American journal of clinical pathology最新文献

{"title":"Diffuse expression of p16 in pancreatic neuroendocrine tumors (PanNETs) and the association of morphology variants.","authors":"John Yablonski, Chanjuan Shi, Wei Chen","doi":"10.1093/ajcp/aqae184","DOIUrl":"10.1093/ajcp/aqae184","url":null,"abstract":"<p><strong>Objective: </strong>Distinguishing grade 3 pancreatic neuroendocrine tumors (PanNETs) from neuroendocrine carcinomas (PanNECs) is sometimes challenging. Recently, a diffuse p16-positive pattern was reported in PanNECs but not in grade 3 PanNETs, suggesting that p16 could help differentiate these entities. This study aimed to investigate p16 expression in PanNETs of various grades and its association with clinicopathologic features.</p><p><strong>Methods: </strong>A total of 114 PanNETs were selected, and their H&E resection slides were reviewed for pathologic features, with a focus on morphologic variants. Tissue microarrays were constructed, and p16 immunohistochemistry was performed. The results were categorized as diffuse positive, partial positive, or negative. Patient electronic health records were reviewed for follow-up data.</p><p><strong>Results: </strong>Among the 114 PanNETs reviewed, 13 (11.4%) exhibited diffuse p16 expression, 40 (35.1%) were negative, and 61 (53.5%) had partial expression. Diffuse p16 expression occurred in 6 of 38 (15.8%) grade 1, 6 of 60 (10.0%) grade 2, and 1 of 16 (6.3%) grade 3 tumors. Expression did not differ substantially with patient demographics, tumor size, grading, staging, or survival, but diffuse p16 expression was more frequent in body/tail tumors (12/65 [18.5%], P = .019) and in stromal-rich tumors (10/23 [43.5%], P < .001).</p><p><strong>Conclusions: </strong>Diffuse p16 expression is not uncommon in PanNETs and may be associated with stroma-rich variants.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"758-765"},"PeriodicalIF":2.3,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031764","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}

{"title":"Sensitivity and specificity of immunohistochemistry for the diagnosis of filamentous fungal infections.","authors":"Victoria L Thomas, Alvaro C Laga, Isaac H Solomon","doi":"10.1093/ajcp/aqaf037","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf037","url":null,"abstract":"<p><strong>Objectives: </strong>Many fungal species share overlapping morphologic features in tissue sections, preventing reliable identification and optimal treatment. We sought to determine whether immunohistochemistry (IHC) using a panel of commercially available antibodies could effectively distinguish between fungi commonly encountered in anatomic pathology specimens.</p><p><strong>Methods: </strong>Anti-Aspergillus, anti-Rhizopus, and anti-Candida IHC was performed on formalin-fixed, paraffin-embedded tissue sections from 24 cases with fungal infections identified by culture or sequencing (including 4 polyfungal infections).</p><p><strong>Results: </strong>Anti-Aspergillus IHC was positive in 6 of 6 Aspergillus and focally in 1 of 4 Candida species infections and negative in all cases of Fusarium, Scedosporium, Rhizopus, and Mucor species, yielding overall sensitivity of 100% and specificity of 95%. Anti-Rhizopus IHC was positive in 4 of 4 Rhizopus and 1 of 3 Mucor species infections and negative in all other cases, with a sensitivity of 71% and a specificity of 100%. Anti-Candida IHC was positive in 4 of 4 Candida species infections and showed some cross-reactivity in all other cases, resulting in 100% sensitivity and 0% specificity.</p><p><strong>Conclusions: </strong>Anti-Aspergillus IHC was highly sensitive and specific in its ability to distinguish Aspergillus from other similar-appearing hyaline molds, including Fusarium and Scedosporium species. Anti-Rhizopus IHC was moderately sensitive and highly specific, while anti-Candida IHC was highly sensitive but had minimal specificity.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959013","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}

{"title":"Residual red blood cells in liquid plasma products: A quality assessment.","authors":"Furkan Yigitbilek, Suchitra Pandey, Tho Pham, Mrigender Singh Virk","doi":"10.1093/ajcp/aqaf036","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf036","url":null,"abstract":"<p><strong>Objectives: </strong>Liquid plasma (LP) is an increasingly utilized blood product due to its immediate availability for transfusion without requiring thawing. While concerns exist regarding the presence of intact residual red blood cells (RBCs) in plasma products that have never been frozen, limited data are available on their levels in LP. This study aimed to evaluate residual RBC content in LP products to assess their safety for transfusion.</p><p><strong>Methods: </strong>Liquid plasma units were prepared from whole-blood donations at the Stanford Blood Center. Seven group AB-positive, 1 group AB-negative, 10 group A-positive, and 2 group A-negative whole-blood units were collected in citrate phosphate dextrose anticoagulant, stored at 1 °C to 6 °C for 24 hours, centrifuged, and processed into LP. On day 2 of storage, 2-mL plasma samples were analyzed for RBC count, hemoglobin, and hematocrit.</p><p><strong>Results: </strong>No residual RBCs were detected in any LP units, with all samples showing RBC counts below the limit of detection, hemoglobin levels of 0 g/dL, and hematocrit values of 0%. Given the uniform absence of RBC contamination, statistical analysis was not required.</p><p><strong>Conclusions: </strong>The findings confirm that LP prepared under current blood processing standards contains no detectable residual RBCs, supporting its safety for transfusion with ABO-compatible products without the need for consideration of RhD compatibility.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952151","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}

{"title":"Impact of PlGF immunoassay imprecision on preeclampsia risk assessment with the sFlt-1 to PlGF ratio.","authors":"Guanmin Chen, Clarence W Chan, Richard F Schaefer, Sarosh Rana, Kiang-Teck J Yeo","doi":"10.1093/ajcp/aqaf032","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf032","url":null,"abstract":"<p><strong>Objective: </strong>The US Food and Drug Administration recently approved the ratio of soluble FMS-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) using the Thermo Fisher Scientific B·R·A·H·M·S KRYPTOR autoanalyzer-the first preeclampsia marker used for clinical testing. We evaluated the analytical precision of the sFlt-1 and PlGF assays, focusing on the effects of PlGF imprecision on the sFlt-1 to PlGF ratio interpretation and clinical reliability for preeclampsia risk assessment.</p><p><strong>Methods: </strong>We measured sFlt-1 and PlGF on the KRYPTOR instrument using a homogeneous sandwich fluoroimmunoassay. Between-day precision was assessed using 3 levels of commercial quality control (QC) materials and analyzed over 3 months. In all, 180 samples obtained from 161 hospitalized pregnant women were analyzed to assess the relationship between PlGF levels and the sFlt-1 to PlGF ratio.</p><p><strong>Results: </strong>The sFlt-1 assay demonstrated good precision (coefficient of variation (s/x̄) × 100 [CV] = approximately 3.0%) across all QC levels, while the PlGF assay exhibited higher imprecision, particularly at low QC levels (CV = 7.7%-11.3%). Long-term QC monitoring revealed a downward drift in PlGF values, with improved stability after reagent lot changes. Despite higher imprecision at lower PlGF levels (23.1-34.7 ng/L), the clinical interpretation of the sFlt-1 to PlGF ratio remained robust because low PlGF consistently correlated with ratios well above the critical cutoff of 40.</p><p><strong>Conclusions: </strong>Despite the suboptimal precision observed at low QC levels and potential drifts in PlGF results, the sFlt-1 to PlGF ratio remains a reliable tool for preeclampsia risk assessment. This study highlights the need for critical evaluation of analytical performance beyond FDA approval and the importance of assessing the potential impact of assay imprecision on patient care for individual biomarkers.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143956331","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}

{"title":"Evaluation of turnaround times and performance of in-house ChromaCode high-definition PCR compared to send-out next-generation sequencing in non-small cell lung cancer.","authors":"Nathan C Hogarth, Mustafa Al-Kawaaz, Mark W Linder","doi":"10.1093/ajcp/aqaf038","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf038","url":null,"abstract":"<p><strong>Objective: </strong>Lung cancer is the leading cause of cancer deaths globally, with 1.8 million deaths annually. Advances in targeted therapy and molecular testing for key mutations in non-small cell lung cancer (NSCLC) have improved survival rates. The benchmark turnaround time for molecular testing is 10 days; however, send-out next-generation sequencing (NGS) can often take 14 to 28 days.</p><p><strong>Methods: </strong>The ChromaCode NSCLC assay uses a novel \"high-definition polymerase chain reaction (PCR)\" technology on digital PCR instruments to detect mutations in 9 genes derived from the most current guidelines provided by the National Comprehensive Cancer Network, as well as separate testing guidelines as a collaborative effort by the College of American Pathologists, the International Association for the Study of Lung Cancer, and the Association for Molecular Pathology. This includes testing for mutations in EGFR, BRAF, KRAS (G12C only), MET and RNA fusions in RET, ROS1, ALK, and NTRK1/2/3. This study retrospectively assessed the feasibility of implementing the assay in a medium-sized academic institution, with a detailed workflow analysis using 58 paraffin-embedded tissue specimens diagnosed as NSCLC.</p><p><strong>Results: </strong>Of the 58 samples, 100% concordance was observed between NGS and ChromaCode assays, with all 5 (~8.6%) positive cases-including 1 ROS1, 1 EGFR L858R, 1 KRAS G12C, and 2 NTRK1/2/3 rearrangements-accurately detected. Implementation of the ChromaCode NSCLC assay allows for an average institution-specific turnaround time of 5.01 days, subject to logistical constraints, compared to 10.4 days for send-out next-generation sequencing (U statistic = 153; α = 0.05).</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143951979","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}

{"title":"Pediatric thyroid nodules: A comprehensive study of cytology, histology, molecular findings, and risk of malignancy with emphasis on atypia of undetermined significance category.","authors":"Sandra Ixchel Sanchez, Shirin Abbasi, Mahalia T Robinson, Zahra Maleki","doi":"10.1093/ajcp/aqaf034","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf034","url":null,"abstract":"<p><strong>Objective: </strong>Pediatric thyroid nodules are more challenging in clinical practice than in adults. Herein, we report our comprehensive experience with pediatric thyroid nodules, including cytology, histology, and molecular correlation.</p><p><strong>Methods: </strong>Pediatric thyroid fine needle aspiration (FNA) performed from 2014 to 2024 was identified. Patients' demographics, FNA site, number and size of nodules, Bethesda category diagnosis, molecular studies, and surgical diagnoses were recorded.</p><p><strong>Results: </strong>In 310 reports, 378 nodules from 302 patients were included. Patients' mean age was 17.0 years (range, 1-21 years). Applying the Bethesda system, benign diagnoses were most common (198/378, 52.4%), while the indeterminate category of atypia of undetermined significance (AUS) was the most prevalent (51/378, 13.5%). Surgical resection was performed in 36.8% (139/378) of cases, revealing malignancy in 50.0% of AUS, 45.4% of follicular neoplasms, and 93.8% of suspicious-for-malignancy cases. Among AUS subtypes, nuclear atypia was most frequently noted (16/30, 53.3%) and linked to papillary thyroid carcinoma in half of these cases (8/16, 50.0%). The risk of malignancy (ROM) increased with age and showed a female predominance (81.9%), with 86.1% of malignancies in the 16- to 21-year age group and no malignant histology in ages 0 to 5 years. Molecular testing, including Afirma (34/38, 89.5%) and Thyroseq (4/38, 10.5%), often returned suspicious (16/34, 47.1%) or intermediate (3/4, 75.0%) results.</p><p><strong>Conclusions: </strong>Indeterminate diagnoses in pediatrics posed a significant ROM, particularly in female adolescents and early adulthood (ages 16-21 years). The AUS category was the most common among indeterminate categories, with AUS nuclear highly associated with malignancy. No malignancy was seen in ages 0 to 5 years.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965580","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}

{"title":"Loss of α-smooth muscle actin immunostaining is not a useful marker for functional impairment: a comparison from patients with and without small bowel motility disorder.","authors":"Katrina Collins, Iván A González, Muhammad T Idrees, Anita Gupta, John M Wo, Omer A M Saeed","doi":"10.1093/ajcp/aqaf033","DOIUrl":"https://doi.org/10.1093/ajcp/aqaf033","url":null,"abstract":"<p><strong>Objective: </strong>Prior studies have reported the loss of α-smooth muscle actin (α-SMA) immunoreactivity in the inner circular layer of the muscularis propria in small bowel motility disorder cases, but this remains controversial with conflicting data. In this study, we aimed to characterize α-SMA immunoreactivity in the muscularis propria of the small intestine-specifically, jejunum-in patients with and without small bowel motility disorder.</p><p><strong>Methods: </strong>A total of 28 transmural proximal jejunum biopsy specimens from adult patients with clinical impression of upper gastrointestinal dysmotility disorder and 64 control tissues were evaluated. The controls were full-thickness, longitudinal tissue sections from segmental resections performed due to gunshot wounds, multivisceral transplant donation, and tumors. Immunostaining for α-SMA was performed with appropriate controls to confirm the presence of immunoreactivity in the circular and longitudinal muscle layers of the muscularis propria in each sample and recorded as retained or diminished.</p><p><strong>Results: </strong>In the small bowel motility disorder and control cases, 42.9% (12/28) and 70.3% (49/64) of the cases showed no or minimal α-SMA immunoreactivity in the inner circular layer with peripheral accentuation, respectively.</p><p><strong>Conclusions: </strong>Loss or diminished α-SMA immunoreactivity in the inner circular layer of the muscularis propria occurs with a similar frequency in cases with and without small bowel motility disorder and does not correlate with impairment of function.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143958913","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}

{"title":"Survey of clinical microbiology and infectious disease testing capabilities among institutions in Africa.","authors":"Jeremy W Jacobs, Brian D Adkins, Danny A Milner, Evan M Bloch, Quentin Eichbaum","doi":"10.1093/ajcp/aqae148","DOIUrl":"10.1093/ajcp/aqae148","url":null,"abstract":"<p><strong>Objectives: </strong>Inadequate laboratory infrastructure and testing capabilities are a major impediment to addressing the infectious disease burden in Africa. Therefore, the aims of this study were to characterize the clinical microbiology/infectious disease laboratory capabilities among countries in Africa.</p><p><strong>Methods: </strong>A survey to assess the microbiological testing capabilities at hospitals, government laboratories, and free-standing public and private laboratories in African countries was developed by subject matter experts. Questions included institutional demographics and microbiology services in the broad categories of bacteriology, virology, mycology, parasitology, and rapid diagnostics/point-of-care testing. The survey was distributed using the American Society of Clinical Pathology email listserv between June and August 2022.</p><p><strong>Results: </strong>In total, 131 unique institutions in 28 countries endorsed at least 1 type of microbiology service, with parasitology (80.9%, 106/131) and bacteriology (77.9%, 102/131) being most common, while mycology (45.0%, 59/131) and virology (45.8%, 60/131) laboratories were less prevalent. The most frequently performed bacteriology test was bacterial identification (90.2%, 92/102), followed by aerobic bacterial cultures and antimicrobial susceptibility testing (both 89.2%, 91/102). Among all clinical microbiology/infectious disease laboratories, the most commonly tested agents were HIV (90.8%, 119/131), Treponema pallidum (78.6%, 103/131), Plasmodium falciparum (76.3%, 100/131), Mycobacterium tuberculosis (76.3%, 100/131), and hepatitis C virus (74.8%, 98/131).</p><p><strong>Conclusions: </strong>These findings provide contemporary data regarding the availability of critical infectious disease testing capabilities among institutions in Africa. These results and future additional studies will be crucial for understanding where strategic investment in the laboratory and public health infrastructure is warranted.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"526-530"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12009664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612185","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":"How I diagnose high-grade B-cell lymphoma.","authors":"Erika M Moore, Sarah E Gibson","doi":"10.1093/ajcp/aqae158","DOIUrl":"10.1093/ajcp/aqae158","url":null,"abstract":"<p><strong>Objectives: </strong>High-grade B-cell lymphoma (HGBL), introduced in the 2016 World Health Organization (WHO) revised fourth edition classification, included cases defined by MYC and BCL2 and/or BCL6 rearrangements or by high-grade morphology. Diagnostic criteria and nomenclature for these lymphomas were refined in the 2022 WHO fifth edition (WHO-5) classification and International Consensus Classification (ICC). This review describes our approach to the diagnosis of HGBL.</p><p><strong>Methods: </strong>Two cases are presented illustrating how we diagnose HGBL, including 1 case harboring MYC and BCL6 rearrangements and a second showing TdT expression in an HGBL with MYC and BCL2 rearrangements. The ways in which these cases are distinguished from other lymphomas with high-grade features and the appropriate nomenclature using WHO-5 and ICC classifications are emphasized.</p><p><strong>Results: </strong>An HGBL diagnosis requires integration of morphology, immunophenotype, and genetics and exclusion of other lymphomas with high-grade morphology, including Burkitt lymphoma, B-lymphoblastic leukemia/lymphoma (B-LBL/ALL), and blastoid mantle cell lymphoma. A diagnosis of HGBL/large B-cell lymphoma with 11q aberration should also be considered in certain patient populations.</p><p><strong>Conclusions: </strong>High-grade B-cell lymphomas are subclassified based on morphologic and genetic features. There are differences in the nomenclature and definition of these lymphomas in the WHO-5 and ICC classifications. Distinguishing HGBLs from other mature B-cell lymphomas and B-LBL/ALL is critical so that patients receive appropriate treatment.</p>","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"487-500"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845592","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}

{"title":"Correspondence: Integrating automated messaging with laboratory information systems for critical result communication.","authors":"Princess Morales, Andrés Pérez-López, Mohammed Suleiman, Carl Bjorkhammer, Andrés Pérez-López","doi":"10.1093/ajcp/aqae164","DOIUrl":"10.1093/ajcp/aqae164","url":null,"abstract":"","PeriodicalId":7506,"journal":{"name":"American journal of clinical pathology","volume":" ","pages":"642"},"PeriodicalIF":2.3,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373510","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}