Annals of the American Thoracic Society最新文献

{"title":"Albuterol Reuse to Reduce the Carbon Footprint of Pulmonary Function Testing.","authors":"Alexandra M Peirce, Korin K Calkins, Tonia Allen, Daphne Lewis-Hawkins, Hallie C Prescott, Alexander S Rabin","doi":"10.1513/AnnalsATS.202410-1050RL","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202410-1050RL","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560215","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":"Association of Standardized Liberation Trials and Duration of V-V ECMO in Patients with Acute Respiratory Failure.","authors":"Ricardo Teijeiro-Paradis, Laveena Munshi, Niall D Ferguson, Kuan Liu, Eddy Fan","doi":"10.1513/AnnalsATS.202412-1252OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202412-1252OC","url":null,"abstract":"<p><strong>Rationale: </strong>There is a paucity of evidence around strategies to liberate patients from veno-venous extracorporeal membrane oxygenation (V-V ECMO) for acute respiratory failure.</p><p><strong>Objectives: </strong>The primary aim of this study was to determine if adopting standardized liberation trials (SLTs) for V-V ECMO is associated with duration of ECMO. The secondary aim was to identify factors associated with unsafe liberation, and the effects of unsafe liberation on mortality to ICU discharge.</p><p><strong>Methods: </strong>This was a single centre retrospective cohort study of patients on V-V ECMO for severe respiratory failure comparing endpoints between intervention (SLT) and control (no SLT) periods.</p><p><strong>Main results: </strong>A total of 262 patients were included in the study, 13% (35/262) received SLTs, and 150 patients were decannulated from ECMO. Implementing SLTs was strongly associated with the duration of V-V ECMO to first successful liberation trial (HR 1.88, 95% CI 1.16-3.06, p = 0.01) and decannulation (HR 1.92, 95% CI 1.0-3.06, p = 0.01) without increasing the frequency of unsafe liberation (SLTs - 21% [5/23]) vs. (No-SLTs - 19% [24/127]) (OR 1.19; 95% CI - 0.4-3.5, p = 0.7). Unsafe liberation was strongly associated with ICU mortality (HR 4.15, 95% CI 1.24-13.9, p = 0.02). Factors associated with unsafe liberation were respiratory rate (OR 1.49 per 5 breaths/min increase, 95% CI 1.07-2.08, p =0.02) and PaO2/FiO2 (OR 0.73 per 30 mmHg increase, 95% CI 0.57-0.93, p = 0.01) immediately prior to decannulation.</p><p><strong>Conclusion: </strong>Incorporating SLTs was significantly associated with duration of V-V ECMO without increasing the frequency of unsafe liberation. Unsafe liberation was associated with increased ICU mortality.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560216","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":"Echocardiographic Measure of Right Ventricular-pulmonary Arterial Coupling Predicts Survival in Lung Cancer.","authors":"Zvonimir A Rako, Michael Cekay, Athiththan Yogeswaran, Selin Yildiz, Philipp F Arndt, Nils Kremer, Simon Schaefer, Patrick Janetzko, Bruno Brito da Rocha, Chris M Mummert, Johanna K Franken, Henrik Soethe, Hannah F Werner, Rio Dumitrascu, Friedrich Grimminger, Hossein A Ghofrani, Soni S Pullamsetti, Werner Seeger, Robert Naeije, Rajkumar Savai, Bastian Eul, Khodr Tello","doi":"10.1513/AnnalsATS.202409-949OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202409-949OC","url":null,"abstract":"<p><strong>Rationale: </strong>Echocardiographic indicators of pulmonary hypertension have been reported to predict decreased survival in lung cancer.</p><p><strong>Objective: </strong>We tested the hypothesis that this may be associated with impaired right ventricular (RV)-systolic pulmonary arterial pressure (sPAP) coupling.</p><p><strong>Methods: </strong>This prospective observational study included 220 outpatients with non-small cell lung cancer (NSCLC) examined by Doppler, strain, and 3-dimensional echocardiography before starting therapy. Of the included patients, 41% were female and the median age was 68 years [61, 74]. Prediction of one-year overall survival was assessed by univariable analysis followed by multivariate Cox regression, receiver operating characteristic (ROC) curves and Kaplan-Meier analyses.</p><p><strong>Results: </strong>Median sPAP was within the limits of normal (31 mmHg [26, 36]); 30% of the patients had sPAP ≥ 35 mmHg. In univariable analysis, one-year overall survival was associated with RV systolic function and probability of pulmonary hypertension. In multivariate Cox regression, only RV global longitudinal strain (GLS)/sPAP (hazard ratio [HR]: 8.76 [95% confidence interval (CI): 1.24-61.82], P = 0.03), forced expiratory volume in 1 second (HR: 0.98 [95% CI: 0.96-1.00], P = 0.03) and Eastern Cooperative Oncology Group performance status < 2 (HR: 0.34 [95% CI: 0.17-0.68], P = 0.003) independently predicted survival. The optimal ROC curve-derived RV GLS/sPAP cut-off to predict survival was -0.54%/mmHg. Among patients in Union for International Cancer Control (UICC) stage 4, those with impaired RV-arterial coupling (RV GLS/sPAP > -0.54%/mmHg) had worse survival than those with maintained RV-arterial coupling (HR: 2.89 [95% CI: 1.55-5.42], P < 0.001); the latter subgroup had similar survival compared with patients in UICC stage 3 (HR: 0.65 [95% CI: 0.35-1.20], P = 0.17).</p><p><strong>Conclusions: </strong>RV GLS/sPAP as an echocardiographic measure of RV-arterial coupling adds to prognostication by the UICC status in NSCLC.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560277","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":"Provider Practices in Pulmonary Exacerbations of Cystic Fibrosis in the Era of Highly Effective Modulator Therapy.","authors":"Alexandra Toporek, Shivani Patel, Kevin J Psoter, Noah Lechtzin, Kristin A Riekert, Natalie E West","doi":"10.1513/AnnalsATS.202408-831OC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202408-831OC","url":null,"abstract":"<p><strong>Rationale: </strong>Since the approval of elexacaftor/tezacaftor/ivacaftor (ETI), data suggests there have been changes in the management of pulmonary exacerbations (PEx) of Cystic Fibrosis (CF).</p><p><strong>Objective: </strong>Given the subjective nature of PEx diagnosis and management, we sought to characterize provider PEx management practices in people with CF (pwCF) prescribed highly effective modulator therapy (HEMT) and to identify practice changes that may impact clinical outcomes.</p><p><strong>Methods: </strong>We conducted semi-structured qualitative interviews amongst clinicians in the United States (US) in late 2021 to 2022 to investigate changes in the management of PEx in pwCF prescribed ETI. Inductive coding of transcripts was utilized in a thematic analysis.</p><p><strong>Results: </strong>We conducted 19 qualitative interviews with providers at 15 CF centers. Thematic analysis identified five themes regarding the presentation, diagnosis, and management of PEx in pwCF prescribed ETI: (1) PEx have changed in the era of HEMT to become a more subtle pathology that may result in providers questioning PEx diagnosis; (2) providers feel less anxious about clinical outcomes after PEx; (3) providers are expanding their assessment of PEx in the era of HEMT to identify more subtle PEx phenotypes; (4) pwCF are driving their care during PEx more than in the pre-HEMT era, with interviewees reporting that some \"patients don't really contact us [with mild PEx symptoms]…we hear about it in retrospect.\" Interviewees expressed concern that this may result in more severe PEx; (5) provider management is less aggressive in the post-HEMT era, reflecting reduced PEx severity. Participants emphasized that their approach to PEx in general is unchanged and that \"[providers] treat depending on severity…and the background of the patient.\" Interviewees reported they increasingly recommend maintenance therapies for PEx treatment before prescribing antibiotics.</p><p><strong>Conclusions: </strong>Participants report that PEx in pwCF prescribed ETI appear milder, resulting in less anxiety about outcomes and a more conservative approach to management. Providers express uncertainty regarding the diagnosis of PEx given its evolving presentation and reduced in-person evaluation. Further research is necessary to identify sensitive markers of PEx and to assess the impact of conservative management on clinical outcomes.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560283","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":"Characteristics of Virtual Pulmonary Rehabilitation Programs in the United States: Results from a National Electronic Survey.","authors":"Marilyn L Moy, Judy Corn, Aimee Kizziar, Rachel Kaye, Grace Anne Dorney Koppel, Surya P Bhatt, Richard Casaburi, Julia T Desiato, Chris Garvey","doi":"10.1513/AnnalsATS.202408-896OC","DOIUrl":"10.1513/AnnalsATS.202408-896OC","url":null,"abstract":"<p><strong>Rationale: </strong>Understanding virtual pulmonary rehabilitation (VPR) in the U.S. would inform clinicians and patients, guide healthcare systems to ensure quality and safety, and inform payers on reimbursement issues.</p><p><strong>Objective: </strong>To characterize U.S. VPR programs.</p><p><strong>Methods: </strong>A 40-question online survey was developed by the American Thoracic Society PR Reimbursement Working Group to assess delivery methods, program content, and outcome assessments. U.S. VPR programs were identified from the Livebetter database, the internet, and scientific publications. Veterans Affairs (VA) sites were identified from an email sent to medical service chiefs asking whether their site offered VPR. The survey was sent to 53 programs using SurveyMonkey. Responses were summarized as percentages of available data. The 2010 Rural-Urban Commuting Area Codes characterized rurality.</p><p><strong>Results: </strong>Twenty-five sites currently and 5 previously offered VPR; 23 were offered by an outpatient hospital department (7 non-VA, 16 VA), 5 were commercial, 1 physician office-based, and 1 independent. Eighty-four percent (16/19) of VPR programs offered by outpatient hospital departments concomitantly provided in-person PR, while 25% (1/4) of commercial sites did. Delivery method was 'live' 2-way videoconferencing for 88% (22/25) of sites; 47% (7/15) VA sites was also telephone-based, and 60% (3/5) commercial entities also used pre-recorded videos or website/mobile applications. Ninety-two percent (23/25) of programs provided an exercise prescription and resistance training, and 96% (24/25) provided aerobic training. Nearly one-quarter of respondents did not describe exercise progression. Seventy-four percent (17/23) of all programs provided exercise equipment, with 54% (7/13) VA programs using pedometers. Thirty-five percent (6/17) of outpatient hospital department sites conducted outcome assessments in-person only, 12% (2/17) conducted them virtually only, and 53% (9/17) provided both options, while 100% (5/5) commercial programs did so virtually. Six-minute walk test was the most common measure of exercise performance, used by 76% (13/17) outpatient hospital department sites and 20% (1/5) commercial programs. All VPR addresses were categorized as metropolitan or micropolitan; none were small town or rural.</p><p><strong>Conclusions: </strong>VPR in the U.S. is heterogeneous. Although most delivered the broad components of PR, there is lack of in-person assessments, in-person standardized exercise testing, and plans for exercise progression, most notably by commercial programs.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143560219","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":"Bexotegrast Shows Dose-Dependent Integrin α_vβ₆ Receptor Occupancy in Lungs of Participants with Idiopathic Pulmonary Fibrosis: A Phase 2, Open-Label Clinical Trial.","authors":"Joshua J Mooney, Susan Jacobs, Éric A Lefebvre, Gregory P Cosgrove, Annie Clark, Scott M Turner, Martin Decaris, Chris N Barnes, Marzena Jurek, Brittney Williams, Heying Duan, Richard Kimura, Gaia Rizzo, Graham Searle, Mirwais Wardak, H Henry Guo","doi":"10.1513/AnnalsATS.202409-969OC","DOIUrl":"10.1513/AnnalsATS.202409-969OC","url":null,"abstract":"<p><p><b>Rationale:</b> Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disease characterized by dyspnea and loss of lung function. Transforming growth factor-β (TGF-β) activation mediated by α_v integrins is central to the pathogenesis of IPF. Bexotegrast (PLN-74809) is an oral, once-daily, dual-selective inhibitor of α_vβ₆ and α_vβ₁ integrins under investigation for the treatment of IPF. Positron emission tomography (PET) using an α_vβ₆-specific PET tracer could confirm target engagement of bexotegrast in the lungs of participants with IPF. <b>Objectives:</b> This Phase 2 study evaluated α_vβ₆ receptor occupancy in the lung as assessed by changes from baseline in α_vβ₆ PET tracer uptake, after single-dose administration of bexotegrast to participants with IPF. <b>Methods:</b> In this open-label, single-center study, adults with IPF received up to two single doses of bexotegrast, ranging from 60 to 320 mg with or without background IPF therapy (pirfenidone or nintedanib). At baseline and approximately 4 hours after each orally administered bexotegrast dose, a 60-minute dynamic PET-computed tomography scan was conducted after administration of an α_vβ₆-specific PET probe ([¹⁸F]FP-R₀1-MG-F2). α_vβ₆ receptor occupancy by bexotegrast was estimated from the changes in PET tracer uptake after bexotegrast administration. Pharmacokinetics, safety, and tolerability of bexotegrast were also assessed. <b>Results:</b> Eight participants completed the study. Total and unbound plasma bexotegrast concentrations increased in a dose-dependent manner, and regional PET volume of distribution values decreased in a dose- and concentration-dependent manner. The data for volume of distribution fit a simple saturation model, producing an unbound bexotegrast half maximal effective concentration estimate of 3.32 ng/ml. Estimated maximum receptor occupancy was 35%, 53%, 71%, 88%, and 92% after single 60-, 80-, 120-, 240-, and 320-mg doses of bexotegrast, respectively. No treatment-emergent adverse events related to bexotegrast were reported. <b>Conclusions:</b> Dose and concentration-dependent α_vβ₆ receptor occupancy by bexotegrast was observed by PET imaging, supporting once-daily 160- to 320-mg dosing to evaluate efficacy in clinical trials of IPF. Clinical trial registered with www.clinicaltrials.gov (NCT04072315).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"350-358"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585065","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":"Erratum: Rural Residence, Tobacco Use, and Nationwide Chronic Obstructive Pulmonary Disease Prevalence: Analyses fromthe National Health Interview Survey.","authors":"","doi":"10.1513/AnnalsATS.22i3Erratum","DOIUrl":"10.1513/AnnalsATS.22i3Erratum","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 3","pages":"471"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525528","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":"Impact of Heat on Respiratory Hospitalizations among Older Adults in 120 Large U.S. Urban Areas.","authors":"Cassandra R O'Lenick, Stephanie E Cleland, Lucas M Neas, Mallory W Turner, E Melissa Mcinroe, K Lloyd Hill, Andrew J Ghio, Meghan E Rebuli, Ilona Jaspers, Ana G Rappold","doi":"10.1513/AnnalsATS.202405-470OC","DOIUrl":"10.1513/AnnalsATS.202405-470OC","url":null,"abstract":"<p><p><b>Rationale:</b> Extreme heat exposure is a well-known cause of mortality among older adults. However, the impacts of exposure on respiratory morbidity across U.S. cities and population subgroups are not well understood. <b>Objectives:</b> A nationwide study was conducted to determine the impact of high heat on respiratory disease hospitalizations among older adults (≥65 yr of age) living in the 120 largest U.S. cities between 2000 and 2017. <b>Methods:</b> Daily rates of inpatient respiratory hospitalizations were examined with respect to variations in ZIP code-level daily mean temperature or heat index. For each city, we estimated cumulative associations (lag days 0-6) between warm-season heat (June to September) and cause-specific respiratory hospitalizations using time-stratified conditional quasi-Poisson regression with distributed lag nonlinear models. We estimated nationwide associations using multivariate meta-regression and updated city-specific associations via best linear unbiased prediction. With stratified models, we explored effect modification by age, sex, and race (Black or White). Results are reported as percentage change in hospitalizations at high temperatures (95th percentile) compared with median temperatures for each outcome, demographic group, and metropolitan area. <b>Results:</b> We identified 3,275,033 respiratory hospitalizations among Medicare beneficiaries across 120 large U.S. cites between 2000 and 2017. Nationwide, 7-day cumulative associations at high temperatures resulted in a 1.2% (95% confidence interval, 0.4-2.0%) increase in hospitalizations for primary diagnoses of all-cause respiratory disease, driven primarily by increases in respiratory tract infections (1.8% [95% confidence interval, 0.6-3.0%]) and chronic respiratory diseases and/or respiratory failure (1.2% [95% confidence interval, 0.0-2.4%]). Stronger associations were observed when exposure was defined using the heat index instead of mean temperature. Across the 120 cities, we observed considerable geographic variation in the relative risk of heat-related respiratory hospitalizations, and we observed disproportionate burdens of heat-related respiratory hospitalizations among the oldest beneficiaries (≥85 yr of age) and among Black beneficiaries living in South Atlantic cities. During the 18-year study period, there were an estimated 11,710 excess respiratory hospitalizations due to heat exposure. <b>Conclusions:</b> Results suggest that high temperature and humidity contribute to exacerbation of respiratory tract infections and chronic lung diseases among older adults. Geographic variation in heat-related hospitalization rates suggests that contextual factors largely account for disproportionate burdens, and area-level influences should be further investigated in multicity studies.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"367-377"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585041","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":"Unmasking Heat's Silent Toll on Respiratory Health.","authors":"Barrak Alahmad","doi":"10.1513/AnnalsATS.202412-1347ED","DOIUrl":"10.1513/AnnalsATS.202412-1347ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"328-330"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371403","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":"Spontaneous Pneumothorax in a Patient with Isolated Cardiac Sarcoidosis.","authors":"Patrick J Kramer, Arindam Singha, Jose A Plaza, Elliott D Crouser","doi":"10.1513/AnnalsATS.202403-317CC","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202403-317CC","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":"22 3","pages":"450-455"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525535","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}