Annals of the American Thoracic Society最新文献

{"title":"A House of Cards: Radiographic Foundations of Personalized Therapy in Autoimmune ILD.","authors":"Scott M Matson","doi":"10.1513/AnnalsATS.202506-603PS","DOIUrl":"https://doi.org/10.1513/AnnalsATS.202506-603PS","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024882","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":"Long-Term Exposure to Ambient Air Pollution and Lower Respiratory Tract Infection in Adults: Danish Nationwide Evidence.","authors":"Jiawei Zhang, Youn-Hee Lim, Rina So, Zhebin Yu, Stéphane Tuffier, Marie Bergmann, Thomas Cole-Hunter, George Maria Napolitano, Laust H Mortensen, Thomas Scheike, Steffen Loft, Kees de Hoogh, Gerard Hoek, Erik Melén, Zorana Jovanovic Andersen","doi":"10.1513/AnnalsATS.202501-087OC","DOIUrl":"10.1513/AnnalsATS.202501-087OC","url":null,"abstract":"<p><p><b>Rationale:</b> Long-term exposure to air pollution has been linked with acute lower respiratory infections (ALRIs) in children, but the evidence in adults is still mixed and sparse. <b>Objective:</b> We aimed to examine the association between long-term exposure to air pollution and incident ALRIs in adults. <b>Methods:</b> We followed all Danish residents aged ≥30 years (<i>N</i> = 3,083,227) for the first-ever hospital contact (inpatient, outpatient, or emergency) for ALRIs (and pneumonia or influenza separately) from 2000 to 2018. Long-term exposure to air pollution was defined as annual mean concentrations of fine particulate matter (i.e., aerodynamic diameter ≤2.5 μm [PM_2.5]), nitrogen dioxide (NO₂), and black carbon (BC), which were modeled using hybrid land-use regression models and assigned to baseline residential addresses. Cox regression models were used to assess the association between air pollution and the incidences of ALRIs in total, pneumonia, and influenza. <b>Results:</b> During a mean of 16 years of follow-up, there were 322,035, 309,092, and 11,977 incident cases of ALRIs, pneumonia, and influenza, respectively. We detected positive associations of air pollution and incident ALRIs, with hazard ratios (95% confidence interval) of 1.08 (1.07-1.09) per 10 μg/m³ for NO₂, 1.07 (1.06-1.08) per 0.5 10^-5·m^-1 for BC, and 1.04 (1.03-1.04) per 2 μg/m³ for PM_2.5. We detected similar associations with pneumonia but detected no association with influenza. <b>Conclusions:</b> Long-term exposure to air pollution may contribute to an increased risk of contracting ALRIs, particularly pneumonia, that require hospital care. Associations persisted for all major pollutants (PM_2.5, NO₂, and BC) even at exposure lower than the current European Union limits and World Health Organization guideline.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1305-1313"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044712","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 Intensive Care Unit Patient-to-Clinician Ratios with Mortality across Two U.S. Health Systems.","authors":"Hayley B Gershengorn, George L Anesi, Vincent X Liu, Deena K Costa, Erich M Dress, Amy L Dzierba, Robert Fowler, Andrew A Kramer, Danny Lizano, Damon C Scales, Allan Garland, Hannah Wunsch","doi":"10.1513/AnnalsATS.202501-045OC","DOIUrl":"10.1513/AnnalsATS.202501-045OC","url":null,"abstract":"<p><p><b>Rationale:</b> The association of interprofessional team member workload with intensive care unit (ICU) outcomes is understudied. <b>Objectives:</b> To evaluate the association of patient-to-intensivist ratio (PIR), patient-to-respiratory therapist ratio (PRTR), and patient-to-clinical pharmacist ratio (PpharmR) with hospital mortality. <b>Methods:</b> We conducted a retrospective study of adults admitted from the emergency department to an ICU with acute respiratory failure or sepsis within two U.S. healthcare systems (2013-2018). Our primary exposures were patient-to-clinician ratios (PIR, PRTR, and PpharmR) averaged over the ICU stay; our primary outcome was hospital mortality. We used multivariable mixed-effects regression, with patient-to-clinician ratios modeled as restricted cubic splines (four knots). We primarily considered each exposure separately, then included all ratios together. <b>Results:</b> Our cohort included 45,036 patients (mean age, 66.0 [standard deviation, 16.6] years; 23,420 [52.0%] men) across 27 ICUs within 24 hospitals. Of these, 29,326 (65.1%) had acute respiratory failure, 32,434 (72.0%) had sepsis, and 9,675 (21.5%) died in the hospital. The average PIR was 9.3 (standard deviation, 3.6), and the average PRTR was 7.9 (standard deviation, 3.2); the average PpharmR was 15.0 (standard deviation, 5.5) among patients (<i>n</i> = 8,950 of 45,036) in ICUs with clinical pharmacists (<i>n</i> = 8 of 27). We found no significant association between average daily PIR (Wald test for all spline terms: <i>P</i> = 0.24) or PRTR (<i>P</i> = 0.18) and hospital mortality in the full cohort; similarly, among patients in ICUs with pharmacists, no significant association of PpharmR with mortality was observed (<i>P</i> = 0.08). Models including ratios together yielded similar null results. <b>Conclusions:</b> We did not identify an association of any average daily patient-to-clinician ratio with hospital mortality for U.S. ICU patients with sepsis or respiratory failure.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1372-1381"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055029","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":"Diabetes Mellitus and Lung Cancer Screening Outcomes in the National Lung Screening Trial.","authors":"Robert P Young, Ralph C Ward, Raewyn J Scott, Gerard A Silvestri","doi":"10.1513/AnnalsATS.202411-1235OC","DOIUrl":"10.1513/AnnalsATS.202411-1235OC","url":null,"abstract":"<p><p><b>Rationale:</b> Current eligibility criteria for lung cancer (LC) screening are derived from randomized controlled trials and largely based on age and smoking history. However, the individualized benefits of screening are highly variable and may be affected by the presence of coexisting comorbid disease, including diabetes mellitus (DM). <b>Objectives:</b> This study examines differences in screening outcomes for those with or without DM. <b>Methods:</b> This was a secondary analysis of 53,452 high-risk subjects from the National Lung Screening Trial and compared outcomes after screening with computed tomography (CT) or chest radiography according to DM status. Models of LC mortality were derived after adjustment, and LC rate ratios (per 1,000 person-years), including 95% confidence intervals (95% CIs), were examined according to screening arm and DM status. <b>Results:</b> Compared with those without DM, subjects with DM (<i>n</i> = 5,174; 9.7%) had twofold greater baseline prevalence of cardiovascular comorbidity (<i>P</i> < 0.0001), twofold greater non-LC mortality (<i>P</i> < 0.0001), and greater LC lethality (<i>P</i> = 0.02), with more later-stage lung cancer (<i>P</i> = 0.04). We found comparable stage shift and surgical rates favoring the CT arm in both DM and non-DM subgroups, but LC mortality was higher in the CT arm for subjects with DM (2.2% vs. 2.1%), whereas for subjects without DM, it was lower (1.6% vs. 2.0%). However, the unadjusted <i>P</i> value for the interaction between DM status and screening arm was not significant (<i>P</i> = 0.28). In a competing-risk proportional hazards model for LC mortality adjusted for relevant risk factors, the non-DM group had a significant estimated screening benefit (hazard ratio, 0.82; 95% CI, 0.72, 0.94; <i>P</i> = 0.003), whereas the DM group did not (hazard ratio, 1.03; 95% CI, 0.71, 1.50; <i>P</i> = 0.88). However, the interaction between DM status and screening arm was again not significant (<i>P</i> = 0.27), indicating no overall screening difference according to DM status. <b>Conclusions:</b> Those reporting DM experienced more advanced LC, greater LC lethality, and greater non-LC mortality, whereas the benefits of CT-based screening remain unclear. Limitations from underpowering, lack of DM severity data, and older treatment approaches may have contributed to inconclusive results, and larger studies are warranted to better examine the effects of comorbid DM on current LC screening outcomes.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1409-1418"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144337335","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":"Chronic Exposure to PM_2.5 Can Be Deadly for People with Chronic Obstructive Pulmonary Disease.","authors":"Shawn D Aaron","doi":"10.1513/AnnalsATS.202507-703ED","DOIUrl":"10.1513/AnnalsATS.202507-703ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1297-1298"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416317/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602531","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":"Endothelial Glycocalyx Degradation in Sepsis: Analysis of the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) Trial, a Multicenter, Phase 3, Randomized Trial.","authors":"Kaori Oshima, Chiara Di Gravio, Bailu Yan, Sarah A McMurtry, Ryan Burke, Lisa M Levoir, Max S Kravitz, Daniel Stephenson, Aaron Issaian, Kirk C Hansen, Angelo D'Alessandro, Ivor S Douglas, Wesley H Self, Christopher J Lindsell, Jonathan S Schildcrout, Eric P Schmidt, Nathan I Shapiro","doi":"10.1513/AnnalsATS.202501-012OC","DOIUrl":"10.1513/AnnalsATS.202501-012OC","url":null,"abstract":"<p><p><b>Rationale:</b> Prior evidence suggests that endothelial glycocalyx degradation contributes to sepsis pathogenesis and is potentially worsened by intravenous fluid resuscitation. <b>Objectives:</b> To assess <i>1</i>) the association of endothelial glycocalyx degradation with sepsis mortality, <i>2</i>) the impact of a randomly assigned liberal versus restrictive intravenous fluid resuscitation strategy on endothelial glycocalyx degradation, and <i>3</i>) whether there is a differential treatment effect for mortality based on baseline endothelial glycocalyx degradation. <b>Methods:</b> We used an enriched sampling strategy to define a cohort of 574 patients enrolled in the CLOVERS (Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis) trial, which compared liberal versus restrictive intravenous fluid resuscitation strategies. We used mass spectrometry to quantify plasma heparan sulfate as the primary measure of endothelial glycocalyx degradation. Plasma syndecan-1, quantified by enzyme-linked immunoassay, served as a clinically feasible complementary index of endothelial glycocalyx degradation. The primary outcome was 90-day all-cause mortality. <b>Results:</b> There was an association between baseline heparan sulfate level and mortality, with increasing mortality by baseline heparan sulfate tertile: lower tertile, 9.9% (95% confidence interval, 7.0-12.7%); middle tertile, 20.4% (15.6-25.0%); and upper tertile, 44.2% (35.6-51.6%) (<i>P</i> < 0.001; log-rank test), with an adjusted hazard ratio for interquartile range change in heparan sulfate of 3.12 (95% confidence interval, 2.18-4.46). We observed no effect of assigned fluid resuscitation strategy on endothelial glycocalyx degradation 24 hours after randomization. We observed no evidence of differential treatment effect of fluid resuscitation strategy based on baseline plasma heparan sulfate for 90-day mortality. Similar findings were observed using plasma syndecan-1 as an index of endothelial glycocalyx degradation. <b>Conclusions:</b> Endothelial glycocalyx degradation is a strong predictor of mortality in sepsis. Fluid resuscitation strategy had no impact on endothelial glycocalyx degradation, and there was no evidence for a differential effect of resuscitation strategy by baseline levels of endothelial glycocalyx degradation. Clinical trial registered with www.clinicaltrials.gov (NCT03434028).</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1382-1393"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008723","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":"Quantitative Computed Tomography Measures of Lung Fibrosis and Outcomes in the National Lung Screening Trial.","authors":"Jennifer M Wang, Swaraj Bose, Susan Murray, Wassim W Labaki, Ella A Kazerooni, Jonathan H Chung, Kevin R Flaherty, MeiLan K Han, Charles R Hatt, Justin M Oldham","doi":"10.1513/AnnalsATS.202410-1048OC","DOIUrl":"10.1513/AnnalsATS.202410-1048OC","url":null,"abstract":"<p><p><b>Rationale:</b> Incidental features of interstitial lung disease (ILD) are commonly observed on chest computed tomography (CT) scans and are independently associated with poor outcomes. Although most studies to date have relied on qualitative assessments of ILD, quantitative imaging algorithms have the potential to effectively detect ILD and assist in risk stratification for population-based cohorts. <b>Objectives:</b> To determine whether quantitative measures of ILD are associated with clinically relevant outcomes in the NLST (National Lung Screening Trial). <b>Methods:</b> Quantitative measures of ILD were generated using low-dose CT (LDCT) data collected as part of the NLST and processed with Computer-Aided Lung Informatics for Pathology Evaluation and Ratings (CALIPER) and deep learning-based usual interstitial pneumonia (DL-UIP) algorithms (Imbio Inc.). A multivariable Cox proportional hazard regression model was used to test the association between ILD measures (percentage ground-glass opacity, reticular opacity, and honeycombing of total lung volume and binary DL-UIP classification) and all-cause mortality. Secondary outcomes of incident lung cancer and lung cancer mortality were also explored. <b>Results:</b> Quantitative CT data were generated in 11,518 individuals. Mean age was 61.5 years, and 58.7% were male. An increased risk of all-cause mortality was observed for each percentage increase in CALIPER-derived ground-glass opacity (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01-1.02), reticular opacity (HR, 1.18; 95% CI, 1.12-1.24), and honeycombing (HR, 6.23; 95% CI, 4.23-9.16). Individuals with a positive DL-UIP classification pattern had a 4.8-fold increased risk of all-cause mortality (HR, 4.75; 95% CI, 2.50-9.04). CALIPER-derived reticular opacity was also associated with increased lung cancer-specific mortality. No quantitative measures of ILD were associated with incident lung cancer. <b>Conclusions:</b> Quantitative measures of ILD on LDCT are associated with clinically relevant endpoints in a large at-risk population of individuals with tobacco use history.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1314-1320"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12376207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055487","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":"How Low Can You Go: Exploring the Role of Low-Dose Computed Tomography in Interstitial Lung Disease Detection.","authors":"Na'ama Avitzur, Amanda Grant-Orser","doi":"10.1513/AnnalsATS.202507-751ED","DOIUrl":"10.1513/AnnalsATS.202507-751ED","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1295-1297"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710251","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":"Post-Thoracentesis Ultrasound versus Chest Radiography for the Evaluation of Effusion Evacuation and Lung Reexpansion: A Multicenter Study.","authors":"Ankush Ratwani, Horiana B Grosu, Shaikh M Noor Husnain, Trinidad M Sanchez, Gulmira Yermakhanova, Jasleen Pannu, Labib G Debiane, Zachary DePew, Lonny Yarmus, Fabien Maldonado, Robert J Lentz, Otis B Rickman, David Feller-Kopman, Muhammad H Arain, Holly New, Heidi Chen, Sheau-Chiann Chen, David E Ost, Frank Dana, Leila Rezai Gharai, Mark Parker, Peter M J Lee, Danai Khemasuwan, Ray W Shepherd, Najib M Rahman, Samira Shojaee","doi":"10.1513/AnnalsATS.202410-1095OC","DOIUrl":"10.1513/AnnalsATS.202410-1095OC","url":null,"abstract":"<p><p><b>Rationale:</b> Post-thoracentesis chest radiography (CXR) is often used to evaluate the degree of residual fluid after thoracentesis. Whether post-drainage ultrasound examination is comparable to CXR in the evaluation of pleural space evacuation is unknown. <b>Objectives:</b> How do post-thoracentesis ultrasound and CXR compare in assessing the effectiveness of pleural space evacuation? <b>Methods:</b> In this prospective, multicenter study, patients with free-flowing pleural effusions with minimal to no septations requiring thoracentesis were recruited. Post-thoracentesis ultrasound was performed immediately postprocedure; CXR was performed within 4 hours postprocedure. The primary outcome was agreement on complete pleural space evacuation between ultrasound and CXR. Complete pleural space evacuation was defined as the absence of pleural fluid on anterior, midaxillary, and posterior ultrasound views and lack of costophrenic angle blunting on CXR. Interobserver reliability was assessed via independent image reviews by two pulmonologists and two radiologists blinded to patient and procedure data, with disagreements resolved by a third reviewer. <b>Results:</b> Of the 147 patients enrolled (February 2021-May 2022), 145 were included in the final analysis. The median age was 64 years (56-75), and malignancy was the most frequent effusion etiology (<i>n</i> = 49). The lung was considered trapped in 50% (<i>n</i> = 73). A total of 826 ultrasound images were collected for blind review. The Gwet's agreement coefficient 1 assessing complete pleural evacuation between ultrasound and CXR was 0.93 (95% confidence interval [CI], 0.83-1.00). When assessing agreement on the basis of pre-specified criteria of effusion size (small vs. large), a substantial level of agreement was observed between ultrasound and CXR, indicated by a kappa of 0.64 (95% CI, 0.51-0.77). There was strong agreement (kappa = 0.81; 95% CI, 0.71-0.90) between proceduralist and blind ultrasound reviewers regarding complete pleural space evacuation. <b>Conclusions:</b> Post-thoracentesis ultrasound is an equally effective alternative to CXR in evaluating pleural space evacuation in simple pleural effusions.</p>","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1321-1328"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176330","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":"Reducing Lung Cancer Disparities Calls for Another Look: Inclusion of Priority Populations in Screening Guidelines.","authors":"Randi M Williams, Lilianna Phan","doi":"10.1513/AnnalsATS.202501-032VP","DOIUrl":"10.1513/AnnalsATS.202501-032VP","url":null,"abstract":"","PeriodicalId":93876,"journal":{"name":"Annals of the American Thoracic Society","volume":" ","pages":"1292-1294"},"PeriodicalIF":5.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055491","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}