HCA healthcare journal of medicine最新文献

{"title":"A Complex Case of a Large Fibroid Uterus Compressing the Inferior Vena Cava Causing Recurrent Deep Vein Thrombosis and Pulmonary Embolisms.","authors":"Jessica Gil, Jessica Klingensmith, Lauren Hendrix, Patrick J Stocker, Olugbenga Oyesanmi","doi":"10.36518/2689-0216.1942","DOIUrl":"10.36518/2689-0216.1942","url":null,"abstract":"<p><strong>Background: </strong>Uterine fibroids have been found to increase the risk for venous thromboembolism. There have been other case reports linking large uterine fibroids, pulmonary embolisms, and deep vein thrombosis (DVT) together due to compression of blood vessels and increased venous stasis. This case report will discuss a case of a large fibroid uterus compressing the inferior vena cava causing a patient with few risk factors to have recurrent DVTs and pulmonary embolisms.</p><p><strong>Case presentation: </strong>The patient was a 35-year-old woman who presented with repeated unprovoked thrombosis episodes. The patient had a full workup after the first episode of DVT and was started on anticoagulation; however, the patient stopped taking her anticoagulation medication due to cost and presented to the emergency room 4 months later with a right lower extremity DVT and bilateral pulmonary embolisms.</p><p><strong>Conclusion: </strong>There are many common causes that can explain recurrent thrombotic events in patients; however, it is important to also consider gynecological causes as a differential diagnosis when a patient presents with recurrent unexplained thrombotic events. Uterine fibroids that are large enough can compress large vessels and cause venous stasis in a relatively healthy person. Treating uterine fibroids can decrease the risk of another thrombotic event and can ultimately keep the patient off anticoagulation.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"345-347"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425414/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-Center Survey of Medicine Residents and Self-Assessment on Cardiac Complications in Obstetric Patients.","authors":"Kevyn Niu, Christie A Tran, Robert J Subbiondo, Olubenga Oyesanmi","doi":"10.36518/2689-0216.1856","DOIUrl":"10.36518/2689-0216.1856","url":null,"abstract":"<p><strong>Background: </strong>Internal medicine (IM) residents receive significant cardiology training, and previous surveys have evaluated IM resident competency on obstetric (OB)-related subjects. However, there is minimal literature on self-reported competence of cardiac-specific complications in OB patients. Our study assessed self-reported comfort and competency regarding cardiovascular complications in OB patients with medical residents across several specialties.</p><p><strong>Methods: </strong>We surveyed 207 residents across 3 specialties and 3 teaching hospitals on 10 questions regarding their self-reported confidence in managing cardiovascular complications in OB patients, including practice setting, specific cardiac issues, and stages of labor. We received 42 responses. Results were obtained using Google Sheets and analyzed with Microsoft Excel.</p><p><strong>Results: </strong>Internal medicine residents reported being less confident in managing cardiac complications in OB patients compared to family medicine (FM) and obstetrics and gynecology (OBGYN) residents across all categories. PGY3 IM residents rated themselves on par with FM/OB residents in the ICU setting. The presence of OB services in the hospital did not affect IM resident self-assessment.</p><p><strong>Conclusion: </strong>Internal medicine residents demonstrated low self-assessment scores regarding confidence managing cardiac conditions in OB patients. There may be opportunities to introduce specific OB-related teaching material to increase confidence.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"377-383"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425412/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Challenges Faced by Female Graduate Medical Education Trainees: A Qualitative Content Analysis of Physician Coaching Requests.","authors":"Nathalie Dieujuste, Adrienne Mann, Kimiko Dunbar, Pari Shah Thibodeau, Tyra Fainstad, Brooke Dorsey Holliman","doi":"10.36518/2689-0216.1991","DOIUrl":"10.36518/2689-0216.1991","url":null,"abstract":"<p><strong>Background: </strong>Physician burnout, particularly among female graduate medical education (GME) trainees, is a growing concern that affects physician wellness and patient safety. Professional coaching has shown promise in improving physician wellness. The Better Together Physician Coaching program (BT) is a web-based, group-coaching program, piloted using female GME trainees, aimed at improving key indicators of well-being, including burnout and impostor syndrome. In this qualitative study, we aimed to understand the challenges faced by female physician trainees shared in the pilot of the BT coaching intervention.</p><p><strong>Methods: </strong>A total of 101 female physician trainees participated in the BT pilot. A sample of 41 of the 80 group coaching calls and all 21 written coaching requests were included in this study. A qualitative content analysis was conducted of 132 coaching instances, using a team-based, deductive and inductive, rapid domain analysis strategy.</p><p><strong>Results: </strong>Deductive analysis of 132 coaching instances confirmed burnout, impostor syndrome, self-compassion, and moral injury as key areas for which female physician trainees sought coaching. Inductive analysis also identified additional areas for which trainees sought coaching, including career uncertainty, feedback navigation, and relationship stress.</p><p><strong>Conclusion: </strong>The preliminary findings highlight the importance of addressing these specific challenges and tailoring coaching interventions to meet the needs of female physician trainees.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"319-329"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425416/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Message in a Bottle.","authors":"Saptarshi Biswas","doi":"10.36518/2689-0216.2308","DOIUrl":"10.36518/2689-0216.2308","url":null,"abstract":"<p><p>Description The title of the image is inspired by a famous old song by the British rock band The Police. The song featured Sting's evocative lyrics and captures a profound sense of isolation and longing. The song tells the story of a castaway who sends out a distress signal, only to discover that he is not alone in his feelings of loneliness. Through its haunting melody and rhythmic pulse, the track conveys themes of connection and the human experience, illustrating how, despite physical separation, people share similar struggles and emotions. The metaphor of the bottle serves as a poignant reminder of our desire to reach out and find understanding in a vast and often indifferent world. Interestingly the image was taken in a street festival in India from a pandal decoration. Psychologically, the concept taps into deep-seated human desires for connection and understanding. A message in a bottle represents hope and the possibility of connecting others, spread across vast distances. Such notion can evoke feelings of belonging and purpose, counteracting feelings of isolation. Furthermore, the randomness of finding a message adds an element of serendipity, reinforcing the idea that connections can happen in unexpected ways.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"387-388"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sevoflurane in Status Asthmaticus: A Case Report and Literature Review.","authors":"Amelia L Gurley, Thomas W Church, Sana Hadyah, Brandon Abrajan, Julia Cheree Glavinic","doi":"10.36518/2689-0216.1961","DOIUrl":"10.36518/2689-0216.1961","url":null,"abstract":"<p><strong>Background: </strong>Sevoflurane and other inhaled anesthetics are gradually entering provider awareness as rescue therapies for patients in refractory status asthmaticus. This paper documents a case report and a literature review involving the use of sevoflurane to treat status asthmaticus.</p><p><strong>Case presentation: </strong>A 27-year-old man presented to the emergency room in acute hypoxic respiratory failure due to status asthmaticus, refractory to multiple therapies and requiring intubation. He was successfully extubated following sevoflurane administration in the operating room, and his care was complicated by transient hypotension. A multidisciplinary effort was critical in ensuring successful and timely therapy.</p><p><strong>Methods: </strong>We performed a literature review using the search terms \"sevoflurane,\" \"status asthmaticus,\" \"acute asthma,\" and \"asthma\" in PubMed and Google Scholar. Our search returned a total of 1825 results, of which 1772 covered other topics and 53 discussed the use of sevoflurane for treatment of status asthmaticus. Eighteen articles were duplicates, and 2 were not available in English translation. Two additional sources were found by following citations within texts.</p><p><strong>Results: </strong>We found 22 articles describing the use of sevoflurane to treat status asthmaticus, covering 30 total patient cases. All cases described resolution of status asthmaticus following sevoflurane administration. In 2 cases, sevoflurane was administered via mask to awake patients. Hypotension was a noted complication in 1 case.</p><p><strong>Conclusion: </strong>Although not yet considered standard of care, sevoflurane has been extensively documented as a successful treatment for refractory status asthmaticus in multiple case reports. Administration of this therapy often requires multidisciplinary coordination. Hypotension is one noted adverse effect. However, further study is needed to investigate best practices and possible complications.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"355-361"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recurrent, Acute Limb Ischemia Secondary to Arterial Thrombosis: A Devastating Complication in the Setting of Severe COVID-19 Infection.","authors":"Shaikh Afaq, Kyle S Strouse, Sini Saju, Olugbenga Oyesanmi, Mohamad Eid, Salman Muddassir","doi":"10.36518/2689-0216.1580","DOIUrl":"10.36518/2689-0216.1580","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 infection, particularly with the Delta variant, has been associated with a heightened risk of thromboembolic events due to a profound hypercoagulable state. While venous thrombosis is more commonly reported, arterial thrombosis-including acute limb ischemia-has emerged as a serious complication with significant morbidity and mortality.</p><p><strong>Case presentation: </strong>We report the case of a 53-year-old man with severe COVID-19 pneumonia who developed recurrent acute limb ischemia secondary to an aortic mural thrombus. Despite therapeutic anticoagulation and multiple surgical interventions-including thrombectomy, angioplasty, and stenting-the patient experienced repeated episodes of arterial thrombosis. His clinical course was further complicated by pneumothorax and hemothorax, ultimately resulting in cardiopulmonary arrest and death.</p><p><strong>Conclusion: </strong>This case highlights the aggressive and resistant nature of arterial thrombosis in the setting of severe COVID-19. Recurrent arterial thrombosis in severe COVID-19 underscores the need for early recognition and aggressive anticoagulation strategies. Further research is warranted to establish protocols for thromboembolic prevention in this high-risk population.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 4","pages":"331-334"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Lichenoid Reaction and Eruptive Keratoacanthomas Following PD-1 Inhibitor Therapy.","authors":"Paul Vance, Michael Hohnadel","doi":"10.36518/2689-0216.1914","DOIUrl":"10.36518/2689-0216.1914","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitors, such as nivolumab, have become integral in treating metastatic malignancies by enhancing immune responses against tumors. However, they are associated with immune-related adverse events (irAEs), including cutaneous reactions. We report a case of persistent lichenoid dermatitis during therapy and eruptive keratoacanthomas (KAs) following the cessation of nivolumab.</p><p><strong>Case presentation: </strong>A 77-year-old Caucasian man presented with a subcutaneous melanoma on the left lateral chest, treated with excision followed by adjuvant nivolumab. Seven weeks into therapy, he developed pruritic erythematous macules, forming patches on his forearms, later spreading to his trunk. Biopsy confirmed lichenoid dermatitis. Treatment with triamcinolone cream 0.1% provided limited relief. Despite completing nivolumab therapy, the rash persisted. Oral prednisone 10 mg daily for 14 days yielded temporary improvement. Nineteen weeks post-therapy, he developed tender nodules on his left lower extremity, diagnosed as KAs via biopsy. Further KAs emerged and were treated and resolved with intralesional 5-fluorouracil. Forty weeks post-therapy, the lichenoid dermatitis remained stable with topical and intermittent oral steroids. The patient opted against additional treatments, such as UV-B therapy, preferring to await spontaneous resolution.</p><p><strong>Conclusion: </strong>This case underscores the need for vigilance in identifying and managing dermatologic irAEs associated with programmed cell death protein 1 inhibitors. Persistent lichenoid dermatitis and eruptive KAs present unique challenges, requiring tailored therapeutic strategies. Further research is essential to optimize management of these adverse events and improve patient outcomes.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"283-286"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Autoimmune Polyarthritis due to COVID-19 Vaccine.","authors":"Ramesh Pandit, Namratha Pallipamu, Trupiti Pandit","doi":"10.36518/2689-0216.1619","DOIUrl":"10.36518/2689-0216.1619","url":null,"abstract":"<p><strong>Background: </strong>Vaccinations for COVID-19 have played a pivotal role in controlling the global pandemic, with most adverse events being mild and transient. However, rare post-vaccination autoimmune responses have been reported. The understanding of long-term rheumatologic sequelae, particularly autoimmune polyarthritis following COVID-19 vaccination, remains limited.</p><p><strong>Case presentation: </strong>We report the case of a 41-year-old previously healthy man who developed progressive polyarthritis and systemic symptoms following the Johnson & Johnson COVID-19 vaccine. The initial symptoms of joint swelling and arthralgia appeared within a week of the first vaccine dose, subsiding temporarily with medication. After receiving a booster dose, the patient experienced worsening polyarthritis affecting multiple joints including knees, elbows, wrists, shoulders, and neck, along with low-grade fever, fatigue, and functional decline. Despite outpatient anti-inflammatory therapy, symptoms persisted and worsened over the next six months, prompting hospitalization. Workup revealed elevated inflammatory markers (ESR 77 mm/hr, CRP 193.2 mg/L), synovial fluid consistent with inflammatory arthritis, and infectious serologies. Imaging showed joint effusions and calcified pulmonary granulomas. He was diagnosed with vaccine-induced reactive arthritis. Treatment with intravenous corticosteroids led to partial symptom relief, and he was discharged on oral steroids and initiated on methotrexate for long-term management.</p><p><strong>Conclusion: </strong>Clinicians should maintain a high index of suspicion for autoimmune phenomena such as reactive polyarthritis following COVID-19 vaccination, especially in patients with new-onset joint symptoms. Early recognition and referral to rheumatology may improve outcomes. Further studies are needed to clarify the pathophysiology, risk factors, and long-term prognosis of such vaccine-associated autoimmune conditions.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"263-267"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beneath the Label - Evaluating the FDA Approval of Copenhagen Classic Snuff as a Modified Risk Tobacco Product.","authors":"Yisroel Grabie, Tafani Chowdhury, Sudeep Acharya","doi":"10.36518/2689-0216.1832","DOIUrl":"10.36518/2689-0216.1832","url":null,"abstract":"<p><p>Description In this review, we critically evaluate the Food and Drug Administration's modified risk tobacco product (MRTP) status granted to a smokeless tobacco product (March 2023), Copenhagen Classic Snuff (CCS). This new status necessitates an assessment of the product CCS use and its public health impacts. We assess the impact of CCS as it relates to the reduction of lung cancer risk and the potential increased risk for nasopharyngeal cancer, chronic rhinitis, nicotine dependence, and other health hazards. Concerns persist regarding nicotine's harm and public misperception due to risk reclassification, and caution should be maintained to discourage novel snuff users. Advocating prudent interpretation of MRTP status and comprehensive post-market surveillance is necessary for critical assessment by health care professionals and consumers.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"209-212"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes After Hospitalization for Acute Coronary Syndrome in Patients Treated with Semaglutide Versus Bariatric Surgery: A Retrospective Multicenter Analysis.","authors":"Nameer Ascandar, Charles Boadu, Gauthier Stepman, George Skaf, Olugbenga Oyesanmi, Sabry Omar, Rias Ali, Michael Schandorf-Lartey","doi":"10.36518/2689-0216.1960","DOIUrl":"10.36518/2689-0216.1960","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a chronic medical condition with a rising prevalence in the United States. A wide range of morbidity and mortality is associated with obesity, with coronary artery disease being among the most common. Ischemic heart disease continues to be the primary cause of death in the United States. Taken together, interventions to minimize the detrimental effects of obesity on patients at risk of heart disease will not only benefit the patient, but the health care system as well.</p><p><strong>Methods: </strong>In this retrospective study, we used the HCA Healthcare enterprise data warehouse to identify all adult patients who were admitted for acute coronary syndrome (ACS) and were currently or previously treated for obesity with either semaglutide or bariatric surgery. Descriptive and regression analysis were performed to examine our primary and secondary outcomes of interest.</p><p><strong>Results: </strong>Of 10 316 total patients who met inclusion criteria, 6920 (67.1%) were in the semaglutide group and 3396 (32.9%) were in the bariatric surgery group. The semaglutide cohort was on average older, more frequently men, nonwhite race, and less frequently smokers compared with the bariatric surgery group. Results of regression analysis showed the semaglutide group was associated with lower odds of in-hospital mortality (AOR, 0.61; 95% CI, 0.41-0.92) and higher odds of acute heart failure (AOR, 3.45; 95% CI, 2.2-5.4) compared to bariatric surgery. Furthermore, negative binomial regression showed a 1.5 shorter duration of hospital stay for the semaglutide cohort following inpatient admission for ACS compared with the bariatric group. The semaglutide cohort was linked with higher odds of achieving revascularization via percutaneous coronary intervention (AOR, 1.19; 95% CI, 1.04-1.35) compared with the bariatric surgery group. Lastly, the semaglutide group was associated with higher odds of acute heart failure (3.45; 2.19-5.44) compared with the bariatric surgery group.</p><p><strong>Conclusion: </strong>Semaglutide use was associated with lower in-hospital mortality and shorter duration of hospital stay but higher odds of acute heart failure compared with patients who had prior bariatric surgery. Semaglutide use was associated with higher odds of acquiring revascularization. Lastly, semaglutide may be an effective alternative to prevent major adverse events in obese patients at risk of ischemic heart disease.</p>","PeriodicalId":73198,"journal":{"name":"HCA healthcare journal of medicine","volume":"6 3","pages":"249-257"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12240409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}