Andressa Varella Gonsioroski, Mayra Tsoi, Meredith Leigh Cronin, Nicholas Vetter
{"title":"Intrahepatic Cholangiocarcinoma With Pulmonary Metastasis in a Rhesus Macaque (<i>Macaca mulatta</i>).","authors":"Andressa Varella Gonsioroski, Mayra Tsoi, Meredith Leigh Cronin, Nicholas Vetter","doi":"10.1177/01926233251353515","DOIUrl":"https://doi.org/10.1177/01926233251353515","url":null,"abstract":"<p><p>A 28-year-old, female Rhesus macaque (<i>Macaca mulatta</i>) was lethargic and inappetent despite supportive treatment. Euthanasia was elected. Necropsy revealed numerous nodules in the liver and lung. Microscopically, the liver and lung were multifocally effaced by a poorly demarcated proliferation of neoplastic epithelial cells arranged in irregular and tortuous tubules and nests. Neoplastic cells showed positive immunolabeling for CK7 and negative immunolabeling for Hep-Par1. Findings in the liver and lung were consistent with cholangiocarcinoma, which is a rare neoplasm in non-human primates and has not been previously reported as a spontaneous finding in laboratory-kept Rhesus macaques. Rhesus macaques exhibit increased tumor incidence with age similar to humans, emphasizing the need for a comprehensive understanding of spontaneous neoplasia in this species.</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"1926233251353515"},"PeriodicalIF":1.4,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675645","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}
Heather Priest, Julie Schwartz, Angela Wilcox, A Eric Schultze
{"title":"Rare Occurrence of an Acute Myeloid Leukemia in a Cynomolgus Macaque <i>(Macaca fascicularis)</i>.","authors":"Heather Priest, Julie Schwartz, Angela Wilcox, A Eric Schultze","doi":"10.1177/01926233251350661","DOIUrl":"https://doi.org/10.1177/01926233251350661","url":null,"abstract":"<p><p>This report presents the findings of a spontaneous case of acute myeloid leukemia (AML) in a 6-year-old male cynomolgus macaque enrolled in a 9-month repeat dose-toxicity and toxicokinetic study. Abnormal hematology findings occurred approximately 6 months into daily oral dosing that included markedly decreased red blood cell mass and reticulocyte count, moderately decreased platelet counts, and the identification of abnormal cells in blood that were interpreted as neoplastic. Cytologic characteristics of the neoplastic cells included a moderate to high nucleus to cytoplasm ratio, medium to deep blue cytoplasm, and a round to oval nucleus with fine chromatin, often with multiple, irregularly shaped nucleoli. Following humane euthanasia, evaluation of bone marrow smears and formalin fixed paraffin embedded tissues revealed neoplastic cells of similar morphology. A panel of immunohistochemistry and cytochemical stains demonstrated expression of CD68 and myeloperoxidase, with weaker and less consistent expression of CD11c and CD45. No staining was detected for CD34, CD14, and T (CD3) and B (CD20) lymphoid markers. The neoplastic cells did not stain for any of the cytochemical stains applied (Periodic Acid Schiff, α-naphthyl acetate esterase, Sudan Black B, α-naphthyl butyrate esterase, and chloroacetate esterase). An interpretation of AML was made suggestive of a myelomonocytic lineage.</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"1926233251350661"},"PeriodicalIF":1.4,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144668571","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}
Marjory B Brooks, Cindy E Fishman, Mohanapriya Kamalakannan, Paula Katavolos, Claire E O'Brien, Jennifer B Pierson, Florence Poitout-Belissent, Michael K Pugsley, Kurex Sidik, Brett R Winters, A Eric Schultze
{"title":"Evaluation of Biomarkers to Detect Early Prothrombotic Imbalance in Rat Models of Hypercoagulability Induced by Thromboplastin Infusion and Hypofibrinolysis Induced by Tranexamic Acid.","authors":"Marjory B Brooks, Cindy E Fishman, Mohanapriya Kamalakannan, Paula Katavolos, Claire E O'Brien, Jennifer B Pierson, Florence Poitout-Belissent, Michael K Pugsley, Kurex Sidik, Brett R Winters, A Eric Schultze","doi":"10.1177/01926233251349767","DOIUrl":"https://doi.org/10.1177/01926233251349767","url":null,"abstract":"<p><p>Thrombotic complications including myocardial infarction, stroke, venous thrombosis and pulmonary thromboembolism are common causes of drug attrition often discovered at late stages of drug development. Current nonclinical safety assessments include screening tests that detect hemorrhagic complications but do not identify conditions signaling a risk of thrombosis. Our study aimed to identify sensitive tests for detecting prothrombotic imbalance, without overt thrombosis, for use in early nonclinical drug safety assessments in rodents. Sprague Dawley rats were administered different doses of thromboplastin or tranexamic acid to induce variable intensity hypercoagulable or hypofibrinolytic states, respectively. A panel of functional and quantitative assays measuring hemostatic proteins and pathways were evaluated, in concert with traditional coagulation screening tests and blood cell counts. Profound changes were observed with different patterns of test abnormalities for the different stimuli. Measurements of D-dimer and thrombin antithrombin complex concentrations, plasminogen activator inhibitor-1 and Factor VIIa activity were among the most sensitive tests of hypercoagulability. In contrast, hypofibrinolysis was best characterized in a kinetic, turbidimetric assay. Traditional coagulation screening tests were relatively insensitive, and no single test defined the cause of prothrombotic imbalance. Our results demonstrate that customized biomarker panels can detect early drug-induced prothrombotic states in rats arising from distinct mechanisms.</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"1926233251349767"},"PeriodicalIF":1.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144643637","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}
Toxicologic PathologyPub Date : 2025-07-01Epub Date: 2025-03-31DOI: 10.1177/01926233251328970
Tracey L Papenfuss, Ashwini Phadnis Moghe, Lauren E Himmel, Ana Goyos, Daniel Weinstock
{"title":"Immunotoxicology From a Pathology Perspective: A Continuing Education Course Presented at the Annual STP Meeting in Baltimore, MD, Held June 16-19, 2024.","authors":"Tracey L Papenfuss, Ashwini Phadnis Moghe, Lauren E Himmel, Ana Goyos, Daniel Weinstock","doi":"10.1177/01926233251328970","DOIUrl":"10.1177/01926233251328970","url":null,"abstract":"<p><p>This article is a summary of a half-day continuing education course jointly sponsored by the Society for Toxicologic Pathology (STP) and the Health and Environmental Sciences Institute (HESI) at the annual meeting of the STP in Baltimore, MD, held June 16-19, 2024. Presenters discussed pathology, toxicology, immunotoxicology, and regulatory implications of findings in the immune system in context of development of immunomodulatory therapeutics. Interpretation of pathology findings requires knowledge of immune system morphology and function including species-specific differences and spontaneous findings in animal model systems. A weight of evidence (WoE) approach is required to integrate pathology findings and immunotoxicology assay results to assess translatability to humans. Communication and collaboration among scientists of various disciplines can be instrumental in optimal generation and interpretation of appropriate data for development of immunomodulatory therapeutics.</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"494-500"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754621","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}
Toxicologic PathologyPub Date : 2025-07-01Epub Date: 2025-04-05DOI: 10.1177/01926233251331580
JoAnn C L Schuh, Lyn M Wancket, Brad Bolon, Kathleen A Funk, Nicole Kirchhof, Joanna M Rybicka
{"title":"Toxicologic Pathology Forum*: Opinion on Addressing Gaps in INHAND Terminology for Medical Devices-A Proposal to Add New Diagnostic Nomenclature.","authors":"JoAnn C L Schuh, Lyn M Wancket, Brad Bolon, Kathleen A Funk, Nicole Kirchhof, Joanna M Rybicka","doi":"10.1177/01926233251331580","DOIUrl":"10.1177/01926233251331580","url":null,"abstract":"<p><p>Historically, safety and efficacy assessment of medical devices began and has continued as standards under the International Organization for Standardization (ISO) rather than under regulatory agency guidelines applied to developing other biomedical product classes. These parallel and unequal pathways have led to multiple and substantive differences in methods and endpoints to determine adverse biological responses among therapeutic classes. Toxicologic pathologists with medical device experience consider standardized nomenclature and diagnostic criteria for medical devices and device-containing combination products as a critical unmet need for nonclinical pathology evaluations. The International Harmonization of Nomenclature and Diagnostic Criteria for Lesions (INHAND) initiative has established globally accepted terminology for proliferative and nonproliferative lesions in various laboratory animal species. Experienced pathologists have identified that some existing INHAND terms for rodents and particularly nonrodents are already used or can be modified for use in medical device studies, but new terms for diagnostic features unique to medical device studies are needed to close gaps in existing INHAND nomenclature. The best approach to establishing appropriate INHAND terms for medical devices (and by extension, device-containing combination products) will be to develop and implement suitable terminology (modified and new, as warranted) to address unmet needs for this distinctive therapeutic class.</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"488-493"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789227","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}
Toxicologic PathologyPub Date : 2025-07-01Epub Date: 2025-03-31DOI: 10.1177/01926233251321805
Rebecca Kohnken, Lauren Himmel, Magali Guffroy, Eric A G Blomme
{"title":"Toxicologic Pathology Forum*: Opinion on New Technologies and Trends Disrupting Drug Discovery and Development: How Can the Next Generation of Toxicologic Pathologists Be Prepared for Evolving Roles?","authors":"Rebecca Kohnken, Lauren Himmel, Magali Guffroy, Eric A G Blomme","doi":"10.1177/01926233251321805","DOIUrl":"10.1177/01926233251321805","url":null,"abstract":"<p><p>The pace of technological innovation in the pharmaceutical industry, like in many other sectors, is accelerating rapidly. This is not only reshaping how pharmaceutical Research and Development (R&D) is conducted (e.g., introduction of novel models, endpoints, and instrumentation) but also influencing the types of therapeutic modalities being developed. In addition, societal and regulatory expectations have evolved to emphasize approaches that align with the 4Rs principles (Replacement, Reduction, Refinement, and Responsibility) and to encourage the replacement of animal testing with new approach methods (NAMs) through the FDA Modernization Act 2.0. While innovation, societal changes, and regulatory evolution are not new, what stands out is the unprecedented speed and scale at which these transformations are occurring. This acceleration is fueled predominantly by groundbreaking technological advancements (e.g., artificial intelligence, deep learning, communication tools, and digital pathology) in the context of rapidly changing societal dynamics such as globalization, social networking, and the increase in remote working. Given these potentially disruptive changes, it is essential to consider how toxicologic pathologists need to adapt. More importantly, how can they leverage these advancements to contribute even more significantly to the discovery and development of novel, safe, and effective medicines? In essence, what types of toxicologic pathologists will the pharmaceutical industry require in the future?</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"484-487"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754580","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}
Toxicologic PathologyPub Date : 2025-07-01Epub Date: 2025-05-30DOI: 10.1177/01926233251339653
Juergen Funk, Gregoire Clement, Matteo Togninalli, Yaniv Cohen, Tom Albrecht, Ruth Sullivan, Josep Arus Pous, Marco Tecilla, Fernando Romero-Palomo, Amadeusz Abramowski, Angelo D'Annunzio, Yun Yvonna Li, Trung Nguyen, Fangyao Hu, Vanessa Schumacher
{"title":"Comparison of an Attention-Based Multiple Instance Learning (MIL) With a Visual Transformer Model: Two Weakly Supervised Deep Learning (DL) Algorithms for the Detection of Histopathologic Lesions in the Rat Liver to Distinguish Normal From Abnormal.","authors":"Juergen Funk, Gregoire Clement, Matteo Togninalli, Yaniv Cohen, Tom Albrecht, Ruth Sullivan, Josep Arus Pous, Marco Tecilla, Fernando Romero-Palomo, Amadeusz Abramowski, Angelo D'Annunzio, Yun Yvonna Li, Trung Nguyen, Fangyao Hu, Vanessa Schumacher","doi":"10.1177/01926233251339653","DOIUrl":"10.1177/01926233251339653","url":null,"abstract":"<p><p>The histopathologic evaluation of regulatory toxicity studies using artificial intelligence (AI) has the potential to increase study efficiency. For example, AI could initially identify and exclude all organs without histopathologic lesions, allowing pathologists to focus solely on evaluating organs with identified lesions. In this study, whole slide images (WSIs) of liver sections from 58 different rat toxicity studies were collected, along with their corresponding histopathologic lesion diagnoses. Each WSI was labeled as either \"lesion\" or \"no lesion\" based on the presence or absence of reported histopathologic lesions. Multiple instance learning (MIL) approaches, including a transformer variant, were tested to predict lesions within a weakly supervised framework. Both methods achieved acceptable to excellent area under the receiver operating characteristic curve (AUROC) scores. Heatmap overlays were employed to visually assess the MIL model's effectiveness in detecting lesions, confirming the accuracy of targeted areas on the WSIs. In addition, using transfer learning principles, the MIL model initially developed for liver WSIs was adapted to kidney WSIs, demonstrating the model's versatility. This study showcases the application of weakly supervised learning for lesion detection in rat WSIs from toxicity studies, with the potential to significantly enhance the efficiency of the histopathologic evaluation process.</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"456-478"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144187993","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}
Toxicologic PathologyPub Date : 2025-07-01Epub Date: 2025-03-13DOI: 10.1177/01926233251320080
Elaine Debien, Felix Goulet, Lee Silverman, Esther Millette, Qian Wu
{"title":"Case Report: Glioneuronal Hamartoma in the Cerebral Cortex of a Juvenile Cynomolgus Monkey (<i>Macaca fascicularis</i>).","authors":"Elaine Debien, Felix Goulet, Lee Silverman, Esther Millette, Qian Wu","doi":"10.1177/01926233251320080","DOIUrl":"10.1177/01926233251320080","url":null,"abstract":"<p><p>Two dark and raised foci were observed on the left hemisphere of the brain of a 3-year-old cynomolgus monkey during the routine necropsy procedures of a preclinical toxicity study. Microscopic examination revealed a lesion in the cerebral cortex at the junction of the parietal and occipital lobes, consisting of disorganized, but generally well-circumscribed collections of mixed glial and neuronal cells within a fibrillar stroma. Numerous eosinophilic granular bodies, brown pigment-laden macrophages, and lymphocytic infiltrates were also noted. Immunohistochemical staining for glial fibrillary acidic protein, neurofilament, and Ki-67, as well as histochemical stains Masson's Trichrome and Klüver-Barrera confirmed the presence of both glial and neuronal cells within a collagenous stroma, without significant proliferation. Both histopathological and immuno/histochemical stains were consistent with a glioneuronal hamartoma. This report describes the first case of such a lesion in a nonhuman primate.</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"479-483"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626168","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}
Toxicologic PathologyPub Date : 2025-07-01Epub Date: 2025-03-20DOI: 10.1177/01926233251321781
Karyn Colman, Kathleen A Funk, Michael Boyle, Sebastian Brennan, Gary Cain, Curtis Colleton, Laura Dill Morton, Anna Maria Giusti, Eric Jacquinet, Lisa LaFranco-Scheuch, Luann McKinney, Elizabeth Neyens, Annette Romeike, Shim-Mo Hayashi, John L Vahle, Lindsay Tomlinson
{"title":"Scientific and Regulatory Policy Committee Points to Consider* for Determining and Reporting Cause of Death/Moribundity in Non-Rodent Species in Toxicity Studies.","authors":"Karyn Colman, Kathleen A Funk, Michael Boyle, Sebastian Brennan, Gary Cain, Curtis Colleton, Laura Dill Morton, Anna Maria Giusti, Eric Jacquinet, Lisa LaFranco-Scheuch, Luann McKinney, Elizabeth Neyens, Annette Romeike, Shim-Mo Hayashi, John L Vahle, Lindsay Tomlinson","doi":"10.1177/01926233251321781","DOIUrl":"10.1177/01926233251321781","url":null,"abstract":"<p><p>The Cause of Death in Non-Rodents (CODN) Working Group is an initiative under the Scientific and Regulatory Policy Committee (SRPC) of the Society of Toxicologic Pathology (STP), focused on understanding existing practices and expectations among pharmaceutical companies, academic entities, and contract research organizations (CROs) when it comes to identifying and reporting the \"Cause of Death\" (COD) or moribundity for early or unplanned necropsies in non-rodent animal species (mainly non-human primates [NHP] and dogs) within both GLP (Good Laboratory Practice) and non-GLP toxicity studies. A survey was sent out to STP members to collect data on industry practices for determining COD in animals that underwent unscheduled euthanasia or were found deceased. Other non-rodent animals (such as pigs and rabbits) were also included to evaluate different approaches taken with various species. The insights obtained led to the development of \"Points to Consider\" for establishing and documenting the COD in large animal toxicity studies. Four key considerations include utilizing information from both control and treated animals in the study, consideration of COD for cohabiting or co-shipped non-study animals, including additional evaluations to help rule-in or rule-out specific causes, and recording the COD consistently in pathology databases or reports as a standard practice.</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"501-510"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664443","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}
Toxicologic PathologyPub Date : 2025-07-01Epub Date: 2025-03-28DOI: 10.1177/01926233251322767
Ruba Ibrahim, Abraham Nyska, Susan A Elmore, Molly Boyle, Yuval Ramot
{"title":"Interpretative Challenges in Animal Studies: Review of Case Studies and Implications for Toxicologic Pathology.","authors":"Ruba Ibrahim, Abraham Nyska, Susan A Elmore, Molly Boyle, Yuval Ramot","doi":"10.1177/01926233251322767","DOIUrl":"10.1177/01926233251322767","url":null,"abstract":"<p><p>Toxicologic pathologists play a crucial role in the evaluation of animal studies for drugs, environmental chemicals, medical devices, and other agents to determine their safety and potential toxic effects. A significant challenge in this domain is the differentiation between incidental or procedural changes and genuine treatment-related effects. Correct identification and interpretation of such findings are essential to ensure that safety assessments are accurate and reliable for subsequent approval for human use. This review presents several cases in which non-test item-related findings were encountered. By examining procedure-related findings and considering spontaneous background pathology, we underscore the need for meticulous pathological evaluation and proper contextual understanding to avoid misinterpretations that could lead to erroneous conclusions about a substance's safety profile. The insights shared in this review aim to enhance the proficiency of toxicologic pathologists in recognizing and managing various interpretative challenges, with the goal of ultimately improving the accuracy of toxicological assessments, thereby contributing to the safe development of new therapeutics and medical devices and sound characterization of potentially hazardous substances in our environment.</p>","PeriodicalId":23113,"journal":{"name":"Toxicologic Pathology","volume":" ","pages":"440-455"},"PeriodicalIF":1.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143731190","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}