JAMA Psychiatry最新文献

{"title":"Biomedical Advances for Health Impacts of Nondisordered Drug Use.","authors":"Boris Sabirzhanov,Leonardo M Angelone,Elena Koustova","doi":"10.1001/jamapsychiatry.2025.0660","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.0660","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"11 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive Emotion Dysregulation in Opioid Use Disorder and Normalization by Mindfulness-Oriented Recovery Enhancement: A Secondary Analysis of a Randomized Clinical Trial.","authors":"Eric L Garland,Justin Hudak,Adam W Hanley,Edward Bernat,Brett Froeliger","doi":"10.1001/jamapsychiatry.2025.0569","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.0569","url":null,"abstract":"ImportanceIt remains unknown whether difficulties in positive emotion regulation (ER) drive opioid use disorder (OUD) and whether these difficulties may be remediated.ObjectiveTo test whether OUD is associated with attenuated positive ER and whether such positive emotion dysregulation may be treated by mindfulness-based intervention.Design, Setting, and ParticipantsIn this mechanistic substudy of a randomized clinical trial, patients with chronic pain who did and did not meet criteria for OUD (OUD+ and OUD-, respectively) were recruited from primary care and pain clinics in Utah from January 2016 to and January 2020 and completed a positive ER task and questionnaires. A subsample of participants at risk for opioid misuse were randomized 1:1 to 8 weeks of Mindfulness-Oriented Recovery Enhancement (MORE) or supportive group (SG) therapy and then completed the ER task at posttreatment and questionnaires through 3-month follow-up. Data were analyzed from December 2022 to June 2024.Main Outcomes and MeasuresThe primary mechanistic outcome was parietal late positive potential (LPP) and P300 amplitude during positive ER. Secondary outcomes included self-reported anhedonia, positive affect, attention to positive information, and opioid craving.ResultsThe 160 participants used opioids for a mean (SD) duration of 9.7 (8.4) years, and 98 participants (61.3%) were classified as OUD+. Mean (SD) participant age was 53.7 (11.9) years, and 102 participants (63.8%) were female. A significant group × task strategy (View, Regulate) interaction was observed during positive ER, characterized by the OUD+ group exhibiting lower LPP responses during Regulate compared to View trials relative to the OUD- group (B = 1.91; 95% CI, 0.85-2.96; P < .001). A significant group × strategy interaction was also observed for the P300 (B = 1.40; 95% CI, 0.14-2.67; P = .03). LPP blunting during positive ER mediated the association between OUD status and elevated opioid craving. In the treatment subsample (n = 62), patients treated with MORE showed greater increases in the LPP during Regulate compared with View trials than patients treated with SG (B = 1.53; 95% CI, 0.33-2.73; P = .01). Additionally, MORE improved attention to positive information (B = 1.32; 95% CI, 1.14-5.57; P = .004), positive affect (B = 4.73; 95% CI, 1.22-8.24; P = .01), and anhedonia (B = 2.94; 95% CI, 0.58-5.31; P = .02) while reducing craving (B = -10.88; 95% CI, -21.29 to -0.48; P = .04) to a greater extent than SG. Higher positive ER efficacy predicted lower craving at follow-up (B = -2.38; 95% CI, -4.55 to -0.21; P = .03).Conclusions and RelevanceOUD among patients with chronic pain is characterized by difficulties in positive ER, evident in neurophysiological markers of salience detection and emotional elaboration. In this study, training in mindfulness and savoring via MORE enhanced positive ER, which in turn reduced craving, indicating that interventions that normalize reward system function may remediate","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"25 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distinct Convergent Brain Alterations in Sleep Disorders and Sleep Deprivation","authors":"Gerion M. Reimann, Alireza Hoseini, Mihrican Koçak, Melissa Beste, Vincent Küppers, Ivana Rosenzweig, David Elmenhorst, Gabriel Natan Pires, Angela R. Laird, Peter T. Fox, Kai Spiegelhalder, Kathrin Reetz, Simon B. Eickhoff, Veronika I. Müller, Masoud Tahmasian","doi":"10.1001/jamapsychiatry.2025.0488","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.0488","url":null,"abstract":"ImportanceSleep disorders have different etiologies yet share some nocturnal and daytime symptoms, suggesting common neurobiological substrates; healthy individuals undergoing experimental sleep deprivation also report analogous daytime symptoms. However, brain similarities and differences between long-term sleep disorders and short-term sleep deprivation are unclear.ObjectiveTo investigate the shared and specific neural correlates across sleep disorders and sleep deprivation.Data SourcesPubMed, Web of Science, Embase, Scopus, and BrainMap were searched up to January 2024 to identify relevant structural and functional neuroimaging articles.Study SelectionWhole-brain neuroimaging articles reporting voxel-based group differences between patients with different sleep disorders and healthy control participants or between total or partial sleep-deprived and well-rested individuals were included.Data Extraction and SynthesisSignificant coordinates of group comparisons, their contrast direction (eg, patients < controls), and imaging modality were extracted. For each article, 2 raters independently evaluated eligibility and extracted data. Subsequently, several meta-analyses were performed with the revised activation likelihood estimation algorithm using <jats:italic>P</jats:italic> < .05 cluster-level familywise error correction.Main Outcomes and MeasuresTransdiagnostic regional brain alterations were identified across sleep disorders and among articles reporting sleep deprivation. Their associated behavioral functions and task-based or task-free connectivity patterns were explored using 2 independent datasets (BrainMap and the enhanced Nathan Kline Institute–Rockland Sample).ResultsA total of 231 articles (140 unique experiments, 3380 unique participants) were retrieved. The analysis across sleep disorders (n = 95 experiments) identified the subgenual anterior cingulate cortex (176 voxels, <jats:italic>z</jats:italic> score = 4.86), associated with reward, reasoning, and gustation, and the amygdala and hippocampus (130 voxels, <jats:italic>z</jats:italic> score = 4.00), associated with negative emotion processing, memory, and olfaction. Both clusters had positive functional connectivity with the default mode network. The right thalamus (153 voxels, <jats:italic>z</jats:italic> score = 5.21) emerged as a consistent regional alteration following sleep deprivation (n = 45 experiments). This cluster was associated with thermoregulation, action, and pain perception and showed positive functional connectivity with subcortical and (pre)motor regions. Subanalyses regarding the direction of alterations demonstrated that the subgenual anterior cingulate cortex exhibited decreased activation, connectivity, and/or volume, while the amygdala and hippocampus cluster and the thalamus cluster demonstrated increased activation, connectivity, and/or volume.Conclusions and RelevanceDistinct convergent brain abnormalities were observed between long-t","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"70 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key Considerations in Mediation Analysis for Psychiatric Research.","authors":"Zui C Narita,Mitsuhiro Miyashita,Toshi A Furukawa,Atsuhi Nishida","doi":"10.1001/jamapsychiatry.2025.0566","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.0566","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"5 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Placebo Mechanisms to Reduce Attrition in Psychiatric Trials.","authors":"Nathan T M Huneke,Samuele Cortese,Marco Solmi","doi":"10.1001/jamapsychiatry.2025.0303","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.0303","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"8 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143846431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cognitive Behavior Therapy for Mental Disorders in Adults","authors":"Pim Cuijpers, Mathias Harrer, Clara Miguel, Marketa Ciharova, Davide Papola, Djordje Basic, Cristina Botella, Ioana Cristea, Nino de Ponti, Tara Donker, Ellen Driessen, Pamela Franco, Irene Gómez-Gómez, Jessica Hamblen, Noelia Jiménez-Orenga, Eirini Karyotaki, Aaron Keshen, Jake Linardon, Emma Motrico, Minoo Matbouriahi, Olga M. Panagiotopoulou, Rory A. Pfund, Constantin Yves Plessen, Heleen Riper, Paula P. Schnurr, Marit Sijbrandij, Marieke B. J. Toffolo, Lingyao Tong, Wouter van Ballegooijen, Els van der Ven, Annemieke van Straten, Yingying Wang, Toshi A. Furukawa","doi":"10.1001/jamapsychiatry.2025.0482","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.0482","url":null,"abstract":"ImportanceCognitive behavior therapy (CBT) is a first-line treatment for most mental disorders. However, no meta-analytic study has yet integrated the results of randomized clinical trials on CBT across different disorders, using uniform methodologies and providing a complete overview of the field.ObjectiveTo examine the effect sizes of CBT for 4 anxiety disorders, 2 eating disorders, major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and psychotic and bipolar disorders on symptoms of the respective disorders using uniform methodologies for data extraction, risk of bias (RoB) assessment, and meta-analytic techniques.Data SourcesMajor bibliographical databases (PubMed, PsycINFO, and Embase for all disorders) were searched up to January 1, 2024, for each disorder separately. Data analysis was performed from August 2024 to January 2025.Study SelectionRandomized clinical trials comparing CBT with inactive control conditions in adults with 1 of the mental disorders established through a clinical interview were included.Data Extraction and SynthesisBasic characteristics of patients, CBT, and studies were extracted. RoB was assessed with the Cochrane RoB tool 2. Meta-analyses were conducted using random-effects models.Main Outcomes and MeasuresThe primary outcome was the standardized mean difference (Hedges <jats:italic>g</jats:italic>) indicating the difference between CBT and controls at posttreatment on symptoms of the respective disorders.ResultsA total of 375 trials (423 comparisons) between CBT and controls were included among 32 968 patients. The overall mean (SD) patient age was 43.4 (13.7) years, and the mean (SD) proportion of women was 0.68 (0.24). Effect sizes for CBT compared to all control conditions (<jats:italic>g</jats:italic>) were lower than 0.5 for bipolar and psychotic disorder; between 0.5 and 1.0 for panic, social anxiety, and generalized anxiety disorders, bulimia nervosa, binge eating disorders, depression, and OCD; and larger than 1.0 for PTSD and specific phobias (range of effect sizes: 0.31 for bipolar disorder to 1.27 for PTSD). Large effect sizes (<jats:italic>g</jats:italic> &amp;amp;gt; 0.94) were observed in waitlist-controlled trials, a control condition mostly used in anxiety and eating disorders, PTSD, and OCD. Trials using care as usual showed more modest effect sizes (0.22-1.13). Study dropout rates within the CBT conditions ranged from 8% for specific phobia to 24% for PTSD.Conclusions and RelevanceIn this unified series of meta-analyses, CBT was probably effective in the treatment of mental disorders, including major depression, anxiety disorders, PTSD, OCD, and eating disorders, and possibly effective in psychotic and bipolar disorders. However, the effect sizes depended on the type of control condition.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"26 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Issues in Clinical Trial Design—Lessons From the FDA’s Rejection of MDMA","authors":"Samuel T. Wilkinson, Gerard Sanacora","doi":"10.1001/jamapsychiatry.2025.0442","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.0442","url":null,"abstract":"This Viewpoint explores potential justifications underlying the US Food and Drug Administration (FDA)’s rejection of methylenedioxymethamphetamine (MDMA) as a treatment for posttraumatic stress disorder, including lack of blinding and issues around the integrity of relevant clinical trials.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"51 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Negative Effects During Placebo Treatment","authors":"Tom Bschor, Josephine Unger, Lea Nagel, Guido Schwarzer, Christopher Baethge","doi":"10.1001/jamapsychiatry.2025.0336","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.0336","url":null,"abstract":"ImportanceAnalyzing effects within placebo groups allows for transdiagnostic comparisons, as placebo is the only substance systematically studied across all major psychiatric diagnoses. Recently, the study team meta-analytically showed that improvement under placebo varies across major psychiatric diagnoses. However, comprehensive transdiagnostic comparisons of negative effects under placebo (nocebo effects) are lacking.ObjectiveTo compare premature study termination rates in placebo groups of high-quality randomized clinical trials (RCTs) across 9 major psychiatric disorders, focusing on total dropouts, dropouts due to adverse events, and dropouts due to lack of effect.Data SourcesThis analysis is part of a broader research project using a systematic approach to identifying the most recent high-quality systematic review for each diagnosis (Open-Science-Foundation preregistered: &lt;jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://osf.io/u469a/\"&gt;u469a&lt;/jats:ext-link&gt;).Study SelectionFrom these reviews, the 10 highest quality and most recent placebo-controlled RCTs were selected for each diagnosis, totaling 90 RCTs.Data Extraction and SynthesisSearches and data extraction were conducted according to the Cochrane Handbook. Pooled dropout rates (DRs) with 95% CIs were calculated.Main Outcomes and MeasuresThe primary outcome was total DR per diagnosis, determined in random-effects meta-analyses. Diagnostic differences were tested for statistical significance using &lt;jats:italic&gt;Q&lt;/jats:italic&gt; tests. Potential confounders were examined in multivariable meta-regression analyses.ResultsEighty-six of the 90 studies reported total DRs (10 056 participants). DR differed between diagnoses (&lt;jats:italic&gt;Q&lt;/jats:italic&gt; = 82.2; &lt;jats:italic&gt;df&lt;/jats:italic&gt; = 8; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001), with schizophrenia (DR, 0.41; 95% CI, 0.35-0.48), panic disorder, and mania showing the highest rates, and posttraumatic stress disorder, major depressive disorder (MDD), and attention-deficit/hyperactivity disorder (ADHD) (DR, 0.17; 95% CI, 0.11-0.25) had the lowest. Schizophrenia and mania also had the highest DR due to lack of effect, while ADHD and MDD had the lowest (&lt;jats:italic&gt;Q&lt;/jats:italic&gt; = 71.3; &lt;jats:italic&gt;df&lt;/jats:italic&gt; = 8; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). Most dropouts due to adverse events occurred in obsessive-compulsive disorder (DR, 0.07; 95% CI, 0.05-0.09) and panic disorder studies and the fewest occurred in MDD and ADHD trials (&lt;jats:italic&gt;Q&lt;/jats:italic&gt; = 32.1; &lt;jats:italic&gt;df&lt;/jats:italic&gt; = 8; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). Meta-regression revealed no additional associated factors on DRs.Conclusion and RelevanceThese findings indicate that placebo treatment is associated with adverse effects that differ among psychiatric diagnoses. The main negative effect was lack of effect, with diagnostic variations corroborating findings on positive placebo","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"26 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons Learned From Drug Decriminalization Remedies in British Columbia.","authors":"John F Kelly","doi":"10.1001/jamapsychiatry.2025.1006","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.1006","url":null,"abstract":"","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"108 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143831676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automating the Addiction Behaviors Checklist for Problematic Opioid Use Identification","authors":"Angus H. Chatham, Eli D. Bradley, Vanessa Troiani, Donielle L. Beiler, Parker Christy, Lori Schirle, Sandra Sanchez-Roige, David C. Samuels, Alvin D. Jeffery","doi":"10.1001/jamapsychiatry.2025.0424","DOIUrl":"https://doi.org/10.1001/jamapsychiatry.2025.0424","url":null,"abstract":"ImportanceIndividuals whose chronic pain is managed with opioids are at high risk of developing an opioid use disorder. Electronic health records (EHR) allow large-scale studies to identify a continuum of problematic opioid use, including opioid use disorder. Traditionally, this is done through diagnostic codes, which are often unreliable and underused.ObjectiveTo determine whether regular expressions, an interpretable natural language processing technique, could automate a validated clinical tool (Addiction Behaviors Checklist) to identify problematic opioid use.Design, Setting, and ParticipantsThis cross-sectional study reports on a retrospective cohort with data analyzed from 2021 through 2023. The approach was evaluated against a blinded, manually reviewed holdout test set and validated against an independent test set at a separate institution. The study used data from Vanderbilt University Medical Center’s Synthetic Derivative, a deidentified version of the EHR for research purposes. This cohort comprised 8063 individuals with chronic pain, defined by diagnostic codes on at least 2 days. The study team collected free-text notes, demographics, and diagnostic codes and performed an external validation with 100 individuals with chronic pain from Geisinger, recruited from an interventional pain clinic cohort.Main Outcomes and MeasuresThe primary outcome was the evaluation of the automated method in identifying patients demonstrating problematic opioid use and its comparison with manual medical record review and opioid use disorder diagnostic codes. Methods with F1 scores were evaluated (a single value that combines sensitivity and positive predictive value at a single threshold) and areas under the curve (a single value that combines sensitivity and specificity across multiple thresholds).ResultsAmong the 8063 patients in the primary site (5081 female [63%] and 2982 male [37%]; mean [SD] age, 56 [16] years) and 100 patients in the validation site (57 female [57%] and 43 male [43%]; mean [SD] age, 54 [13] years), the automated approach outperformed diagnostic codes based on F1 scores (0.73; 95% CI, 0.62-0.83 vs 0.08; 95% CI, 0.00-0.19 at the primary site and 0.70; 95% CI, 0.50-0.85 vs 0.29; 95% CI, 0.07-0.50 at the validation site) and areas under the curve (0.82; 95% CI, 0.73-0.89 vs 0.52; 95% CI, 0.50-0.55 at the primary site and 0.86; 95% CI, 0.76-0.94 vs 0.59;95% CI, 0.50-0.67 at validation site).ConclusionsThis automated data extraction technique may facilitate earlier identification of people at risk for and who are experiencing problematic opioid use, and create new opportunities for studying long-term sequelae of opioid pain management.","PeriodicalId":14800,"journal":{"name":"JAMA Psychiatry","volume":"8 2 1","pages":""},"PeriodicalIF":25.8,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143806244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}