{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T14:15:33Z","timestamp":1783433733791,"version":"3.54.6"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"8","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006306","name":"Sigrid Jus\u00e9liuksen S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","award":["250056"],"award-info":[{"award-number":["250056"]}],"id":[{"id":"10.13039\/501100006306","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The role of low muscle mass in acute neck infections is underexplored. This study aimed to validate the reliability of MRI-based masseter muscle area (MMA) measurements, derive normative age-related data in a diverse patient cohort, and evaluate the association between MMA measurements and infection severity and clinical outcomes in patients with acute neck infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      In this retrospective single-center study, 526 patients with clinically confirmed acute neck infections who underwent emergency neck MRI had bilateral MMA measured on T2-weighted Dixon images at the mandibular foramen level. MMA was normalized to height squared (MMA\/h\n                      <jats:sup>2<\/jats:sup>\n                      ). Interobserver reliability of MMA was assessed between two readers using intraclass correlation coefficients (ICC). Among adults, associations with infection severity markers and clinical outcomes were examined using univariable and multivariable tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The interobserver agreement for MMA was excellent (ICC\u2009=\u20090.991). MMA\/h\n                      <jats:sup>2<\/jats:sup>\n                      declined significantly with age (r\u2009=\u2009\u22120.21,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). In adults, MMA\/h\n                      <jats:sup>2<\/jats:sup>\n                      correlated negatively with age, maximal abscess diameter, and length of hospital stay (LOS;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01 for all); patients with abscesses had lower MMA\/h\n                      <jats:sup>2<\/jats:sup>\n                      than those without (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Multivariable analysis confirmed that MMA\/h\n                      <jats:sup>2<\/jats:sup>\n                      independently predicted abscess diameter after adjustment for age and C-reactive protein (CRP) (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), but not LOS (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.136).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Opportunistic MRI-based MMA measurements are highly reliable and associated with age, LOS, and abscess presence and size in acute neck infections. Our findings suggest a link between low masseter muscle mass and disease severity in patients with acute neck infections.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Low muscle mass associates with adverse outcomes in various diseases, yet its prognostic role in acute neck infections remains underexplored.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>MRI-based masseter muscle area measurements showed excellent reliability, declined with age, and predicted larger abscess diameter and longer hospital stay in adult patients.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Opportunistic MRI measurement of masseter muscle area is reliable and clinically associated with abscess size and length of hospital stay in patients with acute neck infections, providing clinically relevant information and supporting early risk stratification<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12500-z","type":"journal-article","created":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T18:04:46Z","timestamp":1775239486000},"page":"6365-6375","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["MRI-based measurement of masseter muscle area: reliability and clinical relevance in acute neck infections"],"prefix":"10.1007","volume":"36","author":[{"given":"Akseli","family":"Elo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jari-Pekka","family":"Vierula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaakko","family":"Heikkinen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janne","family":"Nurminen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatu","family":"Happonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Nyman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jarno","family":"Velhonoja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heikki","family":"Irjala","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tero","family":"Soukka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimmo","family":"Mattila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Otso","family":"Arponen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aapo","family":"Sir\u00e9n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0368-3746","authenticated-orcid":false,"given":"Jussi","family":"Hirvonen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,3]]},"reference":[{"key":"12500_CR1","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1016\/j.otc.2008.01.002","volume":"41","author":"F Vieira","year":"2008","unstructured":"Vieira F, Allen SM, Stocks RMS, Thompson JW (2008) Deep neck infection. Otolaryngol Clin North Am 41:459\u2013483. https:\/\/doi.org\/10.1016\/j.otc.2008.01.002","journal-title":"Otolaryngol Clin North Am"},{"key":"12500_CR2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s13244-022-01347-9","volume":"14","author":"J Hirvonen","year":"2023","unstructured":"Hirvonen J, Heikkinen J, Nyman M et al (2023) MRI of acute neck infections: evidence summary and pictorial review. Insights Imaging 14:5. https:\/\/doi.org\/10.1186\/s13244-022-01347-9","journal-title":"Insights Imaging"},{"key":"12500_CR3","doi-asserted-by":"publisher","unstructured":"Hirvonen J, Lingam RK, Connor S (2025) ESR Essentials: acute infections of the head and neck\u2014practice recommendations by the European Society of Head and Neck Radiology. Eur Radiol. https:\/\/doi.org\/10.1007\/s00330-025-11818-4","DOI":"10.1007\/s00330-025-11818-4"},{"key":"12500_CR4","doi-asserted-by":"publisher","first-page":"109943","DOI":"10.1016\/j.ejrad.2021.109943","volume":"145","author":"A Tolonen","year":"2021","unstructured":"Tolonen A, Pakarinen T, Sassi A et al (2021) Methodology, clinical applications, and future directions of body composition analysis using computed tomography (CT) images: a review. Eur J Radiol 145:109943. https:\/\/doi.org\/10.1016\/j.ejrad.2021.109943","journal-title":"Eur J Radiol"},{"key":"12500_CR5","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1093\/ageing\/afy169","volume":"48","author":"AJ Cruz-Jentoft","year":"2019","unstructured":"Cruz-Jentoft AJ, Bahat G, Bauer J et al (2019) Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing 48:16\u201331. https:\/\/doi.org\/10.1093\/ageing\/afy169","journal-title":"Age Ageing"},{"key":"12500_CR6","doi-asserted-by":"publisher","first-page":"e172","DOI":"10.1093\/pubmed\/fdaa226","volume":"44","author":"F Petermann-Rocha","year":"2022","unstructured":"Petermann-Rocha F, Pell JP, Celis-Morales C, Ho FK (2022) Frailty, sarcopenia, cachexia and malnutrition as comorbid conditions and their associations with mortality: a prospective study from UK Biobank. J Public Health 44:e172\u2013e180. https:\/\/doi.org\/10.1093\/pubmed\/fdaa226","journal-title":"J Public Health"},{"key":"12500_CR7","doi-asserted-by":"publisher","first-page":"e0251455","DOI":"10.1371\/journal.pone.0251455","volume":"16","author":"S-W Chang","year":"2021","unstructured":"Chang S-W, Tsai Y-H, Hsu C-M et al (2021) Masticatory muscle index for indicating skeletal muscle mass in patients with head and neck cancer. PLoS One 16:e0251455. https:\/\/doi.org\/10.1371\/journal.pone.0251455","journal-title":"PLoS One"},{"key":"12500_CR8","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-51589-4","volume":"14","author":"A Janovi\u0107","year":"2024","unstructured":"Janovi\u0107 A, Mili\u010di\u0107 B, Anti\u0107 S et al (2024) Feasibility of using cross-sectional area of masticatory muscles to predict sarcopenia in healthy aging subjects. Sci Rep 14:2079. https:\/\/doi.org\/10.1038\/s41598-024-51589-4","journal-title":"Sci Rep"},{"key":"12500_CR9","doi-asserted-by":"publisher","first-page":"15","DOI":"10.21037\/qims-21-43","volume":"12","author":"HC Van Heusden","year":"2022","unstructured":"Van Heusden HC, Chargi N, Dankbaar JW et al (2022) Masseter muscle parameters can function as an alternative for skeletal muscle mass assessments on cross-sectional imaging at lumbar or cervical vertebral levels. Quant Imaging Med Surg 12:15\u201327. https:\/\/doi.org\/10.21037\/qims-21-43","journal-title":"Quant Imaging Med Surg"},{"key":"12500_CR10","doi-asserted-by":"publisher","first-page":"e19069","DOI":"10.1097\/MD.0000000000019069","volume":"99","author":"Y Hwang","year":"2020","unstructured":"Hwang Y, Lee YH, Cho DH et al (2020) Applicability of the masseter muscle as a nutritional biomarker. Medicine (Baltimore) 99:e19069. https:\/\/doi.org\/10.1097\/MD.0000000000019069","journal-title":"Medicine (Baltimore)"},{"key":"12500_CR11","doi-asserted-by":"publisher","first-page":"111777","DOI":"10.1016\/j.exger.2022.111777","volume":"163","author":"C-S Lin","year":"2022","unstructured":"Lin C-S, Liu L-K, Lee W-J et al (2022) Low masseter muscle mass is associated with frailty in community-dwelling older adults: I-Lan Longitudinal Aging Study. Exp Gerontol 163:111777. https:\/\/doi.org\/10.1016\/j.exger.2022.111777","journal-title":"Exp Gerontol"},{"key":"12500_CR12","doi-asserted-by":"publisher","first-page":"716","DOI":"10.1001\/jamasurg.2019.0988","volume":"154","author":"C Tanabe","year":"2019","unstructured":"Tanabe C, Reed MJ, Pham TN et al (2019) Association of brain atrophy and masseter sarcopenia with 1-year mortality in older trauma patients. JAMA Surg 154:716. https:\/\/doi.org\/10.1001\/jamasurg.2019.0988","journal-title":"JAMA Surg"},{"key":"12500_CR13","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.ejvs.2018.11.011","volume":"57","author":"NKJ Oksala","year":"2019","unstructured":"Oksala NKJ, Lindstr\u00f6m I, Khan N et al (2019) Pre-operative masseter area is an independent predictor of long-term survival after carotid endarterectomy. Eur J Vasc Endovasc Surg 57:331\u2013338. https:\/\/doi.org\/10.1016\/j.ejvs.2018.11.011","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"12500_CR14","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1016\/j.bjoms.2021.07.020","volume":"60","author":"DM McGoldrick","year":"2022","unstructured":"McGoldrick DM, Yassin Alsabbagh A, Shaikh M et al (2022) Masseter muscle defined sarcopenia and survival in head and neck cancer patients. Br J Oral Maxillofac Surg 60:454\u2013458. https:\/\/doi.org\/10.1016\/j.bjoms.2021.07.020","journal-title":"Br J Oral Maxillofac Surg"},{"key":"12500_CR15","doi-asserted-by":"publisher","first-page":"107421","DOI":"10.1016\/j.jstrokecerebrovasdis.2023.107421","volume":"32","author":"J Boriesosdick","year":"2023","unstructured":"Boriesosdick J, Surov A, Michael A et al (2023) Sarcopenia is a predictor of patient death in acute ischemic stroke. J Stroke Cerebrovasc Dis 32:107421. https:\/\/doi.org\/10.1016\/j.jstrokecerebrovasdis.2023.107421","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"12500_CR16","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1055\/a-1990-0201","volume":"195","author":"D Vogele","year":"2023","unstructured":"Vogele D, Otto S, Sollmann N et al (2023) Sarcopenia\u2014definition, radiological diagnosis, clinical significance. RoFo 195:393\u2013405. https:\/\/doi.org\/10.1055\/a-1990-0201","journal-title":"RoFo"},{"key":"12500_CR17","doi-asserted-by":"publisher","first-page":"105549","DOI":"10.1016\/j.archger.2024.105549","volume":"126","author":"JH Koh","year":"2024","unstructured":"Koh JH, Tan LTP, Lim CYJ et al (2024) Association of head and neck CT-derived sarcopenia with mortality and adverse outcomes: a systematic review. Arch Gerontol Geriatr 126:105549. https:\/\/doi.org\/10.1016\/j.archger.2024.105549","journal-title":"Arch Gerontol Geriatr"},{"key":"12500_CR18","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.1097\/JTO.0000000000000690","volume":"10","author":"EY Kim","year":"2015","unstructured":"Kim EY, Kim YS, Park I et al (2015) Prognostic significance of CT-determined sarcopenia in patients with small-cell lung cancer. J Thorac Oncol 10:1795\u20131799. https:\/\/doi.org\/10.1097\/JTO.0000000000000690","journal-title":"J Thorac Oncol"},{"key":"12500_CR19","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1007\/s00330-021-08200-5","volume":"32","author":"J Heikkinen","year":"2022","unstructured":"Heikkinen J, Nurminen J, Velhonoja J et al (2022) Clinical and prognostic significance of emergency MRI findings in neck infections. Eur Radiol 32:1078\u20131086. https:\/\/doi.org\/10.1007\/s00330-021-08200-5","journal-title":"Eur Radiol"},{"key":"12500_CR20","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1002\/jcsm.12783","volume":"13","author":"F Petermann-Rocha","year":"2022","unstructured":"Petermann-Rocha F, Balntzi V, Gray SR et al (2022) Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle 13:86\u201399. https:\/\/doi.org\/10.1002\/jcsm.12783","journal-title":"J Cachexia Sarcopenia Muscle"},{"key":"12500_CR21","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","volume":"15","author":"TK Koo","year":"2016","unstructured":"Koo TK, Li MY (2016) A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 15:155\u2013163. https:\/\/doi.org\/10.1016\/j.jcm.2016.02.012","journal-title":"J Chiropr Med"},{"key":"12500_CR22","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1007\/s00117-025-01504-3","volume":"65","author":"B Atasoy","year":"2025","unstructured":"Atasoy B, Balsak S, Alkan A et al (2025) Associations between masseter and temporal muscle measurements and sarcopenia and nutritional status in older adults. Radiologie (Heidelb) 65:116\u2013125. https:\/\/doi.org\/10.1007\/s00117-025-01504-3","journal-title":"Radiologie (Heidelb)"},{"key":"12500_CR23","doi-asserted-by":"publisher","unstructured":"Kikuta S, Iwata E, Takeshita Y et al (2025) Impact of CT-assessed sarcopenia on the severity of odontogenic deep neck infections: a retrospective cohort study. Odontology. https:\/\/doi.org\/10.1007\/s10266-025-01204-3","DOI":"10.1007\/s10266-025-01204-3"},{"key":"12500_CR24","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1016\/j.ebiom.2019.10.034","volume":"49","author":"C Nelke","year":"2019","unstructured":"Nelke C, Dziewas R, Minnerup J et al (2019) Skeletal muscle as potential central link between sarcopenia and immune senescence. eBioMedicine 49:381\u2013388. https:\/\/doi.org\/10.1016\/j.ebiom.2019.10.034","journal-title":"eBioMedicine"},{"key":"12500_CR25","doi-asserted-by":"publisher","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","volume":"56","author":"LP Fried","year":"2001","unstructured":"Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56:M146\u2013M157. https:\/\/doi.org\/10.1093\/gerona\/56.3.M146","journal-title":"J Gerontol A Biol Sci Med Sci"},{"key":"12500_CR26","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.3389\/fphys.2017.01045","volume":"8","author":"S Dalle","year":"2017","unstructured":"Dalle S, Rossmeislova L, Koppo K (2017) The role of inflammation in age-related sarcopenia. Front Physiol 8:1045. https:\/\/doi.org\/10.3389\/fphys.2017.01045","journal-title":"Front Physiol"},{"key":"12500_CR27","doi-asserted-by":"publisher","first-page":"1330386","DOI":"10.3389\/fimmu.2024.1330386","volume":"15","author":"A Tylutka","year":"2024","unstructured":"Tylutka A, Walas \u0141, Zembron-Lacny A (2024) Level of IL-6, TNF, and IL-1\u03b2 and age-related diseases: a systematic review and meta-analysis. Front Immunol 15:1330386. https:\/\/doi.org\/10.3389\/fimmu.2024.1330386","journal-title":"Front Immunol"},{"key":"12500_CR28","doi-asserted-by":"publisher","first-page":"1591","DOI":"10.1001\/jama.2013.278481","volume":"310","author":"ZA Puthucheary","year":"2013","unstructured":"Puthucheary ZA, Rawal J, McPhail M et al (2013) Acute skeletal muscle wasting in critical illness. JAMA 310:1591. https:\/\/doi.org\/10.1001\/jama.2013.278481","journal-title":"JAMA"},{"key":"12500_CR29","doi-asserted-by":"publisher","first-page":"3428","DOI":"10.3390\/nu16203428","volume":"16","author":"S Damanti","year":"2024","unstructured":"Damanti S, Senini E, De Lorenzo R et al (2024) Acute sarcopenia: mechanisms and management. Nutrients 16:3428. https:\/\/doi.org\/10.3390\/nu16203428","journal-title":"Nutrients"},{"key":"12500_CR30","doi-asserted-by":"crossref","unstructured":"Vierula J-P, Merisaari H, Heikkinen J et al (2025) MRI-based risk factors for intensive care unit admissions in acute neck infections. Eur J Radiol Open 14:100648","DOI":"10.1016\/j.ejro.2025.100648"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12500-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-026-12500-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-026-12500-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:32:03Z","timestamp":1783431123000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-026-12500-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,3]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["12500"],"URL":"https:\/\/doi.org\/10.1007\/s00330-026-12500-z","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,3]]},"assertion":[{"value":"9 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 February 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 March 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 April 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The scientific guarantor of this publication is Jussi Hirvonen.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","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":"Written informed consent was not required for this study because of the national legislature on retrospective register studies.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was not required because of the national legislature on retrospective register studies.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Some study subjects or cohorts have been previously reported in Vierula et al [\n                      \n                      ].","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}