{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T15:55:27Z","timestamp":1781798127264,"version":"3.54.5"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004702","name":"Universit\u00e0 degli Studi di Genova","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004702","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Orthop Trauma Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The number of total hip arthroplasties (THAs) performed worldwide is steadily increasing, and, consequently, the demand for revision procedures is expected to rise as well. two-stage revision procedure continues to be considered the gold standard in many clinical scenarios. During the first step, failure to restore femoral offset has been implicated as a contributor to instability and mechanical failure, although a clear consensus is still lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The primary aim of this study is to evaluate the restoration of biomechanical parameters of the hip\u2014specifically leg length discrepancy (LLD), femoral offset (FO), acetabular offset (AO), and global offset (GO)\u2014following implantation of a specific type of articulating hip spacer during the first stage of a two-stage revision for PJI. A secondary objective is to assess the correlation between variations in offset parameters and the rate of interstage mechanical complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed all patients undergoing staged revision with a specific articulating spacer between 2020 and 2022 at a single institution. Harris Hip Scores, Oxford Hip Scores, and Visual Analogue Scales for pain were obtained at different time points. Radiographic analysis included LLD, FO, AO and GO measurements on the affected (spacer and post-reimplantation) and the contralateral side. Complications were recorded during the interstage and post-reimplantation period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-seven patients (47 hips), were enrolled. The mean follow-up was 25.3 months. Clinical outcomes showed significant improvement from pre-operative visit to interim period and at the last follow-up (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01). No statistically significant differences for FO, AO and GO between contralateral and spacer side were observed. LLD before reimplantation was 10.1\u2009\u00b1\u20097.5\u00a0mm. GO increased of 4\u2009\u00b1\u20093.2\u00a0mm at final follow-up (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05) with a final LLD of 5.6\u2009\u00b1\u20094.9\u00a0mm. Six complications (12.8%) occurred during the interstage period: 4 spacer dislocations (8.5%) and 2 intraoperative femoral peri-spacer fractures (4.3%). Comparison between stable and dislocated spacers showed statistically significant differences for mean \u0394FO (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02) and \u0394GO (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The articulated spacer assessed in this study, especially when used in combination with a custom-made acetabular component, allowed approximation of the main biomechanical parameters, with small, non-significant differences compared to the contralateral side. Offset parameters reduction may be associated with spacer dislocation rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00402-026-06384-3","type":"journal-article","created":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T15:43:04Z","timestamp":1781797384000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Radiographic assessment of femoral, acetabular and global offset following hip spacer implantation in staged total hip arthroplasty\u201d"],"prefix":"10.1007","volume":"146","author":[{"given":"Luca","family":"Cavagnaro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Ferrari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Providenti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Marciante","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuliana","family":"Carrega","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Formica","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"6384_CR1","doi-asserted-by":"crossref","unstructured":"Shichman I, Askew N, Habibi A, Nherera L, Macaulay W, Seyler T, Schwarzkopf R (20239 Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2040\u20132060. Arthroplast Today May 30;21:101152","DOI":"10.1016\/j.artd.2023.101152"},{"issue":"6S","key":"6384_CR2","doi-asserted-by":"publisher","first-page":"S79","DOI":"10.1016\/j.arth.2020.02.030","volume":"35","author":"AM Schwartz","year":"2020","unstructured":"Schwartz AM, Farley KX, Guild GN, Bradbury TL Jr. (2020) Projections and Epidemiology of Revision Hip and Knee Arthroplasty in the United States to 2030. J Arthroplasty 35(6S):S79\u2013S85","journal-title":"J Arthroplasty"},{"issue":"1_suppl","key":"6384_CR3","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1177\/1120700020926932","volume":"30","author":"F Chiarlone","year":"2020","unstructured":"Chiarlone F, Cavagnaro L, Zanirato A, Alessio Mazzola M, Lovisolo S, Mosconi L, Felli L, Burastero G (2020) Cup-on-cup technique: a reliable management solution for severe acetabular bone loss in revision total hip replacement. Hip Int 30(1_suppl):12\u201318","journal-title":"Hip Int"},{"issue":"3","key":"6384_CR4","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1007\/s00402-020-03334-5","volume":"140","author":"F Chiarlone","year":"2020","unstructured":"Chiarlone F, Zanirato A, Cavagnaro L, Alessio-Mazzola M, Felli L, Burastero G (2020) Acetabular custom-made implants for severe acetabular bone defect in revision total hip arthroplasty: a systematic review of the literature. Arch Orthop Trauma Surg 140(3):415\u2013424","journal-title":"Arch Orthop Trauma Surg"},{"key":"6384_CR5","doi-asserted-by":"crossref","unstructured":"Dale H, Fenstad AM, Hallan G, Overgaard S, Pedersen AB, Hailer NP, K\u00e4rrholm J, Rolfson O, Eskelinen A, M\u00e4kel\u00e4 KT, Furnes O (20239 Increasing risk of revision due to infection after primary total hip arthroplasty: results from the Nordic Arthroplasty Register Association. Acta Orthop Jun 27;94:307\u2013315","DOI":"10.2340\/17453674.2023.13648"},{"key":"6384_CR6","doi-asserted-by":"publisher","first-page":"646","DOI":"10.2174\/1874325001610010646","volume":"30","author":"M Nguyen","year":"2016","unstructured":"Nguyen M, Sukeik M, Zahar A, Nizam I, Haddad FS (2016) One-stage Exchange Arthroplasty for Periprosthetic Hip and Knee Joint Infections. Open Orthop J Nov 30:10:646\u2013653","journal-title":"Open Orthop J Nov"},{"issue":"1","key":"6384_CR7","first-page":"10","volume":"86","author":"G Carrega","year":"2020","unstructured":"Carrega G, Casalino-Finocchio G, Cavagnaro L, Felli L, Riccio G, Burastero G (2020) Long-term outcome of prosthetic joint infections treated with two-stage revision. Acta Orthop Belg 86(1):10\u201316","journal-title":"Acta Orthop Belg"},{"issue":"3S","key":"6384_CR8","doi-asserted-by":"publisher","first-page":"S31","DOI":"10.1016\/j.arth.2019.11.007","volume":"35","author":"SM Sporer","year":"2020","unstructured":"Sporer SM (2020) Spacer Design Options and Consideration for Periprosthetic Joint Infection. J Arthroplasty 35(3S):S31\u2013S34","journal-title":"J Arthroplasty"},{"issue":"9S1","key":"6384_CR9","doi-asserted-by":"publisher","first-page":"S236","DOI":"10.1016\/j.arth.2024.05.017","volume":"39","author":"J Tseng","year":"2024","unstructured":"Tseng J, Oladipo VA, Acu\u00f1a AJ, Jones CM, Tsintolas J, Levine BR (2024) Evaluating Modern Spacer Options and Outcomes in Revision Hip Arthroplasty. J Arthroplasty 39(9S1):S236\u2013S242","journal-title":"J Arthroplasty"},{"issue":"5","key":"6384_CR10","doi-asserted-by":"publisher","first-page":"2341","DOI":"10.1007\/s00402-022-04427-z","volume":"143","author":"A Sambri","year":"2023","unstructured":"Sambri A, Fiore M, Rondinella C, Morante L, Paolucci A, Giannini C, Alfonso C, De Paolis M (2023) Mechanical complications of hip spacers: a systematic review of the literature. Arch Orthop Trauma Surg 143(5):2341\u20132353","journal-title":"Arch Orthop Trauma Surg"},{"issue":"6","key":"6384_CR11","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.1016\/j.arth.2019.02.012","volume":"34","author":"CW Jones","year":"2019","unstructured":"Jones CW, Selemon N, Nocon A, Bostrom M, Westrich G, Sculco PK (2019) The Influence of Spacer Design on the Rate of Complications in Two-Stage Revision Hip Arthroplasty. J Arthroplast 34(6):1201\u20131206","journal-title":"J Arthroplast"},{"issue":"5","key":"6384_CR12","doi-asserted-by":"publisher","first-page":"274","DOI":"10.7150\/ijms.6.274","volume":"6","author":"K Anagnostakos","year":"2009","unstructured":"Anagnostakos K, Jung J, Schmid NV, Schmitt E, Kelm J (2009) Mechanical complications and reconstruction strategies at the site of hip spacer implantation. Int J Med Sci 6(5):274\u20139","journal-title":"Int J Med Sci"},{"issue":"2","key":"6384_CR13","first-page":"344","volume":"81","author":"P Barreira","year":"2015","unstructured":"Barreira P, Leite P, Neves P, Soares D, Sousa R (2015) Preventing mechanical complications of hip spacer implantation: technical tips and pearls. Acta Orthop Belg Jun; 81(2):344\u2013348","journal-title":"Acta Orthop Belg"},{"issue":"3","key":"6384_CR14","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1016\/j.otsr.2017.11.016","volume":"104","author":"R Erivan","year":"2018","unstructured":"Erivan R, Lecointe T, Villatte G, Mulliez A, Descamps S, Boisgard S (2018) Complications with cement spacers in 2-stage treatment of periprosthetic joint infection on total hip replacement. Orthop Traumatol Surg Res 104(3):333\u2013339","journal-title":"Orthop Traumatol Surg Res"},{"key":"6384_CR15","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.jor.2019.09.016","volume":"18","author":"JO Kipp","year":"2019","unstructured":"Kipp JO, Lamm M, S\u00f8balle K, Jakobsen SS (2019) Periprosthetic hip infection treated with two-stage stage-one Select Spacer- complication rate and restoration of anatomy. J Orthop 18:138\u2013142","journal-title":"J Orthop"},{"issue":"5","key":"6384_CR16","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1016\/j.arth.2018.02.078","volume":"33","author":"J Parvizi","year":"2018","unstructured":"Parvizi J, Tan TL, Goswami K, Higuera C, Della Valle C, Chen AF, Shohat N (2018) The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. J Arthroplast 33(5):1309-1314e.e2","journal-title":"J Arthroplast"},{"issue":"4","key":"6384_CR17","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1097\/CORR.0000000000001133","volume":"478","author":"A Coughlan","year":"2020","unstructured":"Coughlan A, Taylor F (2020) Classifications in Brief: The McPherson Classification of Periprosthetic Infection. Clin Orthop Relat Res 478(4):903\u2013908","journal-title":"Clin Orthop Relat Res"},{"issue":"1","key":"6384_CR18","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/0883-5403(94)90135-X","volume":"9","author":"WG Paprosky","year":"1994","unstructured":"Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplast 9(1):33\u201344","journal-title":"J Arthroplast"},{"key":"6384_CR19","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1097\/00003086-200403000-00009","volume":"420","author":"CJ Della Valle","year":"2004","unstructured":"Della Valle CJ, Paprosky WG (2004) The femur in revision total hip arthroplasty evaluation and classification. Clin Orthop Relat Res 420:55\u201362","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"6384_CR20","doi-asserted-by":"publisher","first-page":"2154","DOI":"10.1007\/s11999-014-4076-x","volume":"473","author":"KT Hug","year":"2015","unstructured":"Hug KT, Alton TB, Gee AO (2015) Classifications in brief: Brooker classification of heterotopic ossification after total hip arthroplasty. Clin Orthop Relat Res 473(6):2154\u20132157","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"6384_CR21","doi-asserted-by":"publisher","first-page":"487","DOI":"10.3109\/17453679509002300","volume":"66","author":"B Espehaug","year":"1995","unstructured":"Espehaug B, Havelin LI, Engesaeter LB, Vollset SE, Langeland N (1995) Early revision among 12,179 hip prostheses. A comparison of 10 different brands reported to the Norwegian Arthroplasty register, 1987\u20131993. Acta Orthop Scand 66(6):487\u2013493","journal-title":"Acta Orthop Scand"},{"key":"6384_CR22","doi-asserted-by":"crossref","unstructured":"DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res (121):20\u20133228","DOI":"10.1097\/00003086-197611000-00003"},{"key":"6384_CR23","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1097\/00003086-197906000-00002","volume":"141","author":"TA Gruen","year":"1979","unstructured":"Gruen TA, McNeice GM, Amstutz HC (1979) \u201cModes of failure\u201d of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Orthop Relat Res 141:17\u201327","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"6384_CR24","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.jor.2019.05.013","volume":"16","author":"J Warnock","year":"2019","unstructured":"Warnock J, Hill J, Humphreys L, Gallagher N, Napier R, Beverland D (2019) Independent restoration of femoral and acetabular height reduces limb length discrepancy and improves reported outcome following total hiparthroplasty. J Orthop 16(6):483\u2013488","journal-title":"J Orthop"},{"issue":"9","key":"6384_CR25","doi-asserted-by":"publisher","first-page":"1317","DOI":"10.1007\/s00402-016-2527-4","volume":"136","author":"ND Clement","year":"2016","unstructured":"Clement ND, Patrick-Patel S, MacDonald R, Breusch D SJ (2016) Total hip replacement: increasing femoral offset improves functional outcome. Acta Orthop Trauma Surg 136(9):1317\u20131323","journal-title":"Acta Orthop Trauma Surg"},{"issue":"9","key":"6384_CR26","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1177\/0284185116684676","volume":"58","author":"B Al-Amiry","year":"2017","unstructured":"Al-Amiry B, Mahmood S, Krupic F, Sayed-Noor A (2017) Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem -stem or cup positioning? Acta Radiol 58(9):1125\u20131131","journal-title":"Acta Radiol"},{"issue":"2","key":"6384_CR27","doi-asserted-by":"publisher","first-page":"187","DOI":"10.5301\/hipint.5000446","volume":"27","author":"G Burastero","year":"2016","unstructured":"Burastero G, Basso M, Carrega G et al (2016) Acetabular Spacers in 2-Stage Hip Revision: Is it Worth it? A Single-Centre Retrospective Study. HIP Int 27(2):187\u2013192. https:\/\/doi.org\/10.5301\/hipint.5000446","journal-title":"HIP Int"},{"issue":"11","key":"6384_CR28","doi-asserted-by":"publisher","first-page":"1617","DOI":"10.1007\/s00402-018-3038-2","volume":"138","author":"C Lausmann","year":"2018","unstructured":"Lausmann C, Citak M, Hessling U, Wolff M, Gehrke T, Suero EM, Zahar A (2018) Preliminary results of a novel spacer technique in the management of septic revision hip arthroplasty. Arch Orthop Trauma Surg Nov 138(11):1617\u20131622","journal-title":"Arch Orthop Trauma Surg Nov"},{"issue":"4","key":"6384_CR29","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/s002640050244","volume":"22","author":"M Leunig","year":"1998","unstructured":"Leunig M, Chosa E, Speck M, Ganz R (1998) A cement spacer for two-stage revision of infected implants of the hip joint. Int Orthop 22(4):209\u2013214","journal-title":"Int Orthop"},{"issue":"5","key":"6384_CR30","doi-asserted-by":"publisher","first-page":"494","DOI":"10.5301\/hipint.5000482","volume":"27","author":"I Molinas","year":"2017","unstructured":"Molinas I, Garcia-Oltra E, Fern\u00e1ndez-Valencia JA, Tomas X, Gal- lart X, Riba J et al (2017) Relationship between femoral off-set and dislocation in preformed antibiotic-loaded cement spacers (Spacer-G\u00ae). Hip Int 27(5):494\u2013499","journal-title":"Hip Int"},{"issue":"6","key":"6384_CR31","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.2214\/ajr.180.6.1801701","volume":"180","author":"R Gee","year":"2003","unstructured":"Gee R, Munk PL, Keogh C, Nicolaou S, Masri B, Marchinkow LO, Ellis J, Chan LP (2003) Radiography of the PROSTALAC (prosthesis with antibiotic-loaded acrylic cement) orthopedic implant. AJR Am J Roentgenol 180(6):1701\u20131706","journal-title":"AJR Am J Roentgenol"},{"issue":"11","key":"6384_CR32","doi-asserted-by":"publisher","first-page":"1431","DOI":"10.1302\/0301-620X.91B11.22026","volume":"91","author":"GS Biring","year":"2009","unstructured":"Biring GS, Kostamo T, Garbuz DS, Masri BA, Duncan CP (2009) Two-stage revision arthroplasty of the hip for infection using an interim articulated Prostalac hip spacer: a 10- to 15-year follow-up study. J Bone Joint Surg Br 91(11):1431\u20131437","journal-title":"J Bone Joint Surg Br"},{"issue":"9","key":"6384_CR33","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1016\/j.arth.2014.04.013","volume":"29","author":"JD Tsung","year":"2014","unstructured":"Tsung JD, Rohrsheim JA, Whitehouse SL, Wilson MJ, Howell JR (2014) Management of periprosthetic joint infection after total hip arthroplasty using a custom-made articulating spacer (CUMARS); the Exeter experience. J Arthroplasty 29(9):1813\u20131818","journal-title":"J Arthroplasty"},{"issue":"3","key":"6384_CR34","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1177\/1120700020960669","volume":"32","author":"J Quayle","year":"2022","unstructured":"Quayle J, Barakat A, Klasan A, Mittal A, Stott P (2022) External validation study of hip peri-prosthetic joint infection with cemented custom-made articulating spacer (CUMARS). Hip Int 32(3):379\u2013385","journal-title":"Hip Int"},{"issue":"4","key":"6384_CR35","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.otsr.2010.02.006","volume":"96","author":"G Pasquier","year":"2010","unstructured":"Pasquier G, Ducharne G, Ali ES, Giraud F, Mouttet A, Durante E (2010) Total hip arthroplasty offset measurement: is C T scan the most accurate option? Orthop Traumatol Surg Res Jun 96(4):367\u2013375","journal-title":"Orthop Traumatol Surg Res Jun"}],"container-title":["Archives of Orthopaedic and Trauma Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06384-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00402-026-06384-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00402-026-06384-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T15:43:06Z","timestamp":1781797386000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00402-026-06384-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,18]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["6384"],"URL":"https:\/\/doi.org\/10.1007\/s00402-026-06384-3","relation":{},"ISSN":["1434-3916"],"issn-type":[{"value":"1434-3916","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,18]]},"assertion":[{"value":"23 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 June 2026","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 no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"226"}}