Virchows Archiv最新文献

{"title":"PTEN hamartoma of soft tissue (PHOST) and fibroadipose vascular anomaly (FAVA): a comparative clinicopathologic and molecular analysis.","authors":"Shuang Xue, Fangfang Fu, Ying Wang, Dakan Liu, Haohui Zhu, Li Xiao, Jing Huang, Qiuyu Liu","doi":"10.1007/s00428-025-04273-5","DOIUrl":"https://doi.org/10.1007/s00428-025-04273-5","url":null,"abstract":"<p><p>PTEN hamartoma of soft tissue (PHOST) is a rare entity within the PTEN-related hamartoma tumor syndrome spectrum. It often presents with overlapping clinical features with other vascular anomalies, such as fibroadipose vascular anomaly (FAVA). While both conditions are characterized by intramuscular vascular anomalies, their underlying genetic mutations and histopathological features are distinct. This study aims to elucidate the genetic and clinicopathological characteristics of PHOST, and to compare it with FAVA, highlighting critical diagnostic features. We retrospectively reviewed all cases that underwent surgical treatment in our pathology database from 2021 to 2024 and selected 28 cases with complex vascular malformations, all of which tested negative for PIK3CA mutations by fluorescent quantitative PCR (qPCR). Subsequently, next-generation sequencing (NGS) was performed on these 28 cases to evaluate their mutation profiles. Comprehensive clinicopathological evaluations, including imaging, were conducted. Treatment outcomes and recurrence rates were analyzed during long-term follow-up. The histological and genetic findings were compared between PHOST and FAVA cases. PHOST typically presents with vascular nodules in a fibrous and adipocytic background. It features numerous small vessels resembling arteries and veins, along with indeterminate channels. The presence of larger vessels with arterial-to-venous transitions and thick-walled muscular vessels suggests arteriovenous shunting, a feature absent in FAVA. Unlike PHOST, FAVA cases predominantly harbored PIK3CA mutations and exhibited localized, low-flow vascular anomalies. Detecting PTEN gene mutations in complex vascular malformations is crucial for the accurate diagnosis of PHOST. This study underscores the importance of genetic testing and tailored therapeutic approaches for these rare vascular anomalies.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151041","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":"An artificial intelligence model of whole-slide pathology specimens differentiating cutaneous high-grade squamous proliferations.","authors":"Anne Petzold, Anja Wessely, Michael Erdmann, Stefan Schliep, Stephan Schreml, Luis Carlos Rivera Monroy, Julio Vera, Konstantin Drexler, Dennis Niebel, Kinan Maurice Hayani, Franklin Kiesewetter, Carola Berking, Elias A T Koch, Markus V Heppt","doi":"10.1007/s00428-025-04272-6","DOIUrl":"https://doi.org/10.1007/s00428-025-04272-6","url":null,"abstract":"<p><p>Cutaneous squamous cell carcinoma (cSCC) and verruca vulgaris (VV) are skin conditions involving the proliferation of epidermal keratinocytes requiring fundamentally different treatments. Histological evaluation of highly differentiated squamous cell proliferations can be challenging, particularly in small or superficial samples. This study aims to improve diagnostic accuracy using an AI model to distinguish cSCC from VV. We developed a deep-learning model using clustering-constrained attention multiple instance learning (CLAM) to classify hematoxylin and eosin-stained whole-slide images (WSIs) as cSCC or VV. The dataset comprised 289 WSIs (n = 148 cSCC, n = 141 VV). Quality control was ensured through expert review: the training cohort was evaluated by four dermatopathologists, and the evaluation cohort by six additional experts. On the training set, the model achieved an AUROC of 0.99, with an accuracy of 94.9% for cSCC and 91.2% for VV. On the evaluation set, it reached an AUROC of 0.96, and accuracies of 82.4% (cSCC) and 97.4% (VV), similar to the average performance of individual dermatopathologists. We successfully trained and implemented an interpretable deep-learning-based weakly supervised model on WSIs distinguishing cSCC from VV, which could enhance AI-supported diagnostics in the future.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145151076","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":"Myxoid epithelioid smooth muscle tumor with a novel MEF2A::NCOA2 fusion arising in the rectum: case report and literature review.","authors":"Junko Kunieda, Kyoko Yamashita, Akito Dobashi, Yuki Togashi, Satoko Baba, Norihito Inoue, Kaoru Nakano, Akiko Chino, Shoichi Saito, Noriko Yamamoto, Hiroshi Kawachi, Kengo Takeuchi","doi":"10.1007/s00428-025-04275-3","DOIUrl":"https://doi.org/10.1007/s00428-025-04275-3","url":null,"abstract":"<p><p>Mesenchymal tumors of the gastrointestinal (GI) tract include a range of entities such as gastrointestinal stromal tumor (GIST), schwannoma, and leiomyoma; however, the genetic background of GI leiomyomas has not been elucidated. Herein, we report a case of rectal myxoid epithelioid smooth muscle tumor harboring a novel MEF2A::NCOA2 gene fusion. A 67-year-old male presented with a 16 mm tumor in the lower rectum. Pathological examination revealed a well-circumscribed lesion within the muscularis mucosae, characterized by epithelioid to spindle cells arranged in a myxoid matrix. The tumor cells displayed minimal cytological atypia and no mitotic figures. Immunohistochemistry showed strong positivity for desmin, α-SMA, h-caldesmon, and CD34, and weak DOG1 positivity. RNA sequencing revealed an in-frame MEF2A::NCOA2 fusion, which was confirmed by direct sequencing. Fluorescence in situ hybridization further verified NCOA2 rearrangement. This novel fusion gene may have been functional in this case, serving as a driver. Recently, 5 myxoid epithelioid smooth muscle tumors with MEF2D::NCOA2 gene fusion were reported in the vulvovaginal region. Given the characteristic histological and molecular findings, this case may represent a new entity in the gastrointestinal tract related to the vulvovaginal tumor, serving as a foundation for future studies.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145131987","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":"Metastatic mismatch repair deficient oesophageal squamous cell carcinoma leading to diagnosis of Lynch syndrome with a complete response to nivolumab treatment.","authors":"H H Wang, G Kats-Ugurlu, R H Sijmons, J L Kluiver, S Z Commandeur-Jan, W Noordzij, B van Etten, J T M Plukker, G A P Hospers, D G Knapen","doi":"10.1007/s00428-025-04269-1","DOIUrl":"https://doi.org/10.1007/s00428-025-04269-1","url":null,"abstract":"<p><p>A 59-year-old woman with two colorectal adenocarcinomas in 2015 and 2022 (both with loss of MSH2 and focal presence of MSH6 protein, thus MMR-deficient profile) had a variant of c.1012G > C p.(Gly338Arg) in the MSH2 gene, classified as Variant of Uncertain Significance (VUS) in 2023. That year, she was also diagnosed with oesophageal squamous cell carcinoma (ESCC), again MMR-deficient. Although uncommon, a proportion of ESCC can be MMR-deficient. The ESCC showed complete response to nivolumab. Genetic studies of the three tumours showed the same germline variant. During follow-up, the tumour board requested a reclassification of the VUS due to suspected Lynch syndrome. This time the genetic variant was classified as likely pathogenic, confirming Lynch syndrome in May 2025. This case highlights the importance of additional MMR profile evaluation in patients with multiple tumours, even if tumour types are unusual. Such evaluation may improve individual treatment and classification of syndrome-associated tumours.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087364","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":"A paired sequencing study of goblet cell adenocarcinomas with coincident sessile serrated lesions and low-grade appendiceal mucinous neoplasms.","authors":"Anna H Bauer, Jonathan A Nowak, Mark Redston, David J Papke","doi":"10.1007/s00428-025-04259-3","DOIUrl":"https://doi.org/10.1007/s00428-025-04259-3","url":null,"abstract":"<p><p>Appendiceal goblet cell carcinoma (GCA) is a rare tumor type that has no known precursor. In our diagnostic practice, we observed co-occurrence of GCA with sessile serrated lesions (SSLs) and low-grade appendiceal mucinous neoplasms (LAMNs). Reviewing clinical archives, we identified 35 in-house resections of GCA, in which six (17%) harbored coincident SSLs or LAMNs. Here, we performed paired next-generation sequencing of adenocarcinomas and the coincident lesions to investigate the possibility of shared clonal relationships. For comparison, we also performed paired sequencing on three conventional appendiceal adenocarcinomas with goblet cell differentiation and coincident SSLs or LAMNs. All nine sequenced SSLs or LAMNs harbored activating KRAS mutations, two with concurrent GNAS mutations. There were no apparent shared somatic alterations between the coincident lesions and the six GCAs, the latter of which harbored alterations in other genes including ARID1A, ERBB2, RHOA, and ARHGAP35. In the three conventional adenocarcinomas, there were shared somatic alterations between the adenocarcinomas and the coincident SSLs or LAMNs, including in KRAS, SMAD4, and TP53. In contrast to conventional adenocarcinoma, GCAs do not evidently arise from KRAS-mutated precursor lesions. Based on our paired sequencing study, GCAs were clonally unrelated to coincident KRAS-mutant SSLs and LAMNs, and the reason for the relatively high prevalence of co-occurring lesions among appendectomies containing GCA remains uncertain.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087745","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":"Differential expression profiles of immunoregulatory genes in anaplastic thyroid carcinomas with a coexistent papillary carcinoma component.","authors":"Giulia Orlando, Francesca Napoli, Vanessa Zambelli, Francesca Maletta, Giulia Capella, Eleonora Duregon, Marco Volante, Mauro Papotti","doi":"10.1007/s00428-025-04262-8","DOIUrl":"https://doi.org/10.1007/s00428-025-04262-8","url":null,"abstract":"<p><p>Limited data exist on the immunoregulatory mechanisms involv ed in thyroid cancer, particularly in aggressive forms. This study aimed at identifying the expression profiles of immune-related genes and miRNAs in anaplastic (ATC) and poorly differentiated thyroid carcinomas (PDTC) associated with papillary carcinoma (PTC) components. Immune-related genes were investigated using the nCounter® PanCancer Immune Profiling Panel in separate ATC and PTC components of 12 cases, and in PDTC component only of nine additional cases associated with PTC. Global miRNAs profiling was also analyzed separately in ATC and PTC components of 8 out of the 12 cases. Comparative analysis between ATC and matched PTC components revealed largely stable gene expression patterns, with only a few genes deregulated. Of these, five genes (MAP3K1, PRKCD, CYFIP2, BLNK, and EPCAM) were downregulated, while six (RIPK2, ITGB1, CCL3L1, ITGA5, PLAUR, and TICAM2) were upregulated in ATC. Furthermore, 54 miRNAs were significantly upregulated in ATC, as compared to PTC components. One of the most regulated pathways was the MAPK signaling, with six of these deregulated miRNAs targeting the MAP3K1 gene. Comparing ATC and PDTC, over 200 genes were differentially expressed between PDTC and ATC samples, involving all major immune-related pathways, with a consistent downregulation in PDTC. In conclusion, ATC displays high levels of expression of immunoregulatory genes as compared to PDTC. Moreover, a subset of genes and miRNAs is significantly de-regulated along progression from PTC to ATC, suggesting their potential role as biomarkers and involvement in key functional mechanisms.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081910","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":"Solitary fibrous tumor of kidney and renal hilus: a multi-institutional clinicopathologic analysis of 43 cases.","authors":"Güneş Güner, Mahmut Akgul, Michael Michal, Asli Yilmaz, Buşra Yaprak Bayrak, Bermal Hasbay, Aylin Yazgan, Nilüfer Kandemir, Murat Oktay, Deniz Bayçelebi, Arkar Htoo, Jose Lopez, Ondrej Hes, Arndt Hartmann, Dilek E Baydar, Kril Trpkov, Sambit K Mohanty, Abbas Agaimy, Pedram Argani, Kemal Kösemehmetoğlu","doi":"10.1007/s00428-025-04264-6","DOIUrl":"https://doi.org/10.1007/s00428-025-04264-6","url":null,"abstract":"<p><p>Solitary fibrous tumor (SFT) is a fibroblastic neoplasm characterized by prominent, staghorn, or delicate \"hemangiopericytoma (HPC)-like vasculature\", NAB2::STAT6 gene fusion, and its surrogate STAT6 expression. SFT may exhibit an unpredictable clinical course, necessitating risk assessment based on tumor characteristics. Renal SFTs are rare and have not been well characterized. Forty-three primary kidney SFT cases are reviewed for clinical, morphological, and immunohistochemical (STAT6, BCL2, CD34, and PAX8) features. A four-variable risk stratification by Demicco was applied based on patient age, tumor size, mitotic activity, and tumor necrosis. The mean age was 49 years (range 11-83 years) with a slight female predominance (male:female = 20:23). The mean tumor size was 7.8 cm (1.6-32 cm). Tumors were mainly located at the hilus (22/32, 68%) and had well-demarcated borders (31/42, 74%). Morphologically, tumors were categorized as 1) Fibrous (\"SFT-like\", 19/43, 44%), characterized by hypocellularity and prominent fine-reticular or keloidal collagen; 2) Cellular (\"HPC-like\", 8/43, 19%), with hypercellularity, short spindle to small cell-like proliferation, and lacking a collagenous background; 3) mixed fibrous/cellular (16/43, 37%) displaying both components. Four cases featured a lipomatous component. BCL2 was positive in all tested cases (28/28), CD34 in all but 3 cases (93%), and STAT6 in all but one case (39/40, 97.5%). PAX8 was positive in 6/34 (18%) cases. Most cases (29/43, 68%) were classified as low-risk, followed by intermediate (12/43, 27%) and high-risk (2/43, 5%) groups. Five of 29 (18%) patients had metastatic disease, and two patients with high-risk and one with intermediate-risk tumors died from the disease, while 25 patients with low- or intermediate-risk tumors were alive for an average of about 36 months. We emphasize the usefulness of the risk stratification system in predicting prognosis. PAX8 expression in a subset of renal SFT represents a potential diagnostic pitfall.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145081879","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":"Pathologists' role in fungal infection diagnosis using an integrated histomolecular approach: highlighting novelties and the need for real-life pragmatic guidelines.","authors":"Alexis Trecourt, Meja Rabodonirina, Mojgan Devouassoux-Shisheboran, Martin Zacharias, Jean Menotti, Gregor Gorkiewicz","doi":"10.1007/s00428-025-04245-9","DOIUrl":"https://doi.org/10.1007/s00428-025-04245-9","url":null,"abstract":"","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070680","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":"HER2-low breast cancer in routine practice: a nationwide study of diagnostic variability across pathology laboratories.","authors":"Zeynep E Kain, Ximena Baez-Navarro, Nils A 't Hart, Carolien H M van Deurzen","doi":"10.1007/s00428-025-04266-4","DOIUrl":"https://doi.org/10.1007/s00428-025-04266-4","url":null,"abstract":"<p><p>Patients with HER2-low breast cancer (BC) may be eligible for trastuzumab-deruxtecan (T-DXd) treatment. However, studies have shown that different HER2 antibodies vary in their sensitivity for low HER2 expression, potentially impacting HER2-low BC diagnosis and patient selection for T-DXd. We investigated the frequency of HER2-low BC in relation to the HER2-antibody used across Dutch pathology laboratories. Patients with primary BC without neoadjuvant treatment, diagnosed between 2013 and 2024, were included. HER2-low frequencies from 34 laboratories were obtained from the Dutch Nationwide Pathology Databank (Palga). Additional information (e.g., type of HER2 antibody, staining protocol) was obtained through a questionnaire. A total of 88,713 patients were included, representing 103,505 tumors, of which 94,934 had a conclusive HER2 status. Among non-amplified cases, HER2-low frequencies varied widely across laboratories (33.4%-94.5%), with a gradual increase since 2022. The most commonly used antibody clones were 4B5 (n = 21), DG44 (n = 7), A0485 (n = 4), and SP3 (n = 2). HER2-low proportions were highest with A0485 (71.5%), followed by DG44 (66.7%), SP3 (60.1%), and 4B5 (59.1% with Ultraview, 57.0% with Optiview). Substantial inter-laboratory variation was observed even within the same antibody group (4B5/Ultraview: 40.5%-80.4%; 4B5/Optiview: 37.3%-68.4%; DG44: 40.6%-95.4%; A0485: 62.3%-94.7%; SP3: 31.6%-78.6%). Our data showed a notable variation in HER2-low BC frequency across Dutch pathology laboratories, even among those using the same antibody and detection system. These differences may influence patient eligibility for T-DXd.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076190","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":"Can Dedifferentiated Liposarcoma be Reliably Excluded Based on Mitotic Rate? Prognostic and Diagnostic Implications of Mitotic Activity in Liposarcoma.","authors":"Jieun Lee, Seyoung Moon, Hyun Jung Kwon, Gheeyoung Choe, Kyu Sang Lee","doi":"10.1007/s00428-025-04235-x","DOIUrl":"https://doi.org/10.1007/s00428-025-04235-x","url":null,"abstract":"<p><p>Distinguishing well-differentiated liposarcoma (WDLPS) from dedifferentiated liposarcoma (DDLPS) is challenging, particularly when the low-grade (LG) sarcoma component does not meet the histopathological criteria for typical DDLPS. Previous studies have suggested that the diagnosis of DDLPS requires at least five mitotic figures per 10 high-power fields (≥ 5/10 HPF). This study aimed to validate the prognostic and diagnostic significance of the mitotic rate in LPS. We retrospectively reviewed 238 cases of WDLPS and DDLPS from our institution and assessed the prognostic value of the mitotic rate, MDM2/CEP12 amplification ratio, and Ki-67 proliferation index. Digital pathology and automated image analysis were used to obtain precise mitotic counts and minimise inter-observer variability. Among 238 patients, 165 had WDLPS, 26 had LG DDLPS, and 47 had DDLPS. LG DDLPS was reclassified when intermediate histological features were observed along with a mitotic rate < 5/10 HPF. Recurrence-free survival (RFS) was significantly worse in LG DDLPS than in WDLPS (P = 0.012) but better than in DDLPS (P = 0.001). Notably, lung metastasis occurred in two (7.7%) of the 26 LG DDLPS cases. The MDM2 amplification ratio progressively increased from WDLPS to DDLPS, whereas the Ki-67 expression level was not significantly associated with prognosis. This study demonstrated that the mitotic rate is a crucial diagnostic and prognostic marker in LPS. LG DDLPS exhibits more aggressive behaviour than WDLPS. Our results suggest that LG DDLPS should not be underestimated or classified as WDLPS based solely on mitotic rate.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145055997","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}