Journal of Clinical Pathology最新文献

{"title":"Developing a national proficiency testing programme for biospecimens: the Thailand Biobank Consortium experience.","authors":"Piyavat Apisampinvong, Chawanit Wongkasa, Thanastha Thanomchard, Natthanich Denchairat, Natthaorn Luepongpatthana, Ratikorn Kamngoen, Rassanee Bissanum, Pasarat Khongkow, Kunchit Judprasong, Dhitiwass Suvagandha, Arnat Pasena, Natini Jinawath","doi":"10.1136/jcp-2026-210762","DOIUrl":"10.1136/jcp-2026-210762","url":null,"abstract":"<p><strong>Aims: </strong>To address the absence of nationally accessible proficiency testing (PT) for biospecimens in Thailand, we developed and evaluated a pilot PT programme consisting of four schemes covering DNA extraction, quantification, purity and integrity assessment.</p><p><strong>Methods: </strong>The pilot PT programme comprised two <i>processing</i> schemes: DNA extraction from whole blood (P-DNABLD) and frozen tissue (P-DNAFRT) and two <i>testing</i> schemes: DNA quantification and purity (T-DNAQ) and DNA integrity (T-DNAI). All schemes were conducted in accordance with ISO/IEC 17043:2023 and ISO 13528:2022. PT items were assessed for homogeneity and stability, and participant performance was evaluated based on consensus values using <i>z</i>- or <i>z</i>'-scores.</p><p><strong>Results: </strong>All PT items satisfied the ISO 13528:2022 requirements for homogeneity and stability after accounting for instability-related uncertainty in T-DNAQ. 30 laboratories participated nationwide in at least one scheme (P-DNABLD, n=28; P-DNAFRT, n=17; T-DNAQ, n=29; T-DNAI, n=13). All PT items were received within 3 days of dispatch, with ≥90% arriving within the acceptable temperature range. DNA extraction yield-related measurands demonstrated substantial interlaboratory variability (CV 78.2‒95.3%), whereas purity and integrity measurands were more consistent (CV 1.3‒11.2%). In T-DNAQ, A₂₆₀/A₂₃₀ showed the greatest interlaboratory variability (CV 8.2‒16.4%); within-platform variability was low in T-DNAI. Across all schemes, ≥75% of participants achieved at least Satisfactory performance (|z or z'| ≤ 2.0). Direct costs were approximately 12% of those of comparable international PT schemes.</p><p><strong>Conclusions: </strong>This pilot demonstrates the feasibility and accessibility of a nationally coordinated PT programme for biospecimens and supports the establishment of a sustainable PT framework to harmonise biospecimen quality practices.</p>","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":"702-712"},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective analysis of Claudin 18.2 expression in 64 patients with advanced gastrointestinal peritoneal disease: a potential therapeutic target for high-grade appendiceal mucinous carcinoma.","authors":"Colman T Clarke, Ailin C Rogers, Darren Cowzer, Ann Treacy, John Aird, Meera Patel, Jurgen Mulsow, Naoimh J O'Farrell","doi":"10.1136/jcp-2026-210851","DOIUrl":"10.1136/jcp-2026-210851","url":null,"abstract":"<p><strong>Aims: </strong>Specific to normal gastric epithelium, Claudin 18.2 (CLDN18.2) is a tight junction protein. CLDN18.2 immunohistochemistry is a companion diagnostic used to identify oesophageal and gastric adenocarcinoma patients eligible for targeted therapy with zolbetuximab. It has demonstrated survival benefits in advanced upper gastrointestinal (UGI) cancers, with many studies now exploring its potential use beyond the UGI tract. This study aimed to examine CLDN18.2 expression in a peritoneal malignancy patient cohort.</p><p><strong>Methods: </strong>CLDN18.2 immunohistochemistry was performed on archived tissue from patients who underwent cytoreductive surgery at a national centre for peritoneal malignancy. CLDN18.2 immunoprofiles were compared in two key tumour cohorts: peritoneal metastases from colorectal adenocarcinoma and appendiceal mucinous neoplasms. Positivity was defined as moderate-to-strong membranous staining in <u>></u>75% of tumour cells. In addition, any CLDN18.2 positivity in tumour cells (>0% of cells showing moderate-to-strong membranous staining) was recorded in all cases.</p><p><strong>Results: </strong>64 cases were examined; primary tumour sites of origin were colorectal (n=34, 53%) and appendiceal (n=30, 47%). CLDN18.2 positivity in the overall appendiceal group was 17% compared with 3% in colorectal adenocarcinomas (p=0.090). In the appendiceal group, CLDN18.2 positivity was only demonstrated in high-grade appendiceal mucinous carcinomas (22%, 5 of 23). CLDN18.2 positive staining (>0% of tumour cells) was significantly increased in the appendiceal group compared with colorectal adenocarcinoma (53% vs 3%, respectively) (p<0.0001).</p><p><strong>Conclusions: </strong>These results demonstrate CLDN18.2 expression in a subset of appendiceal peritoneal metastases. This is one of the first focused studies showing CLDN18.2 expression in this tumour group, perhaps highlighting a future role for targeted therapies in those with limited curative oncological options.</p>","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":"696-701"},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond root cause analysis: a practical systems engineering approach to incident investigation in histopathology.","authors":"Omar E Rakha, Emad A Rakha","doi":"10.1136/jcp-2026-210875","DOIUrl":"10.1136/jcp-2026-210875","url":null,"abstract":"<p><p>Patient safety and diagnostic quality are central to modern histopathology practice. Current incident investigation approaches often rely on root cause analysis; however, its routine use as a universal method is insufficient to address the highly variable, cognitive, sociotechnical and multifactorial nature of histopathology errors. In practice, incidents range from simple technical failures to complex system-level events requiring distinct investigative strategies. A key limitation of current practice is the lack of proportionality, where similar methods are applied irrespective of case complexity. In addition, corrective actions frequently target the immediate error without adequately considering the broader system context, potentially increasing workload, introducing new risks or degrading long-term service performance and operational sustainability. In this narrative review, we propose a practical five-stage systems framework for incident management in histopathology. This framework integrates proportional incident classification, structured systems investigation, prospective evaluation of corrective actions to minimise unintended consequences, implementation of system-level improvements and continuous performance monitoring. By selectively applying established human factors and quality improvement methodologies according to incident complexity, the framework shifts incident management from retrospective error investigation towards proactive system optimisation and continuous organisational learning. Ultimately, it provides a practical, scalable approach that improves diagnostic reliability, reduces recurrence, enhances efficiency and ensures that corrective actions are effective, sustainable and aligned with real-world laboratory practice.</p>","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":"649-658"},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148603307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No eosinophilic and lymphocytic infiltration in lower oesophageal sphincter biopsies from achalasia patients.","authors":"Alexander Ionov, Yuki Birgit Werner, Thomas Rösch, Markus Glatzel, Frank Jacobsen, Till Sebastian Clauditz, Guido Schachschal, Fadi Younis, Tania Ruppenthal, Oliver Mann, Alexander Quaas, Susanne Sehner, Jocelyn de Heer","doi":"10.1136/jcp-2025-210419","DOIUrl":"https://doi.org/10.1136/jcp-2025-210419","url":null,"abstract":"<p><strong>Introduction: </strong>Achalasia has been proposed as a muscle-predominant variant of eosinophilic or lymphocytic oesophagitis. Peroral endoscopic myotomy (POEM) enables direct biopsy of the oesophageal muscular layer. We assessed eosinophilic and lymphocytic infiltration in the distal oesophageal muscle.</p><p><strong>Methods: </strong>We retrospectively analysed POEM patients without mucosal eosinophilia who underwent lower oesophageal sphincter biopsies over 42 months. Eosinophils (EOs) were quantified per mm²; lymphocytes and nerve tissue were assessed by CD3 and S-100 staining. Seven patients with proximal oesophageal cancer served as controls.</p><p><strong>Results: </strong>Among 141 patients (52.4% male; mean age 47.5 years), mean EO density was 0.4/mm²; 10.6% had ≥1 EO/mm². CD3 staining was absent or minimal in most, with mild increases in 5.7%. Lymphocyte density correlated with achalasia subtype (p=0.03), but not with EOs or outcomes. Controls showed negligible inflammation.</p><p><strong>Conclusion: </strong>Lower oesophageal sphincter biopsies showed no significant eosinophilic or lymphocytic infiltration, arguing against an inflammatory myopathy as the basis of achalasia.</p>","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-grade neuroendocrine neoplasms (HG-NENs): integrating morphology, Ki-67 and molecular diagnostics.","authors":"Alessandro Mangogna, Valentina Angerilli, Giovanna Sabella, Michele Simbolo, Matteo Fassan, Massimo Milione","doi":"10.1136/jcp-2026-210906","DOIUrl":"https://doi.org/10.1136/jcp-2026-210906","url":null,"abstract":"","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ALK overexpression without rearrangement widely exists in <i>EWSR1</i>/<i>FUS</i>-rearranged soft tissue tumours.","authors":"Lihong Li, Lihua Gong","doi":"10.1136/jcp-2026-210760","DOIUrl":"https://doi.org/10.1136/jcp-2026-210760","url":null,"abstract":"<p><strong>Aims: </strong>Anaplastic lymphoma kinase (ALK) is implicated in ALK fusion-positive non-small cell lung cancer and inflammatory myofibroblastic tumours. Based on prior studies and our observations, ALK overexpression appears to be associated with FET (<i>FUS</i>/<i>EWSR1</i>/<i>TAF15</i>) family rearrangements (<i>EWSR1</i> and <i>FUS</i>).</p><p><strong>Methods: </strong>In this study, we analysed 119 FET-rearranged tumours spanning 20 tumour types. Using ALK D5F3 immunohistochemistry (IHC), ALK overexpression was defined as positive only for scores of 2+ or 3+. Cases with ALK overexpression by IHC were further confirmed to lack ALK gene rearrangements.</p><p><strong>Results: </strong>Among the cases, 28.6% (34/119) demonstrated ALK overexpression (≥2+). 9 disease types displayed ALK overexpression (≥2+), including soft tissue sarcomas and salivary gland carcinomas. Notably, Ewing sarcoma had the highest ALK overexpression rate (51%, 22/43). Both analysed clear cell sarcoma-like tumour of the gastrointestinal tract (GNET) cases (2/2) were strongly positive (3+), while extraskeletal myxoid chondrosarcoma exhibited a high overexpression rate (50%, 2/4). Additionally, angiomatoid fibrous histiocytoma showed moderate staining (75%, 3/4, 2+). The other tumours with ALK overexpression were pulmonary myoepithelial carcinoma (1/1), <i>EWSR1</i>-rearranged rhabdomyosarcoma (1/1), desmoplastic small round cell tumour (25%, 1/4), clear cell sarcoma of soft tissue (7.7%, 1/13) and myxoid liposarcoma (6.7%, 1/15). ALK overexpression (IHC≥2+) occurred in both <i>EWSR1</i>-rearranged and <i>FUS</i>-rearranged tumours. Among fusion partners, <i>FLI1</i>-rearranged cases had the strongest ALK overexpression (70%, 7/10).</p><p><strong>Conclusions: </strong>Our findings demonstrate that ALK overexpression is frequent in FET-rearranged tumours, warranting caution to avoid misdiagnosis, while also presenting potential therapeutic opportunities.</p>","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148840507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A classification criteria-based gating strategy improves anti-neutrophil cytoplasmic antibody (ANCA) testing performance characteristics for the diagnosis of ANCA-associated vasculitis.","authors":"Yi Tong Vincent Aw, Jason Chun Lao, Richard Fulton, Jamma Li, Suran L Fernando","doi":"10.1136/jcp-2026-210632","DOIUrl":"10.1136/jcp-2026-210632","url":null,"abstract":"<p><p>The 2017 guideline-recommended gating strategy (RGS) for antineutrophil cytoplasmic antibody (ANCA) testing for ANCA-associated vasculitis (AAV) diagnosis has not been evaluated in Australia, and the optimal gating strategy remains unclear. We aimed to determine the performance characteristics of the RGS, a novel classification criteria-based gating strategy (CCGS) and the non-gated strategy (NGS) and estimated local cost-savings. We performed a retrospective analysis of ANCA tests at a tertiary referral laboratory (n=516, 19 AAV cases). NGS had 89.5% sensitivity, 98.2% specificity, 65.4% positive predictive value (PPV), 99.6% negative predictive value (NPV), likelihood ratios (LR+ and LR-) LR+49.4 and LR- 0.11. RGS had improved PPV (94.4%) and LR+ (444.7) and would have avoided 79.8% of ANCA tests. CCGS performed the same but would have avoided 85.9% of ANCA tests. No AAV cases were missed. CCGS would have yielded annual healthcare cost-savings of $A86 574. Implementing gating strategies may improve ANCA diagnostic performance for AAV, reduce testing volume and lead to significant healthcare cost-savings.</p>","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":"639-644"},"PeriodicalIF":2.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric B-lymphoblastic leukaemia with low peripheral blasts: a potential diagnostic pitfall.","authors":"Emily M Harris, Matthew M Heeney, Andrew E Place, Marian H Harris, Mark D Fleming, Lewis B Silverman, Jacob R Bledsoe","doi":"10.1136/jcp-2026-210639","DOIUrl":"10.1136/jcp-2026-210639","url":null,"abstract":"<p><p>B cell acute lymphoblastic leukaemia (B-ALL) infrequently presents with undetectable or very low peripheral blood (PB) lymphoblasts, which may cause diagnostic difficulties. We report the clinicopathological features of paediatric patients with B-ALL who presented with low (<5%; n=31) PB lymphoblasts by flow cytometry. 15 patients presented with <1% PB lymphoblasts (range: 0.0%-0.9%), a level potentially undetectable by manual smear review and standard 100-cell count. Compared with patients presenting with ≥5% PB lymphoblasts (n=45), those with <5% had more frequent musculoskeletal symptoms, less frequent lymphadenopathy and hepatosplenomegaly, higher platelet counts, lower white blood cell counts and lower lactate dehydrogenase. The presence of low PB lymphoblasts was associated with favourable cytogenetics (<i>ETV6::RUNX1</i> or high hyperdiploidy without <i>IKZF1</i> deletion) and less frequent central nervous system involvement. Aleukemic/low PB lymphoblast presentation of B-ALL is associated with unique clinicopathological features that overlap with non-malignant disorders. A high degree of clinical suspicion and careful review of PB flow cytometry data are required for timely diagnosis.</p>","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":"629-633"},"PeriodicalIF":2.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148317376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promise and pragmatism of AI in global-scale digital pathology: pan-cancer approaches for clinical practice.","authors":"Sarah E Coupland, Arvind Rao, Danny Jonigk, Roman Bülow, Runjan Chetty, Swapnil Ulhas Rane, Sandeep Dave, Kikkeri N Naresh","doi":"10.1136/jcp-2026-210720","DOIUrl":"10.1136/jcp-2026-210720","url":null,"abstract":"<p><p>Artificial intelligence (AI) tools for digital pathology have crossed the threshold from pilot project to clinical deployment, with regulatory approvals, commercial products and prospective trials now accumulating across multiple tumour types. However, global-scale implementation demands careful evaluation of both opportunities and challenges. Traditional histopathology faces mounting pressures including interobserver variability and escalating workloads. At the same time, molecular diagnostics have become increasingly complex, while core workflows have remained fundamentally unchanged for decades. Digital pathology infrastructure and AI algorithms promise solutions through enhanced diagnostic accuracy, improved efficiency, democratised access to expertise and unprecedented research capabilities. AI has already demonstrated clinical value across multiple subspecialties, including prostate, breast and colorectal cancer, with applications spanning automated biomarker quantification, molecular subtype prediction and prognostic modelling. Systematic reviews also identify important limitations that temper enthusiasm for AI adoption. These include heterogeneity in study design, publication bias favouring positive results, limited generalisability across diverse populations and practice settings, concentration of research in narrow subspecialties and insufficient external validation. Critical implementation barriers include substantial infrastructure requirements, concerns around data privacy and security, gaps in regulatory oversight and the risk that algorithmic bias may exacerbate health disparities. Professional bodies advocate for responsible deployment guided by evidence-based standards. Key priorities include rigorous validation, workforce training, workflow integration and continuous performance monitoring. Making transformation equitable, safe and effective requires balancing innovation with accountability. AI should augment rather than replace pathologist expertise and be supported by robust governance frameworks that prioritise patient safety and diagnostic quality over commercial consideration.</p>","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":"577-586"},"PeriodicalIF":2.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myeloid-derived suppressor cells in anaplastic thyroid carcinoma: insights from prospective immune profiling and implications for targeted immunotherapy.","authors":"Monikongkona Boruah, Shipra Agarwal, Riyaz Ahmad Mir, Chirom A Singh, Rajeev Kumar, Kapil Sikka, Kamal Kataria","doi":"10.1136/jcp-2025-210585","DOIUrl":"10.1136/jcp-2025-210585","url":null,"abstract":"<p><strong>Purpose: </strong>Anaplastic thyroid carcinoma (ATC) exhibits limited responsiveness to immunotherapy. The current study characterises the immune cell repertoire in ATC compared with differentiated thyroid carcinoma (DTC) and thyroid follicular nodular disease (TFND) and evaluates <i>IFN-γ</i> and <i>TGF-β</i> mRNA expression.</p><p><strong>Methods: </strong>Cytotoxic T lymphocytes (CTLs), regulatory T cells (TREGs), natural killer cells (NK), B lymphocytes and myeloid-derived suppressor cells (MDSCs) were analysed by multicolour flow cytometry in prospectively collected ATC, DTC and TFND tissues. <i>IFN-γ</i> and <i>TGF-β</i> mRNA expression was quantified using RT-PCR.</p><p><strong>Results: </strong>ATC demonstrated significantly higher MDSC infiltration than DTC or TFND. CTLs were elevated in ATC relative to DTC, while TREGs, NK and B-cells were lower. <i>IFN-γ</i> and <i>TGF-β</i> expression did not differ significantly although <i>IFN-γ</i> expression was higher in DTC and ATC than in TFND.</p><p><strong>Conclusion: </strong>ATC microenvironment is rich in immunosuppressive MDSCs. These findings support MDSC-focused immunomodulation as a promising adjunct therapy in ATC.</p>","PeriodicalId":15391,"journal":{"name":"Journal of Clinical Pathology","volume":" ","pages":"634-638"},"PeriodicalIF":2.6,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148030795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}