Case Reports in Psychiatry最新文献

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Ketamine Therapy in Complex Cases: A Cautionary Tale of Exacerbated Personality Traits and the Crucial Role of Comprehensive Follow-Up and Psychosocial Interventions. 复杂病例中的氯胺酮疗法:人格特征加剧的警示故事以及全面随访和社会心理干预的关键作用。
Case Reports in Psychiatry Pub Date : 2024-06-17 eCollection Date: 2024-01-01 DOI: 10.1155/2024/2143372
Jai Ahuja, Luba Leontieva
{"title":"Ketamine Therapy in Complex Cases: A Cautionary Tale of Exacerbated Personality Traits and the Crucial Role of Comprehensive Follow-Up and Psychosocial Interventions.","authors":"Jai Ahuja, Luba Leontieva","doi":"10.1155/2024/2143372","DOIUrl":"10.1155/2024/2143372","url":null,"abstract":"<p><p>This case report examines the unexpected increase in suicidal ideation following ketamine infusion therapy in a 75-year-old female with a history of treatment-resistant depression. Despite ketamine's established efficacy in treating depression and acute suicidality, this patient's condition deteriorated posttreatment. The report delves into the patient's complex background, including psychosocial stressors, genetic predisposition to depression, and a history of personality traits that may have influenced her response to ketamine. This case underscores the importance of cautious administration of ketamine, especially in patients with personality disorders, and calls for deeper understanding and individualized treatment plans in mental health care. It is a reminder of the complexities involved in treating mental health conditions and the varying effects of treatments like ketamine on different individuals.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2024 ","pages":"2143372"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11208781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141466413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reintroduction of Clozapine following Neuroleptic Malignant Syndrome in a Young Patient with Resistant Schizophrenia 一名年轻的抗药性精神分裂症患者在出现神经性恶性综合征后重新使用氯氮平
Case Reports in Psychiatry Pub Date : 2024-05-10 DOI: 10.1155/2024/9936663
Miriam Chandad, Rajae Chlihfane, Safae Kodad, B. Oneib, F. Elghazouani
{"title":"Reintroduction of Clozapine following Neuroleptic Malignant Syndrome in a Young Patient with Resistant Schizophrenia","authors":"Miriam Chandad, Rajae Chlihfane, Safae Kodad, B. Oneib, F. Elghazouani","doi":"10.1155/2024/9936663","DOIUrl":"https://doi.org/10.1155/2024/9936663","url":null,"abstract":"The incidence of neuroleptic malignant syndrome justifies the immediate discontinuation of the drug in question and the reinstitution of therapy with another drug. In the case of resistant schizophrenia treated with clozapine, there are insufficient therapeutic options. We report the case of a young patient followed up for resistant schizophrenia who developed neuroleptic malignant syndrome after 5 years of therapy with clozapine. Clozapine therapy was successfully reinitiated, and the dosage was increased to 300 mg/day over 62 days. In light of this clinical case and a review of the literature, we report the possibility of reintroducing clozapine following an incidence of malignant syndrome in patients with resistant schizophrenia with respect to certain rules; in particular, a slow increase in dose after a reasonable period of time and close monitoring.","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":" 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140990472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Perceived Conjunctival Foreign Material Egress in Morgellons Disease: A Case Study 莫吉隆斯病的结膜异物排出感:病例研究
Case Reports in Psychiatry Pub Date : 2024-05-10 DOI: 10.1155/2024/9952722
Sean Ghiam, Badal Sojitra, Collin Reiff, Connie M. Sears, Justin N. Karlin
{"title":"Perceived Conjunctival Foreign Material Egress in Morgellons Disease: A Case Study","authors":"Sean Ghiam, Badal Sojitra, Collin Reiff, Connie M. Sears, Justin N. Karlin","doi":"10.1155/2024/9952722","DOIUrl":"https://doi.org/10.1155/2024/9952722","url":null,"abstract":"The purpose of this report is to present a case of a 63-year-old man with orbital Morgellons disease. A 63-year-old man presented reporting 15 years of daily egress of different foreign bodies apparently found in the superior fornices of both eyes, exhibiting a classic manifestation known as the matchbox sign. He described the symptoms starting after a facial trauma. The patient stated that at several points over the 15-year course of his condition, he was so distressed that he had contemplated suicide. On multiple exams by a range of ophthalmic professionals, there was no evidence of foreign body. Further investigation involving MRI and plain radiographs demonstrated similar lack of findings. A trial of gabapentin was performed without improvement in symptoms. He discontinued care 5 months later. Morgellons disease is a poorly understood condition, particularly ophthalmic presentations of the disease. Despite extensive investigation, the exact cause of Morgellons disease remains unclear, and there is no definitive treatment for the condition. We highlight the importance of empathetic listening in building trust, as a means of helping the patient to seek psychological help.","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":" 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140993616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Electroconvulsive Therapy in Transgender and Gender Diverse Population: A Case Report and Review of Literature. 变性和性别多元化人群的电休克疗法:病例报告和文献综述。
Case Reports in Psychiatry Pub Date : 2024-05-07 eCollection Date: 2024-01-01 DOI: 10.1155/2024/5552781
Lachlan Draper, Ashis Vikas, Subhash Das, Suresh Yadav, Frances Walker, Ivona Bandilovska
{"title":"Electroconvulsive Therapy in Transgender and Gender Diverse Population: A Case Report and Review of Literature.","authors":"Lachlan Draper, Ashis Vikas, Subhash Das, Suresh Yadav, Frances Walker, Ivona Bandilovska","doi":"10.1155/2024/5552781","DOIUrl":"10.1155/2024/5552781","url":null,"abstract":"<p><strong>Objective: </strong>Present a case of a transgender and gender diverse (TGD) individual receiving gender affirming hormone therapy (GAHT) who presented with first episode bipolar mania and received electroconvulsive therapy (ECT). To understand the safety and efficacy of ECT in the TGD population including those receiving GAHT through literature review.</p><p><strong>Materials and methods: </strong>Case report using informed consent from an individual TGD patient who received ECT. A review of the literature was conducted using PubMed, Embase, and Medline.</p><p><strong>Results: </strong>The case illustrated safe and effective ECT use in a TGD individual receiving GAHT. Eight studies were reviewed. GAHT has been reported to interfere with certain anaesthetic agents used in ECT. ECT appeared to be a safe and effective treatment in the TGD samples in those studies.</p><p><strong>Conclusion: </strong>There is limited literature on the safety and efficacy of ECT for TGD individuals receiving GAHT. More research is required to address mental health inequalities in this population and to support safe and effective gender affirming treatment modalities.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2024 ","pages":"5552781"},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11093682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140921090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three Prospective Case Studies Examining Mifepristone's Efficacy in Patients with Treatment-Resistant PTSD. 三项前瞻性病例研究,探讨米非司酮对难治性创伤后应激障碍患者的疗效。
Case Reports in Psychiatry Pub Date : 2024-04-26 eCollection Date: 2024-01-01 DOI: 10.1155/2024/4768647
Agnes van Minnen, Lizelotte Vos, Pierre M Bet, Ad de Jongh, Felix Linsen, Hein J F van Marle, Onno C Meijer, Willem M Otte, Marije Russcher, Christiaan H Vinkers
{"title":"Three Prospective Case Studies Examining Mifepristone's Efficacy in Patients with Treatment-Resistant PTSD.","authors":"Agnes van Minnen, Lizelotte Vos, Pierre M Bet, Ad de Jongh, Felix Linsen, Hein J F van Marle, Onno C Meijer, Willem M Otte, Marije Russcher, Christiaan H Vinkers","doi":"10.1155/2024/4768647","DOIUrl":"https://doi.org/10.1155/2024/4768647","url":null,"abstract":"<p><p>Despite the availability of various treatment approaches for patients with posttraumatic stress disorder (PTSD), some patients do not respond to these therapies, and novel treatment approaches are needed. This study investigated the efficacy of mifepristone, a glucocorticoid receptor antagonist, in treatment-resistant PTSD patients. Three patients with PTSD who were resistant to standard psychological and pharmacological treatments were prescribed mifepristone (600-1,200 mg/day) for 1 week. A baseline-controlled single-case design was used, involving a 2-week baseline phase (no intervention), a 1-week intervention phase (mifepristone), and a 2-week postintervention phase. The primary outcome measure, self-reported PTSD symptom severity (PCL-5), was assessed daily, with participants providing their own control condition. Two of the three patients experienced a significant reduction in PTSD symptom severity after the intervention phase and no longer met the diagnostic criteria for PTSD. These positive results were maintained during long-term follow-up. These findings support the potential effectiveness of mifepristone in the treatment of patients with treatment-resistant PTSD. However, our findings must be interpreted with caution, and further studies with larger sample sizes and more rigorous designs are necessary to confirm the promising results.</p>","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"2024 ","pages":"4768647"},"PeriodicalIF":0.0,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11068447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Case of Anorexia Nervosa with Focal Cortical Dysplasia 一个神经性厌食症伴局灶性皮质发育不良的病例
Case Reports in Psychiatry Pub Date : 2024-04-12 DOI: 10.1155/2024/7478666
Hiroki Nemoto, K. Imagawa, T. Enokizono, Yosuke Masuda, Masayuki Ide, Takuma Deguchi, Monami Hara, Atsushi Morita, Takahiro Kido, Mai Tanaka, T. Ohto, H. Takada
{"title":"A Case of Anorexia Nervosa with Focal Cortical Dysplasia","authors":"Hiroki Nemoto, K. Imagawa, T. Enokizono, Yosuke Masuda, Masayuki Ide, Takuma Deguchi, Monami Hara, Atsushi Morita, Takahiro Kido, Mai Tanaka, T. Ohto, H. Takada","doi":"10.1155/2024/7478666","DOIUrl":"https://doi.org/10.1155/2024/7478666","url":null,"abstract":"Anorexia nervosa (AN) is a fatal condition associated with extreme underweight and undernutrition. It is more common in young females, with a female-to-male ratio of 10 : 1. Focal cortical dysplasia (FCD) is characterized by dysplasia of the cerebral cortex and is a common cause of pharmacoresistant epilepsy. However, FCD associated with AN has never been reported. We report the first case of AN in a 12-year-old male diagnosed with FCD-type 2 on head magnetic resonance imaging (MRI). He became concerned about lower abdominal distention and began reducing his food intake. He was admitted to our hospital after weight loss of 10 kg in a 1 year. Head MRI showed a localized high-signal area from the cortex to the white matter of the fusiform gyrus near the left hippocampus, with no associated decreased blood flow or electroencephalography (EEG) abnormalities. These findings were characteristic of FCD type II. In males with AN, the search for underlying disease is particularly important. The pathophysiology of the association between AN and FCD is unclear. However, both conditions are reportedly associated with autism spectrum disorder. Further cases are needed to clarify whether FCD is associated with eating disorders.","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"52 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Review of Risk Factors, Pathophysiology, Management Principles, and Role of Medications 风险因素、病理生理学、管理原则和药物作用回顾
Case Reports in Psychiatry Pub Date : 2024-04-09 DOI: 10.1155/2024/5456490
Shreyus Kankanady Shivanand
{"title":"Review of Risk Factors, Pathophysiology, Management Principles, and Role of Medications","authors":"Shreyus Kankanady Shivanand","doi":"10.1155/2024/5456490","DOIUrl":"https://doi.org/10.1155/2024/5456490","url":null,"abstract":"This is a case report of one patient experiencing psychotic symptoms in the setting of Charles Bonnet syndrome (CBS). Case description is included, and patient has been deidentified. Patient's consent could not be obtained for the submission of the report. The case report focuses on understanding and formulating key psychological issues addressed in this case. It is important to identify that the absence of psychotic illness is classical in patients presenting with psychotic symptoms in CBS and the role of antipsychotic medication is uncertain. A literature review on the management of CBS guidelines published across the world and summarization of the management approach applicable to this case. Visual hallucination is a perception of a visual stimuli when none exists. CBS is characterized by the presence of complex visual hallucinations experienced by the visually impaired, i.e., in an individual with ocular pathology causing vision loss without having true psychosis or dementia. Furthermore, the person having these experiences has a preserved insight into the unreal nature of the perceptions and the absence of mental disorders. An introduction to the terminology “atypical CBS” or “CBS plus” was done to consider visual hallucinations in individuals with low level of insight in a setting of possible cognitive deficits or other hallucinatory modalities.","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"34 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140726871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Psychotropic Management in Cotard Syndrome: Case Reports Supporting Dual Medication Management 科塔德综合征的精神药物治疗:支持双重药物管理的病例报告
Case Reports in Psychiatry Pub Date : 2024-04-09 DOI: 10.1155/2024/7630713
Adam J. Fusick, Chemar Davis, Steven R Gunther, Cory Klippel, Gregory Sullivan
{"title":"Psychotropic Management in Cotard Syndrome: Case Reports Supporting Dual Medication Management","authors":"Adam J. Fusick, Chemar Davis, Steven R Gunther, Cory Klippel, Gregory Sullivan","doi":"10.1155/2024/7630713","DOIUrl":"https://doi.org/10.1155/2024/7630713","url":null,"abstract":"Cotard syndrome is a rare presentation where patients present with nihilistic thoughts of dying or already being dead. These delusions manifest from either a medical or psychiatric etiology and can be difficult to treat. Recently Couto and Gonçalves purposed that treatment should include an atypical antipsychotic alone or in combination with either a mood stabilizer or antidepressant. Here the authors advocate for a more specific but well-known psychotropic regimen, namely the combination of olanzapine and fluoxetine. We conducted a literature review and of 246 papers identified, only three reported using a combination of fluoxetine and olanzapine with many of them having limited or confounding information that make it difficult for us to comment on the historically efficacy of this medication combination. Therefore, the authors provide two case examples of patients being treated successfully with olanzapine and fluoxetine. One, a 66-year-old male veteran and another 76-year-old male veteran. Both of these cases hold significance as the patient's psychotic depression was so severe as to warrant ECT as a possible treatment. In both cases, this medication combination was able to avoid the procedure. Overall, with the addition of our cases and the sparse information available in the literature, we propose the combination of fluoxetine and olanzapine as an effective Cotard syndrome treatment.","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140721046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
When Imagination Feels Like Reality: A Case Study of False Memories and Maladaptive Daydreaming in Visual Impairment 当想象像现实:视觉障碍患者的虚假记忆和不适应性白日梦案例研究
Case Reports in Psychiatry Pub Date : 2024-04-09 DOI: 10.1155/2024/9391645
Eli Somer
{"title":"When Imagination Feels Like Reality: A Case Study of False Memories and Maladaptive Daydreaming in Visual Impairment","authors":"Eli Somer","doi":"10.1155/2024/9391645","DOIUrl":"https://doi.org/10.1155/2024/9391645","url":null,"abstract":"Background When a person experiences maladaptive daydreaming (MD), they spend a prolonged period daydreaming with a strong sense of presence. The symptoms of MD are often excessive, interfere with functioning, and are linked to distress and comorbid mental disorders. In this paper, apparent false memory is described in the context of a woman with MD and visual impairment due to a progressive eye condition. Her vivid daydreams seemed indistinguishable from actual memories. Case Report. A 35-year-old woman with a lifelong MD reported three incidents of fabricating detailed false memories of events that her family confirmed never occurred: obtaining a new job, miscarrying twins, and hospitalization for COVID-19. She experienced anxiety and shame when the stories were disproven. The assessment confirmed MD, PTSD, OCD, and other disorders. Her verbal memory was below average, especially for longer narratives. Her misattributions of daydreams as real-life memories may relate to reliance on vivid mental images over deteriorating vision and source monitoring deficits. Conclusion This first reported case of confabulations in an individual with MD and visual disability suggests daydreams could potentially be mistaken for actual events in some MD cases. While sensitive, more research is needed on the prevalence of false memories among individuals with MD. The default mode network, prefrontal cortex, and their connectivity may be implicated in generating vivid daydreams and misattributing them to actual episodic events. Understanding the relationship between sensory impairments, dissociation, and susceptibility to memory distortions could inform interventions to improve reality testing for some MD patients.","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"137 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140725307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Presentation and Management of Acute Mania in Fanconi–Bickel Syndrome, A Metabolic Genetic Disorder 范康尼-比克尔综合征(一种代谢性遗传疾病)急性躁狂症的表现与处理
Case Reports in Psychiatry Pub Date : 2024-04-04 DOI: 10.1155/2024/5593846
Allen P. F. Chen, Geoffrey Russell, Amnie Ashour, Adeeb Yacoub
{"title":"Presentation and Management of Acute Mania in Fanconi–Bickel Syndrome, A Metabolic Genetic Disorder","authors":"Allen P. F. Chen, Geoffrey Russell, Amnie Ashour, Adeeb Yacoub","doi":"10.1155/2024/5593846","DOIUrl":"https://doi.org/10.1155/2024/5593846","url":null,"abstract":"Fanconi–Bickel syndrome (FBS) is a rare metabolic disorder caused by decreased glucose transporter 2 (GLUT2) function due to several known mutations in the SLC2A2 gene. As of 2020, 144 cases of FBS have been described in the literature. Metabolic and somatic sequelae include dysglycemia and accumulation of glycogen in the kidney and liver. However, there are no descriptions in the literature of possible neuropsychiatric manifestations of FBS. This case report is to our knowledge the first in this regard, describing a patient with FBS who was admitted to our psychiatric inpatient unit while experiencing acute mania. We conceptualize the case as a novel psychiatric presentation of acute mania in FBS, which may inform our understanding of bipolar disorder pathophysiology because of the hypothesized functional changes in neural pathways involving the paraventricular thalamus induced by decreased GLUT2 activity in FBS.","PeriodicalId":9631,"journal":{"name":"Case Reports in Psychiatry","volume":"31 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140744958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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