Journal of Clinical Psychiatry最新文献

{"title":"Klotho and Matrix Metalloproteinase-9 Levels and Their Association With Inhibitory Dyscontrol in Adolescents With First-Episode Major Affective Disorders.","authors":"Li-Chi Chen, Ya-Mei Bai, Shih-Jen Tsai, Ju-Wei Hsu, Mu-Hong Chen","doi":"10.4088/JCP.24m15696","DOIUrl":"https://doi.org/10.4088/JCP.24m15696","url":null,"abstract":"<p><p><b>Background:</b> The roles of Klotho and matrix metalloproteinase (MMP)-9 in the pathomechanisms underlying first episode major affective disorders as well as their impact on related inhibitory control function remain unclear.</p><p><p><b>Methods:</b> This study included 44 adolescents with first-episode bipolar disorder, 60 with first-episode major depressive disorder, and 46 age matched healthy controls between January 1, 2021, and August 31, 2024. <i>DSM-5</i> criteria were used to make the diagnoses of 2 major affective disorders. All the participants were assessed for levels of Klotho and MMP-9 and completed the go/no-go task. Generalized linear models (GLMs) were employed to compare Klotho and MMP 9 levels, along with inhibitory control function, between groups.</p><p><p><b>Results:</b> After adjustments for demographic characteristics, clinical symptoms, and psychotropic medication use, the GLMs indicated that adolescents with bipolar disorder and those with major depressive disorder exhibited significantly lower Klotho levels compared with the control group (<i>P</i> = .007). Additionally, adolescents with bipolar disorder had the highest MMP-9 levels (<i>P</i> = .002), followed by those with major depressive disorder (<i>P</i> = .031), compared with healthy controls. Furthermore, lower Klotho levels and higher MMP-9 levels were associated with inhibitory control deficits.</p><p><p><b>Conclusions:</b> Adolescents experiencing first-episode bipolar disorder and major depressive disorder exhibited decreased Klotho levels and increased MMP-9 levels, both of which were associated with deficits in inhibitory control function. Additional studies are warranted to clarify the specific pathomechanisms underlying the complex associations between major affective disorders, Klotho and MMP-9 dysregulation, and deficits in inhibitory control function.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651029","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":"How Do We Get Ketamine Safety Right? Three Questions From a Clinical Service.","authors":"Benjamin D Brody, Dennis M Popeo, Roy W Smetana, Dora Kanellopoulos","doi":"10.4088/JCP.25com15946","DOIUrl":"https://doi.org/10.4088/JCP.25com15946","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651028","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":"Actigraphy-Measured Sleep/Wake Characteristics Associated With Suicidal Ideation in Older Adults Who Have Depression and High Suicide Risk.","authors":"Stephen F Smagula, Gehui Zhang, Sara Albert, Sarah Lim, Allison G Harvey, Michael R Irwin, William Vaughn McCall, Charles F Reynolds, Daniel J Buysse, Robert T Krafty","doi":"10.4088/JCP.24m15522","DOIUrl":"10.4088/JCP.24m15522","url":null,"abstract":"<p><p><b>Objective:</b> The aim of this study was to identify sleep/wake characteristics associated with suicidal ideation (SI) severity among older adults who are at risk for suicide.</p><p><p><b>Methods:</b> This 6-week observational study examined associations between weekly actigraphy-derived sleep/wake measures and SI severity (Beck Scale for Suicidal Ideation [SSI]). The sample (n = 30; 83% female; average age = 62 years), enrolled April 2021 through March 2023, self reported a physician diagnosis of <i>DSM-5</i> major depressive disorder with an episode in the last 6 months and also had either recent active SI or a past suicide attempt. Weekly sleep/wake measures included sleep duration, fragmentation, and 2 rhythm variables (interdaily stability and relative amplitude). Primary analyses used age- and sex-adjusted repeated-measure linear mixed models, 1 model per sleep/wake variable, to assess associations between weekly sleep/ wake and SI reported at week's end. We examined if associations of sleep/wake factors with SI were independent of depression severity (Patient Health Questionnaire-8 scores).</p><p><p><b>Results:</b> Longer sleep duration, greater interdaily stability, and higher relative amplitude were associated with lower SI (eg, for each standard deviation higher interdaily stability, SSI scores were an estimated 1.4 points lower [<i>P</i> = .005]). After adjusting for depression severity, both sleep/wake rhythm variables remained significantly associated with SI, whereas the association between sleep duration and SI severity was attenuated by >80%.</p><p><p><b>Conclusion:</b> In this sample, sleep/wake rhythm disruption (but not sleep duration or fragmentation) related to SI independent of depression severity. Targeting disruptions in sleep/wake rhythms may be an important avenue for future trials of sleep medicine approaches to reduce SI in older adults.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651027","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":"Prognostic and Prescriptive Predictors of Treatment Response to Adjunctive VNS Therapy in Major Depressive Disorder: A RECOVER Trial Report.","authors":"Scott T Aaronson, Charles R Conway, Charles Gordon, Ying-Chieh Lisa Lee, Mark S George, John Zajecka, Patricio Riva-Posse, David L Dunner, Matthew Macaluso, Peter B Rosenquist, Brian J Mickey, Yvette I Sheline, Vasilis C Hristidis, Hunter Brown, Christopher L Kriedt, Quyen Tran, Mark T Bunker, Harold A Sackeim, A John Rush","doi":"10.4088/JCP.25m15850","DOIUrl":"10.4088/JCP.25m15850","url":null,"abstract":"<p><p><b>Objective:</b> Vagus nerve stimulation (VNS) therapy is a long-term intervention for treatment-resistant major depression (TRD) adjunctive to treatment as usual (TAU). To enhance clinical decision- making, we identified subgroups that respond especially well or poorly with active VNS vs no stimulation sham VNS (prognostic predictors) and subgroups that specifically benefit from active VNS vs sham VNS (prescriptive predictors).</p><p><p><b>Methods:</b> In the RECOVER trial, patients with marked TRD (N=493) were randomized to either active VNS (N=249) or sham VNS (N=244); both groups continued TAU. Baseline demographic, clinical, and treatment history characteristics were evaluated as potential prognostic and/or prescriptive outcome predictors. Outcome assessment was based on a tripartite measure that combined depressive symptoms (Quick Inventory of Depressive Symptomatology-Clinician), psychosocial function (Work Productivity and Activity Impairment Questionnaire item 6), and quality of life (Mini-Quality of Life Enjoyment and Satisfaction Questionnaire). Generalized linear mixed models were employed to identify both prognostic and prescriptive predictors of tripartite outcomes.</p><p><p><b>Results:</b> Several baseline features predicted outcomes across the entire sample and within the sham VNS group (prognostic prediction). History of treatment with electroconvulsive therapy (ECT; lifetime and current episode) or transcranial magnetic stimulation (TMS; current episode) was associated with poorer prognosis. However, these same features were associated with greater benefit from active VNS vs sham VNS. The presence of comorbid anxiety disorders was predictive of a better prognosis overall, but smaller benefit from active VNS vs sham VNS.</p><p><p><b>Conclusions:</b> Marked TRD patients with a history of ECT or TMS had especially poorer outcomes when receiving sham VNS plus TAU for 1 year than those without this history. These same subgroups showed significant differential benefit with active VNS than with sham VNS (positive prescriptive effect). The absence of a comorbid anxiety disorder was linked to superior benefit from active VNS vs sham VNS. These predictors may inform clinical decision-making when considering VNS.</p><p><p><b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03887715.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651030","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":"Exploring Vascular Endothelial Growth Factor and Other Blood-Brain Barrier Biomarkers in Cognition of First-Episode Psychosis: An Observational Study.","authors":"Alejandro Ballesteros, María Flores-Lopez, Ana M Sánchez-Torres, Gustavo J Gil-Berrozpe, Lucía Moreno-Izco, Ana Gavito, Antonia Serrano, Fernando Rodríguez de Fonseca, Manuel J Cuesta","doi":"10.4088/JCP.24m15486","DOIUrl":"10.4088/JCP.24m15486","url":null,"abstract":"<p><p><b>Background:</b> Cognitive deficits are a core feature of early stages of schizophrenia. However, according to neurodevelopmental models, the extent to which chemokines and growth factors are involved in cognitive function remains debatable. We aimed to investigate whether homeostatic/inflammatory chemokines and growth factors are associated with cognitive impairment in patients with first-episode psychosis (FEP) in remission.</p><p><p><b>Methods:</b> Fifty patients, 21 healthy siblings, and 24 controls participated in the study. The primary outcomes were associations between cognition and growth factors (brain-derived neurotrophic factor [BDNF] and vascular endothelial growth factor [VEGF]), homeostatic markers (CXCL12), and inflammatory chemokines (CCL2, CCL3, CX3CL1, and CCL11) using a whole-blood immunoassay procedure. Differences between the FEP group, siblings, and controls were also examined to understand distinct group profiles.</p><p><p><b>Results:</b> The VEGF levels were significantly higher in the FEP group than in the control group. High VEGF levels are significantly associated with lower social cognition scores. Moreover, a post hoc hierarchical regression model explained 34.5% of the variance in social cognition (<i>F</i>_{11, 32}=1.533, <i>P</i>=.168), with inflammatory variables explaining 13.5% and VEGF showing statistical significance (β=-1.936, <i>P</i>=.022). No additional significant results were found for the other inflammatory biomarkers.</p><p><p><b>Conclusions:</b> Our preliminary results suggest that an increase in VEGF might help preserve social cognition after first- episode psychosis. These findings might suggest that a compensatory mechanism could outweigh other VEGF- related hypotheses, such as blood-brain barrier opening and chronic neuroinflammation. However, this hypothesis requires further investigation to address the methodological challenges of determining chemokine levels and controlling for confounding variables.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602086","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 Case Series of Intimate Partner Violence in Older Adults Within an Older Persons' Mental Health Service.","authors":"Anant Sharma, Sharon Reutens, Anne P F Wand","doi":"10.4088/JCP.24m15495","DOIUrl":"10.4088/JCP.24m15495","url":null,"abstract":"<p><p><b>Purpose:</b> The aim of this case series is to explore the range of considerations (ethical, practical, and legal) for mental health clinical assessment and management of older adults experiencing intimate partner violence (IPV).</p><p><p><b>Case Series:</b> Three case reports are described. Participants were older adults presenting to an Older Persons Mental Health service in a metropolitan area who reported experiencing recent IPV (either as a survivor or perpetrator). Each case illustrates aspects of the complex issues to be considered in the assessment and management of IPV in older adults, including clinical factors (eg, cognition, interpersonal relationships, mental illness), ethical dilemmas, and legal, sociocultural, and practical considerations.</p><p><p><b>Conclusion:</b> This case series highlights the complexity in assessing and managing IPV in both members of the older adult dyad within a mental health service. Specific approaches to IPV are required given the physical, emotional, and cognitive interdependency often present in older adults.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602071","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 Primer on Individual Participant Data Meta-Analysis and Its Strengths and Limitations.","authors":"Chittaranjan Andrade","doi":"10.4088/JCP.25f16001","DOIUrl":"10.4088/JCP.25f16001","url":null,"abstract":"<p><p>In conventional (aggregate data) meta-analysis, the results of many similar studies are statistically combined to yield a single pooled result. Conventional meta-analyses have many limitations. They cannot examine research questions that were not examined in the source studies, interactions between variables cannot be studied, granular analyses cannot be performed, and systematic biases in the source study data will be retained in the pooled results. Individual participant data meta-analysis (IPD-MA) differs from conventional meta-analyses in that, instead of pooling the results of already completed analyses from source studies, the statistical team obtains and processes individual participant data from the source studies. This allows the specification of a new study protocol that can be uniformly applied, across source studies, to the individual participant data. Matters that can thus be harmonized across the source studies include participant eligibility criteria, choice of exposures and outcomes, operational definitions of exposures and outcomes, time points for data examination, and the method of data analysis. IPD-MA can be performed as a 1-stage or 2-stage procedure; the latter is simpler. Whereas IPD-MA overcomes some of the limitations of conventional meta-analysis, it has its own limitations. Obtaining individual participant data can be difficult and time-consuming, reprocessing and reanalyzing source study data requires time and effort, and new biases may be introduced. The new biases arise from lack of availability of individual participant data from all source studies, limitation of the generalizability of findings when harmonization of the study protocol excludes subjects from analysis, loss of randomization structure when participant eligibility restrictions are applied in IPD-MAs of randomized controlled trials, and failure to adequately adjust for necessary covariates. Readers need to be aware of these biases, and authors of IPD-MAs need to report on the potential impact of these biases on their results.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602085","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 Global Population-Based Study on the Association Between Ketamine and Esketamine With Suicidality Using WHO VigiBase.","authors":"Angela T H Kwan, Moiz Lakhani, Joshua D Rosenblat, Rodrigo B Mansur, Taeho Greg Rhee, Kayla M Teopiz, Bing Cao, Roger Ho, Sabrina Wong, Gia Han Le, Roger S McIntyre","doi":"10.4088/JCP.24m15534","DOIUrl":"10.4088/JCP.24m15534","url":null,"abstract":"<p><p><b>Background:</b> Ketamine and esketamine have been reported to rapidly alleviate various parameters of suicidality, with antisuicidal effects that may be independent of their rapid-acting antidepressant effects. However, it remains unclear whether ketamine and/or esketamine are associated with the emergence or worsening of suicidality.</p><p><p><b>Methods:</b> In this global observational pharmacovigilance cohort study, we analyzed suicidality reports associated with ketamine and esketamine using data from the World Health Organization's VigiBase, accessed from its inception through January 2024. Disproportionality was assessed using the reporting odds ratio (ROR), with significance defined as <i>P</i> < .05.</p><p><p><b>Results:</b> Compared to lithium, esketamine exhibited higher disproportionality for suicidal ideation (ROR = 5.13, 95% CI, 4.48-5.87, <i>P</i> < .0001), while ketamine showed lower disproportionality for suicidal ideation (ROR = 0.76, 95% CI, 0.58-0.99, <i>P</i> = .043), suicide attempt (ROR =0.17, 95% CI, 0.12-0.24, <i>P</i> < .0001), and completed suicide (ROR =0.30, 95% CI, 0.22-0.40, <i>P</i> < .0001). Esketamine also had lower RORs for suicide attempt (ROR = 0.46, 95% CI, 0.39-0.54, <i>P</i> < .0001) and completed suicide (ROR =0.36, 95% CI, 0.30-0.43, <i>P</i> < .0001). When fluoxetine was used as the reference, esketamine showed higher disproportionality for suicidal ideation (ROR = 3.34, 95% CI, 3.06-3.65, <i>P</i> < .0001), while ketamine had a lower ROR (ROR =0.49, 95% CI, 0.39-0.63, <i>P</i> < .0001). For suicidal behavior, esketamine had a lower ROR (ROR =0.37, 95% CI, 0.17-0.81, <i>P</i> = .012), and both ketamine (ROR =0.15, 95% CI, 0.10-0.21, <i>P</i> < .0001) and esketamine (ROR = 0.39, 95% CI, 0.34-0.45, <i>P</i> < .0001) had lower RORs for suicide attempt. Both agents also had lower RORs for completed suicides (ketamine: ROR = 0.24, 95% CI, 0.18-0.32, <i>P</i> < .0001; esketamine: ROR= 0.29, 95% CI, 0.25-0.35, <i>P</i> < .0001).</p><p><p><b>Conclusion:</b> Both increased and decreased RORs for suicidality parameters were observed with ketamine and esketamine, with similar results regardless of whether lithium or fluoxetine was used as the reference. However, causality between ketamine/esketamine use and changes in suicidality cannot be determined.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602084","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":"Zuranolone for Postpartum Depression in Real-World Clinical Practice.","authors":"Maxwell Z Price, Richard L Price","doi":"10.4088/JCP.25cr15876","DOIUrl":"https://doi.org/10.4088/JCP.25cr15876","url":null,"abstract":"","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561817","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":"Using GenAI to Train Mental Health Professionals in Suicide Risk Assessment: Preliminary Findings.","authors":"Zohar Elyoseph, Inbar Levkovitch, Yuval Haber, Yossi Levi-Belz","doi":"10.4088/JCP.24m15525","DOIUrl":"https://doi.org/10.4088/JCP.24m15525","url":null,"abstract":"<p><p><b>Background:</b> Suicide risk assessment is a critical skill for mental health professionals (MHPs), yet traditional training in this area is often limited. This study examined the potential of generative artificial intelligence (GenAI)- based simulator to enhance self-efficacy in suicide risk assessment among MHPs.</p><p><p><b>Methods:</b> A quasiexperimental mixed methods study was conducted. Participants interacted with an AI-based simulator (AIBS) that embodied the role of a patient seeking suicide risk assessment. Each participant conducted a real-time risk assessment interview with the virtual patient and received comprehensive feedback on their assessment approach and performance. Quantitative data were collected through pre- and postintervention questionnaires measuring suicide risk assessment self efficacy and willingness to treat suicidal patients (using 11-point Likert scales). Qualitative data were gathered through open-ended questions analyzing participants' experiences, perceived benefits, and concerns regarding the AI simulator.</p><p><p><b>Results:</b> Among the 43 participating MHPs, we found a significant increase in self efficacy scores from preintervention (mean = 6.0, SD = 2.4) to postintervention (mean = 6.4, SD = 2.1, <i>P</i> < .05). Willingness to treat patients presenting suicide risk increased slightly from (mean = 4.76, SD =2.64) to (mean = 5.00, SD = 2.50) but did not reach significance. Participants reported positive experiences with the simulator, with high likelihood to recommend to colleagues (mean = 7.63, SD =2.27). Qualitative feedback indicated that participants found the simulator engaging and valuable for professional development. However, participants raised concerns about overreliance on AI and the need for human supervision during training.</p><p><p><b>Conclusion:</b> This preliminary study suggests that AIBSs show promise for improving MHPs' self-efficacy in suicide risk assessment. However, further research with larger samples and control groups is needed to confirm these findings and address ethical considerations surrounding AI use in suicide risk assessment training. AI powered simulation tools may have potential to increase access to training in mental health, potentially contributing to global suicide prevention efforts. However, their implementation should be carefully considered to ensure they complement rather than replace human expertise.</p>","PeriodicalId":50234,"journal":{"name":"Journal of Clinical Psychiatry","volume":"86 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561816","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}