{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:35:41Z","timestamp":1787020541137,"version":"build-2736575974"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T00:00:00Z","timestamp":1720742400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T00:00:00Z","timestamp":1720742400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Guangxi Natural Science Foundation of China","award":["No.2023GXNSFAA026320"],"award-info":[{"award-number":["No.2023GXNSFAA026320"]}]},{"name":"The R&D project of Guangxi Zhuang Autonomous Region Key Trauma Surgery","award":["No.GXKTS202203305"],"award-info":[{"award-number":["No.GXKTS202203305"]}]},{"name":"Guangxi Medical and Health Appropriate Technology development and application project","award":["NO.S2022094"],"award-info":[{"award-number":["NO.S2022094"]}]},{"name":"Health Commission of Guangxi Autonomous Region self-funded research project","award":["No.Z-A20230609"],"award-info":[{"award-number":["No.Z-A20230609"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BioMed Eng OnLine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Management of inferior ramus of the pubis-ischium ramus remains controversial, and related research is sparse. The main intention of this study is to describe the biomechanical and clinical outcomes of pubis-ischium ramus fractures in Tile B pelvic injuries and to identify the feasibility and necessity of fixation of the inferior ramus of the pubis-ischium ramus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study comprised two parts: a biomechanical test and a retrospective clinical study. For the biomechanical tests, Tile B-type pelvic injuries were modeled in six cadaver specimens by performing pubis-ischium osteotomies and disruption of the anterior and interosseous sacroiliac ligaments. The superior and\/or inferior rami of the pubis-ischium ramus were repaired with reconstruction plates and separated into three groups (A, B, and C). Specimens were placed in the standing position and were loaded axially with two-leg support for three cycles at 500\u00a0N. The displacements of sacroiliac joints at osteotomy were measured with Vernier calipers and compared using statistical software. To investigate the clinical outcomes of this technique, 26 patients were retrospectively analyzed and divided into a superior ramus fixation group (Group D) and a combined superior and inferior ramus of the pubis-ischium ramus fixation group (Group E). The main outcome measures were time of operation, blood loss, postoperative radiographic reduction grading, and functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the vertical loading test, Group E showed better pelvic ring stability than Group D (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). However, the shift of the sacroiliac joints was almost identical among the three groups. In our clinical case series, all fractures in Group E achieved bony union. Group E demonstrated earlier weight-bearing functional exercise (2.54\u2009\u00b1\u20091.45 vs 4.77\u2009\u00b1\u20092.09;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.004), earlier bony union (13.23\u2009\u00b1\u20092.89 vs 16.55\u2009\u00b1\u20093.11;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.013), and better functional outcomes (89.77\u2009\u00b1\u20097.27 vs 82.38\u2009\u00b1\u20098.81;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.028) than Group D. The incidence of sexual dysfunction was significantly lower in Group E than that in Group D (2\/13 vs 7\/13;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.039). Bone nonunion occurred in two patients in Group D, and two patients in Group E had heterotopic ossification. None of the patients exhibited wound complications, infections, implant failures, or bone\u2013implant interface failures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Fixation of the inferior ramus of a pubis-ischium ramus fracture based on conventional fixation of the anterior pelvic ring is mechanically superior in cadaveric Tile B pelvic injury and shows rapid recovery, good functional outcomes, and low incidence of complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12938-024-01262-8","type":"journal-article","created":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T03:02:09Z","timestamp":1720753329000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Plate fixation of inferior ramus in pubis-ischium ramus improves mechanical stability in Tile B pelvic injures: a cadaveric biomechanical analysis and early clinical experience"],"prefix":"10.1186","volume":"23","author":[{"given":"Zhongjie","family":"Pan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lili","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaorong","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuquan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muwen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wengui","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanjun","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinmin","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,7,12]]},"reference":[{"key":"1262_CR1","doi-asserted-by":"publisher","DOI":"10.1007\/s00590-023-03589-9","author":"MM Lawson","year":"2023","unstructured":"Lawson MM, Peterson DF, Friess DM, Cook MR, Working ZM. Delay of fixation increases 30-day complications and mortality in traumatic pelvic ring injuries. Eur J Orthop Surg Traumatol. 2023. https:\/\/doi.org\/10.1007\/s00590-023-03589-9.","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"1262_CR2","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1097\/00003086-198602000-00033","volume":"203","author":"JG Gamble","year":"1986","unstructured":"Gamble JG, Simmons SC, Freedman M. The symphysis pubis. anatomic and pathologic considerations. Clin Orthop Related Res. 1986;203:261\u201372.","journal-title":"Clin Orthop Related Res"},{"issue":"9","key":"1262_CR3","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1097\/BOT.0b013e3181f8be33","volume":"25","author":"B Bruce","year":"2011","unstructured":"Bruce B, Reilly M, Sims S. OTA highlight paper predicting future displacement of nonoperatively managed lateral compression sacral fractures: can it be done? J Orthop Trauma. 2011;25(9):523\u20137.","journal-title":"J Orthop Trauma"},{"issue":"2","key":"1262_CR4","doi-asserted-by":"publisher","first-page":"422","DOI":"10.3349\/ymj.2012.53.2.422","volume":"53","author":"WS Choy","year":"2012","unstructured":"Choy WS, Kim KJ, Lee SK, Park HJ. Anterior pelvic plating and sacroiliac joint fixation in unstable pelvic ring injuries. Yonsei Med J. 2012;53(2):422\u20136.","journal-title":"Yonsei Med J"},{"issue":"12","key":"1262_CR5","doi-asserted-by":"publisher","first-page":"3899","DOI":"10.1016\/j.injury.2022.09.027","volume":"53","author":"EC Hempen","year":"2022","unstructured":"Hempen EC, Wheatley BM, Schimoler PJ, Kharlamov A, Melvin PR, Miller MC, et al. A biomechanical comparison of superior ramus plating versus intramedullary screw fixation for unstable lateral compression pelvic ring injuries(,). Injury. 2022;53(12):3899\u2013903.","journal-title":"Injury"},{"issue":"2","key":"1262_CR6","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1007\/s00068-017-0788-4","volume":"44","author":"S McLachlin","year":"2018","unstructured":"McLachlin S, Lesieur M, Stephen D, Kreder H, Whyne C. Biomechanical analysis of anterior ring fixation of the ramus in type C pelvis fractures. Eur J Trauma Emerg Surg. 2018;44(2):185\u201390.","journal-title":"Eur J Trauma Emerg Surg"},{"issue":"2","key":"1262_CR7","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1016\/j.injury.2018.07.011","volume":"50","author":"L MacCormick","year":"2019","unstructured":"MacCormick L, Chen F, Gilbertson J, Khan S, Schroder L, Bechtold J, et al. A biomechanical study comparing minimally invasive anterior pelvic ring fixation techniques to external fixation. Injury. 2019;50(2):251\u20135.","journal-title":"Injury"},{"key":"1262_CR8","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59040740","author":"T Berk","year":"2023","unstructured":"Berk T, Zderic I, Caspar J, Schwarzenberg P, Pastor T, Halvachizadeh S, et al. A novel implant for superior pubic ramus fracture fixation-development and a biomechanical feasibility study. Medicina. 2023. https:\/\/doi.org\/10.3390\/medicina59040740.","journal-title":"Medicina"},{"issue":"4","key":"1262_CR9","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1007\/s00264-023-05710-3","volume":"47","author":"T Berk","year":"2023","unstructured":"Berk T, Zderic I, Schwarzenberg P, Pastor T, Lesche F, Halvachizadeh S, et al. Evaluation of cannulated compression headless screws as an alternative implant for superior pubic ramus fracture fixation: a biomechanical study. Int Orthop. 2023;47(4):1079\u201387.","journal-title":"Int Orthop"},{"issue":"5","key":"1262_CR10","first-page":"1045","volume":"65","author":"M Sorensen","year":"2008","unstructured":"Sorensen M, Wessells H, Rivara F, Zonies D, Jurkovich G, Wang J, et al. Prevalence and predictors of sexual dysfunction 12 months after major trauma: a national study. J Trauma. 2008;65(5):1045\u201352.","journal-title":"J Trauma"},{"key":"1262_CR11","doi-asserted-by":"publisher","first-page":"3764","DOI":"10.12659\/MSM.900673","volume":"22","author":"C Bi","year":"2016","unstructured":"Bi C, Wang Q, Nagelli C, Wu J, Wang Q, Wang J. Treatment of unstable posterior pelvic ring fracture with pedicle screw-rod fixator versus locking compression plate: a comparative study. Med Sci Monit. 2016;22:3764\u201370.","journal-title":"Med Sci Monit"},{"issue":"1","key":"1262_CR12","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1186\/s13018-021-02348-y","volume":"16","author":"L Liu","year":"2021","unstructured":"Liu L, Zeng D, Fan S, Peng Y, Song H, Jin D, et al. Biomechanical study of Tile C3 pelvic fracture fixation using an anterior internal system combined with sacroiliac screws. J Orthop Surg Res. 2021;16(1):225.","journal-title":"J Orthop Surg Res"},{"key":"1262_CR13","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1097\/00003086-199608000-00022","volume":"329","author":"P Tornetta","year":"1996","unstructured":"Tornetta P, Matta J. Outcome of operatively treated unstable posterior pelvic ring disruptions. Clin Orthop Relat Res. 1996;329:186\u201393.","journal-title":"Clin Orthop Relat Res"},{"key":"1262_CR14","doi-asserted-by":"publisher","DOI":"10.1097\/00005131-199803000-00001","author":"F Dujardin","year":"1998","unstructured":"Dujardin F, Hossenbaccus M, Duparc F, Biga N, Thomine J. Long-term functional prognosis of posterior injuries in high-energy pelvic disruption. J Orthop Trauma. 1998. https:\/\/doi.org\/10.1097\/00005131-199803000-00001.","journal-title":"J Orthop Trauma"},{"key":"1262_CR15","first-page":"823","volume":"13","author":"L Wei","year":"2022","unstructured":"Wei L, Jianwen C, Shiting T, Jinmin Z, Zhi Y, Feng H, et al. Anatomic and clinical application of lateral-perineal approach for inferior ramus of pubis-ischium ramus. Chin J Orthop. 2022;13:823\u201330.","journal-title":"Chin J Orthop"},{"issue":"4","key":"1262_CR16","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/j.injury.2007.01.019","volume":"38","author":"M Oransky","year":"2007","unstructured":"Oransky M, Tortora M. Nonunions and malunions after pelvic fractures: why they occur and what can be done? Injury. 2007;38(4):489\u201396.","journal-title":"Injury"},{"issue":"5","key":"1262_CR17","doi-asserted-by":"publisher","first-page":"721","DOI":"10.2106\/00004623-200205000-00004","volume":"84","author":"D Mears","year":"2002","unstructured":"Mears D, Velyvis J. In situ fixation of pelvic nonunions following pathologic and insufficiency fractures. J Bone Joint Surg Am. 2002;84(5):721\u20138.","journal-title":"J Bone Joint Surg Am"},{"key":"1262_CR18","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/00003086-199608000-00011","volume":"329","author":"J Matta","year":"1996","unstructured":"Matta J. Indications for anterior fixation of pelvic fractures. Clin Orthop Relat Res. 1996;329:88\u201396.","journal-title":"Clin Orthop Relat Res"},{"issue":"11","key":"1262_CR19","doi-asserted-by":"publisher","first-page":"e109","DOI":"10.1097\/BOT.0b013e3181d527f2","volume":"24","author":"M Archdeacon","year":"2010","unstructured":"Archdeacon M, Kuhlman G, Kazemi N. Fellow\u2019s corner: grand rounds from the university of cincinnati medical center\u2013painful superior and inferior pubic rami nonunion. J Orthop Trauma. 2010;24(11):e109\u201312.","journal-title":"J Orthop Trauma"},{"key":"1262_CR20","first-page":"395","volume":"54","author":"D Templeman","year":"2005","unstructured":"Templeman D, Simpson T, Matta J. Surgical management of pelvic ring injuries. Instr Course Lect. 2005;54:395\u2013400.","journal-title":"Instr Course Lect"},{"issue":"1","key":"1262_CR21","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1097\/00005373-199801000-00030","volume":"44","author":"N Ebraheim","year":"1998","unstructured":"Ebraheim N, Biyani A, Wong F. Nonunion of pelvic fractures. J Trauma. 1998;44(1):202\u20134.","journal-title":"J Trauma"},{"key":"1262_CR22","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1097\/00003086-199608000-00024","volume":"329","author":"J Matta","year":"1996","unstructured":"Matta J, Dickson K, Markovich G. Surgical treatment of pelvic nonunions and malunions. Clin Orthop Relat Res. 1996;329:199\u2013206.","journal-title":"Clin Orthop Relat Res"},{"key":"1262_CR23","first-page":"124","volume":"151","author":"G Pennal","year":"1980","unstructured":"Pennal G, Massiah K. Nonunion and delayed union of fractures of the pelvis. Clin Orthop Relat Res. 1980;151:124\u20139.","journal-title":"Clin Orthop Relat Res"},{"issue":"3","key":"1262_CR24","first-page":"352","volume":"66","author":"A Ter-Grigorian","year":"2013","unstructured":"Ter-Grigorian A, Kasyan G, Pushkar D. Urogenital disorders after pelvic ring injuries. Central Eur J Urol. 2013;66(3):352\u20136.","journal-title":"Central Eur J Urol"},{"issue":"1","key":"1262_CR25","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.jamcollsurg.2006.03.017","volume":"203","author":"I Papadopoulos","year":"2006","unstructured":"Papadopoulos I, Kanakaris N, Bonovas S, Triantafillidis A, Garnavos C, Voros D, et al. Auditing 655 fatalities with pelvic fractures by autopsy as a basis to evaluate trauma care. J Am Coll Surg. 2006;203(1):30\u201343.","journal-title":"J Am Coll Surg"},{"issue":"10","key":"1262_CR26","doi-asserted-by":"publisher","first-page":"2687","DOI":"10.1007\/s00264-021-05153-8","volume":"45","author":"G Rovere","year":"2021","unstructured":"Rovere G, Perna A, Meccariello L, De Mauro D, Smimmo A, Proietti L, et al. Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review. Int Orthop. 2021;45(10):2687\u201397.","journal-title":"Int Orthop"},{"key":"1262_CR27","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9378(15)33150-1","author":"T Pohlemann","year":"1996","unstructured":"Pohlemann T, G\u00e4nsslen A, Schellwald O, Culemann U, Tscherne H. Outcome after pelvic ring injuries. Injury. 1996. https:\/\/doi.org\/10.1016\/S0002-9378(15)33150-1.","journal-title":"Injury"},{"issue":"5","key":"1262_CR28","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1590\/S1677-5538.IBJU.2014.0170","volume":"41","author":"Y Guan","year":"2015","unstructured":"Guan Y, Wendong S, Zhao S, Liu T, Liu Y, Zhang X, et al. The vascular and neurogenic factors associated with erectile dysfunction in patients after pelvic fractures. Inte Braz J Urol. 2015;41(5):959\u201366.","journal-title":"Inte Braz J Urol"},{"issue":"4","key":"1262_CR29","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.cjtee.2015.04.004","volume":"18","author":"H Ceylan","year":"2015","unstructured":"Ceylan H, Kuyucu E, Erdem R, Polat G, Y\u03b9lmaz F, G\u00fcm\u00fc\u015f B, et al. Does pelvic injury trigger erectile dysfunction in men? Chin J traumatol = Zhonghua chuang shang za zhi. 2015;18(4):229\u201331.","journal-title":"Chin J traumatol = Zhonghua chuang shang za zhi"},{"issue":"5","key":"1262_CR30","doi-asserted-by":"publisher","first-page":"308","DOI":"10.1097\/BOT.0b013e31821d700e","volume":"26","author":"H Vallier","year":"2012","unstructured":"Vallier H, Cureton B, Schubeck D. Pelvic ring injury is associated with sexual dysfunction in women. J Orthop Trauma. 2012;26(5):308\u201313.","journal-title":"J Orthop Trauma"},{"issue":"1","key":"1262_CR31","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1007\/s00068-019-01213-2","volume":"47","author":"F Fensky","year":"2021","unstructured":"Fensky F, Weiser L, Sellenschloh K, Vollmer M, Hartel MJ, Morlock MM, et al. Biomechanical analysis of anterior pelvic ring fractures with intact peripelvic soft tissues: a cadaveric study. Eur J Trauma Emerg Surg. 2021;47(1):187\u201393.","journal-title":"Eur J Trauma Emerg Surg"},{"key":"1262_CR32","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1097\/00003086-199608000-00016","volume":"329","author":"J Matta","year":"1996","unstructured":"Matta J, Tornetta P. Internal fixation of unstable pelvic ring injuries. Clin Orthop Relat Res. 1996;329:129\u201340.","journal-title":"Clin Orthop Relat Res"},{"issue":"2","key":"1262_CR33","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1302\/0301-620X.71B2.2925751","volume":"71","author":"S Majeed","year":"1989","unstructured":"Majeed S. Grading the outcome of pelvic fractures. J Bone Joint Surg Br Vol. 1989;71(2):304\u20136.","journal-title":"J Bone Joint Surg Br Vol"}],"container-title":["BioMedical Engineering OnLine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12938-024-01262-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12938-024-01262-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12938-024-01262-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,12]],"date-time":"2024-07-12T03:04:45Z","timestamp":1720753485000},"score":1,"resource":{"primary":{"URL":"https:\/\/biomedical-engineering-online.biomedcentral.com\/articles\/10.1186\/s12938-024-01262-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,12]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["1262"],"URL":"https:\/\/doi.org\/10.1186\/s12938-024-01262-8","relation":{},"ISSN":["1475-925X"],"issn-type":[{"value":"1475-925X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,12]]},"assertion":[{"value":"24 February 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 June 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 July 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":"This project fully considered and protected the rights and interests of the study objects. It meets the criteria of Ethical Review Committee. Ethical approval of this study was provided by the second affiliated hospital of Guangxi Medical University Review Board [No. 2022-KY(0137)]. Written informed consent for publication was obtained from all participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors approved the final manuscript and the submission to this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"66"}}