{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T08:14:40Z","timestamp":1788250480151,"version":"build-2803163510"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005972","name":"German Cancer Aid","doi-asserted-by":"crossref","award":["personal grant from the Mildred Scheel Nachwuchszentrum Hamburg (MSNZ HaTriCS4)"],"award-info":[{"award-number":["personal grant from the Mildred Scheel Nachwuchszentrum Hamburg (MSNZ HaTriCS4)"]}],"id":[{"id":"10.13039\/501100005972","id-type":"DOI","asserted-by":"crossref"}]},{"name":"EU and the State Budget of Czechia OP JAC","award":["SALVAGE, No. CZ.02.01.01\/00\/22_008\/0004\u2009644"],"award-info":[{"award-number":["SALVAGE, No. CZ.02.01.01\/00\/22_008\/0004\u2009644"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurooncol"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Real-world longitudinal data documenting the diagnostic impact of DNA methylation array (MA) profiling in pediatric ependymoma remain sparse. We report a single-center retrospective analysis evaluating MA-driven reclassification, molecular subgroup distribution, and long-term survival outcomes in a national pediatric referral cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Sixty-three pediatric patients with a histological ependymoma diagnosis treated at Motol and Homolka University Hospital (2010\u20132025) were included. DNA methylation profiling, RNA sequencing, copy number variation and t-SNE analysis were performed. Survival was estimated by the Kaplan\u2013Meier method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      MA confirmed ependymoma in 48 patients (76.2%) and reclassified 15 (23.8%) as non-ependymoma entities, including newly described tumor types. The reclassification rate was 36.1% in the pre-2019 cohort versus 7.4% post-2019. Posterior fossa group A (PFA) ependymoma was the predominant subgroup (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200926). Ten-year overall survival (OS) was 69.6% and event-free survival (EFS) 47.7%. Gross total resection was the only factor significantly associated with improved survival (OS 75% vs. 40%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.017). Chromosome 1q gain, identified exclusively in PFA patients, was associated with a high relapse rate despite standard therapy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MA-driven reclassification affected nearly one quarter of patients, with substantially higher rates in the pre-molecular era, confirming that integrated molecular diagnosis is indispensable in all pediatric CNS tumors referred with a histological diagnosis of ependymoma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11060-026-05740-y","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:42:08Z","timestamp":1785919328000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric ependymoma in the molecular era: real-world experience with diagnostic correlation and long-term clinical outcomes"],"prefix":"10.1007","volume":"179","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0125-8014","authenticated-orcid":false,"given":"Katerina","family":"Trkova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3075-5554","authenticated-orcid":false,"given":"Ales","family":"Vicha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4988-9974","authenticated-orcid":false,"given":"David","family":"Sumerauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Ghasemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6557-895X","authenticated-orcid":false,"given":"Vijay","family":"Ramaswamy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenka","family":"Krskova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miroslav","family":"Koblizek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Zamecnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6210-6351","authenticated-orcid":false,"given":"Martin","family":"Kyncl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbora","family":"Ondrova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucie","family":"Stolova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Rybkova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6954-8687","authenticated-orcid":false,"given":"Katarina","family":"Horcicakova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7269-0392","authenticated-orcid":false,"suffix":"3rd","given":"Vladimir","family":"Benes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5446-9571","authenticated-orcid":false,"given":"Stefan","family":"Rutkowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9013-2546","authenticated-orcid":false,"given":"Michal","family":"Zapotocky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"5740_CR1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noag016","author":"DR Ghasemi","year":"2026","unstructured":"Ghasemi DR, Obrecht-Sturm D, Wallgren KM et al (2026) A brief history of ependymoma. Neuro Oncol. https:\/\/doi.org\/10.1093\/neuonc\/noag016","journal-title":"Neuro Oncol"},{"key":"5740_CR2","doi-asserted-by":"publisher","first-page":"2451","DOI":"10.1007\/s00381-021-05207-7","volume":"37","author":"ST J\u00fcnger","year":"2021","unstructured":"J\u00fcnger ST, Timmermann B, Pietsch T (2021) Pediatric ependymoma: an overview of a complex disease. Child\u2019s Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 37:2451\u20132463. https:\/\/doi.org\/10.1007\/s00381-021-05207-7","journal-title":"Child\u2019s Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg"},{"key":"5740_CR3","doi-asserted-by":"publisher","first-page":"v1","DOI":"10.1093\/neuonc\/noac202","volume":"24","author":"QT Ostrom","year":"2022","unstructured":"Ostrom QT, Price M, Neff C et al (2022) CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2015\u20132019. Neuro Oncol 24:v1\u2013v95. https:\/\/doi.org\/10.1093\/neuonc\/noac202","journal-title":"Neuro Oncol"},{"key":"5740_CR4","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/1477-5751-10-7","volume":"10","author":"DW Ellison","year":"2011","unstructured":"Ellison DW, Kocak M, Figarella-Branger D et al (2011) Histopathological grading of pediatric ependymoma: reproducibility and clinical relevance in European trial cohorts. J Negat Results Biomed 10:7. https:\/\/doi.org\/10.1186\/1477-5751-10-7","journal-title":"J Negat Results Biomed"},{"key":"5740_CR5","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1016\/j.ccell.2015.04.002","volume":"27","author":"KW Pajtler","year":"2015","unstructured":"Pajtler KW, Witt H, Sill M et al (2015) Molecular Classification of Ependymal Tumors across All CNS Compartments, Histopathological Grades, and Age Groups. Cancer Cell 27:728\u2013743. https:\/\/doi.org\/10.1016\/j.ccell.2015.04.002","journal-title":"Cancer Cell"},{"key":"5740_CR6","doi-asserted-by":"publisher","first-page":"3182","DOI":"10.1200\/JCO.2009.27.3359","volume":"28","author":"A Korshunov","year":"2010","unstructured":"Korshunov A, Witt H, Hielscher T et al (2010) Molecular staging of intracranial ependymoma in children and adults. J Clin Oncol Off J Am Soc Clin Oncol 28:3182\u20133190. https:\/\/doi.org\/10.1200\/JCO.2009.27.3359","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"5740_CR7","unstructured":"Lyon: International Agency for Research (2021) WHO Classification of Tumours Editorial Board. World Health Organization Classification of Tumours of the Central Nervous System. 5th ed"},{"key":"5740_CR8","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1007\/s00401-019-02056-2","volume":"138","author":"DR Ghasemi","year":"2019","unstructured":"Ghasemi DR, Sill M, Okonechnikov K et al (2019) MYCN amplification drives an aggressive form of spinal ependymoma. Acta Neuropathol 138:1075\u20131089. https:\/\/doi.org\/10.1007\/s00401-019-02056-2","journal-title":"Acta Neuropathol"},{"key":"5740_CR9","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1007\/s00401-023-02674-x","volume":"147","author":"LC Pohl","year":"2024","unstructured":"Pohl LC, Leitheiser M, Obrecht D et al (2024) Molecular characteristics and improved survival prediction in a cohort of 2023 ependymomas. Acta Neuropathol 147:24. https:\/\/doi.org\/10.1007\/s00401-023-02674-x","journal-title":"Acta Neuropathol"},{"key":"5740_CR10","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s40478-020-01064-8","volume":"8","author":"A Tauzi\u00e8de-Espariat","year":"2020","unstructured":"Tauzi\u00e8de-Espariat A, Pierron G, Siegfried A et al (2020) The EP300:BCOR fusion extends the genetic alteration spectrum defining the new tumoral entity of CNS tumors with BCOR internal tandem duplication. Acta Neuropathol Commun 8:178","journal-title":"Acta Neuropathol Commun"},{"key":"5740_CR11","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1016\/j.cell.2016.01.015","volume":"164","author":"D Sturm","year":"2016","unstructured":"Sturm D, Orr BA, Toprak UH et al (2016) New Brain Tumor Entities Emerge from Molecular Classification of CNS-PNETs. Cell 164:1060\u20131072. https:\/\/doi.org\/10.1016\/j.cell.2016.01.015","journal-title":"Cell"},{"key":"5740_CR12","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1007\/s00401-025-02917-z","volume":"150","author":"M-K Keck","year":"2025","unstructured":"Keck M-K, Al-Hussaini M, Amayiri N et al (2025) PLAG1 fusions define a third subtype of CNS embryonal tumor with PLAG family gene alteration. Acta Neuropathol 150:12. https:\/\/doi.org\/10.1007\/s00401-025-02917-z","journal-title":"Acta Neuropathol"},{"key":"5740_CR13","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1186\/s40478-023-01695-7","volume":"12","author":"A Tauzi\u00e8de-Espariat","year":"2024","unstructured":"Tauzi\u00e8de-Espariat A, Nicaise Y, Sievers P et al (2024) CNS tumors with PLAGL1-fusion: beyond ZFTA and YAP1 in the genetic spectrum of supratentorial ependymomas. Acta Neuropathol Commun 12:55. https:\/\/doi.org\/10.1186\/s40478-023-01695-7","journal-title":"Acta Neuropathol Commun"},{"key":"5740_CR14","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1007\/s00401-021-02356-6","volume":"142","author":"P Sievers","year":"2021","unstructured":"Sievers P, Henneken SC, Blume C et al (2021) Recurrent fusions in PLAGL1 define a distinct subset of pediatric-type supratentorial neuroepithelial tumors. Acta Neuropathol 142:827\u2013839. https:\/\/doi.org\/10.1007\/s00401-021-02356-6","journal-title":"Acta Neuropathol"},{"key":"5740_CR15","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1200\/JCO.18.01765","volume":"37","author":"TE Merchant","year":"2019","unstructured":"Merchant TE, Bendel AE, Sabin ND et al (2019) Conformal Radiation Therapy for Pediatric Ependymoma, Chemotherapy for Incompletely Resected Ependymoma, and Observation for Completely Resected, Supratentorial Ependymoma. J Clin Oncol Off J Am Soc Clin Oncol 37:974\u2013983. https:\/\/doi.org\/10.1200\/JCO.18.01765","journal-title":"J Clin Oncol Off J Am Soc Clin Oncol"},{"key":"5740_CR16","doi-asserted-by":"publisher","first-page":"887544","DOI":"10.3389\/fneur.2022.887544","volume":"13","author":"P Leblond","year":"2022","unstructured":"Leblond P, Massimino M, English M et al (2022) Toward Improved Diagnosis Accuracy and Treatment of Children, Adolescents, and Young Adults With Ependymoma: The International SIOP Ependymoma II Protocol. Front Neurol 13:887544. https:\/\/doi.org\/10.3389\/fneur.2022.887544","journal-title":"Front Neurol"},{"key":"5740_CR17","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1016\/S1470-2045(07)70208-5","volume":"8","author":"RG Grundy","year":"2007","unstructured":"Grundy RG, Wilne SA, Weston CL et al (2007) Primary postoperative chemotherapy without radiotherapy for intracranial ependymoma in children: the UKCCSG\/SIOP prospective study. Lancet Oncol 8:696\u2013705. https:\/\/doi.org\/10.1016\/S1470-2045(07)70208-5","journal-title":"Lancet Oncol"},{"key":"5740_CR18","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1038\/nature26000","volume":"555","author":"D Capper","year":"2018","unstructured":"Capper D, Jones DTW, Sill M et al (2018) DNA methylation-based classification of central nervous system tumours. Nature 555:469\u2013474. https:\/\/doi.org\/10.1038\/nature26000","journal-title":"Nature"},{"key":"5740_CR19","doi-asserted-by":"publisher","first-page":"2230","DOI":"10.1158\/2159-8290.CD-20-0963","volume":"11","author":"T Zheng","year":"2021","unstructured":"Zheng T, Ghasemi DR, Okonechnikov K et al (2021) Cross-Species Genomics Reveals Oncogenic Dependencies in ZFTA\/C11orf95 Fusion-Positive Supratentorial Ependymomas. Cancer Discov 11:2230\u20132247. https:\/\/doi.org\/10.1158\/2159-8290.CD-20-0963","journal-title":"Cancer Discov"},{"key":"5740_CR20","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.1093\/neuonc\/noad096","volume":"25","author":"AM Donson","year":"2023","unstructured":"Donson AM, Bertrand KC, Riemondy KA et al (2023) Significant increase of high-risk chromosome 1q gain and 6q loss at recurrence in posterior fossa group A ependymoma: A multicenter study. Neuro Oncol 25:1854\u20131867. https:\/\/doi.org\/10.1093\/neuonc\/noad096","journal-title":"Neuro Oncol"},{"key":"5740_CR21","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1093\/neuonc\/noab034","volume":"23","author":"LV Baroni","year":"2021","unstructured":"Baroni LV, Sundaresan L, Heled A et al (2021) Ultra high-risk PFA ependymoma is characterized by loss of chromosome 6q. Neuro Oncol 23:1360\u20131370. https:\/\/doi.org\/10.1093\/neuonc\/noab034","journal-title":"Neuro Oncol"},{"key":"5740_CR22","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1007\/s00401-020-02169-z","volume":"140","author":"ST J\u00fcnger","year":"2020","unstructured":"J\u00fcnger ST, Andreiuolo F, Mynarek M et al (2020) CDKN2A deletion in supratentorial ependymoma with RELA alteration indicates a dismal prognosis: a retrospective analysis of the HIT ependymoma trial cohort. Acta Neuropathol 140:405\u2013407. https:\/\/doi.org\/10.1007\/s00401-020-02169-z","journal-title":"Acta Neuropathol"},{"key":"5740_CR23","doi-asserted-by":"publisher","first-page":"4168","DOI":"10.1002\/cncr.31583","volume":"124","author":"R Kumar","year":"2018","unstructured":"Kumar R, Liu APY, Orr BA et al (2018) Advances in the classification of pediatric brain tumors through DNA methylation profiling: From research tool to frontline diagnostic. Cancer 124:4168\u20134180. https:\/\/doi.org\/10.1002\/cncr.31583","journal-title":"Cancer"},{"key":"5740_CR24","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1038\/nature22973","volume":"547","author":"PA Northcott","year":"2017","unstructured":"Northcott PA, Buchhalter I, Morrissy AS et al (2017) The whole-genome landscape of medulloblastoma subtypes. Nature 547:311\u2013317. https:\/\/doi.org\/10.1038\/nature22973","journal-title":"Nature"},{"key":"5740_CR25","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1007\/s00401-012-1077-2","volume":"125","author":"EC Schwalbe","year":"2013","unstructured":"Schwalbe EC, Williamson D, Lindsey JC et al (2013) DNA methylation profiling of medulloblastoma allows robust subclassification and improved outcome prediction using formalin-fixed biopsies. Acta Neuropathol 125:359\u2013371. https:\/\/doi.org\/10.1007\/s00401-012-1077-2","journal-title":"Acta Neuropathol"},{"key":"5740_CR26","doi-asserted-by":"publisher","unstructured":"Smith AA, Onar-Thomas A, Lensing S et al (2025) Phase 3 randomized trial of post-irradiation chemotherapy in patients with newly diagnosed ependymoma, a report from the Children\u2019s Oncology Group. https:\/\/doi.org\/10.1093\/neuonc\/noaf285. Neuro Oncol","DOI":"10.1093\/neuonc\/noaf285"},{"key":"5740_CR27","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1093\/neuonc\/noaf218","volume":"28","author":"K von Hoff","year":"2026","unstructured":"von Hoff K, Obrecht-Sturm D, Ghasemi DR et al (2026) Developing an advanced risk stratification model for pediatric intracranial ependymoma based on the prospective trial E-HIT2000 and subsequent registries. Neuro Oncol 28:520\u2013534. https:\/\/doi.org\/10.1093\/neuonc\/noaf218","journal-title":"Neuro Oncol"},{"key":"5740_CR28","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1007\/s00401-023-02566-0","volume":"145","author":"J Goddard","year":"2023","unstructured":"Goddard J, Castle J, Southworth E et al (2023) Molecular characterisation defines clinically-actionable heterogeneity within Group 4 medulloblastoma and improves disease risk-stratification. Acta Neuropathol 145:651\u2013666. https:\/\/doi.org\/10.1007\/s00401-023-02566-0","journal-title":"Acta Neuropathol"},{"key":"5740_CR29","doi-asserted-by":"publisher","first-page":"e70018","DOI":"10.1111\/bpa.70018","volume":"35","author":"C Hawkins","year":"2025","unstructured":"Hawkins C, Aldape K, Capper D et al (2025) cIMPACT-NOW update 10: Recommendations for defining new types for central nervous system tumor classification. Brain Pathol 35:e70018","journal-title":"Brain Pathol"},{"key":"5740_CR30","doi-asserted-by":"publisher","first-page":"e70165","DOI":"10.1002\/1545-5017.70165","volume":"73","author":"S Rutkowski","year":"2026","unstructured":"Rutkowski S, Fr\u00fchwald MC, Fleischhack G et al (2026) The HIT Network for Children and Adolescents With CNS Tumors Facilitates Improvements of Diagnostic Assessments, Multimodal Treatments, Individual Counseling, and Research in Germany, Austria, and Switzerland. Pediatr Blood Cancer 73:e70165. https:\/\/doi.org\/10.1002\/1545-5017.70165","journal-title":"Pediatr Blood Cancer"}],"container-title":["Journal of Neuro-Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-026-05740-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11060-026-05740-y","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11060-026-05740-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T07:27:05Z","timestamp":1788247625000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11060-026-05740-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["5740"],"URL":"https:\/\/doi.org\/10.1007\/s11060-026-05740-y","relation":{},"ISSN":["0167-594X","1573-7373"],"issn-type":[{"value":"0167-594X","type":"print"},{"value":"1573-7373","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"26 June 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This is an observational study. The Institutional Ethics Committee of the Motol and Homolka University Hospital has confirmed that no ethical approval is required.","order":1,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":2,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"30"}}