Schizophrenia Bulletin最新文献

{"title":"Trends in Antipsychotic Polypharmacy and Potential Overtreatment with Antipsychotics: A Naturalistic Cohort Study of People in Long-term Care","authors":"Stijn Crutzen, Shiral Gangadin, Ken Ho Hua, Ellen Visser, Frederike Jörg, Lisette van der Meer, Gerdina Hendrika Maria Pijnenborg, Wim Veling, Stynke Castelein","doi":"10.1093/schbul/sbaf041","DOIUrl":"https://doi.org/10.1093/schbul/sbaf041","url":null,"abstract":"Background Due to the side effects of antipsychotics, overtreatment is an important concern. Previous research focused on antipsychotic polypharmacy and excessively high doses. In this study, the aim is to map changes over the years in potential overtreatment, antipsychotic polypharmacy, total antipsychotic dose, and subjective side effect burden. Moreover, the association of the total dose and antipsychotic polypharmacy with the subjective side effect burden will be investigated. Study design Data from a naturalistic longitudinal cohort were used (PHAMOUS, 2013–2021). Potential overtreatment was defined as a antipsychotic dose equivalent to > 5 mg risperidone or antipsychotic polypharmacy, in combination with a high subjective side effect burden. Mixed effect models were used to investigate trends in potential overtreatment, antipsychotic polypharmacy, total antipsychotic dose, and subjective side effect burden and to assess the association of total dose and antipsychotic polypharmacy with subjective side effect burden. Study results Overall, 15,717 observations nested in 5,107 participants were used. One-third of the participants were potentially overtreated, which did not change over time. The prevalence of a dose above the equivalent of 5 mg risperidone decreased, antipsychotic polypharmacy prevalence increased, and the subjective side effect burden decreased. A higher dose and antipsychotic polypharmacy were associated with higher subjective side effect burden. Conclusion Potentially overtreated patients should be revaluated to assess whether changes are needed. To assess whether a patient is truly overtreated, their clinical history, number of relapses, patients’ preferences, overall functioning, previous attempts to reduce antipsychotic treatment, and previous severity of disease should be taken into account.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"25 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915352","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":"Outside My Comfort Zone.","authors":"Jason Jepson","doi":"10.1093/schbul/sbaf039","DOIUrl":"https://doi.org/10.1093/schbul/sbaf039","url":null,"abstract":"","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043967","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":"Latent Trajectories of Positive, Negative Symptoms and Functioning in Early Intervention Services for First-Episode Psychosis: A 2-Year Follow-Up Study","authors":"Olivier Percie du Sert, Joshua Unrau, Manish Dama, Lena Palaniyappan, Jai Shah, Ridha Joober, Delphine Raucher-Chéné, Ashok Malla, Martin Lepage","doi":"10.1093/schbul/sbaf045","DOIUrl":"https://doi.org/10.1093/schbul/sbaf045","url":null,"abstract":"Background From the first episode (FEP), the course of psychosis is marked by substantial heterogeneity of clinical and functional outcomes which poses significant challenges in providing prognostic guidance to patients and families. To better understand such heterogeneity within the context of early intervention services (EIS), this study aimed to examine latent trajectories of positive and negative symptoms and functioning among FEP individuals undergoing EIS. Study Design The Prevention and Early Intervention Program for Psychoses (PEPP-Montreal) is a 2-year EIS for FEP that conducted longitudinal assessments of 689 individuals aged 14-35, including sociodemographics, cognition, psychopathology, and functioning. Latent growth mixture modeling was used to identify distinct patterns of clinical and functional trajectories. The inter-relationship between trajectories, and the association of trajectory membership with baseline characteristics and distal outcomes were investigated using the manual 3-step approach. Study Results Two positive symptom trajectories (Stable-low—32%, Fluctuating—68%,), 3 negative symptom trajectories (Decreasing—41%, Fluctuating—15%, and Stable-high—44%), and 2 functioning trajectories (Increasing—57%, Stable-moderate—43%) were identified. Early treatment response, particularly on negative symptoms, consistently and strongly predicted better outcome trajectories (OR = [3.4-5.5]). Trajectories of higher symptom severity were associated with trajectory of worse functioning (RR = [1.5-2.2]), which exhibited lower rates of clinical and functional remission. Conclusion These findings offer insights into clinically meaningful subgroups of individuals that could inform the prognosis of FEP and the development of individually tailored EIS. Individuals who do not show early improvement in negative symptoms may benefit from earlier psychosocial interventions specifically targeting actionable factors that contribute to secondary negative symptoms.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"271 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143910151","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":"Ecological Momentary Assessment of Emotion Regulation and Suicidal Ideation in First-Episode Psychosis","authors":"Heather M Wastler, Henry R Cowan, Nicholas J K Breitborde, Jeffrey V Tabares, Mengda Yu, Xueliang Pan, Bethany Boettner, Christopher Browning, Craig J Bryan","doi":"10.1093/schbul/sbaf042","DOIUrl":"https://doi.org/10.1093/schbul/sbaf042","url":null,"abstract":"Individuals with first-episode psychosis (FEP) are at increased risk for suicide, though few studies have examined the extent to which emotion regulation abnormalities contribute to this risk. The current study sought to address this gap by examining which stages of emotion regulation (ie, identification, selection, implementation) are related to suicidal ideation among individuals with FEP. Forty-one participants completed 28 days of ecological momentary assessment to assess suicidal ideation, negative affect, and emotion regulation in real-time. Results indicated that all 3 stages of emotion regulation were related to suicidal ideation in FEP. Specifically, within-person emotion regulation interacted with between-person negative affect to predict concurrent suicidal ideation (identification stage). Additionally, decreased use of adaptive strategies and increased use of maladaptive strategies were associated with more severe suicidal ideation (selection stage). Finally, decreased emotion regulation effectiveness was associated with more severe suicidal ideation (implementation stage). These findings suggest that emotion regulation difficulties might contribute to the high rates of suicide risk among individuals with FEP. Additional research is needed to determine whether these emotion regulation difficulties are unique to FEP or if they also appear in other high-risk groups.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"35 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884848","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":"Deciphering the Heterogeneity of Schizophrenia: A Multimodal and Multivariate Neuroimaging Framework for Unveiling Brain-Symptom Relationships and Underlying Subtypes","authors":"Luli Wei, Wei Liu, Xin Li, Yu Zhang, Yun Luo, Yingying Xie, Liyuan Lin, Zhongyu Chang, Xiaotong Du, Xiaotong Wei, Yi Ji, Zhen Zhao, Meng Liang, Hao Ding, Liping Liu, Xijin Wang, Lina Wang, Hongjun Tian, Gang Wang, Bin Zhang, Juanjuan Ren, Chen Zhang, Chunshui Yu, Wen Qin","doi":"10.1093/schbul/sbaf037","DOIUrl":"https://doi.org/10.1093/schbul/sbaf037","url":null,"abstract":"Background and Hypothesis Schizophrenia manifests large heterogeneities in either symptoms or brain abnormalities. However, the neurobiological basis of symptomatic diversity remains poorly understood. We hypothesized that schizophrenia’s diverse symptoms arise from the interplay of structural and functional alterations across multiple brain regions, rather than isolated abnormalities in a single area. Study Design A total of 495 schizophrenia patients and 507 healthy controls from 8 sites were recruited. Five symptomatic dimensions of schizophrenia patients were derived from the Positive and Negative Syndrome Scale. Multivariate canonical correlation analysis was introduced to identify symptom-related multimodal magnetic resonance imaging composite indicators (MRICIs) derived from gray matter volume, functional connectivity strength, and white matter fractional anisotropy. The intergroup differences in MRICIs were compared, and the paired-wise correlations between symptom dimensions and MRICIs were resolved. Finally, K-means clustering was used to identify the underlying biological subtypes of schizophrenia based on MRICIs. Study Results Canonical correlation analysis identified 15 MRICIs in schizophrenia that were specifically contributed by the neuroimaging measures of multiple regions, respectively. These MRICIs can effectively characterize the complexity of symptoms, showing correlations within and across symptom dimensions, and were consistent across both first-episode and chronic patients. Additionally, some of these indicators could moderately differentiate schizophrenia patients from healthy controls. K-means clustering identified 2 schizophrenia subtypes with distinct MRICI profiles and symptom severity. Conclusions Symptom-guided multimodal and multivariate MRICIs could decode the symptom heterogeneity of schizophrenia patients and might be considered as potential biomarkers for schizophrenia.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"37 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884886","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":"Disturbed Functional Connectivity Between Anterior Default Mode and Sensory Processing Regions Is Linked to Peripheral Inflammatory Markers and Psychopathology in Schizophrenia","authors":"Emanuel Mlynek, Xiaolin Tan, Sarah Edith Lammertz, Sabrina Schaffrath, Gerhard Gründer, Frank Schneider, Thomas Frodl, Klaus Mathiak, Arnim Johannes Gaebler","doi":"10.1093/schbul/sbaf048","DOIUrl":"https://doi.org/10.1093/schbul/sbaf048","url":null,"abstract":"Background and Hypothesis Both elevated inflammatory markers and aberrant functional connectivity have been detected in patients with schizophrenia, but there is limited knowledge on the relationship between the two phenomena. Some positive symptoms may arise from external misattribution of self-generated actions mediated by decoupling of the default mode network (DMN) with sensory processing regions. Since the anterior DMN also exhibits bidirectional interaction with the immune system, we hypothesized its decoupling would be associated with elevated inflammatory markers as well as the burden of positive symptomatology. Study Design Resting-state functional magnetic resonance imaging, diffusion tensor imaging (DTI), clinical and laboratory data (serum concentrations of interleukin-6 and C-reactive protein) were collected within a neuroimaging trial on schizophrenia. Neuroimaging data were assessed applying seed-to-voxel and region-of-interest-to-region-of-interest functional connectivity analyses as well as DTI tractography. Associations between neuroimaging and laboratory as well as behavioral data were studied employing regression analyses. Study Results For both inflammatory markers, a consistent pattern of hypo-connectivity emerged between the anterior DMN and different brain regions involved in sensory processing and self-monitoring. The strongest association was detected for the connectivity between the anterior DMN and the right parietal operculum which was not explained by the structural integrity of the respective white matter tract. Finally, this functional connection was correlated both with the burden of positive and negative symptoms. Conclusions Our findings reveal a mechanistically plausible neurobiological link between inflammation and psychopathology in schizophrenia.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"13 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866186","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":"Abdominal Ultrasound Stimulation Alleviates Negative Symptoms Through Modulation of Serotonin Signaling and Gut Microbiota in the MK-801 Model of Schizophrenia","authors":"Feng-Yi Yang, Yi-Ju Pan, Yin-Ting Zheng, Shih-Jen Tsai","doi":"10.1093/schbul/sbaf031","DOIUrl":"https://doi.org/10.1093/schbul/sbaf031","url":null,"abstract":"Background and Hypothesis Abdominal low-intensity pulsed ultrasound (LIPUS) stimulation has potential as a novel therapeutic strategy against neuroinflammation via inhibition of inflammatory responses in the colon. This study aimed to evaluate whether abdominal LIPUS could alleviate MK-801-induced schizophrenia-like negative symptoms through gut–brain communication. Study Design Rats administered with MK-801 were treated daily for 5 days with either LIPUS or Lactobacillus plantarum PS128, while another group of MK-801-administered rats received no treatment. Following LIPUS or PS128 treatment, rats underwent behavioral testing, western blot analysis, and histological examination. Changes in the gut bacteria composition were examined through 16S rRNA sequencing analysis. Study Results MK-801 administration reduced NMDAR1 and VGAT expression in the medial prefrontal cortex (mPFC) of rats, leading to an imbalance in the excitation/inhibition (E/I) ratio. It also decreased 5-HT1AR and 5-HT2AR density, resulting in reduced concentrations of dopamine and serotonin (5-HT). This induced prepulse inhibition, anhedonia, and social withdrawal behaviors, accompanied by a reduction in gut microbiota diversity. Abdominal LIPUS stimulation effectively lessened the MK-801-induced reduction in gut microbiota diversity, restored NMDAR1, 5-HT1AR, and 5-HT2AR density, enhanced dopaminergic neuron activity, and increased dopamine and 5-HT release in the mPFC, thereby reversing behavioral abnormalities. Conclusions These results suggest that abdominal LIPUS alleviates MK-801-induced schizophrenia-like negative symptoms by modulating serotonin signaling and the gut microbiota.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"56 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143851072","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":"Insight and Its Trajectory: Predicting the Risk of Psychiatric Hospitalizations Among First-Episode Psychosis During the First Year of Coordinated Specialty Care","authors":"Hadar Hazan, Maria Ferrara, Toni Gibbs-Dean, Sümeyra N Tayfur, Silvia Corbera, Sneha Karmani, Zhiqian Song, Fangyong Li, Ilias Vlachos, Mirjana Selakovic, Cenk Tek, Vinod H Srihari","doi":"10.1093/schbul/sbaf019","DOIUrl":"https://doi.org/10.1093/schbul/sbaf019","url":null,"abstract":"Background This study explored how baseline insight predicts psychiatric hospitalization risk among 186 individuals with first-episode psychosis in coordinated specialty care (CSC). We hypothesized that insight, a potentially modifiable factor, moderates the relationship between CSC enrollment and outcomes, with a high baseline and stable high insight predicting greater reductions in hospitalizations and lengths of stay (LOS). Design Insight was assessed using the G12 item of the positive and negative syndrome scale, categorizing participants into low (G12 ≥ 4; n = 87) or high (G12 < 4; n = 99) insight groups at baseline. Six longitudinal trajectories were identified: stable high (n = 48), increasing (n = 41), declining (n = 31), stable low (n = 27), high-low-high (n = 20), and low-high-low (n = 19). Hospitalization data were collected for 12 months pre- and post-CSC enrollment. Results Participants with high baseline insight demonstrated a 95% greater relative reduction in hospitalizations (relative risk reduction = 1.95, P = .002), indicating that insight moderated the relationship between CSC enrollment and hospitalization outcomes. Longitudinally, the stable high insight group exhibited the most substantial reductions in hospitalizations (risk ratio [RR] = 0.12, P < .001) and LOS (RR = 0.04, P < .001), outperforming the stable low and fluctuating insight groups. Conclusion Insight moderates the relationship between CSC enrollment and hospitalization outcomes, predicting clinical improvements in early psychosis. Interventions targeting insight may enhance CSC benefits by reducing hospitalizations and improving recovery trajectories.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"26 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143832432","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":"The Retinal Age Gap as a Marker of Accelerated Aging in the Early Course of Schizophrenia","authors":"Paweł Krukow, Adam Domagała, Adam Kiersztyn, Brittany A Blose, Adriann Lai, Steven M Silverstein","doi":"10.1093/schbul/sbaf038","DOIUrl":"https://doi.org/10.1093/schbul/sbaf038","url":null,"abstract":"Background and Hypothesis Given the available findings confirming accelerated brain aging in schizophrenia (SZ), we conducted a study aimed at verifying whether quantitative retinal morphological data enable age prediction and whether schizophrenia patients present with a positive retinal age gap (RAG). Study Design Two samples of patients and controls were enrolled: one included 59 SZ patients and 60 controls, all of whom underwent optical coherence tomography (OCT) enabling the measurement of 72 variables. A second sample of 65 SZ patients and 70 controls was then combined with the first sample, to generate a database where each subject was represented by 28 morphological variables. Four different machine learning (ML) algorithms were used for age prediction based on z-standardized OCT data. The associations between RAG, demographic, and clinical data were also analyzed. Study Results Patients from both samples had significantly higher retinal age and positive RAG ranging between 5.88 and 7.44 years depending on the specific sample. Predictions based on the larger group but with fewer OCT variables exhibited higher prediction relative error. All ML algorithms generated similar outcomes regarding retinal age. RAG correlated with the dose of antipsychotic medication and the severity of symptoms. Correlations with chronological age showed that RAG was the highest in younger patients, and from the age of about 45 years, it decreased. Conclusions ML-based results corroborated accelerated retinal aging in schizophrenia and showed its associations with pharmacological treatment and syndrome severity. The finding of a larger RAG in younger patients is novel and requires replication.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"3 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143832433","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":"Combining the Risk: The Poly-Environmental Risk Score and Psychotic Symptoms in Adolescents","authors":"Diandra C Bouter, Susan J Ravensbergen, Nita G M de Neve-Enthoven, Sibel Ercan, Benno Bakker, Mark H de Jong, Witte J G Hoogendijk, Nina H Grootendorst-van Mil","doi":"10.1093/schbul/sbaf046","DOIUrl":"https://doi.org/10.1093/schbul/sbaf046","url":null,"abstract":"Background and Hypothesis Psychotic symptoms are common in adolescents and predictive of psychiatric disorders. Numerous risk factors have been shown to precede psychiatric disorders. However, investigating individual risk factors does not account for the cumulative effect these risk factors may have. Therefore, we combined well-researched environmental risk factors for psychotic disorder in a composite measure: the poly-environmental risk score (PERS). Study Design Risk factors were assessed in a cohort of 801 adolescents (aged 15) at risk for psychopathology. Binarized risk factors included winter birth, low gestational age, low birth weight, ethnic minority status, urban living environment, cannabis use, victim of bullying, emotional abuse, physical abuse, sexual abuse, high paternal age, parental severe mental illness, parental divorce, and parental death. The PERS was weighted with the log odds derived from recent meta-analyses. At age 18, self-reported psychotic experiences (PE) and clinician-rated psychotic symptoms (PS) were assessed. This updated PERS was compared to previous PERS models, which included fewer risk factors and different weightings. Study Results The PERS was associated with PE and PS. Specifically, a PERS between 3 and 4, and PERS > 4 corresponded with a 2.2- and 5.2-fold increase in the odds of psychotic symptoms in late adolescence. The updated 14-item PERS performed better compared to previous compositions of the PERS. Conclusions A composite score of childhood and adolescent risk factors measured at age 15 was associated with psychotic symptoms at age 18. Future research should consider the cumulative effect of risk factors when examining the determinants of psychopathology.","PeriodicalId":21530,"journal":{"name":"Schizophrenia Bulletin","volume":"3 1","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143832132","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}