Journal of Clinical Microbiology最新文献

{"title":"Direct thin-layer agar for bedaquiline-susceptibility testing of <i>Mycobacterium tuberculosis</i> at BSL2 level yields high accuracy in 15 days from sputum processing.","authors":"I Cuella-Martin, D Runyambo, S De Bock, M Diels, H Niyompano, F Hakizayezu, J Keysers, W B De Rijk, Y M Habimana, N Gahamanyi, E Ardizzoni, C M Muvunyi, B C de Jong, J C S Ngabonziza, L Rigouts","doi":"10.1128/jcm.01806-24","DOIUrl":"10.1128/jcm.01806-24","url":null,"abstract":"<p><p>This study evaluated thin-layer agar (TLA) as a faster alternative for both indirect minimum inhibitory concentration (MIC) determination of bedaquiline (BDQ) from culture isolates and direct drug-susceptibility testing (DST) from sputum samples. Indirect BDQ-MIC results from TLA were compared to the established 7H11 solid DST. Direct-TLA-DST performance was assessed using 143 baseline sputum samples from rifampicin-resistant TB cases. Direct-TLA tested susceptibility to rifampicin, isoniazid, levofloxacin, and BDQ, with results compared to Löwenstein-Jensen (LJ) and MGIT. For indirect BDQ-MIC determination, TLA accurately identified H37Rv MICs within the WHO control range (0.015-0.12μg/mL). Optimal results were obtained with standard incubation and day 7 reading of the plates. TLA correctly classified all wild-type clinical strains as BDQ-susceptible and detected 9 out of 10 BDQ-resistant strains with elevated MICs. Direct-TLA-DST detected MTB in 53.8% of samples, compared to 55.9% on LJ and 69.4% in MGIT. Uninterpretable results due to contamination or medium drying were low (4.9%). The median time to result was 15 days for smear-positive and 22 days for smear-negative samples, faster than WHO-endorsed methods. Sensitivity was 100% for rifampicin and 87.8% for isoniazid, with a specificity of 100% for all drugs except isoniazid (96.2%). No BDQ nor levofloxacin resistance was detected, thus direct TLA sensitivity could not be assessed. In conclusion, direct-TLA-DST offers a reliable and faster alternative to conventional DST methods for BDQ and other anti-TB drugs. Essentially, this technique can be operated at BioSafety Level 2, allowing decentralization of pDST for managing drug-resistant TB in settings with limited laboratory infrastructure.</p><p><strong>Importance: </strong>This paper addresses the critical need for faster direct drug-susceptibility testing (DST) on sputum, especially for bedaquiline (BDQ), which is a key drug in treating drug-resistant TB. Currently, there is a lack of rapid, reliable methods for direct BDQ testing from sputum samples, limiting timely and accurate treatment decisions and monitoring. By demonstrating the potential of thin-layer agar (TLA) for direct BDQ-MIC determination, this study offers a promising solution that could significantly improve patient care.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0180624"},"PeriodicalIF":6.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical significance and antifungal susceptibility profile of 103 clinical isolates of <i>Scedosporium</i> species complex and <i>Lomentospora prolificans</i> obtained from NIH patients.","authors":"Mary M Czech, Jennifer Cuellar-Rodriguez, Kyung J Kwon-Chung, Frida Stock, Chioma I Aneke, Kenneth N Olivier, Kevin P Fennelly, Juan Gea-Banacloche, Christa S Zerbe, Alexandra F Freeman, Steven M Holland, Michail S Lionakis, Amir Seyedmousavi","doi":"10.1128/jcm.01550-24","DOIUrl":"10.1128/jcm.01550-24","url":null,"abstract":"<p><p>Reduced susceptibility to antifungals is common among members of genera <i>Scedosporium</i> and <i>Lomentospora</i>, with optimal treatments still not fully defined. <i>In vitro</i> antifungal susceptibility results and clinical data do not comprehensively account for the advent of new <i>Scedosporium</i> species identified by molecular phylogenetics. Using Clinical and Laboratory Standards Institute (CLSI) methodology, we tested a total of 103 clinical isolates obtained from patients at the NIH Clinical Center. The most frequent species were <i>Scedosporium apiospermum</i> (63%) and <i>Scedosporium boydii</i> (11%), followed by <i>Lomentospora prolificans</i> (7%). The novel antifungal olorofim showed the lowest MICs against all <i>Scedosporium</i> spp. and <i>L. prolificans</i>, followed by micafungin. Among the triazoles, voriconazole showed lower MICs against <i>Scedosporium</i> spp. Amphotericin B and posaconazole demonstrated species-specific and inter-species variable activity. Itraconazole, isavuconazole, and terbinafine had higher MIC values against <i>Scedosporium</i> spp. and <i>L. prolificans</i>. Clinical data were retrospectively reviewed for 90 isolates, of which nine patients (28 isolates) had active disease/infection and received antifungal treatment that included voriconazole or posaconazole. Five of these patients (56%) died, while three patients (33%) with chronic granulomatous disease were cured following hematopoietic cell transplantation. In 24 patients (62 isolates), the presence of the fungus was considered airway colonization. In conclusion, our data support the existence of species-specific and inter-species differences in the antifungal susceptibility patterns among members of genera <i>Scedosporium</i> and <i>L. prolificans</i>. The novel investigational antifungal olorofim may be a promising therapy. Our clinical data suggest that host status and administration of antifungal therapy most effective for each <i>Scedosporium</i> species complex are important determinants of outcomes.IMPORTANCEUnderstanding the epidemiology and clinical spectrum of infections caused by <i>Scedosporium</i> species complex and <i>Lomentospora prolificans</i> is integral to improving outcomes, particularly in severely ill and immunocompromised patients. <i>In vitro</i> antifungal susceptibility testing can provide an estimate of antifungal activity against fungal pathogens. Our study showed that species-specific and inter-species differences exist in the distribution of antifungal susceptibility patterns between <i>Scedosporium</i> and <i>L. prolificans</i>. Our clinical data also highlight that host status, along with effective antifungal therapy, plays a crucial role in determining treatment outcomes.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0155024"},"PeriodicalIF":6.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid fingerprinting by MALDI Biotyper Sirius instrument fails to differentiate the three subspecies of the <i>Mycobacterium abscessus</i> complex.","authors":"Mitsunori Yoshida, Hanako Fukano, Koji Yahara, Satoshi Nakano, Takeshi Komine, Masato Suzuki, Azumi Fujinaga, Kohei Doke, Yoshihiko Hoshino","doi":"10.1128/jcm.01484-24","DOIUrl":"10.1128/jcm.01484-24","url":null,"abstract":"","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0148424"},"PeriodicalIF":6.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proceedings of the Clinical Microbiology Open 2024: artificial intelligence applications in clinical microbiology.","authors":"Jennifer Dien Bard, Andrea M Prinzi, Paige M K Larkin, David R Peaper, Daniel D Rhoads","doi":"10.1128/jcm.01804-24","DOIUrl":"10.1128/jcm.01804-24","url":null,"abstract":"<p><p>The Clinical Microbiology Open (CMO) is a meeting sponsored by the American Society for Microbiology (ASM) in collaboration with its Corporate Council and Clinical and Public Health Microbiology representatives, which is held to discuss topics that are relevant to both industry and practicing clinical microbiologists. The 2024 CMO was held in Oceanside, California on February 1 and 2. Participants included clinical and public health laboratory directors, representatives from government agencies, and biotechnology industry partners. The group engaged in discussions with the theme, \"The Lab of the Future.\" One of the primary topics discussed was artificial intelligence (AI) opportunities in clinical microbiology laboratories. This report summarizes the discussion and sentiment of the group regarding AI tools, opportunities and challenges of AI in clinical laboratories, and potential future directions for AI in clinical microbiology practice.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0180424"},"PeriodicalIF":6.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A call for healing and unity.","authors":"Patrick D Schloss","doi":"10.1128/jcm.00338-25","DOIUrl":"10.1128/jcm.00338-25","url":null,"abstract":"","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0033825"},"PeriodicalIF":6.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143515764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Brief Case: Complexity of laboratory diagnosis of <i>Mycobacterium genavense</i>-a classic case of an unusual pathogen.","authors":"Daniel Montelongo-Jauregui, Jessica McFarland, Jonathan Pham, Salika M Shakir","doi":"10.1128/jcm.01463-24","DOIUrl":"10.1128/jcm.01463-24","url":null,"abstract":"","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":"63 4","pages":"e0146324"},"PeriodicalIF":6.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standard E TB-Feron ELISA and Standard F TB-Feron FIA positivity rates and agreement with QuantiFERON-TB Gold Plus among TB high-risk population in Bandung, Indonesia.","authors":"Dewi Kartika Turbawaty, Syifa Nur Maulida, Darin Rizka Anadhea, Mulyanusa Amarullah Ritonga, Basti Andriyoko, Rudi Wisaksana, Agnes Rengga Indrati, Nanny Natalia Mulyani Soetedjo, Laniyati Hamijoyo, Raspati Cundarani Koesoemadinata, Bachti Alisjahbana, Ida Parwati","doi":"10.1128/jcm.01486-24","DOIUrl":"10.1128/jcm.01486-24","url":null,"abstract":"<p><p>Tuberculosis (TB) remains a global public health problem. The determination of tuberculosis infection (TBI) using interferon-gamma release assay has now been used widely. We aim to evaluate the positivity rates of Standard E TB-Feron enzyme-linked immunosorbent assay (TB-Feron ELISA) and Standard F TB-Feron fluorescent immunoassay (TB-Feron FIA) and their agreement with QuantiFERON-TB Gold Plus (QFT-Plus) among TB high-risk populations in Bandung City, Indonesia. We conducted a cross-sectional study, including people with a high risk of acquiring TB. We screened subjects for TB symptoms and offered chest X-ray (CXR). Anyone with cough or CXR suggestive of TB was asked to give sputum samples for GeneXpert MTB/RIF Ultra test. The positivity rates and corresponding 95% confidence intervals (CI) were calculated among patients with bacteriologically confirmed TB and among patients with no evidence of TB, no history of TB, and no known contact with TB patient (low risk of TBI). The agreement with QFT-Plus was calculated using Cohen's κ score. We enrolled 527 subjects, and the proportion of positive results among bacteriologically confirmed TB patients were 8 (53.3%; 95% CI 26.6-78.7), 9 (60.0%, 95% CI 32.3-83.7), and 10 (66.7%, 95% CI 38.4-88.8) by TB-Feron FIA, TB-Feron ELISA and QFT-Plus. The agreement between TB-Feron FIA and QFT-Plus among all subjects was similar to that of TB-Feron ELISA and QFT-Plus (84.1%, κ = 0.66, 95% CI 0.59-0.72). TB-Feron FIA and TB-Feron ELISA showed an acceptable clinical performance compared with QFT-Plus. These tests are useful alternatives for detecting TB infection.IMPORTANCEThis study evaluates the performance of two alternative interferon-gamma release assays, Standard E TB-Feron enzyme-linked immunosorbent assay and Standard F TB-Feron fluorescent immunoassay, for diagnosing tuberculosis infection (TBI) among high-risk populations in Bandung, Indonesia. Both assays demonstrated comparable clinical performance to the widely used QuantiFERON-TB Gold Plus (QFT-Plus). Given the global burden of tuberculosis, particularly in resource-limited settings, these findings suggest that the TB-Feron assays could serve as reliable alternatives to QFT-Plus for TBI detection. This research highlights the potential for these assays to improve tuberculosis diagnosis, offering a more accessible and efficient screening tool, especially for high-risk populations, and supporting broader tuberculosis surveillance.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0148624"},"PeriodicalIF":6.1,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11980364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An overview of the laboratory diagnosis of <i>Pneumocystis jirovecii</i> pneumonia.","authors":"Alexis Jaramillo Cartagena, Osaretin Emmanuel Asowata, Dianna Ng, N Esther Babady","doi":"10.1128/jcm.00361-24","DOIUrl":"10.1128/jcm.00361-24","url":null,"abstract":"<p><p><i>Pneumocystis jirovecii</i> (<i>P. jirovecii</i>) is a fungal pathogen associated with significant morbidity in immunocompromised patients, including both HIV- and non-HIV-infected patients. The nonspecific clinical and radiological presentation makes clinical diagnostic challenging, emphasizing the need for accurate laboratory diagnostic tests. However, <i>P. jirovecii</i> does not grow in routine culture media, which presents diagnostic challenges in the laboratory as well. Recent publications from the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium continue to rely on direct detection of <i>P. jirovecii</i> organisms in tissues and respiratory samples to define proven <i>P. jirovecii</i> pneumonia (PCP) even as the sensitivity of these methods are lower. Novel, standardized methods are needed to improve the clinical and laboratory diagnosis and management of PCP. This minireview provides an overview of current diagnostic tests for PCP and emerging applications that aim at filling existing diagnostic gaps and providing more accurate and less invasive diagnoses for this significant disease.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0036124"},"PeriodicalIF":6.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A novel framework for the automated characterization of Gram-stained blood culture slides using a large-scale vision transformer.","authors":"Jack McMahon, Naofumi Tomita, Elizabeth S Tatishev, Adrienne A Workman, Cristina R Costales, Niaz Banaei, Isabella W Martin, Saeed Hassanpour","doi":"10.1128/jcm.01514-24","DOIUrl":"10.1128/jcm.01514-24","url":null,"abstract":"<p><p>This study introduces a new framework for the artificial intelligence-based characterization of Gram-stained whole-slide images (WSIs). As a test for the diagnosis of bloodstream infections, Gram stains provide critical early data to inform patient treatment in conjunction with data from rapid molecular tests. In this work, we developed a novel transformer-based model for Gram-stained WSI classification, which is more scalable to large data sets than previous convolutional neural network-based methods as it does not require patch-level manual annotations. We also introduce a large Gram stain data set from Dartmouth-Hitchcock Medical Center (Lebanon, New Hampshire, USA) to evaluate our model, exploring the classification of five major categories of Gram-stained WSIs: gram-positive cocci in clusters, gram-positive cocci in pairs/chains, gram-positive rods, gram-negative rods, and slides with no bacteria. Our model achieves a classification accuracy of 0.858 (95% CI: 0.805, 0.905) and an area under the receiver operating characteristic curve (AUC) of 0.952 (95% CI: 0.922, 0.976) using fivefold nested cross-validation on our 475-slide data set, demonstrating the potential of large-scale transformer models for Gram stain classification. Results were measured against the final clinical laboratory Gram stain report after growth of organism in culture. We further demonstrate the generalizability of our trained model by applying it without additional fine-tuning on a second 27-slide external data set from Stanford Health (Palo Alto, California, USA) where it achieves a binary classification accuracy of 0.926 (95% CI: 0.885, 0.960) and an AUC of 0.8651 (95% CI: 0.6337, 0.9917) while distinguishing gram-positive from gram-negative bacteria.</p><p><strong>Importance: </strong>This study introduces a scalable transformer-based deep learning model for automating Gram-stained whole-slide image classification. It surpasses previous methods by eliminating the need for manual annotations and demonstrates high accuracy and generalizability across multiple data sets, enhancing the speed and reliability of Gram stain analysis.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0151424"},"PeriodicalIF":6.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the Filamentous Fungi Library v4.0 MALDI Biotyper Platform vs MSI-2 performance for identifying filamentous fungi from liquid cultures.","authors":"María F Gonzalez-Lara, Carla M Román-Montes, Paulette Díaz-Lomelí, Winston Hernández-Ceballos, Lizeth Morales-Camilo, Axel Cervantes-Sánchez, Andrea Cordero-Rangel, Jazmín Tejeda-Olán, Alexandro Bonifaz-Trujillo, Alfredo Ponce-de-León, Areli Martínez-Gamboa","doi":"10.1128/jcm.01371-24","DOIUrl":"10.1128/jcm.01371-24","url":null,"abstract":"<p><p>Correct, rapid, and reliable filamentous fungi identification is crucial for timely diagnosis and therapy. We compared the performance of the FFLv4.0 MALDI Biotyper and MSI-2 to identify filamentous fungi from clinical isolates. We analyzed 307 clinical isolates of <i>Aspergillus</i> spp.<i>, Fusarium</i> spp.<i>,</i> and <i>Mucorales</i> and compared them to sequencing as the reference standard. The overall identification rates to genus (<i>Mucorales</i>), section (<i>Aspergillus</i>), and species complex (<i>Fusarium</i>) level were 96% (296/307) for FFLv4.0 and 78.5% (241/307) for MSI-2. By each genus, correct species identification was achieved by FFLv4.0 and MSI-2 as follows: 72.4% (165/228) and 55.3% (126/228) for <i>Aspergillus</i> species, 17.6% (6/34) and 38.2% (13/34) for <i>Fusarium</i> species, and 88.9% (40/45) and 55.5% (25/45) for the <i>Mucorales</i>. The rates of non-identification by FFLv4.0 and MSI-2, respectively, were 4% (9/228) and 18% (41/228) for <i>Aspergillus</i> spp., 0% and 17.6% (6/34) for <i>Fusarium</i> spp. and 4.4% (2/45) and 42.2% (19/45%) for the <i>Mucorales</i>. Misidentification rates by FFLv4.0 and MSI-2, respectively, were 16.2% (37/228) and 6.1% (14/228) for <i>Aspergillus</i> species, 67.6% (23/34) and 14.7% (5/34) for <i>Fusarium</i> spp., and 0% and 2.2% (1/45) for the <i>Mucorales</i>. The FFLv4.0 MALDI Biotyper outperformed MSI-2 in identifying filamentous fungi from liquid culture spectra.</p>","PeriodicalId":15511,"journal":{"name":"Journal of Clinical Microbiology","volume":" ","pages":"e0137124"},"PeriodicalIF":6.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}