Pub Date : 2023-11-01DOI: 10.3928/00485713-20231025-02
Amit Chopra, John W. Winkelman
{"title":"Sleep and Mental Health Conditions","authors":"Amit Chopra, John W. Winkelman","doi":"10.3928/00485713-20231025-02","DOIUrl":"https://doi.org/10.3928/00485713-20231025-02","url":null,"abstract":"","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"48 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135455110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Major depressive disorder (MDD) is associated with profound sleep architectural alterations including reduced slow wave activity, increased delta sleep ratio, REM sleep disinhibition, shortened REM onset latency, and increased REM density. Antidepressants, though mitigating depressive symptoms, often disrupt sleep patterns, highlighting the delicate balance between treatment benefits and sleep-related impacts. Comprehensive assessment and management of insomnia is pivotal due to its significant implications for effective clinical management and treatment outcomes in MDD. Nonpharmacological treatments, notably cognitive-behavioral therapy for insomnia (CBTi), and digital CBTi (dCBTi) should be considered. CBTi unravels maladaptive sleep beliefs and behaviors, yielding improvements in both insomnia and MDD symptoms. Digital CBTi platforms extend accessibility, offering potential relief to a broader demographic. Sedating antidepressants, nonbenzodiazepine hypnotics, and atypical antipsychotics address insomnia within MDD, with cautious consideration for side effects. A combination of pharmacotherapy with CBTi might yield augmented outcomes in patients with MDD and comorbid insomnia. Ketamine, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagal nerve stimulation (VNS), and deep brain stimulation (DBS) explore novel dimensions in treating treatment-resistant depression, potentially influencing sleep disruptions. [ Psychiatr Ann . 2023;53(11):502–507.]
{"title":"The Intersection of Insomnia Disorder and Major Depressive Disorder: A Clinical Perspective","authors":"Anil Bachu, Garima Yadav, Maliha Ansari, Hansini Kochhar, Tiffany Cabrera, Amit Chopra","doi":"10.3928/00485713-20231024-01","DOIUrl":"https://doi.org/10.3928/00485713-20231024-01","url":null,"abstract":"Major depressive disorder (MDD) is associated with profound sleep architectural alterations including reduced slow wave activity, increased delta sleep ratio, REM sleep disinhibition, shortened REM onset latency, and increased REM density. Antidepressants, though mitigating depressive symptoms, often disrupt sleep patterns, highlighting the delicate balance between treatment benefits and sleep-related impacts. Comprehensive assessment and management of insomnia is pivotal due to its significant implications for effective clinical management and treatment outcomes in MDD. Nonpharmacological treatments, notably cognitive-behavioral therapy for insomnia (CBTi), and digital CBTi (dCBTi) should be considered. CBTi unravels maladaptive sleep beliefs and behaviors, yielding improvements in both insomnia and MDD symptoms. Digital CBTi platforms extend accessibility, offering potential relief to a broader demographic. Sedating antidepressants, nonbenzodiazepine hypnotics, and atypical antipsychotics address insomnia within MDD, with cautious consideration for side effects. A combination of pharmacotherapy with CBTi might yield augmented outcomes in patients with MDD and comorbid insomnia. Ketamine, electroconvulsive therapy (ECT), repetitive transcranial magnetic stimulation (rTMS), vagal nerve stimulation (VNS), and deep brain stimulation (DBS) explore novel dimensions in treating treatment-resistant depression, potentially influencing sleep disruptions. [ Psychiatr Ann . 2023;53(11):502–507.]","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"24 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135455883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.3928/00485713-20231003-01
Patrick Ho, Ayesha Haq, Laura Taylor, Eleonora Sikic-Klisovic, David Kasick
As firearms are frequently used in suicide attempts, there is wide recognition of this potential danger with restrictions and barriers present in many jurisdictions to limit the purchase and possession of firearms. However since nail guns were introduced in the 1950s, nail gun discharge (NGD) injuries have been an increasing phenomenon due to more widespread availability and ease of use without restrictions on possession. Although existing literature has described suicide attempts by NGD to single body sites, reports of injuries to multiple body sites are rarer. In this case report, we present the case of a patient who survived multiple, severe, self-inflicted penetrating wounds secondary to a suicide attempt by NGD. Through this case report, we aim to identify future opportunities to tailor aspects of risk assessment for patients who may have occupational access to tools such as nail guns, as this should be a consideration when screening for risk and safety planning. [ Psychiatr Ann . 2023;53(11):525–527.]
{"title":"Suicide Attempt by Successive Nail Gun Discharges to the Head and Chest: A Case Report","authors":"Patrick Ho, Ayesha Haq, Laura Taylor, Eleonora Sikic-Klisovic, David Kasick","doi":"10.3928/00485713-20231003-01","DOIUrl":"https://doi.org/10.3928/00485713-20231003-01","url":null,"abstract":"As firearms are frequently used in suicide attempts, there is wide recognition of this potential danger with restrictions and barriers present in many jurisdictions to limit the purchase and possession of firearms. However since nail guns were introduced in the 1950s, nail gun discharge (NGD) injuries have been an increasing phenomenon due to more widespread availability and ease of use without restrictions on possession. Although existing literature has described suicide attempts by NGD to single body sites, reports of injuries to multiple body sites are rarer. In this case report, we present the case of a patient who survived multiple, severe, self-inflicted penetrating wounds secondary to a suicide attempt by NGD. Through this case report, we aim to identify future opportunities to tailor aspects of risk assessment for patients who may have occupational access to tools such as nail guns, as this should be a consideration when screening for risk and safety planning. [ Psychiatr Ann . 2023;53(11):525–527.]","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"23 10","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135455886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.3928/00485713-20231030-01
Andrew A. Nierenberg
{"title":"Lithium, Life Span, and Aging","authors":"Andrew A. Nierenberg","doi":"10.3928/00485713-20231030-01","DOIUrl":"https://doi.org/10.3928/00485713-20231030-01","url":null,"abstract":"","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"47 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135455115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.3928/00485713-20230828-01
Meghan M. Mallya, Michael S. Miller
A 43-year-old man presented with three episodes of priapism in 4 weeks following testosterone replacement therapy and mirtazapine use. He previously had a two-episode history of priapism 5 years ago after taking trazodone. The exact mechanism for mirtazapine-induced priapism is unclear. However, the timing of the patient's priapism onset suggests that mirtazapine was driving these episodes. Given the unusual circumstances of this case, there may be patient-specific risk factors for recurrent priapism, such as a history of priapism. Therefore, careful use of mirtazapine is advised in patients with previous episodes of priapism. Furthermore, men taking mirtazapine should be informed of the signs and symptoms of priapism and advised to seek medical attention if they experience prolonged erections. [ Psychiatr Ann . 2023;53(10):482–484.]
{"title":"Association Between Mirtazapine Use and Priapism in a Middle-Aged Man: A Case Report","authors":"Meghan M. Mallya, Michael S. Miller","doi":"10.3928/00485713-20230828-01","DOIUrl":"https://doi.org/10.3928/00485713-20230828-01","url":null,"abstract":"A 43-year-old man presented with three episodes of priapism in 4 weeks following testosterone replacement therapy and mirtazapine use. He previously had a two-episode history of priapism 5 years ago after taking trazodone. The exact mechanism for mirtazapine-induced priapism is unclear. However, the timing of the patient's priapism onset suggests that mirtazapine was driving these episodes. Given the unusual circumstances of this case, there may be patient-specific risk factors for recurrent priapism, such as a history of priapism. Therefore, careful use of mirtazapine is advised in patients with previous episodes of priapism. Furthermore, men taking mirtazapine should be informed of the signs and symptoms of priapism and advised to seek medical attention if they experience prolonged erections. [ Psychiatr Ann . 2023;53(10):482–484.]","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135607498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.3928/00485713-20230911-05
David W. Goodman, Greg Mattingly
Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder arising in children that persists in many people for the remainder of their lives. While several diagnostic and treatment guidelines in the United States (US) have been developed for childhood ADHD, no guidelines have been published in the US for adults with ADHD. With the increase of care seeking by adults with ADHD accompanied by increasing ADHD medication prescriptions in the past few years, the American Professional Society for ADHD and Related Disorders Association (APSARD) has recognized the need for diagnostic and treatment guidelines for the US. The development of clinical practice guidelines follows a rigorous scientific process of literature review, conflict of interest management, levels of participation of the working group members, clinical recommendations based on published research, a ranking of the quality of data, and a Delphi process to evaluate the rank order of clinical recommendations with little published research available. The Institute of Medicine (now The National Academy of Medicine) and the American Psychiatric Association have established protocols for each of the aforementioned phases of the manuscript development. This article reviews this process in detail and conveys the complexity of the endeavor. [ Psychiatr Ann . 2023;53(10):449–454.]
{"title":"Practice Guidelines Development: The APSARD United States Guidelines for the Diagnosis and Treatment of ADHD in Adults","authors":"David W. Goodman, Greg Mattingly","doi":"10.3928/00485713-20230911-05","DOIUrl":"https://doi.org/10.3928/00485713-20230911-05","url":null,"abstract":"Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder arising in children that persists in many people for the remainder of their lives. While several diagnostic and treatment guidelines in the United States (US) have been developed for childhood ADHD, no guidelines have been published in the US for adults with ADHD. With the increase of care seeking by adults with ADHD accompanied by increasing ADHD medication prescriptions in the past few years, the American Professional Society for ADHD and Related Disorders Association (APSARD) has recognized the need for diagnostic and treatment guidelines for the US. The development of clinical practice guidelines follows a rigorous scientific process of literature review, conflict of interest management, levels of participation of the working group members, clinical recommendations based on published research, a ranking of the quality of data, and a Delphi process to evaluate the rank order of clinical recommendations with little published research available. The Institute of Medicine (now The National Academy of Medicine) and the American Psychiatric Association have established protocols for each of the aforementioned phases of the manuscript development. This article reviews this process in detail and conveys the complexity of the endeavor. [ Psychiatr Ann . 2023;53(10):449–454.]","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135654210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.3928/00485713-20230911-06
Lenard A. Adler
{"title":"Development of United States Guidelines for the Diagnosis and Treatment of Adults With ADHD","authors":"Lenard A. Adler","doi":"10.3928/00485713-20230911-06","DOIUrl":"https://doi.org/10.3928/00485713-20230911-06","url":null,"abstract":"","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"129 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135655644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.3928/00485713-20230911-02
Deepti Anbarasan, Stephen V. Faraone, Lenard A. Adler
The limited recognition and treatment of attention-deficit/hyperactivity disorder (ADHD) in adults has been studied in the research setting and addressed in the clinical education setting during recent years. Despite these efforts, health care professionals continue to struggle with the management of adult ADHD in everyday practice. To better evaluate and measure meaningful practice metrics, a set of 10 key quality measures (QMs) that can help improve health care outcomes in adult ADHD was identified using a combination of evidence-based literature reviews and expert consensus. Subsequently, these QMs were field-tested in a sample of 71,310 adult ADHD patients in the primary care setting and behavioral health clinics over the course of a decade to assess whether these measures were attained. The results allowed us to understand how the clinician approach to diagnosing and treating ADHD has evolved in the past few years and highlighted the ongoing challenges in practice variation by clinicians caring for patients with adult ADHD. In turn, this information also guides our understanding of the next steps needed to improve the quality of care provided to adults with ADHD in different care settings. Accordingly, the American Professional Society of ADHD and Related Disorders (APSARD) assembled a guidelines committee to create a set of clinical practice guidelines to provide practitioners with a standardized, evidence-based approach to diagnosing and treating ADHD in adults. [ Psychiatr Ann . 2023;53(10):444–448.]
{"title":"Update on Identifying and Evaluating Quality Measures for Adult Attention-Deficit/Hyperactivity Disorder","authors":"Deepti Anbarasan, Stephen V. Faraone, Lenard A. Adler","doi":"10.3928/00485713-20230911-02","DOIUrl":"https://doi.org/10.3928/00485713-20230911-02","url":null,"abstract":"The limited recognition and treatment of attention-deficit/hyperactivity disorder (ADHD) in adults has been studied in the research setting and addressed in the clinical education setting during recent years. Despite these efforts, health care professionals continue to struggle with the management of adult ADHD in everyday practice. To better evaluate and measure meaningful practice metrics, a set of 10 key quality measures (QMs) that can help improve health care outcomes in adult ADHD was identified using a combination of evidence-based literature reviews and expert consensus. Subsequently, these QMs were field-tested in a sample of 71,310 adult ADHD patients in the primary care setting and behavioral health clinics over the course of a decade to assess whether these measures were attained. The results allowed us to understand how the clinician approach to diagnosing and treating ADHD has evolved in the past few years and highlighted the ongoing challenges in practice variation by clinicians caring for patients with adult ADHD. In turn, this information also guides our understanding of the next steps needed to improve the quality of care provided to adults with ADHD in different care settings. Accordingly, the American Professional Society of ADHD and Related Disorders (APSARD) assembled a guidelines committee to create a set of clinical practice guidelines to provide practitioners with a standardized, evidence-based approach to diagnosing and treating ADHD in adults. [ Psychiatr Ann . 2023;53(10):444–448.]","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136117407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.3928/00485713-20230911-03
Thomas J. Spencer, Olivia Descorbeth, Frances R. Levin
Clinical practice guidelines (CPGs) require skilled contributors who may have conflicts of interest (COI) that need to be assessed and managed to minimize possible biased influence. Different organizations have unique COI management policies depending on their available expertise, circumstances, and judgment. To inform the development of the American Professional Society of ADHD and Related Disorders (APSARD) COI management procedures, we reviewed the literature. Because there are no CPGs for adult attention-deficit/hyperactivity disorder (ADHD) in the United States, we reviewed COI management policies of related CPGs with a focus on ADHD. There were many common elements, including matching levels of permitted involvement with type of COI. Examples included withdrawals from industry activities and limitations on participation in discussions, deliberations, and/or voting on specific matters. Due to the complexities of COIs, it is impossible to fully operationalize COI management. Ultimately, management of COIs is determined after review by the co-chairs and steering committee in discussion with the task force member. [ Psychiatr Ann . 2023;53(10):455–460.]
{"title":"Conflict of Interest Management in Adult Attention-Deficit/Hyperactivity Disorder Clinical Practice Guidelines","authors":"Thomas J. Spencer, Olivia Descorbeth, Frances R. Levin","doi":"10.3928/00485713-20230911-03","DOIUrl":"https://doi.org/10.3928/00485713-20230911-03","url":null,"abstract":"Clinical practice guidelines (CPGs) require skilled contributors who may have conflicts of interest (COI) that need to be assessed and managed to minimize possible biased influence. Different organizations have unique COI management policies depending on their available expertise, circumstances, and judgment. To inform the development of the American Professional Society of ADHD and Related Disorders (APSARD) COI management procedures, we reviewed the literature. Because there are no CPGs for adult attention-deficit/hyperactivity disorder (ADHD) in the United States, we reviewed COI management policies of related CPGs with a focus on ADHD. There were many common elements, including matching levels of permitted involvement with type of COI. Examples included withdrawals from industry activities and limitations on participation in discussions, deliberations, and/or voting on specific matters. Due to the complexities of COIs, it is impossible to fully operationalize COI management. Ultimately, management of COIs is determined after review by the co-chairs and steering committee in discussion with the task force member. [ Psychiatr Ann . 2023;53(10):455–460.]","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"280 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136117408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-01DOI: 10.3928/00485713-20230911-04
Ann Childress, Maggie Sibley, Mary V. Solanto, Max Wiznitzer, Jeffrey H. Newcorn
Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder that begins in childhood and frequently persists into adulthood. During the past two decades, impairment from persisting ADHD symptoms has increasingly been recognized, and along with it, an increase in the number of adults being diagnosed and treated. Medication treatment of adults with ADHD can decrease the long-term negative impact of ADHD symptoms and behavioral interventions can improve executive function. Educational interventions designed to improve clinician knowledge and practice toward ADHD have been shown to be effective. However, although there are professional guidelines for the assessment and treatment of ADHD in children and adolescents in the United States (US), there are no guidelines for adults. This is increasingly problematic given the large number of adults being diagnosed and treated, and the range of professionals offering this treatment. The development of US guidelines for ADHD offers the potential to improve healthcare outcomes by standardizing care among clinicians with differing levels of expertise. [ Psychiatr Ann . 2023;53(10):461–469.]
{"title":"Guidelines in the United States for the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Adults: Why They Are Needed","authors":"Ann Childress, Maggie Sibley, Mary V. Solanto, Max Wiznitzer, Jeffrey H. Newcorn","doi":"10.3928/00485713-20230911-04","DOIUrl":"https://doi.org/10.3928/00485713-20230911-04","url":null,"abstract":"Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral disorder that begins in childhood and frequently persists into adulthood. During the past two decades, impairment from persisting ADHD symptoms has increasingly been recognized, and along with it, an increase in the number of adults being diagnosed and treated. Medication treatment of adults with ADHD can decrease the long-term negative impact of ADHD symptoms and behavioral interventions can improve executive function. Educational interventions designed to improve clinician knowledge and practice toward ADHD have been shown to be effective. However, although there are professional guidelines for the assessment and treatment of ADHD in children and adolescents in the United States (US), there are no guidelines for adults. This is increasingly problematic given the large number of adults being diagnosed and treated, and the range of professionals offering this treatment. The development of US guidelines for ADHD offers the potential to improve healthcare outcomes by standardizing care among clinicians with differing levels of expertise. [ Psychiatr Ann . 2023;53(10):461–469.]","PeriodicalId":20917,"journal":{"name":"Psychiatric Annals","volume":"2015 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135655640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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