{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T01:29:15Z","timestamp":1794533355881,"version":"4.9.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T00:00:00Z","timestamp":1727654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100014584","name":"Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014584","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Pre-operative assessment of surgical risk is essential for patient counselling in the elderly patient population. Our purpose was to compare validated geriatric assessment scores (GAS) in predicting postoperative morbidity and mortality in patients\u2009\u2265\u200980 years.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Overall, eight preoperative GAS were assessed for each patient who received RC from 2016 to 2021. Postoperative morbidity was recorded according to the Clavien-Dindo classification (CDC) of surgical complications. Binary logistic regression analyses were used to determine prediction of 30-d morbidity and 90-d mortality in patients\u2009\u2265\u200980 years.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In total, 424 patients were analysed (77.4% male) with median age of 71 years (IQR: 68.82;70.69), of which 67 (15.8%) were \u2265\u200980 years. Patients age\u2009\u2265\u200980 years showed more 30-d CDC grade\u2009\u2265\u2009IIIb (41.07% vs. 27.74% compared to &lt;\u200980 years, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and worse 90-d mortality (26.87% vs. 4.76%, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). In patients\u2009\u2265\u200980 years, morbidity was predicted by simplified Frailty Index (sFI)\u00a0\u2009\u2265\u20092 (OR: 2.06, 95% CI: 1.27\u20133.34, <jats:italic>p<\/jats:italic>\u2009=\u2009.004), Eastern Cooperative Oncology Group (ECOG) performance status\u2009\u2265\u20092 (OR: 2.78, 95% CI: 1.18\u20136.54, <jats:italic>p<\/jats:italic>\u2009=\u2009.019) and severe Adult Comorbidity Evaluation (ACE)-27 score (OR: 2.07, 95% CI: 1.13\u20133.79, <jats:italic>p<\/jats:italic>\u2009=\u2009.019), while 90-d mortality was predicted by CDC grade\u2009\u2265\u2009IIIb (OR: 22.91, 95% CI: 8.74\u201360.09, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and ECOG\u2009\u2265\u20092 (OR: 2.87, 95% CI: 1.05\u20137.86, <jats:italic>p<\/jats:italic>\u2009=\u2009.04).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Even in a high-volume center of RC, 90-d mortality is significantly higher in patients age\u2009\u2265\u200980. Our results suggest in patient age\u2009\u2265\u200980, sFI\u2009\u2265\u20092, ECOG performance status\u2009\u2265\u20092 and severe ACE-27 score as clinical cut-off value to evaluate alternative bladder-sparing concepts.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00345-024-05248-y","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T13:02:37Z","timestamp":1727701357000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Radical cystectomy in patients aged\u2009&lt;\u200980 years versus \u2265\u200980 years: analysis of preoperative geriatric assessment scores in predicting postoperative morbidity and mortality"],"prefix":"10.1007","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7008-1238","authenticated-orcid":false,"given":"Gregor","family":"Duwe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Wagner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katarzyna E.","family":"Banasiewicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa Johanna","family":"Frey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikita Dhruva","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Bierlein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"R\u00f6lz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Haack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Mager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher C. M.","family":"Neumann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"Boehm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Sparwasser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Tsaur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed M.","family":"Kamal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Haferkamp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian Peter","family":"Brandt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"H\u00f6fner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,9,30]]},"reference":[{"key":"5248_CR1","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.eururo.2021.09.026","volume":"81","author":"R Cathomas","year":"2022","unstructured":"Cathomas R, Lorch A, Bruins HM, Comp\u00e9rat EM, Cowan NC, Efstathiou JA et al (2022) The 2021 updated european association of urology guidelines on metastatic urothelial carcinoma. Eur Urol 81:95\u2013103","journal-title":"Eur Urol"},{"key":"5248_CR2","doi-asserted-by":"publisher","first-page":"302","DOI":"10.1097\/JU.0000000000002242","volume":"207","author":"AP Mitra","year":"2022","unstructured":"Mitra AP, Cai J, Miranda G, Bhanvadia S, Quinn DI, Schuckman AK et al (2022) Management trends and outcomes of patients undergoing radical cystectomy for urothelial carcinoma of the bladder: evolution of the University of Southern California experience over 3,347 cases. J Urol 207:302\u2013313","journal-title":"J Urol"},{"key":"5248_CR3","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1016\/j.juro.2014.01.097","volume":"192","author":"S Daneshmand","year":"2014","unstructured":"Daneshmand S, Ahmadi H, Schuckman AK, Mitra AP, Cai J, Miranda G et al (2014) Enhanced recovery protocol after radical cystectomy for bladder cancer. J Urol 192:50\u201355","journal-title":"J Urol"},{"key":"5248_CR4","doi-asserted-by":"publisher","first-page":"2525","DOI":"10.1016\/S0140-6736(18)30996-6","volume":"391","author":"DJ Parekh","year":"2018","unstructured":"Parekh DJ, Reis IM, Castle EP, Gonzalgo ML, Woods ME, Svatek RS et al (2018) Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet 391:2525\u20132536","journal-title":"Lancet"},{"key":"5248_CR5","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1111\/bju.15334","volume":"128","author":"A Richters","year":"2021","unstructured":"Richters A, Ripping TM, Kiemeney LA, Leliveld AM, van Rhijn BWG, Oddens JR et al (2021) Hospital volume is associated with postoperative mortality after radical cystectomy for treatment of bladder cancer. BJU Int 128:511\u2013518","journal-title":"BJU Int"},{"issue":"Suppl 3","key":"5248_CR6","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1111\/bju.13227","volume":"116","author":"L Izquierdo","year":"2015","unstructured":"Izquierdo L, Peri L, Leon P, Ram\u00edrez-Backhaus M, Manning T, Alcaraz A et al (2015) The role of cystectomy in elderly patients - a multicentre analysis. BJU Int 116(Suppl 3):73\u201379","journal-title":"BJU Int"},{"key":"5248_CR7","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/j.eururo.2009.05.008","volume":"56","author":"M Froehner","year":"2009","unstructured":"Froehner M, Brausi MA, Herr HW, Muto G, Studer UE (2009) Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol 56:443\u2013454","journal-title":"Eur Urol"},{"key":"5248_CR8","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1111\/bju.14636","volume":"124","author":"M Mossanen","year":"2019","unstructured":"Mossanen M, Krasnow RE, Zlatev DV, Tan WS, Preston MA, Trinh QD et al (2019) Examining the relationship between complications and perioperative mortality following radical cystectomy: a population-based analysis. BJU Int 124:40\u201346","journal-title":"BJU Int"},{"key":"5248_CR9","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1016\/j.eururo.2008.07.031","volume":"55","author":"A Shabsigh","year":"2009","unstructured":"Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C et al (2009) Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 55:164\u2013174","journal-title":"Eur Urol"},{"key":"5248_CR10","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1111\/bju.14718","volume":"124","author":"A Hampson","year":"2019","unstructured":"Hampson A, Vincent A, Dasgupta P, Vasdev N (2019) Radical cystectomy complications and perioperative mortality. BJU Int 124:3\u20134","journal-title":"BJU Int"},{"key":"5248_CR11","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.euo.2019.11.005","volume":"3","author":"HM Bruins","year":"2020","unstructured":"Bruins HM, Veskim\u00e4e E, Hern\u00e1ndez V, Neuzillet Y, Cathomas R, Comp\u00e9rat EM et al (2020) The importance of hospital and surgeon volume as major determinants of morbidity and mortality after radical cystectomy for bladder cancer: a systematic review and recommendations by the European Association of urology muscle-invasive and metastatic bladder cancer guideline panel. Eur Urol Oncol 3:131\u2013144","journal-title":"Eur Urol Oncol"},{"key":"5248_CR12","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.eururo.2023.08.016","volume":"85","author":"J Alfred Witjes","year":"2024","unstructured":"Alfred Witjes J, Max Bruins H, Carri\u00f3n A, Cathomas R, Comp\u00e9rat E, Efstathiou JA et al (2024) European association of urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2023 guidelines. Eur Urol 85:17\u201331","journal-title":"Eur Urol"},{"key":"5248_CR13","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1016\/j.juro.2011.04.089","volume":"186","author":"TM Morgan","year":"2011","unstructured":"Morgan TM, Keegan KA, Barocas DA, Ruhotina N, Phillips SE, Chang SS et al (2011) Predicting the probability of 90-day survival of elderly patients with bladder cancer treated with radical cystectomy. J Urol 186:829\u2013834","journal-title":"J Urol"},{"key":"5248_CR14","doi-asserted-by":"publisher","first-page":"2384","DOI":"10.1002\/cncr.23462","volume":"112","author":"TM Koppie","year":"2008","unstructured":"Koppie TM, Serio AM, Vickers AJ, Vora K, Dalbagni G, Donat SM et al (2008) Age-adjusted Charlson comorbidity score is associated with treatment decisions and clinical outcomes for patients undergoing radical cystectomy for bladder cancer. Cancer 112:2384\u20132392","journal-title":"Cancer"},{"key":"5248_CR15","doi-asserted-by":"publisher","first-page":"e1141","DOI":"10.1016\/j.clgc.2018.07.022","volume":"16","author":"GB Schulz","year":"2018","unstructured":"Schulz GB, Grimm T, Buchner A, Jokisch F, Kretschmer A, Casuscelli J et al (2018) Surgical high-risk patients with ASA\u2009\u2265\u20093 undergoing radical cystectomy: morbidity, mortality, and predictors for major complications in a high-volume tertiary center. Clin Genitourin Cancer 16:e1141\u2013e9","journal-title":"Clin Genitourin Cancer"},{"key":"5248_CR16","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1016\/j.euf.2017.12.011","volume":"5","author":"NJ Sathianathen","year":"2019","unstructured":"Sathianathen NJ, Jarosek S, Lawrentschuk N, Bolton D, Konety BR (2019) A simplified frailty index to predict outcomes after radical cystectomy. Eur Urol Focus 5:658\u2013663","journal-title":"Eur Urol Focus"},{"key":"5248_CR17","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","volume":"40","author":"ME Charlson","year":"1987","unstructured":"Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373\u2013383","journal-title":"J Chronic Dis"},{"key":"5248_CR18","doi-asserted-by":"publisher","first-page":"2441","DOI":"10.1001\/jama.291.20.2441","volume":"291","author":"JF Piccirillo","year":"2004","unstructured":"Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL (2004) Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 291:2441\u20132447","journal-title":"JAMA"},{"key":"5248_CR19","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1097\/ALN.0000000000000972","volume":"124","author":"Y Le Manach","year":"2016","unstructured":"Le Manach Y, Collins G, Rodseth R, Le Bihan-Benjamin C, Biccard B, Riou B et al (2016) Preoperative score to Predict Postoperative Mortality (POSPOM): derivation and validation. Anesthesiology 124:570\u2013579","journal-title":"Anesthesiology"},{"key":"5248_CR20","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1111\/j.1532-5415.1999.tb05204.x","volume":"47","author":"J McCusker","year":"1999","unstructured":"McCusker J, Bellavance F, Cardin S, Tr\u00e9panier S, Verdon J, Ardman O (1999) Detection of older people at increased risk of adverse health outcomes after an emergency visit: the ISAR screening tool. J Am Geriatr Soc 47:1229\u20131237","journal-title":"J Am Geriatr Soc"},{"key":"5248_CR21","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.eururo.2019.08.011","volume":"77","author":"MW Vetterlein","year":"2020","unstructured":"Vetterlein MW, Klemm J, Gild P, Bradtke M, Soave A, Dahlem R et al (2020) Improving estimates of perioperative morbidity after radical cystectomy using the European Association of Urology Quality Criteria for standardized reporting and introducing the comprehensive complication index. Eur Urol 77:55\u201365","journal-title":"Eur Urol"},{"key":"5248_CR22","doi-asserted-by":"publisher","first-page":"E222","DOI":"10.1111\/j.1464-410X.2012.10938.x","volume":"110","author":"R Mayr","year":"2012","unstructured":"Mayr R, May M, Martini T, Lodde M, Pycha A, Comploj E et al (2012) Predictive capacity of four comorbidity indices estimating perioperative mortality after radical cystectomy for urothelial carcinoma of the bladder. BJU Int 110:E222\u2013E227","journal-title":"BJU Int"},{"key":"5248_CR23","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.juro.2013.01.010","volume":"190","author":"SA Boorjian","year":"2013","unstructured":"Boorjian SA, Kim SP, Tollefson MK, Carrasco A, Cheville JC, Thompson RH et al (2013) Comparative performance of comorbidity indices for estimating perioperative and 5-year all cause mortality following radical cystectomy for bladder cancer. J Urol 190:55\u201360","journal-title":"J Urol"},{"key":"5248_CR24","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1002\/jso.27255","volume":"128","author":"P Dell\u2019Oglio","year":"2023","unstructured":"Dell\u2019Oglio P, Tappero S, Panunzio A, Antonelli A, Salvador D, Xylinas E et al (2023) Age represents the main driver of surgical decision making in patients candidate to radical cystectomy. J Surg Oncol 128:142\u2013154","journal-title":"J Surg Oncol"},{"key":"5248_CR25","doi-asserted-by":"publisher","first-page":"3502","DOI":"10.1245\/s10434-018-6381-1","volume":"25","author":"C Groeben","year":"2018","unstructured":"Groeben C, Koch R, Baunacke M, Schmid M, Borkowetz A, Wirth MP et al (2018) Urinary diversion after radical cystectomy for bladder cancer: comparing trends in the US and Germany from 2006 to 2014. Ann Surg Oncol 25:3502\u20133509","journal-title":"Ann Surg Oncol"},{"key":"5248_CR26","first-page":"E261","volume":"16","author":"FZ Arthuso","year":"2022","unstructured":"Arthuso FZ, Fairey AS, Boul\u00e9 NG, Courneya KS (2022) Associations between body mass index and bladder cancer survival: is the obesity paradox short-lived? Can Urol Assoc J 16:E261\u2013E7","journal-title":"Can Urol Assoc J"},{"key":"5248_CR27","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.eururo.2013.12.018","volume":"66","author":"A Aziz","year":"2014","unstructured":"Aziz A, May M, Burger M, Palisaar RJ, Trinh QD, Fritsche HM et al (2014) Prediction of 90-day mortality after radical cystectomy for bladder cancer in a prospective European multicenter cohort. Eur Urol 66:156\u2013163","journal-title":"Eur Urol"},{"key":"5248_CR28","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1016\/j.euf.2017.08.005","volume":"4","author":"TD Haden","year":"2018","unstructured":"Haden TD, Prunty MC, Jones AB, Deroche CB, Murray KS, Pokala N (2018) Comparative perioperative outcomes in septuagenarians and octogenarians undergoing radical cystectomy for bladder cancer-do outcomes differ? Eur Urol Focus 4:895\u2013899","journal-title":"Eur Urol Focus"},{"key":"5248_CR29","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1007\/s00345-016-1972-6","volume":"35","author":"DM Golombos","year":"2017","unstructured":"Golombos DM, O\u2019Malley P, Lewicki P, Nguyen DP, Stone BV, Al Hussein Al Awamlh B et al (2017) The impact of socioeconomic status on perioperative complications and oncologic outcomes in patients undergoing radical cystectomy. World J Urol 35:1063\u20131071","journal-title":"World J Urol"},{"key":"5248_CR30","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1016\/S1470-2045(23)00170-5","volume":"24","author":"AR Zlotta","year":"2023","unstructured":"Zlotta AR, Ballas LK, Niemierko A, Lajkosz K, Kuk C, Miranda G et al (2023) Radical cystectomy versus trimodality therapy for muscle-invasive bladder cancer: a multi-institutional propensity score matched and weighted analysis. Lancet Oncol 24:669\u2013681","journal-title":"Lancet Oncol"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-024-05248-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-024-05248-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-024-05248-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T21:23:25Z","timestamp":1735853005000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-024-05248-y"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,30]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["5248"],"URL":"https:\/\/doi.org\/10.1007\/s00345-024-05248-y","relation":{},"ISSN":["1433-8726"],"issn-type":[{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,30]]},"assertion":[{"value":"20 May 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 August 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 September 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 study was approved by the Ethics Committee of the Rhineland-Palatinate State Medical Association (application number: 2021\u201315768). Our research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants"}},{"value":"All other authors have nothing to declare.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"552"}}