{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T15:03:54Z","timestamp":1783523034969,"version":"3.55.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T00:00:00Z","timestamp":1752278400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T00:00:00Z","timestamp":1752278400000},"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":["Ann Surg Oncol"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>This prospective observational multicenter study aimed to provide evidence-based data on the risk factors for feeding tube dependence, oral intake level, and speech function after tongue reconstruction.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Patients and Methods<\/jats:title>\n            <jats:p>This study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical group across 21 Japanese institutions. Patients with oral tongue squamous cell carcinoma who underwent microsurgical reconstruction following subtotal\/total glossectomy were included. Functional evaluations were performed 1 year postoperatively. The primary endpoint was postoperative feeding tube dependence. The other outcome variables were oral intake level and speech function at the time of evaluation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Overall, 189 patients were enrolled, of whom 121 (64.0%) were followed up for 1 year after surgery and were eligible for the final analysis. The overall rate of feeding tube dependence was 12.4% (<jats:italic>n<\/jats:italic> = 15) at the primary endpoint. Univariate analysis revealed that tongue defect type, laryngeal suspension, and postoperative chemotherapy were associated with feeding tube dependence. The oral intake level was affected by age at surgery, laryngeal suspension, and postoperative chemoradiation. Speech function was affected by age at surgery, American Society of Anesthesiologists physical status (class 2), medical comorbidities of hypertension and cardiac dysrhythmia, primary tumor stage (T4), neck dissection, reconstructive procedure, laryngeal suspension, and postoperative radiation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This study provides useful data for estimating individual risk factors associated with feeding tube dependence, oral intake level, and speech function before tongue reconstruction. These results can help surgeons and patients make informed decisions and optimize the functional outcomes of tongue reconstruction.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1245\/s10434-025-17762-3","type":"journal-article","created":{"date-parts":[[2025,7,12]],"date-time":"2025-07-12T16:37:59Z","timestamp":1752338279000},"page":"9198-9213","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Functional Outcomes after Subtotal\/Total Glossectomy with Microsurgical Reconstruction: A Multicenter Prospective Observational Study in Japan"],"prefix":"10.1245","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6024-9607","authenticated-orcid":false,"given":"Jun","family":"Araki","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keita","family":"Mori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshichika","family":"Yasunaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Nakagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tetsuro","family":"Onitsuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Yurikusa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Kimata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Sakuraba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Higashino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ikuo","family":"Hyodo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuhiro","family":"Ishida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shimpei","family":"Miyamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keisuke","family":"Takanari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaoru","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaki","family":"Arikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroki","family":"Umezawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideki","family":"Kadota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miwako","family":"Fujii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsumori","family":"Hamahata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tateki","family":"Kubo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisuke","family":"Yanagisawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koreyuki","family":"Kurosawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Umekawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuya","family":"Iida","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunji","family":"Sarukawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisashi","family":"Migita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,12]]},"reference":[{"key":"17762_CR1","first-page":"7","volume":"70","author":"RL Siegel","year":"2020","unstructured":"Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70:7\u201330.","journal-title":"CA Cancer J Clin."},{"key":"17762_CR2","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.oraloncology.2019.03.005","volume":"92","author":"DW Chen","year":"2019","unstructured":"Chen DW, Wang T, Shey-Sen Ni J, et al. Prognostic factors associated with achieving total oral diet after glossectomy with microvascular free tissue transfer reconstruction. Oral Oncol. 2019;92:59\u201366.","journal-title":"Oral Oncol."},{"key":"17762_CR3","doi-asserted-by":"publisher","first-page":"3751","DOI":"10.1007\/s00405-017-4683-8","volume":"274","author":"YB Ji","year":"2017","unstructured":"Ji YB, Cho YH, Song CM, et al. Long-term functional outcomes after resection of tongue cancer: determining the optimal reconstruction method. Eur Arch Otorhinolaryngol. 2017;274:3751\u20136.","journal-title":"Eur Arch Otorhinolaryngol."},{"key":"17762_CR4","doi-asserted-by":"publisher","first-page":"3061","DOI":"10.1245\/s10434-015-4386-6","volume":"22","author":"EI Chang","year":"2015","unstructured":"Chang EI, Yu P, Skoracki RJ, Liu J, Hanasono MM. Comprehensive analysis of functional outcomes and survival after microvascular reconstruction of glossectomy defects. Ann Surg Oncol. 2015;22:3061\u20139.","journal-title":"Ann Surg Oncol."},{"key":"17762_CR5","doi-asserted-by":"publisher","first-page":"2320","DOI":"10.1245\/s10434-012-2298-2","volume":"19","author":"S Miyamoto","year":"2012","unstructured":"Miyamoto S, Sakuraba M, Nagamatsu S, Kayano S, Kamizono K, Hayashi R. Risk factors for gastric-tube dependence following tongue reconstruction. Ann Surg Oncol. 2012;19:2320\u20136.","journal-title":"Ann Surg Oncol."},{"key":"17762_CR6","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1016\/j.oraloncology.2011.10.010","volume":"48","author":"C Guerin-Lebailly","year":"2012","unstructured":"Guerin-Lebailly C, Mallet Y, Lambour V, et al. Functional and sensitive outcomes after tongue reconstruction: about a series of 30 patients. Oral Oncol. 2012;48:272\u20137.","journal-title":"Oral Oncol."},{"key":"17762_CR7","first-page":"1388","volume":"40","author":"CM Speksnijder","year":"2011","unstructured":"Speksnijder CM, van der Bilt A, van der Glas HW, Koole R, Merkx MA. Tongue function in patients treated for malignancies in tongue and\/or floor of mouth; a one year prospective study. Int J Oral Maxillofac Surg. 2011;40:1388\u201394.","journal-title":"Int J Oral Maxillofac Surg."},{"key":"17762_CR8","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1002\/hed.20804","volume":"30","author":"C Yanai","year":"2008","unstructured":"Yanai C, Kikutani T, Adachi M, Thoren H, Suzuki M, Iizuka T. Functional outcome after total and subtotal glossectomy with free flap reconstruction. Head Neck. 2008;30:909\u201318.","journal-title":"Head Neck."},{"key":"17762_CR9","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1016\/j.ejso.2005.12.010","volume":"32","author":"CY Chien","year":"2006","unstructured":"Chien CY, Su CY, Hwang CF, Chuang HC, Jeng SF, Chen YC. Ablation of advanced tongue or base of tongue cancer and reconstruction with free flap: functional outcomes. Eur J Surg Oncol. 2006;32:353\u20137.","journal-title":"Eur J Surg Oncol."},{"key":"17762_CR10","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1097\/00005537-200305000-00024","volume":"113","author":"Y Kimata","year":"2003","unstructured":"Kimata Y, Sakuraba M, Hishinuma S, et al. Analysis of the relations between the shape of the reconstructed tongue and postoperative functions after subtotal or total glossectomy. Laryngoscope. 2003;113:905\u20139.","journal-title":"Laryngoscope."},{"key":"17762_CR11","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1097\/00006534-200010000-00012","volume":"106","author":"Y Kimata","year":"2000","unstructured":"Kimata Y, Uchiyama K, Ebihara S, et al. Postoperative complications and functional results after total glossectomy with microvascular reconstruction. Plast Reconstr Surg. 2000;106:1028\u201335.","journal-title":"Plast Reconstr Surg."},{"key":"17762_CR12","doi-asserted-by":"publisher","first-page":"693e","DOI":"10.1097\/PRS.0000000000010428","volume":"152","author":"J Araki","year":"2023","unstructured":"Araki J, Mori K, Yasunaga Y, et al. A novel risk model for predicting dysphagia after tongue reconstruction: a retrospective multicenter study in Japan. Plast Reconstr Surg. 2023;152:693e\u2013706e.","journal-title":"Plast Reconstr Surg."},{"key":"17762_CR13","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1186\/s12903-021-01709-7","volume":"21","author":"Y Ohashi","year":"2021","unstructured":"Ohashi Y, Shiga K, Katagiri K, et al. Evaluation and comparison of oral function after resection of cancer of the upper gingiva in patients who underwent reconstruction surgery versus those treated with a prosthesis. BMC Oral Health. 2021;21:347.","journal-title":"BMC Oral Health."},{"key":"17762_CR14","doi-asserted-by":"publisher","first-page":"2265","DOI":"10.1016\/j.ejso.2021.04.044","volume":"47","author":"JB Melan","year":"2021","unstructured":"Melan JB, Philouze P, Pradat P, et al. Functional outcomes of soft palate free flap reconstruction following oropharyngeal cancer surgery. Eur J Surg Oncol. 2021;47:2265\u201371.","journal-title":"Eur J Surg Oncol."},{"key":"17762_CR15","doi-asserted-by":"publisher","first-page":"1819","DOI":"10.1056\/NEJMoa040093","volume":"350","author":"L Neumayer","year":"2004","unstructured":"Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med. 2004;350:1819\u201327.","journal-title":"N Engl J Med."},{"key":"17762_CR16","first-page":"93","volume":"67","author":"MB Amin","year":"2017","unstructured":"Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more \u201cpersonalized\u201d approach to cancer staging. CA Cancer J Clin. 2017;67:93\u20139.","journal-title":"CA Cancer J Clin."},{"key":"17762_CR17","first-page":"401","volume":"65","author":"AC Chi","year":"2015","unstructured":"Chi AC, Day TA, Neville BW. Oral cavity and oropharyngeal squamous cell carcinoma\u2014an update. CA Cancer J Clin. 2015;65:401\u201321.","journal-title":"CA Cancer J Clin."},{"key":"17762_CR18","first-page":"400","volume":"62","author":"JB Epstein","year":"2012","unstructured":"Epstein JB, Thariat J, Bensadoun RJ, et al. Oral complications of cancer and cancer therapy: from cancer treatment to survivorship. CA Cancer J Clin. 2012;62:400\u201322.","journal-title":"CA Cancer J Clin."},{"key":"17762_CR19","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1007\/s00455-020-10224-w","volume":"36","author":"S Bhattacharya","year":"2021","unstructured":"Bhattacharya S, Thankappan K, Joseph ST, et al. Volume and location of the defect as predictors of swallowing outcome after glossectomy: correlation with a classification. Dysphagia. 2021;36:974\u201383.","journal-title":"Dysphagia."},{"key":"17762_CR20","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1097\/MLG.0b013e3180621109","volume":"117","author":"SS Khariwala","year":"2007","unstructured":"Khariwala SS, Vivek PP, Lorenz RR, et al. Swallowing outcomes after microvascular head and neck reconstruction: a prospective review of 191 cases. Laryngoscope. 2007;117:1359\u201363.","journal-title":"Laryngoscope."},{"key":"17762_CR21","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1002\/hed.20013","volume":"26","author":"BR Pauloski","year":"2004","unstructured":"Pauloski BR, Rademaker AW, Logemann JA, et al. Surgical variables affecting swallowing in patients treated for oral\/oropharyngeal cancer. Head Neck. 2004;26:625\u201336.","journal-title":"Head Neck."},{"key":"17762_CR22","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.1097\/MLG.0b013e3180686590","volume":"117","author":"Y Fujimoto","year":"2007","unstructured":"Fujimoto Y, Hasegawa Y, Yamada H, Ando A, Nakashima T. Swallowing function following extensive resection of oral or oropharyngeal cancer with laryngeal suspension and cricopharyngeal myotomy. Laryngoscope. 2007;117:1343\u20138.","journal-title":"Laryngoscope."},{"key":"17762_CR23","first-page":"18","volume":"144","author":"V Achim","year":"2018","unstructured":"Achim V, Bolognone RK, Palmer AD, et al. Long-term functional and quality-of-life outcomes after transoral robotic surgery in patients with oropharyngeal cancer. JAMA Otolaryngol Head Neck Surg. 2018;144:18\u201327.","journal-title":"JAMA Otolaryngol Head Neck Surg."},{"key":"17762_CR24","doi-asserted-by":"publisher","first-page":"1112","DOI":"10.1001\/archoto.2011.172","volume":"137","author":"CF Sinclair","year":"2011","unstructured":"Sinclair CF, McColloch NL, Carroll WR, Rosenthal EL, Desmond RA, Magnuson JS. Patient-perceived and objective functional outcomes following transoral robotic surgery for early oropharyngeal carcinoma. Arch Otolaryngol Head Neck Surg. 2011;137:1112\u20136.","journal-title":"Arch Otolaryngol Head Neck Surg."},{"key":"17762_CR25","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1002\/cncr.29022","volume":"121","author":"J Setton","year":"2015","unstructured":"Setton J, Lee NY, Riaz N, et al. A multi-institution pooled analysis of gastrostomy tube dependence in patients with oropharyngeal cancer treated with definitive intensity-modulated radiotherapy. Cancer. 2015;121:294\u2013301.","journal-title":"Cancer."},{"key":"17762_CR26","doi-asserted-by":"publisher","first-page":"1634","DOI":"10.1002\/hed.23200","volume":"35","author":"MK Bhayani","year":"2013","unstructured":"Bhayani MK, Hutcheson KA, Barringer DA, et al. Gastrostomy tube placement in patients with oropharyngeal carcinoma treated with radiotherapy or chemoradiotherapy: factors affecting placement and dependence. Head Neck. 2013;35:1634\u201340.","journal-title":"Head Neck."},{"key":"17762_CR27","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1001\/archoto.2010.245","volume":"137","author":"S Miyamoto","year":"2011","unstructured":"Miyamoto S, Sakuraba M, Asano T, et al. Free jejunal patch graft for reconstruction after partial hypopharyngectomy with laryngeal preservation. Arch Otolaryngol Head Neck Surg. 2011;137:181\u20136.","journal-title":"Arch Otolaryngol Head Neck Surg."},{"key":"17762_CR28","doi-asserted-by":"publisher","first-page":"M634","DOI":"10.1093\/gerona\/55.11.M634","volume":"55","author":"MA Nicosia","year":"2000","unstructured":"Nicosia MA, Hind JA, Roecker EB, et al. Age effects on the temporal evolution of isometric and swallowing pressure. J Gerontol A Biol Sci Med Sci. 2000;55:M634\u201340.","journal-title":"J Gerontol A Biol Sci Med Sci."},{"key":"17762_CR29","doi-asserted-by":"publisher","first-page":"E52","DOI":"10.1002\/lary.28667","volume":"131","author":"CA Jones","year":"2021","unstructured":"Jones CA, Ciucci MR, Abdelhalim SM, McCulloch TM. Swallowing pressure variability as a function of pharyngeal region, bolus volume, age, and sex. Laryngoscope. 2021;131:E52\u20138.","journal-title":"Laryngoscope."},{"key":"17762_CR30","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/j.oraloncology.2013.03.001","volume":"49","author":"L Lam","year":"2013","unstructured":"Lam L, Samman N. Speech and swallowing following tongue cancer surgery and free flap reconstruction\u2014a systematic review. Oral Oncol. 2013;49:507\u201324.","journal-title":"Oral Oncol."},{"key":"17762_CR31","doi-asserted-by":"publisher","first-page":"2015","DOI":"10.1097\/00006534-199912000-00011","volume":"104","author":"K Kiyokawa","year":"1999","unstructured":"Kiyokawa K, Tai Y, Inoue Y, Yanaga H, Mori K, Nakashima T. Functional reconstruction of swallowing and articulation after total glossectomy without laryngectomy: money pouch-like reconstruction method using rectus abdominis myocutaneous flap. Plast Reconstr Surg. 1999;104:2015\u201320.","journal-title":"Plast Reconstr Surg."},{"key":"17762_CR32","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1055\/s-0040-1709493","volume":"36","author":"CR Yi","year":"2020","unstructured":"Yi CR, Jeong WS, Oh TS, Koh KS, Choi JW. Analysis of speech and functional outcomes in tongue reconstruction after hemiglossectomy. J Reconstr Microsurg. 2020;36:507\u201313.","journal-title":"J Reconstr Microsurg."},{"key":"17762_CR33","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1016\/j.jcms.2018.02.013","volume":"46","author":"HH Jeong","year":"2018","unstructured":"Jeong HH, Jeong WS, Choi JW, et al. 3D computer simulation analysis of the flap volume change in total tongue reconstruction flaps. J Craniomaxillofac Surg. 2018;46:844\u201350.","journal-title":"J Craniomaxillofac Surg."}],"container-title":["Annals of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-17762-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1245\/s10434-025-17762-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1245\/s10434-025-17762-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,17]],"date-time":"2025-10-17T15:40:07Z","timestamp":1760715607000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1245\/s10434-025-17762-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,12]]},"references-count":33,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025,11]]}},"alternative-id":["17762"],"URL":"https:\/\/doi.org\/10.1245\/s10434-025-17762-3","relation":{},"ISSN":["1068-9265","1534-4681"],"issn-type":[{"value":"1068-9265","type":"print"},{"value":"1534-4681","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,12]]},"assertion":[{"value":"28 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare that there is no conflict of interest. The authors report no commercial associations or financial disclosures regarding this manuscript. This study was funded by the Shizuoka Cancer Center Hospital. The funders had no role to play in the design and conduct of the study; management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Only data acquisition was funded by the funder.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosure"}}]}}