{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T08:17:48Z","timestamp":1793089068648,"version":"4.5.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T00:00:00Z","timestamp":1708905600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T00:00:00Z","timestamp":1708905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Rheumatol"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To evaluate the clinical features and pregnancy outcomes in patients experiencing recurrent miscarriage (RM) with either low-titer or medium-high titer positivity of antiphospholipid antibodies (aPL).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A retrospective review of medical records was conducted for patients with aPL positivity and recurrent miscarriage between 2018 and 2022. The clinical features, treatment strategies, outcomes were compared between the patients with low (<jats:italic>n<\/jats:italic> = 92) and medium (<jats:italic>n<\/jats:italic> = 32) titer of aPL.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 118 patients, resulting in 124 obstetric episodes (pregnancies), with a mean age of 33. 15 \u00b1 4.56 and 31.47 \u00b1 4.41\u00a0years between the two groups. The low-titer group exhibited a higher frequency of anti-cardiolipin antibodies IgM (<jats:italic>P<\/jats:italic> &lt; 0.001), whereas the medium-high titer group demonstrated a higher frequency of anti-\u03b22-glycoprotein 1 antibodies IgG (<jats:italic>P<\/jats:italic> &lt; 0.001) and IgM (<jats:italic>P<\/jats:italic> = 0.032). Moreover, the medium-high titer group displayed a significantly elevated erythrocyte sedimentation rate compared to the low-titer group (P &lt; 0.05). In the low-titer group, 71 patients (77.2%) received appropriate treatment, resulting in 48 live births (67.6%) and 23 repeat abortions (32.4%). In the medium-high titer group, 29 patients (90.6%) received relevant treatment, leading to 23 live births (79.3%) and 6 repeat abortions (20.7%). No significant differences were observed in live births or maternal-fetal complications between the two groups (all <jats:italic>P<\/jats:italic> &gt; 0.05).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Noteworthy distinctions in laboratory parameters were identified between the low-titer and medium-high titer groups. However, when appropriately treated, the fetal-maternal outcomes were comparable in both groups. Timely intervention by clinicians is imperative to enhance pregnancy outcomes in patients experiencing recurrent miscarriage with low levels of aPL.<jats:table-wrap><jats:table><jats:tbody>\n                      <jats:tr>\n                        <jats:td colspan=\"2\"><jats:bold>Key Points<\/jats:bold>\u2022 <jats:italic>This study challenges the conventional belief that only the higher antiphospholipid antibodies (aPL) titers directly correlated with worse pregnancy outcomes, which emphasized the importance of patients with low titer positive aPL-positive RM.<\/jats:italic>\u2022 <jats:italic>The results underscore the need for timely intervention in women with low titer aPL-positive RM, as it leads to favorable maternal\u2013fetal outcomes.<\/jats:italic><\/jats:td>\n                      <\/jats:tr>\n                    <\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10067-023-06843-x","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T11:02:32Z","timestamp":1708945352000},"page":"1327-1334","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Recurrent miscarriage and low-titer antiphospholipid antibodies"],"prefix":"10.1007","volume":"43","author":[{"given":"Jian","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Yue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian-Yu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,26]]},"reference":[{"issue":"10","key":"6843_CR1","doi-asserted-by":"publisher","first-page":"2208","DOI":"10.1111\/j.1538-7836.2010.04015.x","volume":"8","author":"DM Cohn","year":"2010","unstructured":"Cohn DM, Goddijn M, Middeldorp S et al (2010) Recurrent miscarriage and antiphospholipid antibodies: prognosis of subsequent pregnancy. J Thromb Haemost 8(10):2208\u20132213. https:\/\/doi.org\/10.1111\/j.1538-7836.2010.04015.x","journal-title":"J Thromb Haemost"},{"issue":"9535","key":"6843_CR2","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/s0140-6736(06)69204-0","volume":"368","author":"R Rai","year":"2006","unstructured":"Rai R, Regan L (2006) Recurrent miscarriage. Lancet 368(9535):601\u2013611. https:\/\/doi.org\/10.1016\/s0140-6736(06)69204-0","journal-title":"Lancet"},{"issue":"2","key":"6843_CR3","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1111\/j.1538-7836.2006.01753.x","volume":"4","author":"S Miyakis","year":"2006","unstructured":"Miyakis S, Lockshin MD, Atsumi T et al (2006) International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost 4(2):295\u2013306. https:\/\/doi.org\/10.1111\/j.1538-7836.2006.01753.x","journal-title":"J Thromb Haemost"},{"issue":"3","key":"6843_CR4","doi-asserted-by":"publisher","first-page":"267","DOI":"10.4103\/0366-6999.198934","volume":"130","author":"Y Song","year":"2017","unstructured":"Song Y, Wang HY, Qiao J et al (2017) Antiphospholipid antibody titers and clinical outcomes in patients with recurrent miscarriage and antiphospholipid antibody syndrome: a prospective study. Chin Med J (Engl) 130(3):267\u2013272. https:\/\/doi.org\/10.4103\/0366-6999.198934","journal-title":"Chin Med J (Engl)"},{"issue":"10","key":"6843_CR5","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1136\/ard-2023-224609","volume":"82","author":"M Barbhaiya","year":"2023","unstructured":"Barbhaiya M, Zuily S, Naden R et al (2023) 2023 ACR\/EULAR antiphospholipid syndrome classification criteria. Ann Rheum Dis 82(10):1258\u20131270. https:\/\/doi.org\/10.1136\/ard-2023-224609","journal-title":"Ann Rheum Dis"},{"issue":"3","key":"6843_CR6","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1097\/mbc.0000000000000218","volume":"26","author":"S Ofer-Shiber","year":"2015","unstructured":"Ofer-Shiber S, Molad Y (2015) Frequency of vascular and pregnancy morbidity in patients with low vs. moderate-to-high titers of antiphospholipid antibodies. Blood Coagul Fibrinolysis 26(3):261\u2013266. https:\/\/doi.org\/10.1097\/mbc.0000000000000218","journal-title":"Blood Coagul Fibrinolysis"},{"issue":"2","key":"6843_CR7","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1016\/j.jri.2012.02.004","volume":"94","author":"A Mekinian","year":"2012","unstructured":"Mekinian A, Loire-Berson P, Nicaise-Roland P et al (2012) Outcomes and treatment of obstetrical antiphospholipid syndrome in women with low antiphospholipid antibody levels. J Reprod Immunol 94(2):222\u2013226. https:\/\/doi.org\/10.1016\/j.jri.2012.02.004","journal-title":"J Reprod Immunol"},{"issue":"6","key":"6843_CR8","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1093\/rheumatology\/kez419","volume":"59","author":"J Alijotas-Reig","year":"2020","unstructured":"Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R et al (2020) Comparative study of obstetric antiphospholipid syndrome (OAPS) and non-criteria obstetric APS (NC-OAPS): report of 1640 cases from the EUROAPS registry. Rheumatology 59(6):1306\u20131314. https:\/\/doi.org\/10.1093\/rheumatology\/kez419","journal-title":"Rheumatology"},{"issue":"21","key":"6843_CR9","doi-asserted-by":"publisher","first-page":"2010","DOI":"10.1056\/NEJMra1705454","volume":"378","author":"D Garcia","year":"2018","unstructured":"Garcia D, Erkan D (2018) Diagnosis and management of the antiphospholipid syndrome. N Engl J Med 378(21):2010\u20132021. https:\/\/doi.org\/10.1056\/NEJMra1705454","journal-title":"N Engl J Med"},{"issue":"4","key":"6843_CR10","doi-asserted-by":"publisher","first-page":"425","DOI":"10.3899\/jrheum.120576","volume":"40","author":"T Del Ross","year":"2013","unstructured":"Del Ross T, Ruffatti A, Visentin MS et al (2013) Treatment of 139 pregnancies in antiphospholipid-positive women not fulfilling criteria for antiphospholipid syndrome: a retrospective study. J Rheumatol 40(4):425\u2013429. https:\/\/doi.org\/10.3899\/jrheum.120576","journal-title":"J Rheumatol"},{"issue":"3","key":"6843_CR11","doi-asserted-by":"publisher","first-page":"464","DOI":"10.1097\/grf.0000000000000214","volume":"59","author":"J Kaiser","year":"2016","unstructured":"Kaiser J, Branch DW (2016) Recurrent pregnancy loss: generally accepted causes and their management. Clin Obstet Gynecol 59(3):464\u2013473. https:\/\/doi.org\/10.1097\/grf.0000000000000214","journal-title":"Clin Obstet Gynecol"},{"issue":"1","key":"6843_CR12","doi-asserted-by":"publisher","DOI":"10.1136\/lupus-2016-000197","volume":"5","author":"A Antovic","year":"2018","unstructured":"Antovic A, Sennstr\u00f6m M, Bremme K et al (2018) Obstetric antiphospholipid syndrome. Lupus Sci Med 5(1):e000197. https:\/\/doi.org\/10.1136\/lupus-2016-000197","journal-title":"Lupus Sci Med"},{"key":"6843_CR13","doi-asserted-by":"publisher","first-page":"18005","DOI":"10.1038\/nrdp.2018.5","volume":"4","author":"K Schreiber","year":"2018","unstructured":"Schreiber K, Sciascia S, de Groot PG et al (2018) Antiphospholipid syndrome. Nat Rev Dis Prim 4:18005. https:\/\/doi.org\/10.1038\/nrdp.2018.5","journal-title":"Nat Rev Dis Prim"},{"issue":"4","key":"6843_CR14","doi-asserted-by":"publisher","first-page":"406","DOI":"10.1016\/j.autrev.2018.12.006","volume":"18","author":"J Alijotas-Reig","year":"2019","unstructured":"Alijotas-Reig J, Esteve-Valverde E, Ferrer-Oliveras R et al (2019) The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): a survey of 1000 consecutive cases. Autoimmun Rev 18(4):406\u2013414. https:\/\/doi.org\/10.1016\/j.autrev.2018.12.006","journal-title":"Autoimmun Rev"},{"issue":"7","key":"6843_CR15","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1038\/s41584-018-0032-6","volume":"14","author":"PL Meroni","year":"2018","unstructured":"Meroni PL, Borghi MO, Grossi C et al (2018) Obstetric and vascular antiphospholipid syndrome: same antibodies but different diseases? Nat Rev Rheumatol 14(7):433\u2013440. https:\/\/doi.org\/10.1038\/s41584-018-0032-6","journal-title":"Nat Rev Rheumatol"},{"issue":"4","key":"6843_CR16","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1177\/0961203310361490","volume":"19","author":"DW Branch","year":"2010","unstructured":"Branch DW, Silver RM, Porter TF (2010) Obstetric antiphospholipid syndrome: current uncertainties should guide our way. Lupus 19(4):446\u2013452. https:\/\/doi.org\/10.1177\/0961203310361490","journal-title":"Lupus"},{"issue":"18","key":"6843_CR17","doi-asserted-by":"publisher","first-page":"1740","DOI":"10.1056\/NEJMcp1005330","volume":"363","author":"DW Branch","year":"2010","unstructured":"Branch DW, Gibson M, Silver RM (2010) Clinical practice. Recurrent miscarriage. N Engl J Med 363(18):1740\u20131747. https:\/\/doi.org\/10.1056\/NEJMcp1005330","journal-title":"N Engl J Med"},{"issue":"1","key":"6843_CR18","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1177\/0961203312460722","volume":"22","author":"C Gardiner","year":"2013","unstructured":"Gardiner C, Hills J, Machin SJ et al (2013) Diagnosis of antiphospholipid syndrome in routine clinical practice. Lupus 22(1):18\u201325. https:\/\/doi.org\/10.1177\/0961203312460722","journal-title":"Lupus"},{"issue":"7","key":"6843_CR19","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1177\/0961203312440058","volume":"21","author":"J Alijotas-Reig","year":"2012","unstructured":"Alijotas-Reig J, Ferrer-Oliveras R (2012) The European Registry on Obstetric Antiphospholipid Syndrome (EUROAPS): a preliminary first year report. Lupus 21(7):766\u2013768. https:\/\/doi.org\/10.1177\/0961203312440058","journal-title":"Lupus"},{"issue":"3","key":"6843_CR20","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1093\/rheumatology\/keaa203","volume":"60","author":"F Pregnolato","year":"2021","unstructured":"Pregnolato F, Gerosa M, Raimondo MG et al (2021) EUREKA algorithm predicts obstetric risk and response to treatment in women with different subsets of anti-phospholipid antibodies. Rheumatology 60(3):1114\u20131124. https:\/\/doi.org\/10.1093\/rheumatology\/keaa203","journal-title":"Rheumatology"},{"issue":"11","key":"6843_CR21","first-page":"2214","volume":"33","author":"L Opatrny","year":"2006","unstructured":"Opatrny L, David M, Kahn SR et al (2006) Association between antiphospholipid antibodies and recurrent fetal loss in women without autoimmune disease: a meta analysis. J Rheumatol 33(11):2214\u20132221","journal-title":"J Rheumatol"},{"issue":"10","key":"6843_CR22","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1136\/annrheumdis-2019-215213","volume":"78","author":"MG Tektonidou","year":"2019","unstructured":"Tektonidou MG, Andreoli L, Limper M et al (2019) EULAR recommendations for the management of antiphospholipid syndrome in adults. Ann Rheum Dis 78(10):1296\u20131304. https:\/\/doi.org\/10.1136\/annrheumdis-2019-215213","journal-title":"Ann Rheum Dis"},{"issue":"4","key":"6843_CR23","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1002\/art.41191","volume":"72","author":"LR Sammaritano","year":"2020","unstructured":"Sammaritano LR, Bermas BL, Chakravarty EE et al (2020) 2020 American College of Rheumatology guideline for the management of reproductive health in rheumatic and musculoskeletal diseases. Arthritis Rheumatol 72(4):529\u2013556. https:\/\/doi.org\/10.1002\/art.41191","journal-title":"Arthritis Rheumatol"},{"issue":"5","key":"6843_CR24","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1016\/j.autrev.2015.01.008","volume":"14","author":"CA Viall","year":"2015","unstructured":"Viall CA, Chamley LW (2015) Histopathology in the placentae of women with antiphospholipid antibodies: a systematic review of the literature. Autoimmun Rev 14(5):446\u2013471. https:\/\/doi.org\/10.1016\/j.autrev.2015.01.008","journal-title":"Autoimmun Rev"},{"issue":"2","key":"6843_CR25","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1111\/j.1600-0897.2009.00717.x","volume":"62","author":"MJ Mulla","year":"2009","unstructured":"Mulla MJ, Brosens JJ, Chamley LW et al (2009) Antiphospholipid antibodies induce a pro-inflammatory response in first trimester trophoblast via the TLR4\/MyD88 pathway. Am J Reprod Immunol 62(2):96\u2013111. https:\/\/doi.org\/10.1111\/j.1600-0897.2009.00717.x","journal-title":"Am J Reprod Immunol"},{"issue":"1","key":"6843_CR26","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.semarthrit.2020.10.001","volume":"51","author":"A Ruffatti","year":"2021","unstructured":"Ruffatti A, Tonello M, Favaro M et al (2021) The efficacy and safety of second-line treatments of refractory and\/or high risk pregnant antiphospholipid syndrome patients. A systematic literature review analyzing 313 pregnancies. Semin Arthritis Rheum 51(1):28\u201335. https:\/\/doi.org\/10.1016\/j.semarthrit.2020.10.001","journal-title":"Semin Arthritis Rheum"},{"issue":"12","key":"6843_CR27","doi-asserted-by":"publisher","first-page":"1395","DOI":"10.4103\/0366-6999.207471","volume":"130","author":"SL Ye","year":"2017","unstructured":"Ye SL, Gu XK, Tao LY et al (2017) Efficacy of different treatment regimens for antiphospholipid syndrome-related recurrent spontaneous abortion. Chin Med J (Engl) 130(12):1395\u20131399. https:\/\/doi.org\/10.4103\/0366-6999.207471","journal-title":"Chin Med J (Engl)"},{"issue":"1","key":"6843_CR28","doi-asserted-by":"publisher","first-page":"485","DOI":"10.4049\/jimmunol.174.1.485","volume":"174","author":"J Berman","year":"2005","unstructured":"Berman J, Girardi G, Salmon JE (2005) TNF-alpha is a critical effector and a target for therapy in antiphospholipid antibody-induced pregnancy loss. J Immunol 174(1):485\u2013490. https:\/\/doi.org\/10.4049\/jimmunol.174.1.485","journal-title":"J Immunol"},{"issue":"6","key":"6843_CR29","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/s11926-017-0663-7","volume":"19","author":"CB Chighizola","year":"2017","unstructured":"Chighizola CB, Raimondo MG, Meroni PL (2017) Does APS impact women\u2019s fertility? Curr Rheumatol Rep 19(6):33. https:\/\/doi.org\/10.1007\/s11926-017-0663-7","journal-title":"Curr Rheumatol Rep"},{"issue":"9","key":"6843_CR30","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1002\/art.40136","volume":"69","author":"VM Abrahams","year":"2017","unstructured":"Abrahams VM, Chamley LW, Salmon JE (2017) Emerging treatment models in rheumatology: antiphospholipid syndrome and pregnancy: pathogenesis to translation. Arthritis Rheumatol 69(9):1710\u20131721. https:\/\/doi.org\/10.1002\/art.40136","journal-title":"Arthritis Rheumatol"},{"issue":"2","key":"6843_CR31","doi-asserted-by":"publisher","first-page":"273.e271","DOI":"10.1016\/j.ajog.2015.09.078","volume":"214","author":"S Sciascia","year":"2016","unstructured":"Sciascia S, Hunt BJ, Talavera-Garcia E et al (2016) The impact of hydroxychloroquine treatment on pregnancy outcome in women with antiphospholipid antibodies. Am J Obstet Gynecol 214(2):273.e271-273.e278. https:\/\/doi.org\/10.1016\/j.ajog.2015.09.078","journal-title":"Am J Obstet Gynecol"},{"issue":"7","key":"6843_CR32","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/j.autrev.2012.12.006","volume":"12","author":"C Comarmond","year":"2013","unstructured":"Comarmond C, Cacoub P (2013) Antiphospholipid syndrome: from pathogenesis to novel immunomodulatory therapies. Autoimmun Rev 12(7):752\u2013757. https:\/\/doi.org\/10.1016\/j.autrev.2012.12.006","journal-title":"Autoimmun Rev"},{"key":"6843_CR33","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.jaut.2016.04.008","volume":"75","author":"ML Bertolaccini","year":"2016","unstructured":"Bertolaccini ML, Contento G, Lennen R et al (2016) Complement inhibition by hydroxychloroquine prevents placental and fetal brain abnormalities in antiphospholipid syndrome. J Autoimmun 75:30\u201338. https:\/\/doi.org\/10.1016\/j.jaut.2016.04.008","journal-title":"J Autoimmun"}],"container-title":["Clinical Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-023-06843-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10067-023-06843-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10067-023-06843-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,18]],"date-time":"2024-03-18T04:38:59Z","timestamp":1710736739000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10067-023-06843-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,26]]},"references-count":33,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["6843"],"URL":"https:\/\/doi.org\/10.1007\/s10067-023-06843-x","relation":{},"ISSN":["0770-3198","1434-9949"],"issn-type":[{"value":"0770-3198","type":"print"},{"value":"1434-9949","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,26]]},"assertion":[{"value":"17 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 November 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 December 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 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":"None.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}