{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T01:33:21Z","timestamp":1793410401935,"version":"4.5.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T00:00:00Z","timestamp":1754524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82201496"],"award-info":[{"award-number":["82201496"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Guangdong Science and Technology Department-Regional Joint Fund","award":["2020A1515111133"],"award-info":[{"award-number":["2020A1515111133"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"DOI":"10.1186\/s12879-025-11404-5","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T06:12:22Z","timestamp":1754547142000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Acute haemorrhagic necrotizing encephalopathy and inflammatory demyelinating encephalopathy associated with COVID-19 in adults in Southern China"],"prefix":"10.1186","volume":"25","author":[{"given":"Sha","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunping","family":"Cui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"En-Peng","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilong","family":"Shan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyu","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Qiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengqi","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,7]]},"reference":[{"issue":"6","key":"11404_CR1","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1001\/jamaneurol.2020.1127","volume":"77","author":"L Mao","year":"2020","unstructured":"Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in wuhan, China. JAMA Neurol. 2020;77(6):683\u201390.","journal-title":"JAMA Neurol"},{"issue":"9","key":"11404_CR2","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/S1474-4422(20)30221-0","volume":"19","author":"MA Ellul","year":"2020","unstructured":"Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol. 2020;19(9):767\u201383.","journal-title":"Lancet Neurol"},{"issue":"23","key":"11404_CR3","doi-asserted-by":"publisher","first-page":"2268","DOI":"10.1056\/NEJMc2008597","volume":"382","author":"J Helms","year":"2020","unstructured":"Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020;382(23):2268\u201370.","journal-title":"N Engl J Med"},{"issue":"1\u20132","key":"11404_CR4","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.neurol.2020.10.001","volume":"177","author":"A Maury","year":"2021","unstructured":"Maury A, Lyoubi A, Peiffer-Smadja N, de Broucker T, Meppiel E. Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: a narrative review for clinicians. Rev Neurol (Paris). 2021;177(1\u20132):51\u201364.","journal-title":"Rev Neurol (Paris)"},{"issue":"1","key":"11404_CR5","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1186\/s41983-021-00413-1","volume":"57","author":"VV Ermilov","year":"2021","unstructured":"Ermilov VV, Dorofeev NA. Clinical and morphological features of SARS-COV-2 associated acute hemorrhagic necrotizing encephalopathy: case report. Egypt J Neurol Psychiatr Neurosurg. 2021;57(1):158.","journal-title":"Egypt J Neurol Psychiatr Neurosurg"},{"key":"11404_CR6","doi-asserted-by":"crossref","unstructured":"Manzano GS, McEntire C, Martinez-Lage M, Mateen FJ, Hutto SK. Acute disseminated encephalomyelitis and acute hemorrhagic leukoencephalitis following COVID-19: systematic review and Meta-synthesis. Neurol Neuroimmunol Neuroinflamm. 2021;8(6).","DOI":"10.1212\/NXI.0000000000001080"},{"issue":"1","key":"11404_CR7","first-page":"1","volume":"24","author":"HS Wang","year":"2001","unstructured":"Wang HS, Huang SC. Acute necrotizing encephalopathy of childhood. Chang Gung Med J. 2001;24(1):1\u201310.","journal-title":"Chang Gung Med J"},{"issue":"10","key":"11404_CR8","doi-asserted-by":"publisher","first-page":"928","DOI":"10.1016\/j.braindev.2016.05.002","volume":"38","author":"HY Lim","year":"2016","unstructured":"Lim HY, Ho VP, Lim TC, Thomas T, Chan DW. Serial outcomes in acute necrotising encephalopathy of childhood: a medium and long term study. Brain Dev. 2016;38(10):928\u201336.","journal-title":"Brain Dev"},{"key":"11404_CR9","doi-asserted-by":"crossref","unstructured":"Dixon L, Varley J, Gontsarova A, Mallon D, Tona F, Muir D et al. COVID-19-related acute necrotizing encephalopathy with brain stem involvement in a patient with aplastic anemia. Neurol Neuroimmunol Neuroinflamm. 2020;7(5).","DOI":"10.1212\/NXI.0000000000000789"},{"issue":"23","key":"11404_CR10","doi-asserted-by":"publisher","first-page":"e2269","DOI":"10.1212\/WNL.0000000000012930","volume":"97","author":"S Misra","year":"2021","unstructured":"Misra S, Kolappa K, Prasad M, Radhakrishnan D, Thakur KT, Solomon T, et al. Frequency of neurologic manifestations in COVID-19: a systematic review and Meta-analysis. Neurology. 2021;97(23):e2269\u201381.","journal-title":"Neurology"},{"issue":"4","key":"11404_CR11","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1515\/revneuro-2021-0082","volume":"33","author":"R Zamani","year":"2022","unstructured":"Zamani R, Pouremamali R, Rezaei N. Central neuroinflammation in Covid-19: a systematic review of 182 cases with encephalitis, acute disseminated encephalomyelitis, and necrotizing encephalopathies. Rev Neurosci. 2022;33(4):397\u2013412.","journal-title":"Rev Neurosci"},{"key":"11404_CR12","doi-asserted-by":"publisher","first-page":"102194","DOI":"10.1016\/j.msard.2020.102194","volume":"43","author":"JM Levine","year":"2020","unstructured":"Levine JM, Ahsan N, Ho E, Santoro JD. Genetic acute necrotizing encephalopathy associated with RANBP2: clinical and therapeutic implications in pediatrics. Mult Scler Relat Disord. 2020;43:102194.","journal-title":"Mult Scler Relat Disord"},{"key":"11404_CR13","doi-asserted-by":"publisher","first-page":"1070379","DOI":"10.3389\/fimmu.2022.1070379","volume":"13","author":"V Bonetto","year":"2022","unstructured":"Bonetto V, Pasetto L, Lisi I, Carbonara M, Zangari R, Ferrari E, et al. Markers of blood-brain barrier disruption increase early and persistently in COVID-19 patients with neurological manifestations. Front Immunol. 2022;13:1070379.","journal-title":"Front Immunol"},{"issue":"11","key":"11404_CR14","doi-asserted-by":"publisher","first-page":"3870","DOI":"10.1111\/ene.14966","volume":"28","author":"D Ziemele","year":"2021","unstructured":"Ziemele D, Kauke G, Skrejane K, Jaunozoli\u0146a L, Karelis G. A fatal case of COVID-19-associated acute necrotizing encephalopathy. Eur J Neurol. 2021;28(11):3870\u20132.","journal-title":"Eur J Neurol"},{"issue":"23","key":"11404_CR15","first-page":"e2262","volume":"97","author":"S C Valencia","year":"2021","unstructured":"C Valencia S, Theel E, Binnicker M, Toledano M, McKeon A. Autoimmune encephalitis after SARS-CoV-2 infection: case frequency, findings, and outcomes. Neurology. 2021;97(23):e2262\u20138.","journal-title":"Neurology"},{"issue":"2","key":"11404_CR16","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1136\/jnnp.74.2.262","volume":"74","author":"S Yamada","year":"2003","unstructured":"Yamada S, Kameyama T, Nagaya S, Hashizume Y, Yoshida M. Relapsing herpes simplex encephalitis: pathological confirmation of viral reactivation. J Neurol Neurosurg Psychiatry. 2003;74(2):262\u20134.","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"5","key":"11404_CR17","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/s00281-017-0629-x","volume":"39","author":"R Channappanavar","year":"2017","unstructured":"Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol. 2017;39(5):529\u201339.","journal-title":"Semin Immunopathol"},{"issue":"1","key":"11404_CR18","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s12974-021-02339-0","volume":"19","author":"S Jarius","year":"2022","unstructured":"Jarius S, Pache F, Kortvelyessy P, Hashizume Y, Yoshida M. Cerebrospinal fluid findings in COVID-19: a multicenter study of 150 lumbar punctures in 127 patients. J Neuroinflammation. 2022;19(1):19.","journal-title":"J Neuroinflammation"},{"key":"11404_CR19","doi-asserted-by":"publisher","first-page":"102506","DOI":"10.1016\/j.jaut.2020.102506","volume":"114","author":"Y Rodriguez","year":"2020","unstructured":"Rodriguez Y, Novelli L, Rojas M, De Santis M, Acosta-Ampudia Y, Monsalve DM, et al. Autoinflammatory and autoimmune conditions at the crossroad of COVID-19. J Autoimmun. 2020;114:102506.","journal-title":"J Autoimmun"},{"key":"11404_CR20","doi-asserted-by":"publisher","first-page":"866153","DOI":"10.3389\/fimmu.2022.866153","volume":"13","author":"M Guasp","year":"2022","unstructured":"Guasp M, Munoz-Sanchez G, Martinez-Hernandez E, Santana D, Carbayo \u00c1, Naranjo L, et al. CSF biomarkers in COVID-19 associated encephalopathy and encephalitis predict Long-Term outcome. Front Immunol. 2022;13:866153.","journal-title":"Front Immunol"},{"issue":"7","key":"11404_CR21","doi-asserted-by":"publisher","first-page":"641","DOI":"10.1080\/14737175.2023.2224503","volume":"23","author":"N Qin","year":"2023","unstructured":"Qin N, Wang J, Peng X, Wang L. Pathogenesis and management of acute necrotizing encephalopathy. Expert Rev Neurother. 2023;23(7):641\u201350.","journal-title":"Expert Rev Neurother"},{"issue":"6","key":"11404_CR22","doi-asserted-by":"publisher","first-page":"597","DOI":"10.3988\/jcn.2022.0431","volume":"19","author":"S Karami","year":"2023","unstructured":"Karami S, Khalaj F, Sotoudeh H, Tajabadi Z, Shahidi R, Habibi MA, et al. Acute necrotizing encephalopathy in adult patients with COVID-19: a systematic review of case reports and case series. J Clin Neurol. 2023;19(6):597\u2013611.","journal-title":"J Clin Neurol"},{"issue":"9","key":"11404_CR23","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1016\/S1474-4422(16)30043-6","volume":"15","author":"TA Hardy","year":"2016","unstructured":"Hardy TA, Reddel SW, Barnett MH, Palace J, Lucchinetti CF, Weinshenker BG. Atypical inflammatory demyelinating syndromes of the CNS. Lancet Neurol. 2016;15(9):967\u201381.","journal-title":"Lancet Neurol"},{"key":"11404_CR24","doi-asserted-by":"crossref","unstructured":"Novi G, Rossi T, Pedemonte E, Saitta L, Rolla C, Roccatagliata L et al. Acute disseminated encephalomyelitis after SARS-CoV-2 infection. Neurol Neuroimmunol Neuroinflamm. 2020;7(5).","DOI":"10.1212\/NXI.0000000000000797"},{"issue":"5","key":"11404_CR25","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1007\/s00234-021-02667-1","volume":"63","author":"B Varadan","year":"2021","unstructured":"Varadan B, Shankar A, Rajakumar A, Subramanian S, Sathya AC, Hakeem AR, et al. Acute hemorrhagic leukoencephalitis in a COVID-19 patient-a case report with literature review. Neuroradiology. 2021;63(5):653\u201361.","journal-title":"Neuroradiology"},{"issue":"1","key":"11404_CR26","doi-asserted-by":"publisher","first-page":"E223","DOI":"10.1148\/radiol.2020202040","volume":"297","author":"A Radmanesh","year":"2020","unstructured":"Radmanesh A, Derman A, Lui YW, Raz E, Loh JP, Hagiwara M, et al. COVID-19-associated diffuse leukoencephalopathy and microhemorrhages. Radiology. 2020;297(1):E223\u20137.","journal-title":"Radiology"},{"issue":"11","key":"11404_CR27","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1177\/13524585221094241","volume":"28","author":"TA Hardy","year":"2022","unstructured":"Hardy TA, Guo Y, Flanagan EP, Lucchinetti CF, Tobin WO. The clinical spectrum of haemorrhagic CNS inflammatory demyelinating lesions. Mult Scler. 2022;28(11):1710\u20138.","journal-title":"Mult Scler"},{"issue":"2","key":"11404_CR28","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1177\/1941874412466873","volume":"3","author":"MR Rahmlow","year":"2013","unstructured":"Rahmlow MR, Kantarci O. Fulminant demyelinating diseases. Neurohospitalist. 2013;3(2):81\u201391.","journal-title":"Neurohospitalist"},{"issue":"1","key":"11404_CR29","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1177\/0883073807299971","volume":"22","author":"ET Payne","year":"2007","unstructured":"Payne ET, Rutka JT, Ho TK, Halliday WC, Banwell BL. Treatment leading to dramatic recovery in acute hemorrhagic leukoencephalitis. J Child Neurol. 2007;22(1):109\u201313.","journal-title":"J Child Neurol"},{"key":"11404_CR30","doi-asserted-by":"publisher","first-page":"6008375","DOI":"10.1155\/2022\/6008375","volume":"2022","author":"M Alromaihi","year":"2022","unstructured":"Alromaihi M. Acute hemorrhagic leukoencephalitis (AHLE): a comprehensive review on causes, symptoms, link with COVID-19, diagnosis, and treatment. Biomed Res Int. 2022;2022:6008375.","journal-title":"Biomed Res Int"},{"key":"11404_CR31","doi-asserted-by":"publisher","first-page":"577751","DOI":"10.1016\/j.jneuroim.2021.577751","volume":"361","author":"SS Pujari","year":"2021","unstructured":"Pujari SS, Kulkarni RV, Ojha P, Gursahani R, Nadgir D, Patil S, et al. Acute haemorrhagic leukoencephalitis (AHLE) - our experience and a short review. J Neuroimmunol. 2021;361:577751.","journal-title":"J Neuroimmunol"},{"issue":"10","key":"11404_CR32","doi-asserted-by":"publisher","first-page":"3324","DOI":"10.1111\/ene.14703","volume":"28","author":"J Virhammar","year":"2021","unstructured":"Virhammar J, Naas A, Fallmar D, Cunningham JL, Klang A, Ashton NJ, et al. Biomarkers for central nervous system injury in cerebrospinal fluid are elevated in COVID-19 and associated with neurological symptoms and disease severity. Eur J Neurol. 2021;28(10):3324\u201331.","journal-title":"Eur J Neurol"},{"issue":"8","key":"11404_CR33","doi-asserted-by":"publisher","first-page":"1224","DOI":"10.1212\/WNL.59.8.1224","volume":"59","author":"S Tenembaum","year":"2002","unstructured":"Tenembaum S, Chamoles N, Fejerman N. Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients. Neurology. 2002;59(8):1224\u201331.","journal-title":"Neurology"},{"issue":"5","key":"11404_CR34","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1001\/jamaneurol.2014.34","volume":"71","author":"CE Otten","year":"2014","unstructured":"Otten CE, Creutzfeldt CJ. Fulminant acute disseminated encephalomyelitis presenting in an adult. JAMA Neurol. 2014;71(5):648\u20139.","journal-title":"JAMA Neurol"},{"issue":"4","key":"11404_CR35","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/j.chom.2013.03.010","volume":"13","author":"OO Koyuncu","year":"2013","unstructured":"Koyuncu OO, Hogue IB, Enquist LW. Virus infections in the nervous system. Cell Host Microbe. 2013;13(4):379\u201393.","journal-title":"Cell Host Microbe"},{"issue":"9","key":"11404_CR36","doi-asserted-by":"publisher","first-page":"e3019","DOI":"10.1093\/cid\/ciaa1933","volume":"73","author":"A Pilotto","year":"2021","unstructured":"Pilotto A, Masciocchi S, Volonghi I, De Giuli V, Caprioli F, Mariotto S, et al. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) encephalitis is a cytokine release syndrome: evidences from cerebrospinal fluid analyses. Clin Infect Dis. 2021;73(9):e3019\u201326.","journal-title":"Clin Infect Dis"},{"issue":"22","key":"11404_CR37","doi-asserted-by":"publisher","first-page":"e2247","DOI":"10.1212\/WNL.0000000000207263","volume":"100","author":"S Legriel","year":"2023","unstructured":"Legriel S, Badenes R, Engrand N, Mendoza-Trujillo R, Soulier P, Benghanem S, et al. Outcomes in patients with COVID-19 with acute encephalopathy and coma: an international prospective study. Neurology. 2023;100(22):e2247\u201358.","journal-title":"Neurology"},{"key":"11404_CR38","doi-asserted-by":"crossref","unstructured":"Stoian A, Bajko Z, Stoian M, Cioflinc RA, Niculescu R, Arb\u0103nai EM et al. The occurrence of acute disseminated encephalomyelitis in SARS-CoV-2 infection\/vaccination: our experience and a systematic review of the literature. Vaccines (Basel).2023;11(7).","DOI":"10.3390\/vaccines11071225"},{"issue":"4","key":"11404_CR39","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1007\/s00415-011-6258-8","volume":"259","author":"D Athauda","year":"2012","unstructured":"Athauda D, Andrews TC, Holmes PA, Howard RS. Multiphasic acute disseminated encephalomyelitis (ADEM)\u2002following\u2002influenza\u2002type A (swine specific H1N1). J Neurol. 2012;259(4):775\u20138.","journal-title":"J Neurol"},{"issue":"9","key":"11404_CR40","doi-asserted-by":"publisher","first-page":"914","DOI":"10.1016\/S1474-4422(15)00111-8","volume":"14","author":"JE Fugate","year":"2015","unstructured":"Fugate JE, Rabinstein AA. Posterior reversible encephalopathy syndrome: clinical and radiological manifestations, pathophysiology, and outstanding questions. Lancet Neurol. 2015;14(9):914\u201325.","journal-title":"Lancet Neurol"},{"issue":"5","key":"11404_CR41","doi-asserted-by":"publisher","first-page":"125","DOI":"10.31083\/j.jin2105125","volume":"21","author":"H Guo","year":"2022","unstructured":"Guo H, Sun L, Shen X, Hu W. A retrospective study of the clinical characteristics of Japanese encephalitis in adults. J Integr Neurosci. 2022;21(5):125.","journal-title":"J Integr Neurosci"},{"issue":"12","key":"11404_CR42","doi-asserted-by":"publisher","first-page":"2250","DOI":"10.3174\/ajnr.A6803","volume":"41","author":"HA Vanjare","year":"2020","unstructured":"Vanjare HA, Selvi BT, Karuppusami R, Manesh A, Gunasekaran K, Prabhakar AT, et al. Clinical and radiolo,ic findings of acute necrotizing encephalopathy in young adults. AJNR Am J Neuroradiol. 2020;41(12):2250\u20134.","journal-title":"AJNR Am J Neuroradiol"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-11404-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-025-11404-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-11404-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T22:27:52Z","timestamp":1757370472000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-025-11404-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,7]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["11404"],"URL":"https:\/\/doi.org\/10.1186\/s12879-025-11404-5","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,7]]},"assertion":[{"value":"19 June 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 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":"Written informed consent was obtained from the patient for the participation as well as the publication of the case report and any accompanying images. And this study was approved by the ethics committee of South China Agricultural University (ethical number: CR2023-011-01).A copy of the written consent is available upon request from the corresponding author.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Written informed consent for publication of identifying images or other personal or clinical details was obtained from the the participants or parents or legal guardians of any participant under the age of 18.","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":"990"}}