British Journal of Sports Medicine最新文献

{"title":"Why exercise may never be effective medicine: an evolutionary perspective on the efficacy versus effectiveness of exercise in treating type 2 diabetes.","authors":"Christopher MacDonald, Mia Bennekou, Julie Midtgaard, Hennig Langberg, Daniel Lieberman","doi":"10.1136/bjsports-2024-108396","DOIUrl":"10.1136/bjsports-2024-108396","url":null,"abstract":"<p><p>Most cases of type 2 diabetes (T2D) can be prevented by adopting a healthy lifestyle, highlighting that lifestyle modifications should be the primary defence against developing T2D. Although accumulating evidence suggests that exercise can be an efficacious therapy for T2D, especially in conjunction with pharmacological interventions, its long-term effectiveness remains controversial owing to significant adherence challenges. In this narrative review, we combine an evolutionary perspective with epidemiological and prospective interventional studies to examine the efficacy versus effectiveness of varying volumes of exercise prescriptions for treating T2D. Commonly prescribed and recommended volumes of moderate-intensity physical activity (150 min/week) have demonstrated low-to-moderate efficacy in improving glycaemic control, reflected by improvements in glycated haemoglobin levels. Higher exercise volumes have been shown to enhance efficacy. While exercise can be moderately efficacious under the optimal circumstances of short-term exercise interventions (≤1 year), there is little evidence of its long-term effectiveness, primarily due to poor adherence. To date, no study has demonstrated long-term adherence to exercise programmes in individuals with T2D (>1 year). From an evolutionary perspective, the finding that exercise interventions are often ineffective over time is unsurprising. Although often overlooked, humans never evolved to exercise. Exercise is a counter-instinctive behaviour that can be difficult to maintain, even in healthy populations and can be especially challenging for individuals who are unfit or have T2D morbidities. We conclude by presenting several considerations informed by evolutionary logic that may be useful for practitioners, policymakers and advocates of exercise as medicine to improve exercise adherence.</p>","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":" ","pages":"118-125"},"PeriodicalIF":11.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of sports psychiatry: a clinical intersection of mental health and physical activity","authors":"Malte Christian Claussen, David Prossor, Carolyn Nahman, James W Burger, David Baron, Carla Edwards, Ira D Glick","doi":"10.1136/bjsports-2024-109208","DOIUrl":"https://doi.org/10.1136/bjsports-2024-109208","url":null,"abstract":"Long before the term ‘sports psychiatry’ was first introduced nearly 40 years ago,1 2 clinicians and academics recognised the critical role of mental and brain health in sports. For example, Jokl and Guttmann explored neurological and psychiatric studies in boxers as far back as 1932.3 More recently, with efforts spanning the last 30 years, the International Society for Sports Psychiatry (ISSP) has driven development of this field of medicine and psychiatry in the world of competitive and elite sports.4 However, the aim of sports psychiatry is not only to bring more psychiatric expertise into the care of athletes but also to bring more sport and exercise into psychiatry5 (figure 1). This multinational editorial aims to create awareness of the role of exercise medicine in psychiatric disease and advance the integration of sports psychiatry into the care of athletes by sports medicine professionals globally. Figure 1 The evolution of sports psychiatry. The definition and skill set of the sports psychiatrist is outlined in the recently published First International Consensus Statement on Sports Psychiatry.5 Sports psychiatrists complete medical and psychiatric training before specialising in sports psychiatry. The Role of a Sport Psychiatrist on the Sports Medicine Team, Circa 2021 by Stull and Glick et al comprehensively sets out the wide range of roles, relationships and impact that a sports psychiatrist has within a sports medicine setting.6 These included awareness of gender-specific treatment, drug and alcohol disorders, racial discrimination and trauma, treating athletes, coaches and their support personnel. Finally, Glick and Reardon et al emphasised the importance of early detection of mental distress in their paper titled Sports Psychiatry: An Update and the Emerging Role of the Sports Psychiatrist on the Sports Medicine Team.7 They highlight that early and appropriate intervention by a sports psychiatrist may potentially prevent …","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"27 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Road cones of medicine","authors":"Blair Jarratt","doi":"10.1136/bjsports-2024-109531","DOIUrl":"https://doi.org/10.1136/bjsports-2024-109531","url":null,"abstract":"They invade our lives at some point or another. At times, they cause us intense angst, and other times, we pass by without thinking about what they mean—blending into the background. So why am I talking about road cones in the warm-up for BJSM? They could symbolise us, medicine, the journey. In New Zealand, it has been reported that we have more of these than people; the road cone numbers have surpassed our national icon—the humble sheep. Road cones might be a symbol of repair or a symbol of progress—that is your perspective. I am just back from a fantastic weekend at our Sports and Exercise Physiotherapy New Zealand (SEPNZ) conference. Our Physiotherapy Keynote speakers, Tania Pizzari and Sally McLaine, made the trek across the ditch from Australia to New …","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"3 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk for exertional heat illness among US army enlistees: climate indexes, intrinsic factors and their interactions","authors":"Josh B Kazman, D Alan Nelson, Anwar E Ahmed, Patricia A Deuster, Francis G O'Connor, James D Mancuso, Stephen A Lewandowski","doi":"10.1136/bjsports-2024-108441","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108441","url":null,"abstract":"Objectives To characterise intrinsic and extrinsic (climatic) risks for mild and severe exertional heat illness (EHI) among first-year army enlistees. Methods We examined 337 786 soldiers who enlisted between 2012 and 2019. Survival models were used to predict incident EHI from intrinsic factors (demographics, healthcare utilisation, chronic conditions, body mass index (BMI), Army Physical Fitness Test (APFT), upper/lower respiratory tract infections (URTI and LRTI), skin and soft-tissue infections (SSTI), extrinsic factors (geographical region, daily mean Universal Thermal Climate Index (UTCI), wet bulb globe temperature (WBGT)) and interactions. Results There were 1390 cases of mild and 359 cases of severe EHI. Females had a higher risk for mild (adjusted OR (aOR) 1.78; 95% CI 1.57 to 2.02) but a lower risk for severe (aOR 0.61; 95% CI 0.38 to 0.87) EHI. Obesity was associated with severe EHI (aOR: 1.76; 95% CI 1.09 to 2.84) but not mild EHI (aOR: 1.03; 95% CI 0.76 to 1.39). URTI was associated with severe (aOR: 2.44; 95% CI 1.12 to 5.30) and mild (aOR 3.72, 95% CI 2.84 to 4.87) EHI, as were LRTI (severe, aOR: 11.40; 95% CI 6.09 to 21.32; mild, aOR 2.06; 95% CI 1.22 to 3.46), but not SSTI. UTCI outperformed WBGT in predicting EHI. Outside the Southern USA, EHI risk was elevated at lower UTCI. Associations varied over climate conditions and generally did not increase with climatic heat stress. Conclusions Respiratory infections were associated with the highest risk for EHI in soldiers. Risk mitigation strategies may include monitoring prevention and recovery from respiratory infections. Female sex and obesity may have different associated risks over climate conditions. No data are available. Data are derived from official population military records and sources, and were provided to us under strict data use agreement guidelines. Therefore, we cannot reasonably share the data with outside parties. We are willing to share our code to other researchers with access to similar data.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"133 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142886951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards evidence-based breast protective equipment in contact, combat and pseudo-contact sport","authors":"Celeste E Coltman, Isabel S Moore, Daniel S Cottam, Susan L Sokolowski, Elisabeth MP Williams, Eddi Pianca, Sam Tomkins, Brooke R Brisbine","doi":"10.1136/bjsports-2024-108750","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108750","url":null,"abstract":"The use of breast protective equipment has been recommended as a potential injury prevention strategy to reduce the frequency and severity of breast injury.1 2 However, no research has evaluated the efficacy of breast protective equipment as an injury prevention strategy.1 3 The aim of this editorial is to outline the current state of play for breast protective equipment as an injury prevention strategy and the current use of breast protective equipment in contact, combat and pseudo-contact sports. We highlight the need to evaluate the efficacy of breast protective equipment and propose steps towards the development of evidence-based breast protection. Female breasts are susceptible to injury when women participate in contact and combat sports, as well as pseudo-contact sports (in which contact between players is permitted to limited extent, eg, basketball and water polo), due to their anatomical position on the front of the torso and lack of musculoskeletal protection.1 3 Indeed, a high prevalence of contact breast injuries have been reported in sports such as Rugby 7s, Rugby League, Australian Football, Basketball, Softball, Volleyball, Water Polo and Soccer.4–7 Breast injuries are known to negatively affect sporting performance6 7 and contribute to acute (eg, painful, swollen or bruised breast tissue) and long-term health impacts (eg, damage to the ductal system of lactating breasts and breast implant rupture).8 9 Discomfort associated with breast injuries may also act as a barrier to participation for girls and women in contact, combat and pseudo-contact sports. As such, a growing body of research has recommended the use of specialised breast …","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"291 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142884380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application of the IOC Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) across 200+ elite athletes.","authors":"Ida A Heikura, Walter T P McCluskey, Ming-Chang Tsai, Liz Johnson, Holly Murray, Margo Mountjoy, Kathryn E Ackerman, Matthew Fliss, Trent Stellingwerff","doi":"10.1136/bjsports-2024-108121","DOIUrl":"10.1136/bjsports-2024-108121","url":null,"abstract":"<p><strong>Objective: </strong>This cross-sectional retrospective and prospective study implemented the 2023 International Olympic Committee Relative Energy Deficiency in Sport (REDs) Clinical Assessment Tool version 2 (CAT2) to determine the current severity of REDs (primary outcome) and future risk of bone stress injuries (BSI, exploratory outcome) in elite athletes.</p><p><strong>Methods: </strong>Female (n=143; 23.3±4.3 years) and male (n=70; 23.1±3.7 years) athletes (performance tier 3 (52%), tier 4 (36%), tier 5 (12%)) participated in a baseline CAT2 (with minor modifications) assessment, including a self-report questionnaire (menstrual function (females), BSI, Eating Disorder Examination Questionnaire (EDE-Q)), bone mineral density (BMD via DXA) and fasted blood analysis (triiodothyronine (T3), testosterone, cholesterol). Athletes were assigned a green, yellow, orange or red light via CAT2. The prospective risk of new self-report of physician-diagnosed BSI was assessed over a subsequent 6-24 months.</p><p><strong>Results: </strong>REDs prevalence was 55% green, 36% yellow, 5% orange and 4% red light. The CAT2 identified a greater prevalence of amenorrhoea and BSI and lower T3, testosterone and BMD (p<0.01) in red, orange and yellow (those with REDs) versus green light. ORs for a prospective self-reported BSI (majority physician diagnosed) were greater in orange vs green (OR 7.71, 95% CI (1.26 to 39.83)), in females with severe amenorrhoea (OR 4.6 (95% CI 0.98 to 17.85)), in males with low sex drive (OR 16.0 (95% CI 4.79 to 1038.87)), and athletes with elevated EDE-Q global scores (OR 1.45 (95% CI 0.97 to 1.97)).</p><p><strong>Conclusion: </strong>The CAT2 has high validity in demonstrating current severity of REDs, with increased future risk of self-reported BSI in athletes with a more severe REDs traffic light category.</p>","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":" ","pages":"24-35"},"PeriodicalIF":11.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dr Diamond plays his part to save the heart!","authors":"Anusha Lekshminarayanan, Amy Valasek","doi":"10.1136/bjsports-2024-109134","DOIUrl":"https://doi.org/10.1136/bjsports-2024-109134","url":null,"abstract":"Survival from out-of-hospital sudden cardiac arrest (SCA) is roughly 10%.1 Higher rates of survival are achieved by the administration of prompt cardiopulmonary resuscitation (CPR) and early defibrillation.1–3 Bystander administered CPR improves survival by approximately three-fold.4 Without an automated external defibrillator (AED) available on-site after an exercise-related SCA, neurological impairment is estimated at 90%.5 Yet, public awareness of the importance of AEDs for survival is relatively low.6 While annual screening to identify common structural or electrical cardiac conditions is still debated, the importance of timely CPR and AED application cannot be overstated.7 In 1999, Project ADAM was launched in the USA in honour of a multisport high school athlete, Adam, who collapsed during a basketball game. Despite CPR, an AED was not used during his event, and Adam did not survive his SCA. Initially begun by Dr. Stuart Berger (a paediatric cardiologist in Wisconsin), today, there are over 40 Project ADAM affiliate healthcare sites active across the USA. Through this initiative, many schools, summer camps, youth sports programmes, day care centres …","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"24 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142867303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Elite para athletes with active coping behaviour are less likely to report a sports injury","authors":"Kristina Fagher, Linda Sällström, Örjan Dahlström, Jenny Jacobsson, Toomas Timpka, Jan Lexell","doi":"10.1136/bjsports-2024-108192","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108192","url":null,"abstract":"Objective Elite para athletes report a high incidence of sports injuries. Research suggests that athletes’ strategies to manage adversities may influence the sports injury risk, but knowledge about para athletes’ coping behaviours and their association with injuries is limited. The aim was to describe the distribution of coping behaviours in Swedish elite para athletes by sex, age, impairment, sport and to examine associations between coping behaviours and the probability of reporting a prospective sports injury during a 52-week study period. Method Eighty-three para athletes participating in the ‘Sports-related injuries and illnesses in Paralympic sport study’ completed the Brief COPE Inventory. Over the following 52 weeks, athletes reported any sports injuries they sustained. The analysis of coping behaviours comprised descriptive statistics and linear regression, and associations between coping behaviour and the probability of being injured were examined by logistic regression analyses. Results The most frequently used coping behaviours were acceptance, active coping and planning. The most common less-useful coping behaviour was self-blame. Athletes with more active coping behaviours were less likely to report an injury, and using humour as coping behaviour was associated with a higher probability of injury among young athletes. Also, athletes with physical impairment reported a higher use of active coping and emotional support compared with athletes with visual impairment, and athletes participating in individual sports used acceptance as a coping behaviour to a larger extent than athletes in team sports. Conclusion Use of active coping in Swedish elite para athletes was associated with a lower likelihood of reporting an injury. Young athletes using humour as a coping strategy had a higher likelihood of reporting an injury. The results suggest that support of active coping behaviours and a sport context fostering help-seeking behaviours should be considered in future prevention measures. Data are available upon reasonable request.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"89 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142867304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Questioning the rules of engagement: a critical analysis of the use of limb symmetry index for safe return to sport after anterior cruciate ligament reconstruction","authors":"Rebecca Simonsson, Axel Sundberg, Ramana Piussi, Johan Högberg, Carl Senorski, Roland Thomeé, Kristian Samuelsson, Francesco Della Villa, Eric Hamrin Senorski","doi":"10.1136/bjsports-2024-108079","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108079","url":null,"abstract":"Objective To evaluate the association between limb symmetry index (LSI) in quadriceps and hamstrings strength together with hop tests, as a proxy of recovery, and the deviation from being symmetrical (LSI 100%), with a safe return to sport (RTS) after anterior cruciate ligament reconstruction (ACL-R). Methods Athletes between 15 and 30 years old with a preinjury Tegner activity level ≥6 were eligible for inclusion. Data were extracted from a rehabilitation-specific registry, Project ACL (Gothenburg, Sweden) at the time of or after RTS for each athlete. The outcome of interest in this study was a safe RTS—not suffering a second ACL injury within 2 years from RTS—addressed by using the LSI in five different ways with results from the test battery which include five tests of muscle function at or after the time of RTS. Logistic regression analyses were performed with safe RTS as a dependent variable and presented with ORs and 95% CIs. Results In total, 233 athletes (51.1% women) were included. The best-differentiating cut-offs for strength and hop tests showed non-significantly poor discriminatory ability between athletes who had a safe RTS and those who did not (Youden J 0.09–0.24 and area under the curve 0.50–0.59). Athletes who had ≥80% or ≥85% LSI had significantly lower odds of safe RTS compared with athletes who did not meet the cut-offs of safe RTS (OR=0.32 (95% CI 0.12 to 0.87) and OR=0.39 (95% CI 0.18 to 0.84), respectively). There was no effect of a 1% increase in LSI or deviation from 100% symmetry on safe RTS. Conclusion The use of LSI from tests of muscle function to determine safe RTS after ACL-R, that is, RTS without sustaining a second ACL injury within 2 years, cannot differentiate between athletes who had a safe RTS and those who did not, regardless of whether LSI was used as cut-offs, incremental or as deviation from symmetry. Thus, it is of clinical importance that clinicians do not solely rely on the LSI to clear athletes for RTS. Data are available on reasonable request. Data can be obtained on request due to privacy reasons and ethical statements.","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"40 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142867305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dr David Sabgir and Walk with a Doc—every step counts","authors":"Amy Valasek, Anusha Lekshminarayanan","doi":"10.1136/bjsports-2024-108983","DOIUrl":"https://doi.org/10.1136/bjsports-2024-108983","url":null,"abstract":"Physical activity is a universal prescription that benefits people of all ages. From childhood to adulthood, movement is important for the human development, health and wellness.1–3 Yet across all continents, populations remain physically inactive leading to a rise in health comorbidities and chronic disease.4–6 Sports medicine physicians are faced with inactive populations in clinical practice and are uniquely positioned to confront this enormous challenge. The integration of exercise medicine and physical activity promotion into training curricula for medical students, residents and sports medicine fellowships is key to facilitate change.7–12 Each step towards physical activity promotion clinically could lead to healthier populations. Dr David Sabgir, an adult cardiologist in Ohio, is a great example of a singular physician who incorporated physical activity promotion into his clinical practice to make a global impact. He grew increasingly frustrated with his inability to effectively change his patients’ inactivity. The thousands of conversations he had with patients regarding the importance of physical activity for health were not fruitful nor were the exercise prescriptions or follow-up …","PeriodicalId":9276,"journal":{"name":"British Journal of Sports Medicine","volume":"76 1","pages":""},"PeriodicalIF":18.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142867277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}