{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T02:28:38Z","timestamp":1790216918033,"version":"4.1.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Spine J"],"published-print":{"date-parts":[[2024,4]]},"DOI":"10.1007\/s00586-024-08165-1","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T16:03:12Z","timestamp":1708358592000},"page":"1624-1636","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"33","author":[{"given":"Jes\u00fas","family":"Burgos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Hevia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignacio","family":"Sanpera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Garc\u00eda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Teresa","family":"de Santos Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5166-198X","authenticated-orcid":false,"given":"Gonzalo","family":"Mariscal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Barrios","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,19]]},"reference":[{"issue":"8","key":"8165_CR1","doi-asserted-by":"publisher","first-page":"556","DOI":"10.1097\/BRS.0000000000002362","volume":"43","author":"T Akazawa","year":"2018","unstructured":"Akazawa T, Kotani T, Sakuma T, Minami S, Orita S, Inage K et al (2018) Modic Changes and disc degeneration of nonfused segments 27 to 45 years after harrington instrumentation for adolescent idiopathic scoliosis: comparison to healthy controls. Spine (Phila Pa 1976) 43(8):556\u2013561. https:\/\/doi.org\/10.1097\/BRS.0000000000002362. (PMID: 28767629)","journal-title":"Spine (Phila Pa 1976)"},{"issue":"2","key":"8165_CR2","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1097\/00042752-200203000-00005","volume":"12","author":"D Parsch","year":"2002","unstructured":"Parsch D, G\u00e4rtner V, Brocai DR, Carstens C, Schmitt H (2002) Sports activity of patients with idiopathic scoliosis at long-term follow-up. Clin J Sport Med 12(2):95\u201398. https:\/\/doi.org\/10.1097\/00042752-200203000-00005","journal-title":"Clin J Sport Med"},{"issue":"7","key":"8165_CR3","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.1007\/s00586-021-06874-5","volume":"30","author":"CK Chiu","year":"2021","unstructured":"Chiu CK, Tan CS, Chung WH, Mohamad SM, Kwan MK, Chan CYW (2021) Mid-long-term outcome and degeneration of the remaining unfused lumbar intervertebral disc in adolescent idiopathic scoliosis patients who had posterior spinal fusion surgery. Eur Spine J 30(7):1978\u20131987. https:\/\/doi.org\/10.1007\/s00586-021-06874-5","journal-title":"Eur Spine J"},{"key":"8165_CR4","doi-asserted-by":"publisher","unstructured":"Dehnokhalaji M, Golbakhsh MR, Siavashi B, Talebian P, Javidmehr S, Bozorgmanesh M (2018) Evaluation of the degenerative changes of the distal intervertebral discs after internal fixation surgery in adolescent idiopathic scoliosis. Asian Spine J 12(6):1060\u20131068. https:\/\/doi.org\/10.31616\/asj.2018.12.6.1060.","DOI":"10.31616\/asj.2018.12.6.1060"},{"issue":"6","key":"8165_CR5","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1097\/BPB.0000000000000696","volume":"29","author":"A Duramaz","year":"2020","unstructured":"Duramaz A, Karaali E, \u00d6zt\u00fcrk V, Ziro\u011flu N, \u0130lter MH, Bayrak A (2020) Importance of lowest instrumented vertebra on clinical and radiological outcomes in patients with Lenke type 3C adolescent idiopathic scoliosis: a minimum 4-year follow-up. J Pediatr Orthop B 29(6):580\u2013589. https:\/\/doi.org\/10.1097\/BPB.0000000000000696","journal-title":"J Pediatr Orthop B"},{"issue":"23","key":"8165_CR6","doi-asserted-by":"publisher","first-page":"1948","DOI":"10.1097\/BRS.0b013e3181ff1ea9","volume":"36","author":"DW Green","year":"2011","unstructured":"Green DW, Lawhorne TW 3rd, Widmann RF, Kepler CK, Ahern C, Mintz DN et al (2011) Long-term magnetic resonance imaging follow-up demonstrates minimal transitional level lumbar disc degeneration after posterior spine fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 36(23):1948\u20131954. https:\/\/doi.org\/10.1097\/BRS.0b013e3181ff1ea9","journal-title":"Spine (Phila Pa 1976)"},{"key":"8165_CR7","doi-asserted-by":"publisher","unstructured":"Akazawa T, Kotani T, Sakuma T, Minami S, Orita S, Fujimoto K et al. (2017) Spinal fusion on adolescent idiopathic scoliosis patients with the level of L4 or lower can increase lumbar disc degeneration with sagittal imbalance 35 years after surgery. Spine Surg Relat Res 1(2):72\u201377. https:\/\/doi.org\/10.22603\/ssrr.1.2016-0017.","DOI":"10.22603\/ssrr.1.2016-0017"},{"issue":"6","key":"8165_CR8","doi-asserted-by":"publisher","first-page":"1038","DOI":"10.1016\/j.spinee.2021.12.002","volume":"22","author":"MK Mesregah","year":"2022","unstructured":"Mesregah MK, Yoshida B, Lashkari N, Abedi A, Meisel HJ, Diwan A et al (2022) Demographic, clinical, and operative risk factors associated with postoperative adjacent segment disease in patients undergoing lumbar spine fusions: a systematic review and meta-analysis. Spine J 22(6):1038\u20131069. https:\/\/doi.org\/10.1016\/j.spinee.2021.12.002","journal-title":"Spine J"},{"issue":"1","key":"8165_CR9","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1186\/s13018-020-02032-7","volume":"15","author":"T Wang","year":"2020","unstructured":"Wang T, Ding W (2020) Risk factors for adjacent segment degeneration after posterior lumbar fusion surgery in treatment for degenerative lumbar disorders: a meta-analysis. J Orthop Surg Res 15(1):582. https:\/\/doi.org\/10.1186\/s13018-020-02032-7","journal-title":"J Orthop Surg Res"},{"key":"8165_CR10","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1016\/j.wneu.2021.09.066","volume":"157","author":"S Kirnaz","year":"2022","unstructured":"Kirnaz S, Capadona C, Wong T, Goldberg JL, Medary B, Sommer F et al (2022) Fundamentals of intervertebral disc degeneration. World Neurosurg 157:264\u2013273. https:\/\/doi.org\/10.1016\/j.wneu.2021.09.066","journal-title":"World Neurosurg"},{"issue":"7","key":"8165_CR11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000100","volume":"6","author":"A Liberati","year":"2009","unstructured":"Liberati A, Altman DG, Tetzlaff J, Mulrow C, G\u00f8tzsche PC, Ioannidis JP et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med 6(7):e1000100. https:\/\/doi.org\/10.1371\/journal.pmed.1000100","journal-title":"PLoS Med"},{"key":"8165_CR12","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1097\/00007632-200109010-00011","volume":"26","author":"CW Pfirrmann","year":"2001","unstructured":"Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873\u20131878. https:\/\/doi.org\/10.1097\/00007632-200109010-00011","journal-title":"Spine (Phila Pa 1976)"},{"issue":"6","key":"8165_CR13","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1016\/j.jspd.2018.03.013","volume":"6","author":"BS Lonner","year":"2018","unstructured":"Lonner BS, Ren Y, Upasani VV, Marks MM, Newton PO, Samdani AF et al (2018) Disc degeneration in unfused caudal motion segments ten years following surgery for adolescent idiopathic scoliosis. Spine Deform 6(6):684\u2013690. https:\/\/doi.org\/10.1016\/j.jspd.2018.03.013","journal-title":"Spine Deform"},{"issue":"9","key":"8165_CR14","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, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712\u2013716. https:\/\/doi.org\/10.1046\/j.1445-2197.2003.02748.x","journal-title":"ANZ J Surg"},{"issue":"3","key":"8165_CR15","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0118961","volume":"10","author":"KP Allagh","year":"2015","unstructured":"Allagh KP, Shamanna BR, Murthy GV, Ness AR, Doyle P, Neogi SB, Pant HB, Wellcome Trust- PHFI Folic Acid project team (2015) Birth prevalence of neural tube defects and orofacial clefts in India: a systematic review and meta-analysis. PLoS ONE 10(3):e0118961. https:\/\/doi.org\/10.1371\/journal.pone.0118961","journal-title":"PLoS ONE"},{"key":"8165_CR16","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604","volume-title":"Cochrane handbook for systematic reviews of interventions","author":"JP Higgins","year":"2019","unstructured":"Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ et al (2019) Cochrane handbook for systematic reviews of interventions. Wiley, New york"},{"key":"8165_CR17","doi-asserted-by":"publisher","unstructured":"Akazawa T, Umehara T, Iinuma M, Asano K, Kuroya S, Torii Y et al (2019) Spinal alignments of residual lumbar curve affect disc degeneration after spinal fusion in patients with adolescent idiopathic scoliosis: follow-up after 5 or more years. Spine Surg Relat Res 4(1):50\u201356. https:\/\/doi.org\/10.22603\/ssrr.2019-0048.","DOI":"10.22603\/ssrr.2019-0048"},{"issue":"2","key":"8165_CR18","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1007\/s43390-021-00428-x","volume":"10","author":"S Jakkepally","year":"2022","unstructured":"Jakkepally S, Viswanathan VK, Shetty AP, Hajare S, Kanna RM, Rajasekaran S (2022) The analysis of progression of disc degeneration in distal unfused segments and evaluation of long-term functional outcome in adolescent idiopathic scoliosis patients undergoing long-segment instrumented fusion. Spine Deform 10(2):343\u2013350. https:\/\/doi.org\/10.1007\/s43390-021-00428-x","journal-title":"Spine Deform"},{"issue":"5","key":"8165_CR19","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1016\/j.jspd.2015.04.001","volume":"3","author":"A Nohara","year":"2015","unstructured":"Nohara A, Kawakami N, Seki K, Tsuji T, Ohara T, Saito T et al (2015) The effects of spinal fusion on lumbar disc degeneration in patients with adolescent idiopathic scoliosis: a minimum 10-year follow-up. Spine Deform 3(5):462\u2013468. https:\/\/doi.org\/10.1016\/j.jspd.2015.04.001","journal-title":"Spine Deform"},{"key":"8165_CR20","doi-asserted-by":"publisher","unstructured":"Takahashi S, Del\u00e9crin J, Passuti N (1997) Changes in the unfused lumbar spine in patients with idiopathic scoliosis. A 5- to 9-year assessment after cotrel-dubousset instrumentation. Spine (Phila Pa 1976) 22(5):517\u201323. https:\/\/doi.org\/10.1097\/00007632-199703010-00009.","DOI":"10.1097\/00007632-199703010-00009"},{"issue":"21","key":"8165_CR21","doi-asserted-by":"publisher","first-page":"1690","DOI":"10.1097\/BRS.0000000000001120","volume":"40","author":"BB Hansen","year":"2015","unstructured":"Hansen BB, Bendix T, Grindsted J, Bliddal H, Christensen R, Hansen P et al (2015) Effect of lumbar disc degeneration and low-back pain on the lumbar lordosis in supine and standing: a cross-sectional MRI study. Spine (Phila Pa 1976) 40(21):1690\u20131696. https:\/\/doi.org\/10.1097\/BRS.0000000000001120","journal-title":"Spine (Phila Pa 1976)"},{"key":"8165_CR22","doi-asserted-by":"publisher","unstructured":"Danielsson AJ, Cederlund CG, Ekholm S, Nachemson AL (2001) The prevalence of disc aging and back pain after fusion extending into the lower lumbar spine. A matched MR study twenty-five years after surgery for adolescent idiopathic scoliosis. Acta Radiol 42(2):187\u201397. https:\/\/doi.org\/10.1080\/028418501127346495.","DOI":"10.1080\/028418501127346495"},{"issue":"5","key":"8165_CR23","doi-asserted-by":"publisher","first-page":"1488","DOI":"10.1002\/art.33462","volume":"64","author":"D Samartzis","year":"2012","unstructured":"Samartzis D, Karppinen J, Chan D, Luk KD, Cheung KM (2012) The association of lumbar intervertebral disc degeneration on magnetic resonance imaging with body mass index in overweight and obese adults: a population-based study. Arthritis Rheum 64(5):1488\u20131496. https:\/\/doi.org\/10.1002\/art.33462","journal-title":"Arthritis Rheum"},{"issue":"4","key":"8165_CR24","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1097\/00007632-200202150-00012","volume":"27","author":"FJ Schwab","year":"2002","unstructured":"Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine (Phila Pa 1976) 27(4):387\u2013392. https:\/\/doi.org\/10.1097\/00007632-200202150-00012","journal-title":"Spine (Phila Pa 1976)"},{"key":"8165_CR25","doi-asserted-by":"crossref","unstructured":"Crawford CH 3rd, Glassman SD, Bridwell KH, Berven SH, Carreon LY (2015) The minimum clinically important difference in SRS-22R total score, appearance, activity and pain domains after surgical treatment of adult spinal deformity. Spine (Phila Pa 1976) 40(6):377\u201381. .1097\/BRS.0000000000000761.","DOI":"10.1097\/BRS.0000000000000761"},{"key":"8165_CR26","doi-asserted-by":"publisher","unstructured":"van Tulder MW, Assendelft WJ, Koes BW, Bouter LM (1997) Spinal radiographic findings and nonspecific low back pain. A systematic review of observational studies. Spine (Phila Pa 1976) 22(4):427\u201334. https:\/\/doi.org\/10.1097\/00007632-199702150-00015.","DOI":"10.1097\/00007632-199702150-00015"},{"issue":"4","key":"8165_CR27","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1016\/j.spinee.2018.10.009","volume":"19","author":"AR Teles","year":"2019","unstructured":"Teles AR, Ocay DD, Bin Shebreen A, Tice A, Saran N, Ouellet JA et al (2019) Evidence of impaired pain modulation in adolescents with idiopathic scoliosis and chronic back pain. Spine J 19(4):677\u2013686. https:\/\/doi.org\/10.1016\/j.spinee.2018.10.009","journal-title":"Spine J"},{"issue":"20","key":"8165_CR28","doi-asserted-by":"publisher","first-page":"S208","DOI":"10.1097\/01.BRS.0000092483.10776.2A","volume":"28","author":"TG Lowe","year":"2003","unstructured":"Lowe TG, Betz R, Lenke L, Clements D, Harms J, Newton P et al (2003) Anterior single-rod instrumentation of the thoracic and lumbar spine: saving levels. Spine (Phila Pa 1976) 28(20):S208\u2013S216. https:\/\/doi.org\/10.1097\/01.BRS.0000092483.10776.2A","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"8165_CR29","doi-asserted-by":"publisher","first-page":"147","DOI":"10.4184\/asj.2018.12.1.147","volume":"12","author":"T Akg\u00fcl","year":"2018","unstructured":"Akg\u00fcl T, Sar\u0131y\u0131lmaz K, Korkmaz M, \u00d6zkunt O, Kaya \u00d6, Dikici F (2018) Influence of distal fusion level on sagittal spinopelvic and spinal parameters in the surgical management of adolescent idiopathic scoliosis. Asian Spine J 12(1):147\u2013155. https:\/\/doi.org\/10.4184\/asj.2018.12.1.147","journal-title":"Asian Spine J"},{"issue":"5","key":"8165_CR30","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1097\/BRS.0000000000000242","volume":"40","author":"T Toyone","year":"2015","unstructured":"Toyone T, Ozawa T, Inada K, Orita S, Ohtori S, Takahashi K (2015) Horizontal fixation of the L3 vertebra with a tilt of less than 5\u00b0 can prevent the long-term curve progression of unfused adult scoliosis: ten-year follow-up study of concave PLIF at the wedged disc below the caudal end vertebra. Spine (Phila Pa 1976) 40(5):312\u2013315. https:\/\/doi.org\/10.1097\/BRS.0000000000000242","journal-title":"Spine (Phila Pa 1976)"},{"issue":"23","key":"8165_CR31","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1097\/BRS.0b013e31825bfb85","volume":"37","author":"HL Wu","year":"2012","unstructured":"Wu HL, Ding WY, Shen Y, Zhang YZ, Guo JK, Sun YP et al (2012) Prevalence of vertebral endplate modic changes in degenerative lumbar scoliosis and its associated factors analysis. Spine (Phila Pa 1976) 37(23):1958\u20131964. https:\/\/doi.org\/10.1097\/BRS.0b013e31825bfb85","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"8165_CR32","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1007\/s00167-017-4545-3","volume":"26","author":"WA Witwit","year":"2018","unstructured":"Witwit WA, Kovac P, Sward A, Agnvall C, Todd C, Thoreson O et al (2018) Disc degeneration on MRI is more prevalent in young elite skiers compared to controls. Knee Surg Sports Traumatol Arthrosc 26(1):325\u2013332. https:\/\/doi.org\/10.1007\/s00167-017-4545-3","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"issue":"13","key":"8165_CR33","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.1097\/00007632-199907010-00008","volume":"24","author":"JJ Salminen","year":"1999","unstructured":"Salminen JJ, Erkintalo MO, Pentti J, Oksanen A, Kormano MJ (1999) Recurrent low back pain and early disc degeneration in the young. Spine (Phila Pa 1976) 24(13):1316\u20131321. https:\/\/doi.org\/10.1097\/00007632-199907010-00008","journal-title":"Spine (Phila Pa 1976)"},{"key":"8165_CR34","doi-asserted-by":"publisher","unstructured":"Oh YM, Eun JP (2013) The relationship between sagittal spinopelvic parameters and the degree of lumbar intervertebral disc degeneration in young adult patients with low-grade spondylolytic spondylolisthesis. Bone Joint J 95-B(9):1239\u20131243. https:\/\/doi.org\/10.1302\/0301-620X.95B9.31717.","DOI":"10.1302\/0301-620X.95B9.31717"},{"key":"8165_CR35","doi-asserted-by":"publisher","unstructured":"Kim YK, Kang D, Lee I, Kim SY (2018) Differences in the incidence of symptomatic cervical and lumbar disc herniation according to age, sex and national health insurance eligibility: a pilot study on the disease's association with work. Int J Environ Res Public Health 15(10):2094. https:\/\/doi.org\/10.3390\/ijerph15102094.","DOI":"10.3390\/ijerph15102094"}],"container-title":["European Spine Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-024-08165-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00586-024-08165-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00586-024-08165-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,5]],"date-time":"2024-04-05T02:13:24Z","timestamp":1712283204000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00586-024-08165-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,19]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["8165"],"URL":"https:\/\/doi.org\/10.1007\/s00586-024-08165-1","relation":{},"ISSN":["0940-6719","1432-0932"],"issn-type":[{"value":"0940-6719","type":"print"},{"value":"1432-0932","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,19]]},"assertion":[{"value":"13 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 December 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 January 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 February 2024","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 authors have no relevant financial or nonfinancial interests to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}