American Journal of Cardiology最新文献

{"title":"Sex Disparities in Acute Myocardial Infarction Diagnosis and Treatment.","authors":"Mary T Imboden, Erin Koltner, Jane H Bryant, Adrienne Jones, Renee C Swanson, Lori M Tam, Kevin J Woolf","doi":"10.1016/j.amjcard.2025.09.013","DOIUrl":"10.1016/j.amjcard.2025.09.013","url":null,"abstract":"<p><p>This study sought to assess sex differences in timely diagnosis (time-to-ECG) and treatment (time-to-percutaneous coronary intervention (PCI)) of ST-elevation myocardial infarction (STEMI) and Non-STEMI (NSTEMI) patients utilizing a retrospective cross-sectional analysis of 1,098 STEMI (306 females and 792 males) and 2,179 NSTEMI (747 females, 1,432 males) patients that presented to 2 urban EDs between January 2022 and December 2024 was performed. Sex differences in time-to-ECG were assessed in both STEMI and NSTEMI patients, whereas differences in time-to-PCI were assessed in STEMI patients only. Time-to-ECG and time-to-PCI were compared continuously, as well as categorically (ECG delay = time-to-ECG >10 min and PCI delay = time-to-PCI >90 min or >120 min when a transfer occurred). Median time-to-ECG was 3.0 min shorter for male STEMI and NSTEMI patients. Males also had a reduced likelihood of an ECG delay (OR: 0.64 [95% CI 0.51 to 0.82]). Sex disparities remained when assessing only patients with a chief complaint of chest pain (OR:0.74 [95% CI 0.56 to 0.97]). Male STEMI patients also had a shorter wait time for PCI compared to females (walk-in: 1:26:00 vs 1:41:00, transfer: 2:19:30 vs 2:44:30, respectively). However, sex was not a significant predictor of PCI delay after controlling for time-to-ECG. In conclusion, sex disparities were found in time-to-ECG for STEMI and NSTEMI patents, as well as time-to-PCI for STEMI patients. However, sex was not significantly associated with PCI delay after controlling for time-to-ECG. This highlights the importance of timely diagnosis to ensure timely revascularization in acute myocardial infarction patients.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Escalation From Intra-Aortic Balloon Pump in Cardiogenic Shock Patients: A Multistate Analysis of the Altshock-2 Registry.","authors":"Nuccia Morici, Alice Sacco, Davide Paolo Bernasconi, Simone Frea, Giulia Maj, Nicoletta D'Ettore, Giovanna Viola, Pier Paolo Bocchino, Andrea Cesari, Ignazio Cusmano, Maurizio Bertaina, Matteo Pagnesi, Martina Briani, Mario Iannaccone, Carlotta Sorini Dini, Serafina Valente, Marco Marini, Mario Sabatino, Luciano Potena, Silvia Di Lauro, Gaetano Maria De Ferrari, Navin K Kapur, Guido Tavazzi, Federico Pappalardo","doi":"10.1016/j.amjcard.2025.09.010","DOIUrl":"10.1016/j.amjcard.2025.09.010","url":null,"abstract":"<p><p>Cardiogenic shock is a deadly disorder and temporary mechanical circulatory support devices (tMCS) have been introduced to improve survival. However, criteria and strategies for timely placement and escalation are lacking. A major limitation of previous research is the focus on a single intervention or device; in clinical practice, these patients are transitioned through multiple configurations of tMCS. Accordingly, we have applied the generalized framework of a multistate model to enhance our understanding of the disease process. A multistate survival analysis was conducted on the Altshock-2 registry to describe the proportions, over time, of patients alive without tMCS (starting state), and being treated with tMCS until heart replacement therapy (disease transitions) or, ultimately, death (absorbing state). Among 544 included patients 199 (36.6%) did not receive any tMCS, 252 (46.3%) received a single device (81% intra-aortic balloon pump [IABP]), and 93 (17.1%) underwent escalation. Considering only patients with IABP (281 patients), 77 (27.4%) underwent escalation whereas 204 received IABP as the only tMCS, with in-hospital death of 59.1% and 40.5%, respectively (p <0.01). IABP escalation was associated with increased mortality compared with IABP alone only in the acute coronary syndrome (ACS) group (RR 1.74, 95% CI 1.29 to 2.35), whereas no difference was observed in the heart failure (HF) group (RR 0.66, 95% CI 0.28 to 1.58), also after adjustment for SCAI stage at 24 hours from admission. In conclusion, the need to escalate from IABP to other tMCS devices is associated with increased mortality in the setting of ACS-CS. Timely implantation of the right tMCS is a key factor in CS treatment.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics and Outcomes of ST-Segment Elevation Myocardial Infarction Due to Left Main Coronary Artery Stenosis.","authors":"Ramy Sedhom, Mohamed Omer, Mohamed Khedr, Dmitry Abramov, Aditya S Bharadwaj, Ahmed Athar, Vinoy Prasad, Khaldoon Alaswad, Mir B Basir, Emmanouil S Brilakis, Michael Megaly","doi":"10.1016/j.amjcard.2025.09.016","DOIUrl":"10.1016/j.amjcard.2025.09.016","url":null,"abstract":"<p><p>There is limited data on the incidence and outcomes of ST-segment elevation myocardial infarction (STEMI) due to the left main coronary artery (LMCA) lesions. We aimed to examine the trends and outcomes of STEMI due to LMCA lesions. The Nationwide Readmissions Database was utilized to identify hospitalizations with LMCA STEMI between January 2016 and December 2022. The primary outcome was all-cause in-hospital mortality during index admission. Among 1,528,764 weighted hospitalizations with STEMI from 2016 to 2022, 4,885 (0.3%) were due to LMCA lesions, of which 2156 (44.1%) had cardiogenic shock (CS). The number of LMCA STEMI hospitalizations and the incidence of CS increased over time. Mechanical circulatory support was used in 78.8% of the patients with LMCA STEMI and CS, with intra-aortic balloon pump being the most common modality (63%). Impella utilization increased from 4.5% in Q1 2016 to 34% in Q4 2022. Revascularization was performed in 78.2% of cases, with percutaneous coronary intervention (PCI) being the most common revascularization modality (62.1%). Among those who had PCI, intravascular imaging (IVI) was used in 18.3%, with a significant increase from 9.6% in Q1 2016 to 26.3% in Q4 2022. All-cause in-hospital mortality was 25.5% and was significantly higher among CS patients (43.4% vs 11.4%, p < 0.001). In conclusion, the incidence of LMCA STEMI increased from 2016 to 2022 with nearly half of the patients developing CS. IVI use in LMCA PCI was low (18.3%) but increased over time. More than 1 in 4 patients with LMCA STEMI died during the index hospitalization.</p>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Functional Mitral Regurgitation Associated With Heart Failure with Mildly Reduced or Preserved Ejection Fraction","authors":"Ga Yun Kim MD,&nbsp;So-Min Lim MD,&nbsp;Sahmin Lee MD, PhD,&nbsp;Byung Joo Sun MD, PhD,&nbsp;Jong-Min Song MD, PhD,&nbsp;Duk-Hyun Kang MD, PhD","doi":"10.1016/j.amjcard.2025.08.067","DOIUrl":"10.1016/j.amjcard.2025.08.067","url":null,"abstract":"<div><div>While functional mitral regurgitation (FMR) is frequently observed in patients with heart failure (HF), its underlying mechanisms and clinical significance may differ among various HF subgroups. Data regarding the clinical significance of FMR in heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) are limited. We tried to investigate the predominant mechanisms of FMR in HFmrEF and HFpEF and evaluate the impact of FMR on long-term outcomes in these two groups. From 2013 to 2022, 407 consecutive patients with HFmrEF or HFpEF with moderate-to-severe FMR were evaluated prospectively. FMR was classified as either ventricular functional mitral regurgitation (VFMR) or atrial functional mitral regurgitation (AFMR). The primary endpoint was a composite of cardiovascular mortality or hospitalization due to HF, and secondary endpoints included significant MR progression and mitral valve intervention. VFMR was predominant in patients with HFmrEF (87.8%), while AFMR was more common in patients with HFpEF (83.3%, p &lt;0.001). The incidence of the primary endpoint was similar between the two groups (29.5% for HFmrEF vs 30.3% for HFpEF, p = 0.865). However, MR progression (35.9% vs 21.2%, p = 0.002) and mitral valve interventions (17.5% vs 5.1%, p &lt;0.001) were more common in HFpEF. MR progression was independently associated with the primary endpoint in both HFmrEF (HR: 3.014, 95% CI: 1.586 to 5.727; p = 0.001) and HFpEF (HR: 1.737, 95% CI: 1.055 to 2.860; p = 0.030). Among patients with HFmrEF or HFpEF with moderate-to-severe FMR, VFMR and AFMR were the dominant mechanisms of FMR in HFmrEF and HFpEF, respectively. Progression of MR was associated with cardiovascular events in both groups. A comprehensive understanding of the distinct mechanisms of FMR in these HF subgroups may guide tailored therapeutic strategies for managing FMR.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 165-171"},"PeriodicalIF":2.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145111515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Major Clinical Outcomes in Patients With Carotid Artery Stenosis Undergoing Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-analysis","authors":"Theoni Theodoropoulou MD, MSc ,&nbsp;Nikolaos Vythoulkas-Biotis MD ,&nbsp;Anastasios Apostolos MD,MSc ,&nbsp;Nikolaos Ktenopoulos MD, MSc ,&nbsp;Leonidas Koliastasis MD, PhD ,&nbsp;Andreas Synetos MD, PhD ,&nbsp;Maria Drakopoulou MD, PhD ,&nbsp;Sotirios Tsalamandris MD, PhD ,&nbsp;George Latsios MD, PhD ,&nbsp;Konstantinos Tsioufis MD, PhD ,&nbsp;Konstantinos Toutouzas MD, PhD","doi":"10.1016/j.amjcard.2025.09.007","DOIUrl":"10.1016/j.amjcard.2025.09.007","url":null,"abstract":"<div><div>Data on carotid artery stenosis (CAS) prevalence in patients undergoing transcatheter aortic valve replacement (TAVR) are limited. It remains unclear whether CAS serves as a predictor of worse outcomes following TAVR. This meta-analysis aims to assess the impact of CAS on major clinical outcomes in this population. A comprehensive literature search was conducted across 3 databases to identify relevant studies. The primary endpoint was the 30-day incidence of Stroke or Transient Ischemic Attack (TIA) in patients with CAS≥50% and CAS≥70%, respectively. Secondary endpoints included in-hospital Stroke/TIA, in-hospital mortality, 30-day mortality, bleeding events, myocardial infarction (MI), acute kidney injury (AKI), periprocedural vascular complications, and permanent pacemaker implantation (PPM) up to 30 days. A total of 15 studies, involving 129,155 patients, were included in the meta-analysis. CAS was associated with higher rates of 30-day Stroke/TIA: 1) CAS ≥50% (Risk Ratio (RR): 1.38, 95% Confidence Intervals (CI): 1.19, 1.59), 2) CAS ≥70% (RR: 1.61, 95% CI: 1.10, 2.36). CAS comorbidity was also linked to increased risk for in-hospital stroke/TIA (RR: 1.73, 95% CI: 1.28, 2.33), 30-day mortality (RR: 1.29, 95% CI: 1.13, 1.47), and 30-day bleeding events (RR: 1.15, 95% CI: 1.08, 1.23). No differences were observed in the rest secondary endpoints. In conclusion, CAS was associated with a higher risk of 30-day and in-hospital cerebrovascular events following TAVR. Patients with CAS are at an increased risk of 30-day all-cause mortality without any impact on in-hospital mortality. Further studies are required to validate our results.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"256 ","pages":"Pages 145-154"},"PeriodicalIF":2.1,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence, Predictors, and Outcomes of Subclinical Valve Thrombosis After TAVR in Bicuspid Aortic Valve Stenosis","authors":"Xue-Chen Qiao MD ,&nbsp;Yue Yin MD ,&nbsp;Meng-Yun Yan MD ,&nbsp;Yu Tang MD ,&nbsp;Wei-Ya Li MD ,&nbsp;Ying Zhang MD ,&nbsp;Tian-Yuan Xiong MD ,&nbsp;Yi-Ming Li MD ,&nbsp;Jun-Li Li MD ,&nbsp;Lin Bai MD ,&nbsp;Xin Wei MD ,&nbsp;Yuan-Weixiang Ou MD ,&nbsp;Zhong-Kai Zhu MD ,&nbsp;Yi-Jun Yao MD ,&nbsp;Qiao Li MD ,&nbsp;Yi-Jian Li MD ,&nbsp;Fei Chen MD ,&nbsp;Jia-Fu Wei MD ,&nbsp;Yong Peng MD ,&nbsp;Yuan Feng MD ,&nbsp;Mao Chen MD, PhD","doi":"10.1016/j.amjcard.2025.09.005","DOIUrl":"10.1016/j.amjcard.2025.09.005","url":null,"abstract":"<div><div>Subclinical valve thrombosis, radiographically defined as hypo-attenuated leaflet thickening (HALT) on computed tomography angiography (CTA), may impact bioprosthetic valve durability and outcomes following transcatheter aortic valve replacement (TAVR). This study aimed to evaluate HALT incidence, identify distinct predictors in bicuspid (BAV) versus tricuspid (TAV) aortic valves, and assess its clinical and hemodynamic implications. A total of 508 patients (285 BAV, 223 TAV) were included in the analysis. HALT incidence was comparable between groups (13.6% [39/285] vs 13.0% [29/223], p = 0.823), though severity and predictors differed. TAV patients showed greater leaflet thickening (2.7 ± 1.5 mm vs 1.9 ± 1.1 mm, p = 0.04). In BAV, independent predictors included elevated D-dimer, deeper transcatheter heart valve (THV) implantation, higher THV nadir eccentricity index, and asymmetric leaflet expansion. In TAV, predictors included elevated D-dimer, lower early peak transvalvular velocity, and asymmetric leaflet expansion. HALT was not associated with 1-year transvalvular gradients or left ventricular ejection fraction in either group. Clinically, HALT was associated with higher cerebrovascular event rates (2.9% vs 0.5%, p = 0.031) and an increased risk of major adverse cardiac and cerebrovascular events (MACCE) (13.2% vs 5.7%, p = 0.036; HR = 2.24). In conclusion, HALT incidence is comparable between BAV and TAV patients, but predictors differ: THV expansion characteristics are dominant in BAV, while hemodynamic parameters prevail in TAV. Elevated D-dimer is a consistent predictor across both groups. Although HALT does not affect mid-term hemodynamics, its potential association with higher MACCE risk warrants long-term surveillance and individualized management strategies.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"258 ","pages":"Pages 180-189"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Performance of Prosthetic Heart Valve Infective Endocarditis: A Comparison of Diagnostic Modalities and Proposed Algorithm","authors":"Ben Thiravetyan MD,&nbsp;Chanokporn Puchongmart MD,&nbsp;Diego Cruz MD,&nbsp;Cristian Castillo Rodriguez MD,&nbsp;Dina Soliman MD","doi":"10.1016/j.amjcard.2025.09.006","DOIUrl":"10.1016/j.amjcard.2025.09.006","url":null,"abstract":"<div><div>Prosthetic valve endocarditis (PVE) is a potentially life-threatening complication following valve replacement surgery, with an increasing incidence due to the rise in prosthetic valve procedures. Accurate and timely diagnosis of PVE remains challenging due to altered cardiac anatomy and imaging artifacts. Traditional diagnostic tools, such as Duke criteria, were originally developed for native valve endocarditis and demonstrate suboptimal sensitivity and specificity in the context of PVE. Recent advancements incorporated novel molecular and imaging modalities, such as polymerase chain reaction and nuclear imaging techniques, in an attempt to improve the diagnostic accuracy. However, no single modality currently serves as a definitive gold standard. In conclusion, in this review, we critically compare the diagnostic performance of available tools for PVE, analyzing their sensitivity, specificity, positive predictive value, and negative predictive value. We further propose a practice approach to facilitate early and accurate diagnosis, ultimately aiming to improve clinical outcomes in patients with suspected PVE.</div></div>","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"255 ","pages":"Pages 146-154"},"PeriodicalIF":2.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145084855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to “Cardiac screening findings and referral patterns in male African-American basketball players: Analysis of the HeartBytes Registry”[The American Journal of Cardiology 243 (2025) 73-80]","authors":"Douglas Corsi MD ,&nbsp;Avinash Saraiya BS ,&nbsp;Maggie Doyle BS ,&nbsp;Vacha Shah BS ,&nbsp;Blaise O’Malley MPH ,&nbsp;Grace Qiu BS ,&nbsp;Renee Lanstaff PA-A ,&nbsp;Imran Masood DO ,&nbsp;Brian Osler MD ,&nbsp;Alexander G. Hajduczok MD ,&nbsp;Drew Johnson MD ,&nbsp;David Shipon MD","doi":"10.1016/j.amjcard.2025.08.015","DOIUrl":"10.1016/j.amjcard.2025.08.015","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":"255 ","pages":"Page 109"},"PeriodicalIF":2.1,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Stratifying Acute Total Occlusions in Non-ST-Segment Elevation Myocardial Infarction: Time for a Modified GRACE Score?","authors":"S Elissa Altin, Jennifer Miao","doi":"10.1016/j.amjcard.2025.08.053","DOIUrl":"10.1016/j.amjcard.2025.08.053","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular Assist Devices in Patients With Transposition of the Great Arteries.","authors":"S Sekhon, B Cheema, S Argaw, T Wu, R Harap, F S Ahmed, K Ghafourian, M Monge, A Pawale, D T Pham, Y Raza, A Tibrewala, J D Rich, E Vorovich, J Wilcox, Q R Youmans, I S Okwuosa","doi":"10.1016/j.amjcard.2025.09.001","DOIUrl":"10.1016/j.amjcard.2025.09.001","url":null,"abstract":"","PeriodicalId":7705,"journal":{"name":"American Journal of Cardiology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}