Journal of psychiatric research最新文献

Corrigendum to “The identification and measurement of postpartum anxiety in England: A Delphi survey” [J. Psychiatr. Res. 168 (2023) 381–391] 英格兰产后焦虑的识别与测量：德尔菲调查"[J. Psychiatr. Res. 168 (2023) 381-391] 更正

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-28 DOI: 10.1016/j.jpsychires.2024.10.027

引用次数: 0

Effect of combined Tai Chi and repetitive transcranial magnetic stimulation for sleep disturbance in older adults: A randomized controlled trial 太极拳与重复经颅磁刺激相结合对老年人睡眠障碍的影响：随机对照试验

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-26 DOI: 10.1016/j.jpsychires.2024.10.025

Background and aims

Novel approaches to improve sleep disturbance in older adults are needed. Our study comprises a pioneering attempt to test the efficacy of Tai Chi (TC) combined with repetitive transcranial magnetic stimulation (rTMS) in improving sleep disturbance in older adults. The influence of baseline depressive symptoms was tested in a subset of the sample.

Method

In the randomized controlled trial, 152 participants were each allocated to one of the following groups: (1) TC plus active rTMS (n = 38), (2) TC plus sham rTMS (n = 38), (3) TC alone (n = 38), and (4) low-intensity physical exercise (PE) control group (n = 38). Four-week interventions were conducted for each group. The outcomes included insomnia severity, actigraphy-assessed and self-reported sleep parameters, mood states, and quality of life. Assessments were carried out at baseline (T0), post-intervention (T1), and 3-month follow-up (T2).

Results

Of the 152 randomized participants, the mean (SD) age was 67.68 (4.98) years, with 112 female (73.68%). The findings revealed that TC plus active rTMS induced a significant reduction in actigraphy-assessed sleep onset latency compared to TC plus sham rTMS at T1 and T2. In the subsample without depressive symptoms, the combination treatment exhibited a greater benefit in actigraphy-assessed sleep efficiency and wake time after sleep onset compared to both variables in the PE group and in the sham comparator group at T1, respectively. The other subsample with depressive symptoms showed the improvements with TC plus active rTMS, TC plus sham rTMS, and TC alone differed significantly from PE at T1 and T2.

Conclusions

This study has demonstrated the positive effect of TC combined with rTMS on sleep disturbance in older adults. Specific sample characteristics should be considered when applying TC, either alone or combined with rTMS.

背景和目的：改善老年人睡眠障碍需要新的方法。我们的研究是一项开创性的尝试，旨在测试太极拳（TC）与重复经颅磁刺激（rTMS）相结合对改善老年人睡眠障碍的疗效。我们还在部分样本中测试了基线抑郁症状的影响：在随机对照试验中，152 名参与者被分配到以下几组中的一组：（1）经颅磁刺激加主动经颅磁刺激组（38 人）；（2）经颅磁刺激加假经颅磁刺激组（38 人）；（3）单独经颅磁刺激组（38 人）；（4）低强度体育锻炼（PE）对照组（38 人）。每组进行为期四周的干预。研究结果包括失眠严重程度、动图评估和自我报告的睡眠参数、情绪状态和生活质量。评估分别在基线（T0）、干预后（T1）和 3 个月随访（T2）时进行：在 152 名随机参与者中，平均（标清）年龄为 67.68（4.98）岁，女性 112 人（73.68%）。研究结果显示，与TC加假经颅磁刺激相比，在T1和T2阶段，TC加活性经颅磁刺激能显著降低动觉测定的睡眠开始潜伏期。在无抑郁症状的子样本中，联合疗法分别在T1的动觉计评估睡眠效率和睡眠开始后的唤醒时间方面比PE组和假参照组的两个变量都有更大的优势。另一个有抑郁症状的子样本显示，在T1和T2，TC加活性经颅磁刺激、TC加假经颅磁刺激和单独使用TC的改善效果与PE有显著差异：本研究证明了经颅磁刺激联合经颅磁刺激对老年人睡眠障碍的积极影响。在单独应用TC或与经颅磁刺激联合应用时，应考虑特定的样本特征。

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引用次数: 0

Maternal gut-microbiota impacts the influence of intrauterine environmental stressors on the modulation of human cognitive development and behavior 母体肠道微生物群影响宫内环境压力因素对人类认知发展和行为的调节。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-24 DOI: 10.1016/j.jpsychires.2024.10.028

This review examines the longstanding debate of nature and intrauterine environmental challenges that shapes human development and behavior, with a special focus on the influence of maternal prenatal gut microbes. Recent research has revealed the critical role of the gut microbiome in human neurodevelopment, and evidence suggest that maternal microbiota can impact fetal gene and microenvironment composition, as well as immunophysiology and neurochemical responses. Furthermore, intrauterine neuroepigenetic regulation may be influenced by maternal microbiota, capable of having long-lasting effects on offspring behavior and cognition. By examining the complex relationship between maternal prenatal gut microbes and human development, this review highlights the importance of early-life environmental factors in shaping neurodevelopment and cognition.

这篇综述探讨了长期以来关于自然界和宫内环境挑战对人类发育和行为的影响的争论，并特别关注母体产前肠道微生物的影响。最近的研究揭示了肠道微生物群在人类神经发育中的关键作用，有证据表明母体微生物群会影响胎儿的基因和微环境组成，以及免疫生理学和神经化学反应。此外，胎儿宫内的神经表观遗传调控可能会受到母体微生物群的影响，从而对后代的行为和认知产生持久的影响。通过研究母体产前肠道微生物与人类发育之间的复杂关系，本综述强调了生命早期环境因素对塑造神经发育和认知的重要性。

引用次数: 0

Exploring accelerated aging as a target of bipolar disorder treatment: A systematic review 将加速衰老作为躁郁症治疗目标的探索：系统综述。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-23 DOI: 10.1016/j.jpsychires.2024.10.026

Bipolar disorder (BD) has been linked to accelerated aging processes, with many studies suggesting that drugs used to treat BD may modulate pathways related to aging. This systematic review aimed to determine whether FDA-approved pharmacotherapies for BD have reported effects on aging biomarkers across clinical and preclinical studies. We conducted searches in PubMed and PsychINFO and followed PRISMA guidelines. Out of 6400 records identified, 19 studies met the inclusion criteria. Most preclinical studies tested the effects of BD drugs, especially lithium, on lifespan and telomere biology in cell and animal models. Clinical studies predominantly focused on lithium, evaluating aging markers like telomere length, telomerase, mitochondrial DNA copy number, and epigenetic age acceleration in individuals with BD. Findings indicate that chronic lithium treatment is associated with modulatory effects on aging biomarkers, particularly increased telomere length and telomerase activity. Conversely, some negative results were also reported. Limited evidence suggests potential aging-modulating properties of other mood stabilizers like valproic acid and lamotrigine, evidencing that further investigation is required. Despite variability across studies, the overall findings support the notion that pharmacotherapies used in BD present many effects of aging biomarkers. However, the field is still developing, with a clear emphasis on lithium and a lack of standardized methods to evaluate aging biomarkers in clinical samples. Further research exploring the anti-accelerated aging effects of BD drugs beyond lithium, their mechanisms of action, and potential synergistic effects is warranted.

躁郁症（BD）与加速衰老过程有关，许多研究表明，用于治疗躁郁症的药物可能会调节与衰老有关的途径。本系统性综述旨在确定FDA批准的治疗躁郁症的药物疗法在临床和临床前研究中是否对衰老生物标志物有影响。我们在 PubMed 和 PsychINFO 中进行了检索，并遵循了 PRISMA 指南。在找到的 6400 条记录中，有 19 项研究符合纳入标准。大多数临床前研究测试了 BD 药物（尤其是锂）在细胞和动物模型中对寿命和端粒生物学的影响。临床研究主要集中于锂，评估端粒长度、端粒酶、线粒体 DNA 拷贝数等衰老标志物，以及 BD 患者的表观遗传年龄加速。研究结果表明，长期锂治疗对衰老生物标志物有调节作用，尤其是端粒长度和端粒酶活性的增加。相反，也有一些负面结果的报道。有限的证据表明，丙戊酸和拉莫三嗪等其他情绪稳定剂也具有潜在的衰老调节作用，这证明还需要进一步的研究。尽管各项研究之间存在差异，但总体研究结果支持这样一种观点，即用于 BD 的药物疗法会对衰老生物标志物产生多种影响。然而，这一领域仍在发展之中，其重点显然是锂，而且缺乏评估临床样本中衰老生物标志物的标准化方法。有必要进一步研究锂以外的 BD 药物的抗加速衰老作用、作用机制以及潜在的协同效应。

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引用次数: 0

Editorial: Influence of race, social justice, and health equity in physically impaired child and adolescent psychiatry 社论：种族、社会正义和健康公平对身体受损的儿童和青少年精神病学的影响。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-22 DOI: 10.1016/j.jpsychires.2024.10.023

引用次数: 0

Association between frailty and suicidal ideation in older adults: A cross-sectional study 老年人体弱与自杀倾向之间的关系：一项横断面研究。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-22 DOI: 10.1016/j.jpsychires.2024.10.024

Objectives

This study seeks to investigate the potential correlation between various levels of frailty and suicidal ideation (SI) in older adults from the USA.

Methods

Our cross-sectional study extracted data on adults ≥60 years from the NHANES in 2005–2018. Frailty levels were assessed by computing the Frailty Index, classifying individuals into robust, prefrail, and frail categories. SI was evaluated utilizing Item #9 of PHQ-9. Logistic regression and restricted cubic splines were employed for analysis.

Results

The analysis comprised 8564 participants, revealing that 3.3% reported experiencing SI. The association between frailty and SI in older adults was statistically significant in crude model (OR: 5.94, 95% CI: 3.46–11.27, P < 0.001). Upon adjusting for baseline characteristics, the association remained robust (AOR: 5.35, 95% CI: 3.09–10.19, P < 0.001). Model II did not substantially alter the association between frailty and SI after further adjustment for lifestyle factors (AOR: 5.23, 95% CI: 3.02–9.98, P < 0.001). In a sensitivity analysis controlling for depression, the association remained statistically significant (AOR:3.62, 95%CI: 1.76–8.75, P = 0.001). Furthermore, the associations between the Frailty Index and SI were pronounced in the restricted cubic spline (RCS) models (P _overall < 0.001, P _nonlinearity = 0.771).

Conclusion

Frailty appears to heighten vulnerability to suicidal ideation in older adults. Training healthcare professionals to identify and address mental health issues related to frailty is crucial. Through comprehensive intervention measures, we can better safeguard the mental well-being of older adults and reduce the risk of suicide.

研究目的本研究旨在调查美国老年人不同程度的虚弱与自杀意念（SI）之间的潜在相关性：我们的横断面研究从 2005-2018 年的 NHANES 中提取了年龄≥60 岁的成年人的数据。评估虚弱程度的方法是计算虚弱指数，将个体分为健壮型、前虚弱型和虚弱型。SI利用PHQ-9的第9项进行评估。分析采用了逻辑回归和限制性三次样条：分析包括 8564 名参与者，结果显示有 3.3% 的人报告患有 SI。在粗略模型中，老年人体弱与 SI 之间的关系具有显著的统计学意义（OR：5.94，95% CI：3.46-11.27，总 P <0.001，P 非线性 = 0.771）：结论：体弱似乎会使老年人更容易产生自杀意念。培训医护人员识别和解决与虚弱相关的心理健康问题至关重要。通过综合干预措施，我们可以更好地保护老年人的精神健康，降低自杀风险。

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引用次数: 0

Emotion dysregulation in misophonia: Findings from a nationally representative sample 失声症患者的情绪失调：来自全国代表性样本的研究结果。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-22 DOI: 10.1016/j.jpsychires.2024.10.022

A core feature of misophonia is the emotional distress that occurs in response to specific sounds (e.g., slurping, pen clicking). Despite the theorized connection between emotion dysregulation and misophonia, there is very little research on this topic. Examining emotion dysregulation and identifying the specific emotion regulation deficits that are associated with worse misophonia symptoms would advance our understanding of potential transdiagnostic factors central to misophonia symptoms; thereby informing the development of more targeted interventions. The current study sought to: 1) characterize emotion dysregulation among individuals with misophonia, 2) compare emotion dysregulation between individuals with clinical and subclinical misophonia, and 3) examine the unique role of emotion dysregulation across three domains of misophonia symptoms. This study included a large, nationally representative sample of U.S. adults (N = 4005; 51.5% female; 62.5% White, non-Hispanic). Participants completed self-report questionnaires to assess misophonia symptoms (i.e., misophonia sounds, emotional and behavioral reactions to misophonia sounds, and misophonia-related impairment), stress, and emotion dysregulation. The results revealed participants with misophonia reported significantly worse emotion regulation abilities compared to individuals with subclinical levels of misophonia. In addition, emotion dysregulation was significantly associated with sensitivity to misophonia sounds, reactions to misophonia sounds, and misophonia-related impairment, even after accounting for covariates. Results support emotion dysregulation as an important element in misophonia and suggest certain dimensions of emotion dysregulation should be considered in future research and in the evaluation of treatment strategies used to reduce misophonia symptoms.

失声症的核心特征是对特定声音（如啧啧声、钢笔点击声）产生情绪困扰。尽管理论上认为情绪失调与失声症之间存在联系，但这方面的研究却很少。研究情绪失调并确定与失声症状加重相关的特定情绪调节缺陷，将促进我们对导致失声症状的潜在跨诊断因素的了解，从而为制定更有针对性的干预措施提供信息。本研究旨在1）描述失声症患者情绪失调的特征；2）比较临床和亚临床失声症患者的情绪失调；3）研究情绪失调在失声症症状的三个领域中的独特作用。这项研究包括一个具有全国代表性的大型美国成年人样本（样本数 = 4005；51.5% 为女性；62.5% 为非西班牙裔白人）。参与者填写了自我报告问卷，以评估失音症状（即失音声音、对失音声音的情绪和行为反应以及与失音相关的损伤）、压力和情绪失调。结果显示，与亚临床水平的失音患者相比，失音患者的情绪调节能力明显较差。此外，情绪失调与对误发音的敏感性、对误发音的反应以及与误发音相关的损伤有显著关联，即使在考虑了协变量之后也是如此。研究结果表明，情绪失调是失声症的一个重要因素，并建议在今后的研究和评估用于减轻失声症症状的治疗策略时，应考虑情绪失调的某些方面。

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引用次数: 0

Microstructural abnormalities of the right hemisphere in preschool autism spectrum disorders 学龄前自闭症谱系障碍右半球微结构异常。

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-22 DOI: 10.1016/j.jpsychires.2024.10.020

Background

This study aims to investigate microstructural abnormalities within and between hemispheres in preschool children with autism spectrum disorders (ASD) using diffusion basis spectrum imaging (DBSI).

Methods

A total of 35 ASD patients and 32 healthy controls (HC), matched for sex and age, underwent DBSI at 3T. We analyzed DBSI-derived indices of brain white matter using tract-based spatial statistics (TBSS) to compare ASD and HC groups. Support vector machine (SVM) classification was employed to evaluate the potential of positive DBSI parameters in distinguishing ASD patients. Additionally, correlation analyses were conducted to explore relationships between positive DBSI parameters and clinical scales.

Results

Patients in the ASD group exhibited significantly higher fiber ratios in the right brainstem tracts, increased radial diffusivity in the left superior longitudinal fasciculus, and reduced fractional anisotropy (FA) in various fiber tracts, including projection, commissural, and association fibers, compared to HC. Notably, the FA of the right cingulum correlated positively with the Gesell scale (r = 0.439, p = 0.008) and achieved a specificity of 90% in identifying ASD.

Conclusion

The DBSI findings suggest asynchronous myelination in the right hemisphere and cerebellum in preschool ASD, with the FA value of the right cingulate gyrus appearing to be a reliable marker for ASD and may serve as a potential diagnostic parameter for preschool ASD.

背景：本研究旨在利用弥散基谱成像（DBSI）技术研究自闭症谱系障碍（ASD）学龄前儿童大脑半球内部和半球之间的微结构异常：本研究旨在利用弥散基谱成像（DBSI）研究学龄前自闭症谱系障碍（ASD）儿童大脑半球内部和半球之间的微结构异常：共有 35 名 ASD 患者和 32 名健康对照者（HC）在 3T 下接受了 DBSI。我们使用基于束的空间统计（TBSS）分析了DBSI衍生的脑白质指数，以比较ASD组和HC组。我们采用支持向量机（SVM）分类来评估 DBSI 阳性参数在区分 ASD 患者方面的潜力。此外，研究人员还进行了相关分析，以探讨DBSI阳性参数与临床量表之间的关系：结果：与HC相比，ASD组患者右侧脑干束的纤维比率明显升高，左侧上纵筋束的径向扩散率升高，投射、汇合和联结纤维等各种纤维束的分数各向异性（FA）降低。值得注意的是，右侧扣带回的FA与格塞尔量表呈正相关（r = 0.439，p = 0.008），在识别ASD方面的特异性达到90%：DBSI的研究结果表明，学龄前ASD患者右半球和小脑的髓鞘化不同步，右扣带回的FA值似乎是ASD的可靠标记，可作为学龄前ASD的潜在诊断参数。

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引用次数: 0

Impact of comorbid sleep-disordered breathing on escitalopram treatment in patients newly diagnosed with generalized anxiety disorder: A 12-week prospective observational study 合并睡眠呼吸障碍对新诊断为广泛性焦虑症患者的艾司西酞普兰治疗的影响：为期 12 周的前瞻性观察研究

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-21 DOI: 10.1016/j.jpsychires.2024.10.021

We aimed to evaluate the presence of sleep-disordered breathing (SDB) in generalized anxiety disorder (GAD) patients and its impacts after 12-week of escitalopram treatment. In this prospective observational study, GAD patients were followed up to determine whether comorbid SDB affects their treatment response. They underwent a home sleep apnea test (HSAT), and oxygen desaturation index ≥5 was considered indicative of SDB. All participants were treated with escitalopram 5 mg in the first 2 weeks and 10 mg in the remaining 10 weeks. They underwent assessments of heart rate variability and completed questionnaires for sleep, mood, attention, and daytime sleepiness on the day of enrollment, and 2 weeks, 4 weeks, and 12 weeks later. A total of 45 GAD participants (mean age, 56.2 years) were included in the study. Of these, 53.3% had comorbid SDB. Participants with GAD and SDB had higher baseline Beck Anxiety Inventory (BAI) and STOP-BANG scores. Both groups of participants with GAD showed overall improvement in anxiety, depression, and insomnia symptoms after 12 weeks of escitalopram treatment. Additionally, there were no statistically significant differences in the changes in BAI, Beck Depression Inventory, and Epworth Sleepiness Scale scores between the two groups at the Week 2, Week 4, and Week 12 assessments compared to baseline. However, the GAD group with comorbid SDB seemed to have a lower tendency for improvement in depressive symptoms than the group with non-comorbid SDB. Compared with the GAD group without comorbid SDB, the GAD group with comorbid SDB exhibited more severe anxiety symptoms at baseline and tended to show less improvement in depressive symptoms after 12 weeks of escitalopram treatment.

我们旨在评估广泛性焦虑症（GAD）患者是否存在睡眠呼吸障碍（SDB）及其在接受 12 周艾司西酞普兰治疗后的影响。在这项前瞻性观察研究中，我们对 GAD 患者进行了随访，以确定合并 SDB 是否会影响他们的治疗反应。他们接受了家庭睡眠呼吸暂停测试（HSAT），氧饱和度指数≥5被认为是SDB的指征。所有参与者在前两周接受 5 毫克的艾司西酞普兰治疗，其余 10 周接受 10 毫克的艾司西酞普兰治疗。他们在入组当天以及 2 周、4 周和 12 周后接受了心率变异性评估，并填写了睡眠、情绪、注意力和白天嗜睡的调查问卷。共有 45 名 GAD 患者（平均年龄 56.2 岁）参与了这项研究。其中 53.3% 的人合并有 SDB。患有 GAD 和 SDB 的参与者的贝克焦虑量表 (BAI) 和 STOP-BANG 基线得分较高。两组 GAD 患者在接受为期 12 周的艾司西酞普兰治疗后，焦虑、抑郁和失眠症状均有总体改善。此外，与基线相比，两组患者在第2周、第4周和第12周的BAI、贝克抑郁量表和埃普沃思嗜睡量表评分的变化在统计学上没有显著差异。不过，与未合并 SDB 的 GAD 组相比，合并 SDB 的 GAD 组在抑郁症状方面的改善趋势似乎较低。与不合并 SDB 的 GAD 组相比，合并 SDB 的 GAD 组在基线时表现出更严重的焦虑症状，而且在接受 12 周的艾司西酞普兰治疗后，抑郁症状的改善程度往往较低。

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引用次数: 0

Influence of temperament and emotional dysregulation on depressive symptoms in adults with attention-deficit/hyperactivity disorder: A structural equation modelling analysis 气质和情绪失调对注意力缺陷/多动障碍成人抑郁症状的影响：结构方程模型分析

IF 3.7 2区医学 Q1 PSYCHIATRY

Journal of psychiatric research

Pub Date : 2024-10-20 DOI: 10.1016/j.jpsychires.2024.10.019

Objective

Depressive symptoms in adults with Attention-Deficit/Hyperactivity Disorder (ADHD) are common. Clinical evidence suggests that affective temperaments and emotional dysregulation are reasonable putative explanatory factors of this association. In this study, we thus investigated the role of these features in influencing concomitant depressive symptoms in adults with ADHD.

Methods

Outpatients with ADHD were consecutively enrolled. Depressive symptoms were measured by the Symptom Checklist-90 Revised (SCL-90-R), while the Temperament Evaluation Memphis for Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) was used to assess the affective temperament dimensions. We tested emotional dysregulation using the Difficulties in Emotion Regulation Scale (DERS). Structural equation modeling was performed to test the interplay between temperament, emotional dysregulation, and depressive symptoms, accounting for other clinical variables that showed an association with depressive symptoms at univariate level.

Results

A total of 164 individuals with ADHD (mean age of 29.8 ± 10.7 years), of which 61 (37.2%) women, were recruited. Data showed that, accounting for the possible influence of psychopharmacological treatment and ADHD severity, both emotional dysregulation (p < 0.001) and dysthymic temperament (p = 0.003), though not other affective temperament dimensions, might influence depressive symptoms in people with ADHD.

Conclusions

Despite some limitations, our study emphasizes the role of dysthymic temperament and emotional dysregulation in contributing to levels of depressive symptoms among individuals with ADHD. A comprehensive temperament assessment in adults with ADHD can offer valuable insights for developing tailored treatment strategies and enhancing overall patient care.

目的：患有注意力缺陷/多动障碍（ADHD）的成年人出现抑郁症状很常见。临床证据表明，情感气质和情绪失调是这种关联的合理解释因素。因此，我们在本研究中调查了这些特征在影响成人多动症患者伴随抑郁症状中的作用：方法：连续招募门诊ADHD患者。抑郁症状由症状核对表-90修订版（SCL-90-R）测量，而比萨、巴黎和圣地亚哥气质评估孟菲斯-自动问卷（TEMPS-A）则用于评估情感气质维度。我们使用情绪调节困难量表（DERS）对情绪调节障碍进行了测试。在考虑了单变量水平上显示与抑郁症状相关的其他临床变量后，我们进行了结构方程建模，以检验气质、情绪失调和抑郁症状之间的相互作用：共招募了 164 名多动症患者（平均年龄为 29.8 ± 10.7 岁），其中女性 61 人（37.2%）。数据显示，考虑到精神药物治疗和多动症严重程度的可能影响，情绪失调（p 结论：尽管存在一些局限性，但我们的研究强调了情绪失调的重要性：尽管存在一些局限性，但我们的研究强调了癔症气质和情绪失调对多动症患者抑郁症状水平的影响。对成人多动症患者进行全面的气质评估可为制定有针对性的治疗策略和加强对患者的整体护理提供有价值的见解。

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引用次数: 0