Ro-Ting Lin, Hathaichon Boonhat, Yu-Yu Lin, Sonja Klebe, Ken Takahashi
{"title":"Health Effects of Occupational and Environmental Exposures to Nuclear Power Plants: A Meta-Analysis and Meta-Regression.","authors":"Ro-Ting Lin, Hathaichon Boonhat, Yu-Yu Lin, Sonja Klebe, Ken Takahashi","doi":"10.1007/s40572-024-00453-8","DOIUrl":"10.1007/s40572-024-00453-8","url":null,"abstract":"<p><strong>Purpose of review: </strong>Numerous epidemiological studies have shown increased health risks among workers and residents living near nuclear power plants exposed to radiation levels meeting regulatory dose limits. This study aimed to evaluate the association between radiation exposure and disease risks among these populations exposed to radiation levels meeting the current regulatory dose limits.</p><p><strong>Recent findings: </strong>We searched four databases (Cochrane Library, PubMed, ScienceDirect, and Web of Science) for studies published before August 2023, screened eligible studies (inclusion and exclusion criteria based on population, exposure, comparator, and outcome framework), and collected data on exposure indicators and disease risks. We applied random-effects models of meta-analysis to estimate the pooled effects and meta-regression to assess the dose-response relationship (radiation dose rate for workers and distance for residents). We identified 47 studies, 13 with worker and 34 with resident samples, covering 175 nuclear power plants from 17 countries, encompassing samples of 480,623 workers and 7,530,886 residents. Workers had a significantly lower risk for all-cancer and a significantly higher risk for mesothelioma. Residents had significantly higher risks for all-cancer, thyroid cancer, and leukemia. Notably, children under 5 years old showed the highest risk for all-cancer. Our meta-regression showed a significantly positive dose-response relationship between cumulative dose of radiation exposure and risk for circulatory disease among workers. Our findings demonstrated higher risks for mesothelioma for workers and all-cancer, thyroid cancer, and leukemia for residents exposed to low-dose radiation from nuclear power plants. Some included studies did not adjust for cancer risk confounders, which could overestimate the association between radiation exposure and cancer risk and increase the risk of bias.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"329-339"},"PeriodicalIF":7.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141418288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Megan C Hansel, Abigail M Rosenberg, Carolyn W Kinkade, Camila Capurro, Zorimar Rivera-Núñez, Emily S Barrett
{"title":"Exposure to Synthetic Endocrine-Disrupting Chemicals in Relation to Maternal and Fetal Sex Steroid Hormones: A Scoping Review.","authors":"Megan C Hansel, Abigail M Rosenberg, Carolyn W Kinkade, Camila Capurro, Zorimar Rivera-Núñez, Emily S Barrett","doi":"10.1007/s40572-024-00455-6","DOIUrl":"10.1007/s40572-024-00455-6","url":null,"abstract":"<p><strong>Purpose of review: </strong>Many synthetic endocrine-disrupting chemicals (EDCs) are ubiquitous in the environment and highly detected among pregnant people. These chemicals may disrupt maternal and/or fetal sex steroid hormones, which are critical to pregnancy maintenance and fetal development. Here, we review the epidemiological literature examining prenatal exposure to common synthetic EDCs in relation to maternal and fetal sex steroid hormones.</p><p><strong>Recent findings: </strong>We performed a literature search using PubMed, SCOPUS, and Embase, ultimately identifying 29 articles for full review. Phenols, parabens, and persistent organic pollutants generally showed inverse associations with androgens, estrogens, and progesterone. Phthalates and per-and polyfluoroalkyl substances tended to be inversely associated with progesterone, while evidence regarding androgens and estrogens was mixed. Inconsistent, but noteworthy, differences by fetal sex and timing of exposure/outcome were observed. Overall, the literature suggests EDCs may disrupt maternal and fetal sex steroid activity, though findings are mixed. Given the pervasive, high-volume production of these synthetic chemicals and the critical functions sex steroid hormones play during gestation, additional research is warranted.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"356-379"},"PeriodicalIF":7.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Emily S Barrett, Jennifer L Ames, Stephanie M Eick, Alicia K Peterson, Zorimar Rivera-Núñez, Anne P Starling, Jessie P Buckley
{"title":"Advancing Understanding of Chemical Exposures and Maternal-child Health Through the U.S. Environmental Influences on Child Health Outcomes (ECHO) Program: A Scoping Review.","authors":"Emily S Barrett, Jennifer L Ames, Stephanie M Eick, Alicia K Peterson, Zorimar Rivera-Núñez, Anne P Starling, Jessie P Buckley","doi":"10.1007/s40572-024-00456-5","DOIUrl":"10.1007/s40572-024-00456-5","url":null,"abstract":"<p><strong>Purpose of review: </strong>Environmental chemical exposures may disrupt child development, with long-lasting health impacts. To date, U.S. studies of early environmental exposures have been limited in size and diversity, hindering power and generalizability. With harmonized data from over 60,000 participants representing 69 pregnancy cohorts, the National Institutes of Health's Environmental influences on Child Health Outcomes (ECHO) Program is the largest study of U.S. children's health. Here, we: (1) review ECHO-wide studies of chemical exposures and maternal-child health; and (2) outline opportunities for future research using ECHO data.</p><p><strong>Recent findings: </strong>As of early 2024, in addition to over 200 single-cohort (or award) papers on chemical exposures supported by ECHO, ten collaborative multi-cohort papers have been made possible by ECHO data harmonization and new data collection. Multi-cohort papers have examined prenatal exposure to per- and polyfluoroalkyl substances (PFAS), phthalates, phenols and parabens, organophosphate esters (OPEs), metals, melamine and aromatic amines, and emerging contaminants. They have primarily focused on describing patterns of maternal exposure or examining associations with maternal and infant outcomes; fewer studies have examined later child outcomes (e.g., autism) although follow up of enrolled ECHO children continues. The NICHD's Data and Specimen Hub (DASH) database houses extensive ECHO data including over 470,000 chemical assay results and complementary data on priority outcome areas (pre, peri-, and postnatal, airway, obesity, neurodevelopment, and positive health), making it a rich resource for future analyses. ECHO's extensive data repository, including biomarkers of chemical exposures, can be used to advance our understanding of environmental influences on children's health. Although few published studies have capitalized on these unique harmonized data to date, many analyses are underway with data now widely available.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"390-403"},"PeriodicalIF":7.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11324705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141562880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arce Domingo-Relloso, Maria Tellez-Plaza, Linda Valeri
{"title":"Methods for the Analysis of Multiple Epigenomic Mediators in Environmental Epidemiology.","authors":"Arce Domingo-Relloso, Maria Tellez-Plaza, Linda Valeri","doi":"10.1007/s40572-024-00436-9","DOIUrl":"10.1007/s40572-024-00436-9","url":null,"abstract":"<p><strong>Purpose of review: </strong>Epigenetic changes can be highly influenced by environmental factors and have in turn been proposed to influence chronic disease. Being able to quantify to which extent epigenomic processes are mediators of the association between environmental exposures and diseases is of interest for epidemiologic research. In this review, we summarize the proposed mediation analysis methods with applications to epigenomic data.</p><p><strong>Recent findings: </strong>The ultra-high dimensionality and high correlations that characterize omics data have hindered the precise quantification of mediated effects. Several methods have been proposed to deal with mediation in high-dimensional settings, including methods that incorporate dimensionality reduction techniques to the mediation algorithm. Although important methodological advances have been conducted in the previous years, key challenges such as the development of sensitivity analyses, dealing with mediator-mediator interactions, including environmental mixtures as exposures, or the integration of different omic data should be the focus of future methodological developments for epigenomic mediation analysis.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"109-117"},"PeriodicalIF":7.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930433","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":"Opportunities and Challenges Associated with the Uptake of Residential Clean Fuel Usage.","authors":"Darpan Das, Sohail Ahmad, Joshua Kirshner","doi":"10.1007/s40572-024-00438-7","DOIUrl":"10.1007/s40572-024-00438-7","url":null,"abstract":"<p><strong>Purpose of review: </strong>Almost 3 billion people worldwide use solid fuel for cooking and heating. This review examines (i) household energy practices and infrastructures and their influence on fuel usage in different contexts; (ii) barriers in adoption of household clean energy technologies and uses in diverse settings and population groups and (iii) potential air pollution exposure reduction in homes through using processed fuel.</p><p><strong>Recent findings: </strong>Population health burden from solid fuel combustion-derived particulate air pollution has been estimated in several low- and middle-income countries. However, such studies have not been carried out in high income countries (e.g., UK). Irrespective of the region, fuel prices are the most dominant factor influencing the choice of fuel. Laboratory studies suggest processed fuel - pellets and briquettes - reduce particulate matter emissions by 70-80% and can be a promising alternative. Adoption of clean fuels for domestic energy needs facilitates progress towards five of the UN Sustainable Development Goals (SDGs). There is evidence that a variety of factors, including cost savings, encourage and hinder such uptake. These factors include price fluctuations, expenses, and the usage of clean fuels. Due to their distinct development scenarios, more expansive policy frameworks, and political economies of energy, these determinants are localized in character and differ significantly amongst economies. Therefore, in order to create innovative plans for the adoption of clean fuel use, strategies centred on local settings must be developed while keeping broad socio-technical and socio-economic issues in mind. Solid fuel processing - pelletization and briquetting - have the potential to reach Liquefied Petroleum Gas (LPG)-like emissions, and could be a potential strategy to mitigate exposure to household air pollution.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"204-209"},"PeriodicalIF":7.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Challenges of Air Pollution and Health in East Asia.","authors":"Xihao Du, Renjie Chen, Haidong Kan","doi":"10.1007/s40572-024-00433-y","DOIUrl":"10.1007/s40572-024-00433-y","url":null,"abstract":"<p><strong>Purpose of review: </strong>Air pollution has been a serious environmental and public health issue worldwide, particularly in Asian countries. There have been significant increases in epidemiological studies on fine particulate matter (PM<sub>2.5</sub>) and ozone pollution in East Asia, and an in-depth review of epidemiological evidence is urgent. Thus, we carried out a systematic review of the epidemiological research on PM<sub>2.5</sub> and ozone pollution in East Asia released in recent years.</p><p><strong>Recent findings: </strong>Recent studies have indicated that PM<sub>2.5</sub> and ozone are the most detrimental air pollutants to human health, resulting in substantial disease burdens for Asian populations. Many epidemiological studies of PM<sub>2.5</sub> and ozone have been mainly performed in three East Asian countries (China, Japan, and South Korea). We derived the following summary findings: (1) both short-term and long-term exposure to PM<sub>2.5</sub> and ozone could raise the risks of mortality and morbidity, emphasizing the need for continuing improvements in air quality in East Asia; (2) the long-term associations between PM<sub>2.5</sub> and mortality in East Asia are comparable to those observed in Europe and North America, whereas the short-term associations are relatively smaller in magnitude; and (3) further cohort and intervention studies are required to yield robust and precise evidence that can promote evidence-based policymaking in East Asia. This updated review presented an outline of the health impacts of PM<sub>2.5</sub> and ozone in East Asia, which may be beneficial for the development of future regulatory policies and standards, as well as for designing subsequent investigations.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"89-101"},"PeriodicalIF":7.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139697092","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 Review of the Interactive Effects of Climate and Air Pollution on Human Health in China.","authors":"Meilin Yan, Tiantian Li","doi":"10.1007/s40572-024-00432-z","DOIUrl":"10.1007/s40572-024-00432-z","url":null,"abstract":"<p><strong>Purpose of review: </strong>Through a systematic search of peer-reviewed epidemiologic studies, we reviewed the literature on the human health impacts of climate and ambient air pollution, focusing on recently published studies in China. Selected previous literature is discussed where relevant in tracing the origins.</p><p><strong>Recent findings: </strong>Climate variables and air pollution have a complex interplay in affecting human health. The bulk of the literature we reviewed focuses on the air pollutants ozone and fine particulate matter and temperatures (including hot and cold extremes). The interaction between temperature and ozone presented substantial interaction, but evidence about the interactive effects of temperature with other air pollutants is inconsistent. Most included studies used a time-series design, usually with daily mean temperature and air pollutant concentration as independent variables. Still, more needs to be studied about the co-occurrence of climate and air pollution. The co-occurrence of extreme climate and air pollution events is likely to become an increasing health risk in China and many parts of the world as climate changes. Climate change can interact with air pollution exposure to amplify risks to human health. Challenges and opportunities to assess the combined effect of climate variables and air pollution on human health are discussed in this review. Implications from epidemiological studies for implementing coordinated measures and policies for addressing climate change and air pollution will be critical areas of future work.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"102-108"},"PeriodicalIF":7.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139729222","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":"The Association Between Personal Air Pollution Exposures and Fractional Exhaled Nitric Oxide (FeNO): A Systematic Review.","authors":"Abhay Anand, Elliana Castiglia, Misti Levy Zamora","doi":"10.1007/s40572-024-00430-1","DOIUrl":"10.1007/s40572-024-00430-1","url":null,"abstract":"<p><strong>Purpose of review: </strong>Airway inflammation is a common biological response to many types of environmental exposures and can lead to increased nitric oxide (NO) concentrations in exhaled breath. In recent years, several studies have evaluated airway inflammation using fractional exhaled nitric oxide (FeNO) as a biomarker of exposures to a range of air pollutants. This systematic review aims to summarize the studies that collected personal-level air pollution data to assess the air pollution-induced FeNO responses and to determine if utilizing personal-level data resulted in an improved characterization of the relationship between air pollution exposures and FeNO compared to using only ambient air pollution exposure data.</p><p><strong>Recent findings: </strong>Thirty-six eligible studies were identified. Overall, the studies included in this review establish that an increase in personal exposure to particulate and gaseous air pollutants can significantly increase FeNO. Nine out of the 12 studies reported statistically significant FeNO increases with increasing personal PM<sub>2.5</sub> exposures, and up to 11.5% increase in FeNO per IQR increase in exposure has also been reported between FeNO and exposure to gas-phase pollutants, such as ozone, NO<sub>2,</sub> and benzene. Furthermore, factors such as chronic respiratory diseases, allergies, and medication use were found to be effect modifiers for air pollution-induced FeNO responses. About half of the studies that compared the effect estimates using both personal and ambient air pollution exposure methods reported that only personal exposure yielded significant associations with FeNO response. The evidence from the reviewed studies confirms that FeNO is a sensitive biomarker for air pollutant-induced airway inflammation. Personal air pollution exposure assessment is recommended to accurately assess the air pollution-induced FeNO responses. Furthermore, comprehensive adjustments for the potential confounding factors including the personal exposures of the co-pollutants, respiratory disease status, allergy status, and usage of medications for asthma and allergies are recommended while assessing the air pollution-induced FeNO responses.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"210-224"},"PeriodicalIF":7.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11180488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139930434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Health-Related and Learning Performance Effects of Air Pollution and Other Urban-Related Environmental Factors on School-Age Children and Adolescents-A Scoping Review of Systematic Reviews.","authors":"Inés Valls Roche, Mònica Ubalde-Lopez, Carolyn Daher, Mark Nieuwenhuijsen, Mireia Gascon","doi":"10.1007/s40572-024-00431-0","DOIUrl":"10.1007/s40572-024-00431-0","url":null,"abstract":"<p><strong>Purpose of review: </strong>This scoping review aims to assess the impact of air pollution, traffic noise, heat, and green and blue space exposures on the physical and cognitive development of school-age children and adolescents. While existing evidence indicates adverse effects of transport-related exposures on their health, a comprehensive scoping review is necessary to consolidate findings on various urban environmental exposures' effects on children's development.</p><p><strong>Recent findings: </strong>There is consistent evidence on how air pollution negatively affects children's cognitive and respiratory health and learning performance, increasing their susceptibility to diseases in their adult life. Scientific evidence on heat and traffic noise, while less researched, indicates that they negatively affect children's health. On the contrary, green space exposure seems to benefit or mitigate these adverse effects, suggesting a potential strategy to promote children's cognitive and physical development in urban settings. This review underscores the substantial impact of urban exposures on the physical and mental development of children and adolescents. It highlights adverse health effects that can extend into adulthood, affecting academic opportunities and well-being beyond health. While acknowledging the necessity for more research on the mechanisms of air pollution effects and associations with heat and noise exposure, the review advocates prioritizing policy changes and urban planning interventions. This includes minimizing air pollution and traffic noise while enhancing urban vegetation, particularly in school environments, to ensure the healthy development of children and promote lifelong health.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"300-316"},"PeriodicalIF":7.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082043/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139899482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Supporting Decarbonization of Health Systems-A Review of International Policy and Practice on Health Care and Climate Change.","authors":"Emily Hough, Arielle Cohen Tanugi-Carresse","doi":"10.1007/s40572-024-00434-x","DOIUrl":"10.1007/s40572-024-00434-x","url":null,"abstract":"<p><strong>Purpose of review: </strong>Healthcare is a significant contributor of carbon emissions, which contribute to climate change. There has been an increased focus on the role healthcare should play in reducing emissions in recent years. This review, completed in September and October 2022, explored national commitments among 73 countries to reduce emissions from healthcare and the policies and delivery plans that exist to support their implementation.</p><p><strong>Recent findings: </strong>Whilst some countries such as Norway, Columbia, and Australia are working to understand current emissions and develop plans to reduce them, few have published delivery plans for meeting national targets. Broader policies and reports published to date provide a clear set of actions that healthcare can take to reduce emissions. However, more research, innovation, and service redesign will be needed to close the gap to net zero healthcare. Some health systems are already taking action to reduce their emissions. However, national incentives, including standardized metrics and reporting, can help drive broader action and pace of delivery.</p>","PeriodicalId":10775,"journal":{"name":"Current Environmental Health Reports","volume":" ","pages":"266-278"},"PeriodicalIF":7.4,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11082023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139734690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}