{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:30:19Z","timestamp":1787020219375,"version":"build-2736575974"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T00:00:00Z","timestamp":1693267200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T00:00:00Z","timestamp":1693267200000},"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 Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Community-acquired pneumonia (CAP) is usually diagnosed in children, and the type of respiratory specimen is critical. Differences in pathogens detection between induced sputum (IS) and bronchoalveolar lavage fluid (BALF) have not been evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In 2018, paired sputum and BALF samples from CAP hospitalised children with indications for bronchoalveolar lavage (BAL) were subjected to multiplex PCR for the detection of 11 common respiratory pathogens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 142 children with paired sputum and BALF were tested. The overall positivity rate was 85.9% (122\/142) for sputum and 80.3% (114\/142) for BALF. The two specimens presented almost perfect agreement between the detection on\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      , influenza A, influenza B, bocavirus and RSV. In contrast, adenovirus had the lowest kappa value of 0.156, and a false negative rate (FNR) of 66.7%. Rhinovirus had the highest false positive rate (FPR) as 18.5%. The consistent rate was significantly higher in school-age children than those under 1 year old (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.005). Bacterial co-infection in BALF specimens were observed in 14.8% (21\/142). Of the 11 discordant pairs of specimens, 9 cases were sputum(+)\/BALF(-) with adenovirus predominating.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings suggest that the consistency of results between sputum and BALF is pathogen specific. Careful consideration needs to be given to whether sputum can be used as a substitute for BALF when children are young or co-infections with bacteria are suspected.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-023-08522-3","type":"journal-article","created":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T08:02:01Z","timestamp":1693296121000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Comparative study of diagnostic efficacy of sputum and bronchoalveolar lavage fluid specimens in community-acquired pneumonia children treated with fiberoptic bronchoscopy"],"prefix":"10.1186","volume":"23","author":[{"given":"Le","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sukun","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghui","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,8,29]]},"reference":[{"issue":"3","key":"8522_CR1","doi-asserted-by":"publisher","first-page":"267","DOI":"10.1001\/jamapediatrics.2015.4276","volume":"170","author":"C Pediatrics","year":"2016","unstructured":"Global Burden of Disease, Pediatrics C, Kyu HH, Pinho C, et al. Global and national Burden of Diseases and Injuries among children and adolescents between 1990 and 2013: findings from the global burden of Disease 2013 study [J]. JAMA Pediatr. 2016;170(3):267\u201387.","journal-title":"JAMA Pediatr"},{"issue":"1","key":"8522_CR2","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1038\/s41598-021-03741-7","volume":"12","author":"S Serigstad","year":"2022","unstructured":"Serigstad S, Markussen D, Grewal HMS, et al. Rapid syndromic PCR testing in patients with respiratory tract infections reduces time to results and improves microbial yield [J]. Sci Rep. 2022;12(1):326.","journal-title":"Sci Rep"},{"issue":"6","key":"8522_CR3","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1016\/j.cmi.2019.12.018","volume":"26","author":"MC Zanella","year":"2020","unstructured":"Zanella MC, Meylan P, Kaiser L. Syndromic panels or \u2018panel syndrome\u2019? A perspective through the lens of respiratory tract infections [J]. Clin Microbiol Infect. 2020;26(6):665\u20138.","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"8522_CR4","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1186\/s12890-020-01275-8","volume":"20","author":"Z Peng","year":"2020","unstructured":"Peng Z, Zhou J, Tian L. Pathogenic characteristics of sputum and bronchoalveolar lavage fluid samples from patients with lower respiratory tract infection in a large teaching hospital in China: a retrospective study [J]. BMC Pulm Med. 2020;20(1):233.","journal-title":"BMC Pulm Med"},{"issue":"2","key":"8522_CR5","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s00431-017-3044-3","volume":"177","author":"A Escribano Montaner","year":"2018","unstructured":"Escribano Montaner A, Garcia De Lomas J, Villa Asensi JR, et al. Bacteria from bronchoalveolar lavage fluid from children with suspected chronic lower respiratory tract infection: results from a multi-center, cross-sectional study in Spain [J]. Eur J Pediatr. 2018;177(2):181\u201392.","journal-title":"Eur J Pediatr"},{"issue":"2","key":"8522_CR6","first-page":"95","volume":"27","author":"LY Xie","year":"2013","unstructured":"Xie LY, Zhong LL, Zhang B, et al. [Virus detection in bronchoalveolar lavage fluid of 122 children with severe pneumonia] [J]. Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2013;27(2):95\u20137.","journal-title":"Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi"},{"issue":"Suppl 2","key":"8522_CR7","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1086\/511159","volume":"44","author":"LA Mandell","year":"2007","unstructured":"Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America\/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults [J]. Clin Infect Dis. 2007;44(Suppl 2):27\u201372.","journal-title":"Clin Infect Dis"},{"issue":"1","key":"8522_CR8","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1179\/2046905512Y.0000000017","volume":"33","author":"MY Li","year":"2013","unstructured":"Li MY, Kelly J, Subhi R, et al. Global use of the WHO pocket book of hospital care for children [J]. Paediatr Int Child Health. 2013;33(1):4\u201317.","journal-title":"Paediatr Int Child Health"},{"issue":"13","key":"8522_CR9","first-page":"983","volume":"33","author":"H C C T E S","year":"2018","unstructured":"Technical Expert Group on Paediatric Respiratory Endoscopy N, H C C T E S. C. Chinese Pediatric Flexible Bronchoscopy Guidelines (2018 Edition) [J]. Chin J Appl Clin Pediatr. 2018;33(13):983\u20139.","journal-title":"Chin J Appl Clin Pediatr"},{"issue":"7","key":"8522_CR10","doi-asserted-by":"publisher","first-page":"e25","DOI":"10.1093\/cid\/cir531","volume":"53","author":"JS Bradley","year":"2011","unstructured":"Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the infectious Diseases Society of America [J]. Clin Infect Dis. 2011;53(7):e25\u201376.","journal-title":"Clin Infect Dis"},{"issue":"3","key":"8522_CR11","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.jinf.2008.06.012","volume":"57","author":"A Tamura","year":"2008","unstructured":"Tamura A, Matsubara K, Tanaka T, et al. Methylprednisolone pulse therapy for refractory Mycoplasma pneumoniae pneumonia in children [J]. J Infect. 2008;57(3):223\u20138.","journal-title":"J Infect"},{"issue":"9","key":"8522_CR12","doi-asserted-by":"publisher","first-page":"e0162411","DOI":"10.1371\/journal.pone.0162411","volume":"11","author":"L Wang","year":"2016","unstructured":"Wang L, Zhao M, Shi Z, et al. A GeXP-Based assay for simultaneous detection of multiple viruses in hospitalized children with community acquired pneumonia [J]. PLoS ONE. 2016;11(9):e0162411.","journal-title":"PLoS ONE"},{"issue":"1","key":"8522_CR13","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis JR, Koch GG. The measurement of observer agreement for categorical data [J]. Biometrics. 1977;33(1):159\u201374.","journal-title":"Biometrics"},{"issue":"5","key":"8522_CR14","doi-asserted-by":"publisher","first-page":"2666","DOI":"10.21037\/jtd.2018.04.46","volume":"10","author":"X Tang","year":"2018","unstructured":"Tang X, Xiao M, Zhuo C, et al. Multi-level analysis of bacteria isolated from inpatients in respiratory departments in China [J]. J Thorac Dis. 2018;10(5):2666\u201375.","journal-title":"J Thorac Dis"},{"key":"8522_CR15","doi-asserted-by":"publisher","first-page":"105731","DOI":"10.1016\/j.mimet.2019.105731","volume":"166","author":"J Gunasekaran","year":"2019","unstructured":"Gunasekaran J, Saksena R, Jain M, et al. Can sputum gram stain be used to predict lower respiratory tract infection and guide empiric antimicrobial treatment: experience from a tertiary care hospital. J Microbiol Methods. 2019;166:105731.","journal-title":"J Microbiol Methods"},{"issue":"5","key":"8522_CR16","doi-asserted-by":"publisher","first-page":"570","DOI":"10.1016\/S1053-2498(03)00228-6","volume":"23","author":"JT Lehto","year":"2004","unstructured":"Lehto JT, Anttila VJ, Lommi J, et al. Clinical usefulness of bronchoalveolar lavage in heart transplant recipients with suspected lower respiratory tract infection [J]. J Heart Lung Transplant. 2004;23(5):570\u20136.","journal-title":"J Heart Lung Transplant"},{"issue":"7","key":"8522_CR17","first-page":"4009","volume":"12","author":"Z Wang","year":"2020","unstructured":"Wang Z, Zang Y, Gao Y, et al. Evaluation of bronchoalveolar lavage fluid combined with the loop-mediated isothermal amplification assay in lower respiratory tract infections [J]. Am J Transl Res. 2020;12(7):4009\u201316.","journal-title":"Am J Transl Res"},{"issue":"4","key":"8522_CR18","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1002\/ppul.23953","volume":"53","author":"KM Kloepfer","year":"2018","unstructured":"Kloepfer KM, Deschamp AR, Ross SE, et al. In children, the microbiota of the nasopharynx and bronchoalveolar lavage fluid are both similar and different [J]. Pediatr Pulmonol. 2018;53(4):475\u201382.","journal-title":"Pediatr Pulmonol"},{"issue":"8","key":"8522_CR19","first-page":"807","volume":"34","author":"H Yang","year":"2009","unstructured":"Yang H, Chen P, Jiang H, et al. [Diagnostic value of sterility sputum aspirating tube and bronchoalveolar lavage by bronchofibroscope in mechanically ventilated patients with lower respiratory tract infection] [J]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2009;34(8):807\u201310.","journal-title":"Zhong Nan Da Xue Xue Bao Yi Xue Ban"},{"issue":"7","key":"8522_CR20","doi-asserted-by":"publisher","first-page":"851","DOI":"10.1007\/s00431-010-1360-y","volume":"170","author":"D Xu","year":"2011","unstructured":"Xu D, Li S, Chen Z, et al. Detection of Mycoplasma pneumoniae in different respiratory specimens [J]. Eur J Pediatr. 2011;170(7):851\u20138.","journal-title":"Eur J Pediatr"},{"issue":"11","key":"8522_CR21","first-page":"1127","volume":"23","author":"YH Luo","year":"2021","unstructured":"Luo YH, Dai JH, Geng G, et al. Consistency between nasopharyngeal aspirates and bronchoalveolar lavage fluid in pathogen detection in children with pneumonia: an analysis of 533 cases [J]. Zhongguo Dang Dai Er Ke Za Zhi. 2021;23(11):1127\u201331.","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi"},{"issue":"Suppl 2","key":"8522_CR22","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1016\/S0140-6736(18)30409-4","volume":"391","author":"S Jobran","year":"2018","unstructured":"Jobran S, Kattan R, Shamaa J, et al. Adenovirus respiratory tract infections in infants: a retrospective chart-review study [J]. Lancet. 2018;391(Suppl 2):43.","journal-title":"Lancet"},{"issue":"20","key":"8522_CR23","doi-asserted-by":"publisher","first-page":"e776","DOI":"10.1097\/MD.0000000000000776","volume":"94","author":"KH Hung","year":"2015","unstructured":"Hung KH, Lin LH. Adenovirus pneumonia complicated with acute respiratory distress syndrome: a case report [J]. Med (Baltim). 2015;94(20):e776.","journal-title":"Med (Baltim)"},{"issue":"5","key":"8522_CR24","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1002\/ppul.1145","volume":"32","author":"M Pichler","year":"2001","unstructured":"Pichler M, Herrmann G, Schmidt H, et al. Persistent adenoviral infection and chronic obstructive bronchitis in children: is there a link? [J]. Pediatr Pulmonol. 2001;32(5):367\u201371.","journal-title":"Pediatr Pulmonol"},{"issue":"1","key":"8522_CR25","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1186\/s12879-023-08127-w","volume":"23","author":"H Wang","year":"2023","unstructured":"Wang H, Li X, Zheng Y, et al. Concordance in pathogen identification at the upper and lower respiratory tract of children with severe pneumonia [J]. BMC Infect Dis. 2023;23(1):170.","journal-title":"BMC Infect Dis"},{"issue":"1","key":"8522_CR26","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s12985-019-1177-x","volume":"16","author":"L Wang","year":"2019","unstructured":"Wang L, Yang S, Yan X, et al. Comparing the yield of oropharyngeal swabs and sputum for detection of 11 common pathogens in hospitalized children with lower respiratory tract infection [J]. Virol J. 2019;16(1):84.","journal-title":"Virol J"},{"issue":"Pt 3","key":"8522_CR27","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1099\/jmm.0.45888-0","volume":"54","author":"R Raty","year":"2005","unstructured":"Raty R, Ronkko E, Kleemola M. Sample type is crucial to the diagnosis of Mycoplasma pneumoniae pneumonia by PCR [J]. J Med Microbiol. 2005;54(Pt 3):287\u201391.","journal-title":"J Med Microbiol"},{"issue":"4","key":"8522_CR28","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.1128\/JCM.38.4.1382-1384.2000","volume":"38","author":"J Honda","year":"2000","unstructured":"Honda J, Yano T, Kusaba M, et al. Clinical use of capillary PCR to diagnose Mycoplasma pneumonia [J]. J Clin Microbiol. 2000;38(4):1382\u20134.","journal-title":"J Clin Microbiol"},{"issue":"2","key":"8522_CR29","first-page":"144","volume":"21","author":"YL Guo","year":"2019","unstructured":"Guo YL, Yang YX, Dong PP. [Pathogens in bronchoalveolar lavage fluid of children with lower respiratory tract infection] [J]. Zhongguo Dang Dai Er Ke Za Zhi. 2019;21(2):144\u20139.","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi"},{"issue":"3","key":"8522_CR30","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1097\/INF.0b013e31827687fc","volume":"32","author":"F Rodrigues","year":"2013","unstructured":"Rodrigues F, Foster D, Nicoli E, et al. Relationships between rhinitis symptoms, respiratory viral infections and nasopharyngeal colonization with Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus in children attending daycare [J]. Pediatr Infect Dis J. 2013;32(3):227\u201332.","journal-title":"Pediatr Infect Dis J"},{"issue":"4","key":"8522_CR31","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.jinf.2013.06.010","volume":"67","author":"LM Verhagen","year":"2013","unstructured":"Verhagen LM, Gomez-Castellano K, Snelders E, et al. Respiratory infections in Enepa Amerindians are related to malnutrition and Streptococcus pneumoniae carriage [J]. J Infect. 2013;67(4):273\u201381.","journal-title":"J Infect"},{"issue":"4","key":"8522_CR32","doi-asserted-by":"publisher","first-page":"e284","DOI":"10.1016\/S2666-5247(21)00304-9","volume":"3","author":"A Tsitsiklis","year":"2022","unstructured":"Tsitsiklis A, Osborne CM, Kamm J, et al. Lower respiratory tract infections in children requiring mechanical ventilation: a multicentre prospective surveillance study incorporating airway metagenomics [J]. Lancet Microbe. 2022;3(4):e284\u2013e93.","journal-title":"Lancet Microbe"},{"issue":"1","key":"8522_CR33","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.chom.2018.12.006","volume":"25","author":"MG Netea","year":"2019","unstructured":"Netea MG, Schlitzer A, Placek K, et al. Innate and adaptive Immune memory: an Evolutionary Continuum in the host\u2019s response to pathogens [J]. Cell Host Microbe. 2019;25(1):13\u201326.","journal-title":"Cell Host Microbe"},{"issue":"12","key":"8522_CR34","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1001\/archinte.1981.00340130043013","volume":"141","author":"CH Ramirez-Ronda","year":"1981","unstructured":"Ramirez-Ronda CH, Fuxench-Lopez Z, Nevarez M. Increased pharyngeal bacterial colonization during viral illness [J]. Arch Intern Med. 1981;141(12):1599\u2013603.","journal-title":"Arch Intern Med"},{"issue":"5","key":"8522_CR35","first-page":"375","volume":"15","author":"F Du","year":"2013","unstructured":"Du F, Huang Y, Shu C, et al. [Mixed infection and risk factors in children with severe adenovirus pneumonia] [J]. Zhongguo Dang Dai Er Ke Za Zhi. 2013;15(5):375\u20138.","journal-title":"Zhongguo Dang Dai Er Ke Za Zhi"},{"issue":"2","key":"8522_CR36","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.jmii.2014.04.008","volume":"49","author":"SH Lai","year":"2016","unstructured":"Lai SH, Liao SL, Wong KS, et al. Preceding human metapneumovirus infection increases adherence of Streptococcus pneumoniae and severity of murine pneumococcal pneumonia [J]. J Microbiol Immunol Infect. 2016;49(2):216\u201324.","journal-title":"J Microbiol Immunol Infect"},{"issue":"8","key":"8522_CR37","doi-asserted-by":"publisher","first-page":"4846","DOI":"10.1002\/jmv.26864","volume":"93","author":"SZ Zeng","year":"2021","unstructured":"Zeng SZ, Xie LY, Yu T, et al. Persistent viral shedding of human adenovirus type 7 in children with severe pneumonia [J]. J Med Virol. 2021;93(8):4846\u201355.","journal-title":"J Med Virol"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-023-08522-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-023-08522-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-023-08522-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,17]],"date-time":"2023-11-17T11:06:34Z","timestamp":1700219194000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-023-08522-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,29]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["8522"],"URL":"https:\/\/doi.org\/10.1186\/s12879-023-08522-3","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,29]]},"assertion":[{"value":"23 February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 August 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 August 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study is approved by the Health Research Ethics Committee of Hebei Children\u2019s Hospital affiliated with Hebei Medical University (Approval #2017016), in compliance with the principles of the Declaration of Helsinki, the Code of Ethics of the World Medical Association. All methods were carried out in accordance with relevant guidelines and regulations. The requirement for informed consent were waived by Health Research Ethics Committee of Hebei Children\u2019s Hospital affiliated with Hebei Medical University as the study is retrospective and presents no risk of harm to subjects, and no privacy of individuals is exposed.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable as all data presented in the article are de-identified.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"None to declare.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"565"}}