<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.3 20210610//EN" "JATS-journalpublishing1-3.dtd">
<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">smjournal</journal-id><journal-title-group><journal-title xml:lang="ru">Спортивная медицина: наука и практика</journal-title><trans-title-group xml:lang="en"><trans-title>Sports medicine: research and practice</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2223-2524</issn><issn pub-type="epub">2587-9014</issn><publisher><publisher-name>NEICON</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.17238/ISSN2223-2524.2018.4.16</article-id><article-id custom-type="elpub" pub-id-type="custom">smjournal-132</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ФИЗИОЛОГИЯ И БИОХИМИЯ СПОРТА</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>SPORTS PHYSIOLOGY AND BIOCHEMISTRY</subject></subj-group></article-categories><title-group><article-title>Эндокринный аспект перетренированности спортсменов</article-title><trans-title-group xml:lang="en"><trans-title>Endocrine aspect of overtraining in athletes</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Орджоникидзе</surname><given-names>З. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Ordzhonikidze</surname><given-names>Z. G.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Демидов</surname><given-names>Н. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Demidov</surname><given-names>N. A.</given-names></name></name-alternatives><email xlink:type="simple">nicolay13@mail.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Павлов</surname><given-names>В. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Pavlov</surname><given-names>V. I.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Бадтиева</surname><given-names>В. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Badtieva</surname><given-names>V. A.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Резепов</surname><given-names>А. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Rezepov</surname><given-names>A. S.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Волкова</surname><given-names>О. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Volkova</surname><given-names>O. S.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-4"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Плотников</surname><given-names>С. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Plotnikov</surname><given-names>S. G.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-5"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гвинианидзе</surname><given-names>М. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Gvinianidze</surname><given-names>M. V.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff xml:lang="ru" id="aff-1"><institution>ГАУЗ МНПЦ МРВиСМ, Клиника Спортивной Медицины, Департамент здравоохранения г. Москвы</institution><country>Russian Federation</country></aff><aff xml:lang="ru" id="aff-2"><institution>ГБУЗ Больница г. Московский, Департамент здравоохранения г. Москвы</institution><country>Russian Federation</country></aff><aff xml:lang="ru" id="aff-3"><institution>ПФК «Арсенал»</institution><country>Russian Federation</country></aff><aff xml:lang="ru" id="aff-4"><institution>ООО «Профи-Клиник»</institution><country>Russian Federation</country></aff><aff xml:lang="ru" id="aff-5"><institution>ГБУ Центр спортивной подготовки по легкой атлетике, Департамент спорта г. Москвы</institution><country>Russian Federation</country></aff><pub-date pub-type="collection"><year>2018</year></pub-date><pub-date pub-type="epub"><day>21</day><month>08</month><year>2020</year></pub-date><volume>8</volume><issue>4</issue><fpage>16</fpage><lpage>21</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Орджоникидзе З.Г., Демидов Н.А., Павлов В.И., Бадтиева В.А., Резепов А.С., Волкова О.С., Плотников С.Г., Гвинианидзе М.В., 2020</copyright-statement><copyright-year>2020</copyright-year><copyright-holder xml:lang="ru">Орджоникидзе З.Г., Демидов Н.А., Павлов В.И., Бадтиева В.А., Резепов А.С., Волкова О.С., Плотников С.Г., Гвинианидзе М.В.</copyright-holder><copyright-holder xml:lang="en">Ordzhonikidze Z.G., Demidov N.A., Pavlov V.I., Badtieva V.A., Rezepov A.S., Volkova O.S., Plotnikov S.G., Gvinianidze M.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.smjournal.ru/jour/article/view/132">https://www.smjournal.ru/jour/article/view/132</self-uri><abstract><p>Стремление к достижению целей тренировочного процесса при нерациональном применении физических нагрузок способно приводить к снижению адаптационных и резервных возможностей спортсмена. Следствием развивающихся при этом изменений со стороны эндокринной, сердечно-сосудистой и центральной нервной систем, может быть развитие синдрома перетренированности. До настоящего времени в литературе отсутствует единый подход к определению, диагностике, лечению и профилактике синдрома перетренированности. Недостаточно изучены, в первую очередь, эндокринные аспекты развития синдрома перетренированности, в частности отсутствует четкое понимание степени участия различных гормональных механизмов в его патогенезе, неоднозначны представления о возможностях использования определения уровней гормонов для диагностики данного состояния. Целью данной публикации является краткое изложение и систематизация имеющихся концепций в отношении эндокринных аспектов синдрома перетренированности.</p></abstract><trans-abstract xml:lang="en"><p>Striving to achieve the goals of the training process with the irrational use of physical activity can lead to a decrease in the adaptive and reserve capabilities of the athlete. The development of changes in the endocrine, cardiovascular and central nervous systems may result in the development of overtraining syndrome. There is no unified approach to the definition, diagnosis, treatment and prevention of overtraining syndrome in the literature up to the present day. The endocrine aspects of the development of the overtraining syndrome are not sufficiently studied. In particular, there is no clear understanding of the degree of involvement of various hormonal mechanisms in its pathogenesis and ideas about the possibilities of using hormone levels to diagnose this condition. The purpose of this publication is to summarize and systematize the available concepts regarding the endocrine aspects of the overtraining syndrome.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>синдром перетренированности</kwd><kwd>спортсмен</kwd><kwd>перегрузка</kwd><kwd>восстановление</kwd><kwd>тестостерон</kwd><kwd>кортизол</kwd><kwd>пролактин</kwd></kwd-group><kwd-group xml:lang="en"><kwd>overtraining syndrome</kwd><kwd>athlete</kwd><kwd>overload</kwd><kwd>recovery</kwd><kwd>testosterone</kwd><kwd>cortisol</kwd><kwd>prolactin</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Hawley C.J., Schoene R.B. Overtraining syndrome. A guide to diagnosis, treatment, and prevention // The physician and sport medicine. 2003. Vol. 31, № 6. P. 25-31.</mixed-citation><mixed-citation xml:lang="en">Hawley C.J., Schoene R.B. Overtraining syndrome. A guide to diagnosis, treatment, and prevention // The physician and sport medicine. 2003. Vol. 31, № 6. P. 25-31.</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Дембо А.Г. Влияние хронического физического перенапряжения на организм спортсмена // Теория и практика физической культуры. 1976. № 3. С. 21-3.</mixed-citation><mixed-citation xml:lang="en">Дембо А.Г. Влияние хронического физического перенапряжения на организм спортсмена // Теория и практика физической культуры. 1976. № 3. С. 21-3.</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Карпман В.Л. Спортивная медицина. М.: Физкультура и спорт, 1987. 304 с.</mixed-citation><mixed-citation xml:lang="en">Карпман В.Л. Спортивная медицина. М.: Физкультура и спорт, 1987. 304 с.</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Макарова Г.А. Спортивная медицина. М.: Советский спорт, 2003. 480 с.</mixed-citation><mixed-citation xml:lang="en">Макарова Г.А. Спортивная медицина. М.: Советский спорт, 2003. 480 с.</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">Meeusen R., Duclos М., Foster С., Fry A., Gleeson M., Nieman D.C., Raglin J., Rietjens G., Steinacker J., Urhausen A. Prevention, diagnosis and treatment of the overtraining syndrome: Joint consensus statement of the European College of Sport Science (ECSS) and the American College of Sports Medicine (ACSM) // European Journal of Sport Science. 2012. Vol. 13, № 1. P. 1-24.</mixed-citation><mixed-citation xml:lang="en">Meeusen R., Duclos М., Foster С., Fry A., Gleeson M., Nieman D.C., Raglin J., Rietjens G., Steinacker J., Urhausen A. Prevention, diagnosis and treatment of the overtraining syndrome: Joint consensus statement of the European College of Sport Science (ECSS) and the American College of Sports Medicine (ACSM) // European Journal of Sport Science. 2012. Vol. 13, № 1. P. 1-24.</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Lehmann M., Foster C., Keul J. Overtraining in endurance athletes: a brief review // Med Sci Sports Exerc. 1993. Vol. 25, № 7. P. 854-62.</mixed-citation><mixed-citation xml:lang="en">Lehmann M., Foster C., Keul J. Overtraining in endurance athletes: a brief review // Med Sci Sports Exerc. 1993. Vol. 25, № 7. P. 854-62.</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">Urhausen A., Gabriel H., Kindermann W.Blood hormones as markers of training stress and overtraining // Sports Med. 1995. № 20. P. 251-76.</mixed-citation><mixed-citation xml:lang="en">Urhausen A., Gabriel H., Kindermann W.Blood hormones as markers of training stress and overtraining // Sports Med. 1995. № 20. P. 251-76.</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Meeusen R., Piacentini M.F., Busschaert B., Buyse L., De Schütter G., Stray-Gundersen J. Hormonal responses in athletes: the use of a two bout exercise protocol to detect subtle differences in (over)training status // Eur J Appl Physiol. 2004. № 91. P. 140-6.</mixed-citation><mixed-citation xml:lang="en">Meeusen R., Piacentini M.F., Busschaert B., Buyse L., De Schütter G., Stray-Gundersen J. Hormonal responses in athletes: the use of a two bout exercise protocol to detect subtle differences in (over)training status // Eur J Appl Physiol. 2004. № 91. P. 140-6.</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">Heyes M.P., Garnett E.S., Coates G. Central dopaminergic activity influences rats ability to exercise // Life Sci. 1985. Vol. 36, № 7. P. 671-7.</mixed-citation><mixed-citation xml:lang="en">Heyes M.P., Garnett E.S., Coates G. Central dopaminergic activity influences rats ability to exercise // Life Sci. 1985. Vol. 36, № 7. P. 671-7.</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Fry R., Morton A., Keast D. Overtraining in athletes: An update // Sports Med. 1991. № 12. P. 32-65.</mixed-citation><mixed-citation xml:lang="en">Fry R., Morton A., Keast D. Overtraining in athletes: An update // Sports Med. 1991. № 12. P. 32-65.</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Kirwan J.P., Costill D.L., Flynn M.G. et al. Physiological responses to successive days of intense training in competitive swimmers // Med Sci Sports Exerc. 1988. Vol. 20, № 3. P. 255-9.</mixed-citation><mixed-citation xml:lang="en">Kirwan J.P., Costill D.L., Flynn M.G. et al. Physiological responses to successive days of intense training in competitive swimmers // Med Sci Sports Exerc. 1988. Vol. 20, № 3. P. 255-9.</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">O'Connor P.J., Morgan W.P., Raglin J.S. Psychobiological effects of increased training in female and male swimmers // Med Sci Sports Exerc. 1991. Vol. 23, № 9. P. 1055-61.</mixed-citation><mixed-citation xml:lang="en">O'Connor P.J., Morgan W.P., Raglin J.S. Psychobiological effects of increased training in female and male swimmers // Med Sci Sports Exerc. 1991. Vol. 23, № 9. P. 1055-61.</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">Barron G., Noakes T., Levy W., Smidt C., Millar R. Hypothalamic dysfunction in overtrained athletes // J Clin Endocrin Metabol. 1985. № 60. P. 803-6.</mixed-citation><mixed-citation xml:lang="en">Barron G., Noakes T., Levy W., Smidt C., Millar R. Hypothalamic dysfunction in overtrained athletes // J Clin Endocrin Metabol. 1985. № 60. P. 803-6.</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Flavio A. Cadegiani, Claudio E. Kater. Hypothalamic-Pituitary-Adrenal (HPA) Axis Functioning in Overtraining Syndrome: Findings from Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) - EROS-HPA Axis // Sports Med Open. 2017. № 3. P. 45.</mixed-citation><mixed-citation xml:lang="en">Flavio A. Cadegiani, Claudio E. Kater. Hypothalamic-Pituitary-Adrenal (HPA) Axis Functioning in Overtraining Syndrome: Findings from Endocrine and Metabolic Responses on Overtraining Syndrome (EROS) - EROS-HPA Axis // Sports Med Open. 2017. № 3. P. 45.</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Adlercreutz H., Hiirkonen M., Kuoppasalmi K. et al. Effect of training on plasma anabolic and catabolic steroid hormones and their response during physical exercise // Int J Sports Med. 1986. № 7. P. 27-8.</mixed-citation><mixed-citation xml:lang="en">Adlercreutz H., Hiirkonen M., Kuoppasalmi K. et al. Effect of training on plasma anabolic and catabolic steroid hormones and their response during physical exercise // Int J Sports Med. 1986. № 7. P. 27-8.</mixed-citation></citation-alternatives></ref><ref id="cit16"><label>16</label><citation-alternatives><mixed-citation xml:lang="ru">Duclos M. A critical assessment of hormonal methods used in monitoring training status in athletes // Intern Sport Med Journal. 2008. Vol. 9, № 2. P. 56-66.</mixed-citation><mixed-citation xml:lang="en">Duclos M. A critical assessment of hormonal methods used in monitoring training status in athletes // Intern Sport Med Journal. 2008. Vol. 9, № 2. P. 56-66.</mixed-citation></citation-alternatives></ref><ref id="cit17"><label>17</label><citation-alternatives><mixed-citation xml:lang="ru">Lehmann M., Petersen K.G., Liu Y., Gastmann U., Lormes W., Steinacker J.M. Chronische und erschöpfende Belastungen im Sport - Einfluss von Leptin und Inhibin. [Chronic and exhausting training in sports - influence of leptin and inhibin] // Dtsch Z Sportmed. 2001. № 51. P. 234-43.</mixed-citation><mixed-citation xml:lang="en">Lehmann M., Petersen K.G., Liu Y., Gastmann U., Lormes W., Steinacker J.M. Chronische und erschöpfende Belastungen im Sport - Einfluss von Leptin und Inhibin. [Chronic and exhausting training in sports - influence of leptin and inhibin] // Dtsch Z Sportmed. 2001. № 51. P. 234-43.</mixed-citation></citation-alternatives></ref><ref id="cit18"><label>18</label><citation-alternatives><mixed-citation xml:lang="ru">Kanaley J., Weltman J., Pieper K., Weltman A., Hartman M. Cortisol and growth hormone responses to exercise at different times of day // J Clin Endocrinol Metabol. 2001. № 86. P. 2881-9.</mixed-citation><mixed-citation xml:lang="en">Kanaley J., Weltman J., Pieper K., Weltman A., Hartman M. Cortisol and growth hormone responses to exercise at different times of day // J Clin Endocrinol Metabol. 2001. № 86. P. 2881-9.</mixed-citation></citation-alternatives></ref><ref id="cit19"><label>19</label><citation-alternatives><mixed-citation xml:lang="ru">De Graaf-Roelfsema E., Keizer H., Wijnberg I., van der Kolk J. Hormonal responses to acute exercise, training and overtraining. A review with emphasis on the horse // Vet. Q. 2001. № 29. P. 82-101.</mixed-citation><mixed-citation xml:lang="en">De Graaf-Roelfsema E., Keizer H., Wijnberg I., van der Kolk J. Hormonal responses to acute exercise, training and overtraining. A review with emphasis on the horse // Vet. Q. 2001. № 29. P. 82-101.</mixed-citation></citation-alternatives></ref><ref id="cit20"><label>20</label><citation-alternatives><mixed-citation xml:lang="ru">Justin X. Nicoll, Disa L. Hatfield, Kathleen J. Melanson, Christopher S. Nasin. Thyroid hormones and commonly cited symptoms of overtraining in collegiate female endurance runners // Eur J Appl Physiol. 2018. Vol. 118, № 1. P. 65-73. DOI: 10.1007/s00421-017-3723-9.</mixed-citation><mixed-citation xml:lang="en">Justin X. Nicoll, Disa L. Hatfield, Kathleen J. Melanson, Christopher S. Nasin. Thyroid hormones and commonly cited symptoms of overtraining in collegiate female endurance runners // Eur J Appl Physiol. 2018. Vol. 118, № 1. P. 65-73. DOI: 10.1007/s00421-017-3723-9.</mixed-citation></citation-alternatives></ref><ref id="cit21"><label>21</label><citation-alternatives><mixed-citation xml:lang="ru">Jürimäe J., Mäestu J., Jürimäe T., Mangus В., von Duvillard S. Peripheral signals of energy homeostasis as possible markers of training stress in athletes: a review // Metabolism. 2011. № 60. P. 335-50.</mixed-citation><mixed-citation xml:lang="en">Jürimäe J., Mäestu J., Jürimäe T., Mangus В., von Duvillard S. Peripheral signals of energy homeostasis as possible markers of training stress in athletes: a review // Metabolism. 2011. № 60. P. 335-50.</mixed-citation></citation-alternatives></ref><ref id="cit22"><label>22</label><citation-alternatives><mixed-citation xml:lang="ru">Flavio A. Cadegiani, Claudio E. Kater. Hormonal aspects of overtraining syndrome: a systematic review // BMC Sports Science, Medicine and Rehabilitation. 2017. № 9. P. 14. DOI: 10.1186/sl3102-017-0079-8.</mixed-citation><mixed-citation xml:lang="en">Flavio A. Cadegiani, Claudio E. Kater. Hormonal aspects of overtraining syndrome: a systematic review // BMC Sports Science, Medicine and Rehabilitation. 2017. № 9. P. 14. DOI: 10.1186/sl3102-017-0079-8.</mixed-citation></citation-alternatives></ref><ref id="cit23"><label>23</label><citation-alternatives><mixed-citation xml:lang="ru">Meeusen R., Piacentini M.F., Busschaert B., Buyse L., De Schütter G., Stray-Gundersen J. Hormonal responses in athletes: the use of a two bout exercise protocol to detect subtle differences in (over)training status // Eur J Appl Physiol. 2004. № 91. P. 140-6.</mixed-citation><mixed-citation xml:lang="en">Meeusen R., Piacentini M.F., Busschaert B., Buyse L., De Schütter G., Stray-Gundersen J. Hormonal responses in athletes: the use of a two bout exercise protocol to detect subtle differences in (over)training status // Eur J Appl Physiol. 2004. № 91. P. 140-6.</mixed-citation></citation-alternatives></ref><ref id="cit24"><label>24</label><citation-alternatives><mixed-citation xml:lang="ru">Meeusen R., Nederhof E., Buyse L., Roelands B., De Schütter G., Piacentini M.F. Diagnosing overtraining in athletes using the two bout exercise protocol // Br J Sports Med. 2010. Vol. 44, № 9. P. 642-8.</mixed-citation><mixed-citation xml:lang="en">Meeusen R., Nederhof E., Buyse L., Roelands B., De Schütter G., Piacentini M.F. Diagnosing overtraining in athletes using the two bout exercise protocol // Br J Sports Med. 2010. Vol. 44, № 9. P. 642-8.</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
