Revista Do Instituto De Medicina Tropical De Sao Paulo最新文献

{"title":"Candidemia caused by Candida haemulonii: a case report and literature review in neonates.","authors":"Minxue Liu, Chunyun Fu, Xingchun Chen","doi":"10.1590/S1678-9946202567042","DOIUrl":"10.1590/S1678-9946202567042","url":null,"abstract":"<p><p>Candidemia poses a significant challenge for hospitalized neonates with an increase in morbidity and mortality. However, candidemia caused by Candida haemulonii in newborns is rare but fatal. We report such a case in China and performed a literature review. A neonate with a gestational age of 31+6 weeks and a birth weight of 1,420g was diagnosed with C. haemulonii candidemia. The infectious agent was identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and sequencing of the internal transcribed spacer region. The in vitro antifungal susceptibility testing indicated high minimal inhibitory concentrations for fluconazole (>128 µg/mL), voriconazole (>8 μg/mL), and amphotericin B (>4 µg/mL). Fortunately, the newborn was successfully treated with fluconazole. After a literature review of C. haemulonii candidemia, we found that the risk factors of the candidemia might involve premature, low birth weight, invasive therapeutic devices, broad-spectrum antimicrobial agents, and parenteral nutrition infusion. This study will broaden our knowledge on neonatal candidemia caused by C. haemulonii.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e42"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteomyelitis and aortic arteritis with thrombosis as primary manifestations of severe paracoccidioidomycosis: a case report.","authors":"Amaro Nunes Duarte-Neto, Katia Cristina Dantas, Suzete Cleusa F Spina Lombardi, Roseli Santos de Freitas-Xavier, Adriana P Vicentini, Alfredo Mendroni Junior, Simon Claros Claros, Luiz Fernando Ferraz da Silva, Paulo Hilário Nascimento Saldiva, Marisa Dolhnikoff, Marielton Dos Passos Cunha, Thais Mauad","doi":"10.1590/S1678-9946202567044","DOIUrl":"10.1590/S1678-9946202567044","url":null,"abstract":"<p><p>Paracoccidioidomycosis (PCM) configures a deep mycosis caused by Paracoccidioides spp., a neglected tropical disease. We describe a fatal case of PCM that manifested itself as osteomyelitis with thrombosis in the iliac artery in a man with frequent contact with an endemic region in Sao Paulo, Brazil. A 67-year-old man living in an endemic area presented with osteomyelitis of the femur and iliac artery thrombosis on admission to the hospital. Computed tomography of the chest showed multiple cavitated pulmonary nodules. The patient rapidly progressed to irreversible respiratory failure. The autopsy showed disseminated PCM and iliac artery thrombosis. Laboratory investigation confirmed P. brasiliensis infection with a strain identified in Sao Paulo as P. brasiliensis complex by phylogenetic analysis. Atypical PCM remains a diagnostic challenge. Increased awareness of the sites of infection and its clinical presentations will improve patient management.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e44"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression of inflammatory factors and distribution of pathogens in patients with septic shock and their correlation with prognosis: a cross-sectional study.","authors":"Jialin Chen, Mengzhu Tan, Tao Xiang","doi":"10.1590/S1678-9946202567045","DOIUrl":"10.1590/S1678-9946202567045","url":null,"abstract":"<p><p>This study aimed to investigate the relationship between inflammatory factors, pathogen distribution, and prognosis in patients with septic shock admitted to the emergency department of internal medicine. A total of 140 patients with septic shock admitted to the emergency department of The Third People's Hospital of Chengdu, China, from January 2021 to January 2023 were selected for analysis of the distribution of pathogens and infection sites. Patients were divided into death (36 cases) and survival groups (104 cases) based on their condition after 28 days of treatment. A total of 174 pathogenic bacteria strains were cultured, including 124 Gram-negative bacteria (71.26%) and 43 Gram-positive bacteria (24.71%). The main infection sites were the lungs (33.57%) and the abdominal and gastrointestinal tracts (25.00%). The distribution of pathogens and infection sites in the survival and death groups were compared (P > 0.05). The regression equation predicted patient mortality, with the area under the ROC curve of 0.860 (95% CI: 0.792-0.929; P < 0.05), and sensitivity and specificity of 88.90% and 73.10%, respectively. Pathogen distribution in patients with septic shock in the internal medicine emergency department was not related to prognosis; however, inflammatory factors such as CRP and PCT were predictive of outcomes. Along with age, APACHE II score, and SOFA score, they demonstrated significant prognostic value for patient mortality.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e45"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of metagenomics in the detection of arboviruses in mosquitoes (Diptera: Culicidade): a systematic review.","authors":"Everson Dos Santos David, Shirley Vasconcelos Komninakis, Erique da Costa Fonseca, Anne Caroline da Silva Soledade, Karen Carmo Dos Santos, Raimundo Nonato Picanço Souto","doi":"10.1590/S1678-9946202567046","DOIUrl":"10.1590/S1678-9946202567046","url":null,"abstract":"<p><p>Advances in deforestation and climate change directly cause changes in habits and the distribution of Culicidae across the globe, especially mosquitoes of medical importance and the main vectors of arboviruses. The viral metagenomics technique can be an important tool in characterizing viral diversity in mosquitoes. Thus, this study aimed to identify evidence of the effectiveness of the viral metagenomics technique in detecting arboviruses in mosquitoes. This is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 protocol. The research was carried out using five electronic databases: LILACS, PubMed, SciELO, Scopus, and Web of Science, and included studies published in health and interdisciplinary fields, as well as complementary research on Google Scholar. Studies that used the viral metagenomics approach for the genomic evaluation of arboviruses found in mosquito samples were included; the results demonstrated the presence of viral diversity and the identification of the genome of probable pathogenic viruses. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) platform under the number CRD42024484713. Thus, 249 studies were identified via searches on electronic databases. According to the inclusion/exclusion criteria, only 23 studies met the objectives for the systematic review. In all studies, genomic sequencing was applied to detect viruses, mainly those related to insect-specific viruses (ISV) and arboviruses known to infect humans and animals, belonging to various viral families. Despite the challenges reagrdingthe absence of reference sequences in genomic databases, the effectiveness of the metagenomics technique in characterizing the mosquito virome is clear from the studies, which broadens the understanding of viral diversity.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e46"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serology survey of chikungunya virus in high-risk pregnant women and placental tissue findings.","authors":"Thamirys Cosmo Grillo Fajardo, Antonio Carlos de Quadros Junior, Clóvis Antonio Lopes Pinto, Geovane Ribeiro Dos Santos, Andrea Cristina Botelho da Silva, Daniel Thome Catalan, Ana Paula Antunes Pascalicchio Bertozzi, Rosa Estela Gazeta, Antonio Fernandes Moron, Saulo Duarte Passos, Alexandra Siqueira Mello, Antoni Soriano-Arandes, Ana Alarcon, Alfredo Garcia-Alix, Alify Bertoldo da Silva, Dora Fix Ventura, Danielle Bruna Leal de Oliveira, Danilla Soares Tambalo, Diego da Silva Lima, Dirce Takako Fujiwara, Edison Luiz Durigon, Eduardo Roberto Bagne, Fernanda Guerra Velasco, Luiz Claudio Portnoi Baran, Fernando Novo Arita, Francisco Del Moral Hernandez, Juliana Paula Gomes de Almeida, Karen Richter Camandulli, Lucas Pires de Castro, Márcia Borges Machado, Mayana Zatz, Maria Manoela Duarte Rodrigues, Maria de Fátima Valente Rizzo, Maria Amélia Farrão, Mirella Nayane Barbosa Leite, Nemésio Florence Filho, Patrícia Carvalho Loiola, Raquel Prestes, Rita de Cássia Aguirre Dezena, Sandra Helena Alves Bonon, Sergio Vranjac, Sérgio Rosemberg, Stephanno Gomes Pereira Sarmento, Steven Sol Witkinchi, Tathiana Ghisi de Souza, Viviane Cristina Martori Pandini, Viviam Paschoarelli Paiva","doi":"10.1590/S1678-9946202567043","DOIUrl":"10.1590/S1678-9946202567043","url":null,"abstract":"<p><p>Evidence suggests a risk of maternal transmission of chikungunya virus (CHIKV) during the first and third trimesters, potentially leading to miscarriage or neurological consequences for the fetus. This study aimed to conduct a serological survey for CHIKV among women with high-risk pregnancies and analyze neonatal variables and placental tissue alterations. From March 2016 to April 2021, serological, histological, and molecular tests for CHIKV were performed. Blood samples were analyzed for anti-CHIKV IgG and IgM antibodies, and placental tissue was examined for CHIKV RNA and histological changes. Among pregnant patients, 1.33% (7/526) had reactive IgG, and 0.38% (2/526) had IgM/IgG-type antibodies during delivery. Although placental histology of CHIKV disease showed alterations, no viral genetic material was identified in the analyzed tissues. Therefore, further research is needed, including the use of complementary diagnostic techniques, to better understand the impact of this relatively new disease among high-risk pregnant women and newborns.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e43"},"PeriodicalIF":1.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An alternative real-time fluorescence reverse transcription loop-mediated isothermal amplification assay for the rapid detection of SARS-CoV-2.","authors":"Janisara Rudeeaneksin, Wiphat Klayut, Benjawan Phetsuksiri, Ballang Uppapong, Thanee Wongchai, Nuttagarn Chuenchom","doi":"10.1590/S1678-9946202567037","DOIUrl":"10.1590/S1678-9946202567037","url":null,"abstract":"<p><p>COVID-19, caused by SARS-CoV-2 virus infection, remains a public health concern in many countries. Reverse transcription loop-mediated isothermal amplification (RT-LAMP) is a rapid and cost-effective alternative test for COVID-19 diagnosis. In this study, we developed and evaluated a real-time RT-LAMP (rRT-LAMP) assay coupled with a melting curve analysis to detect SARS-CoV-2. The reaction was carried out in a real-time thermal cycler at 63 °C for 45 min to amplify the region of SARS-CoV-2 orf8; real-time monitoring of amplification was performed by fluorescence detection. The performance was assessed by comparing it to a real-time reverse transcription-polymerase reaction (rRT-PCR) as a reference. The rRT-LAMP could detect as few as 15 copies of SARS-CoV-2 RNA per reaction. Positive results appeared within 30 min, while the melting-temperature analysis could verify the amplification specificity. No positive results from non-SARS-CoV-2 templates and no mis-amplification were observed. The comparative analysis using 262 RNA extracted from nasopharyngeal swab samples revealed the overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) of the rRT-LAMP at 88.55% (95% CI: 77.52-100%), 84.13% (95% CI: 71.56-98.27%), 100% (95% CI: 78.38-100%), 100% (95% CI: 85.06-100%), and 70.87% (95% CI: 55.55-89.11%), respectively. The greatest sensitivity was as high as 98-100% for specimens with threshold rRT-PCR cycle (Ct) values of less than 30 cycles. Overall, this rRT-LAMP showed good performance for the rapid detection of SARS-CoV-2. It is proposed as a potential method for real-time amplification detection, offering increased laboratory capacity for SARS-CoV-2 testing in a cost-effective and timely manner.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e37"},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rickettsiosis cases presenting with rash: a case series from an endemic region in Turkey.","authors":"Enes Dalmanoğlu, Mehmet Ali Tüz, Hande İdil Tüz, Derya Tuna Ecer","doi":"10.1590/S1678-9946202567041","DOIUrl":"10.1590/S1678-9946202567041","url":null,"abstract":"<p><p>Rickettsia species are Gram-negative, pleomorphic coccobacilli that are obligate intracellular pathogens transmitted by arthropod vectors such as ticks. Among them, Rickettsia conorii, the causative agent of Mediterranean spotted fever (MSF), is endemic in many Mediterranean countries, including Turkey. This case series describes three patients from Balıkesir, Turkey, who developed high-grade fever, generalized maculopapular rash involving the palms and feet soles, arthralgia, and necrotic eschars (tache noire) at the tick bite sites. All cases occurred during summer and had documented exposure to Rhipicephalus sanguineus. Laboratory evaluations ruled out other tick-borne diseases, while real-time PCR performed on skin biopsy samples confirmed Rickettsia spp. Subsequent DNA sequencing of the gltA and ompA gene regions enabled species identification. Additionally, serological tests showed a significant rise in IgM and IgG antibody titers reacting with Rickettsia conorii antigen by indirect immunofluorescence assay. All patients were treated with doxycycline and recovered without complications. This case series highlights the importance of considering rickettsial infections in the differential diagnosis of febrile patients with rash and recent tick exposure, especially in endemic regions during warm seasons.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e41"},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of Furrundu phlebovirus in Aedes scapularis (Diptera: Culicidae) collected in urban parks, in a highly urbanized city.","authors":"Gabriel Matheus do Nascimento, Camila Malta Romano, Andrei Rozanski, Thaís de Moura Coletti, Paulo Roberto Urbinatti, Delsio Natal, Mauro Toledo Marrelli, Alessandra Bergamo de Araújo, Marcello Schiavo Nardi, Antonio Charlys da Costa, Lícia Natal Fernandes","doi":"10.1590/S1678-9946202567038","DOIUrl":"10.1590/S1678-9946202567038","url":null,"abstract":"<p><p>Mosquitoes (Diptera: Culicidae) are arthropods of medical importance because they can carry arboviruses. High-throughput sequencing (HTS) technology and metagenomic approaches conducted in mosquitoes have contributed to the discovery of many insect-specific viruses (ISVs), which have the potential to affect their vector competence. Mosquitoes were collected in urban parks in Sao Paulo city, Brazil and 20 pools with female mosquitoes were subjected to HTS by HiSeq 2500 sequencing system (Illumina). Long viral sequences (1,585-6,701 base pairs) were recovered from two pools of Aedes scapularis. BLASTx analyses revealed they had greater identity with segment L and S of Salarivirus and segment M of Furrundu phlebovirus, which encode, respectively, the RNA-dependent RNA polymerase (RdRd), the nucleocapsid protein, and a polyprotein. Phylogenetic tree of the segment L and S of the Phenuiviridae Family showed our sequences grouped with unverified sequences of Furrundu phlebovirus, an unclassified ISV that belongs to the Hareavirales Order and was first reported in mosquitoes in the Brazilian Pantanal, the largest natural tropical wetland worldwide. We report the second detection of Furrundu phlebovirus in mosquitoes collected in urban parks, showing it could be in mosquitoes from natural places and in green areas in urban cities. We conclude that Furrundu phlebovirus possibly occurs in Aedes scapularis in green areas, in Sao Paulo. Further studies should elucidate the role of this virus in the vector competence of Aedes scapularis and its interaction with different arboviruses.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e38"},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204209/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can archived lesion smears be used to identify Leishmania species in regions with high species diversity?","authors":"João Guilherme Pontes Lima Assy, Nara Karyne Delduck Feitosa, Jaqueline Alves Delprete, Vanessa Kehdy, Rose Grace Brito Marques, Expedito José de Albuquerque Luna, José Angelo Lauletta Lindoso, Lucia Maria Almeida Braz","doi":"10.1590/S1678-9946202567039","DOIUrl":"10.1590/S1678-9946202567039","url":null,"abstract":"<p><p>The identification of Leishmania species is crucial for eco-epidemiological purposes and may be useful for clinical management. Notably, archived smear slides can be valuable in this scenario. ITS-1 PCR followed by sequencing was used to identify Leishmania species from archived lesion smears of patients with suspected cutaneous leishmaniasis in Santarem city, Para State, Brazil. A total of 44 microscopically positive lesion smears were analyzed, of which 34 yielded positive PCR results. Of these, 22 were subjected to Sanger sequencing and 15 were successfully sequenced, revealing five Leishmania species. This study demonstrates the applicability of molecular testing on archived samples. ITS-1 sequencing effectively differentiated between species, revealing significant diversity of Leishmania in the Brazilian Amazon.</p>","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e39"},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nipah virus infection: preparedness for the pathological diagnosis of an emerging Paramyxoviridae disease with epidemic potential.","authors":"Cinthya Dos Santos Cirqueira Borges, Ana Maria Gonçalves, Fernanda Alencar Rodrigues, Thais de Souza Lima, Ana Catharina Seixas Nastri, Venâncio Avancini Ferreira Alves, Mirian Nacagami Sotto, Thais Mauad, Soon Hao Tan, Paulo Hilário Nascimento Saldiva, Luiz Fernando Ferraz Silva, Kum Thong Wong, Marisa Dolhnikoff, Amaro Nunes Duarte-Neto","doi":"10.1590/S1678-9946202567040","DOIUrl":"10.1590/S1678-9946202567040","url":null,"abstract":"","PeriodicalId":54466,"journal":{"name":"Revista Do Instituto De Medicina Tropical De Sao Paulo","volume":"67 ","pages":"e40"},"PeriodicalIF":1.5,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12204208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}