{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T23:17:32Z","timestamp":1782947852356,"version":"3.54.5"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":55,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"the Medical and Health Science and Technology Project of Zhejiang Province","award":["2025KY461"],"award-info":[{"award-number":["2025KY461"]}]},{"name":"the Medical and Health Science and Technology Project of Zhejiang Province","award":["2025HY1462"],"award-info":[{"award-number":["2025HY1462"]}]},{"name":"the Natural Science Foundation of Zhejiang Province","award":["LTGY23H190003"],"award-info":[{"award-number":["LTGY23H190003"]}]},{"name":"the Foundation of Taizhou Science and Technology Bureau","award":["23ywa22"],"award-info":[{"award-number":["23ywa22"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Microbiol"],"DOI":"10.1186\/s12866-026-05080-x","type":"journal-article","created":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T13:53:41Z","timestamp":1778248421000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comprehensive genomic analysis of carbapenem-resistant Citrobacter freundii and characterization of a co-carrying blaKPC\u22122 and blaNDM\u22121 isolate in Zhejiang Province\uff0c China"],"prefix":"10.1186","volume":"26","author":[{"given":"Xinhua","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yali","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianbo","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Lan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huimin","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darong","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"5080_CR1","doi-asserted-by":"publisher","first-page":"1163","DOI":"10.2147\/IDR.S248147","volume":"13","author":"S Xie","year":"2020","unstructured":"Xie S, Fu S, Li M, Guo Z, Zhu X, Ren J, Hu F. Microbiological characteristics of carbapenem-resistant enterobacteriaceae clinical isolates collected from county hospitals. Infect Drug Resist. 2020;13:1163\u20139.","journal-title":"Infect Drug Resist"},{"issue":"1","key":"5080_CR2","doi-asserted-by":"publisher","first-page":"16333","DOI":"10.1038\/s41598-024-64992-8","volume":"14","author":"B Tuhamize","year":"2024","unstructured":"Tuhamize B, Bazira J. Carbapenem-resistant enterobacteriaceae in the livestock, humans and environmental samples around the globe: a systematic review and meta-analysis. Sci Rep. 2024;14(1):16333.","journal-title":"Sci Rep"},{"key":"5080_CR3","doi-asserted-by":"publisher","first-page":"1276982","DOI":"10.3389\/frabi.2023.1276982","volume":"2","author":"I Jabeen","year":"2023","unstructured":"Jabeen I, Islam S, Hassan A, Tasnim Z, Shuvo SR. A brief insight into citrobacter species - a growing threat to public health. Front Antibiot. 2023;2:1276982.","journal-title":"Front Antibiot"},{"issue":"9","key":"5080_CR4","doi-asserted-by":"publisher","first-page":"e55","DOI":"10.1016\/j.ajic.2011.02.009","volume":"39","author":"S Chen","year":"2011","unstructured":"Chen S, Hu F, Liu Y, Zhu D, Wang H, Zhang Y. Detection and spread of carbapenem-resistant Citrobacter freundii in a teaching hospital in China. Am J Infect Control. 2011;39(9):e55\u201360.","journal-title":"Am J Infect Control"},{"key":"5080_CR5","doi-asserted-by":"publisher","first-page":"120460","DOI":"10.1016\/j.cca.2025.120460","volume":"577","author":"H Xie","year":"2025","unstructured":"Xie H, Li J, Liu C, Zheng J, Gao S, Shen H, Cao X. Genomic and clinical characterization of carbapenem-resistant Citrobacter freundii isolates in a tertiary hospital (2013\u20132021). Clin Chim Acta. 2025;577:120460.","journal-title":"Clin Chim Acta"},{"key":"5080_CR6","doi-asserted-by":"crossref","unstructured":"Moran RA, Behruznia M, Holden E, Garvey MI, McNally A. pQEB1: a hospital outbreak plasmid lineage carrying bla (KPC-2). Microb Genom. 2024;10(9):001291.","DOI":"10.1099\/mgen.0.001291"},{"issue":"9","key":"5080_CR7","doi-asserted-by":"publisher","first-page":"e714","DOI":"10.1016\/j.ijid.2013.02.007","volume":"17","author":"P Gaibani","year":"2013","unstructured":"Gaibani P, Ambretti S, Farruggia P, Bua G, Berlingeri A, Tamburini MV, Cordovana M, Guerra L, Mazzetti M, Roncarati G, et al. Outbreak of Citrobacter freundii carrying VIM-1 in an Italian Hospital, identified during the carbapenemases screening actions, June 2012. Int J Infect Dis. 2013;17(9):e714\u2013717.","journal-title":"Int J Infect Dis"},{"issue":"11","key":"5080_CR8","doi-asserted-by":"publisher","first-page":"3117","DOI":"10.1093\/jac\/dkw289","volume":"71","author":"AM Hammerum","year":"2016","unstructured":"Hammerum AM, Hansen F, Nielsen HL, Jakobsen L, Stegger M, Andersen PS, Jensen P, Nielsen TK, Hansen LH, Hasman H, et al. Use of WGS data for investigation of a long-term NDM-1-producing Citrobacter freundii outbreak and secondary in vivo spread of blaNDM-1 to Escherichia coli, Klebsiella pneumoniae and Klebsiella oxytoca. J Antimicrob Chemother. 2016;71(11):3117\u201324.","journal-title":"J Antimicrob Chemother"},{"issue":"8","key":"5080_CR9","doi-asserted-by":"publisher","first-page":"e0001922","DOI":"10.1128\/aem.00019-22","volume":"88","author":"Y Ota","year":"2022","unstructured":"Ota Y, Prah I, Nukui Y, Koike R, Saito R. bla(KPC-2)-Encoding IncP-6 Plasmids in Citrobacter freundii and Klebsiella variicola Strains from Hospital Sewage in Japan. Appl Environ Microbiol. 2022;88(8):e0001922.","journal-title":"Appl Environ Microbiol"},{"key":"5080_CR10","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.jgar.2025.10.021","volume":"45","author":"I Manr\u00edquez-Cuadra","year":"2025","unstructured":"Manr\u00edquez-Cuadra I, Matus-K\u00f6hler M, Aguayo-Reyes A, Quezada-Aguiluz M, Morales-Leon F, Gonz\u00e1lez-Rocha G, Opazo-Capurro A. Genomic characterization of a carbapenem-resistant Citrobacter freundii complex strain co-carrying bla(NDM-1), bla(CTX-M-30), armA, rmtC, and rmtD from Chile. J Glob Antimicrob Resist. 2025;45:290\u20133.","journal-title":"J Glob Antimicrob Resist"},{"key":"5080_CR11","doi-asserted-by":"publisher","first-page":"1388651","DOI":"10.3389\/fmicb.2024.1388651","volume":"15","author":"N Liu","year":"2024","unstructured":"Liu N, Tang B, Wang H, Chen X, Wen P, Wang Z, Chen X, Guo X, Gou J, Song Y. Coexistence of a novel NDM-1-encoding MDR plasmid and an IMP-4-encoding IncN-IncU hybrid plasmid in a clinical isolate of Citrobacter freundii BC73. Front Microbiol. 2024;15:1388651.","journal-title":"Front Microbiol"},{"issue":"1","key":"5080_CR12","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1089\/mdr.2020.0417","volume":"28","author":"R Dziri","year":"2022","unstructured":"Dziri R, Ku\u015fkucu MA, Arfaoui A, Fethi M, Ifaoui S, Bellaaj R, Ouzari I, Salto\u011flu N, Klibi N. Whole genome sequencing of a citrobacter freundii strain isolated from the hospital environment: an extremely multiresistant NDM-1 and VIM-48 coproducing isolate. Microb Drug Resist. 2022;28(1):18\u201322.","journal-title":"Microb Drug Resist"},{"key":"5080_CR13","doi-asserted-by":"crossref","unstructured":"Jolivet S, Couturier J, Le Neindre K, Ehmig M, Dortet L, Emeraud C, Barbut F. Persistence of OXA-48-producing ST-22 Citrobacter freundii in patients and the hospital environment, Paris, France, 2016 to 2022. Euro Surveill. 2024;29(49):2400262.","DOI":"10.2807\/1560-7917.ES.2024.29.49.2400262"},{"key":"5080_CR14","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1016\/j.jgar.2022.04.014","volume":"29","author":"Y Li","year":"2022","unstructured":"Li Y, Fang C, Qiu Y, Dai X, Zhang L. Genomic characterization of a carbapenem-resistant Citrobacter freundii cocarrying bla(KPC-2) and bla(NDM-1). J Glob Antimicrob Resist. 2022;29:289\u201392.","journal-title":"J Glob Antimicrob Resist"},{"key":"5080_CR15","doi-asserted-by":"publisher","first-page":"5855","DOI":"10.2147\/IDR.S426148","volume":"16","author":"J Huang","year":"2023","unstructured":"Huang J, Zhao J, Yi M, Yuan Y, Xia P, Yang B, Liao J, Dang Z, Xia Y. Emergence of tigecycline and carbapenem-resistant Citrobacter freundii co-carrying tmexCD1-toprJ1, bla(KPC-2), and bla(NDM-1) from a sepsis patient. Infect Drug Resist. 2023;16:5855\u201368.","journal-title":"Infect Drug Resist"},{"issue":"2","key":"5080_CR16","doi-asserted-by":"publisher","first-page":"e0195324","DOI":"10.1128\/spectrum.01953-24","volume":"13","author":"J Zhou","year":"2025","unstructured":"Zhou J, Zhen M, Gao K, Xu L, Zhang D, Yang J. Emergence and clonal dissemination of KPC-2- and NDM-1-coharboring Citrobacter freundii in China with an IncR plasmid. Microbiol Spectr. 2025;13(2):e0195324.","journal-title":"Microbiol Spectr"},{"issue":"10","key":"5080_CR17","doi-asserted-by":"publisher","first-page":"e0090525","DOI":"10.1128\/spectrum.00905-25","volume":"13","author":"Y Li","year":"2025","unstructured":"Li Y, Han X, Shi X, Mao C, Yu T, Zhu Y, Wu S, Huang Y, Yu Y, Fu Y. High transconjugation efficiency of fusion plasmid pNDM_KPC in carbapenem-resistant Citrobacter freundii and its formation driven by IS26-mediated integration. Microbiol Spectr. 2025;13(10):e0090525.","journal-title":"Microbiol Spectr"},{"key":"5080_CR18","doi-asserted-by":"publisher","first-page":"1074612","DOI":"10.3389\/fmicb.2023.1074612","volume":"14","author":"J Qiao","year":"2023","unstructured":"Qiao J, Chen Y, Ge H, Xu H, Guo X, Liu R, Li C, Chen R, Gou J, Chen M, et al. Coexistence of bla(IMP-4), bla(NDM-1) and bla(OXA-1) in bla(KPC-2)-producing Citrobacter freundii of clinical origin in China. Front Microbiol. 2023;14:1074612.","journal-title":"Front Microbiol"},{"issue":"1","key":"5080_CR19","doi-asserted-by":"publisher","first-page":"5114","DOI":"10.1038\/s41467-018-07641-9","volume":"9","author":"C Jain","year":"2018","unstructured":"Jain C, Rodriguez RL, Phillippy AM, Konstantinidis KT, Aluru S. High throughput ANI analysis of 90K prokaryotic genomes reveals clear species boundaries. Nat Commun. 2018;9(1):5114.","journal-title":"Nat Commun"},{"key":"5080_CR20","unstructured":"Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. 34th ed. CLSI supplement M100. Wayne, PA : Clinical and Laboratory Standards Institute; 2024."},{"issue":"D1","key":"5080_CR21","doi-asserted-by":"publisher","first-page":"D690","DOI":"10.1093\/nar\/gkac920","volume":"51","author":"BP Alcock","year":"2023","unstructured":"Alcock BP, Huynh W, Chalil R, Smith KW, Raphenya AR, Wlodarski MA, Edalatmand A, Petkau A, Syed SA, Tsang KK, et al. CARD 2023: expanded curation, support for machine learning, and resistome prediction at the comprehensive antibiotic resistance database. Nucleic Acids Res. 2023;51(D1):D690\u20139.","journal-title":"Nucleic Acids Res"},{"key":"5080_CR22","doi-asserted-by":"crossref","unstructured":"Florensa AF, Kaas RS, Clausen P, Aytan-Aktug D, Aarestrup FM. ResFinder - an open online resource for identification of antimicrobial resistance genes in next-generation sequencing data and prediction of phenotypes from genotypes. Microb Genom. 2022;8(1):000748.","DOI":"10.1099\/mgen.0.000748"},{"issue":"Database issue","key":"5080_CR23","doi-asserted-by":"publisher","first-page":"D32","DOI":"10.1093\/nar\/gkj014","volume":"34","author":"P Siguier","year":"2006","unstructured":"Siguier P, Perochon J, Lestrade L, Mahillon J, Chandler M. ISfinder: the reference centre for bacterial insertion sequences. Nucleic Acids Res. 2006;34(Database issue):D32\u201336.","journal-title":"Nucleic Acids Res"},{"issue":"4","key":"5080_CR24","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1002\/mlf2.12046","volume":"1","author":"P Wang","year":"2022","unstructured":"Wang P, Jiang X, Mu K, Jing Y, Yin Z, Cui Y, Li C, Luo X, Chen F, Yu T, et al. DANMEL: a manually curated reference database for analyzing mobile genetic elements associated with bacterial drug resistance. mLife. 2022;1(4):460\u20134.","journal-title":"mLife"},{"key":"5080_CR25","doi-asserted-by":"crossref","unstructured":"Tamma PD, Heil EL, Justo JA, Mathers AJ, Satlin MJ, Bonomo RA. Infectious diseases society of america 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections. Clin Infect Dis. 2024:ciae403.","DOI":"10.1093\/cid\/ciae403"},{"key":"5080_CR26","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.jgar.2025.03.003","volume":"42","author":"Q Zhao","year":"2025","unstructured":"Zhao Q, Guo L, Ye K, Wang L, Yang J, Ye L. Epidemiology, phylogeny and genetic characterization of carbapenem-resistant Citrobacter spp. from 5 hospitals in China. J Glob Antimicrob Resist. 2025;42:207\u201313.","journal-title":"J Glob Antimicrob Resist"},{"issue":"2","key":"5080_CR27","first-page":"136","volume":"24","author":"P Sabbagh","year":"2021","unstructured":"Sabbagh P, Rajabnia M, Maali A, Ferdosi-Shahandashti E. Integron and its role in antimicrobial resistance: a literature review on some bacterial pathogens. Iran J Basic Med Sci. 2021;24(2):136\u201342.","journal-title":"Iran J Basic Med Sci"},{"key":"5080_CR28","doi-asserted-by":"publisher","first-page":"979558","DOI":"10.3389\/fmicb.2022.979558","volume":"13","author":"X Guo","year":"2022","unstructured":"Guo X, Chen R, Wang Q, Li C, Ge H, Qiao J, Li Y. Global prevalence, characteristics, and future prospects of IncX3 plasmids: a review. Front Microbiol. 2022;13:979558.","journal-title":"Front Microbiol"},{"key":"5080_CR29","doi-asserted-by":"crossref","unstructured":"Partridge SR, Kwong SM, Firth N, Jensen SO. Mobile genetic elements associated with antimicrobial resistance. Clin Microbiol Rev. 2018;31(4):e00088-17.","DOI":"10.1128\/CMR.00088-17"},{"key":"5080_CR30","doi-asserted-by":"publisher","first-page":"3827","DOI":"10.2147\/IDR.S330362","volume":"14","author":"M Sun","year":"2021","unstructured":"Sun M, Xiao W, Xu Q. IncN1 ST7 epidemic plasmid carrying blaIMP-4 in one ST85-type klebsiella oxytoca clinical isolate with porin deficiency. Infect Drug Resist. 2021;14:3827\u201335.","journal-title":"Infect Drug Resist"},{"key":"5080_CR31","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.2217\/fmb-2017-0067","volume":"12","author":"Y Zhao","year":"2017","unstructured":"Zhao Y, Wang L, Zhang Z, Feng J, Kang H, Fang L, Jiang X, Zhang D, Zhan Z, Zhou D, et al. Structural genomics of pNDM-BTR harboring In191 and Tn6360, and other bla (NDM)-carrying IncN1 plasmids. Future Microbiol. 2017;12:1271\u201381.","journal-title":"Future Microbiol"},{"issue":"10","key":"5080_CR32","doi-asserted-by":"publisher","first-page":"4497","DOI":"10.1128\/AAC.00665-10","volume":"54","author":"V Miriagou","year":"2010","unstructured":"Miriagou V, Papagiannitsis CC, Kotsakis SD, Loli A, Tzelepi E, Legakis NJ, Tzouvelekis LS. Sequence of pNL194, a 79.3-kilobase IncN plasmid carrying the blaVIM-1 metallo-beta-lactamase gene in Klebsiella pneumoniae. Antimicrob Agents Chemother. 2010;54(10):4497\u2013502.","journal-title":"Antimicrob Agents Chemother"},{"issue":"16","key":"5080_CR33","doi-asserted-by":"publisher","first-page":"4093","DOI":"10.1128\/JB.180.16.4093-4101.1998","volume":"180","author":"JM Santini","year":"1998","unstructured":"Santini JM, Stanisich VA. Both the fipA gene of pKM101 and the pifC gene of F inhibit conjugal transfer of RP1 by an effect on traG. J Bacteriol. 1998;180(16):4093\u2013101.","journal-title":"J Bacteriol"},{"key":"5080_CR34","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1016\/j.plasmid.2018.10.001","volume":"100","author":"M Oliva","year":"2018","unstructured":"Oliva M, Monno R, Addabbo P, Pesole G, Scrascia M, Calia C, Dionisi AM, Chiara M, Horner DS, Manzari C, et al. IS26 mediated antimicrobial resistance gene shuffling from the chromosome to a mosaic conjugative FII plasmid. Plasmid. 2018;100:22\u201330.","journal-title":"Plasmid"},{"key":"5080_CR35","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.jgar.2024.01.007","volume":"36","author":"C Chen","year":"2024","unstructured":"Chen C, Wang W, Zhang J, Zhang L, Zhao J, Deng J, Li W, Li X, Zhuo W, Huang L, et al. Genomic characteristics of two strains of ESBL-producing Klebsiella pneumoniae ST268 isolated from different samples of one patient. J Glob Antimicrob Resist. 2024;36:319\u201325.","journal-title":"J Glob Antimicrob Resist"},{"issue":"6","key":"5080_CR36","doi-asserted-by":"publisher","first-page":"3556","DOI":"10.1128\/AAC.04442-14","volume":"59","author":"P McGann","year":"2015","unstructured":"McGann P, Snesrud E, Ong AC, Appalla L, Koren M, Kwak YI, Waterman PE, Lesho EP. War wound treatment complications due to transfer of an IncN plasmid harboring bla(OXA-181) from Morganella morganii to CTX-M-27-producing sequence type 131 Escherichia coli. Antimicrob Agents Chemother. 2015;59(6):3556\u201362.","journal-title":"Antimicrob Agents Chemother"},{"issue":"8","key":"5080_CR37","first-page":"987","volume":"49","author":"Y Deng","year":"2009","unstructured":"Deng Y, Zeng Z, Liu J, Chen Z. [Insertion sequence common region element: a novel gene-capturing system in bacteria\u2013a review]. Wei Sheng Wu Xue Bao. 2009;49(8):987\u201393.","journal-title":"Wei Sheng Wu Xue Bao"},{"key":"5080_CR38","doi-asserted-by":"publisher","first-page":"2579","DOI":"10.3389\/fmicb.2018.02579","volume":"9","author":"C Lallement","year":"2018","unstructured":"Lallement C, Pasternak C, Ploy MC, Jov\u00e9 T. The role of ISCR1-borne P(OUT) promoters in the expression of antibiotic resistance genes. Front Microbiol. 2018;9:2579.","journal-title":"Front Microbiol"}],"container-title":["BMC Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12866-026-05080-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-026-05080-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-026-05080-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T22:38:35Z","timestamp":1782945515000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12866-026-05080-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5080"],"URL":"https:\/\/doi.org\/10.1186\/s12866-026-05080-x","relation":{},"ISSN":["1471-2180"],"issn-type":[{"value":"1471-2180","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,8]]},"assertion":[{"value":"19 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 May 2026","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 study was conducted in accordance with the Declaration of Helsinki. The use of human specimens and all related experimental protocols was reviewed and approved by the Ethics Committee of Taizhou Municipal Hospital, Zhejiang, China, in accordance with the medical research regulations of the Ministry of Health, China. Research and all related procedures involving biohazardous materials were approved by the Biosafety Committee of Taizhou Municipal Hospital. The Ethics Committee of Taizhou Municipal Hospital, Zhejiang, China granted a waiver of the requirement for informed consent for this study. This research was conducted in China.","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"}}],"article-number":"579"}}