{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T11:55:36Z","timestamp":1768823736139,"version":"3.49.0"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100017515","name":"Heidelberger Stiftung Chirurgie","doi-asserted-by":"publisher","award":["2023\/606"],"award-info":[{"award-number":["2023\/606"]}],"id":[{"id":"10.13039\/501100017515","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017515","name":"Heidelberger Stiftung Chirurgie","doi-asserted-by":"publisher","award":["2023\/606"],"award-info":[{"award-number":["2023\/606"]}],"id":[{"id":"10.13039\/501100017515","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100018936","name":"Universit\u00e4tsklinikum Heidelberg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018936","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J CARS"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>Complicated type B Aortic dissection is a severe aortic pathology that requires treatment through thoracic endovascular aortic repair (TEVAR). During TEVAR a stentgraft is deployed in the aortic lumen in order to restore blood flow. Due to the complicated pathology including an entry, a resulting dissection wall with potentially several re-entries, replicating this structure artificially has proven to be challenging thus far.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We developed a 3d printed, patient-specific and perfused aortic dissection phantom with a flexible dissection flap and all major branching vessels. The model was segmented from CTA images and fabricated out of a flexible material to mimic aortic wall tissue. It was placed in a pulsatile hemodynamic flow loop. Hemodynamics were investigated through pressure and flow measurements and doppler ultrasound imaging. Surgeons performed a TEVAR intervention including stentgraft deployment under fluoroscopic guidance.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The flexible aortic dissection phantom was successfully incorporated in the hemodynamic flow loop, a systolic pressure of 112\u00a0mmHg and physiological flow of 4.05\u00a0L per minute was reached. Flow velocities were higher in true lumen with a up to 35.7\u00a0cm\/s compared to the false lumen with a maximum of 13.3\u00a0cm\/s, chaotic flow patterns were observed on main entry and reentry sights. A TEVAR procedure was successfully performed under fluoroscopy. The position of the stentgraft was confirmed using CTA imaging.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This perfused in-vitro phantom allows for detailed investigation of the complex inner hemodynamics of aortic dissections on a patient-specific level and enables the simulation of TEVAR procedures in a real endovascular operating environment. Therefore, it could provide a dynamic platform for future surgical training and research.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11548-024-03190-3","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T10:01:50Z","timestamp":1717754510000},"page":"391-404","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Simulation of thoracic endovascular aortic repair in a perfused patient-specific model of type B aortic dissection"],"prefix":"10.1007","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7153-1073","authenticated-orcid":false,"given":"Lukas","family":"Mohl","sequence":"first","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4732-8495","authenticated-orcid":false,"given":"Roger","family":"Karl","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5477-6731","authenticated-orcid":false,"given":"Matthias N.","family":"Hagedorn","sequence":"additional","affiliation":[]},{"given":"Armin","family":"Runz","sequence":"additional","affiliation":[]},{"given":"Stephan","family":"Skornitzke","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0804-5794","authenticated-orcid":false,"given":"Malte","family":"Toelle","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1592-3277","authenticated-orcid":false,"given":"C. Soeren","family":"Bergt","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3152-7791","authenticated-orcid":false,"given":"Johannes","family":"Hatzl","sequence":"additional","affiliation":[]},{"given":"Christian","family":"Uhl","sequence":"additional","affiliation":[]},{"given":"Dittmar","family":"B\u00f6ckler","sequence":"additional","affiliation":[]},{"given":"Katrin","family":"Meisenbacher","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8816-7654","authenticated-orcid":false,"given":"Sandy","family":"Engelhardt","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"issue":"S1","key":"3190_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00772-023-00995-5","volume":"28","author":"A Oberhuber","year":"2023","unstructured":"Oberhuber A, Raddatz A, Betge S, Ploenes C, Ito W, Janosi RA, Ott C, Langheim E, Czerny M, Puls R, Ma\u00dfmann A, Zeyer K, Schelzig H (2023) Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection. Gef\u00e4sschirurgie 28(S1):1\u201328. https:\/\/doi.org\/10.1007\/s00772-023-00995-5","journal-title":"Gef\u00e4sschirurgie"},{"key":"3190_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/s00772-015-0075-9","author":"CM B\u00fcnger","year":"2015","unstructured":"B\u00fcnger CM, Knop A, Kische S, Ince H (2015) Aortendissektion Typ B: definitionen, inzidenz, \u00e4tiologie. Gef\u00e4sschirurgie. https:\/\/doi.org\/10.1007\/s00772-015-0075-9","journal-title":"Gef\u00e4sschirurgie"},{"key":"3190_CR3","unstructured":"Deutsche Gesellschaft f\u00fcr Gef\u00e4\u00dfchirurgie und Gef\u00e4\u00dfmedizin (DGG) (2021) Leitlinie: S2K Typ B Aortendissektion 004\u2013034"},{"issue":"41","key":"3190_CR4","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","volume":"35","author":"R Erbel","year":"2014","unstructured":"Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenw\u00f6ger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, von Allmen RS, Vrints CJM (2014) 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task force for the diagnosis and treatment of aortic diseases of the european society of cardiology (ESC). Eur Heart J 35(41):2873\u20132926. https:\/\/doi.org\/10.1093\/eurheartj\/ehu281","journal-title":"Eur Heart J"},{"issue":"2","key":"3190_CR5","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.jvs.2007.03.047","volume":"46","author":"TL Forbes","year":"2007","unstructured":"Forbes TL, Chu MWA, Lawlor DK, DeRose G, Harris KA (2007) Learning curve analysis of thoracic endovascular aortic repair in relation to credentialing guidelines. J Vasc Surg 46(2):218\u2013222. https:\/\/doi.org\/10.1016\/j.jvs.2007.03.047","journal-title":"J Vasc Surg"},{"issue":"4","key":"3190_CR6","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1016\/j.jvs.2011.08.026","volume":"54","author":"CV Riga","year":"2011","unstructured":"Riga CV, Bicknell CD, Sidhu R, Cochennec F, Normahani P, Chadha P, Kashef E, Hamady M, Cheshire NJ (2011) Advanced catheter technology: is this the answer to overcoming the long learning curve in complex endovascular procedures. J Vasc Surg 54(4):1223\u20131224","journal-title":"J Vasc Surg"},{"key":"3190_CR7","doi-asserted-by":"publisher","DOI":"10.1007\/s00270-019-02257-y","author":"JM K\u00e4rkk\u00e4inen","year":"2019","unstructured":"K\u00e4rkk\u00e4inen JM, Sandri G, Tenorio ER, Alexander A, Bjellum K, Matsumoto J, Morris J, Mendes BC, DeMartino RR, Oderich GS (2019) Simulation of endovascular aortic repair using 3D printed abdominal aortic aneurysm model and fluid pump. Cardiovasc Intervent Radiol. https:\/\/doi.org\/10.1007\/s00270-019-02257-y","journal-title":"Cardiovasc Intervent Radiol"},{"issue":"2","key":"3190_CR8","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.ejvs.2017.05.011","volume":"54","author":"IO Torres","year":"2017","unstructured":"Torres IO, de Luccia N (2017) A simulator for training in endovascular aneurysm repair: the use of three dimensional printers. Eur J Vasc Endovasc Surg 54(2):247\u2013253. https:\/\/doi.org\/10.1016\/j.ejvs.2017.05.011","journal-title":"Eur J Vasc Endovasc Surg"},{"issue":"1","key":"3190_CR9","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1038\/s41598-017-00644-4","volume":"7","author":"D Yuan","year":"2017","unstructured":"Yuan D, Luo H, Yang H, Huang B, Zhu J, Zhao J (2017) Precise treatment of aortic aneurysm by three-dimensional printing and simulation before endovascular intervention. Sci Rep 7(1):795. https:\/\/doi.org\/10.1038\/s41598-017-00644-4","journal-title":"Sci Rep"},{"key":"3190_CR10","doi-asserted-by":"publisher","first-page":"797829","DOI":"10.3389\/fcvm.2022.797829","volume":"9","author":"L Morris","year":"2022","unstructured":"Morris L, Tierney P, Hynes N, Sultan S (2022) An in vitro assessment of the haemodynamic features occurring within the true and false lumens separated by a dissection flap for a patient-specific type B aortic dissection. Front Cardiovasc Med 9:797829. https:\/\/doi.org\/10.3389\/fcvm.2022.797829","journal-title":"Front Cardiovasc Med"},{"issue":"1","key":"3190_CR11","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1177\/15266028211034863","volume":"29","author":"D Chen","year":"2022","unstructured":"Chen D, Liang S, Li Z, Mei Y, Dong H, Ma Y, Zhao J, Xu S, Zheng J, Xiong J (2022) A mock circulation loop for in vitro hemodynamic evaluation of aorta: application in aortic dissection. J Endovasc Ther Off J Int Soc Endovasc Spec 29(1):132\u2013142. https:\/\/doi.org\/10.1177\/15266028211034863","journal-title":"J Endovasc Ther Off J Int Soc Endovasc Spec"},{"key":"3190_CR12","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1007\/978-3-030-78710-3_55","volume-title":"Functional imaging and modeling of the heart","author":"J Zimmermann","year":"2021","unstructured":"Zimmermann J, B\u00e4umler K, Loecher M, Cork TE, Kolawole FO, Gifford K, Marsden AL, Fleischmann D, Ennis DB (2021) Quantitative hemodynamics in aortic dissection: comparing in vitro MRI with FSI simulation in a compliant model. In: Ennis DB, Perotti LE, Wang VY (eds) Functional imaging and modeling of the heart. Springer International Publishing, Cham, pp 575\u2013586"},{"issue":"6","key":"3190_CR13","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1016\/j.jvs.2019.06.222","volume":"71","author":"J Birjiniuk","year":"2020","unstructured":"Birjiniuk J, Oshinski JN, Ku DN, Veeraswamy RK (2020) Endograft exclusion of the false lumen restores local hemodynamics in a model of type B aortic dissection. J Vasc Surg 71(6):2108\u20132118. https:\/\/doi.org\/10.1016\/j.jvs.2019.06.222","journal-title":"J Vasc Surg"},{"issue":"5","key":"3190_CR14","doi-asserted-by":"publisher","first-page":"932","DOI":"10.1093\/ejcts\/ezaa198","volume":"58","author":"K Meisenbacher","year":"2020","unstructured":"Meisenbacher K, B\u00f6ckler D, Geisb\u00fcsch P, Hank T, Bischoff MS (2020) Preliminary results of spot-stent grafting in Stanford type B aortic dissection and intramural haematoma. Eur J Cardio-thoracic Surg Off J Eur Assoc Cardio-thoracic Surg 58(5):932\u2013939. https:\/\/doi.org\/10.1093\/ejcts\/ezaa198","journal-title":"Eur J Cardio-thoracic Surg Off J Eur Assoc Cardio-thoracic Surg"},{"issue":"5","key":"3190_CR15","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/j.ejvs.2008.06.023","volume":"36","author":"D Sayer","year":"2008","unstructured":"Sayer D, Bratby M, Brooks M, Loftus I, Morgan R, Thompson M (2008) Aortic morphology following endovascular repair of acute and chronic type B aortic dissection: implications for management. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg 36(5):522\u2013529. https:\/\/doi.org\/10.1016\/j.ejvs.2008.06.023","journal-title":"Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg"},{"key":"3190_CR16","doi-asserted-by":"crossref","unstructured":"Riedle H, Mukai B, Molz P, Franke J (2018) Determination of the mechanical properties of aortic tissue for 3D printed surgical models. In: 2018 11th Biomedical Engineering International Conference (BMEiCON). IEEE, pp 1\u20135","DOI":"10.1109\/BMEiCON.2018.8609983"},{"key":"3190_CR17","doi-asserted-by":"publisher","DOI":"10.1007\/s11548-023-03036-4","author":"R Karl","year":"2023","unstructured":"Karl R, Romano G, Marx J, Eden M, Schlegel P, Stroh L, Fischer S, Hehl M, K\u00fchle R, Mohl L, Karck M, Frey N, de Simone R, Engelhardt S (2023) An ex-vivo and in-vitro dynamic simulator for surgical and transcatheter mitral valve interventions. Int J Comput Assist Radiol Surg. https:\/\/doi.org\/10.1007\/s11548-023-03036-4","journal-title":"Int J Comput Assist Radiol Surg"},{"key":"3190_CR18","doi-asserted-by":"publisher","unstructured":"Leibuss R, Posred\u0146ikova O, Pupkevi\u010da I, Meidrops K, Mackevi\u010ds D, Dekhtyar Y, Stradi\u0146\u0161 P, Str\u012b\u0137e E (2022) Transcranial duplex ultrasonography measurements towards identification of blood vessel conditions: artificial cerebral blood flow in pathologies. In: Proceedings of the latvian academy of sciences. section B. natural, exact, and applied sciences 76(3):\u00a0346\u2013351. https:\/\/doi.org\/10.2478\/prolas-2022-0052","DOI":"10.2478\/prolas-2022-0052"},{"issue":"2","key":"3190_CR19","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1161\/CIRCINTERVENTIONS.108.819722","volume":"2","author":"DY Sze","year":"2009","unstructured":"Sze DY, van den Bosch MAAJ, Dake MD, Miller DC, Hofmann LV, Varghese R, Malaisrie SC, van der Starre PJA, Rosenberg J, Mitchell RS (2009) Factors portending endoleak formation after thoracic aortic stent-graft repair of complicated aortic dissection. Circ Cardiovasc Interv 2(2):105\u2013112. https:\/\/doi.org\/10.1161\/CIRCINTERVENTIONS.108.819722","journal-title":"Circ Cardiovasc Interv"},{"key":"3190_CR20","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2016.00032","author":"AI Azevedo","year":"2016","unstructured":"Azevedo AI, Braga P, Rodrigues A, Ferreira N, Fonseca M, Dias A, Gama Ribeiro V (2016) Persistent type I Endoleak after endovascular treatment with chimney technique. Front Cardiovasc Med. https:\/\/doi.org\/10.3389\/fcvm.2016.00032","journal-title":"Front Cardiovasc Med"},{"issue":"5","key":"3190_CR21","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1093\/icvts\/ivac029","volume":"34","author":"P Panpho","year":"2022","unstructured":"Panpho P, Yang Y, Davies HA, Nawaytou O, Harky A, Torella F, Field M, Madine J, Akhtar R (2022) Time-dependent mechanical behaviour of the aortic chronic dissection flap. Interact Cardiovasc Thorac Surg 34(5):892\u2013901. https:\/\/doi.org\/10.1093\/icvts\/ivac029","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"3190_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2022.110963","author":"G Franzetti","year":"2022","unstructured":"Franzetti G, Bonfanti M, Homer-Vanniasinkam S, Diaz-Zuccarini V, Balabani S (2022) Experimental evaluation of the patient-specific haemodynamics of an aortic dissection model using particle image velocimetry. J Biomech. https:\/\/doi.org\/10.1016\/j.jbiomech.2022.110963","journal-title":"J Biomech"},{"issue":"5","key":"3190_CR23","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1161\/HYPERTENSIONAHA.114.05080","volume":"65","author":"C-Y Liu","year":"2015","unstructured":"Liu C-Y, Chen D, Bluemke DA, Wu CO, Teixido-Tura G, Chugh A, Vasu S, Lima JAC, Hundley WG (2015) Evolution of aortic wall thickness and stiffness with atherosclerosis: long-term follow up from the multi-ethnic study of atherosclerosis. Hypertension 65(5):1015\u20131019. https:\/\/doi.org\/10.1161\/HYPERTENSIONAHA.114.05080","journal-title":"Hypertension"},{"issue":"6","key":"3190_CR24","doi-asserted-by":"publisher","first-page":"793","DOI":"10.21037\/acs-2021-taes-26","volume":"10","author":"A Le Huu","year":"2021","unstructured":"Le Huu A, Preventza O (2021) Endovascular repair of acute type B thoracic aortic dissection. Ann Cardiothorac Surg 10(6):793\u2013800. https:\/\/doi.org\/10.21037\/acs-2021-taes-26","journal-title":"Ann Cardiothorac Surg"},{"issue":"3","key":"3190_CR25","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1007\/s13239-017-0312-3","volume":"8","author":"J Birjiniuk","year":"2017","unstructured":"Birjiniuk J, Timmins LH, Young M, Leshnower BG, Oshinski JN, Ku DN, Veeraswamy RK (2017) Pulsatile flow leads to intimal flap motion and flow reversal in an in vitro model of type B aortic dissection. Cardiovasc Eng Technol 8(3):378\u2013389. https:\/\/doi.org\/10.1007\/s13239-017-0312-3","journal-title":"Cardiovasc Eng Technol"},{"issue":"2","key":"3190_CR26","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.jcin.2015.10.027","volume":"9","author":"F Fanelli","year":"2016","unstructured":"Fanelli F, Cannavale A, O\u2019Sullivan GJ, Gazzetti M, Cirelli C, Lucatelli P, Santoni M, Catalano C (2016) Endovascular repair of acute and chronic aortic type B dissections: main factors affecting aortic remodeling and clinical outcome. JACC Cardiovasc Interv 9(2):183\u2013191. https:\/\/doi.org\/10.1016\/j.jcin.2015.10.027","journal-title":"JACC Cardiovasc Interv"},{"issue":"5","key":"3190_CR27","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1016\/j.jtcvs.2016.06.027","volume":"152","author":"L Zhang","year":"2016","unstructured":"Zhang L, Zhao Z, Chen Y, Sun Y, Bao J, Jing Z, Zhou J (2016) Reintervention after endovascular repair for aortic dissection: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 152(5):1279-1288.e3. https:\/\/doi.org\/10.1016\/j.jtcvs.2016.06.027","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["International Journal of Computer Assisted Radiology and Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11548-024-03190-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11548-024-03190-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11548-024-03190-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T12:20:30Z","timestamp":1739190030000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11548-024-03190-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,7]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["3190"],"URL":"https:\/\/doi.org\/10.1007\/s11548-024-03190-3","relation":{},"ISSN":["1861-6429"],"issn-type":[{"value":"1861-6429","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,7]]},"assertion":[{"value":"5 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 May 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Patient consent and ethical approval was obtained from the Ethics Committee of the Faculty of Medicine of Ruprecht-Karls-University Heidelberg, Germany (S-158\/2015).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}