{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:17:49Z","timestamp":1787066269597,"version":"build-2736575974"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T00:00:00Z","timestamp":1755907200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T00:00:00Z","timestamp":1755907200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Key Project of Tianjin Municipal Health Commission","award":["TJWJ2022ZD010"],"award-info":[{"award-number":["TJWJ2022ZD010"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Microbiol"],"DOI":"10.1186\/s12866-025-04276-x","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T02:17:58Z","timestamp":1755915478000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Molecular epidemiology and genomic features of Bordetella pertussis in Tianjin, China, 2023"],"prefix":"10.1186","volume":"25","author":[{"given":"Xiaohui","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aiping","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangwen","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baolu","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9289-685X","authenticated-orcid":false,"given":"Xiaoyan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,23]]},"reference":[{"issue":"4","key":"4276_CR1","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1097\/inf.0000000000002160","volume":"38","author":"P Fu","year":"2019","unstructured":"Fu P, Wang C, Tian H, Kang Z, Zeng M. Bordetella pertussis infection in infants and young children in Shanghai, China, 2016\u20132017: clinical features, genotype variations of antigenic genes and macrolides resistance. Pediatr Infect Dis J. 2019;38(4):370\u20136. https:\/\/doi.org\/10.1097\/inf.0000000000002160.","journal-title":"Pediatr Infect Dis J"},{"issue":"3","key":"4276_CR2","doi-asserted-by":"publisher","first-page":"e053316","DOI":"10.1136\/bmjopen-2021-053316","volume":"12","author":"J Yu","year":"2022","unstructured":"Yu J, He H, Zhang Y, Gao Y, Chen C, Xu J, et al. Burden of whooping cough in China (PertussisChina): study protocol of a prospective, population-based case\u2013control study. BMJ Open. 2022;12(3):e053316. https:\/\/doi.org\/10.1136\/bmjopen-2021-053316.","journal-title":"BMJ Open"},{"issue":"1","key":"4276_CR3","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2024.2389086","volume":"13","author":"H Yahong","year":"2024","unstructured":"Yahong H, Mengyang G, Meng Q, Yu D, Kaihu Y. Rising pertussis cases and deaths in China: current trends and clinical solutions. Emerg Microbes Infect. 2024;13(1): 2389086. https:\/\/doi.org\/10.1080\/22221751.2024.2389086.","journal-title":"Emerg Microbes Infect"},{"issue":"1","key":"4276_CR4","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2025.2466691","volume":"14","author":"Z Mei","year":"2025","unstructured":"Mei Z, Denis M. As pertussis returns to pre-COVID19 endemicity, vaccination remains our best ally against an evolving Bordetella pertussis. Emerg Microbes Infect. 2025;14(1): 2466691. https:\/\/doi.org\/10.1080\/22221751.2025.2466691.","journal-title":"Emerg Microbes Infect"},{"key":"4276_CR5","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines12121346","author":"LF Bricks","year":"2024","unstructured":"Bricks LF, Vargas-Zambrano JC, Macina D. Epidemiology of pertussis after the COVID-19 pandemic: analysis of the factors involved in the resurgence of the disease in high-, middle-, and low-income countries. Vaccines. 2024. https:\/\/doi.org\/10.3390\/vaccines12121346.","journal-title":"Vaccines"},{"issue":"20","key":"4276_CR6","doi-asserted-by":"publisher","first-page":"437","DOI":"10.46234\/ccdcw2024.085","volume":"6","author":"G Zhou","year":"2024","unstructured":"Zhou G, Li Y, Wang H, Wang Y, Gao Y, Xu J, et al. Emergence of Erythromycin-resistant and Pertactin- and Filamentous hemagglutinin-deficient Bordetella pertussis strains - Beijing, China, 2022\u20132023. China CDC Wkly. 2024;6(20):437\u201341. https:\/\/doi.org\/10.46234\/ccdcw2024.085.","journal-title":"China CDC Wkly"},{"issue":"1","key":"4276_CR7","doi-asserted-by":"publisher","first-page":"9373","DOI":"10.1038\/s41598-021-88852-x","volume":"11","author":"Q Chen","year":"2021","unstructured":"Chen Q, Gray MC, Hewlett E, Stibitz S. Four single-basepair mutations in the Ptx promoter of Bordetella bronchiseptica are sufficient to activate the expression of pertussis toxin. Sci Rep. 2021;11(1):9373. https:\/\/doi.org\/10.1038\/s41598-021-88852-x.","journal-title":"Sci Rep"},{"issue":"8","key":"4276_CR8","doi-asserted-by":"publisher","first-page":"1206","DOI":"10.3201\/eid1508.081511","volume":"15","author":"FR Mooi","year":"2009","unstructured":"Mooi FR, van Loo IH, van Gent M, He Q, Bart MJ, Heuvelman KJ, et al. Bordetella pertussis strains with increased toxin production associated with pertussis resurgence. Emerg Infect Dis. 2009;15(8):1206\u201313. https:\/\/doi.org\/10.3201\/eid1508.081511.","journal-title":"Emerg Infect Dis"},{"key":"4276_CR9","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.ijid.2017.07.015","volume":"62","author":"T Moriuchi","year":"2017","unstructured":"Moriuchi T, Vichit O, Vutthikol Y, Hossain MS, Samnang C, Toda K, et al. Molecular epidemiology of Bordetella pertussis in Cambodia determined by direct genotyping of clinical specimens. Int J Infect Dis. 2017;62:56\u20138. https:\/\/doi.org\/10.1016\/j.ijid.2017.07.015.","journal-title":"Int J Infect Dis"},{"issue":"1","key":"4276_CR10","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3201\/eid3001.221588","volume":"30","author":"P Fu","year":"2023","unstructured":"Fu P, Zhou J, Yang C, Nijiati Y, Zhou L, Yan G, et al. Molecular evolution and increasing macrolide resistance of Bordetella pertussis, Shanghai, China, 2016\u20132022. Emerg Infect Dis. 2023;30(1):29\u201338. https:\/\/doi.org\/10.3201\/eid3001.221588.","journal-title":"Emerg Infect Dis"},{"issue":"2","key":"4276_CR11","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2023.2239945","volume":"12","author":"M Payne","year":"2023","unstructured":"Payne M, Xu Z, Hu D, Kaur S, Octavia S, Sintchenko V, et al. Genomic epidemiology and multilevel genome typing of Bordetella pertussis. Emerg Microbes Infect. 2023;12(2): 2239945. https:\/\/doi.org\/10.1080\/22221751.2023.2239945.","journal-title":"Emerg Microbes Infect"},{"issue":"12","key":"4276_CR12","doi-asserted-by":"publisher","first-page":"2205","DOI":"10.3201\/eid2512.181836","volume":"25","author":"L Li","year":"2019","unstructured":"Li L, Deng J, Ma X, Zhou K, Meng Q, Yuan L, et al. High prevalence of macrolide-resistant Bordetella pertussis and ptxP1 genotype, Mainland China, 2014\u20132016. Emerg Infect Dis. 2019;25(12):2205\u201314. https:\/\/doi.org\/10.3201\/eid2512.181836.","journal-title":"Emerg Infect Dis"},{"issue":"1","key":"4276_CR13","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1080\/22221751.2019.1587315","volume":"8","author":"Z Xu","year":"2019","unstructured":"Xu Z, Wang Z, Luan Y, Li Y, Liu X, Peng X, et al. Genomic epidemiology of erythromycin-resistant Bordetella pertussis in China. Emerg Microbes Infect. 2019;8(1):461\u201370. https:\/\/doi.org\/10.1080\/22221751.2019.1587315.","journal-title":"Emerg Microbes Infect"},{"issue":"1","key":"4276_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2023.106835","volume":"62","author":"J Cai","year":"2023","unstructured":"Cai J, Chen M, Liu Q, Luo J, Yuan L, Chen Y, et al. Domination of an emerging erythromycin-resistant ptxP3 Bordetella pertussis clone in Shanghai, China. Int J Antimicrob Agents. 2023;62(1): 106835. https:\/\/doi.org\/10.1016\/j.ijantimicag.2023.106835.","journal-title":"Int J Antimicrob Agents"},{"key":"4276_CR15","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.ijid.2023.01.005","volume":"128","author":"P Fu","year":"2023","unstructured":"Fu P, Zhou J, Meng J, Liu Z, Nijiati Y, He L, et al. Emergence and spread of MT28 ptxP3 allele macrolide-resistant Bordetella pertussis from 2021 to 2022 in China. Int J Infect Dis. 2023;128:205\u201311. https:\/\/doi.org\/10.1016\/j.ijid.2023.01.005.","journal-title":"Int J Infect Dis"},{"issue":"1","key":"4276_CR16","doi-asserted-by":"publisher","first-page":"102610","DOI":"10.1016\/j.jiph.2024.102610","volume":"18","author":"S Tian","year":"2024","unstructured":"Tian S, Chen Y, Su Q, Sun B, Lin Z, Long Y, et al. Pertussis clinical profile shift, severity, prediction in a tertiary hospital: A comparative study before, during, and after COVID-19 in Southern China. J Infect Public Health. 2024;18(1):102610. https:\/\/doi.org\/10.1016\/j.jiph.2024.102610.","journal-title":"J Infect Public Health"},{"issue":"11","key":"4276_CR17","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.1016\/j.cmi.2024.08.016","volume":"30","author":"P Fu","year":"2024","unstructured":"Fu P, Yan G, Li Y, Xie L, Ke Y, Qiu S, et al. Pertussis upsurge, age shift and vaccine escape post-COVID-19 caused by ptxP3 macrolide-resistant Bordetella pertussis MT28 clone in China. Clin Microbiol Infect. 2024;30(11):1439\u201346. https:\/\/doi.org\/10.1016\/j.cmi.2024.08.016.","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"4276_CR18","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2025.2475841","volume":"14","author":"Y Hu","year":"2025","unstructured":"Hu Y, Zhou L, Du Q, Shi W, Meng Q, Yuan L, et al. Sharp rise in high-virulence Bordetella pertussis with macrolides resistance in Northern China. Emerg Microbes Infect. 2025;14(1): 2475841. https:\/\/doi.org\/10.1080\/22221751.2025.2475841.","journal-title":"Emerg Microbes Infect"},{"issue":"1","key":"4276_CR19","doi-asserted-by":"publisher","first-page":"3807","DOI":"10.1038\/s41467-022-31517-8","volume":"13","author":"S Bridel","year":"2022","unstructured":"Bridel S, Bouchez V, Brancotte B, Hauck S, Armatys N, Landier A, et al. A comprehensive resource for Bordetella genomic epidemiology and biodiversity studies. Nat Commun. 2022;13(1):3807. https:\/\/doi.org\/10.1038\/s41467-022-31517-8.","journal-title":"Nat Commun"},{"key":"4276_CR20","doi-asserted-by":"publisher","first-page":"baac094","DOI":"10.1093\/database\/baac094","volume":"2022","author":"S Kaur","year":"2022","unstructured":"Kaur S, Payne M, Luo L, Octavia S, Tanaka MM, Sintchenko V, et al. MGTdb: a web service and database for studying the global and local genomic epidemiology of bacterial pathogens. Database. 2022;2022:2022:baac094. https:\/\/doi.org\/10.1093\/database\/baac094.","journal-title":"Database"},{"issue":"2","key":"4276_CR21","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000024090","volume":"100","author":"X Lin","year":"2021","unstructured":"Lin X, Zou J, Yao K, Li L, Zhong L. Analysis of antibiotic sensitivity and resistance genes of Bordetella pertussis in Chinese children. Medicine. 2021;100(2): e24090. https:\/\/doi.org\/10.1097\/md.0000000000024090.","journal-title":"Medicine"},{"issue":"5","key":"4276_CR22","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/j.ijantimicag.2006.11.024","volume":"29","author":"E Galanakis","year":"2007","unstructured":"Galanakis E, Englund JA, Abe P, Qin X. Antimicrobial susceptibility of Bordetella pertussis isolates in the state of Washington. Int J Antimicrob Agents. 2007;29(5):609\u201311. https:\/\/doi.org\/10.1016\/j.ijantimicag.2006.11.024.","journal-title":"Int J Antimicrob Agents"},{"key":"4276_CR23","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.ijid.2023.01.005","volume":"128","author":"P Fu","year":"2023","unstructured":"Fu P, Zhou J, Meng J, Liu Z, Nijiati Y, He L, et al. Emergence and spread of MT28\u2009<\u2009em\u2009>\u2009ptxP3\u2009allele macrolide-resistant\u2009<\u2009em\u2009>\u2009Bordetella pertussis\u2009from 2021 to 2022 in China. Int J Infect Dis. 2023;128:205\u201311. https:\/\/doi.org\/10.1016\/j.ijid.2023.01.005.","journal-title":"Int J Infect Dis"},{"key":"4276_CR24","doi-asserted-by":"publisher","first-page":"1428766","DOI":"10.3389\/fmicb.2024.1428766","volume":"15","author":"P Fu","year":"2024","unstructured":"Fu P, Li Y, Qin J, Xie L, Yang C, Wang C. Molecular epidemiology and genomic features of Bordetella parapertussis in Shanghai, China, 2017\u20132022. Front Microbiol. 2024;15:1428766. https:\/\/doi.org\/10.3389\/fmicb.2024.1428766.","journal-title":"Front Microbiol"},{"issue":"20","key":"4276_CR25","doi-asserted-by":"publisher","first-page":"1900519","DOI":"10.2807\/1560-7917.ES.2020.25.20.1900519","volume":"25","author":"M Payne","year":"2020","unstructured":"Payne M, Kaur S, Wang Q, Hennessy D, Luo L, Octavia S, et al. Multilevel genome typing: genomics-guided scalable resolution typing of microbial pathogens. Euro Surveill. 2020;25(20):1900519. https:\/\/doi.org\/10.2807\/1560-7917.ES.2020.25.20.1900519.","journal-title":"Euro Surveill"},{"key":"4276_CR26","doi-asserted-by":"publisher","first-page":"1498638","DOI":"10.3389\/fmicb.2024.1498638","volume":"15","author":"B He","year":"2024","unstructured":"He B, Jia Z, Zheng F, Zhang W, Duan S, Wang L, et al. Molecular characterization and antimicrobial susceptibility for 62 isolates of Bordetella pertussis from children. Front Microbiol. 2024;15:1498638. https:\/\/doi.org\/10.3389\/fmicb.2024.1498638.","journal-title":"Front Microbiol"},{"key":"4276_CR27","doi-asserted-by":"publisher","DOI":"10.1093\/molbev\/msad235","author":"BG Hall","year":"2023","unstructured":"Hall BG, Nisbet J. Building phylogenetic trees from genome sequences with kSNP4. Mol Biol Evol. 2023. https:\/\/doi.org\/10.1093\/molbev\/msad235.","journal-title":"Mol Biol Evol"},{"issue":"5","key":"4276_CR28","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1093\/molbev\/msaa015","volume":"37","author":"BQ Minh","year":"2020","unstructured":"Minh BQ, Schmidt HA, Chernomor O, Schrempf D, Woodhams MD, von Haeseler A, et al. IQ-TREE 2: new models and efficient methods for phylogenetic inference in the genomic era. Mol Biol Evol. 2020;37(5):1530\u20134. https:\/\/doi.org\/10.1093\/molbev\/msaa015.","journal-title":"Mol Biol Evol"},{"issue":"1","key":"4276_CR29","doi-asserted-by":"publisher","DOI":"10.1080\/22221751.2024.2447611","volume":"14","author":"Z Li","year":"2025","unstructured":"Li Z, Xiao F, Hou Y, Jia B, Zhuang J, Cao Y, et al. Genomic epidemiology and evolution of Bordetella pertussis under the vaccination pressure of acellular vaccines in Beijing, China, 2020\u20132023. Emerg Microbes Infect. 2025;14(1): 2447611. https:\/\/doi.org\/10.1080\/22221751.2024.2447611.","journal-title":"Emerg Microbes Infect"},{"issue":"6","key":"4276_CR30","doi-asserted-by":"publisher","first-page":"966","DOI":"10.3201\/eid1806.120091","volume":"18","author":"S Guillot","year":"2012","unstructured":"Guillot S, Descours G, Gillet Y, Etienne J, Floret D, Guiso N. Macrolide-resistant Bordetella pertussis infection in newborn girl, France. Emerg Infect Dis. 2012;18(6):966\u20138. https:\/\/doi.org\/10.3201\/eid1806.120091.","journal-title":"Emerg Infect Dis"},{"issue":"2","key":"4276_CR31","doi-asserted-by":"publisher","first-page":"e31985","DOI":"10.1371\/journal.pone.0031985","volume":"7","author":"N Otsuka","year":"2012","unstructured":"Otsuka N, Han HJ, Toyoizumi-Ajisaka H, Nakamura Y, Arakawa Y, Shibayama K, et al. Prevalence and genetic characterization of pertactin-deficient Bordetella pertussis in Japan. PLoS One. 2012;7(2):e31985. https:\/\/doi.org\/10.1371\/journal.pone.0031985.","journal-title":"PLoS One"},{"issue":"10","key":"4276_CR32","doi-asserted-by":"publisher","first-page":"1703","DOI":"10.1128\/cvi.00367-12","volume":"19","author":"AM Barkoff","year":"2012","unstructured":"Barkoff AM, Mertsola J, Guillot S, Guiso N, Berbers G, He Q. Appearance of Bordetella pertussis strains not expressing the vaccine antigen pertactin in Finland. Clin Vaccine Immunol. 2012;19(10):1703\u20134. https:\/\/doi.org\/10.1128\/cvi.00367-12.","journal-title":"Clin Vaccine Immunol"},{"issue":"9","key":"4276_CR33","doi-asserted-by":"publisher","first-page":"E340","DOI":"10.1111\/j.1469-0691.2012.03925.x","volume":"18","author":"N Hegerle","year":"2012","unstructured":"Hegerle N, Paris AS, Brun D, Dore G, Njamkepo E, Guillot S, et al. Evolution of French Bordetella pertussis and Bordetella parapertussis isolates: increase of bordetellae not expressing Pertactin. Clin Microbiol Infect. 2012;18(9):E340\u20136. https:\/\/doi.org\/10.1111\/j.1469-0691.2012.03925.x.","journal-title":"Clin Microbiol Infect"},{"key":"4276_CR34","unstructured":"Recommended antimicrobial agents for the treatment and postexposure prophylaxis of pertussis. 2005 CDC guidelines MMWR Recomm Rep [updated Date last reviewed: 11\/30\/2005. Available from: https:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/rr5414a1.htm"},{"issue":"3","key":"4276_CR35","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.ijantimicag.2018.12.004","volume":"53","author":"L Ostrer","year":"2019","unstructured":"Ostrer L, Khodursky RF, Johnson JR, Hiasa H, Khodursky A. Analysis of mutational patterns in quinolone resistance-determining regions of GyrA and parc of clinical isolates. Int J Antimicrob Agents. 2019;53(3):318\u201324. https:\/\/doi.org\/10.1016\/j.ijantimicag.2018.12.004.","journal-title":"Int J Antimicrob Agents"},{"key":"4276_CR36","doi-asserted-by":"publisher","unstructured":"Gaurav A, Bakht P, Saini M, Pandey S, Pathania R. Role of bacterial efflux pumps in antibiotic resistance, virulence, and strategies to discover novel efflux pump inhibitors. Microbiol (Reading). 2023;169(5). https:\/\/doi.org\/10.1099\/mic.0.001333.","DOI":"10.1099\/mic.0.001333"}],"container-title":["BMC Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-025-04276-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12866-025-04276-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-025-04276-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T02:18:01Z","timestamp":1755915481000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmicrobiol.biomedcentral.com\/articles\/10.1186\/s12866-025-04276-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,23]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4276"],"URL":"https:\/\/doi.org\/10.1186\/s12866-025-04276-x","relation":{},"ISSN":["1471-2180"],"issn-type":[{"value":"1471-2180","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,23]]},"assertion":[{"value":"28 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 August 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":"Pursuant to the \u201cRegulations on Ethical Review of Life Sciences and Medical Research Involving Human Beings\u201d (National Health Commission and Education Department [2023] No. 4, Web link:\n                      \n                      ), this study is applicable to Article 32, which stipulates that \u201clife sciences and medical research involving human beings that use human information data or biological samples under the following circumstances, which do not cause harm to the human body, do not involve sensitive personal information, or commercial interests, may be exempt from ethical review.\u201d Consequently, ethical review is exempted for this study and participant consent is not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial number"}}],"article-number":"534"}}