{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:12:19Z","timestamp":1784542339815,"version":"3.55.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,8,2]],"date-time":"2020-08-02T00:00:00Z","timestamp":1596326400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,8,2]],"date-time":"2020-08-02T00:00:00Z","timestamp":1596326400000},"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":["BMC Cardiovasc Disord"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Patients with chronic kidney disease (CKD) experience abnormality of intracardiac blood flow status during early-stages of disease. Left ventricular energy loss (EL) derived from vector flow mapping (VFM) represents fluid energy lost as heat in left ventricle and had been used to detect intracardiac blood flow efficiency. We aimed to evaluate the left ventricular EL in stage 1\u20133 CKD patients, and explored whether hypertension, a main cardiovascular risk, deteriorate the abnormality of intracardiac blood flow status.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Transthoracic echocardiography was performed in 41 controls and 48 patients with stages 1\u20133 CKD. CKD patients consisted a subgroup with no hypertension, a subgroup with well-controlled hypertension and a subgroup with poorly controlled hypertension. The EL were calculated in the left ventricle using VFM analysis from the apical 3-chamber view. Furthermore, the correlation and stepwise multiple regression analysis were used to explore the potential independent predictors of left ventricular EL.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Compared with controls, stage 1\u20133 CKD patients showed increased left ventricular EL during total diastole, late diastole, total systole, isovolumic contraction and ejection. CKD patients with poorly controlled hypertension had higher left ventricular EL compared to the other CKD subgroups. Additionally, the ratio of mitral early filling wave peak velocity and early mitral annular peak velocity on septal side, mitral early filling wave peak velocity, and left ventricular mass index were independent predictors of the diastolic EL; whereas systolic blood pressure and left ventricular mass index were independent predictors of the systolic EL.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Left ventricular EL was a useful echocardiographic parameter to evaluate the impaired intracardiac blood flow efficiency in patients with stages 1\u20133 CKD. Hypertension was a crucial contributor for intracardiac blood flow abnormality. This study might provide valuable clinical data to discern cardiac dysfunction and reduce the cardiovascular risk in early-stage CKD.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s12872-020-01640-9","type":"journal-article","created":{"date-parts":[[2020,8,2]],"date-time":"2020-08-02T20:02:31Z","timestamp":1596398551000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Assessment of left ventricular energy loss using vector flow mapping in patients with stages 1\u20133 chronic kidney disease"],"prefix":"10.1186","volume":"20","author":[{"given":"Xiaoxue","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8391-7070","authenticated-orcid":false,"given":"Yueheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijun","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengqin","family":"Qi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Degang","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,8,2]]},"reference":[{"key":"1640_CR1","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1016\/S0140-6736(16)32064-5","volume":"389","author":"AC Webster","year":"2017","unstructured":"Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet (London, England). 2017;389:1238\u201352.","journal-title":"Lancet (London, England)"},{"key":"1640_CR2","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1056\/NEJMc1602469","volume":"375","author":"L Zhang","year":"2016","unstructured":"Zhang L, Long J, Jiang W, Shi Y, He X, Zhou Z, et al. Trends in chronic kidney disease in China. N Engl J Med. 2016;375:905\u20136.","journal-title":"N Engl J Med"},{"key":"1640_CR3","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1161\/CIRCULATIONAHA.106.678342","volume":"116","author":"EL Schiffrin","year":"2007","unstructured":"Schiffrin EL, Lipman ML, Mann JF. Chronic kidney disease: effects on the cardiovascular system. Circulation. 2007;116:85\u201397.","journal-title":"Circulation"},{"key":"1640_CR4","doi-asserted-by":"publisher","first-page":"703","DOI":"10.1016\/j.jcmg.2013.09.025","volume":"7","author":"NC Edwards","year":"2014","unstructured":"Edwards NC, Moody WE, Chue CD, Ferro CJ, Townend JN, Steeds RP. Defining the natural history of uremic cardiomyopathy in chronic kidney disease: the role of cardiovascular magnetic resonance. J Am Coll Cardiol Img. 2014;7:703\u201314.","journal-title":"J Am Coll Cardiol Img"},{"issue":"Suppl 9","key":"1640_CR5","first-page":"ix19","volume":"22","author":"C Daly","year":"2007","unstructured":"Daly C. Is early chronic kidney disease an important risk factor for cardiovascular disease? A background paper prepared for the UK Consensus Conference on early chronic kidney disease. Nephrol Dial Transplant. 2007;22(Suppl 9):ix19\u201325.","journal-title":"Nephrol Dial Transplant"},{"key":"1640_CR6","doi-asserted-by":"publisher","first-page":"1293","DOI":"10.1016\/j.echo.2008.09.013","volume":"21","author":"NC Edwards","year":"2008","unstructured":"Edwards NC, Hirth A, Ferro CJ, Townend JN, Steeds RP. Subclinical abnormalities of left ventricular myocardial deformation in early-stage chronic kidney disease: the precursor of uremic cardiomyopathy? J Am Soc Echocardiogr. 2008;21:1293\u20138.","journal-title":"J Am Soc Echocardiogr"},{"key":"1640_CR7","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1016\/j.amjcard.2017.11.041","volume":"121","author":"MK Hayer","year":"2018","unstructured":"Hayer MK, Price AM, Liu B, Baig S, Ferro CJ, Townend JN, et al. Diffuse myocardial interstitial fibrosis and dysfunction in early chronic kidney disease. Am J Cardiol. 2018;121:656\u201360.","journal-title":"Am J Cardiol"},{"key":"1640_CR8","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1186\/s12933-019-0849-6","volume":"18","author":"HC Lee","year":"2019","unstructured":"Lee HC, Shiou YL, Jhuo SJ, Chang CY, Liu PL, Jhuang WJ, et al. The sodium-glucose co-transporter 2 inhibitor empagliflozin attenuates cardiac fibrosis and improves ventricular hemodynamics in hypertensive heart failure rats. Cardiovasc Diabetol. 2019;18:45.","journal-title":"Cardiovasc Diabetol"},{"key":"1640_CR9","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1016\/j.jcmg.2012.01.003","volume":"5","author":"PP Sengupta","year":"2012","unstructured":"Sengupta PP, Pedrizzetti G, Kilner PJ, Kheradvar A, Ebbers T, Tonti G, et al. Emerging trends in CV flow visualization. J Am Coll Cardiol Img. 2012;5:305\u201316.","journal-title":"J Am Coll Cardiol Img"},{"key":"1640_CR10","doi-asserted-by":"publisher","first-page":"07HF16","DOI":"10.7567\/JJAP.52.07HF16","volume":"52","author":"K Itatani","year":"2013","unstructured":"Itatani K, Okada T, Uejima T, Tanaka T, Ono M, Miyaji K, et al. Intraventricular flow velocity vector visualization based on the continuity equation and measurements of vorticity and wall shear stress. Jpn J Appl Phys. 2013;52:07HF16.","journal-title":"Jpn J Appl Phys"},{"key":"1640_CR11","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s12574-016-0321-5","volume":"15","author":"R Asami","year":"2017","unstructured":"Asami R, Tanaka T, Kawabata KI, Hashiba K, Okada T, Nishiyama T. Accuracy and limitations of vector flow mapping: left ventricular phantom validation using stereo particle image velocimetory. J Echocardiogr. 2017;15:57\u201366.","journal-title":"J Echocardiogr"},{"key":"1640_CR12","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1016\/j.ultrasmedbio.2010.02.017","volume":"36","author":"T Uejima","year":"2010","unstructured":"Uejima T, Koike A, Sawada H, Aizawa T, Ohtsuki S, Tanaka M, et al. A new echocardiographic method for identifying vortex flow in the left ventricle: numerical validation. Ultrasound Med Biol. 2010;36:772\u201388.","journal-title":"Ultrasound Med Biol"},{"key":"1640_CR13","doi-asserted-by":"publisher","first-page":"2063","DOI":"10.7863\/ultra.32.12.2063","volume":"32","author":"M Chen","year":"2013","unstructured":"Chen M, Jin JM, Zhang Y, Gao Y, Liu SL. Assessment of left ventricular diastolic dysfunction based on the intraventricular velocity difference by vector flow mapping. J Ultrasound Med. 2013;32:2063\u201371.","journal-title":"J Ultrasound Med"},{"key":"1640_CR14","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.jjcc.2014.12.012","volume":"66","author":"T Hayashi","year":"2015","unstructured":"Hayashi T, Itatani K, Inuzuka R, Shimizu N, Shindo T, Hirata Y, et al. Dissipative energy loss within the left ventricle detected by vector flow mapping in children: Normal values and effects of age and heart rate. J Cardiol. 2015;66:403\u201310.","journal-title":"J Cardiol"},{"key":"1640_CR15","doi-asserted-by":"publisher","first-page":"1730","DOI":"10.1016\/j.ultrasmedbio.2016.03.008","volume":"42","author":"Y Wang","year":"2016","unstructured":"Wang Y, Ma R, Ding G, Hou D, Li Z, Yin L, et al. Left ventricular energy loss assessed by vector flow mapping in patients with prediabetes and type 2 diabetes mellitus. Ultrasound Med Biol. 2016;42:1730\u201340.","journal-title":"Ultrasound Med Biol"},{"key":"1640_CR16","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1007\/s10554-017-1100-8","volume":"33","author":"CM Li","year":"2017","unstructured":"Li CM, Bai WJ, Liu YT, Tang H, Rao L. Dissipative energy loss within the left ventricle detected by vector flow mapping in diabetic patients with controlled and uncontrolled blood glucose levels. Int J Cardiovasc Imaging. 2017;33:1151\u20138.","journal-title":"Int J Cardiovasc Imaging"},{"key":"1640_CR17","first-page":"4379","volume":"17","author":"Y Cao","year":"2019","unstructured":"Cao Y, Sun XY, Zhong M, Li L, Zhang M, Lin MJ, et al. Evaluation of hemodynamics in patients with hypertrophic cardiomyopathy by vector flow mapping: comparison with healthy subjects. Exp Ther Med. 2019;17:4379\u201388.","journal-title":"Exp Ther Med"},{"key":"1640_CR18","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1253\/circj.CJ-18-0625","volume":"83","author":"S Yoshida","year":"2018","unstructured":"Yoshida S, Miyagawa S, Fukushima S, Yoshikawa Y, Hata H, Saito S, et al. Cardiac function and type of mitral valve surgery affect postoperative blood flow pattern in the left ventricle. Circ J. 2018;83:130\u20138.","journal-title":"Circ J"},{"key":"1640_CR19","doi-asserted-by":"publisher","first-page":"1123","DOI":"10.1007\/s00380-017-0967-6","volume":"32","author":"K Nakashima","year":"2017","unstructured":"Nakashima K, Itatani K, Kitamura T, Oka N, Horai T, Miyazaki S, et al. Energy dynamics of the intraventricular vortex after mitral valve surgery. Heart Vessel. 2017;32:1123\u20139.","journal-title":"Heart Vessel"},{"key":"1640_CR20","doi-asserted-by":"publisher","first-page":"965","DOI":"10.7863\/ultra.15.06009","volume":"35","author":"Y Zhong","year":"2016","unstructured":"Zhong Y, Liu Y, Wu T, Song H, Chen Z, Zhu W, et al. Assessment of left ventricular dissipative energy loss by vector flow mapping in patients with end-stage renal disease. J Ultrasound Med. 2016;35:965\u201373.","journal-title":"J Ultrasound Med"},{"key":"1640_CR21","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1007\/5584_2016_84","volume":"956","author":"SM Hamrahian","year":"2017","unstructured":"Hamrahian SM, Falkner B. Hypertension in chronic kidney disease. Adv Exp Med Biol. 2017;956:307\u201325.","journal-title":"Adv Exp Med Biol"},{"issue":"Suppl 7","key":"1640_CR22","first-page":"vii2","volume":"18","author":"F Locatelli","year":"2003","unstructured":"Locatelli F, Pozzoni P, Tentori F, del Vecchio L. Epidemiology of cardiovascular risk in patients with chronic kidney disease. Nephrol Dial Transplant. 2003;18(Suppl 7):vii2\u20139.","journal-title":"Nephrol Dial Transplant"},{"key":"1640_CR23","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1093\/ndt\/gft321","volume":"29","author":"F Verbeke","year":"2014","unstructured":"Verbeke F, Lindley E, Van Bortel L, Vanholder R, London G, Cochat P, et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease: Improving Global Outcomes (KDIGO) clinical practice guideline for the management of blood pressure in non-dialysis-dependent chronic kidney disease: an endorsement with some caveats for real-life application. Nephrol Dial Transplant. 2014;29:490\u20136.","journal-title":"Nephrol Dial Transplant"},{"key":"1640_CR24","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1093\/ehjci\/jev014","volume":"16","author":"RM Lang","year":"2015","unstructured":"Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:233\u201370.","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"1640_CR25","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1093\/ehjci\/jev035","volume":"16","author":"M Stugaard","year":"2015","unstructured":"Stugaard M, Koriyama H, Katsuki K, Masuda K, Asanuma T, Takeda Y, et al. Energy loss in the left ventricle obtained by vector flow mapping as a new quantitative measure of severity of aortic regurgitation: a combined experimental and clinical study. Eur Heart J Cardiovasc Imaging. 2015;16:723\u201330.","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"1640_CR26","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1046\/j.1540-8175.2002.00467.x","volume":"19","author":"AJ Chamoun","year":"2002","unstructured":"Chamoun AJ, Xie T, Trough M, Esquivel-Avila J, Carson R, DeFilippi C, et al. Color M-mode flow propagation velocity versus conventional Doppler indices in the assessment of diastolic left ventricular function in patients on chronic hemodialysis. Echocardiography (Mount Kisco, NY). 2002;19:467\u201374.","journal-title":"Echocardiography (Mount Kisco, NY)"},{"key":"1640_CR27","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1038\/sj.ki.5000249","volume":"69","author":"PB Mark","year":"2006","unstructured":"Mark PB, Johnston N, Groenning BA, Foster JE, Blyth KG, Martin TN, et al. Redefinition of uremic cardiomyopathy by contrast-enhanced cardiac magnetic resonance imaging. Kidney Int. 2006;69:1839\u201345.","journal-title":"Kidney Int"},{"key":"1640_CR28","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/s12574-019-00436-x","volume":"17","author":"K Dohi","year":"2019","unstructured":"Dohi K. Echocardiographic assessment of cardiac structure and function in chronic renal disease. J Echocardiogr. 2019;17:115\u201322.","journal-title":"J Echocardiogr"},{"key":"1640_CR29","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1111\/j.1540-8175.2009.01122.x","volume":"27","author":"MJ Hung","year":"2010","unstructured":"Hung MJ, Yang NI, Wu IW, Cheng CW, Wu MS, Cherng WJ. Echocardiographic assessment of structural and functional cardiac remodeling in patients with predialysis chronic kidney disease. Echocardiography (Mount Kisco, NY). 2010;27:621\u20139.","journal-title":"Echocardiography (Mount Kisco, NY)"},{"key":"1640_CR30","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1111\/echo.14264","volume":"36","author":"W Wang","year":"2019","unstructured":"Wang W, Wang Y, Chen X, Yuan L, Bai H. Evaluation of left ventricular diastolic function based on flow energetic parameters in chronic kidney disease with diastolic dysfunction. Echocardiography (Mount Kisco, NY). 2019;36:567\u201376.","journal-title":"Echocardiography (Mount Kisco, NY)"},{"key":"1640_CR31","doi-asserted-by":"publisher","first-page":"H718","DOI":"10.1152\/ajpheart.00697.2013","volume":"306","author":"J Bermejo","year":"2014","unstructured":"Bermejo J, Benito Y, Alhama M, Yotti R, Mart\u00ednez-Legazpi P, Del Villar CP, et al. Intraventricular vortex properties in nonischemic dilated cardiomyopathy. Am J Physiol Heart Circ Physiol. 2014;306:H718\u201329.","journal-title":"Am J Physiol Heart Circ Physiol"},{"key":"1640_CR32","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1111\/echo.12584","volume":"32","author":"D Rodr\u00edguez Mu\u00f1oz","year":"2015","unstructured":"Rodr\u00edguez Mu\u00f1oz D, Moya Mur JL, Fern\u00e1ndez-Golf\u00edn C, Becker Filho DC, Gonz\u00e1lez G\u00f3mez A, Fern\u00e1ndez Santos S, et al. Left ventricular vortices as observed by vector flow mapping: main determinants and their relation to left ventricular filling. Echocardiography (Mount Kisco, NY). 2015;32:96\u2013105.","journal-title":"Echocardiography (Mount Kisco, NY)"},{"key":"1640_CR33","doi-asserted-by":"publisher","first-page":"1081","DOI":"10.1111\/j.1540-8175.2012.01737.x","volume":"29","author":"R Chen","year":"2012","unstructured":"Chen R, Zhao BW, Wang B, Tang HL, Li P, Pan M, et al. Assessment of left ventricular hemodynamics and function of patients with uremia by vortex formation using vector flow mapping. Echocardiography (Mount Kisco, NY). 2012;29:1081\u201390.","journal-title":"Echocardiography (Mount Kisco, NY)"},{"key":"1640_CR34","doi-asserted-by":"publisher","first-page":"Iii108","DOI":"10.1161\/01.HYP.6.6_Pt_2.III108","volume":"6","author":"J Wikstrand","year":"1984","unstructured":"Wikstrand J. Left ventricular function in early primary hypertension. Functional consequences of cardiovascular structural changes. Hypertension. 1984;6:Iii108\u201316.","journal-title":"Hypertension"},{"key":"1640_CR35","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1111\/echo.13504","volume":"34","author":"L Xu","year":"2017","unstructured":"Xu L, Sun C, Zhu X, Liu W, Ta S, Zhao D, et al. Characterization of left ventricle energy loss in healthy adults using vector flow mapping: preliminary results. Echocardiography (Mount Kisco, NY). 2017;34:700\u20138.","journal-title":"Echocardiography (Mount Kisco, NY)"},{"key":"1640_CR36","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1161\/HYPERTENSIONAHA.115.06487","volume":"67","author":"G Thomas","year":"2016","unstructured":"Thomas G, Xie D, Chen HY, Anderson AH, Appel LJ, Bodana S, et al. Prevalence and prognostic significance of apparent treatment resistant hypertension in chronic kidney disease: report from the chronic renal insufficiency cohort study. Hypertension. 2016;67:387\u201396.","journal-title":"Hypertension"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-020-01640-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-020-01640-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-020-01640-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,1]],"date-time":"2021-08-01T23:04:59Z","timestamp":1627859099000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-020-01640-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,2]]},"references-count":36,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["1640"],"URL":"https:\/\/doi.org\/10.1186\/s12872-020-01640-9","relation":{},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,2]]},"assertion":[{"value":"11 February 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 July 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 August 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This clinical study was approved by the Ethics Committee of the Second Hospital of Hebei Medical University. Written informed consent were signed by all participants.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"355"}}