Pub Date : 2025-12-16DOI: 10.1213/ane.0000000000007882
Lana Ramic,Karina Branje,Mariam Al-Bayati,Gurlavine D Kidd,Nathaniel Neilipovitz,Brian Hutton,Dianna M Wolfe,Dean Fergusson,Julio F Fiore,Chelsia Gillis,Emily Hladkowicz,Daniel I McIsaac,
BACKGROUNDLow certainty evidence supports exercise prehabilitation's efficacy in reducing complications and length of stay in specific populations. Identification of procedural, participant, and program characteristics associated with greater prehabilitation efficacy is required to optimize effective application of prehabilitation programs. Our objectives were to (1) estimate the pooled efficacy of all approaches to exercise prehabilitation across all procedures, participants, and programs in reducing postoperative complications and length of stay, and (2) identify program, participant, and procedural characteristics associated with greater efficacy of exercise prehabilitation.METHODSA peer-reviewed search strategy was applied to Ovid Medline, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane CENTRAL Register of Controlled Trials (inception to March 1, 2022, and updated on October 25, 2023, and April 10, 2024). Randomized controlled trials addressing a population of adults (≥18 years) undergoing major elective surgery where participants were allocated to an exercise prehabilitation intervention were included. A multistage review of 6675 citations and 1220 full texts was completed independently in duplicate using DistillerSR. Data were pooled using random effects pairwise meta-analyses and meta-regression. Certainty of evidence and credibility of effect modifiers were evaluated. Critical outcomes were postoperative length of stay and the incidence of postoperative complications. Effect modifiers and hypotheses were identified a priori and published in the study's registered protocol (CRD42023487683).RESULTSAcross 99 included trials (n = 8222), pooled data suggested that exercise prehabilitation likely reduces complication rates (odds ratio [OR] = 0.54; 95% confidence interval [CI], 0.44-0.67; P < .01; I2 = 45%; moderate certainty) and length of stay (mean difference = -0.90 days; 95% CI, -1.23 to -0.58; P < .01; I2 = 78%; low certainty). Inspiratory muscle training was the only significant effect modifier for greater efficacy of exercise prehabilitation in reducing both complications (OR = 0.65; 95% CI, 0.44-0.97; low certainty) and length of stay (MD = -1.04; 95% CI, -1.75 to -0.32; low certainty). No other prespecified procedural, participant, or program factors were consistent or credible effect modifiers.CONCLUSIONSExercise prehabilitation may reduce complications and LoS; however, well-reported multicenter trials synthesized using individual participant data are required to identify procedural, participant, and program factors associated with optimal exercise prehabilitation efficacy.
背景：低确定性证据支持运动康复在减少特定人群并发症和住院时间方面的有效性。需要识别与更大的康复效果相关的程序、参与者和项目特征，以优化康复项目的有效应用。我们的目的是：(1)评估所有运动康复方法在减少术后并发症和住院时间方面的综合疗效，以及(2)确定与运动康复更有效相关的方案、参与者和程序特征。方法采用同行评议的搜索策略，对Ovid Medline、Embase、CINAHL、PsycINFO、Web of Science和Cochrane CENTRAL Register of Controlled Trials（成立于2022年3月1日，更新于2023年10月25日和2024年4月10日）。随机对照试验纳入了接受重大选择性手术的成年人（≥18岁），参与者被分配到运动康复干预组。使用DistillerSR独立完成了6675篇引文和1220篇全文的多阶段综述。采用随机效应两两元分析和元回归对数据进行汇总。评估了证据的确定性和效果调节剂的可信度。关键结果是术后住院时间和术后并发症的发生率。效果修饰剂和假设被先验地确定并发表在该研究的注册方案（CRD42023487683）中。结果在纳入的99项试验中（n = 8222），汇总数据显示，锻炼预适应可能降低并发症发生率（优势比[OR] = 0.54； 95%可信区间[CI]， 0.44-0.67; P < 0.01; I2 = 45%；中等确定性）和住院时间（平均差异= -0.90天；95% CI, -1.23至-0.58;P < 0.01; I2 = 78%；低确定性）。在减少并发症（OR = 0.65; 95% CI, 0.44-0.97；低确定性）和住院时间（MD = -1.04; 95% CI, -1.75至-0.32；低确定性）方面，吸气肌训练是唯一的显著影响调节因子。没有其他预先指定的程序、参与者或项目因素是一致的或可信的效果调节剂。结论运动康复可减少并发症，降低术后LoS；然而，需要使用个体参与者数据合成的多中心试验来确定与最佳运动康复效果相关的程序、参与者和项目因素。
{"title":"Pooled Efficacy and Exploration of Effect Modifiers of Exercise Prehabilitation: A Systematic Review and Meta-regression Analysis of Randomized Controlled Trials.","authors":"Lana Ramic,Karina Branje,Mariam Al-Bayati,Gurlavine D Kidd,Nathaniel Neilipovitz,Brian Hutton,Dianna M Wolfe,Dean Fergusson,Julio F Fiore,Chelsia Gillis,Emily Hladkowicz,Daniel I McIsaac, ","doi":"10.1213/ane.0000000000007882","DOIUrl":"https://doi.org/10.1213/ane.0000000000007882","url":null,"abstract":"BACKGROUNDLow certainty evidence supports exercise prehabilitation's efficacy in reducing complications and length of stay in specific populations. Identification of procedural, participant, and program characteristics associated with greater prehabilitation efficacy is required to optimize effective application of prehabilitation programs. Our objectives were to (1) estimate the pooled efficacy of all approaches to exercise prehabilitation across all procedures, participants, and programs in reducing postoperative complications and length of stay, and (2) identify program, participant, and procedural characteristics associated with greater efficacy of exercise prehabilitation.METHODSA peer-reviewed search strategy was applied to Ovid Medline, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane CENTRAL Register of Controlled Trials (inception to March 1, 2022, and updated on October 25, 2023, and April 10, 2024). Randomized controlled trials addressing a population of adults (≥18 years) undergoing major elective surgery where participants were allocated to an exercise prehabilitation intervention were included. A multistage review of 6675 citations and 1220 full texts was completed independently in duplicate using DistillerSR. Data were pooled using random effects pairwise meta-analyses and meta-regression. Certainty of evidence and credibility of effect modifiers were evaluated. Critical outcomes were postoperative length of stay and the incidence of postoperative complications. Effect modifiers and hypotheses were identified a priori and published in the study's registered protocol (CRD42023487683).RESULTSAcross 99 included trials (n = 8222), pooled data suggested that exercise prehabilitation likely reduces complication rates (odds ratio [OR] = 0.54; 95% confidence interval [CI], 0.44-0.67; P < .01; I2 = 45%; moderate certainty) and length of stay (mean difference = -0.90 days; 95% CI, -1.23 to -0.58; P < .01; I2 = 78%; low certainty). Inspiratory muscle training was the only significant effect modifier for greater efficacy of exercise prehabilitation in reducing both complications (OR = 0.65; 95% CI, 0.44-0.97; low certainty) and length of stay (MD = -1.04; 95% CI, -1.75 to -0.32; low certainty). No other prespecified procedural, participant, or program factors were consistent or credible effect modifiers.CONCLUSIONSExercise prehabilitation may reduce complications and LoS; however, well-reported multicenter trials synthesized using individual participant data are required to identify procedural, participant, and program factors associated with optimal exercise prehabilitation efficacy.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765393","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}
BACKGROUNDPostoperative delirium is a frequent and serious complication in older patients after surgery, particularly following hip fracture repair surgery, with an incidence of 10% to 55%. This study investigated whether goal-directed intraoperative blood pressure management could reduce the incidence of postoperative delirium in older patients undergoing hip fracture repair surgery.METHODSIn this single-center randomized controlled trial, 188 older patients (over 65 years) scheduled for elective hip fracture repair surgeries under spinal anesthesia were randomized to either goal-directed arterial blood pressure (ABP) group or control group. The goal-directed ABP group maintained systolic blood pressure (SBP) >80% preoperative values with continuous infusion of norepinephrine, while the control group aimed to keep SBP ≥90 mm Hg using intermittent administration of phenylephrine or ephedrine. The primary outcome was the incidence of postoperative delirium, assessed twice daily using the Confusion Assessment Method (CAM) until hospital discharge. Incidence of postoperative intensive care unit (ICU) admittance was also compared between groups. Quality of life was followed-up via telephone 3 months after surgery using the 3-level version of EuroQol Five Dimensional Questionnaire (EQ-5D-3L).RESULTSAccumulative time spent under 80% preoperative systolic blood pressure (SBP) values was significantly shorter in goal-directed ABP group than in control group (0 [0-8] vs 12 [0-38] minutes; P < 0.001). Incidence of postoperative delirium was 26.6% (25/94) in the goal-directed ABP group and in 36.2% (34/94) in the control group, with an absolute risk reduction (ARR) of 9.6% (95% confidence interval [CI], -3.6 to 22.8), relative risk of 0.735 (95% CI, 0.478-1.130), P = .162. There was no difference in the incidence of postoperative ICU admittance or quality of life at 3 months follow-up.CONCLUSIONSGoal-directed intraoperative blood pressure management did not significantly reduce postoperative delirium in older patients undergoing hip fracture repair surgery under spinal anesthesia.
背景术后谵妄是老年患者手术后常见且严重的并发症，尤其是髋部骨折修复手术后，发生率为10% ~ 55%。本研究探讨了目标导向的术中血压管理是否可以降低老年髋部骨折修复手术患者术后谵妄的发生率。方法采用单中心随机对照试验，188例65岁以上的老年患者在脊髓麻醉下择期行髋部骨折修复手术，随机分为目标动脉血压组（ABP）和对照组。目标导向ABP组通过持续输注去甲肾上腺素将收缩压（SBP）维持在术前值的80%左右，而对照组通过间歇给药苯肾上腺素或麻黄碱将收缩压维持在≥90 mm Hg。主要观察指标是术后谵妄的发生率，每天两次使用混淆评估法（CAM）评估，直至出院。比较两组患者术后重症监护病房（ICU）住院率。术后3个月通过电话随访生活质量，采用3级版EuroQol五维问卷（EQ-5D-3L）。结果目标性ABP组患者在80%术前收缩压（SBP）值下的累计时间明显短于对照组（0 [0-8]vs 12 [0-38] min, P < 0.001）。目标定向ABP组术后谵妄发生率为26.6%(25/94)，对照组为36.2%(34/94)，绝对危险度降低（ARR）为9.6%(95%可信区间[CI]， -3.6 ~ 22.8)，相对危险度为0.735 (95% CI, 0.478 ~ 1.130), P = 0.162。术后3个月随访时两组患者ICU住院率及生活质量无差异。结论术中目标导向血压管理对脊柱麻醉下老年髋部骨折修复术患者术后谵妄无显著降低作用。
{"title":"Effect of Goal-Directed Intraoperative Blood Pressure Management on Postoperative Delirium in Older Patients Undergoing Hip Fracture Surgery: A Randomized Controlled Trial.","authors":"Ziyu Huang,Yunqi Zhu,Jing Yuan,Bo Wang,Hong Zhao,Yi Feng","doi":"10.1213/ane.0000000000007869","DOIUrl":"https://doi.org/10.1213/ane.0000000000007869","url":null,"abstract":"BACKGROUNDPostoperative delirium is a frequent and serious complication in older patients after surgery, particularly following hip fracture repair surgery, with an incidence of 10% to 55%. This study investigated whether goal-directed intraoperative blood pressure management could reduce the incidence of postoperative delirium in older patients undergoing hip fracture repair surgery.METHODSIn this single-center randomized controlled trial, 188 older patients (over 65 years) scheduled for elective hip fracture repair surgeries under spinal anesthesia were randomized to either goal-directed arterial blood pressure (ABP) group or control group. The goal-directed ABP group maintained systolic blood pressure (SBP) >80% preoperative values with continuous infusion of norepinephrine, while the control group aimed to keep SBP ≥90 mm Hg using intermittent administration of phenylephrine or ephedrine. The primary outcome was the incidence of postoperative delirium, assessed twice daily using the Confusion Assessment Method (CAM) until hospital discharge. Incidence of postoperative intensive care unit (ICU) admittance was also compared between groups. Quality of life was followed-up via telephone 3 months after surgery using the 3-level version of EuroQol Five Dimensional Questionnaire (EQ-5D-3L).RESULTSAccumulative time spent under 80% preoperative systolic blood pressure (SBP) values was significantly shorter in goal-directed ABP group than in control group (0 [0-8] vs 12 [0-38] minutes; P < 0.001). Incidence of postoperative delirium was 26.6% (25/94) in the goal-directed ABP group and in 36.2% (34/94) in the control group, with an absolute risk reduction (ARR) of 9.6% (95% confidence interval [CI], -3.6 to 22.8), relative risk of 0.735 (95% CI, 0.478-1.130), P = .162. There was no difference in the incidence of postoperative ICU admittance or quality of life at 3 months follow-up.CONCLUSIONSGoal-directed intraoperative blood pressure management did not significantly reduce postoperative delirium in older patients undergoing hip fracture repair surgery under spinal anesthesia.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145765397","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}
Pub Date : 2025-12-15DOI: 10.1213/ane.0000000000007756
Rishi Kumar,Serena S Dasani,Kara G Fields,Gabriela M Querejeta Roca,Lauren Cornella,Douglas C Shook,Charles B Nyman,Sula Nasra,Chinyere A Archie,Pinak B Shah,Stanton K Shernan,Sergey Karamnov
BACKGROUNDEvaluation of the mitral valve during transcatheter edge-to-edge repair (TEER) for management of mitral regurgitation is commonly guided by intraprocedural interventional transesophageal echocardiography (TEE). The risk of iatrogenic mitral stenosis (MS) remains a concern, particularly in patients requiring multiple clips, since the mitral valve orifice area (MVA) is reduced. The value of conventional flow-based echocardiographic methods to rule out MS is limited by intraprocedural and general anesthesia (GA)-induced hemodynamic variability. This retrospective study introduces the novel adaptation of a 3-dimensional (3D) Orifice Area (3DOA) technique to evaluate post-TEER MVA. We evaluated the degree of agreement between MVAs derived via TEE 3DOA, TEE pressure half-time (PHT), and postprocedure transthoracic echocardiography (TTE) PHT with patients awake.METHODSTEE and TTE images from 20 adult patients with severe mitral regurgitation undergoing a TEER (MitraClip, Abbott) procedure were retrospectively reviewed. MVAs obtained by MTEE 3DOA and TEE PHT under GA were compared to those acquired with TTE PHT with patients awake. Agreement was assessed via calculation of Bland-Altman 95% limits of agreement and Lin's concordance correlation coefficients, both with 95% confidence intervals (CIs).RESULTSThere was good agreement between TEE 3DOA-derived MVA measurements under GA and TTE PHT-derived MVA measurements in awake patients, as reflected by Bland-Altman (lower limit of agreement: -.0.45 [95% CI, -.58 to -.31] and upper limit of agreement: 0.26 [95% CI, 0.12-0.4]), and an excellent concordance correlation coefficient value (0.95 [95% CI, 0.86-0.98]). In contrast, agreement between TEE PHT-derived MVA and TTE PHT-derived MVA was weak, with much broader limits of agreement (lower limit of agreement: -1.6 [95% CI, -2.19 to -1.02] and upper limit of agreement: 1.43 [95% CI, 0.84-2.01]) and a weak concordance correlation coefficient value (0.46 [95% CI, 0.02-0.75]).CONCLUSIONSIn this retrospective cohort study, we demonstrated excellent agreement between TEE-3DOA-derived MVA under GA and TTE PHT-derived MVA in awake patients, but not between TEE versus TTE PHT. These findings warrant further validation in larger patient datasets to assess the utility of 3D echocardiographic approaches in evaluating MVA after TEER.
{"title":"Three-Dimensional Echocardiographic Approach to Mitral Valve After Transcatheter Edge-to-Edge Repair.","authors":"Rishi Kumar,Serena S Dasani,Kara G Fields,Gabriela M Querejeta Roca,Lauren Cornella,Douglas C Shook,Charles B Nyman,Sula Nasra,Chinyere A Archie,Pinak B Shah,Stanton K Shernan,Sergey Karamnov","doi":"10.1213/ane.0000000000007756","DOIUrl":"https://doi.org/10.1213/ane.0000000000007756","url":null,"abstract":"BACKGROUNDEvaluation of the mitral valve during transcatheter edge-to-edge repair (TEER) for management of mitral regurgitation is commonly guided by intraprocedural interventional transesophageal echocardiography (TEE). The risk of iatrogenic mitral stenosis (MS) remains a concern, particularly in patients requiring multiple clips, since the mitral valve orifice area (MVA) is reduced. The value of conventional flow-based echocardiographic methods to rule out MS is limited by intraprocedural and general anesthesia (GA)-induced hemodynamic variability. This retrospective study introduces the novel adaptation of a 3-dimensional (3D) Orifice Area (3DOA) technique to evaluate post-TEER MVA. We evaluated the degree of agreement between MVAs derived via TEE 3DOA, TEE pressure half-time (PHT), and postprocedure transthoracic echocardiography (TTE) PHT with patients awake.METHODSTEE and TTE images from 20 adult patients with severe mitral regurgitation undergoing a TEER (MitraClip, Abbott) procedure were retrospectively reviewed. MVAs obtained by MTEE 3DOA and TEE PHT under GA were compared to those acquired with TTE PHT with patients awake. Agreement was assessed via calculation of Bland-Altman 95% limits of agreement and Lin's concordance correlation coefficients, both with 95% confidence intervals (CIs).RESULTSThere was good agreement between TEE 3DOA-derived MVA measurements under GA and TTE PHT-derived MVA measurements in awake patients, as reflected by Bland-Altman (lower limit of agreement: -.0.45 [95% CI, -.58 to -.31] and upper limit of agreement: 0.26 [95% CI, 0.12-0.4]), and an excellent concordance correlation coefficient value (0.95 [95% CI, 0.86-0.98]). In contrast, agreement between TEE PHT-derived MVA and TTE PHT-derived MVA was weak, with much broader limits of agreement (lower limit of agreement: -1.6 [95% CI, -2.19 to -1.02] and upper limit of agreement: 1.43 [95% CI, 0.84-2.01]) and a weak concordance correlation coefficient value (0.46 [95% CI, 0.02-0.75]).CONCLUSIONSIn this retrospective cohort study, we demonstrated excellent agreement between TEE-3DOA-derived MVA under GA and TTE PHT-derived MVA in awake patients, but not between TEE versus TTE PHT. These findings warrant further validation in larger patient datasets to assess the utility of 3D echocardiographic approaches in evaluating MVA after TEER.","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"20 1","pages":"85-92"},"PeriodicalIF":0.0,"publicationDate":"2025-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145759997","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}
Pub Date : 2025-12-12DOI: 10.1213/ane.0000000000007901
Angelica Faith Tiongco,Anuj Bhatia
{"title":"Editorial: Esmolol as a Part of Perioperative Multimodal Analgesia Regimen: A Pretender or the Real McCoy?","authors":"Angelica Faith Tiongco,Anuj Bhatia","doi":"10.1213/ane.0000000000007901","DOIUrl":"https://doi.org/10.1213/ane.0000000000007901","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"168 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752565","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}
Pub Date : 2025-12-12DOI: 10.1213/ane.0000000000007885
Mary Lyn Stein,Gloria M Al Karaki,Katie Dillon,Katelin Collins,Benjamin Paret,Gwen Owens,Michael Hernandez,Robert Holzman,Viviane G Nasr
{"title":"Implementation and Outcomes of a Scholarly Activity Requirement in an Accreditation Council for Graduate Medical Education Pediatric Anesthesiology Training Program.","authors":"Mary Lyn Stein,Gloria M Al Karaki,Katie Dillon,Katelin Collins,Benjamin Paret,Gwen Owens,Michael Hernandez,Robert Holzman,Viviane G Nasr","doi":"10.1213/ane.0000000000007885","DOIUrl":"https://doi.org/10.1213/ane.0000000000007885","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"168 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752574","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}
Pub Date : 2025-12-12DOI: 10.1213/ane.0000000000007899
Aubrie Ford,Gaston Nyirigira,Menelas Nkeshimana,Belise Uwurukundo,Alice Nsengiyumva,Amanda Rurangwa,Mallika Manyapu,Jackson Kwizera Ndekezi,Vanessa Nadine Ineza,Appolinaire Manirafasha,Tsion Firew,Kara L Neil
{"title":"Filling the Data Gap: A Call for Research on Women and Gender Workforce Issues in Anesthesia, Emergency Medicine, and Critical Care in Africa.","authors":"Aubrie Ford,Gaston Nyirigira,Menelas Nkeshimana,Belise Uwurukundo,Alice Nsengiyumva,Amanda Rurangwa,Mallika Manyapu,Jackson Kwizera Ndekezi,Vanessa Nadine Ineza,Appolinaire Manirafasha,Tsion Firew,Kara L Neil","doi":"10.1213/ane.0000000000007899","DOIUrl":"https://doi.org/10.1213/ane.0000000000007899","url":null,"abstract":"","PeriodicalId":7799,"journal":{"name":"Anesthesia & Analgesia","volume":"111 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145752572","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}
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