{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T11:52:56Z","timestamp":1772711576630,"version":"3.50.1"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000050","name":"NHBLI","doi-asserted-by":"crossref","award":["R01HL153191"],"award-info":[{"award-number":["R01HL153191"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Echo Res Pract"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Orthostatic hypotension (OH) is associated with cardiovascular disease, particularly among older adults. While a standing transthoracic echocardiogram (TTE) could theoretically identify changes in cardiac output to diagnose cardiogenic OH, there are no established protocols for orthostatic TTEs and their feasibility is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and results<\/jats:title>\n            <jats:p>We recruited 115 patients scheduled for elective outpatient TTE. Consenting participants, who were able to stand safely, underwent their scheduled recumbent TTE, followed by a standing TTE, performed within 1\u20132\u00a0minutes of standing. The focused TTE used the apical window to measure velocity time integral across the aortic valve to assess cardiac output. Blood pressure (BP) was measured in the supine and standing positions and patients were asked about symptoms of dizziness and lightheadedness. OH was defined as a change in standing minus supine systolic BP \u2264-20\u00a0mm Hg or in diastolic BP of \u2264-10\u00a0mm Hg. Of the 115 enrolled participants, 102 (89%) completed the standing echocardiogram protocol. Among those completing, mean age was 63.4 (SD, 14.8) years (38% were \u2265\u200970 years), 48% women, and 34% had a BMI\u2009\u2265\u200930\u00a0kg\/m<jats:sup>2<\/jats:sup>. There were 21% with OH. Upon standing, systolic BP changed by -5.9\u00a0mm Hg (95% CI: -9.5, -2.2), diastolic BP by 2.4\u00a0mm Hg (-0.1, 4.8), and cardiac output by -0.4\u00a0L\/min (95% CI: -0.7, -0.1). Change in cardiac output (per 1\u00a0L\/min) was associated with a higher odds of systolic OH (OR: 1.60; 95% CI: 1.05, 2.42), but not diastolic OH (OR: 1.21; 95% CI: 0.63, 2.32).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Standing TTE is safe, well-tolerated, and feasible in the ambulatory setting. Moreover, TTE changes in cardiac output are associated with systolic OH. This clinical assessment shows promise for distinguishing OH etiologies and could inform further research on treatments to prevent OH.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s44156-025-00075-2","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T23:02:36Z","timestamp":1747695756000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Standing transthoracic echocardiography: a feasibility study"],"prefix":"10.1186","volume":"12","author":[{"given":"Stephen P","family":"Juraschek","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Noelle","family":"Ojo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janet","family":"Monroe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jordan B","family":"Strom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica","family":"Stout","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Warren J","family":"Manning","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruth-Alma N.","family":"Turkson-Ocran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabrielle","family":"Kolaci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaitlynn","family":"Geier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Baptista","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Araina","family":"Picanzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth J","family":"Mukamal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason D","family":"Matos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"75_CR1","doi-asserted-by":"crossref","unstructured":"Juraschek SP, Daya N, Appel LJ, Miller ER, McEvoy JW, Matsushita K, Ballantyne CM, Selvin E. Orthostatic hypotension and risk of clinical and subclinical cardiovascular disease in Middle-Aged adults. J Am Heart Assoc. 2018;7.","DOI":"10.1161\/JAHA.118.008884"},{"key":"75_CR2","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1002\/j.1552-4604.1994.tb04977.x","volume":"34","author":"JJ Smith","year":"1994","unstructured":"Smith JJ, Porth CM, Erickson M. Hemodynamic response to the upright posture. J Clin Pharmacol. 1994;34:375\u201386.","journal-title":"J Clin Pharmacol"},{"key":"75_CR3","doi-asserted-by":"crossref","unstructured":"Rowell LB. Human cardiovascular control. Oxford University Press; 1993.","DOI":"10.1093\/oso\/9780195073621.001.0001"},{"key":"75_CR4","doi-asserted-by":"publisher","first-page":"2388","DOI":"10.1161\/HYPERTENSIONAHA.122.18557","volume":"79","author":"I Raber","year":"2022","unstructured":"Raber I, Belanger MJ, Farahmand R, Aggarwal R, Chiu N, Al Rifai M, Jacobsen AP, Lipsitz LA, Juraschek SP. Orthostatic hypotension in hypertensive adults: Harry Goldblatt award for early career investigators 2021. Hypertension. 2022;79:2388\u201396.","journal-title":"Hypertension"},{"key":"75_CR5","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1161\/HYPERTENSIONAHA.118.11337","volume":"72","author":"SP Juraschek","year":"2018","unstructured":"Juraschek SP, Appel LJ, Miller ER, Mukamal KJ, Lipsitz LA. Hypertension treatment effects on orthostatic hypotension and its relationship with cardiovascular disease. Hypertension. 2018;72:986\u201393.","journal-title":"Hypertension"},{"key":"75_CR6","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1093\/eurjpc\/zwad158","volume":"30","author":"Z Pasdar","year":"2023","unstructured":"Pasdar Z, De Paola L, Carter B, Pana TA, Potter JF, Myint PK. Orthostatic hypertension and major adverse events: a systematic review and meta-analysis. Eur J Prev Cardiol. 2023;30:1028\u201338.","journal-title":"Eur J Prev Cardiol"},{"key":"75_CR7","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1016\/j.xkme.2020.10.012","volume":"3","author":"M Rouabhi","year":"2021","unstructured":"Rouabhi M, Durieux J, Al-Kindi S, Cohen JB, Townsend RR, Rahman M. Orthostatic hypertension and hypotension and outcomes in CKD: the CRIC (Chronic renal insufficiency Cohort) study. Kidney Med. 2021;3:206\u2013e2151.","journal-title":"Kidney Med"},{"key":"75_CR8","doi-asserted-by":"crossref","unstructured":"Ottenhoff J, Hewitt M, Makonnen N, Kongkatong M, Thom CD. Comparison of the quality of echocardiography imaging between the left lateral decubitus and supine positions. Cureus. 2022;14(11):e31835.","DOI":"10.7759\/cureus.31835"},{"key":"75_CR9","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/S0733-8651(05)70090-4","volume":"17","author":"E Bossone","year":"1999","unstructured":"Bossone E, Armstrong WF. EXERCISE ECHOCARDIOGRAPHY: principles, methods, and clinical use. Cardiol Clin. 1999;17:447\u201360.","journal-title":"Cardiol Clin"},{"key":"75_CR10","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.echo.2010.10.006","volume":"24","author":"S Joshi","year":"2011","unstructured":"Joshi S, Patel UK, Yao S-S, Castenada V, Isambert A, Winson G, Chaudhry FA, Sherrid MV. Standing and exercise doppler echocardiography in obstructive hypertrophic cardiomyopathy: the range of gradients with upright activity. J Am Soc Echocardiogr. 2011;24:75\u201382.","journal-title":"J Am Soc Echocardiogr"},{"key":"75_CR11","doi-asserted-by":"publisher","first-page":"3237","DOI":"10.1007\/s10439-010-0062-y","volume":"38","author":"DEO Dewi","year":"2010","unstructured":"Dewi DEO, Veldhuizen AG, Burgerhof JGM, Purnama IKE, van Ooijen PMA, Wilkinson MHF, Mengko TLER, Verkerke GJ. Reproducibility of standing posture for X-Ray radiography: A feasibility study of the BalancAid with healthy young subjects. Ann Biomed Eng. 2010;38:3237\u201345.","journal-title":"Ann Biomed Eng"},{"key":"75_CR12","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1007\/BF02347554","volume":"42","author":"G Cybulski","year":"2004","unstructured":"Cybulski G, Michalak E, Ko\u017aluk E, Pi\u0105tkowska A, Niewiadomski W. Stroke volume and systolic time intervals: Beat-to-beat comparison between echocardiography and ambulatory impedance cardiography in supine and Tilted positions. Med Biol Eng Comput. 2004;42:707\u201311.","journal-title":"Med Biol Eng Comput"},{"key":"75_CR13","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1002\/clc.4960081108","volume":"8","author":"A Ansari","year":"1985","unstructured":"Ansari A. M-Mode echocardiography in supine and standing position in control subjects and patients with auscultatory evidence of mitral valve prolapse but negative supine echocardiography: does sensitivity improve? Clin Cardiol. 1985;8:591\u20136.","journal-title":"Clin Cardiol"},{"key":"75_CR14","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1093\/ehjci\/jew313","volume":"19","author":"P Reant","year":"2018","unstructured":"Reant P, Dufour M, Peyrou J, Reynaud A, Rooryck C, Dijos M, Vincent C, Cornolle C, Roudaut R, Lafitte S. Upright treadmill vs. semi-supine bicycle exercise echocardiography to provoke obstruction in symptomatic hypertrophic cardiomyopathy: a pilot study. Eur Heart J Cardiovasc Imaging. 2018;19:31\u20138.","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"75_CR15","doi-asserted-by":"publisher","first-page":"5292","DOI":"10.3390\/jcm12165292","volume":"12","author":"C Cotrim","year":"2023","unstructured":"Cotrim C, Palinkas ED, Cotrim N. The importance of left ventricular outflow tract and Mid-Ventricular gradients in stress echocardiography: A narrative review. J Clin Med. 2023;12:5292.","journal-title":"J Clin Med"},{"key":"75_CR16","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1159\/000320141","volume":"117","author":"J Moon","year":"2010","unstructured":"Moon J, Kim H, Kim J-Y, Chung S, Choi E-Y, Min P-K, Lee BK, Hong B-K, Kwon HM, Rim S-J. Left ventricular hypercontractility immediately after Tilting triggers a disregulated cardioinhibitory reaction in Vasovagal syncope: echocardiographic evaluation during the head-up Tilt test. Cardiology. 2010;117:118\u201323.","journal-title":"Cardiology"},{"key":"75_CR17","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.acvd.2016.04.009","volume":"110","author":"N Hammoudi","year":"2017","unstructured":"Hammoudi N, H\u00e9kimian G, Laveau F, Achkar M, Isnard R, Combes A. Three-dimensional transoesophageal echocardiography for cardiac output in critically ill patients: A pilot study of ultrasound versus the thermodilution method. Arch Cardiovasc Dis. 2017;110:7\u201313.","journal-title":"Arch Cardiovasc Dis"},{"key":"75_CR18","doi-asserted-by":"publisher","first-page":"2103","DOI":"10.1056\/NEJMoa1511939","volume":"373","author":"JT Wright","year":"2015","unstructured":"SPRINT Research Group, Wright JT, Williamson JD, Whelton PK, Snyder JK, Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL, Johnson KC, Goff DC, Fine LJ, Cutler JA, Cushman WC, Cheung AK, Ambrosius WT. A randomized trial of intensive versus standard Blood-Pressure control. N Engl J Med. 2015;373:2103\u201316.","journal-title":"N Engl J Med"},{"key":"75_CR19","doi-asserted-by":"publisher","first-page":"2310","DOI":"10.1111\/jgs.17804","volume":"70","author":"SP Juraschek","year":"2022","unstructured":"Juraschek SP, Appel LJ, Mitchell M, Mukamal C, Lipsitz KJ, Blackford LA, Cai AL, Guralnik Y, Kalyani JM, Michos RR, Schrack ED, Wanigatunga JA, Miller AA. Comparison of supine and seated orthostatic hypotension assessments and their association with falls and orthostatic symptoms. J Am Geriatr Soc. 2022;70:2310\u20139.","journal-title":"J Am Geriatr Soc"},{"key":"75_CR20","volume-title":"Orthostatic hypotension in adults with hypertension","author":"SP Juraschek","year":"2024","unstructured":"Juraschek SP, Cortez MM, Flack JM, Ghazi L, Kenny RA, Rahman M, Spikes T, Shibao CA, Biaggioni I, American Heart Association Council on Hypertension. Orthostatic hypotension in adults with hypertension. Hypertension: A Scientific Statement From the American Heart Association; 2024."},{"key":"75_CR21","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1093\/ajh\/hpw108","volume":"30","author":"SP Juraschek","year":"2017","unstructured":"Juraschek SP, Daya N, Appel LJ, Miller ER, Windham BG, Pompeii L, Griswold ME, Kucharska-Newton A, Selvin E. Orthostatic hypotension in Middle-Age and risk of falls. Am J Hypertens. 2017;30:188\u201395.","journal-title":"Am J Hypertens"},{"key":"75_CR22","doi-asserted-by":"publisher","first-page":"e759","DOI":"10.1212\/WNL.0000000000006027","volume":"91","author":"AM Rawlings","year":"2018","unstructured":"Rawlings AM, Juraschek SP, Heiss G, Hughes T, Meyer ML, Selvin E, Sharrett AR, Windham BG, Gottesman RF. Association of orthostatic hypotension with incident dementia, stroke, and cognitive decline. Neurology. 2018;91:e759\u201368.","journal-title":"Neurology"},{"key":"75_CR23","doi-asserted-by":"crossref","unstructured":"Juraschek SP, Daya N, Rawlings AM, Appel LJ, Miller ER, Windham BG, Griswold ME, Heiss G, Selvin E. Association of history of Dizziness and Long-term adverse outcomes with early vs later orthostatic hypotension assessment times in Middle-aged adults. JAMA Intern Med. 2017;177(9):1316\u201323.","DOI":"10.1001\/jamainternmed.2017.2937"},{"key":"75_CR24","unstructured":"Ringer M, Lappin SL. Orthostatic Hypotension. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2024. Available at: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK448192\/. Accessed May 4, 2024."},{"key":"75_CR25","doi-asserted-by":"crossref","unstructured":"Maharaj A, Teelucksingh J. Syncope in aortic stenosis: not always what it seems. Cureus. 2023;15(3):e36716.","DOI":"10.7759\/cureus.36716"},{"key":"75_CR26","doi-asserted-by":"publisher","first-page":"746","DOI":"10.1016\/0002-9343(81)90353-3","volume":"71","author":"AD Santos","year":"1981","unstructured":"Santos AD, Mathew PK, Hilal A, Wallace WA. Orthostatic hypotension: A commonly unrecognized cause of symptoms in mitral valve prolapse. Am J Med. 1981;71:746\u201350.","journal-title":"Am J Med"},{"key":"75_CR27","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1016\/j.ihj.2019.07.009","volume":"71","author":"N Prasitlumkum","year":"2019","unstructured":"Prasitlumkum N, Kewcharoen J, Angsubhakorn N, Chongsathidkiet P, Rattanawong P. Orthostatic hypotension is associated with new-onset atrial fibrillation: systemic review and meta-analysis. Indian Heart J. 2019;71:320\u20137.","journal-title":"Indian Heart J"},{"key":"75_CR28","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1161\/HYPERTENSIONAHA.111.188151","volume":"59","author":"CD Jones","year":"2012","unstructured":"Jones CD, Loehr L, Franceschini N, Rosamond WD, Chang PP, Shahar E, Couper DJ, Rose KM. Orthostatic hypotension as a risk factor for incident heart failure: the atherosclerosis risk in communities study. Hypertension. 2012;59:913\u20138.","journal-title":"Hypertension"},{"key":"75_CR29","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1016\/j.jacc.2020.07.055","volume":"76","author":"DE Forman","year":"2020","unstructured":"Forman DE, de Lemos JA, Shaw LJ, Reuben DB, Lyubarova R, Peterson E, Spertus JA, Zieman S, Salive M, Rich MW. Cardiovascular biomarkers and imaging in older adults. J Am Coll Cardiol. 2020;76:1577\u201394.","journal-title":"J Am Coll Cardiol"},{"key":"75_CR30","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.hlc.2021.06.525","volume":"31","author":"K Ellenberger","year":"2022","unstructured":"Ellenberger K, Jeyaprakash P, Sivapathan S, Sangha S, Kitley J, Darshni A, Chen D, Negishi K, Pathan F. The effect of obesity on echocardiographic image quality. Heart Lung Circulation. 2022;31:207\u201315.","journal-title":"Heart Lung Circulation"},{"key":"75_CR31","doi-asserted-by":"publisher","first-page":"36","DOI":"10.3949\/ccjm.89gr.22001","volume":"89","author":"AJ Peixoto","year":"2022","unstructured":"Peixoto AJ. Evaluation and management of orthostatic hypotension: limited data, limitless opportunity. CCJM. 2022;89:36\u201345.","journal-title":"CCJM"},{"key":"75_CR32","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1093\/ajh\/hpz015","volume":"32","author":"SP Juraschek","year":"2019","unstructured":"Juraschek SP, Lipsitz LA, Beach JL, Mukamal KJ. Association of orthostatic hypotension timing with clinical events in adults with diabetes and hypertension: results from the ACCORD trial. Am J Hypertens. 2019;32:684\u201394.","journal-title":"Am J Hypertens"},{"key":"75_CR33","doi-asserted-by":"crossref","unstructured":"Petriceks AH, Appel LJ, Miller ER, Mitchell CM, Schrack JA, Mukamal KJ, Lipsitz LA, Wanigatunga AA, Plante TB, Michos ED, Juraschek SP. Timing of orthostatic hypotension and its relationship with falls in older adults. J Am Geriatr Soc. 2023;71(12):3711\u201320.","DOI":"10.1111\/jgs.18573"},{"key":"75_CR34","doi-asserted-by":"publisher","first-page":"102756","DOI":"10.1016\/j.autneu.2020.102756","volume":"231","author":"MPM Harms","year":"2021","unstructured":"Harms MPM, Finucane C, P\u00e9rez-Denia L, Juraschek SP, van Wijnen VK, Lipsitz LA, van Lieshout JJ, Wieling W. Systemic and cerebral circulatory adjustment within the first 60 s after active standing: an integrative physiological view. Auton Neurosci. 2021;231:102756.","journal-title":"Auton Neurosci"},{"key":"75_CR35","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1007\/s12574-018-0382-8","volume":"16","author":"K Suzuki","year":"2018","unstructured":"Suzuki K, Hirano Y, Yamada H, Murata M, Daimon M, Takeuchi M, Seo Y, Izumi C, Akaishi M. Practical guidance for the implementation of stress echocardiography. J Echocardiogr. 2018;16:105\u201329.","journal-title":"J Echocardiogr"}],"container-title":["Echo Research &amp; Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44156-025-00075-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s44156-025-00075-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s44156-025-00075-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T23:02:39Z","timestamp":1747695759000},"score":1,"resource":{"primary":{"URL":"https:\/\/echo.biomedcentral.com\/articles\/10.1186\/s44156-025-00075-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,20]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["75"],"URL":"https:\/\/doi.org\/10.1186\/s44156-025-00075-2","relation":{},"ISSN":["2055-0464"],"issn-type":[{"value":"2055-0464","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,20]]},"assertion":[{"value":"7 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 May 2025","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":"Competing interests"}},{"value":"The authors have nothing to disclose.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}}],"article-number":"12"}}