Persistent Left Superior Vena Cava Identified during Cadaver Dissection: A Case Report

Persistent Left Superior Vena Cava Identified during Cadaver Dissection: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Persistent Left Superior Vena Cava Identified during Cadaver Dissection: A Case Report Xia X. Zhang, Wen Y. She, Zi M. Zhang, Yi Z. Wang, Xin y. Wu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7723772/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Persistent left superior vena cava (SVC), resulting from the persistence of the left anterior cardinal vein, is most frequently observed as a component of a double SVC system. Since this venous anomaly is insignificant in hemodynamics, it is often discovered incidentally during the placement of intravenous catheters or electrode leads. Recognizing such anomalies is clinically significant, because it can help avoid diagnostic errors, suggest the potential presence of associated abnormalities, and aid in the planning of vascular interventions or surgical procedures. In this report, we present a case of persistent left SVC identified during a regional anatomy course, which will significantly enhance the understanding of this congenital variation. Categories: Anatomy, Education persistent left superior vena cava brachiocephalic veins venous anomaly congenital variation Figures Figure 1 Figure 2 Introduction The venous return from the upper half of the body typically converges into the right-sided superior vena cava (SVC), formed by the confluence of the bilateral brachiocephalic veins (BCV). The left BCV, which connects the left internal jugular vein and subclavian vein to the right-sided SVC, usually courses posterior to the thymus and directly anterior and superior to the aortic arch. A persistent left SVC, most commonly existing as part of a double SVC, represents a rare and less recognized systemic venous anomaly [ 1 – 2 ]. It is crucial to understand this variation in upper body venous drainage in clinical practice. In this report, we present a case with a persistent left SVC identified during a regional anatomy course. Case Presentation A 65-year-old male cadaver with an unspecified cause of death was utilized in the regional anatomy course at Anhui Medical University. External examination revealed that the cadaver, preserved in 10% formalin, measured 170 cm in height and exhibited no signs of mechanical trauma. No other notable external abnormalities were observed. During the dissection of the thoracic cavity, it was discovered that the left BCV did not merge with the right BCV to form the right-sided SVC. Instead, the left BCV coursed anterior to the root of the left lung and along the left side of the heart. Upon examination using the inflow-outflow method, the left BCV was found to converge with the great cardiac vein and drain into the right atrium via the coronary sinus (Fig. 1 ). Further detailed measurements were conducted: the left BCV measured 12.4 cm in length, while the right BCV measured 10.8 cm. The outer lumen diameter of the left BCV was 1.3 cm at its ostium and 1.5 cm at its junction with the coronary sinus. The right BCV had an outer lumen diameter of 1.4 cm at its ostium and 2.3 cm at its entrance into the SVC. The distance was 2.8 cm between the upper edge of the aortic arch and the confluence of the left BCV with the great cardiac vein. The left venous angle was 10.1 cm from the upper end of the left atrial appendage, and the right BCV was 5.3 cm from the azygos vein. The coronary sinus exhibited a turning angle of 100 degrees, with a width of 2.5 cm at its entrance and 2.6 cm at its widest point. The length was 5.5 cm from the origin to the turning point of the coronary sinus, and its diaphragmatic surface measured 3.5 cm in length. Notably, after the left BCV and the great cardiac vein converge to form the coronary sinus, the origin of the coronary sinus was significantly enlarged, likely due to hemodynamic changes secondary to this congenital variation. Based on these findings, diagnosis of a persistent left SVC was confirmed (Fig. 2 ). It is worth clarifying here that all instances of “left BCV” mentioned in the above descriptions and measurements actually refer to the persistent left SVC. To the best of our knowledge, the identification of a persistent left SVC during cadaver dissection has been rarely reported. Discussion The Superior Vena Cava is a large, valveless venous trunk located on the right side of the mediastinum, formed by the confluence of the right and left brachiocephalic veins at the level of the first costal cartilage. It serves to collect and drain blood from the upper body into the right atrium. Due to complex deviations in the persistence and regression of segments of the primitive venous network, three types of SVC anomalies have been documented in the literature: persistent left SVC, interruption of the SVC, and anomalous course of the brachiocephalic veins [ 3 ]. Persistent left SVC, which arises from the persistence of the left anterior cardinal vein, occurs in less than 0.5% of the general population. However, its incidence increases to approximately 4% in patients with congenital heart disease [ 4 – 6 ]. As illustrated in the current case, it typically presents as part of a double SVC. Clinically, persistent left SVC can be indicated by a focal widening of the superior left cardiomediastinal contour adjacent to the aortic knob in conventional radiography, but it is more commonly identified when traversed by an intravenous catheter/electrode leads [ 7 – 11 ]. Although the persistent left SVC typically remains insignificant in hemodynamics, it can pose challenges during catheterization of the left brachiocephalic vein via the femoral vein approach. When encountering resistance or difficulties in advancing the guidewire or catheter into the left brachiocephalic vein, clinicians should consider this anatomical variation. Conclusion Persistent left SVC is a very rare congenital vena cava anomaly. The identification of a persistent left SVC during our anatomical course has heightened awareness of this systemic venous variation, which holds clinical significance. By understanding this condition, doctors can let diagnoses more precise and make optimal determinants in order to improve patients’ safety. Declarations Disclosures This study was performed in line with the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Anhui Medical University. Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE Form for Disclosure of Potential COI, all authors declare that there are no other relationships or activities that could influence the submitted work. Funding: This work was supported by Natural scientific research project of colleges and universities in Anhui Province (2023AH050684). References Schwier E, Schneider A, Henzler D, Köhler T: Left-sided superior vena cava. Can J Anaesth. 2023 Feb;70(2):271-272. Imburgio S, Johal A, Akhlaq H, Pannu V, Udongwo N, Mararenko A, Berezovsky D, Heaton J, Singh D. Persistent Left Superior Vena Cava: An Illustrative Example. J Cardiothorac Vasc Anesth. 2023 Jul;37(7):1336-1337. Oliveira JD, Martins L. Congenital systemic venous return anomalies to the right atrium review. Insights Imaging. 2019. PMID: 31802263 Mill MR, et al. Anomalous course of the left brachiocephalic vein. Ann Thorac Surg. 1993. PMID: 8452420 Review Tang PT, Chan K. Isolated Persistent Left Superior Vena Cava. N Engl J Med. 2022 Mar 3;386(9):879. doi: 10.1056/NEJMicm2113492. S Kahkouee, M Sadr, E Pedarzadeh, S Fardin, A Borhani, S Gholami, G Amjad. Anomalous left brachiocephalic vein: important vascular anomaly concomitant with congenital anomalies and heart diseases. Folia Morphol (Warsz) 2017;76(1):51-57. Demos TC, Posniak HV, Pierce KL, Olson MC, Muscato M (2004) Venous anomalies of the thorax. AJR Am J Roentgenol 82(5):1139–1150. Morhy Borges Leal S, et al. Anomalous subaortic course of the left brachiocephalic (innominate) vein: echocardiographic diagnosis and report of an unusual association. Cardiol Young. 2002. PMID: 12018721doi: 10.1016/j.mjafi.2020.01.009. Epub 2020 Apr 30 Dave V, Sesham K, Mehra S, Roy TS, Ahuja MS. Persistent left superior vena cava: An anatomical variation. Med J Armed Forces India. 2022 Sep;78(Suppl 1):S277-S281. Fares WH, Birchard KR, Yankaskas JR. Persistent Left Superior Vena Cava Identified During Central Line Placement: A Case Report.Respir Med CME. 2011;4(3):141-143. doi: 10.1016/j.rmedc.2010.11.003 Puspitasari M, Sinorita H, Bagaswoto HP, Kuswadi I, Prasanto H, Wardhani Y, Kurniawan WT. Persistent Left Superior Vena Cava Identified After Hemodialysis Catheter Insertion: A Case Report. Int Med Case Rep J. 2020 Oct 1;13:465-469. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7723772","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":569076357,"identity":"12994d7e-806e-4ce5-a834-ab2e9729ff36","order_by":0,"name":"Xia X. 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1","display":"","copyAsset":false,"role":"figure","size":1188362,"visible":true,"origin":"","legend":"\u003cp\u003eschematic diagram of persistent left superior vena cava. Drawn with data from the study.\u003c/p\u003e","description":"","filename":"Figure1Simplediagram.png","url":"https://assets-eu.researchsquare.com/files/rs-7723772/v1/4be1c252f2632e50a9ca8f12.png"},{"id":99495647,"identity":"0229fd23-0005-4977-9dd9-00ece030be34","added_by":"auto","created_at":"2026-01-05 06:17:59","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":69759387,"visible":true,"origin":"","legend":"\u003cp\u003eactual specific presentation of cadaver dissection：\u003c/p\u003e\n\u003cp\u003e（A）anterior view：1、left auricle 2、persistent left superior vena cava 3、left venous angle 4、right brachiocephalic vein 5、right venous angle\u003c/p\u003e\n\u003cp\u003e（B）lateral view：1、left auricle 2、persistent left superior vena cava 3、\u003c/p\u003e\n\u003cp\u003eleft venous angle 4、great cardiac vein 5、coronary sinus\u003c/p\u003e","description":"","filename":"Figure2Caption.png","url":"https://assets-eu.researchsquare.com/files/rs-7723772/v1/841fb6bc6c8f55a08fbafac9.png"},{"id":101202403,"identity":"4d0430f8-703f-4179-9fa3-03ff5e7bb581","added_by":"auto","created_at":"2026-01-27 09:30:43","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":75212934,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7723772/v1/5eea3c1b-0853-4fc2-adac-57afc5c1290f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Persistent Left Superior Vena Cava Identified during Cadaver Dissection: A Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe venous return from the upper half of the body typically converges into the right-sided superior vena cava (SVC), formed by the confluence of the bilateral brachiocephalic veins (BCV). The left BCV, which connects the left internal jugular vein and subclavian vein to the right-sided SVC, usually courses posterior to the thymus and directly anterior and superior to the aortic arch. A persistent left SVC, most commonly existing as part of a double SVC, represents a rare and less recognized systemic venous anomaly [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is crucial to understand this variation in upper body venous drainage in clinical practice. In this report, we present a case with a persistent left SVC identified during a regional anatomy course.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 65-year-old male cadaver with an unspecified cause of death was utilized in the regional anatomy course at Anhui Medical University. External examination revealed that the cadaver, preserved in 10% formalin, measured 170 cm in height and exhibited no signs of mechanical trauma. No other notable external abnormalities were observed. During the dissection of the thoracic cavity, it was discovered that the left BCV did not merge with the right BCV to form the right-sided SVC. Instead, the left BCV coursed anterior to the root of the left lung and along the left side of the heart. Upon examination using the inflow-outflow method, the left BCV was found to converge with the great cardiac vein and drain into the right atrium via the coronary sinus (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Further detailed measurements were conducted: the left BCV measured 12.4 cm in length, while the right BCV measured 10.8 cm. The outer lumen diameter of the left BCV was 1.3 cm at its ostium and 1.5 cm at its junction with the coronary sinus. The right BCV had an outer lumen diameter of 1.4 cm at its ostium and 2.3 cm at its entrance into the SVC. The distance was 2.8 cm between the upper edge of the aortic arch and the confluence of the left BCV with the great cardiac vein. The left venous angle was 10.1 cm from the upper end of the left atrial appendage, and the right BCV was 5.3 cm from the azygos vein. The coronary sinus exhibited a turning angle of 100 degrees, with a width of 2.5 cm at its entrance and 2.6 cm at its widest point. The length was 5.5 cm from the origin to the turning point of the coronary sinus, and its diaphragmatic surface measured 3.5 cm in length. Notably, after the left BCV and the great cardiac vein converge to form the coronary sinus, the origin of the coronary sinus was significantly enlarged, likely due to hemodynamic changes secondary to this congenital variation. Based on these findings, diagnosis of a persistent left SVC was confirmed (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). It is worth clarifying here that all instances of \u0026ldquo;left BCV\u0026rdquo; mentioned in the above descriptions and measurements actually refer to the persistent left SVC. To the best of our knowledge, the identification of a persistent left SVC during cadaver dissection has been rarely reported.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe Superior Vena Cava is a large, valveless venous trunk located on the right side of the mediastinum, formed by the confluence of the right and left brachiocephalic veins at the level of the first costal cartilage. It serves to collect and drain blood from the upper body into the right atrium. Due to complex deviations in the persistence and regression of segments of the primitive venous network, three types of SVC anomalies have been documented in the literature: persistent left SVC, interruption of the SVC, and anomalous course of the brachiocephalic veins [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Persistent left SVC, which arises from the persistence of the left anterior cardinal vein, occurs in less than 0.5% of the general population. However, its incidence increases to approximately 4% in patients with congenital heart disease [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As illustrated in the current case, it typically presents as part of a double SVC. Clinically, persistent left SVC can be indicated by a focal widening of the superior left cardiomediastinal contour adjacent to the aortic knob in conventional radiography, but it is more commonly identified when traversed by an intravenous catheter/electrode leads [\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Although the persistent left SVC typically remains insignificant in hemodynamics, it can pose challenges during catheterization of the left brachiocephalic vein via the femoral vein approach. When encountering resistance or difficulties in advancing the guidewire or catheter into the left brachiocephalic vein, clinicians should consider this anatomical variation.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003ePersistent left SVC is a very rare congenital vena cava anomaly. The identification of a persistent left SVC during our anatomical course has heightened awareness of this systemic venous variation, which holds clinical significance. By understanding this condition, doctors can let diagnoses more precise and make optimal determinants in order to improve patients\u0026rsquo; safety.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eDisclosures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Anhui Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman subjects:\u003c/strong\u003e Consent was obtained by all participants in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest:\u003c/strong\u003e In compliance with the ICMJE Form for Disclosure of Potential COI, all authors declare that there are no other relationships or activities that could influence the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This work was supported by Natural scientific research project of colleges and universities in Anhui Province (2023AH050684).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSchwier E, Schneider A, Henzler D, K\u0026ouml;hler T: Left-sided superior vena cava. Can J Anaesth. 2023 Feb;70(2):271-272. \u003c/li\u003e\n\u003cli\u003eImburgio S, Johal A, Akhlaq H, Pannu V, Udongwo N, Mararenko A, Berezovsky D, Heaton J, Singh D. Persistent Left Superior Vena Cava: An Illustrative Example. J Cardiothorac Vasc Anesth. 2023 Jul;37(7):1336-1337. \u003c/li\u003e\n\u003cli\u003eOliveira JD, Martins L. Congenital systemic venous return anomalies to the right atrium review. Insights Imaging. 2019. PMID: 31802263\u003c/li\u003e\n\u003cli\u003eMill MR, et al. Anomalous course of the left brachiocephalic vein. Ann Thorac Surg. 1993. PMID: 8452420 Review\u003c/li\u003e\n\u003cli\u003eTang PT, Chan K. Isolated Persistent Left Superior Vena Cava. N Engl J Med. 2022 Mar 3;386(9):879. doi: 10.1056/NEJMicm2113492. \u003c/li\u003e\n\u003cli\u003eS Kahkouee, M Sadr, E Pedarzadeh, S Fardin, A Borhani, S Gholami, G Amjad. Anomalous left brachiocephalic vein: important vascular anomaly concomitant with congenital anomalies and heart diseases. Folia Morphol (Warsz) 2017;76(1):51-57.\u003c/li\u003e\n\u003cli\u003eDemos TC, Posniak HV, Pierce KL, Olson MC, Muscato M (2004) Venous anomalies of the thorax. AJR Am J Roentgenol 82(5):1139\u0026ndash;1150.\u003c/li\u003e\n\u003cli\u003eMorhy Borges Leal S, et al. Anomalous subaortic course of the left brachiocephalic (innominate) vein: echocardiographic diagnosis and report of an unusual association. Cardiol Young. 2002. PMID: 12018721doi: 10.1016/j.mjafi.2020.01.009. Epub 2020 Apr 30\u003c/li\u003e\n\u003cli\u003eDave V, Sesham K, Mehra S, Roy TS, Ahuja MS. Persistent left superior vena cava: An anatomical variation. Med J Armed Forces India. 2022 Sep;78(Suppl 1):S277-S281.\u003c/li\u003e\n\u003cli\u003eFares WH, Birchard KR, Yankaskas JR. Persistent Left Superior Vena Cava Identified During Central Line Placement: A Case Report.Respir Med CME. 2011;4(3):141-143. doi: 10.1016/j.rmedc.2010.11.003\u003c/li\u003e\n\u003cli\u003ePuspitasari M, Sinorita H, Bagaswoto HP, Kuswadi I, Prasanto H, Wardhani Y, Kurniawan WT. Persistent Left Superior Vena Cava Identified After Hemodialysis Catheter Insertion: A Case Report. Int Med Case Rep J. 2020 Oct 1;13:465-469.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"persistent left superior vena cava, brachiocephalic veins, venous anomaly, congenital variation","lastPublishedDoi":"10.21203/rs.3.rs-7723772/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7723772/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003ePersistent left superior vena cava (SVC), resulting from the persistence of the left anterior cardinal vein, is most frequently observed as a component of a double SVC system. Since this venous anomaly is insignificant in hemodynamics, it is often discovered incidentally during the placement of intravenous catheters or electrode leads. Recognizing such anomalies is clinically significant, because it can help avoid diagnostic errors, suggest the potential presence of associated abnormalities, and aid in the planning of vascular interventions or surgical procedures. In this report, we present a case of persistent left SVC identified during a regional anatomy course, which will significantly enhance the understanding of this congenital variation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCategories: \u003c/strong\u003eAnatomy, Education\u003c/p\u003e","manuscriptTitle":"Persistent Left Superior Vena Cava Identified during Cadaver Dissection: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-05 06:17:49","doi":"10.21203/rs.3.rs-7723772/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"38e214ca-2859-4994-8813-856eb55f3a59","owner":[],"postedDate":"January 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-18T10:38:57+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-05 06:17:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7723772","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7723772","identity":"rs-7723772","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}