Reproductive Sciences最新文献

{"title":"Development and Validation of An Interpretable Machine Learning-Based Prediction Model of Postpartum Hemorrhage in Placenta Previa Following Cesarean Section: A Multicenter Study.","authors":"Mianmian Li, Xinhui Su, Wenxin Liao, Li Huang, Yihong Yang, Xizi Wu, Yao Fan, Jing Liu, Xin Yang, Zhen Zeng, Wencheng Ding, Wanjiang Zeng, Xiaoyan Xu","doi":"10.1007/s43032-025-01937-0","DOIUrl":"10.1007/s43032-025-01937-0","url":null,"abstract":"<p><p>The objective of this study is to predict the occurrence of postpartum hemorrhage in women with placenta previa based on machine learning. This retrospective study enrolled 845 singleton pregnant patients with placenta previa from two hospitals. They were allocated into a training cohort (n = 403), a testing cohort (n = 174), and the external validation cohort (n = 268). Univariate and multivariate regression analyses were employed to select clinical variables (p < 0.05), which were subsequently utilized to develop 11 machine learning prediction models. The area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA), accuracy (ACC), sensitivity (SEN), and specificity (SPE) were used to evaluate the performance of the models. Besides, SHapley Additive exPlanations (SHAP) was used to interpret the role and effectiveness of variables in the predictive model. Three machine learning models with the best predictive performance were combined into a Prediction Ensemble Classifier through voting. The Gradient Boosting Machine demonstrated the best predictive performance. In the validation cohort, AUC of the Gradient Boosting Machine model is 0.810(95% CI 0.754-0.865), ACC was 0.765(95% CI 0.716-0.813), SEN was 0.613(95% CI 0.513-0.723), while these values of the Prediction Ensemble Classifier were 0.813(0.756-0.871), 0.806(0.757-0.854), and 0.480(0.375-0.597), respectively. The importance of SHAP variables in the model, ranked from high to low, is as follows: d-dimer, ultrasound diagnosis of placenta accreta spectrum, neutrophils, prothrombin time, and platelets. The Gradient Boosting Machine model demonstrated excellent performance in predicting postpartum hemorrhage in cases of placenta previa. Furthermore, SHAP analysis enabled interpretation of the variables in the model.</p>","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":"3062-3073"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144837492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting Hormonal Therapy Ineffectiveness and Discontinuation due to Adverse Effects in Patients with Endometriosis-Associated Pain.","authors":"Bahi Fayek, Yang Doris Liu, Christina Williams, Mohamed Elsibai Anter, Caroline Lee, Nasser Kamal Abdelaal, Catherine Allaire, Alaa El Halaby, Ruth Habte, Paul J Yong, Mohamed A Bedaiwy","doi":"10.1007/s43032-025-01947-y","DOIUrl":"10.1007/s43032-025-01947-y","url":null,"abstract":"<p><p>Endometriosis contributes to 5-21% of hospital admissions for pelvic pain. While hormonal therapies are pivotal in managing endometriosis-related pain, no single hormonal treatment suits all patients. We aimed to assess the effectiveness and tolerability of hormonal therapies and factors influencing response in endometriosis-associated pain treatment. Additionally, to investigate adjuvant neuromodulatory drug usage in patients who have used hormonal therapy. This cross-sectional study examined endometriosis patients undergoing hormonal therapy for pelvic pain at a tertiary referral centre for endometriosis and chronic pelvic pain (CPP). We assessed the proportion of patients reporting ineffectiveness of hormonal therapy and rates of discontinuation attributed to side effects. We evaluated factors related to treatment ineffectiveness and discontinuation due to side effects. Lastly, we determined the rates of adjuvant neuromodulatory drug use among patients who used hormonal therapy. 1011 patients were included in the study. Most hormonal therapies' ineffectiveness was related to worse CPP (P < .05). Cul-de-sac obliteration was correlated with better response to cyclic CHCs, DNG, and GnRH agonist (OR = 0.55, 95% CI [0.36 - 0.84]; OR = 0.53, 95% CI [0.29 - 0.98]; OR = 0.26, 95% CI [0.14 - 0.91], respectively). Adjuvant neuromodulatory drugs were more frequently utilized by patients who found hormone therapy ineffective except for those who used norethisterone acetate (NETA). Endometriosis pain is associated with a high chance of failed hormonal therapy. Cul-de-sac obliteration correlated with improved hormonal therapy response, highlighting the multifactorial influence on treatment outcomes. Patients who found hormone therapy ineffective tended to use adjuvant neuromodulatory drugs more frequently.</p>","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":"2946-2963"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144874962","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":"Pituitary Adenylate Cyclase-Activating Polypeptide (PACAP) Alleviates the Defective Epididymis and Sperm Function in Lipopolysaccharide (LPS) Induced Acute Mouse Epididymitis.","authors":"Zhang Xueying, Liu Yanan, Gong Benjiao, Wang Xiaoxin, Liu Xuexia, Liu Fujun","doi":"10.1007/s43032-025-01931-6","DOIUrl":"10.1007/s43032-025-01931-6","url":null,"abstract":"<p><p>This study investigated the protective effects of pituitary adenylate cyclase-activating polypeptide (PACAP) against lipopolysaccharide (LPS)-induced acute epididymitis in mice, with a particular emphasis on its antioxidant and anti-inflammatory mechanisms within the epididymal microenvironment responsible for sperm maturation. Acute epididymitis was triggered by injecting LPS intraperitoneally, with concurrent PACAP administration. Epididymal tissues were collected for histological, immunofluorescence, RT-PCR, and in vitro fertilization analyses. The results demonstrated that PACAP markedly decreased the expression of Il-6 mRNA (2.87 fold decrease, p < 0.05) and Tnf-α mRNA (2.45 fold decrease, p < 0.05) in the cauda epididymis following LPS adminstration for 6 h, alleviated histopathological changes, and improved sperm motility (from 37.8 ± 4.1% in LPS group to 52.7 ± 3.3% in LPS + PACAP group, p < 0.05) and morphology (abnormal sperm rate decreased from 45.7% ± 5.6-22.1% ± 3.8%, p < 0.05). PACAP also preserved the expression of epididymal function-associated proteins (AQP1 and KRT5), suppressed inflammatory gene expression, and enhanced antioxidant gene expression in the cauda epididymidis tissues during acute epididymitis. In vitro fertilization experiments revealed that PACAP significantly restored sperm fertilizing capacity, as evidenced by an increase in sperm-oocyte binding (from 8.7 ± 1.5 to 15.6 ± 2.7, p < 0.05), and improved embryonic development rates compromised by LPS (the two-cell embryo rate increased from 35.7% ± 4.8-62.3% ± 5.1%, p < 0.05). These results demonstrated that PACAP exerted a protective effect by suppressing inflammation and oxidative stress in acute epididymitis, thereby preserving epididymal function and sperm quality. PACAP may represent a potential therapeutic agent for epididymitis and related fertility issues.</p>","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":"3038-3050"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609171","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":"ATF2-mediated Transcriptional Activation of USP4 Stabilizes KMT2A Protein and Promotes Trophoblast Dysfunction.","authors":"Jialin Liu, Ke Pan, Chunli Yang, Mengjie Jiang, Jiangling Cheng, Yao He, Aichun Wang, Hongman Gou","doi":"10.1007/s43032-025-01938-z","DOIUrl":"10.1007/s43032-025-01938-z","url":null,"abstract":"<p><p>Preeclampsia (PE) is a severe and prevalent complication of pregnancy, characterized by insufficient trophoblast invasion, placental hypoxia, and systemic inflammation, which collectively represent the central pathological mechanisms underlying the disease. The molecular mechanism involving activating transcription factor 2 (ATF2), ubiquitin-specific peptidase 4 (USP4), and lysine methyltransferase 2 A (KMT2A) in hypoxia/reoxygenation (H/R)-treated trophoblast cells (HTR-8/SVneo) is explored, aiming to provide a novel theoretical basis for therapeutic strategies against PE. An in vitro H/R model was established using HTR-8/SVneo trophoblast cells to simulate PE pathophysiology. The expression levels of mRNA and protein were evaluated using RT-qPCR and western blotting, respectively. The proliferation, apoptosis, and invasion of cells were assessed using 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), 5-ethynyl-2'-deoxyuridine (EdU), flow cytometry, and transwell assays. Ferroptosis-related markers were measured using commercial kits. The interaction between USP4 and KMT2A was determined by co-immunoprecipitation (Co-IP) and ubiquitination assays. Dual-luciferase reporter and chromatin immunoprecipitation (ChIP) assays were employed to investigate the binding of ATF2 to the USP4 promoter. KMT2A knockdown enhanced hypoxia/reoxygenation (H/R)-induced proliferation and invasiveness and suppressed apoptosis and ferroptosis in HTR-8/SVneo cells. The deubiquitinase USP4 stabilized KMT2A protein expression through deubiquitination. Overexpression of KMT2A reversed the impacts of USP4 silencing on H/R-mediated cellular injury and ferroptosis. Mechanistically, ATF2 transcriptionally activated USP4 expression. Furthermore, USP4 upregulation rescued the influences of ATF2 depletion on H/R-induced HTR-8/SVneo cell injury and ferroptosis. ATF2 activated USP4 transcription, which subsequently deubiquitinated and stabilized KMT2A protein expression, thereby influencing the progression of PE.</p>","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":"3051-3061"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144848534","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":"Evaluating Dexamethasone as an Adjuvant in the Antagonist Protocol in PCOS Patients Undergoing IVF/ICSI: A Randomized Controlled Trial.","authors":"Fahimeh Alizadeh, Malihe Amirian, Nayereh Khadem, Malihe Afiat, Malihe Mahmoudinia, Sahar Ardalan Khales, Fatemeh Barani Moghaddam, Farzaneh Afshar Delkhah, Hassan Mehrad-Majd","doi":"10.1007/s43032-025-01895-7","DOIUrl":"https://doi.org/10.1007/s43032-025-01895-7","url":null,"abstract":"","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966584","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":"Integrated Transcriptomics and Single-Cell RNA Sequencing Analyses Reveal the Potential Role of Obesity-Related Genes in Polycystic Ovary Syndrome.","authors":"Xin Gong","doi":"10.1007/s43032-025-01968-7","DOIUrl":"https://doi.org/10.1007/s43032-025-01968-7","url":null,"abstract":"<p><p>Obesity leads to menstrual dysfunction by impacting the \"hypothalamic-pituitary-ovarian axis\" in women, which can result in polycystic ovary syndrome (PCOS). The differentially expressed genes (DEGs) between the PCOS and control groups were identified using a public database, By intersecting these DEGs with key module genes and obesity related genes (ORGs), we obtained 75 differentially expressed ORGs (DE-ORGs). Further screening using machine learning led to the identification of five potential diagnostic biomarkers: CPT1A, LARS2, GSTP1, TREX1, and PILRB. The expression levels of biomarkers exhibited notable variations between the control and PCOS group, with area under curve (AUC) values exceeding 0.89 for all biomarkers, confirming their role as molecular diagnostic biomarkers for PCOS. The AUC of nomogram achieved 1, indicating its perfect predictive capability for PCOS occurrence. Single-cell analysis highlighted the crucial roles of GSTP1 and epithelial cells in the early stages of PCOS development. This study clarifies the roles of these diagnostic biomarkers, offering a theoretical foundation for the clinical assessment and treament of the disease.</p>","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966642","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":"Beneficial Role of Resveratrol on Oxidative Stress in Women with Polycystic Ovary Syndrome: A Randomized Controlled Trial.","authors":"Negar Ajabi Ardehjani, Marzieh Agha-Hosseini, Maryam Shabani Nashtaei, Mahshad Khodarahmian, Shadi Sadat Seyyed Ebrahimi, Mohammad Hossein Bagheri, Farzane Fereidouni, Tayebeh Rastegar, Fardin Amidi","doi":"10.1007/s43032-025-01967-8","DOIUrl":"https://doi.org/10.1007/s43032-025-01967-8","url":null,"abstract":"<p><p>Polycystic ovary syndrome (PCOS) is a multifactorial endocrine disorder in women. Oxidative stress (OS) plays a pivotal role in the pathogenesis of PCOS. Resveratrol, as a natural polyphenol, has several beneficial therapeutic effects for women with PCOS. In this study, we investigated the antioxidant effect of resveratrol on OS markers in follicular fluid (FF) and granulosa cells (GCs) of patients with PCOS. A total of fifty-six patients with PCOS were randomly assigned to receive 800 mg/day of resveratrol or placebo for 60 days. The main focus was on evaluating OS markers, such as malondialdehyde (MDA) and total thiol (sulfhydryl) content in FF, along with assessing the levels of total antioxidant capacity (TAC) and total oxidant status (TOS) in GCs. Additionally, secondary outcomes included measuring the expression of genes associated with OS responses (Manganese superoxide dismutase (Mn-SOD), catalase (CAT), and uncoupling protein 2 (UCP2)), as well as the expression of UCP2 protein in granulosa cells. Compared with the placebo group, resveratrol reduced MDA and conversely significantly increased total thiol (P = 0.6694 and P = 0.0318, respectively) in FF. Resveratrol significantly reduced TOS and oxidative stress index (OSI) (P = 0.0299 and P = 0.0144, respectively) and significantly increased TAC (P = 0.0484) in GCs. There were significant increases in CAT and UCP2 expression after resveratrol consumption (P = 0.0158 and P = 0.0004, respectively). Although resveratrol increased Mn-SOD expression (P = 0.0914), its effects were not statistically significant. Resveratrol significantly affected UCP2 protein levels (P = 0.0030). These findings suggested that 60 days of supplementation with 800 mg/day resveratrol improves markers of OS in the FF and GCs of patients with PCOS. Trial registration number: http://www.irct.ir ; IRCT20221106056417N1; 2023 February 09.</p>","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966559","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":"Liquiritigenin Restores Declined Oocyte Quality and Improves Embryo Development in Aged Mice.","authors":"Yelan Cai, Jiawei Ma, Haifeng Xu, Huamei Jian, Wenyi Gao, Man Wu, Bailin Liu, Ying Chen","doi":"10.1007/s43032-025-01959-8","DOIUrl":"https://doi.org/10.1007/s43032-025-01959-8","url":null,"abstract":"<p><p>Ovarian aging leads to a decline in oocyte quality and reduced reproductive potential, which is one of the main challenges faced by assisted reproductive technology (ART). Oxidative stress (OS) is a major contributor to this decline. In this study, we investigated the protective effects of natural flavonoid compound liquiritigenin (LQ) on oocyte maturation and embryo development in aged mice. The results showed that 20 μM LQ significantly improved the maturation rate of aged oocytes, restored spindle morphology, and enhanced fertilization and two-cell embryo development rates. Mechanism studies have found that LQ reduces the levels of reactive oxygen species (ROS) in oocytes and restores mitochondrial function, including distribution patterns and membrane potential. Additionally, LQ upregulated the protein expression of Sirtuin 1 (SIRT1) and nuclear factor E2-related factor 2 (NRF2) in the ovaries and oocytes of aging mice, as well as in the human ovarian granulosa tumor cell line (KGN). Although its mRNA level showed minimal change, it suggested that it might play a role through post-translational regulation. These results suggest that LQ protects aged oocytes from oxidative stress by activating the SIRT1/NRF2 signaling pathway, highlighting its potential as a natural antioxidant for alleviating ovarian aging and improving oocyte quality.</p>","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966602","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":"Artificial Uterus and Artificial Embryos: Unsolved Tasks.","authors":"Maxim A Filatov, Iuliia P Baikova, Daria M Dolmatova","doi":"10.1007/s43032-025-01939-y","DOIUrl":"https://doi.org/10.1007/s43032-025-01939-y","url":null,"abstract":"<p><p>Ex utero embryo culture is one of the important tasks that has not been completely solved. In the first part of the current review, we focus on potential roles ex utero mammalian embryo culture could play, such as in infertility treatment or ex utero embryo treatment. Particularly, we discuss ex utero genetic therapy of embryos for correction and prevention of congenital pathologies. We also discuss the benefits of ex utero embryo culture in comparison to the traditional surrogacy programs and review its potential influence on social aspects. In the second part, we discuss key methods for ex utero embryo culture, their limitations, bottlenecks and blank points. Moreover, we analyze methods of artificial embryo production using stem cells and possible uses of such embryos (including those that reproduce stages of postimplantation development) in scientific research. We discuss the risks of using the described technologies and possible approaches that will avoid these risks.</p>","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966623","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":"Treatment Outcomes and Resistance Patterns in Low Risk GTN: A 270-Patient Experience from a Tertiary Center.","authors":"Elham Shirali, Fariba Yarandi, Sara Ramhormozian, Atena Abedini","doi":"10.1007/s43032-025-01960-1","DOIUrl":"https://doi.org/10.1007/s43032-025-01960-1","url":null,"abstract":"<p><p>Because of the lack of fully successful treatment of low-risk gestational trophoblastic neoplasia (GTN) patients after first-line single-agent chemotherapy, some studies have suggested that these patients should be treated with multi-drug chemotherapy from the outset. A score of 0-4 represents the majority of low risk GTN that has been less studied. The present study aimed to investigate the risk factors associated with resistance to first-line single-agent chemotherapy. This retrospective cohort includes patients diagnosed with low-risk GTN who were treated with single-agent chemotherapy using methotrexate and actinomycin. Factors associated with resistance to first-line chemotherapy were analyzed separately in two groups: those with a score of 0-6 and those with a score of 0-4. A total of 270 patients were studied, all of whom achieved remission. Of these, 75.9% responded to first-line single-agent chemotherapy. Patients aged 40 or older had about 7 times higher odds of treatment resistance than younger patients. Choriocarcinoma increased the odds by 5.5 times, and each 1 cm increase in tumor size raised the odds by 53%. In patients with WHO scores of 0-4, each additional year of age increased resistance odds by 6%, and choriocarcinoma raised it by 7.5 times. In both groups, lung metastasis increased the chance of resistance threefold. Increased age, larger tumor size, increase βhCG level and start of treatment with MTX, increase the likelihood of resistance to first-line chemotherapy in the 0-6 score and in the subgroup with a 0-4 score. Future prospective studies are necessary to validate new models Until then, clinicians should be aware of the limitations of the current system and consider individualized clinical judgment.</p>","PeriodicalId":20920,"journal":{"name":"Reproductive Sciences","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144966581","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}