Journal of Developmental and Behavioral Pediatrics最新文献

{"title":"Complex ADHD in a Child With Tic Disorder.","authors":"Tyler Lackey, Demvihin Ihyembe, Zachary Riemenschneider, Tamar Caceres, Johanna M Lewis-Esquerre, Jason Fogler, Elizabeth A Diekroger","doi":"10.1097/DBP.0000000000001389","DOIUrl":"10.1097/DBP.0000000000001389","url":null,"abstract":"<p><strong>Case: </strong>Jaxon is a healthy 12-year-old boy who is referred to your clinic for medication management. He was diagnosed with ADHD using a validated questionnaire at age 9 years. He is currently prescribed OROS methylphenidate 54 mg capsules once daily in the morning, which he has taken for 3 years. This has generally worked well to improve his attention, focus, task persistence, and task completion. However, his parents now report increasing disruptive behaviors over the past 18 months, both at home and at school. There have been no major stressors over this period nor significant life changes or trauma in Jaxon's history.Jaxon's teachers report that although he remains in his seat, he constantly \"squirms\" and moves about. He also makes quick, jerky movements with his hands several times each class period. They report no specific trigger or activity for when this movement occurs, but report it being more intense when Jaxon is working hard to concentrate and stay focused. His mother also reports noticing the frequency increase if Jaxon thinks he is in trouble or when he is very excited (e.g., when he is playing video games). His parents share home videos to support these concerns.His teachers report problems with attention, fidgeting, and talking out of turn. They also report that his movements distract and disrupt the class. These reports are most often from his afternoon classes. Academically, he is doing well. He turns in most of his work, but his grades have dropped this semester. His teacher reports that he seems to lack the focus to complete his assignments and he rushes through them to go to the next activity.When you talk to Jaxon, he reports that he likes school, but he does not like how often he gets into trouble. He admits he gets embarrassed during quiet time when his hands randomly \"move without me moving them.\"When observing Jaxon, you notice that he fidgets in his seat, often moving his hands over anything that is holding his attention (toys, papers). He is also verbally impulsive, interrupting the discussion with his mother multiple times during the visit. Twice, you witness a brisk single jerk of his right hand. It originates at the wrist and rotates away from his body with his hand closed. There was no accompanying vocalization with this movement.His parents are requesting a medication adjustment or change. What would you do?</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e332-e334"},"PeriodicalIF":1.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-occurring Anxiety in a Child With Autism and ADHD.","authors":"Molly Daffner-Deming, Devina Savant, Aqila Blakey-Armstrong, Robyn P Thom, Yamini Jagannath Howe, Jason Fogler, Elizabeth A Diekroger","doi":"10.1097/DBP.0000000000001388","DOIUrl":"10.1097/DBP.0000000000001388","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Case: &lt;/strong&gt;KM is an 11-year-old autistic boy followed by a developmental-behavioral pediatrician (DBP) practicing within a multidisciplinary autism center. He had been prescribed various attention-deficit hyperactivity disorder (ADHD) medications over the years, most recently dextroamphetamine-amphetamine extended-release capsule 10 mg daily.KM initially presented to the DBP for diagnostic confirmation of autism and ADHD at the age of 7 years. His school had conducted a detailed evaluation the year prior, indicating skills in the borderline range for cognitive, adaptive, and language functioning. Based on his developmental history, physical examination, review of school-based testing, and parent- and school-completed standardized questionnaires, he met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for autism spectrum disorder and ADHD with combined presentation.When KM was between the ages of 8 and 10 years, he trialed several medications, including methylphenidate (which led to emotional lability), dextroamphetamine sulfate oral solution (which caused irritability), and clonidine (which led to destructive behavior). Notably, KM's parents were divorced and had differing opinions and experiences surrounding the efficacy and tolerability of his medications, which made medication trials more complex. He eventually was stabilized on extended-release dextroamphetamine-amphetamine at the age of 9 years, which both parents agreed was helpful for improving attention, despite the medication triggering a new self-injurious behavior of punching himself.At the age of 10 years, after 1 year of stability on dextroamphetamine-amphetamine extended-release capsule 10 mg daily, his parents chose not to refill the medication, to see whether it was still helpful for him. They observed that he seemed much \"happier\" with improved mood and decreased anxiety when dextroamphetamine-amphetamine was withheld; however, they did note worsened hyperactivity. A few weeks later, he began demonstrating increased symptoms of anxiety such as somatization and externalizing behaviors. This included frustration, aggression, and oppositionality, especially in anticipation of and/or when confronting anxious stimuli.His neuropsychologist and DBP collaborated to create a behavior monitoring plan to help his parents clarify and track his symptoms across households, with the goal of monitoring symptom severity and differentiating ADHD from anxiety-related symptoms. Because of this, his parents identified hyperactivity and impulsivity as KM's most problematic symptoms; therefore, dextroamphetamine-amphetamine extended-release 10 mg daily was restarted. Although this was effective for his hyperactivity, ongoing monitoring suggested that his anxiety symptoms continued to be clinically significant. The DBP consulted a psychiatrist who advised a trial of escitalopram in conjunction with dextroamphetamine-amphetamine. Several weeks after sta","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":"e329-e331"},"PeriodicalIF":1.8,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triple Nudge for Improving ADHD Assessment: A QI Initiative Using Reminders, Workflow Changes, and EMR Integration.","authors":"Pattra Charleowsak, Therdpong Thongseiratch, Pathrada Tripidok","doi":"10.1097/DBP.0000000000001385","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001385","url":null,"abstract":"","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210091","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":"Qualitative Methods: Centering Patient Voices in Developmental and Behavioral Pediatrics Research.","authors":"Veronica I Underwood Carrasco, Jessa N Culver, Jonathan Junqua, Katharine E Zuckerman, Susanne P Martin-Herz, Jaime W Peterson","doi":"10.1097/DBP.0000000000001379","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001379","url":null,"abstract":"<p><strong>Abstract: </strong>Qualitative design can be an integral method for developmental and behavioral pediatric (DBP) researchers to understand and better comprehend participant experiences. Qualitative methods are meant to be flexible, iterative, and collaborative, allowing the research team to learn through the data collection process as they connect with and gain insight from participants, or those with lived experience of the phenomenon. Even so, guidance is unclear on how to rigorously and thoughtfully implement these methods within DBP. This article aims to use common qualitative reporting guidelines to advise early career researchers on how to use qualitative design from study conception to results dissemination through a study case example in DBP.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144585479","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 Case for Structured Data in Developmental-Behavioral Pediatrics: Project STANDARD (Structured Approach to Neurodevelopmental Care and Clinical Research Data).","authors":"William Barbaresi, Yair Bannett, Nathan J Blum, Shang Chee Chong, Justice Clark, Magdalena Dall, Jeffery N Epstein, Johannes Fellinger, Tanya E Froehlich, Johannes Hofer, Daniel Holzinger, Patty Huang, YingQi Kang, Ramkumar Aishworiya, Marie Reilly, Ann M Reynolds, Gehan Roberts, George Sideridis, Deanna Swain, Carol Weitzman","doi":"10.1097/DBP.0000000000001376","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001376","url":null,"abstract":"<p><strong>Abstract: </strong>Neurodevelopmental and behavioral problems (NBPs) such as attention-deficit hyperactivity disorder and autism spectrum disorder are highly prevalent in children and adolescents. Clinical care for NBPs is characterized by unwarranted variation, a limited number of systematic approaches to measuring outcomes and evidence-based treatments, and significant challenges to conducting large, longitudinal clinical research studies. Clinical documentation of care provided to children with NBPs can be lengthy and time-consuming, lacks standardization, and often does not include precise details about clinically and scientifically important information (e.g., diagnostic criteria, services provided, response to treatment). The lack of standardization and missing data limit the utility of clinical documentation to support clinical research and quality improvement.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175535","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":"Developmental Behavioral Clinicians' Perspectives on Education Transitions for Young Children with Developmental Disorders.","authors":"Sally S Cohen, Jennie Olson, Timothy C Guetterman","doi":"10.1097/DBP.0000000000001381","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001381","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to explore developmental behavioral clinicians' (DBP) perspectives on transitions between education programs for children age 8 and younger with developmental disabilities.</p><p><strong>Method: </strong>We used a qualitative descriptive design to systematically gather and analyze DBP clinicians' perspectives. Most of the 25 participants were members of the Society for Developmental and Behavioral Pediatrics (SDBP). Interviews were conducted between June and October, 2022. Audio recordings of the interviews were transcribed. We used MAXQDA software for thematic analysis.</p><p><strong>Results: </strong>We organized categories regarding barriers and facilitators of educational transitions according to the child and family and broader community levels and identified four major themes: (1) acknowledging that families play critical roles in education transitions; (2) communicating effectively at the intersections of the families and education and health care systems; (3) helping families navigate health and education systems and make education transitions; and (4) overcoming systems-level issue.</p><p><strong>Conclusion: </strong>Organizational and systemic barriers often impede DBP clinicians' ability to be involved with education transition activities. Education transitions often exacerbate underlying inequities in access to assessment, care, and outcomes among children with developmental disabilities from historically minoritized populations. Our data prompted us to propose a new framework that features the intersections among child and family, health care, and education teams. We found innovative ways for coordinating education transitions by cultivating relationships among children and families and professionals in health care and education systems.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210090","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":"Exploring the Genetic Role of MECP2 Mutations on Phenotypic Presentation in Males: A Case Report.","authors":"Hira Aslam, Seema Balasubramaniam, Paige McDunnah, Meghan Harrison","doi":"10.1097/DBP.0000000000001374","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001374","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to explore the genotypic and phenotypic presentation of males with MECP2-related neurodevelopmental disorders. When variants in the MECP2 gene are discovered in patients, Rett syndrome becomes a possible diagnosis. Rett syndrome, however, does not encapsulate all phenotypic variations in MECP2 gene mutations, and specific diagnosis can become tricky especially in the male population as mutations in the gene were historically thought to affect females only. The authors present a rare case of a male with a previously unpublished genetic variant resulting in a distinct clinical presentation not meeting the criteria for typical or atypical Rett syndrome.</p><p><strong>Methods: </strong>This patient's institutional electronic medical record was accessed, and information was reviewed.</p><p><strong>Results: </strong>It was discovered that this patient had a maternally inherited variant in his MECP2 gene, resulting in a unique and previously undescribed form of MECP2-related neurodevelopmental disorder, presenting with language regression followed by speech apraxia and motor discoordination.</p><p><strong>Discussion/conclusion: </strong>Literature reports on various phenotypes associated with MECP2 gene mutations and elaborates on previously identified forms of typical and atypical Rett syndrome. Through this case report, the authors uncovered a pathogenic variant in MECP2 resulting in a rare phenotype of MECP2-related neurodevelopmental disorder that has not previously been described. This should encourage clinicians to think more broadly when approaching diagnosis of children with developmental differences. This also reinforces that Rett syndrome or MECP2 mutations can often present on a spectrum, and it may be beneficial to modify diagnostic criteria to reflect this.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129309","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":"Clinical Presentation and Questions of Identity, Camouflaging, and Self-diagnosed Autism in a Nonbinary Young Adult.","authors":"Aanchal Sharma, Jason Fogler, Amanda Van Scoyoc, Randall Phelps, Marilyn Augustyn","doi":"10.1097/DBP.0000000000001375","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001375","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Case presentation: &lt;/strong&gt;Vee is a nonbinary (sex assigned at birth: female) 16-year-old 11th grader presenting for their initial multidisciplinary team assessment (including developmental-behavioral pediatrics and psychological assessment). Vee's family first became concerned about their development when they were in pre-kindergarten. The school had concerns related to autism and provided Vee with an Individualized Education Plan (IEP) for autism-related services, although a formal medical diagnosis was never made. Vee \"lost\" the autism classification and associated services when they were in the first grade and no longer qualified for an IEP. However, concerns regarding social skills and identity persist 10 years later, and Vee is now questioning whether they are on the autism spectrum. Vee has carried historical diagnoses of obsessive-compulsive disorder (OCD), anxiety, depression, attention-deficit hyperactivity disorder, and specific learning disabilities-none of these diagnoses entirely explaining or satisfying Vee's long-standing sense of neither understanding nor being understood by others. Although symptoms of OCD, including intrusive thoughts, have significantly improved with therapeutic intervention, Vee still struggles with mood and anxiety. Their anxious tendencies include hair pulling and storing the hair in boxes. They \"hate\" school and often engage in school refusal; this has notably worsened since Vee entered middle school. Upon the start of high school, Vee disclosed that they identify as nonbinary to their parents, best friends, and school counselor.Vee struggles with social interactions, especially in novel social situations, and there is a history of bullying. They have 2 best friends, who both recently moved away. Most of their friends are in the online community. Vee has always preferred independent play, loves anime and rescuing animals, and is very imaginative and artistic. Vee has an early history of lining up items, toe-walking, and sensory sensitivities to loud noises, aesthetics of rooms and clothing, and textures of clothing. Vee can be aggressive toward their mother when they are frustrated and may even punch walls. They are not aggressive with any other individuals. Her mother wonders where \"nonbinary begins and neurodiversity ends, never mind just being a teenager!\"During the course of the assessment, which included Module 4 of the Autism Diagnostic Observation Schedule, Second Edition, Vee used little to no eye contact to manage their social interactions. They spoke in a flat monotone, and their use of gestures was greatly reduced for age; their gestures were also stiff and poorly coordinated. During the course of the assessment, Vee narrated their thought process in what they characterized as their \"vocal stim\": silly voices, catch-phrases and blurted swear-words. Vee explained how they use their vocal stim at different times to discharge nervous energy, entertain friends, and cope with challenging ","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121134","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":"Perceived Barriers to Medication Adherence in Adolescents and Young Adults with Attention-Deficit Hyperactivity Disorder: Adapting the Customized Adherence Enhancement Intervention.","authors":"Emma Church, Salayna Abdallah, Kelly Kamimura-Nishimura, Jennifer B Levin, Amarpreet Chela, Molly McVoy","doi":"10.1097/DBP.0000000000001377","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001377","url":null,"abstract":"<p><strong>Objective: </strong>Although the recommended first-line treatment for attention-deficit hyperactivity disorder (ADHD) is medication, poor adherence is still common, particularly in adolescents and young adults (AYAs). This study aimed to adapt Customized Adherence Enhancement (CAE), a psychosocial intervention developed to improve medication adherence in bipolar disorder, to target AYAs with ADHD.</p><p><strong>Methods: </strong>Phase 1 included focus groups with AYAs, caregivers, and health care providers who treat AYAs with ADHD (N = 19). Prompts included barriers and facilitators of medication adherence, impact of ADHD, and reasons treatment regimens may be difficult to maintain. Focus groups were recorded, transcribed, and thematically coded. Phase 2 included cognitive interviews with AYAs with ADHD to assess acceptability and usability of the intervention (N = 6).</p><p><strong>Results: </strong>Main themes were AYAs' perception of ADHD and its negative impact on work, sports performance, and interpersonal relationships. Barriers of adhering to medication were limited access, physiological side effects, difficulty following medication routines, and having comorbidities. Facilitators to medication adherence were having more knowledge about ADHD, benefits from medication adherence, and using external prompts.</p><p><strong>Conclusion: </strong>As untreated or undertreated ADHD negatively affects morbidity and functioning, intervening early and at a critical stage of development has the potential to change the long-term outcomes of AYAs with ADHD. Results informed the adaptation of an existing intervention (CAE) to target AYAs with ADHD and can be applied to adherence interventions more broadly.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121164","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":"Disparity in Internet Access Among Parents with Disabilities in the United States.","authors":"Frank S Li, Sarah Davidson, Zachary Williams, Miriam Heyman, Luci Swinford, J Dalton Stevens, Monika Mitra","doi":"10.1097/DBP.0000000000001371","DOIUrl":"https://doi.org/10.1097/DBP.0000000000001371","url":null,"abstract":"<p><strong>Objective: </strong>Internet access is critical for reaching most modern-day resources and systems. Yet many do not have consistent access, including people with disabilities. This can have an outsized impact on children, which COVID-19 lockdowns revealed in 2020 to 2021. However, internet access for parents with disabilities and their children is not well-studied. This study aims to fill that gap.</p><p><strong>Methods: </strong>We used 2018 to 2022 American Community Survey data. Parents are defined as adults with a co-residing minor for whom they are presumed responsible, and are classified as with or without disabilities. Outcomes include presence of any home internet access and home high-speed internet access, and were analyzed by the presence of disability and type of disability.</p><p><strong>Results: </strong>Results from modified Poisson regression analysis reveals that disabled parents are 1.79 times as likely as nondisabled parents to not have any home internet access (p < 0.001) and 1.40 times as likely to not have home high-speed internet access (p < 0.001). Adjustment for sociodemographic factors somewhat alleviated these disparities, but even after controlling for urbanicity, poverty, program participation, and family employment status, statistically significant disparities remained for most disability subtypes. Parents with hearing disabilities were most likely to lack home internet access.</p><p><strong>Conclusion: </strong>Among US parents, disability status is associated with lacking any home internet access and lacking home high-speed internet access. Given the importance of internet access in nearly all aspects of modern society for children and families, continued and increased support for programs that assist parents with disabilities may be an avenue for improving access.</p>","PeriodicalId":50215,"journal":{"name":"Journal of Developmental and Behavioral Pediatrics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048000","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}