{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T06:52:26Z","timestamp":1790232746347,"version":"4.1.0"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T00:00:00Z","timestamp":1638403200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T00:00:00Z","timestamp":1638403200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002996","name":"Hartstichting","doi-asserted-by":"publisher","award":["2017T064"],"award-info":[{"award-number":["2017T064"]}],"id":[{"id":"10.13039\/501100002996","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009947","name":"Merck Sharp and Dohme","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009947","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objectives<\/jats:title>\n                <jats:p>Closer reading of computed tomography pulmonary angiography (CTPA) scans of patients presenting with acute pulmonary embolism (PE) may identify those at high risk of developing chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to validate the predictive value of six radiological predictors that were previously proposed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Three hundred forty-one patients with acute PE were prospectively followed for development of CTEPH in six European hospitals. Index CTPAs were analysed post hoc by expert chest radiologists blinded to the final diagnosis. The accuracy of the predictors using a predefined threshold for \u2018high risk\u2019 (\u2265\u20093 predictors) and the expert overall judgment on the presence of CTEPH were assessed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>CTEPH was confirmed in nine patients (2.6%) during 2-year follow-up. Any sign of chronic thrombi was already present in 74\/341 patients (22%) on the index CTPA, which was associated with CTEPH (OR 7.8, 95%CI 1.9\u201332); 37 patients (11%) had\u2009\u2265\u20093 of 6 radiological predictors, of whom 4 (11%) were diagnosed with CTEPH (sensitivity 44%, 95%CI 14\u201379; specificity 90%, 95%CI 86\u201393). Expert judgment raised suspicion of CTEPH in 27 patients, which was confirmed in 8 (30%; sensitivity 89%, 95%CI 52\u2013100; specificity 94%, 95%CI 91\u201397).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The presence of\u2009\u2265\u20093 of 6 predefined radiological predictors was highly specific for a future CTEPH diagnosis, comparable to overall expert judgment, while the latter was associated with higher sensitivity. Dedicated CTPA reading for signs of CTEPH may therefore help in early detection of CTEPH after PE, although in our cohort this strategy would not have detected all cases.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p>\u2022 <jats:italic>Three expert chest radiologists re-assessed CTPA scans performed at the moment of acute pulmonary embolism diagnosis and observed a high prevalence of chronic thrombi and signs of pulmonary hypertension.<\/jats:italic><\/jats:p>\n                <jats:p>\u2022 <jats:italic>On these index scans, the presence of<\/jats:italic>\u2009\u2265\u2009<jats:italic>3 of 6 predefined radiological predictors was highly specific for a future diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH), comparable to overall expert judgment.<\/jats:italic><\/jats:p>\n                <jats:p>\u2022 <jats:italic>Dedicated CTPA reading for signs of CTEPH may help in early detection of CTEPH after acute pulmonary embolism.<\/jats:italic><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00330-021-08364-0","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T08:03:01Z","timestamp":1638432181000},"page":"2178-2187","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":40,"title":["Prediction of chronic thromboembolic pulmonary hypertension with standardised evaluation of initial computed tomography pulmonary angiography performed for suspected acute pulmonary embolism"],"prefix":"10.1007","volume":"32","author":[{"given":"Gudula J. A. M.","family":"Boon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne M.","family":"Ende-Verhaar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ludo F. M.","family":"Beenen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan","family":"Coolen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Delcroix","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Golebiowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menno V.","family":"Huisman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert T. A.","family":"Mairuhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian J.","family":"Meijboom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saskia","family":"Middeldorp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Pruszczyk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelis J.","family":"van Rooden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton","family":"Vonk Noordegraaf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia J. M.","family":"Kroft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederikus A.","family":"Klok","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,12,2]]},"reference":[{"key":"8364_CR1","doi-asserted-by":"publisher","first-page":"1973","DOI":"10.1161\/CIRCULATIONAHA.110.015008","volume":"124","author":"J Pepke-Zaba","year":"2011","unstructured":"Pepke-Zaba J, Delcroix M, Lang I et al (2011) Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation 124:1973\u20131981","journal-title":"Circulation"},{"key":"8364_CR2","doi-asserted-by":"publisher","first-page":"18028","DOI":"10.1038\/nrdp.2018.28","volume":"4","author":"MV Huisman","year":"2018","unstructured":"Huisman MV, Barco S, Cannegieter SC et al (2018) Pulmonary embolism. Nat Rev Dis Primers 4:18028","journal-title":"Nat Rev Dis Primers"},{"key":"8364_CR3","doi-asserted-by":"publisher","first-page":"00719","DOI":"10.1183\/23120541.00719-2020:00719-02020","volume":"7","author":"GJAM Boon","year":"2021","unstructured":"Boon GJAM, van den Hout WB, Barco S et al (2021) A model for estimating the health economic impact of earlier diagnosis of chronic thromboembolic pulmonary hypertension. ERJ Open Res 7:00719\u201302020. https:\/\/doi.org\/10.1183\/23120541.00719-2020:00719-02020","journal-title":"ERJ Open Res"},{"key":"8364_CR4","doi-asserted-by":"crossref","unstructured":"Klok FA, Barco S, Konstantinides SV et al (2018) Determinants of diagnostic delay in chronic thromboembolic pulmonary hypertension: results from the European CTEPH Registry. Eur Respir J 52(6):1801687","DOI":"10.1183\/13993003.01687-2018"},{"key":"8364_CR5","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1160\/TH13-07-0538","volume":"112","author":"L Guerin","year":"2014","unstructured":"Guerin L, Couturaud F, Parent F et al (2014) Prevalence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. Thromb Haemost 112:598\u2013605","journal-title":"Thromb Haemost"},{"key":"8364_CR6","doi-asserted-by":"publisher","unstructured":"Lorenz G, Saeedan MB, Bullen J et al (2020) CT-based biomarkers for prediction of chronic thromboembolic pulmonary hypertension after an acute pulmonary embolic event. AJR Am J Roentgenol. https:\/\/doi.org\/10.2214\/AJR.19.22541:1-7","DOI":"10.2214\/AJR.19.22541:1-7"},{"key":"8364_CR7","doi-asserted-by":"publisher","first-page":"1576","DOI":"10.1177\/0284185119836232","volume":"60","author":"AN Rogberg","year":"2019","unstructured":"Rogberg AN, Gopalan D, Westerlund E, Lindholm P (2019) Do radiologists detect chronic thromboembolic disease on computed tomography? Acta Radiol 60:1576\u20131583","journal-title":"Acta Radiol"},{"key":"8364_CR8","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1016\/j.healun.2019.03.003","volume":"38","author":"YM Ende-Verhaar","year":"2019","unstructured":"Ende-Verhaar YM, Meijboom LJ, Kroft LJM et al (2019) Usefulness of standard computed tomography pulmonary angiography performed for acute pulmonary embolism for identification of chronic thromboembolic pulmonary hypertension: results of the InShape III study. J Heart Lung Transplant 38:731\u2013738","journal-title":"J Heart Lung Transplant"},{"key":"8364_CR9","doi-asserted-by":"crossref","unstructured":"Ende-Verhaar YM, Cannegieter SC, Vonk Noordegraaf A et al (2017) Incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: a contemporary view of the published literature. Eur Respir J 49:1601792","DOI":"10.1183\/13993003.01792-2016"},{"key":"8364_CR10","doi-asserted-by":"crossref","unstructured":"Delcroix M, Torbicki A, Gopalan D et al (2021) ERS statement on chronic thromboembolic pulmonary hypertension. Eur Respir J 57:2002828\u00a0","DOI":"10.1183\/13993003.02828-2020"},{"key":"8364_CR11","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.1136\/thoraxjnl-2020-216324","volume":"76","author":"GJAM Boon","year":"2021","unstructured":"Boon GJAM, Ende-Verhaar YM, Bavalia R et al (2021) Non-invasive early exclusion of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism: the InShape II study. Thorax 76:1002\u20131009","journal-title":"Thorax"},{"key":"8364_CR12","doi-asserted-by":"publisher","first-page":"e89","DOI":"10.1055\/s-0038-1636537","volume":"2","author":"YMRD Ende-Verhaar","year":"2018","unstructured":"Ende-Verhaar YMRD, Bogaard HJ, Huisman MV, Meijboom L, Vonk Noordegraaf A, Klok FA (2018) Sensitivity of a simple non-invasive screening algorithm for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. TH Open 2:e89\u2013e95","journal-title":"TH Open"},{"key":"8364_CR13","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1111\/jth.13175","volume":"14","author":"FA Klok","year":"2016","unstructured":"Klok FA, Dzikowska-Diduch O, Kostrubiec M et al (2016) Derivation of a clinical prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. J Thromb Haemost 14:121\u2013128","journal-title":"J Thromb Haemost"},{"key":"8364_CR14","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.thromres.2011.03.004","volume":"128","author":"FA Klok","year":"2011","unstructured":"Klok FA, Surie S, Kempf T et al (2011) A simple non-invasive diagnostic algorithm for ruling out chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism. Thromb Res 128:21\u201326","journal-title":"Thromb Res"},{"key":"8364_CR15","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1016\/j.thromres.2014.12.009","volume":"135","author":"FA Klok","year":"2015","unstructured":"Klok FA, Tesche C, Rappold L et al (2015) External validation of a simple non-invasive algorithm to rule out chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. Thromb Res 135:796\u2013801","journal-title":"Thromb Res"},{"key":"8364_CR16","first-page":"177","volume":"69","author":"N Galie","year":"2016","unstructured":"Galie N, Humbert M, Vachiery JL et al (2016) 2015 ESC\/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 69:177","journal-title":"Eur Heart J"},{"key":"8364_CR17","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1136\/thoraxjnl-2014-206088","volume":"70","author":"S Rajaram","year":"2015","unstructured":"Rajaram S, Swift AJ, Condliffe R et al (2015) CT features of pulmonary arterial hypertension and its major subtypes: a systematic CT evaluation of 292 patients from the ASPIRE Registry. Thorax 70:382\u2013387","journal-title":"Thorax"},{"key":"8364_CR18","doi-asserted-by":"publisher","first-page":"e0201468","DOI":"10.1371\/journal.pone.0201468","volume":"13","author":"A Grosse","year":"2018","unstructured":"Grosse A, Grosse C, Lang I (2018) Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension. PLoS One 13:e0201468","journal-title":"PLoS One"},{"key":"8364_CR19","doi-asserted-by":"crossref","unstructured":"Gopalan D, Delcroix M, Held M (2017) Diagnosis of chronic thromboembolic pulmonary hypertension. Eur Respir Rev 26:160108","DOI":"10.1183\/16000617.0108-2016"},{"key":"8364_CR20","doi-asserted-by":"crossref","unstructured":"Klok FA, Couturaud F, Delcroix M, Humbert M (2020) Diagnosis of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. Eur Respir J 55:2000189","DOI":"10.1183\/13993003.00189-2020"},{"key":"8364_CR21","doi-asserted-by":"publisher","unstructured":"Braams NJ, Boon GJAM, de Man FS, et al (2021) Evolution of CT findings after anticoagulant treatment for acute pulmonary embolism in patients with and without an ultimate diagnosis of CTEPH. Eur Resp J 2100699. https:\/\/doi.org\/10.1183\/13993003.00699-2021","DOI":"10.1183\/13993003.00699-2021"},{"key":"8364_CR22","doi-asserted-by":"publisher","first-page":"1901647","DOI":"10.1183\/13993003.01647-2019","volume":"54","author":"SV Konstantinides","year":"2019","unstructured":"Konstantinides SV, Meyer G, Becattini C et al (2019) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Respir J 54:1901647","journal-title":"Eur Respir J"},{"key":"8364_CR23","doi-asserted-by":"publisher","first-page":"2168","DOI":"10.1111\/jth.14266","volume":"16","author":"YM Ende-Verhaar","year":"2018","unstructured":"Ende-Verhaar YM, van den Hout WB, Bogaard HJ et al (2018) Healthcare utilization in chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. J Thromb Haemost 16:2168\u20132174","journal-title":"J Thromb Haemost"},{"key":"8364_CR24","doi-asserted-by":"publisher","first-page":"978","DOI":"10.1016\/j.amjmed.2016.03.006","volume":"129","author":"VF Tapson","year":"2016","unstructured":"Tapson VF, Platt DM, Xia F et al (2016) Monitoring for pulmonary hypertension following pulmonary embolism: The INFORM Study. Am J Med 129:978-985.e972","journal-title":"Am J Med"},{"key":"8364_CR25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2021.07.001","author":"GJAM Boon","year":"2021","unstructured":"Boon GJAM, Jairam PM, Groot GMC et al (2021) Identification of chronic thromboembolic pulmonary hypertension on CTPAs performed for diagnosing acute pulmonary embolism depending on level of expertise. Eur J Intern Med. https:\/\/doi.org\/10.1016\/j.ejim.2021.07.001","journal-title":"Eur J Intern Med"},{"key":"8364_CR26","first-page":"36","volume-title":"Linking convolutional neural networks with graph convolutional networks: application in pulmonary artery-vein separation","author":"Z Zhai","year":"2019","unstructured":"Zhai Z, Staring M, Zhou X et al (2019) Linking convolutional neural networks with graph convolutional networks: application in pulmonary artery-vein separation. Springer International Publishing, Cham, pp 36\u201343"},{"key":"8364_CR27","doi-asserted-by":"publisher","first-page":"S40","DOI":"10.1097\/RTI.0000000000000492","volume":"1","author":"M Remy-Jardin","year":"2020","unstructured":"Remy-Jardin M, Faivre J-B, Kaergel R et al (2020) Machine learning and deep neural network applications in the thorax: pulmonary embolism, chronic thromboembolic pulmonary hypertension, aorta, and chronic obstructive pulmonary disease. J Thorac Imaging Suppl 1:S40\u2013S48. https:\/\/doi.org\/10.1097\/RTI.0000000000000492","journal-title":"J Thorac Imaging Suppl"},{"key":"8364_CR28","doi-asserted-by":"publisher","first-page":"103962","DOI":"10.1016\/j.compbiomed.2020.103962","volume":"125","author":"O Jimenez-Del-Toro","year":"2020","unstructured":"Jimenez-Del-Toro O, Dicente Cid Y, Platon A et al (2020) A lung graph model for the radiological assessment of chronic thromboembolic pulmonary hypertension in CT. Comput Biol Med 125:103962","journal-title":"Comput Biol Med"},{"key":"8364_CR29","doi-asserted-by":"publisher","first-page":"3567","DOI":"10.1007\/s00330-020-06699-8","volume":"30","author":"W Liu","year":"2020","unstructured":"Liu W, Liu M, Guo X et al (2020) Evaluation of acute pulmonary embolism and clot burden on CTPA with deep learning. Eur Radiol 30:3567\u20133575","journal-title":"Eur Radiol"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-021-08364-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-021-08364-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-021-08364-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,14]],"date-time":"2022-03-14T17:35:32Z","timestamp":1647279332000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-021-08364-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,2]]},"references-count":29,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["8364"],"URL":"https:\/\/doi.org\/10.1007\/s00330-021-08364-0","relation":{},"ISSN":["0938-7994","1432-1084"],"issn-type":[{"value":"0938-7994","type":"print"},{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,2]]},"assertion":[{"value":"19 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 September 2021","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 September 2021","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2021","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The scientific guarantor of this publication is F.A. Klok.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"GJAMB was supported by the Dutch Heart Foundation (2017T064).YEV has no disclosures.LFMB has no disclosures.JC has no disclosures.MD has no disclosures.MG has no disclosures.MVH reports grants from ZonMW Dutch Healthcare Fund, grants and personal fees from Pfizer-BMS, grants and personal fees from Bayer Health Care, grants and personal fees from Daiichi-Sankyo and grants from Leo Pharma, outside the submitted work.ATAM has no disclosures.LJM has no disclosures.SM reports grants and personal fees from Daiichi Sankyo, grants and personal fees from Bayer, personal fees from BMS-Pfizer, personal fees from Boehringer-Ingelheim, personal fees from Portola and personal fees from Abbvie, outside the submitted work.PP has no disclosures.CJR has no disclosures.AVN is supported by the Netherlands CardioVascular Research Initiative (CVON-2012\u201308 PHAEDRA, CVON-2017\u201310 DOLPHIN-GENESIS) and the Netherlands Organization for Scientific Research (NWO-VICI: 918.16.610). In addition, his institute received speaker\u2019s money from Johnson & Johnson, MSD, Actelion, Bayer and Ferrer in the past 3\u00a0years. Finally, he served as a member of the scientific advisory board of Acceleron, MSD and Johnson & Johnson.LJMK has no disclosures.FAK reports research grants from Bayer, Bristol-Myers Squibb, Boehringer-Ingelheim, Daiichi-Sankyo, MSD and Actelion, the Dutch Heart Foundation (2017T064) and the Dutch Thrombosis association, all outside the submitted work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"All patients provided written informed consent before the start of any study procedure.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The study protocol was approved by all institutional review boards of the participating hospitals.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The current study is a predefined post hoc analysis based on results of the InShape II study, which was a prospective, multicentre management study assessing the accuracy of a non-invasive follow-up strategy for early identification of CTEPH in consecutive patients treated for acute PE. Of all 424 InShape II study patients, available CTPA scans at the time of index PE diagnosis were collected post hoc at each of the six study sites and were re-evaluated.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}}]}}