{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T04:23:48Z","timestamp":1767846228402,"version":"3.49.0"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T00:00:00Z","timestamp":1706313600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T00:00:00Z","timestamp":1706313600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Health Sciences"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Endocrinol Invest"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Asymptomatic primary hyperparathyroidism (aPHPT) has been recognized as a condition that can lead to renal complications. Timely identification of prognostic indicators for renal impairment holds the potential to facilitate proactive monitoring and treatment strategies in these patients. This study aims to investigate the utility of acoustic radiation force impulse (ARFI) imaging and renal resistive index (RRI), in identifying renal parenchymal and vascular changes in patients with aPHPT.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Forty-two patients with aPHPT and 42 controls matched for age, sex, and body mass index were included in the study. The presence of renovascular changes was evaluated by RRI measurement with Doppler ultrasonography, and the presence of renal parenchymal involvement was evaluated by ARFI quantification, given as shear wave velocity (SWV).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In aPHPT patients, both the mean RRI and mean SWV values exhibited substantial elevation compared to the control group (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001 for both). Significant associations were observed between SWV values and serum calcium, parathyroid hormone (PTH), and adenoma size within the patient group (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001, <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001, <jats:italic>P<\/jats:italic>\u2009=\u20090.016, respectively). Similarly, the mean RRI demonstrated positive correlations with serum calcium and PTH levels in the patient group (<jats:italic>P<\/jats:italic>&lt;\u20090.001, <jats:italic>P<\/jats:italic>\u2009=\u20090.011, respectively). Multivariate linear regression analysis underscored the connection between mean RRI and mean SWV values with serum calcium levels within the patient group. In addition, serum PTH levels affected mean SWV positively and significantly.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The use of ARFI imaging and RRI measurements appears to hold potential in identifying renal involvement in patients with aPHPT.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s40618-023-02284-0","type":"journal-article","created":{"date-parts":[[2024,1,27]],"date-time":"2024-01-27T06:02:02Z","timestamp":1706335322000},"page":"1679-1689","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ultrasound-based quantitative tools in predicting renal involvement in asymptomatic primary hyperparathyroidism"],"prefix":"10.1007","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1800-6235","authenticated-orcid":false,"given":"B.","family":"Candemir","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Cuce","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S.","family":"Ak\u0131n","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N. E.","family":"Gulcelik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,1,27]]},"reference":[{"issue":"1","key":"2284_CR1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1111\/j.1365-2796.2004.01422.x","volume":"257","author":"JP Bilezikian","year":"2005","unstructured":"Bilezikian JP, Brandi ML, Rubin M, Silverberg SJ (2005) Primary hyperparathyroidism: new concepts in clinical, densitometric and biochemical features. J Intern Med 257(1):6\u201317. https:\/\/doi.org\/10.1111\/j.1365-2796.2004.01422.x","journal-title":"J Intern Med"},{"issue":"10","key":"2284_CR2","doi-asserted-by":"publisher","first-page":"3561","DOI":"10.1210\/jc.2014-1413","volume":"99","author":"JP Bilezikian","year":"2014","unstructured":"Bilezikian JP, Brandi ML, Eastell R et al (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab 99(10):3561\u20133569. https:\/\/doi.org\/10.1210\/jc.2014-1413","journal-title":"J Clin Endocrinol Metab"},{"issue":"11","key":"2284_CR3","doi-asserted-by":"publisher","first-page":"2293","DOI":"10.1002\/jbmr.4677","volume":"37","author":"JP Bilezikian","year":"2022","unstructured":"Bilezikian JP, Khan AA, Silverberg SJ et al (2022) Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the fifth international workshop. J Bone Miner Res 37(11):2293\u20132314. https:\/\/doi.org\/10.1002\/jbmr.4677","journal-title":"J Bone Miner Res"},{"issue":"3","key":"2284_CR4","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1111\/cen.14311","volume":"94","author":"K Agrawal","year":"2021","unstructured":"Agrawal K, Arya AK, Sood A et al (2021) A detailed appraisal of renal manifestations in primary hyperparathyroidism from Indian PHPT registry: Before and after curative parathyroidectomy. Clin Endocrinol (Oxf) 94(3):371\u2013376. https:\/\/doi.org\/10.1111\/cen.14311","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"8","key":"2284_CR5","doi-asserted-by":"publisher","first-page":"3069","DOI":"10.1210\/jc.2015-2132","volume":"100","author":"F Tassone","year":"2015","unstructured":"Tassone F, Guarnieri A, Castellano E, Baffoni C, Attanasio R, Borretta G (2015) Parathyroidectomy halts the deterioration of renal function in primary hyperparathyroidism. J Clin Endocrinol Metab 100(8):3069\u20133073. https:\/\/doi.org\/10.1210\/jc.2015-2132","journal-title":"J Clin Endocrinol Metab"},{"issue":"8","key":"2284_CR6","doi-asserted-by":"publisher","first-page":"2377","DOI":"10.1210\/jc.2011-0569","volume":"96","author":"L Rejnmark","year":"2011","unstructured":"Rejnmark L, Vestergaard P, Mosekilde L (2011) Nephrolithiasis and renal calcifications in primary hyperparathyroidism. J Clin Endocrinol Metab 96(8):2377\u20132385. https:\/\/doi.org\/10.1210\/jc.2011-0569","journal-title":"J Clin Endocrinol Metab"},{"issue":"4","key":"2284_CR7","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1016\/s0272-6386(01)80118-9","volume":"37","author":"JA Manley","year":"2001","unstructured":"Manley JA, O\u2019Neill WC (2001) How echogenic is echogenic? Quantitative acoustics of the renal cortex. Am J Kidney Dis 37(4):706\u2013711. https:\/\/doi.org\/10.1016\/s0272-6386(01)80118-9","journal-title":"Am J Kidney Dis"},{"issue":"1","key":"2284_CR8","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1097\/HJH.0b013e328365b29c","volume":"32","author":"F Viazzi","year":"2014","unstructured":"Viazzi F, Leoncini G, Derchi LE, Pontremoli R (2014) Ultrasound Doppler renal resistive index: a useful tool for the management of the hypertensive patient. J Hypertens 32(1):149\u2013153. https:\/\/doi.org\/10.1097\/HJH.0b013e328365b29c","journal-title":"J Hypertens"},{"issue":"9","key":"2284_CR9","doi-asserted-by":"publisher","first-page":"1853","DOI":"10.2337\/dc08-0168","volume":"31","author":"K Hamano","year":"2008","unstructured":"Hamano K, Nitta A, Ohtake T, Kobayashi S (2008) Associations of renal vascular resistance with albuminuria and other macroangiopathy in type 2 diabetic patients. Diabetes Care 31(9):1853\u20131857. https:\/\/doi.org\/10.2337\/dc08-0168","journal-title":"Diabetes Care"},{"issue":"4","key":"2284_CR10","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1109\/tuffc.2013.2617","volume":"60","author":"JR Doherty","year":"2013","unstructured":"Doherty JR, Trahey GE, Nightingale KR, Palmeri ML (2013) Acoustic radiation force elasticity imaging in diagnostic ultrasound. IEEE Trans Ultrason Ferroelectr Freq Control 60(4):685\u2013701. https:\/\/doi.org\/10.1109\/tuffc.2013.2617","journal-title":"IEEE Trans Ultrason Ferroelectr Freq Control"},{"issue":"4","key":"2284_CR11","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1097\/jim.0000000000000186","volume":"63","author":"M Zaffanello","year":"2015","unstructured":"Zaffanello M, Piacentini G, Bruno C, Brugnara M, Fanos V (2015) Renal elasticity quantification by acoustic radiation force impulse applied to the evaluation of kidney diseases: a review. J Investig Med 63(4):605\u2013612. https:\/\/doi.org\/10.1097\/jim.0000000000000186","journal-title":"J Investig Med"},{"issue":"1","key":"2284_CR12","doi-asserted-by":"publisher","first-page":"132","DOI":"10.2214\/ajr.09.3923","volume":"195","author":"M D'Onofrio","year":"2010","unstructured":"D\u2019Onofrio M, Gallotti A, Mucelli RP (2010) Tissue quantification with acoustic radiation force impulse imaging: Measurement repeatability and normal values in the healthy liver. AJR Am J Roentgenol 195(1):132\u2013136. https:\/\/doi.org\/10.2214\/ajr.09.3923","journal-title":"AJR Am J Roentgenol"},{"issue":"1","key":"2284_CR13","doi-asserted-by":"publisher","first-page":"138","DOI":"10.4103\/1319-2442.252903","volume":"30","author":"AS Koc","year":"2019","unstructured":"Koc AS, Sumbul HE, G\u00fcl\u00fcmsek E (2019) Increased renal cortical stiffness in patients with advanced diabetic kidney disease. Saudi J Kidney Dis Transpl Jan-Feb 30(1):138\u2013150","journal-title":"Saudi J Kidney Dis Transpl Jan-Feb"},{"issue":"2","key":"2284_CR14","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.ultrasmedbio.2013.10.003","volume":"40","author":"WY He","year":"2014","unstructured":"He WY, Jin YJ, Wang WP, Li CL, Ji ZB, Yang C (2014) Tissue elasticity quantification by acoustic radiation force impulse for the assessment of renal allograft function. Ultrasound Med Biol 40(2):322\u2013329. https:\/\/doi.org\/10.1016\/j.ultrasmedbio.2013.10.003","journal-title":"Ultrasound Med Biol"},{"issue":"2\u20133","key":"2284_CR15","doi-asserted-by":"publisher","first-page":"139","DOI":"10.3233\/ch-2010-1340","volume":"46","author":"KF Stock","year":"2010","unstructured":"Stock KF, Klein BS, Vo Cong MT et al (2010) ARFI-based tissue elasticity quantification in comparison to histology for the diagnosis of renal transplant fibrosis. Clin Hemorheol Microcirc 46(2\u20133):139\u2013148. https:\/\/doi.org\/10.3233\/ch-2010-1340","journal-title":"Clin Hemorheol Microcirc"},{"issue":"10","key":"2284_CR16","doi-asserted-by":"publisher","first-page":"3607","DOI":"10.1210\/jc.2014-1417","volume":"99","author":"C Marcocci","year":"2014","unstructured":"Marcocci C, Bollerslev J, Khan AA, Shoback DM (2014) Medical management of primary hyperparathyroidism: proceedings of the fourth International Workshop on the Management of Asymptomatic Primary Hyperparathyroidism. J Clin Endocrinol Metab 99(10):3607\u20133618. https:\/\/doi.org\/10.1210\/jc.2014-1417","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"2284_CR17","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/s0301-5629(01)00499-9","volume":"28","author":"K Nightingale","year":"2002","unstructured":"Nightingale K, Soo MS, Nightingale R, Trahey G (2002) Acoustic radiation force impulse imaging: in vivo demonstration of clinical feasibility. Ultrasound Med Biol 28(2):227\u2013235. https:\/\/doi.org\/10.1016\/s0301-5629(01)00499-9","journal-title":"Ultrasound Med Biol"},{"issue":"4","key":"2284_CR18","doi-asserted-by":"publisher","first-page":"649","DOI":"10.7863\/ultra.34.4.649","volume":"34","author":"F Bob","year":"2015","unstructured":"Bob F, Bota S, Sporea I, Sirli R, Popescu A, Schiller A (2015) Relationship between the estimated glomerular filtration rate and kidney shear wave speed values assessed by acoustic radiation force impulse elastography: a pilot study. J Ultrasound Med 34(4):649\u2013654. https:\/\/doi.org\/10.7863\/ultra.34.4.649","journal-title":"J Ultrasound Med"},{"issue":"2","key":"2284_CR19","doi-asserted-by":"publisher","first-page":"324","DOI":"10.2214\/ajr.14.12493","volume":"204","author":"C Goya","year":"2015","unstructured":"Goya C, Kilinc F, Hamidi C et al (2015) Acoustic radiation force impulse imaging for evaluation of renal parenchyma elasticity in diabetic nephropathy. AJR Am J Roentgenol 204(2):324\u2013329. https:\/\/doi.org\/10.2214\/ajr.14.12493","journal-title":"AJR Am J Roentgenol"},{"issue":"5","key":"2284_CR20","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1111\/cen.14064","volume":"91","author":"C Cipriani","year":"2019","unstructured":"Cipriani C, Pepe J, Colangelo L et al (2019) Investigating subtle kidney injury in primary hyperparathyroidism by means of sensitive and specific biomarkers. Clin Endocrinol (Oxf) 91(5):660\u2013668. https:\/\/doi.org\/10.1111\/cen.14064","journal-title":"Clin Endocrinol (Oxf)"},{"issue":"4","key":"2284_CR21","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1210\/jc.2014-3708","volume":"100","author":"C Cipriani","year":"2015","unstructured":"Cipriani C, Biamonte F, Costa AG et al (2015) Prevalence of kidney stones and vertebral fractures in primary hyperparathyroidism using imaging technology. J Clin Endocrinol Metab 100(4):1309\u20131315. https:\/\/doi.org\/10.1210\/jc.2014-3708","journal-title":"J Clin Endocrinol Metab"},{"issue":"10","key":"2284_CR22","doi-asserted-by":"publisher","first-page":"3580","DOI":"10.1210\/jc.2014-1415","volume":"99","author":"SJ Silverberg","year":"2014","unstructured":"Silverberg SJ, Clarke BL, Peacock M et al (2014) Current issues in the presentation of asymptomatic primary hyperparathyroidism: Proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 99(10):3580\u20133594. https:\/\/doi.org\/10.1210\/jc.2014-1415","journal-title":"J Clin Endocrinol Metab"},{"issue":"9","key":"2284_CR23","doi-asserted-by":"publisher","first-page":"3574","DOI":"10.1210\/jc.2018-00923","volume":"103","author":"H Ejlsmark-Svensson","year":"2018","unstructured":"Ejlsmark-Svensson H, Bislev LS, Rolighed L, Sikjaer T, Rejnmark L (2018) Predictors of renal function and calcifications in primary hyperparathyroidism: a nested case-control study. J Clin Endocrinol Metab 103(9):3574\u20133583. https:\/\/doi.org\/10.1210\/jc.2018-00923","journal-title":"J Clin Endocrinol Metab"},{"issue":"5","key":"2284_CR24","doi-asserted-by":"publisher","first-page":"532","DOI":"10.1007\/s00268-001-0262-6","volume":"26","author":"VG Fr\u00f8kjaer","year":"2002","unstructured":"Fr\u00f8kjaer VG, Mollerup CL (2002) Primary hyperparathyroidism: renal calcium excretion in patients with and without renal stone sisease before and after parathyroidectomy. World J Surg 26(5):532\u2013535. https:\/\/doi.org\/10.1007\/s00268-001-0262-6","journal-title":"World J Surg"},{"issue":"7","key":"2284_CR25","doi-asserted-by":"publisher","first-page":"e68925","DOI":"10.1371\/journal.pone.0068925","volume":"8","author":"LH Guo","year":"2013","unstructured":"Guo LH, Xu HX, Fu HJ, Peng A, Zhang YF, Liu LN (2013) Acoustic radiation force impulse imaging for noninvasive evaluation of renal parenchyma elasticity: preliminary findings. PLoS\u00a0ONE 8(7):e68925. https:\/\/doi.org\/10.1371\/journal.pone.0068925","journal-title":"PLoS\u00a0ONE"},{"issue":"10","key":"2284_CR26","doi-asserted-by":"publisher","first-page":"1692","DOI":"10.1002\/jcb.24832","volume":"115","author":"M Wu","year":"2014","unstructured":"Wu M, Tang RN, Liu H, Ma KL, Lv LL, Liu BC (2014) Nuclear translocation of \u03b2-catenin mediates the parathyroid hormone-induced endothelial-to-mesenchymal transition in human renal glomerular endothelial cells. J Cell Biochem 115(10):1692\u20131701. https:\/\/doi.org\/10.1002\/jcb.24832","journal-title":"J Cell Biochem"},{"issue":"11","key":"2284_CR27","doi-asserted-by":"publisher","first-page":"2330","DOI":"10.1002\/jbmr.4679","volume":"37","author":"G El-Hajj Fuleihan","year":"2022","unstructured":"El-Hajj Fuleihan G, Chakhtoura M, Cipriani C et al (2022) Classical and nonclassical manifestations of primary hyperparathyroidism. J Bone Miner Res 37(11):2330\u20132350. https:\/\/doi.org\/10.1002\/jbmr.4679","journal-title":"J Bone Miner Res"},{"issue":"1","key":"2284_CR28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ultrasmedbio.2014.07.023","volume":"41","author":"S Bota","year":"2015","unstructured":"Bota S, Bob F, Sporea I, \u015eirli R, Popescu A (2015) Factors that influence kidney shear wave speed assessed by acoustic radiation force impulse elastography in patients without kidney pathology. Ultrasound Med Biol 41(1):1\u20136. https:\/\/doi.org\/10.1016\/j.ultrasmedbio.2014.07.023","journal-title":"Ultrasound Med Biol"},{"issue":"4","key":"2284_CR29","doi-asserted-by":"publisher","first-page":"885","DOI":"10.2214\/ajr.180.4.1800885","volume":"180","author":"ME Tublin","year":"2003","unstructured":"Tublin ME, Bude RO, Platt JF (2003) Review. The resistive index in renal Doppler sonography: where do we stand. AJR Am J Roentgenol 180(4):885\u2013892. https:\/\/doi.org\/10.2214\/ajr.180.4.1800885","journal-title":"AJR Am J Roentgenol"},{"issue":"3","key":"2284_CR30","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1161\/hypertensionaha.112.196717","volume":"60","author":"Y Doi","year":"2012","unstructured":"Doi Y, Iwashima Y, Yoshihara F et al (2012) Renal resistive index and cardiovascular and renal outcomes in essential hypertension. Hypertension 60(3):770\u2013777. https:\/\/doi.org\/10.1161\/hypertensionaha.112.196717","journal-title":"Hypertension"},{"issue":"3","key":"2284_CR31","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1111\/jch.12248","volume":"16","author":"J Calabia","year":"2014","unstructured":"Calabia J, Torguet P, Garcia I et al (2014) The relationship between renal resistive index, arterial stiffness, and atherosclerotic burden: the link between macrocirculation and microcirculation. J Clin Hypertens (Greenwich) 16(3):186\u2013191. https:\/\/doi.org\/10.1111\/jch.12248","journal-title":"J Clin Hypertens (Greenwich)"},{"issue":"1","key":"2284_CR32","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1159\/000045711","volume":"86","author":"N Matsumoto","year":"2000","unstructured":"Matsumoto N, Ishimura E, Taniwaki H et al (2000) Diabetes mellitus worsens intrarenal hemodynamic abnormalities in nondialyzed patients with chronic renal failure. Nephron 86(1):44\u201351. https:\/\/doi.org\/10.1159\/000045711","journal-title":"Nephron"}],"container-title":["Journal of Endocrinological Investigation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40618-023-02284-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s40618-023-02284-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s40618-023-02284-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,24]],"date-time":"2024-06-24T11:14:19Z","timestamp":1719227659000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s40618-023-02284-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,27]]},"references-count":32,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["2284"],"URL":"https:\/\/doi.org\/10.1007\/s40618-023-02284-0","relation":{},"ISSN":["1720-8386"],"issn-type":[{"value":"1720-8386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,27]]},"assertion":[{"value":"14 November 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 December 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 January 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 authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethical Committee of our university (Approval no: 2021\/ 30).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research involving human participants and\/or animals"}},{"value":"Written informed consent was obtained from all the patients with PHPT and control subjects who agreed to participate.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}