Journal of Clinical Psychiatry最新文献

{"title":"Incidence and Risk Factors for Suicide Attempt During Pregnancy and the Postpartum Period.","authors":"Sidra Goldman-Mellor, Mark Olfson, Alison Gemmill, Claire Margerison","doi":"10.4088/JCP.24m15633","DOIUrl":"https://doi.org/10.4088/JCP.24m15633","url":null,"abstract":"<p><p></p><p><p><b>Background:</b> In the United States, suicide accounts for 1 out of every 20 deaths that occur during pregnancy and the first 12 months postpartum. Although nonfatal suicide attempts are the strongest known predictor of death by suicide, there are no prior population based estimates of the incidence of and clinical risk factors for pregnancy associated suicide attempts.</p><p><p><b>Methods:</b> This retrospective cohort study used statewide, all-payer, longitudinally linked hospital and emergency department (ED) patient records from California. Participants included all California residents with an index hospital delivery of a live infant between 2010 and 2020. Outcomes included ED presentation for nonfatal suicide attempt during pregnancy or up to 12 months postpartum. Clinical risk factors of interest included healthcare utilization patterns during pregnancy and behavioral health diagnoses recorded at index delivery.</p><p><p><b>Results:</b> Among delivering patients with an index delivery (N = 3,737,792), 0.13% (n = 4,968) had a suicide attempt during pregnancy or the postpartum period. After adjusting for background demographic characteristics, risks of a postpartum suicide attempt were increased 4- to 30-fold by several clinical factors, including prenatal suicide attempt ED visits, psychiatric ED visits, and assault ED visits, and by psychotic disorders, bipolar disorder, alcohol use disorder, recurrent and single-episode major depressive disorder, and anxiety disorders recorded at delivery.</p><p><p><b>Conclusions:</b> Risks of postpartum suicide attempt were substantially elevated for patients who had behavioral health related ED visits during pregnancy and by several psychiatric disorders at delivery. Clinical consideration should be given to monitoring these patients for suicide attempt risk.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plasma NfL, P-tau181, and P-tau181/Aβ42 Ratio in Predicting Mild Behavioral Impairment in Dementia-Free Multiethnic Asian Older Adults With Mixed Pathology in a 5-Year Clinical Cohort.","authors":"Yingqi Liao, Joyce R Chong, Cheuk Ni Kan, Xuhao Zhao, Yuek Ling Chai, Saima Hilal, Mitchell K P Lai, Christopher P Chen, Xin Xu","doi":"10.4088/JCP.24m15558","DOIUrl":"https://doi.org/10.4088/JCP.24m15558","url":null,"abstract":"<p><p><b>Objective:</b> The underlying mechanisms of mild behavioral impairment (MBI), a marker for cognitive impairment and dementia, have remained unclear especially in a multiethnic Asian population. The study aimed to examine whether baseline Alzheimer disease biomarkers, including plasma neurofilament light (NfL) chain, phosphorylated tau-181 (p-tau181), and the p-tau181-to-amyloid-β42 (p-tau181/Aβ42) ratio, could predict MBI incidence in dementia-free Asian older adults.</p><p><p><b>Methods:</b> Participants were recruited from the community and memory clinics from August 2010 to April 2022. All participants underwent cognitive, neuropsychiatric, and clinical assessments annually and neuroimaging scans biennially at baseline and over a maximum of 5 years. Neuropsychiatric symptoms (NPS) and incident MBI were examined using Neuropsychiatric Inventory. Plasma NfL, p-tau181, and Aβ42 were measured using single molecule array assays. Neuroimaging measures of hippocampal volume (HV) and white matter hyperintensities (WMH) were obtained.</p><p><p><b>Results:</b> A total of 305 dementia-free participants were included (age 72.1 ± 7.8 years, 52.5% female, 27.9% no cognitive impairment). Among 248 MBI-free participants at baseline, 55 (25.3%) participants developed incident MBI in 5 years. Higher baseline p-tau181, p-tau181/Aβ42 ratio, and NfL were predictive of increased NPS severity longitudinally and MBI incidence (<i>P</i> < .05). Higher p-tau181 levels (hazard ratio [HR] [95% CI], 2.40 [1.00-5.75], <i>P</i> = .05) were independently associated with an increased likelihood of incident MBI after accounting for incident dementia and plasma NfL. This relationship remained significant when controlling for HV and WMH (HR [95% CI], 2.69 [1.08-6.70], <i>P</i> = .03).</p><p><p><b>Conclusions:</b> Our findings highlighted the relationship between amyloid burden and neuroaxonal degeneration with neurobehavioral changes in multiethnic Asian older adults with underlying mixed pathology.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A New Tool to Refine Lithium Therapy: A Simple Formula for a Complex Problem.","authors":"Gin S Malhi, Erica Bell, Kinga Szymaniak","doi":"10.4088/JCP.24com15743","DOIUrl":"https://doi.org/10.4088/JCP.24com15743","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Results From a Long-Term Observational Follow-Up Study of a Single Dose of Psilocybin for a Treatment-Resistant Episode of Major Depressive Disorder.","authors":"Guy M Goodwin, Ania Nowakowska, Merve Atli, Boadie W Dunlop, David Feifel, David J Hellerstein, Lindsey Marwood, Zainib Shabir, Sunil Mistry, Susan C Stansfield, Emma Teoh, Joyce Tsai, Matthew B Young, Ekaterina Malievskaia","doi":"10.4088/JCP.24m15449","DOIUrl":"https://doi.org/10.4088/JCP.24m15449","url":null,"abstract":"<p><p><b>Background:</b> The largest randomized study of psilocybin to date demonstrated the efficacy of COMP360 25 mg (Compass Pathways' investigational proprietary pharmaceutical-grade synthesized psilocybin formulation) in participants with treatment-resistant depression (COMP 001), compared with 10 mg and 1 mg doses. Here, we report findings from COMP 004, a 52-week observational follow-up of patients from COMP 001 and COMP 003, a small open-label study of the coadministration of 25 mg COMP360 with continuing antidepressant treatment.</p><p><p><b>Methods:</b> Adverse events (AEs) were collected over the full 52-week period. The primary efficacy endpoint was time to a prespecified depressive event over the 52 weeks following COMP360 administration in COMP 001 participants, presented as Kaplan-Meier estimates. A post hoc analysis included only participants that entered COMP 004. Data were collected from July 2020 to July 2022.</p><p><p><b>Results:</b> Sixty-six participants entered COMP 004 (COMP 001, n = 58 [25 mg group n = 22, 10 mg group n = 19, 1 mg group n = 17]; COMP 003, n = 8). Few AEs were reported post-entry into COMP 004, with 1 AE of mild suicidal ideation in the 1 mg group deemed possibly related to study drug. For all COMP 001 patients (n = 233), median time to depressive event was greater for the 25 mg group (92 days) compared to the 10 mg (83 days) and 1 mg (62 days) groups, with the majority of participants having had a depressive event by Week 12 (25 mg n = 37/75, 10 mg n = 38/79, 1 mg n = 44/75). The post hoc supplementary analysis of those who enrolled in COMP 004 from COMP 001 exhibited the difference between groups more strikingly (25 mg, 189 days; 10 mg, 43 days; 1 mg, 21 days); however, only 10 participants experienced a depressive event post-COMP 004 enrollment (25 mg n = 6, 10 mg n = 3, 1 mg n = 1) from COMP 001 and none from COMP 003. At COMP 004 entry, the 1 mg group had the highest number of participants on antidepressant medication (n = 10; 10 mg, n = 9; 25 mg, n = 6) and generally initiated treatment earlier.</p><p><p><b>Conclusion:</b> Over 52 weeks, a single administration of 25 mg psilocybin suggested longer maintenance of antidepressant effect than both 1 mg and 10 mg. Larger long-term studies are required to confirm these findings and provide clarity on the longer-term effects of psilocybin.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT04519957.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Back to the Office: The Room Where It Happens?","authors":"John C Markowitz, Barbara Milrod, Timothy G Heckman, Maja Bergman, Doron Amsalem, Yuval Neria","doi":"10.4088/JCP.24com15710","DOIUrl":"https://doi.org/10.4088/JCP.24com15710","url":null,"abstract":"<p><p></p><p><p></p><p><p></p><p><p></p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 2","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Estimating the 12-Hour Serum Lithium Level (eLi₁₂): Development and Two Proof-of-Concept Studies.","authors":"Ole Köhler-Forsberg, Anne Christine Wiuff, Torben A Devantier, Søren D Østergaard, Stephen V Faraone, Andrew A Nierenberg","doi":"10.4088/JCP.24m15547","DOIUrl":"https://doi.org/10.4088/JCP.24m15547","url":null,"abstract":"<p><p><b>Objective:</b> Most serum lithium (se-Li) tests do not comply with the required timing (12 hours after lithium intake). We aimed to develop an equation estimating 12-hour se-Li levels when lithium blood tests are taken at other time points than 12 hours.</p><p><p><b>Methods:</b> The equation was developed via secondary analyses using data from the Bipolar Clinical Health Outcomes Initiative in Comparative Effectiveness (CHOICE) trial and verified in 2 separate proof-of-concept studies. Bipolar CHOICE included 122 lithium-treated patients (192 se-Li measurements), who had se-Li levels measured and self-reported the time since lithium intake. The proof-of concept studies tested the accuracy of the equation by measuring se-Li concentrations at different time points up to 24 hours after lithium intake and were performed in Boston, US (5 patients, 10 se-Li measurements) and Aarhus, Denmark (21 patients, 159 se-Li measurements).</p><p><p><b>Results:</b> We present a simple equation calculating the estimated 12-hour se-Li level (eLi₁₂) based on the measured se-Li level at the patient-reported time for intake of the last lithium dose. The accuracy was confirmed in both proof-of concept studies, where eLi₁₂showed a mean deviation from the 12-hour se-Li level of 10% compared to 25% for the measured se-Li (<i>P</i> < .0001). For 99 out of 102 (97%) blood tests taken between 3 and 24 hours after the last lithium dose, eLi₁₂was closer to the 12-hour level than the actual measured se-Li level.</p><p><p><b>Conclusion:</b> eLi₁₂provides clinicians with more accurate 12-hour se-Li estimations and gives patients flexibility as to when to show up for lithium blood tests.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Tolerability Profile of Xanomeline-Trospium Combination for the Treatment of Schizophrenia.","authors":"Leslie Citrome","doi":"10.4088/JCP.25com15775","DOIUrl":"https://doi.org/10.4088/JCP.25com15775","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Tolerability of Xanomeline and Trospium Chloride in Schizophrenia: Pooled Results From the 5-Week, Randomized, Double-Blind, Placebo-Controlled EMERGENT Trials.","authors":"Inder Kaul, Amy Claxton, Sharon Sawchak, Colin Sauder, Stephen K Brannan, Edwin Raj, Shiling Ruan, George Konis, David Brown, Andrew J Cutler, Ronald Marcus","doi":"10.4088/JCP.24m15497","DOIUrl":"https://doi.org/10.4088/JCP.24m15497","url":null,"abstract":"<p><p><b>Objective:</b> To further characterize the safety and tolerability of oral xanomeline and trospium chloride in the treatment of people with schizophrenia experiencing acute psychosis.</p><p><p><b>Methods:</b> Pooled analyses were performed on safety data from the 5-week, randomized, double-blind, placebo-controlled, inpatient EMERGENT-1, EMERGENT-2, and EMERGENT-3 trials of xanomeline/ trospium in adults with schizophrenia with a recent worsening of psychosis requiring hospitalization. Adverse events (AEs) including extrapyramidal motor symptoms (EPS), vital signs, and clinical laboratory values were monitored. Additional analyses of AEs were conducted on subgroups based on age (<45 years or ≥45 years), sex, race (Black or White), ethnicity (Hispanic/Latino or not Hispanic/ Latino), country (United States or Ukraine), and baseline body mass index (<30 kg/m² or ≥30 kg/m²).</p><p><p><b>Results:</b> The pooled safety population comprised 683 participants from the acute trials. Discontinuation rates were similar between groups (xanomeline/ trospium, 27.6%; placebo, 22.7%). Treatment-emergent AEs were reported by 67.9% (xanomeline/trospium) and 51.3% (placebo) of participants, and 51.8% (xanomeline/trospium) and 29.4% (placebo) experienced AEs deemed related to treatment. The most common AEs with xanomeline/trospium were mild or moderate in intensity, transient, and generally gastrointestinal in nature. Subgroups demonstrated clinically nonsignificant differences in incidences of the most common AEs. Rates of EPS, somnolence, and weight gain were low in both groups.</p><p><p><b>Conclusions:</b> In pooled analyses, xanomeline/trospium was generally well tolerated in people with schizophrenia. The most common AEs were mild or moderate in intensity, transient, and consistent with the activity of xanomeline and trospium at muscarinic receptors. Rates of EPS, somnolence, and weight gain were low.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifiers: NCT03697252, NCT04659161, NCT04738123.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143568731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Brexpiprazole in Combination With Sertraline and as Monotherapy in Posttraumatic Stress Disorder: A Full-Factorial Randomized Clinical Trial.","authors":"Mary Hobart, Denise Chang, Nanco Hefting, Lori L Davis","doi":"10.4088/JCP.24m15577","DOIUrl":"https://doi.org/10.4088/JCP.24m15577","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the efficacy, safety, and tolerability of brexpiprazole in combination with sertraline and as monotherapy for posttraumatic stress disorder (PTSD).</p><p><p><b>Methods:</b> The trial comprised a 1-week placebo run-in period followed by an 11-week, randomized, double-blind, active-referenced, placebo-controlled, parallel-arm treatment period (with 14-day follow-up). The trial ran from January 2017-November 2018 at 48 clinical trial sites in the United States. Adult outpatients with PTSD (<i>DSM-5</i>) were randomized (1:1:1:1) to oral brexpiprazole + sertraline, brexpiprazole + placebo, sertraline + placebo, or placebo + placebo. Doses were flexible (brexpiprazole 1-3 mg/d; sertraline 100-200 mg/d). The primary endpoint was change in Clinician-Administered PTSD Scale for <i>DSM-5</i> (CAPS-5) total score from randomization (Week 1) to Week 10. Safety assessments included adverse events.</p><p><p><b>Results:</b> Among 321 randomized participants, completion rates were 58/82 (70.7%) for brexpiprazole + sertraline, 50/75 (66.7%) for brexpiprazole +placebo, 59/81 (72.8%) for sertraline + placebo, and 64/83 (77.1%) for placebo+placebo. At Week 10, brexpiprazole + sertraline demonstrated greater improvement in CAPS-5 total score (randomization, 35.7; least-squares [LS] mean change, -16.4; n = 77) vs sertraline + placebo (randomization, 36.5; LS mean change, -11.4; n = 75) with LS mean difference, -5.08 (95% CI, -8.96 to -1.20; <i>P=</i> .011), and also vs brexpiprazole + placebo and vs placebo+ placebo.</p><p><p>Brexpiprazole + placebo and sertraline + placebo did not differ from placebo + placebo. Treatment emergent adverse events with incidence ≥10% were weight increased (12.5%) and somnolence (10.0%) for brexpiprazole + sertraline, akathisia (13.3%) for brexpiprazole + placebo, and nausea (20.3%) and dry mouth (12.7%) for sertraline + placebo.</p><p><p><b>Conclusions:</b> Brexpiprazole in combination with sertraline (but not as monotherapy) has potential to be a new efficacious treatment for PTSD, with a safety profile consistent with brexpiprazole in approved indications.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03033069.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequencing Stimulant Medication and Behavioral Parent Training in Multiplex ADHD Families: A Pilot SMART.","authors":"Joyce H L Lui, Andrea Chronis-Tuscano, Daniel Almirall, Kathryn B Whitlock, William French, Mark A Stein","doi":"10.4088/JCP.24m15463","DOIUrl":"10.4088/JCP.24m15463","url":null,"abstract":"<p><p><b>Objective:</b> To examine the effects of treatment sequence of parent stimulant medication (MED) and behavioral parent training (BPT) on child, maternal, and parenting outcomes among multiplex attention-deficit/hyperactivity disorder (ADHD) families using a pilot Sequential Multiple Assignment Randomized Trial (SMART) design.</p><p><p><b>Methods:</b> To be eligible, mothers had to meet <i>DSM-IV</i> diagnostic criteria for ADHD, and their children had to have elevated ADHD symptoms. Thirty-five mother-child dyads were randomized at baseline and again at week 8. The resulting 4 sequences were MED MED, BPT-BPT, MED-BPT, and BPT MED. Outcomes included child ADHD symptoms, child impairment, maternal ADHD symptoms, and parenting at week 16. Data were collected from September 2012 to December 2016.</p><p><p><b>Results:</b> The BPT-MED sequence demonstrated the most favorable outcomes for child ADHD symptoms (effect size= -0.36) and child impairment (effect sizes -0.33 to -0.51). All 3 sequences involving medication demonstrated similar impact on maternal ADHD symptoms (effect sizes ranged from -0.32 to -0.48). The BPT-MED (effect sizes ranged from 0.30 to 0.35) had the most favorable effects on positive parenting outcomes. For negative parenting outcomes, BPT-MED (effect size= -0.50 for self report) and BPT-BPT (effect size= -0.08 for observation) had the most favorable outcomes.</p><p><p><b>Conclusions:</b> Overall, based on this pilot SMART, combination treatment may be helpful for most multiplex ADHD families, and sequencing treatments with BPT first followed by stimulant medication for the mother may be the most promising approach to improve child ADHD symptoms, impairment, and parenting. These results require replication with a fully powered SMART design. We conclude with considerations for implementing a model of care for multiplex ADHD families.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT01816074.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 1","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143505725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}