CNS Spectrums最新文献

{"title":"Advance directives in patients with schizophrenia.","authors":"Jacob M Appel","doi":"10.1017/S1092852924002207","DOIUrl":"10.1017/S1092852924002207","url":null,"abstract":"<p><p>Balancing autonomy and beneficence remains an ongoing challenge in the ethical treatment of patients with schizophrenia and other psychiatric disorders of thought. Psychiatric advance directives (PADs) offer one mechanism through which individuals can guide their own care, but unlike medical advance directives, they are not widely utilized in the United States. They are also highly limited by state law in the scope of their legal authority. This article explores the evidentiary basis for PADs as well as the legal and ethical issues that arise in the use of PADs in individuals with schizophrenia, arguing that providers' fears of complete opt-out from care by patients are likely unfounded and that PADs offer a powerful tool through which individuals with schizophrenia can ensure meaningful consideration of their own values and goals.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e3"},"PeriodicalIF":3.4,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review on the efficacy of GLP-1 receptor agonists in mitigating psychotropic drug-related weight gain.","authors":"Trisha Menon, Serene Lee, Xuan Yi Gong, Sabrina Wong, Gia Han Le, Angela T H Kwan, Kayla M Teopiz, Roger Ho, Bing Cao, Taeho Greg Rhee, Yang Jing Zheng, Kyle Valentino, Kangguang Lin, Maj Vinberg, Heidi K Y Lo, Roger S McIntyre","doi":"10.1017/S1092852924000531","DOIUrl":"https://doi.org/10.1017/S1092852924000531","url":null,"abstract":"<p><strong>Objective: </strong>Many psychotropic drugs are highly associated with related weight gain. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are established anti-obesity and glucose-lowering agents. Preliminary evidence also indicates they are fit for purpose in mitigating psychotropic drug-related weight gain (PDWG). This systematic review aims to synthesize the extant evidence from randomized controlled trials (RCTs) on the effects of GLP-1RAs on weight change in persons experiencing PDWG.</p><p><strong>Methods: </strong>Online databases (ie, PubMed, OVID Medline, Google Scholar) were searched to identify relevant studies from inception to January 1, 2024. Articles were screened by title, abstract, and full-text by three independent reviewers against inclusion and exclusion criteria.</p><p><strong>Results: </strong>We identified six studies with participants aged ≥18 (n=374) that were eligible for inclusion in our systematic review. Most studies reported a significant and clinically meaningful effect of GLP-1RAs on anthropometrics and/or metabolics. All RCTs replicated the finding of modest or greater effects of GLP-1RAs; the most studied agents were liraglutide and exenatide. There was insufficient literature to conduct a meta-analysis.</p><p><strong>Conclusion: </strong>Evidence suggests that GLP-1RAs are effective in mitigating weight gain in persons prescribed psychiatric medication. It is hypothesized that GLP-1RAs may moderate weight change in persons prescribed psychiatric medication through direct effects on metabolism and cognitive processes implicated in hunger/satiety. Future studies should aim to explore the long-term safety, tolerability, and efficacy profiles of various GLP-1RAs in the treatment and prevention of abnormal weight and metabolic homeostasis in psychiatric populations.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"1-7"},"PeriodicalIF":3.4,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparison between community and treatment-seeking samples of hoarding disorder.","authors":"Bárbara Perdigão Stumpf, Fábio Lopes Rocha, Leonardo F Fontenelle, Izabela Guimarães Barbosa","doi":"10.1017/S1092852924000361","DOIUrl":"https://doi.org/10.1017/S1092852924000361","url":null,"abstract":"<p><strong>Objective: </strong>Hoarding disorder studies are primarily based on persons who seek treatment and demonstrate good insight. The aim of the present study is to evaluate whether there are differences between community and treatment-seeking samples of individuals with hoarding disorder (HD).</p><p><strong>Methods: </strong>Fourteen people with HD from the community and twenty treatment-seeking people with HD were assessed by a battery of instruments to evaluate HD features and other associated characteristics.</p><p><strong>Results: </strong>Compared to the treatment-seeking sample, the HD community sample was older, had poorer insight, and had a lower prevalence of comorbid obsessive-compulsive disorder (OCD). There were no differences in gender, education, presence of psychiatric comorbidities, quality of life, and hoarding behavior characteristics between the samples. The final logistic regression model with the Dimensional Obsessive-Compulsive Scale (DOCS) as the single predictor of treatment-seeking status was statistically significant, indicating that it was able to distinguish between the two samples. The model explained between 20.7% and 27.9% of the variance of subjects, and correctly classified 67.6% of cases.</p><p><strong>Conclusions: </strong>Our results indicate that there appear to be few differences between the treatment-seeking and community samples of individuals with HD. The presence of comorbid OCD in treatment-seeking groups seems to be more frequent than in HD community samples.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"1-5"},"PeriodicalIF":3.4,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142685998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of multiple sclerosis with psychiatric disorders and homelessness among veterans in the United States Department of Veterans Affairs healthcare system.","authors":"Stephanie L Silveira, Hind Beydoun, Jack Tsai","doi":"10.1017/S1092852924002165","DOIUrl":"https://doi.org/10.1017/S1092852924002165","url":null,"abstract":"<p><strong>Objective: </strong>To describe and compare the prevalence of psychosocial and psychiatric disorders among veterans with multiple sclerosis (MS) and a propensity-score-matched group of veterans without MS, and to identify sociodemographic and clinical characteristics associated with comorbid psychosocial and psychiatric problems among veterans with MS.</p><p><strong>Methods: </strong>Data were linked and extracted from the Veterans Affairs (VA) Homeless Operations Management and Evaluation System and the Corporate Data Warehouse. The total sample comprised 27,342 veterans in the VA healthcare system between January 1, 2022, and June 30, 2023, who met eligibility criteria for an MS diagnosis (n=13,671) and 1:1 propensity-score-matched sample of veterans who did not have MS (n=13,671). MS diagnosis, substance use disorder (SUD), mental illness, and homelessness were defined using standard ICD-10 codes. Covariates included sex, age, Charlson Comorbidity Index (CCI), and VA service-connected disability rating.</p><p><strong>Results: </strong>A higher prevalence of mental illness among veterans with MS (33%) was found compared with those without MS (31%). Multivariable logistic regression models indicated MS was negatively associated with diagnoses of alcohol use disorder, stimulant use disorders, posttraumatic stress disorder, and schizophrenia/schizoaffective disorder but positively associated with diagnoses of cannabis use disorder and major depressive disorder. MS was not significantly related to homelessness. Disparities in psychosocial and psychiatric disorders among veterans with MS are described.</p><p><strong>Conclusion: </strong>This study provides novel insights regarding rates of homelessness, SUD, and mental illnesses among veterans with MS. Interdisciplinary approaches to identification and management of mental illness, SUD, and homelessness among veterans with MS are critically needed.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"1-8"},"PeriodicalIF":3.4,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The historical opposition to psychedelic research and implications for credibility in psychiatry.","authors":"Elena Koning, Elvina M Chu, Elisa Brietzke","doi":"10.1017/S1092852924002141","DOIUrl":"https://doi.org/10.1017/S1092852924002141","url":null,"abstract":"<p><p>Psychedelics are a group of psychoactive substances that alter consciousness and produce marked shifts in sensory perception, cognition, and mood. Although psychedelics have been used by indigenous communities for centuries, they have only recently been investigated as an adjunctive therapeutic tool in psychotherapy. Since the early twentieth century, psychedelic-assisted psychotherapy has been explored for the treatment of several neuropsychiatric conditions characterized by rigid thought patterns and treatment resistance. However, this rapidly emerging field of neuroscience has evolved alongside opposition in several areas, including the affiliation with mid-twentieth century counterculture movements, media sensationalization, legislative restriction, and scientific criticisms such as \"breaking the blind\" and \"excessive enthusiasm.\" This perspective article explores the historical opposition to psychedelic research and the implications for the credibility of the field. In the midst of psychedelic drug policy reform, drawing lessons from historical events will contribute to clinical research efforts in psychiatry.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"1-6"},"PeriodicalIF":3.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual release hallucinations presenting as psychosis - a scoping review.","authors":"Nicholas Bonomo, Ben Schoenbachler, Steven Lippmann","doi":"10.1017/S1092852924002281","DOIUrl":"https://doi.org/10.1017/S1092852924002281","url":null,"abstract":"<p><strong>Objective: </strong>Visual release hallucinations are perceptual disturbances that occur in individuals who have experienced vision loss. Almost 50 million people worldwide are believed to experience visual release hallucinations, yet they are profoundly underdiagnosed. Although first described within the Charles Bonnet syndrome, the paradigm underlying this syndrome precludes their consideration in many populations, such as those with underlying psychiatric illness or dementia. Consequently, visual release hallucinations have rarely been studied in patients presenting with psychosis. We conducted a scoping review to determine whether visual-release hallucinations occur in psychotic patients.</p><p><strong>Methods: </strong>The PubMed research database was searched from inception through April 2023. Cases were collected reporting on psychotic patients experiencing suspected visual release hallucinations. Individual treatment courses and responses were extracted.</p><p><strong>Results: </strong>Thirteen cases compiled from 11 different studies were summarized to provide baseline characteristics and overall trends in treatment response. Most patients did not remit from pharmacological management alone. All patients who received reafferentation therapy remitted, though many were not candidates. Almost half of the patients did not achieve remission.</p><p><strong>Conclusions: </strong>Visual release hallucinations can manifest in psychosis and may contribute to treatment-resistant psychosis among psychiatric populations. A shift in our understanding of visual release hallucinations may aid their recognition in psychotic patients by shifting the focus toward visual release features. Recognizing release features among patients with hallucinatory conditions may open new treatment avenues for managing patients with psychosis. A preliminary screening index for visual release features is provided to support this shift.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"1-7"},"PeriodicalIF":3.4,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ayahuasca: pharmacology, safety, and therapeutic effects.","authors":"Rafael Guimarães Dos Santos, Jaime Eduardo Cecilio Hallak","doi":"10.1017/S109285292400213X","DOIUrl":"10.1017/S109285292400213X","url":null,"abstract":"<p><p>Ayahuasca is a botanical hallucinogen traditionally used for therapeutic and ritual purposes by indigenous groups from Northwestern Amazonian countries such as Brazil, Peru, Colombia, and Ecuador. Ayahuasca is made by the decoction of two plants, which are rich in the 5-HT1A/2A partial agonist dimethyltryptamine or DMT (from the leaves of the <i>Psychotria viridis</i> bush) and β-carbolines such as harmine, from the stalks of the <i>Banisteriopsis caapi</i> vine. There is an increasing interest in the possible therapeutic effects of ayahuasca, especially for psychiatric disorders (major depression, posttraumatic stress disorder, and substance use disorder). This review summarizes information on the pharmacology, safety, and therapeutic potentials of ayahuasca. Although human experimental and naturalist studies published until now suggest a good safety and tolerability profile, often associated with improvements in depressive and anxious symptoms, there are few controlled studies, with small sample sizes, using only single doses, and with short follow-ups. Potential benefits of ayahuasca should be evaluated in larger samples in both experimental and observational studies and using different doses in controlled trials.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"e2"},"PeriodicalIF":3.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ketamine for the Treatment of Psychiatric Disorders: A Systematic Review and Meta-Analysis.","authors":"Angela T H Kwan, Moiz Lakhani, Gurkaran Singh, Gia Han Le, Sabrina Wong, Kayla M Teopiz, Donovan A Dev, Arshpreet Singh Manku, Gurnoor Sidhu, Roger S McIntyre","doi":"10.1017/S1092852924000580","DOIUrl":"https://doi.org/10.1017/S1092852924000580","url":null,"abstract":"<p><strong>Background: </strong>Inadequate response to first- and second-line pharmacological treatments for psychiatric disorders is commonly observed. Ketamine has demonstrated efficacy in treating adults with treatment-resistant depression (TRD), with additional off-label benefits reported for various psychiatric disorders. Herein, we performed a systematic review and meta-analysis to examine the therapeutic applications of ketamine across multiple mental disorders, excluding mood disorders.</p><p><strong>Methods: </strong>We conducted a multidatabase literature search of randomized controlled trials and open-label trials investigating the therapeutic use of ketamine in treating mental disorders. Studies utilizing the same psychological assessments for a given disorder were pooled using the generic inverse variance method to generate a pooled estimated mean difference.</p><p><strong>Results: </strong>The search in OVID (MedLine, Embase, AMED, PsychINFO, JBI EBP Database), EBSCO CINAHL Plus, Scopus, and Web of Science yielded 44 studies. Ketamine had a statistically significant effect on PTSD Checklist for DSM-5 (PCL-5) scores (pooled estimate = ‒28.07, 95% CI = [‒40.05, ‒16.11], p < 0.001), Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) scores (pooled estimate = ‒14.07, 95% CI = [‒26.24, ‒1.90], p = 0.023), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores (pooled estimate = ‒8.08, 95% CI = [‒13.64, ‒2.52], p = 0.004) in individuals with PTSD, treatment-resistant PTSD (TR-PTSD), and obsessive compulsive disorder (OCD), respectively. For alcohol use disorders and at-risk drinking, there was disproportionate reporting of decreased urge to drink, increased rate of abstinence, and longer time to relapse following ketamine treatment.</p><p><strong>Conclusions: </strong>Extant literature supports the potential use of ketamine for the treatment of PTSD, OCD, and alcohol use disorders with significant improvement of patient symptoms. However, the limited number of randomized controlled trials underscores the need to further investigate the short- and long-term benefits and risks of ketamine for the treatment of psychiatric disorders.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"1-8"},"PeriodicalIF":3.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of esketamine combined with dexmedetomidine on postoperative delirium and quality of recovery in elderly patients undergoing thoracoscopic radical lung cancer surgery: a randomized controlled trial.","authors":"Cong-Li Zhang, Yan Yan, Yang Zhang, Han-Lin Bai, Qin Zhuang, Nan-Nan Song, Chuan-Jiang Feng, Li-Juan Xie, Si-Yi Wang, Xiao-Hong Li, Di Liu, Li Ren","doi":"10.1017/S1092852924002177","DOIUrl":"https://doi.org/10.1017/S1092852924002177","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the effects of esketamine (Esk) combined with dexmedetomidine (Dex) on postoperative delirium (POD) and quality of recovery (QoR) in elderly patients undergoing thoracoscopic radical lung cancer surgery.</p><p><strong>Methods: </strong>In this prospective, randomized, and controlled study, 172 elderly patients undergoing thoracoscopic radical lung cancer surgery were divided into two groups: the Esk + Dex group (n = 86) and the Dex group a (n = 86). The primary outcome was the incidence of POD within 7 days after surgery and the overall Quality of Recovery-15 (QoR - 15) scores within 3 days after surgery. Secondary outcomes included postoperative adverse reactions, extubation time, PACU stay, and hospitalization time. Serum levels of IL-6, IL-10, S100β protein, NSE, CD3⁺, CD4⁺, and CD8⁺ were detected from T0 to T5.</p><p><strong>Results: </strong>Compared with the Dex group, the incidence of POD in the Esk + Dex group was significantly lower at 7 days after surgery (14.6% vs 30.9%; P = 0.013). The QoR - 15 score was significantly increased 3 days after surgery (P < 0.01). Levels of IL-6 and CD8⁺ were significantly decreased, and IL - 10 levels were significantly increased at T1-T2 (P < 0.05). At T1-T4, NSE levels were significantly decreased, while CD3⁺ and CD4⁺/CD8⁺ values were significantly increased (P < 0.01). At T1-T5, serum S100β protein concentration decreased significantly, and CD4⁺ value increased significantly (P < 0.01). The incidence of nausea/vomiting and hyperalgesia decreased significantly 48 hours after surgery (P < 0.01). The duration of extubation, PACU stay, and postoperative hospitalization were significantly shortened.</p><p><strong>Conclusions: </strong>Esketamine combined with dexmedetomidine can significantly reduce the POD incidence and improve the QoR in patients undergoing thoracoscopic radical lung cancer surgery, which may be related to the improvement of cellular immune function.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"1-10"},"PeriodicalIF":3.4,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing the relationship between psychosis and violence in the forensic psychiatric population: a systematic review.","authors":"Angad Singh, William Pereira, Sapriya Birk, Mark Mohan Kaggwa, John M W Bradford, Gary Chaimowitz, Andrew Toyin Olagunju","doi":"10.1017/S1092852924000488","DOIUrl":"10.1017/S1092852924000488","url":null,"abstract":"<p><strong>Objective: </strong>The relationship between psychosis and violence is often construed focusing on a narrow panel of factors; however, recent evidence suggests violence might be linked to a complex interplay of biopsychosocial factors among forensic psychiatric patients with psychosis (FPPP). This review describes violence incidents in FPPP, the factors associated with violence, and relevant implications.</p><p><strong>Methods: </strong>This review was conducted following the preferred reporting items for systematic reviews and meta-analyses guideline. Databases, including CINAHL, EMBASE, Medline/PubMed, PsycINFO, and Web of Science, were searched for eligible studies that examined violence among adult FPPP. Screening of reports and data extraction were completed by at least two independent reviewers.</p><p><strong>Results: </strong>Across the 29 included studies, violence was consistently related to prior contact with psychiatric services, active psychotic symptoms, impulsivity, adverse experiences, and low social support. However, FPPP who reported violence varied in most other biopsychosocial domains, suggesting the underlying combinatorial effects of multiple risk factors for violence rather than individual factors. Variability in violence was addressed by stratifying FPPP into subgroups using composite/aggregate of identifiable factors (including gender, onset/course of illness, system-related, and other biopsychosocial factors) to identify FPPP with similar risk profiles.</p><p><strong>Conclusions: </strong>There are multiple explanatory pathways to violence in FPPP. Recent studies identify subgroups with underlying similarities or risk profiles for violence. There is a need for future prospective studies to replicate the clinical utility of stratifying FPPP into subgroups and integrate emerging evidence using recent advancements in technology and data mining to improve risk assessment, prediction, and management.</p>","PeriodicalId":10505,"journal":{"name":"CNS Spectrums","volume":" ","pages":"1-12"},"PeriodicalIF":3.4,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}