonstrated delayed physical growth and neurological, psychological, and intellectual development. Notable facial features included arched eyebrows and elongated eyelids toward the lower side. Chest computed tomography revealed pulmonary airway malformation. Whole-exome high-throughput sequencing revealed a novel heterozygous missense mutation in the KMT2D gene, Exon38c.10481C>T (p.Pro3494Leu), a possible pathogenic mutation that has not been previously reported. Both parents were wild-type. The clinical manifestations of KS are complex; however, cases with concomitant CPAM have rarely been reported. This study elucidates the mutation spectrum of the KS gene and the clinical characteristics of KS patients.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"721-726"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146215560","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":"Nationwide trends in pneumonia-associated mortality and the impact of the COVID-19 pandemic.","authors":"Mohammad Abdulelah, Julia Fischer, Sabah Sikandar, Dimitri Melki, Chidubem Ezenna, Hussein Abdulelah, Hashim Al-Ani","doi":"10.1177/10815589251413272","DOIUrl":"10.1177/10815589251413272","url":null,"abstract":"<p><p>Pneumonia-related mortality in the United States has shown a notable decline. However, epidemiological analyses of the COVID-19 pandemic's impact on these trends are limited. We evaluated pneumonia mortality trends pre-and-post the pandemic. Age-adjusted mortality rates (AAMR) per 100,000 were obtained from the CDC WONDER database through ICD-10 codes. Data were stratified based on sex, region, and state. Temporal trends were assessed with average annual percentage changes (AAPC). A total of 3.54% of all deaths (<i>n</i> = 2,360,261) between 1999 and 2023 were due to pneumonia. Males exhibited a 1.3-fold higher AAMR compared to females (AAMR: 20.4 vs 15.3; <i>p</i> = 0.003). However, pneumonia accounted for a greater proportion of all-cause mortality among females than males (2.42% vs 2.06%). Overall, a significant decline in mortality was observed from 1999 to 2018, followed by a sharp rise. No significant AAMR trends were noted over the full study period (AAPC -0.32%; <i>p</i> = 0.81), but excluding COVID-19 deaths revealed a significant decline (AAPC -3.41%; <i>p</i> < 0.005). Marked geographic disparities were observed, with the highest median AAMR in Arkansas (24.9, IQR 6.8) and the lowest in Florida (9.4, IQR 6.3). The East South-Central region exhibited significantly higher pneumonia mortality rates (<i>p</i> < 0.001). The pre-existing declining trend of pneumonia associated mortality was markedly affected by the COVID-19 pandemic. Our findings underscore the need for tailored public health interventions and further research into demographic and geographic factors influencing pneumonia outcomes.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"654-662"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893607","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":"L-Shaped association of fasting serum total bile acids with atrial fibrillation risk in the elderly.","authors":"Qian Li, Shanshan Li, Rong Fan, Yi Zhao, Hui Liu, Tao Wang, Tao Zheng","doi":"10.1177/10815589251393974","DOIUrl":"10.1177/10815589251393974","url":null,"abstract":"<p><p>Serum total bile acid (BA) concentration, while linked to cardiovascular disease, lacks established associations with atrial fibrillation (AF). This cross-sectional study investigated the relationship between fasting serum total BA and AF prevalence/classification (paroxysmal vs persistent) in 522 patients aged ≥75 years. Participants were categorized by AF diagnosis and stratified by BA tertiles. Results revealed significantly lower serum total BA concentrations in AF patients compared to sinus rhythm controls. Notably, within the AF group, persistent cases exhibited lower BA levels than paroxysmal cases (3.00 (1.67-5.00) vs 3.80 (2.30-6.40) μmol/L, <i>p</i> = 0.005). Analysis demonstrated a nonlinear L-shaped relationship between BA and AF prevalence (inflection point: 4.08 μmol/L), with lower BA levels independently associated with higher AF risk (adjusted odds ratio = 1.84, 95% CI: (1.03-3.29), <i>p</i> = 0.040). These findings establish an L-shaped correlation, indicating reduced fasting serum total BA as an independent predictor for increased AF risk in the elderly.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"709-720"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145369317","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":"Effect of monotherapeutic caloric restriction diet on cardiometabolic parameters in adults with overweight or obesity: Insights from meta-analyses of randomized controlled trials.","authors":"Tran Quang Duc, Nguyen Di Khanh, Dang Khoa Dang, Vu Thi Quynh Chi, Nguyen Thi Hoa Huyen, Khanh Van Nguyen, Nguyen Thi Thanh Huong","doi":"10.1177/10815589251409732","DOIUrl":"10.1177/10815589251409732","url":null,"abstract":"<p><p>The cardiometabolic benefits of caloric restriction (CR) often overlap with those of intermittent fasting (IF), creating clinical uncertainty. This meta-analysis updates and refines the evidence on the effects of a monotherapeutic CR diet (MCRD) on cardiometabolic parameters in adults at high cardiovascular risk, compared with a usual diet. A systematic search of four databases through May 2025 identified 17 randomized controlled trials (1066 participants) with low to moderate risk of bias, all involving populations with a mean baseline body mass index ≥ 30 kg/m². The results indicate that MCRD significantly reduced body weight (MD: -6.29 kg; 95% CI: -7.51 to -5.06), waist circumference (MD: -5.09 cm; 95% CI: -6.48 to -3.70), body fat (MD: -4.89 kg; 95% CI: -5.92 to -3.87), central abdominal fat (MD: -0.7 kg; 95% CI: -0.97 to -0.43), and lean body mass (MD: -1.34 kg; 95% CI: -2.14 to -0.53). Significant metabolic improvements were observed, with reductions in fasting insulin (MD: -2.22 μIU/L; 95% CI: -3.83 to -0.61), HbA1c (MD: -0.31%; 95% CI: -0.61 to -0.01), HOMA-IR (MD: -0.97; 95% CI: -1.86 to -0.09), and both systolic (MD: -6.06 mmHg; 95% CI: -9.46 to -2.65) and diastolic blood pressure (MD: -3.79 mmHg; 95% CI: -6.34 to -1.25). No significant effects were observed on lipid profiles, glucose levels, or high-sensitivity C-reactive protein. Meta-regression showed that caloric intake reduction, longer intervention duration, and older age significantly covariate with weight reduction. While beneficial, MCRD requires complementary strategies for optimal health. Further research is needed to clarify its unique mechanisms and distinguish them from the overlapping effects of IF.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"628-640"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893612","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 role of the <i>Journal of Investigative Medicine</i> in human subject protection: Beyond informed consent.","authors":"Mark E Schweitzer","doi":"10.1177/10815589261452237","DOIUrl":"10.1177/10815589261452237","url":null,"abstract":"","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"627"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147848190","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":"Medical students' perceptions of AI-generated practice questions as learning tools.","authors":"Hudson Tate, Brenton T Bicknell, Paul Fiore, John Galloway, Jackson Borak, William S Brooks","doi":"10.1177/10815589251406265","DOIUrl":"10.1177/10815589251406265","url":null,"abstract":"<p><p>Generative artificial intelligence (AI) tools, including large language models such as ChatGPT, have potential as educational adjuncts to enhance student learning. This study evaluated the perceived utility of and performance outcomes associated with formative, AI-generated, United States Medical Licensing Examination-style practice questions among preclinical medical students. Multiple-choice questions (MCQs) aligned with 15 microbiology and endocrinology lectures were generated with ChatGPT 4.0 and distributed via Google Forms to 386 students (198 first-year medical student (MS1), 188 second-year medical student (MS2)) at a U.S. medical school. Each question set consisted of six questions on average, and these groupings were considered individual \"question sets\" in our analysis. Question completion was optional for students and a total of 490 question sets were completed. Students provided feedback on 94.9% of sets, with 82.8% rating the questions as \"Helpful,\" 16.1% as \"Somewhat Helpful,\" and 1.1% as \"Not Helpful.\" MS2s answered a significantly higher number of questions correctly relative to MS1s (84.4% vs 78.6%, <i>p</i> < 0.001), and performance varied by lecture topic. However, average scores did not differ significantly based on whether students provided feedback or how they rated the questions (<i>p</i> = 0.587). These findings suggest that AI-generated MCQs are broadly accepted by students as supplemental formative learning tools. While performance variation was observed, conclusions about broader feasibility should be considered exploratory and warrant further study.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"663-669"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145656821","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 CRP/albumin ratio (CAR) may be more strongly linked to delirium than other indices derived from laboratory parameters in older patients in an intensive care unit.","authors":"Merve Yilmaz Kars, Ilyas Akkar, Mustafa Hakan Dogan, Zeynep Iclal Turgut, Orhan Cicek, Ayse Dikmeer, Korhan Kollu, Ebru Cagri Cakir Ozden, Muhammet Cemal Kizilarslanoglu","doi":"10.1177/10815589261415891","DOIUrl":"10.1177/10815589261415891","url":null,"abstract":"<p><p>The aim of this study is to investigate the association of delirium with laboratory-derived indices and ratios in patients staying in an intensive care unit. Delirium was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria, and laboratory data obtained at the time of diagnosis were retrospectively analyzed. The following indices were calculated: C-reactive protein (CRP)/albumin ratio (CAR), CRP-albumin-lymphocyte, B12-CRP index, systemic immune-inflammation, Prognostic Nutritional Index, advanced lung cancer inflammation, Systemic Inflammation Response Index, and Glasgow Prognostic Score. In addition, inflammation markers derived from the complete blood count were also analyzed. They were compared between patients with and without delirium. The study included 215 patients, of whom 104 had delirium (median age 76 years, 51.6% females). Patients with delirium were older than those without delirium (<i>p</i> = 0.008). The median CAR index was higher in patients with delirium (3.4 mg/g, 0.02-28.23) compared to those without delirium (2.19 mg/g, 0.02-16.74), with borderline statistical significance (<i>p</i> = 0.071). No statistically significant differences were found in other indices and laboratory parameters between patients with delirium and those without it (<i>p</i> > 0.05 for all). When patients were stratified into tertiles based on CAR levels, the occurrence of delirium was significantly higher in the third tertile than in the other two tertiles (<i>p</i> = 0.020). Even after adjusting for all significant confounding factors, CAR remained independently associated with delirium (odds ratio: 1.099, 95% confidence interval: 1.002-1.205, <i>p</i> = 0.046). The findings of this study suggest that the CAR index may serve as an independent associated factor for delirium compared to other laboratory-derived markers in critically ill patients.</p>","PeriodicalId":520677,"journal":{"name":"Journal of investigative medicine : the official publication of the American Federation for Clinical Research","volume":" ","pages":"698-708"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145954937","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}