<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.3 20210610//EN" "JATS-journalpublishing1-3.dtd">
<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">rmt</journal-id><journal-title-group><journal-title xml:lang="ru">Общая реаниматология</journal-title><trans-title-group xml:lang="en"><trans-title>General Reanimatology</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1813-9779</issn><issn pub-type="epub">2411-7110</issn><publisher><publisher-name>FSBI "SRIGR" RAMS</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.15360/1813-9779-2024-6-24-1104</article-id><article-id custom-type="elpub" pub-id-type="custom">rmt-2527</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEWS &amp; SHORT COMMUNICATIONS</subject></subj-group></article-categories><title-group><article-title>Концепция мозга как единого целого: упрощение подходов к пониманию смерти мозга</article-title><trans-title-group xml:lang="en"><trans-title>«The Brain as a Whole» Concept: Facilitating Approaches to Brain Death Understanding</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Мачадо</surname><given-names>К.</given-names></name><name name-style="western" xml:lang="en"><surname>Machado</surname><given-names>C.</given-names></name></name-alternatives><bio xml:lang="ru"><p>кафедра клинической нейрофизиологии</p><p>10400;  ул. Ведадо, д. 29 y D; Ла-Гавана</p></bio><bio xml:lang="en"><p>Calixto Machado</p><p>Department of Clinical Neurophysiology</p><p>10400; 29 y D, Vedado; La Habana</p></bio><email xlink:type="simple">braind@infomed.sld.cu</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дробна Саниова</surname><given-names>Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Drobná Sániová</surname><given-names>B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>медицинский факультет им. Ессениуса и Университетская клиника в Мартине</p><p>03601;  ул. Колларова, д. 2; Мартин</p></bio><bio xml:lang="en"><p>Beata Drobná Sániová</p><p>Jessenius Faculty of Medicine and University Hospital in Martin</p><p>03659; 2 Kollarova Str.; Martin</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Дробны</surname><given-names>М.</given-names></name><name name-style="western" xml:lang="en"><surname>Drobný</surname><given-names>M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>медицинский факультет им. Ессениуса и Университетская клиника в Мартине</p><p>03601;  ул. Колларова, д. 2; Мартин</p></bio><bio xml:lang="en"><p>Michal Drobný</p><p>Jessenius Faculty of Medicine and University Hospital in Martin</p><p>03659; 2 Kollarova Str.; Martin</p></bio><xref ref-type="aff" rid="aff-2"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Институт неврологии и нейрохирургии</institution><country>Куба</country></aff><aff xml:lang="en"><institution>Institute of Neurology and Neurosurgery</institution><country>Cuba</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Клиника анестезиологии и интенсивной медицины, Братиславский университет им. Коменского</institution><country>Словакия</country></aff><aff xml:lang="en"><institution>Clinic of Anaesthesiology and Intensive Medicine, Comenius University in Bratislava</institution><country>Slovakia</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2024</year></pub-date><pub-date pub-type="epub"><day>06</day><month>11</month><year>2024</year></pub-date><volume>20</volume><issue>6</issue><fpage>54</fpage><lpage>56</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Мачадо К., Дробна Саниова Б., Дробны М., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Мачадо К., Дробна Саниова Б., Дробны М.</copyright-holder><copyright-holder xml:lang="en">Machado C., Drobná Sániová B., Drobný M.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.reanimatology.com/rmt/article/view/2527">https://www.reanimatology.com/rmt/article/view/2527</self-uri><abstract><p>   По мнению Джеймса Берната «формулировка «полная смерть мозга» является наиболее адекватной для правильного понимания смерти». Однако недавно автор предложил использовать другое выражение — «мозг как единое целое». Это связано с тем, что у пациентов с первичным поражением ствола мозга, которые в остальном соответствуют клиническим критериям смерти мозга, могут сохраняться признаки активности на ЭЭГ, проявления мозгового кровотока, вызванные потенциалы и нейросекреция в гипоталамо-гипофизарном отделе. Группа исследователей под руководством Берната предложила «ужесточить инструментальные клинические критерии для определения смерти мозга или смягчить критерии констатации полной смерти мозга». Они подчеркивают, что критерий «мозг как единое целое» является промежуточным между концепциями полной смерти мозга и смерти ствола мозга, который допускает необратимое прекращение важнейших функций мозга, в то время как в рамках классического определения смерти мозга, согласно неврологическим критериям, не предусматривается прекращения всех функций мозга или смерти всех нейронов. В данном кратком сообщении мы пересмотрели концепцию мозга как единого целого, которая интуитивно понятна и облегчает подход с концептуальной и практической точек зрения, но требует дальнейшей детализации, чтобы точно определить, прекращение каких функций мозга необходимо документировать для постановки диагноза «смерти мозга».</p></abstract><trans-abstract xml:lang="en"><p>   James Bernat claimed that «the formulation of whole-brain death provides the most congruent map for our correct understanding of death». However, the author has recently proposed the categorization of another phrase: «brain as a whole (BAAW)». This is because patients with primary brainstem lesions who otherwise meet the clinical criteria for BD may still have EEG, CBF, evoked potentials, and hypothalamic-pituitary neurosecretion. Bernat and colleagues suggested «tightening the clinical tests for brain death or loosening the whole-brain criterion of death». They emphasize that the BAAW criterion is an intermediate standard between the whole-brain and brainstem views, tolerating the irreversible cessation of critical brain functions, whereas the BD/DNC determination does not require the cessation of all brain functions or the death of every neuron. In this paper, we have revised the concept of BAAW, which is intuitive and facilitates a conceptual and practical approach, but requires further refinement to specify precisely which brain functions must cease at brain death and which may continue.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>смерть мозга</kwd><kwd>клинические критерии</kwd><kwd>гипоталамус</kwd><kwd>ствол головного мозга</kwd><kwd>вегетативная нервная система</kwd></kwd-group><kwd-group xml:lang="en"><kwd>brain death</kwd><kwd>clinical criteria</kwd><kwd>hypothalamus</kwd><kwd>brainstem</kwd><kwd>autonomic nervous system</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Greer D. Should the brain death exam with apnea test require surrogate informed consent? No: the UDDA revision series. Neurology. 2023; 101 (5): 221–222. DOI: 10.1212/WNL.0000000000207333. PMID: 37429710.</mixed-citation><mixed-citation xml:lang="en">Greer D. Should the brain death exam with apnea test require surrogate informed consent? No: the UDDA revision series. Neurology. 2023; 101 (5): 221–222. DOI: 10.1212/WNL.0000000000207333. PMID: 37429710.</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Lewis A., Liebman J., Kreiger-Benson E., Kumpfbeck A., Bakkar A., Shemie S. D., Sung G., et al. Ancillary testing for determination of death by neurologic criteria around the world. Neurocrit Care. 2021; 34 (2): 473–484. DOI: 10.1007/s12028-020-01039-6. PMID: 32648194.</mixed-citation><mixed-citation xml:lang="en">Lewis A., Liebman J., Kreiger-Benson E., Kumpfbeck A., Bakkar A., Shemie S. D., Sung G., et al. Ancillary testing for determination of death by neurologic criteria around the world. Neurocrit Care. 2021; 34 (2): 473–484. DOI: 10.1007/s12028-020-01039-6. PMID: 32648194.</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Bernat J. L. On irreversibility as a prerequisite for brain death determination. In: Machado C., Shewmon D. L., editors. Brain death and disordees of consciousness. vol. 550. 2004/04/01 ed. New Yorl: Kluwer Academic: Plenum Publishers; 2004: 161–167. Adv Exp Med Biol. 2004: 550: 161–677. DOI: 10.1007/978-0-306-48526-8_14. PMID: 15053434.</mixed-citation><mixed-citation xml:lang="en">Bernat J. L. On irreversibility as a prerequisite for brain death determination. In: Machado C., Shewmon D. L., editors. Brain death and disordees of consciousness. vol. 550. 2004/04/01 ed. New Yorl: Kluwer Academic: Plenum Publishers; 2004: 161–167. Adv Exp Med Biol. 2004: 550: 161–677. DOI: 10.1007/978-0-306-48526-8_14. PMID: 15053434.</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Bernat J. L. A defense of the whole-brain concept of death. Hastings Cent Rep. 1998; 28 (2): 14–23. PMID: 9589289.</mixed-citation><mixed-citation xml:lang="en">Bernat J. L. A defense of the whole-brain concept of death. Hastings Cent Rep. 1998; 28 (2): 14–23. PMID: 9589289.</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">Bernat J. L. The biophilosophical basis of whole-brain death. Soc Philos Policy. 2002; 19 (2): 324–342. DOI: 10.1017/s0265052502192132. PMID: 12678092.</mixed-citation><mixed-citation xml:lang="en">Bernat J. L. The biophilosophical basis of whole-brain death. Soc Philos Policy. 2002; 19 (2): 324–342. DOI: 10.1017/s0265052502192132. PMID: 12678092.</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Bernat J. L. The concept and practice of brain death. Prog Brain Res. 2005; 150: 369–379. DOI: 10.1016/S0079-6123(05)50026-8. PMID: 16186036.</mixed-citation><mixed-citation xml:lang="en">Bernat J. L. The concept and practice of brain death. Prog Brain Res. 2005; 150: 369–379. DOI: 10.1016/S0079-6123(05)50026-8. PMID: 16186036.</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">Schoning M., Scheel P., Holzer M., Fretschner R., Will B. E. Volume measurement of cerebral blood flow: assessment of cerebral circulatory arrest. Transplantation. 2005. 8; 80 (3): 326–331. DOI: 10.1097/01.tp.0000167994.78078.e6. PMID: 16082327.</mixed-citation><mixed-citation xml:lang="en">Schoning M., Scheel P., Holzer M., Fretschner R., Will B. E. Volume measurement of cerebral blood flow: assessment of cerebral circulatory arrest. Transplantation. 2005. 8; 80 (3): 326–331. DOI: 10.1097/01.tp.0000167994.78078.e6. PMID: 16082327.</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Sawicki M., Solek-Pastuszka J., Chamier-Cieminska K., Walecka A., Bohatyrewicz R. Accuracy of computed tomographic perfusion in diagnosis of brain death: a prospective cohort study. Med Sci Monit. 2018; 24: 2777–2785. DOI: 10.12659/MSM.906304. PMID: 29727439.</mixed-citation><mixed-citation xml:lang="en">Sawicki M., Solek-Pastuszka J., Chamier-Cieminska K., Walecka A., Bohatyrewicz R. Accuracy of computed tomographic perfusion in diagnosis of brain death: a prospective cohort study. Med Sci Monit. 2018; 24: 2777–2785. DOI: 10.12659/MSM.906304. PMID: 29727439.</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death: Medical, Legal and Ethical Issues in the Determination of Death. Washington, DC: US Gov Pr Office; 1981. https://onlinebooks.library.upenn.edu/webbin/book/lookupname?key=United%20States.%20President%27s%20Commission%20for%20the%20Study%20of%20Ethical%20Problems%20in%20Medicine%20and%20Biomedical%20and%20Behavioral%20Research.</mixed-citation><mixed-citation xml:lang="en">President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death: Medical, Legal and Ethical Issues in the Determination of Death. Washington, DC: US Gov Pr Office; 1981. https://onlinebooks.library.upenn.edu/webbin/book/lookupname?key=United%20States.%20President%27s%20Commission%20for%20the%20Study%20of%20Ethical%20Problems%20in%20Medicine%20and%20Biomedical%20and%20Behavioral%20Research.</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Bernat J. L. The brain-as-a-whole criterion and the uniform determination of death act. AJOB Neurosci. 2023; 14 (3): 271–274. DOI: 10.1080/21507740.2023.2243889. PMID: 37682673.</mixed-citation><mixed-citation xml:lang="en">Bernat J. L. The brain-as-a-whole criterion and the uniform determination of death act. AJOB Neurosci. 2023; 14 (3): 271–274. DOI: 10.1080/21507740.2023.2243889. PMID: 37682673.</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Mohandas A., Chou S. N. Brain death. A clinical and pathological study. J Neurosurg. 1971; 35 (2): 211–218. DOI: 10.3171/jns.1971.35.2.0211. PMID: 5570782.</mixed-citation><mixed-citation xml:lang="en">Mohandas A., Chou S. N. Brain death. A clinical and pathological study. J Neurosurg. 1971; 35 (2): 211–218. DOI: 10.3171/jns.1971.35.2.0211. PMID: 5570782.</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">Pallis C. Brain stem death--the evolution of a concept. Med Leg J. 1987; 55 (2): 84–107. Semin Thorac Cardiovasc Surg. 990; 2 (2): 135–152. PMID: 2081224.</mixed-citation><mixed-citation xml:lang="en">Pallis C. Brain stem death--the evolution of a concept. Med Leg J. 1987; 55 (2): 84–107. Semin Thorac Cardiovasc Surg. 990; 2 (2): 135–152. PMID: 2081224.</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">Machado C. Brain Death: a reappraisal. Machado C, editor. New York: Springer Science+Bussiness Media, LLC; 2007.</mixed-citation><mixed-citation xml:lang="en">Machado C. Brain Death: a reappraisal. Machado C, editor. New York: Springer Science+Bussiness Media, LLC; 2007.</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Machado C. Reader response: infratentorial brain injury among patients suspected of death by neurologic criteria : a systematic review and meta-analysis. Neurology. 2023; 100 (10): 494–495. DOI: 10.1212/WNL.0000000000207091. PMID: 36878721.</mixed-citation><mixed-citation xml:lang="en">Machado C. Reader response: infratentorial brain injury among patients suspected of death by neurologic criteria : a systematic review and meta-analysis. Neurology. 2023; 100 (10): 494–495. DOI: 10.1212/WNL.0000000000207091. PMID: 36878721.</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Varelas P. N. Must hypothalamic neurosecretory function cease for brain death determination? No: the UDDA Revision Series. Neurology. 2023: 101 (3): 137–139. DOI: 10.1212/WNL.0000000000207336. PMID: 37429713.</mixed-citation><mixed-citation xml:lang="en">Varelas P. N. Must hypothalamic neurosecretory function cease for brain death determination? No: the UDDA Revision Series. Neurology. 2023: 101 (3): 137–139. DOI: 10.1212/WNL.0000000000207336. PMID: 37429713.</mixed-citation></citation-alternatives></ref><ref id="cit16"><label>16</label><citation-alternatives><mixed-citation xml:lang="ru">Nair-Collins M. Must hypothalamic neurosecretory function cease for brain death determination? Yes: The UDDA Revision Series. Neurology. 2023; 101 (3): 134–136. DOI: 10.1212/WNL.0000000000207340. PMID: 37429714.</mixed-citation><mixed-citation xml:lang="en">Nair-Collins M. Must hypothalamic neurosecretory function cease for brain death determination? Yes: The UDDA Revision Series. Neurology. 2023; 101 (3): 134–136. DOI: 10.1212/WNL.0000000000207340. PMID: 37429714.</mixed-citation></citation-alternatives></ref><ref id="cit17"><label>17</label><citation-alternatives><mixed-citation xml:lang="ru">Nair-Collins M., Joffe A. R. Frequent preservation of neurologic function in brain death and brainstem death entails false-positive misdiagnosis and cerebral perfusion. AJOB Neurosci. 2023; 14 (3): 255–268. DOI: 10.1080/21507740.2021.1973148. PMID: 34586014.</mixed-citation><mixed-citation xml:lang="en">Nair-Collins M., Joffe A. R. Frequent preservation of neurologic function in brain death and brainstem death entails false-positive misdiagnosis and cerebral perfusion. AJOB Neurosci. 2023; 14 (3): 255–268. DOI: 10.1080/21507740.2021.1973148. PMID: 34586014.</mixed-citation></citation-alternatives></ref><ref id="cit18"><label>18</label><citation-alternatives><mixed-citation xml:lang="ru">Omelianchuk A., Bernat J., Caplan A., Greer D., Lazaridis C., Lewis A., Pope T., et al. Revise the uniform determination of death act to align the law with practice through neurorespiratory criteria. Neurology. 2022; 98 (13): 532–536. DOI: 10.1212/WNL.0000000000200024. PMID: 35078943.</mixed-citation><mixed-citation xml:lang="en">Omelianchuk A., Bernat J., Caplan A., Greer D., Lazaridis C., Lewis A., Pope T., et al. Revise the uniform determination of death act to align the law with practice through neurorespiratory criteria. Neurology. 2022; 98 (13): 532–536. DOI: 10.1212/WNL.0000000000200024. PMID: 35078943.</mixed-citation></citation-alternatives></ref><ref id="cit19"><label>19</label><citation-alternatives><mixed-citation xml:lang="ru">Nair-Collins M., Joffe A. R. Hypothalamic function in patients diagnosed as brain dead and its practical consequences. Handb Clin Neurol. 2021; 182: 433–446. DOI: 10.1016/B978-0-12-819973-2.00029-0. PMID: 34266610.</mixed-citation><mixed-citation xml:lang="en">Nair-Collins M., Joffe A. R. Hypothalamic function in patients diagnosed as brain dead and its practical consequences. Handb Clin Neurol. 2021; 182: 433–446. DOI: 10.1016/B978-0-12-819973-2.00029-0. PMID: 34266610.</mixed-citation></citation-alternatives></ref><ref id="cit20"><label>20</label><citation-alternatives><mixed-citation xml:lang="ru">Dodaro M. G., Seidenari A., Marino I. R., Berghella V., Bellussi F. Brain death in pregnancy: a systematic review focusing on perinatal outcomes. Am J Obstet Gynecol. 2021; 224 (5): 445–469. DOI: 10.1016/j.ajog.2021.01.033. PMID: 33600780.</mixed-citation><mixed-citation xml:lang="en">Dodaro M. G., Seidenari A., Marino I. R., Berghella V., Bellussi F. Brain death in pregnancy: a systematic review focusing on perinatal outcomes. Am J Obstet Gynecol. 2021; 224 (5): 445–469. DOI: 10.1016/j.ajog.2021.01.033. PMID: 33600780.</mixed-citation></citation-alternatives></ref><ref id="cit21"><label>21</label><citation-alternatives><mixed-citation xml:lang="ru">Motofei I. G., Rowland D. L. The ventral-hypothalamic input route: a common neural network for abstract cognition and sexuality. BJU Int. 2014; 113 (2): 296–303. DOI: 10.1111/bju.12399. PMID: 24053436.</mixed-citation><mixed-citation xml:lang="en">Motofei I. G., Rowland D. L. The ventral-hypothalamic input route: a common neural network for abstract cognition and sexuality. BJU Int. 2014; 113 (2): 296–303. DOI: 10.1111/bju.12399. PMID: 24053436.</mixed-citation></citation-alternatives></ref><ref id="cit22"><label>22</label><citation-alternatives><mixed-citation xml:lang="ru">Rampertaap M. P. Neuroleptic malignant syndrome. South Med J. 1986; 79 (3): 331–336. DOI: 10.1097/00007611-198603000-00018. PMID: 3513330.</mixed-citation><mixed-citation xml:lang="en">Rampertaap M. P. Neuroleptic malignant syndrome. South Med J. 1986; 79 (3): 331–336. DOI: 10.1097/00007611-198603000-00018. PMID: 3513330.</mixed-citation></citation-alternatives></ref><ref id="cit23"><label>23</label><citation-alternatives><mixed-citation xml:lang="ru">Machado C., Estevez M., Perez-Nellar J., Schiavi A. Residual vasomotor activity assessed by heart rate variability in a brain-dead case. BMJ Case Rep. 2015; 2015: bcr2014205677. DOI: 10.1136/bcr-2014-205677. PMID: 25833905.</mixed-citation><mixed-citation xml:lang="en">Machado C., Estevez M., Perez-Nellar J., Schiavi A. Residual vasomotor activity assessed by heart rate variability in a brain-dead case. BMJ Case Rep. 2015; 2015: bcr2014205677. DOI: 10.1136/bcr-2014-205677. PMID: 25833905.</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
