Cornea最新文献

{"title":"Letter Regarding: The Pathophysiology of Keratoconus.","authors":"Alejandro Tello, Virgilio Galvis","doi":"10.1097/ICO.0000000000003955","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003955","url":null,"abstract":"","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752628","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":"Multimodal Imaging of Genetically Confirmed X-Linked Endothelial Corneal Dystrophy.","authors":"Tim Berger, Berthold Seitz, Walter Lisch, Albéric Sneyers, Loay Daas, Elias Flockerzi","doi":"10.1097/ICO.0000000000003951","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003951","url":null,"abstract":"<p><strong>Purpose: </strong>To report clinical features of genetically confirmed x-linked endothelial corneal dystrophies using multimodal corneal imaging.</p><p><strong>Methods: </strong>Four corneas of a 22-year-old male and a 58-year-old female patient with x-linked endothelial corneal dystrophy were examined with slit-lamp biomicroscopy, Scheimpflug tomography, anterior segment optical coherence tomography, in vivo corneal confocal microscopy, and specular microscopy. Clinical features and multimodal imaging findings were analyzed.</p><p><strong>Results: </strong>Best-corrected visual acuity (in logMAR) was 0.2 (OD/OS) in the female, and 0.3 (OD) and 0.5 (OS) in the male. Clinical examination demonstrated moon crater-like lesions of the posterior cornea in the female patient, whereas the male patient showed diffuse stromal opacities with pronounced moon crater-like changes. Anterior segment optical coherence tomography revealed single hyperreflective lesions at the level of Descemet membrane and endothelium in the female patient (central corneal thickness: OD: 580 μm/OS: 586 μm), whereas the male patient demonstrated a stronger hyperreflective thickening of Descemet membrane (central corneal thickness: OD: 659 μm/OS: 676 μm). In vivo corneal confocal microscopy revealed corneal guttae in the female patient, whereas the male patient's findings were subepithelial and stromal hyperreflective fibrosis, parallel, thin, long hyporeflective bands within the corneal stroma, hyperreflectivity at level of Descemet membrane, and hyperreflective endothelial cells with pleomorphism, polymegethism, and enlarged nuclei. Furthermore, Descemet membrane revealed hyporeflective moon crater-like lesions with hyperreflective material in its center.</p><p><strong>Conclusions: </strong>X-linked endothelial corneal dystrophy shares clinical and diagnostic features with other endothelial corneal dystrophies, raising the question of whether it is a distinct subtype or the result of multiple coexisting corneal dystrophies causing a heterogenous clinical picture. Additional genetic testing is necessary to identify the causative genetic background.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752629","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":"Conversion of Conjunctival Nevus to Melanoma in a Patient Taking the TYK2 Inhibitor Deucravacitinib.","authors":"Nicholas Whitcomb, Hyunjoo J Lee","doi":"10.1097/ICO.0000000000003942","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003942","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a case of a patient with a preexisting conjunctival nevus giving rise to conjunctival melanoma as a potential adverse effect of the new selective Janus kinase-signal transducer and activator of transcription (JAK-STAT) inhibitor deucravacitinib.</p><p><strong>Methods: </strong>Single case report.</p><p><strong>Results: </strong>A 50-year-old woman with a medical history of psoriasis, for which she was 6 months into treatment with deucravacitinib, presented with 3 months of progressive enlargement and darkening of a brown-pigmented lesion in the left eye. This lesion evolved in the place of a pigmented nodule in the left eye that had been present and unchanging for at least several years prior. Urgent surgical excision, cryotherapy, and ocular surface reconstruction were performed without complication. Biopsy of the lesion confirmed the presence of a conjunctival melanoma, invasive to a depth of 0.7 mm, arising from a precursor conjunctival nevus. The patient was subsequently referred to an oncologist, who recommended discontinuing deucravacitinib.</p><p><strong>Conclusions: </strong>Deucravacitinib-mediated inhibition of tyrosine kinase 2 (TYK-2) disrupts signaling of cytokines interferon alpha (IFN-α), interleukin (IL)-12 and IL-23, providing a theoretical mechanism for increased risk of malignancy while taking the drug. In this case, the temporal relation between starting deucravacitinib treatment and the rapid growth of a conjunctival melanoma arising from a nevus is concerning for a protumor effect of this immunomodulatory drug. Patients with ocular lesions at risk of malignant transformation should perhaps be closely monitored while on deucravacitinib therapy until more is known regarding the degree of risk of malignant transformation because of immunomodulation from TYK2 inhibition.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752627","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":"Brittle Cornea Syndrome Type 1 in Siblings: Severe Presentation in One and Misdiagnosis as Primary Congenital Glaucoma in the Other.","authors":"Sonam Yangzes, Anupriya Kaur, Survadeep Mitra, Shivam Garg, Anchal Thakur, Jitender Jinagal, Amit Gupta, Chintan Malhotra","doi":"10.1097/ICO.0000000000003939","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003939","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to present two cases of brittle cornea syndrome (BCS) in siblings, one with severe corneal perforation and the other misdiagnosed as primary congenital glaucoma, emphasizing clinical, histopathological, and genetic findings.</p><p><strong>Methods: </strong>This was a case report involving a 4-year-old boy and his 8-year-old brother, both presenting with thin, steep corneas. Clinical examination, Pentacam imaging, genetic analysis, systemic evaluation, and corneal histopathology were performed.</p><p><strong>Results: </strong>The younger sibling presented with corneal perforation after trauma, and histopathology revealed a markedly thinned corneal stroma with disrupted collagen architecture. Genetic testing confirmed a zinc finger protein (ZNF)469 mutation, consistent with brittle cornea syndrome type 1 (BCS1). Sanger sequencing of the older sibling, who was previously misdiagnosed with primary congenital glaucoma, identified the same ZNF469 mutation. He exhibited corneal thinning, bluish sclera, and healthy optic discs.</p><p><strong>Conclusions: </strong>These cases highlight the variability in BCS presentations, the risk of misdiagnosis as glaucoma, and the importance of early genetic testing and protective measures. Histopathological findings provide additional insights into the structural abnormalities in BCS corneas.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728491","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":"Ophthalmic Quality of Life and Its Association With Visual Function, Accommodative and Binocular Vision Performance in Keratoconus Patients: A Study Using Rasch Analysis‏.","authors":"Fatemeh Rafiei, Khosrow Jadidi, Farhad Nejat, Mehdi Khabazkhoob, Payam Nabovati","doi":"10.1097/ICO.0000000000003935","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003935","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the relationship between ophthalmic quality of life with visual function and accommodative/binocular vision performance in patients with keratoconus (KCN), using the Keratoconus Outcomes Research Questionnaire (KORQ).</p><p><strong>Methods: </strong>Seventy patients with KCN were recruited in this study (average age: 27.04 ± 5.60). A Persian adaptation of the KORQ was developed, and its psychometric properties were evaluated through Rasch analysis. The associations between study variables and the KORQ subscales, activity limitations (AL-S) and symptoms (S-S), were evaluated through linear regression models.</p><p><strong>Results: </strong>The Persian KORQ demonstrated good psychometric properties after removing items 5 and 8 from the AL-S and items 4 and 5 from the S-S. The analysis showed a statistically significant direct association between the AL-S score and age (β: 0.280, P < 0.05). In addition, there was a statistically significant direct relationship between the AL-S score with best-corrected visual acuity in the better eye (β: 0.279, P = 0.048), binocular contrast sensitivity (β: 0.319, P = 0.033), and steep keratometry in the better eye (β: 0.409, p-0.007). The near negative fusional vergence parameters-blur (β: -0.460, P = 0.012), break (β: -0.403, P = 0.027), and recovery (β: -0.391, P = 0.033)-showed a statistically significant inverse association with the S-S score.</p><p><strong>Conclusions: </strong>The Persian KORQ is a reliable tool for assessing ophthalmic quality of life in Persian-speaking patients with KCN. The KCN-related AL-S are primarily influenced by age, basic visual functions, and the severity of KCN in the better eye. Deficits in certain binocular vision metrics, particularly a diminished near negative fusional vergence amplitude, may contribute to the symptoms reported by patients with KCN.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697829","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":"Single-Cell RNA Sequencing of Murine Limbal Epithelia Reveals Gas1 as a Novel Stem/Progenitor Cell Marker for the Corneal Epithelium.","authors":"Alexander Richardson, Susan Corley, Naomi Delic, Hue Li, Andrew Lloyd, Nick Di Girolamo","doi":"10.1097/ICO.0000000000003938","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003938","url":null,"abstract":"<p><strong>Purpose: </strong>The corneal epithelium is endowed with a rare population of stem cells that reside within the limbus, a circumferential transition zone that partitions the cornea from the conjunctiva. These cells are thus referred to as limbal epithelial stem cells. Despite the surge in investigations using single-cell RNA sequencing (scRNA-seq) of the ocular surface, a unifying marker(s) that distinguishes these cells from their progeny is yet to be identified.</p><p><strong>Methods: </strong>We used a keratin (K)-14-driven lineage-tracing system and SmartSeq-2 single-cell transcriptomics in 5- to 60-week-old mice to interrogate the identity of limbal epithelia. These results were then validated using flow cytometry, immunofluorescence, and a central corneal injury model.</p><p><strong>Results: </strong>Four cell clusters were identified, derived from both Confetti+ and Confetti- cells (clusters 0-3), with cluster 3 designated as harboring progenitor cells. We focused on one gene of interest in cluster 3, growth arrest-specific gene 1 (Gas1), which codes for a cell-surface protein. PCR, flow cytometry, and immunofluorescence revealed that this gene is expressed in a rare population of limbal epithelial cells. Gas1 was also coexpressed with K14 in both young and old mice and upregulated after a mild mechanical debridement injury to the central cornea.</p><p><strong>Conclusions: </strong>The cell-surface expression of this protein can be used to identify, extract, and enrich progenitor cells for downstream molecular investigations and for generating better-quality cell-based grafts to treat severe corneal disease.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697830","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":"Decade-Long Follow-Up of Autologous Simple Limbal Epithelial Transplantation in Pediatric Patients With Unilateral Chemical Injury: A Case Series.","authors":"Amanjot Kaur, Neha Jain, Vikas Mittal, Tanvi Kamothi","doi":"10.1097/ICO.0000000000003920","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003920","url":null,"abstract":"<p><strong>Purpose: </strong>This study evaluates the decades-long visual and functional outcomes of autologous simple limbal epithelial transplantation (SLET) in pediatric patients with unilateral limbal stem cell deficiency (LSCD). It also observes the challenges faced while managing the ocular burns in such patients.</p><p><strong>Methods: </strong>A retrospective review was conducted on pediatric patients (<15 years) who underwent unilateral SLET for LSCD and had a minimum follow-up of 10 years. The study analyzed demographic data, clinical history, slit-lamp biomicroscopic findings, age at the time of SLET, surgical outcomes, postoperative complications, and visual outcomes after a decade of follow-up. The functional outcome was categorized as complete success if the ocular surface remained stable and avascular.</p><p><strong>Results: </strong>Three pediatric patients with unilateral ocular injuries (grade 6 ocular burns, as per Dua's Classification) caused by lime exposure in 2 cases and a firecracker injury in 1 case were evaluated. These injuries led to complete LSCD and symblepharon formation. All patients initially underwent primary amniotic membrane grafting to promote healing of the epithelial defect. The mean age at the time of SLET was 4 years, with a mean interval of 4 months between the initial injury and SLET. One patient underwent penetrating keratoplasty to address a dense central scar for vision rehabilitation. The donor eyes remained unaffected, and all patients experienced significant visual improvement (visual acuity improving from 1.8 to 0.67 LogMAR). The ocular surface remained stable even after a decade of follow-up.</p><p><strong>Conclusions: </strong>Pediatric ocular burns leading to LSCD are difficult to manage. Autologous SLET with conjunctival autografting is a durable treatment for unilateral chemical injuries in such cases. It offers significant long-term visual and cosmetic improvement while ensuring a stable ocular surface. However, simultaneous amblyopia therapy is necessary, which makes visual recovery challenging.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697828","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":"Eye Donation From Individuals Receiving Medical Assistance in Dying: Retrospective Chart Review of the Eye Bank of Canada (Ontario Division).","authors":"Irina Sverdlichenko, Christine Humphreys, Brendan G Ko, Mor Bareket, Clara C Chan","doi":"10.1097/ICO.0000000000003936","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003936","url":null,"abstract":"<p><strong>Purpose: </strong>In Canada, Medical Assistance in Dying (MAiD) became a legal option for patients in 2016. The characteristics of MAiD donors, specifically for ocular tissue transplantation, have not been studied. The goal of this study was to explore the demographics and health status of these individuals.</p><p><strong>Methods: </strong>A retrospective chart review of MAiD donors from the Eye Bank of Canada (Ontario Division) from January 2019 to March 2024 was conducted. Variables recorded included demographics, medical status, mechanism of death, consent and referral process, and tissue utilization.</p><p><strong>Results: </strong>There were 475 eye donors (6.1% of all eye donors) who underwent the MAiD provision. The average age of donors was 70 years (SD: 5.42), and 50.5% (240/475) were male. Cancer was the most common mechanism of death, in 70% (332) of cases. First-person consent was obtained only 35% (164/474) of the time for ocular tissue donation, and 90% of donors (428/475) were referred from hospitals. Sixty-three percent of eyes were eligible for transplantation, while 37% were eligible for research and training. The most common surgical indication for transplant was endothelial dystrophies/failure (35%, 167/484).</p><p><strong>Conclusions: </strong>This study highlights the unique characteristics of eye donors who chose the MAiD provision. Hospitals made up 90% of MAiD referrals, and only 35% of MAiD donors consented on their own behalf. Efforts should be made to expand referrals for MAiD donation from nonhospital organizations. Furthermore, once MAiD eligibility has been determined, support should be provided to health care providers to navigate difficult discussions around donation.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689143","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":"Machine Learning Model for Predicting Visual Acuity Improvement After Intrastromal Corneal Ring Surgery in Patients With Keratoconus.","authors":"Eva Perez, Nassim Louissi, Sofiene Kallel, Quentin Hays, Nacim Bouheraoua, Malika Hamrani, Anatole Chessel, Vincent Borderie","doi":"10.1097/ICO.0000000000003933","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003933","url":null,"abstract":"<p><strong>Background: </strong>Keratoconus is a progressive, degenerative corneal disease that can lead to significant visual impairment. The intrastromal ring segment implantation procedure is effective in reshaping the cornea and improving vision. However, vision does not improve postoperatively in all operated eyes, and the results vary widely among patients, making it challenging to predict postoperative visual gain.</p><p><strong>Purpose: </strong>This study investigated the potential of machine learning in predicting postoperative visual acuity in keratoconus patients undergoing intrastromal ring segment implantation with the aim of enhancing surgical decision-making.</p><p><strong>Methods: </strong>This retrospective study analyzed 120 eyes of 102 patients with keratoconus who underwent ring segment implantation (1 symmetric or asymmetric segment, 150-300 μm thick, 150 degrees, or 160 degrees-arc). Preoperative and postoperative refraction, corneal topography, and tomographic data were collected. Various models were trained to predict postoperative visual acuity improvements.</p><p><strong>Results: </strong>The models demonstrated excellent performance, with XGBoost achieving perfect results in predicting whether vision will improve after surgery (R2 = 1.0, Youden Index = 1.0; all test observations being correctly classified). The CatBoost model achieved an R2 of 0.59 [0.7-line mean absolute error (MAE)] for predicting postoperative visual acuity, an R2 of 0.76 (MAE, 1.08 D) for predicting keratometry, and an R2 of 0.54 (MAE, 0.29) for predicting corneal asphericity. Key features for accurate predictions included preoperative keratometry values (K1, K2, Kmax), corneal asphericity, and visual acuity, whereas segment characteristics featured low importance.</p><p><strong>Conclusions: </strong>This study shows the strong potential of machine learning for selecting candidates for surgery and predicting postoperative visual improvements after ring segment implantation in keratoconus eyes.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689089","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":"Muraine Sutures for Hydrops in Patients After Penetrating Keratoplasty.","authors":"Lukas Neuhann, Carina Neuhann, Diana Vogel, Aylin Garip-Kuebler, Thomas Neuhann, Irmingard Neuhann","doi":"10.1097/ICO.0000000000003946","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003946","url":null,"abstract":"<p><strong>Purpose: </strong>To report the clinical characteristics of 7 cases of corneal hydrops after penetrating keratoplasty (PKP) for keratoconus and the postoperative results for 6 of these patients treated with predescemetal sutures (also known as Muraine sutures).</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all patients who presented at our center with secondary hydrops after PKP for keratoconus from 2023 to 2025.</p><p><strong>Results: </strong>Seven patients (6 male) presented with corneal hydrops on average 26.8 years (range 20-32 years) after initial PKP. The time between symptom onset and surgery ranged from 1 day to 1 year (mean 12.3 weeks). In all cases, a tear in Descemet membrane could be identified at the temporal or inferotemporal graft-host interface using anterior segment OCT and/or slit-lamp examination. We performed Muraine sutures in 6 patients, all of whom showed significant clearing and reduction of corneal swelling within a few days. Best-corrected visual acuity improved from a mean preoperative value of logMAR 2.17 to logMAR 0.62 at the final follow-up (mean: 10.8 months; range: 6-17 months).</p><p><strong>Conclusions: </strong>This is the first description of the use and surgical results of Muraine sutures for the treatment of corneal hydrops after PKP. Owing to its rarity and potential confounding with graft failure and late rejection, this condition may be underdiagnosed. In all cases, corneal edema resolved rapidly, resulting in a sustained significant improvement in visual acuity. Therefore, repeat keratoplasty could be avoided in all cases until now.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144689090","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}