{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:08:00Z","timestamp":1765818480330,"version":"3.48.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"21","license":[{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T00:00:00Z","timestamp":1747958400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012352","name":"Universit\u00e0 degli Studi di Milano","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Among the possible implant-based reconstructive strategies, the two-stage tissue expander-to-implant procedure is one of the most common options in patients not ideal candidate to direct-to-implant reconstruction. Recently, other filling options such as air or carbon dioxide (CO2) have been reported as alternative fill media than saline for tissue expansion. The aim of this systematic review was to qualitatively and quantitatively synthetize the available evidence on the topic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis were conducted, and they were reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. Only studies with a control group were included. Risk ratios for complications were assessed between breast tissue expanders filled with saline versus air. MINORS criteria were used for bias assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine studies met inclusion and exclusion criteria and were included. They encompassed a total of 1954 patients and 3243 breasts. Pooled risk ratios in air-filled compared to saline-filled breast expanders were calculated: total complications 0.92 [95% CI: 0.67; 1.27,\n                      <jats:italic>p<\/jats:italic>\n                      =0.53], mastectomy flap necrosis 0.86 [95% CI: 0.65; 1.12,\n                      <jats:italic>p<\/jats:italic>\n                      =0.26], hematoma 1.07 [95% CI: 0.63; 1.84,\n                      <jats:italic>p<\/jats:italic>\n                      =0.80], seroma 1.26 [95% CI: 0.91; 1.76,\n                      <jats:italic>p<\/jats:italic>\n                      =0.16], infection 0.80 [95% CI: 0.61; 1.04,\n                      <jats:italic>p<\/jats:italic>\n                      =0.09], extrusion 1.38 [95% CI: 0.82; 2.32,\n                      <jats:italic>p<\/jats:italic>\n                      =0.23], readmission 0.96 [95% CI: 0.58; 1.60,\n                      <jats:italic>p<\/jats:italic>\n                      =0.88]. The mean difference in days needed to achieve final expansion between air-filled and saline-filled breast expanders was -27.59 [95% CI: -46.42; -8.78,\n                      <jats:italic>p<\/jats:italic>\n                      =0.004].\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Air-filled expanders represent an alternative reconstructive option in the field of two-stage breast reconstruction. Despite limited by the only initial available evidence, they appeared to be safe and associated with a similar risk of complications compared to saline-filled expanders. However, they may enable faster postoperative expansion and fewer outpatient expansion visits compared to saline-filled expanders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence III<\/jats:title>\n                    <jats:p>\n                      This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors \u00a0\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-025-04918-5","type":"journal-article","created":{"date-parts":[[2025,5,23]],"date-time":"2025-05-23T10:57:34Z","timestamp":1747997854000},"page":"6025-6037","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of Air Versus Saline-filled Breast Expanders: A Systematic Review and Meta-analysis"],"prefix":"10.1007","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5506-8323","authenticated-orcid":false,"given":"Mario","family":"Alessandri Bonetti","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eleonora","family":"Bulgarelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisa","family":"Dolfato","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaia","family":"Ghiringhelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Catapano","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Carbonaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Borelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Lisa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca","family":"De Lorenzi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Vaienti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,23]]},"reference":[{"key":"4918_CR1","unstructured":"American Cancer Society, Inc., Surveillance Research. Cancer facts & figures 2023."},{"key":"4918_CR2","doi-asserted-by":"publisher","first-page":"7S","DOI":"10.1097\/PRS.0000000000003941","volume":"140","author":"H Panchal","year":"2017","unstructured":"Panchal H, Matros E. Current trends in postmastectomy breast reconstruction. Plast Reconstr Surg. 2017;140:7S-13S.","journal-title":"Plast Reconstr Surg"},{"key":"4918_CR3","unstructured":"Miller AM, Steiner CA, Barrett ML, Fingar KR, Elixhauser A. Breast reconstruction surgery for mastectomy in hospital inpatient and ambulatory settings, 2009\u20132014. Statistical brief #228. In: Healthcare Cost and Utilization Project (HCUP) statistical briefs. Rockville, MD: Agency for Healthcare Research and Quality (US); 2017. PMID: 29400923."},{"key":"4918_CR4","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1007\/s00266-022-02776-z","volume":"46","author":"P Persichetti","year":"2022","unstructured":"Persichetti P, et al. Impact on patient\u2019s appearance perception of autologous and implant based breast reconstruction following mastectomy using BREAST-Q. Aesthet Plast Surg. 2022;46:1153\u201363.","journal-title":"Aesthetic Plast Surg"},{"key":"4918_CR5","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1007\/s00266-021-02584-x","volume":"46","author":"F Santanelli Di Pompeo","year":"2022","unstructured":"Santanelli Di Pompeo F, et al. Predictive factors of satisfaction following breast reconstruction: Do they influence Patients? Aesthet Plast Surg. 2022;46:610\u20138.","journal-title":"Aesthetic Plast Surg"},{"issue":"9","key":"4918_CR6","doi-asserted-by":"publisher","first-page":"1232","DOI":"10.3390\/medicina58091232","volume":"58","author":"M Alessandri Bonetti","year":"2022","unstructured":"Alessandri Bonetti M, Carbonaro R, Borelli F, Amendola F, Cottone G, Mazzocconi L, Mastroiacovo A, Zingaretti N, Parodi PC, Vaienti L. Outcomes in hybrid breast reconstruction: a systematic review. Medicina. 2022;58(9):1232.","journal-title":"Medicina"},{"key":"4918_CR7","doi-asserted-by":"publisher","first-page":"404e","DOI":"10.1097\/PRS.0000000000005290","volume":"143","author":"JD Frey","year":"2019","unstructured":"Frey JD, Salibian AA, Karp NS, Choi M. Implant-based breast reconstruction: hot topics, controversies, and new directions. Plast Reconstr Surg. 2019;143:404e\u201316e.","journal-title":"Plast Reconstr Surg"},{"key":"4918_CR8","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1016\/j.bjps.2020.12.016","volume":"74","author":"F Barbera","year":"2021","unstructured":"Barbera F, et al. Efficacy of short-term antibiotic prophylaxis in immediate two-stage breast reconstruction after mastectomy: a retrospective monocentric study: short term antibiotic prophylaxis in breast reconstruction. J Plast Reconstr Aesthet Surg. 2021;74:1758\u201362.","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"4918_CR9","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1097\/PRS.0000000000008208","volume":"148","author":"RL Shammas","year":"2021","unstructured":"Shammas RL, et al. A comparison of surgical complications in patients undergoing delayed versus staged tissue-expander and free-flap breast reconstruction. Plast Reconstr Surg. 2021;148:501\u20139.","journal-title":"Plast Reconstr Surg"},{"issue":"10","key":"4918_CR10","first-page":"e2501","volume":"7","author":"K Chopra","year":"2019","unstructured":"Chopra K, Slavin B, Khavanin N, Kraenzlin F, Darrach H, Holton L, Landford WN, Singh DP. Cost utility of breast tissue expansion using carbon dioxide versus saline: an analysis of infection risk. Plast Reconstr Surg-Glob Open. 2019;7(10):e2501.","journal-title":"Plast Reconstr Surg-Glob Open"},{"key":"4918_CR11","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1097\/PRS.0b013e3182268b80","volume":"128","author":"AF Connell","year":"2011","unstructured":"Connell AF. Patient-activated controlled expansion for breast reconstruction with controlled carbon dioxide inflation: a feasibility study. Plast Reconstr Surg. 2011;128:848\u201352.","journal-title":"Plast Reconstr Surg"},{"key":"4918_CR12","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjad385","author":"AJ Fijany","year":"2024","unstructured":"Fijany AJ, et al. Post-mastectomy breast reconstruction with gas vs saline tissue expanders: does the fill type matter? Aesthet Surg J. 2024. https:\/\/doi.org\/10.1093\/asj\/sjad385.","journal-title":"Aesthet Surg J"},{"key":"4918_CR13","unstructured":"U.S. Food & Drug Administration. De Novo classification request for AeroForm tissue expander system. 2015. https:\/\/www.accessdata.fda.gov\/cdrh_docs\/reviews\/den150055.pdf"},{"key":"4918_CR14","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/PRS.0000000000009191","volume":"150","author":"PS Yesantharao","year":"2022","unstructured":"Yesantharao PS, et al. Air versus saline: The effect of tissue expander fill on outcomes of prepectoral breast reconstruction. Plast Reconstr Surg. 2022;150:28\u201336.","journal-title":"Plast Reconstr Surg"},{"key":"4918_CR15","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PMED.1003583","author":"MJ Page","year":"2021","unstructured":"Page MJ, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. PLoS Med. 2021. https:\/\/doi.org\/10.1371\/JOURNAL.PMED.1003583.","journal-title":"PLoS Med"},{"key":"4918_CR16","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1136\/emermed-2020-209567","volume":"37","author":"M Amir-Behghadami","year":"2020","unstructured":"Amir-Behghadami M, Janati A. Population, intervention, comparison, outcomes and study (PICOS) design as a framework to formulate eligibility criteria in systematic reviews. Emerg Med J. 2020;37:387\u2013387.","journal-title":"Emerg Med J"},{"key":"4918_CR17","unstructured":"Higgins J, Thomas J. Cochrane handbook for systematic reviews of interventions. 2023."},{"key":"4918_CR18","doi-asserted-by":"publisher","first-page":"3805","DOI":"10.1002\/sim.5453","volume":"31","author":"D Jackson","year":"2012","unstructured":"Jackson D, White IR, Riley RD. Quantifying the impact of between-study heterogeneity in multivariate meta-analyses. Stat Med. 2012;31:3805\u201320.","journal-title":"Stat Med"},{"key":"4918_CR19","doi-asserted-by":"publisher","first-page":"101","DOI":"10.2307\/3001666","volume":"10","author":"WG Cochran","year":"1954","unstructured":"Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10:101.","journal-title":"Biometrics"},{"key":"4918_CR20","doi-asserted-by":"publisher","first-page":"d4002","DOI":"10.1136\/bmj.d4002","volume":"343","author":"JAC Sterne","year":"2011","unstructured":"Sterne JAC, et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 2011;343:d4002\u2013d4002.","journal-title":"BMJ"},{"key":"4918_CR21","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1046\/j.1445-2197.2003.02748.x","volume":"73","author":"K Slim","year":"2003","unstructured":"Slim K, et al. Methodological index for non-randomized studies (Minors): development and validation of a new instrument. ANZ J Surg. 2003;73:712\u20136.","journal-title":"ANZ J Surg"},{"key":"4918_CR22","doi-asserted-by":"publisher","first-page":"6545","DOI":"10.1245\/s10434-023-13763-2","volume":"30","author":"AR Sergesketter","year":"2023","unstructured":"Sergesketter AR, et al. Air or saline? A propensity score-matched analysis on the effect of tissue expander fill on complications in immediate breast reconstruction. Ann Surg Oncol. 2023;30:6545\u201353.","journal-title":"Ann Surg Oncol"},{"issue":"3","key":"4918_CR23","doi-asserted-by":"publisher","first-page":"581","DOI":"10.1097\/PRS.0000000000010711","volume":"153","author":"J Bae","year":"2024","unstructured":"Bae J, Lee KT, Jeon BJ, Mun GH, Bang SI, Pyon JK. Impact of initial filling medium on outcomes of subpectoral, two-stage, implant-based breast reconstruction: air versus saline. Plast Reconstr Surg. 2024;153(3):581\u20139. https:\/\/doi.org\/10.1097\/PRS.0000000000010711.","journal-title":"Plast Reconstr Surg"},{"key":"4918_CR24","doi-asserted-by":"publisher","first-page":"25S","DOI":"10.1097\/PRS.0000000000010478","volume":"152","author":"EL Plotsker","year":"2023","unstructured":"Plotsker EL, et al. Air versus saline in initial prepectoral tissue expansion: a comparison of complications and perioperative patient-reported outcomes. Plast Reconstr Surg. 2023;152:25S-34S.","journal-title":"Plast Reconstr Surg"},{"key":"4918_CR25","doi-asserted-by":"publisher","first-page":"577E","DOI":"10.1097\/PRS.0000000000009987","volume":"151","author":"R Bamba","year":"2023","unstructured":"Bamba R, et al. Evaluation of prepectoral breast tissue expander reconstruction intraoperative fill: Air or saline? Plast Reconstr Surg. 2023;151:577E-580E.","journal-title":"Plast Reconstr Surg"},{"key":"4918_CR26","doi-asserted-by":"publisher","first-page":"S396","DOI":"10.1097\/SAP.0000000000002154","volume":"84","author":"BE Porter","year":"2020","unstructured":"Porter BE, Vonu PM, Mast BA. Comparison of saline expanders and air expanders for breast reconstruction. Ann Plast Surg. 2020;84:S396\u2013400.","journal-title":"Ann Plast Surg"},{"issue":"3","key":"4918_CR27","first-page":"e2051","volume":"7","author":"K Chopra","year":"2019","unstructured":"Chopra K, Singh D, Hricz N, Brassard K, Orlov V, Holton LH III. Two-stage prosthetic prepectoral breast reconstruction: comparing tissue expansion with carbon dioxide and saline. Plast Reconstr Surg-Glob Open. 2019;7(3):e2051.","journal-title":"Plast Reconstr Surg-Glob Open"},{"key":"4918_CR28","doi-asserted-by":"publisher","first-page":"1161","DOI":"10.1097\/PRS.0000000000002784","volume":"138","author":"JA Ascherman","year":"2016","unstructured":"Ascherman JA, et al. Carbon dioxide-based versus saline tissue expansion for breast reconstruction: results of the XPAND prospective Randomized Clinical Trial. Plast Reconstr Surg. 2016;138:1161\u201370.","journal-title":"Plast Reconstr Surg"},{"key":"4918_CR29","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1097\/SAP.0000000000000175","volume":"72","author":"KR Zeidler","year":"2014","unstructured":"Zeidler KR, Berkowitz RL, Chun YS, Alizadeh K, Castle J, Colwell AS, Desai AR, Evans G, Hollenbeck S, Johnson DJ, Morris D. AeroForm patient controlled tissue expansion and saline tissue expansion for breast reconstruction: a randomized controlled trial. Ann Plast Surg. 2014;72:51\u20135.","journal-title":"Ann Plast Surg"},{"key":"4918_CR30","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1080\/17434440.2023.2288911","volume":"21","author":"M-J Cho","year":"2024","unstructured":"Cho M-J, et al. The current use of tissue expanders in breast reconstruction: device design, features, and technical considerations. Expert Rev Med Devices. 2024;21:27\u201335.","journal-title":"Expert Rev Med Devices"},{"issue":"2","key":"4918_CR31","doi-asserted-by":"publisher","first-page":"313","DOI":"10.3390\/pathogens12020313","volume":"12","author":"M Alessandri-Bonetti","year":"2023","unstructured":"Alessandri-Bonetti M, Jeong T, Vaienti L, De La Cruz C, Gimbel ML, Nguyen VT, Egro FM. The role of microorganisms in the development of breast implant-associated anaplastic large cell lymphoma. Pathogens. 2023;12(2):313.","journal-title":"Pathogens"},{"issue":"12","key":"4918_CR32","doi-asserted-by":"publisher","first-page":"411","DOI":"10.21037\/atm-23-1094","volume":"11","author":"JM Escand\u00f3n","year":"2023","unstructured":"Escand\u00f3n JM, Weiss A, Christiano JG, Langstein HN, Escand\u00f3n L, Prieto PA, Gooch JC, Manrique OJ. Prepectoral versus subpectoral two-stage implant-based breast reconstruction: US medical center experience and narrative review. Ann Trans Med. 2023;11(12):411.","journal-title":"Ann Trans Med"},{"key":"4918_CR33","unstructured":"American Society of Plastic Surgeons. 2022 plastic surgery satistics report. 2023. Available at: https:\/\/www.plasticsurgery.org\/documents\/news\/statistics\/2022\/plastic-surgery-statistics-report-2022.pdf. Accessed 16 Apr 2025."},{"key":"4918_CR34","doi-asserted-by":"publisher","first-page":"2534","DOI":"10.1245\/s10434-022-12896-0","volume":"30","author":"RL Shammas","year":"2023","unstructured":"Shammas RL, et al. Complications, costs, and healthcare resource utilization after staged, delayed, and immediate free-flap breast reconstruction: a longitudinal claims-based analysis. Ann Surg Oncol. 2023;30:2534\u201349.","journal-title":"Ann Surg Oncol"},{"key":"4918_CR35","doi-asserted-by":"publisher","first-page":"S208","DOI":"10.1097\/SAP.0000000000001045","volume":"78","author":"GR Sue","year":"2017","unstructured":"Sue GR, Long C, Lee GK. Management of mastectomy skin necrosis in implant based breast reconstruction. Ann Plast Surg. 2017;78:S208\u201311.","journal-title":"Ann Plast Surg"},{"key":"4918_CR36","doi-asserted-by":"publisher","first-page":"S31","DOI":"10.1097\/SAP.0000000000000174","volume":"72","author":"M Nykiel","year":"2014","unstructured":"Nykiel M, Sayid Z, Wong R, Lee GK. Management of mastectomy skin flap necrosis in autologous breast reconstruction. Ann Plast Surg. 2014;72:S31\u20134.","journal-title":"Ann Plast Surg"},{"key":"4918_CR37","doi-asserted-by":"publisher","first-page":"3793","DOI":"10.1245\/s10434-018-6872-0","volume":"25","author":"C Shah","year":"2018","unstructured":"Shah C. Expanding with air: proceed with caution. Ann Surg Oncol. 2018;25:3793\u20134.","journal-title":"Ann Surg Oncol"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-025-04918-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-025-04918-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-025-04918-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:02:58Z","timestamp":1765818178000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00266-025-04918-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,23]]},"references-count":37,"journal-issue":{"issue":"21","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["4918"],"URL":"https:\/\/doi.org\/10.1007\/s00266-025-04918-5","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"type":"print","value":"0364-216X"},{"type":"electronic","value":"1432-5241"}],"subject":[],"published":{"date-parts":[[2025,5,23]]},"assertion":[{"value":"10 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2025","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 declare that they have no conflicts of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest"}},{"value":"This article does not contain any studies with human participants or animals performed by any of the authors.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human or Animals Participants"}},{"value":"For this type of study, informed consent is not required.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}