{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,8]],"date-time":"2026-02-08T04:05:07Z","timestamp":1770523507478,"version":"3.49.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T00:00:00Z","timestamp":1698278400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T00:00:00Z","timestamp":1698278400000},"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 Nephrol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Nephrotic syndrome (NS) is a condition associated with hypercoagulability. Thromboembolic events are a well-recognized complication of NS. Venous thrombosis is well known, while arterial thrombosis, which is more severe, occurs less frequently and is mainly reported in children in the literature. The aim of this study was to understand these rare adult cases of NS associated with acute lower extremity arterial thrombosis and draw attention to them to prevent misdiagnosis and delayed treatment.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>From January 2011 and October 2022, we conducted a retrospective study of patients with NS and arterial thrombosis. Their clinical manifestations, imaging characteristics, treatments and outcomes were analyzed and compared, and a literature review was performed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Nine adults with NS and acute lower limb arterial thrombosis were described. In seven of these patients, six had fresh thrombi that preceded the NS diagnosis, while one had a history of NS for 14 years and previously underwent an emergency thrombectomy. Three of the seven patients eventually underwent above-knee amputations, and the other four underwent arterial revascularization with satisfactory recovery of lower-extremity perfusion. In addition to the seven patients mentioned above, the other two received successful anticoagulant treatment, as the thrombosis was present only in the popliteal artery.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Acute lower extremity arterial thrombosis is a rare but serious and potentially lethal complication in patients with NS, and early recognition and appropriate management are crucial for good patient outcomes.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12882-023-03374-0","type":"journal-article","created":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T13:02:18Z","timestamp":1698325338000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Acute lower extremity arterial thrombosis associated with nephrotic syndrome in adults: case series and literature review"],"prefix":"10.1186","volume":"24","author":[{"given":"Xinqiang","family":"Han","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingang","family":"Ji","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengpeng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,10,26]]},"reference":[{"key":"3374_CR1","doi-asserted-by":"publisher","first-page":"107602962110102","DOI":"10.1177\/10760296211010256","volume":"27","author":"X Chen","year":"2021","unstructured":"Chen X, Geng X, Jin S, Xu J, Guo M, Shen D, Ding X, Liu H, Xu X. The Association of Syndecan-1, Hypercoagulable State and Thrombosis and in patients with Nephrotic Syndrome. Clin Appl Thromb Hemost. 2021;27:10760296211010256. https:\/\/doi.org\/10.1177\/10760296211010256.","journal-title":"Clin Appl Thromb Hemost"},{"key":"3374_CR2","doi-asserted-by":"publisher","first-page":"512","DOI":"10.2174\/157016111203140518172048","volume":"12","author":"A Gigante","year":"2014","unstructured":"Gigante A, Barbano B, Sardo L, Martina P, Gasperini ML, Labbadia R, Liberatori M, Amoroso A, Cianci R. Hypercoagulability and Nephrotic Syndrome. Curr Vasc Pharmacol. 2014;12:512\u20137. https:\/\/doi.org\/10.2174\/157016111203140518172048.","journal-title":"Curr Vasc Pharmacol"},{"key":"3374_CR3","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/j.ekir.2019.12.001","volume":"5","author":"R Lin","year":"2020","unstructured":"Lin R, McDonald G, Jolly T, Batten A, Chacko B. A systematic review of prophylactic anticoagulation in Nephrotic Syndrome. Kidney Int Rep. 2020;5:435\u201347. https:\/\/doi.org\/10.1016\/j.ekir.2019.12.001.","journal-title":"Kidney Int Rep"},{"key":"3374_CR4","doi-asserted-by":"publisher","first-page":"513","DOI":"10.2215\/cjn.10131011","volume":"7","author":"BA Kerlin","year":"2012","unstructured":"Kerlin BA, Ayoob R, Smoyer WE. Epidemiology and pathophysiology of nephrotic syndrome-associated thromboembolic Disease. Clin J Am Soc Nephrol. 2012;7:513\u201320. https:\/\/doi.org\/10.2215\/cjn.10131011.","journal-title":"Clin J Am Soc Nephrol"},{"key":"3374_CR5","doi-asserted-by":"publisher","first-page":"242","DOI":"10.3345\/kjp.2016.59","volume":"59","author":"KH Han","year":"2016","unstructured":"Han KH, Park JY, Min SK, Ha IS, Cheong HI, Kang HG. Bilateral iliac and popliteal arterial Thrombosis in a child with focal segmental glomerulosclerosis. Korean J Pediatr. 2016;59:242\u20135. https:\/\/doi.org\/10.3345\/kjp.2016.59242.","journal-title":"Korean J Pediatr"},{"key":"3374_CR6","doi-asserted-by":"publisher","first-page":"68","DOI":"10.3400\/avd.AVDcr09015","volume":"3","author":"A Kimura","year":"2010","unstructured":"Kimura A, Nishimura K, Miyasaka S, Maeta H, Morimoto K, Taniguchi I. A case of acute arterial Thrombosis caused by Nephrotic Syndrome. Ann Vasc Dis. 2010;3:68\u201370. https:\/\/doi.org\/10.3400\/avd.AVDcr09015.","journal-title":"Ann Vasc Dis"},{"key":"3374_CR7","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1016\/s1001-9294(17)30011-1","volume":"31","author":"M Ma","year":"2016","unstructured":"Ma M, Luo L, Zeng S, Chen X, Liu F, Guan B, Chen Z, Dong X, Yin L. A Case Report of Acute arterial embolization of right Lower Extremity as the initial presentation of Nephrotic Syndrome with minimal changes. Chin Med Sci J. 2016;31:261\u20133. https:\/\/doi.org\/10.1016\/s1001-9294(17)30011-1.","journal-title":"Chin Med Sci J"},{"key":"3374_CR8","first-page":"618","volume":"114","author":"WC Tarry","year":"1993","unstructured":"Tarry WC, Moser AJ, Makhoul RG. Peripheral arterial Thrombosis in the Nephrotic Syndrome. Surgery. 1993;114:618\u201323. PMID: 8367821.","journal-title":"Surgery"},{"key":"3374_CR9","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1159\/000188680","volume":"71","author":"VP Khatri","year":"1995","unstructured":"Khatri VP, Fisher JB, Granson MA. Spontaneous arterial Thrombosis associated with Nephrotic Syndrome: case report and review of the literature. Nephron. 1995;71:95\u20137. https:\/\/doi.org\/10.1159\/000188680.","journal-title":"Nephron"},{"key":"3374_CR10","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1007\/s005950070110","volume":"30","author":"M Nishimura","year":"2000","unstructured":"Nishimura M, Shimada J, Ito K, Kawachi H, Nishiyama K. Acute arterial Thrombosis with antithrombin III deficiency in Nephrotic Syndrome: report of a case. Surg Today. 2000;30:663\u20136. https:\/\/doi.org\/10.1007\/s005950070110.","journal-title":"Surg Today"},{"key":"3374_CR11","doi-asserted-by":"publisher","first-page":"174","DOI":"10.4103\/1319-2442.198246","volume":"28","author":"J Labidi","year":"2017","unstructured":"Labidi J, Selmi Y, Ariba YB, Elloumi Z, Othmani S. A case of abdominal aortic Thrombosis associated with the Nephrotic Syndrome. Saudi J Kidney Dis Transpl. 2017;28:174\u20137. https:\/\/doi.org\/10.4103\/1319-2442.198246.","journal-title":"Saudi J Kidney Dis Transpl"},{"key":"3374_CR12","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1097\/maj.0000000000000208","volume":"347","author":"L Xiang","year":"2014","unstructured":"Xiang L, Zhou H, Jiang Z, Pan J, Yang M. Abdominal aortic Thrombosis associated with Nephrotic Syndrome. Am J Med Sci. 2014;347:91\u20132. https:\/\/doi.org\/10.1097\/maj.0000000000000208.","journal-title":"Am J Med Sci"},{"key":"3374_CR13","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1136\/pgmj.70.830.905","volume":"70","author":"IH Fahal","year":"1994","unstructured":"Fahal IH, McClelland P, Hay CR, Bell GM. Arterial Thrombosis in the Nephrotic Syndrome. Postgrad Med J. 1994;70:905\u20139. https:\/\/doi.org\/10.1136\/pgmj.70.830.905.","journal-title":"Postgrad Med J"},{"key":"3374_CR14","first-page":"28","volume":"5","author":"K El-Reshaid","year":"1994","unstructured":"El-Reshaid K, Kapoor M, Hakim A. Arterial Thrombosis in Nephrotic Syndrome due to minimal change glomerulonephritis. Saudi J Kidney Dis Transpl. 1994;5:28\u201332. PMID: 18583759.","journal-title":"Saudi J Kidney Dis Transpl"},{"key":"3374_CR15","first-page":"311","volume":"17","author":"CH Chuang","year":"2004","unstructured":"Chuang CH, Lee CT, Cheng YF, Huang TL, Hung KH, Chen JB. Bilateral renal infarctions and lower limbs artery Thrombosis in a patient with Nephrotic Syndrome. J Nephrol. 2004;17:311\u20135. PMID: 15293535.","journal-title":"J Nephrol"},{"key":"3374_CR16","doi-asserted-by":"publisher","first-page":"105","DOI":"10.26442\/00403660.2020.06.000667","volume":"92","author":"LA Bobrova","year":"2020","unstructured":"Bobrova LA, Kozlovskaya NL. Thromboembolic Complications in Nephrotic Syndrome. Ter Arkh. 2020;92:105\u201316. https:\/\/doi.org\/10.26442\/00403660.2020.06.000667.","journal-title":"Ter Arkh"},{"key":"3374_CR17","doi-asserted-by":"publisher","first-page":"230","DOI":"10.3346\/jkms.1993.8.3.230","volume":"8","author":"HJ Kim","year":"1993","unstructured":"Kim HJ, Park CH, Kang CM, Park HC, Kim CY, Cho YS. Arterial Thrombosis associated with Nephrotic syndrome\u2013a case report and review (adult cases in the English literature). J Korean Med Sci. 1993;8:230\u20134. https:\/\/doi.org\/10.3346\/jkms.1993.8.3.230.","journal-title":"J Korean Med Sci"},{"key":"3374_CR18","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1016\/j.thromres.2005.03.030","volume":"118","author":"R Singhal","year":"2006","unstructured":"Singhal R, Brimble KS. Thromboembolic Complications in the Nephrotic Syndrome: pathophysiology and clinical management. Thromb Res. 2006;118:397\u2013407. https:\/\/doi.org\/10.1016\/j.thromres.2005.03.030.","journal-title":"Thromb Res"},{"key":"3374_CR19","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1080\/2000966","volume":"7","author":"N Tachamo","year":"2017","unstructured":"Tachamo N, Dhital R, Timilsina B, Nazir S, Lohani S, Poudel DR. Popliteal arterial Thrombosis in Nephrotic Syndrome: a case report. J Community Hosp Intern Med Perspect. 2017;7:34\u20136. https:\/\/doi.org\/10.1080\/20009662017.1286814..","journal-title":"J Community Hosp Intern Med Perspect"},{"key":"3374_CR20","first-page":"129","volume":"19","author":"R Patel","year":"1978","unstructured":"Patel R, Mandal AK. Arterial Thrombosis associated with the Nephrotic Syndrome. J Cardiovasc Surg (Torino). 1978;19:129\u201334. PMID: 659488.","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"3374_CR21","first-page":"353","volume":"34","author":"JC Hoak","year":"1989","unstructured":"Hoak JC. The endothelium, platelets, and coronary vasospasm. Adv Intern Med. 1989;34:353\u201375. PMID: 2644764.","journal-title":"Adv Intern Med"},{"issue":"Suppl 2","key":"3374_CR22","first-page":"66","volume":"60","author":"A Caraba","year":"2007","unstructured":"Caraba A, Romo\u015fan I. Endothelial dysfunction in the Nephrotic Syndrome. Med Pregl. 2007;60(Suppl 2):66\u20139. PMID: 18928161.","journal-title":"Med Pregl"},{"key":"3374_CR23","doi-asserted-by":"publisher","unstructured":"Hulshof AM, Hemker HC, Spronk HMH, Henskens YMC, Ten Cate H. Thrombin-Fibrin(ogen) interactions, Host Defense and risk of Thrombosis. Int J Mol Sci. 2021;22. https:\/\/doi.org\/10.3390\/ijms22052590.","DOI":"10.3390\/ijms22052590"},{"key":"3374_CR24","doi-asserted-by":"publisher","first-page":"1973","DOI":"10.1182\/blood.2020007208","volume":"139","author":"NI Popescu","year":"2022","unstructured":"Popescu NI, Lupu C, Lupu F. Disseminated intravascular coagulation and its immune mechanisms. Blood. 2022;139:1973\u201386. https:\/\/doi.org\/10.1182\/blood.2020007208.","journal-title":"Blood"},{"key":"3374_CR25","doi-asserted-by":"publisher","first-page":"2225","DOI":"10.1016\/j.jacc.2009.12.049","volume":"55","author":"T Sadanaga","year":"2010","unstructured":"Sadanaga T, Sadanaga M, Ogawa S. Evidence that D-dimer levels predict subsequent thromboembolic and cardiovascular events in patients with atrial fibrillation during oral anticoagulant therapy. J Am Coll Cardiol. 2010;55:2225\u201331. https:\/\/doi.org\/10.1016\/j.jacc.2009.12.049.","journal-title":"J Am Coll Cardiol"},{"key":"3374_CR26","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1161\/circulationaha.107.716951","volume":"117","author":"BK Mahmoodi","year":"2008","unstructured":"Mahmoodi BK, ten Kate MK, Waanders F, Veeger NJ, Brouwer JL, Vogt L, Navis G, van der Meer J. High absolute risks and predictors of venous and arterial thromboembolic events in patients with Nephrotic Syndrome: results from a large retrospective cohort study. Circulation. 2008;117:224\u201330. https:\/\/doi:10.1161\/ circulationaha.107.716951.","journal-title":"Circulation"},{"key":"3374_CR27","doi-asserted-by":"publisher","first-page":"50","DOI":"10.4068\/cmj.2013.49.1.50","volume":"49","author":"JK Lee","year":"2013","unstructured":"Lee JK, Baek MS, Mok YM, Kim SA, Lim BJ, Lee JE, Kim H. Successfully treated femoral artery Thrombosis in a patient with minimal change Nephrotic Syndrome. Chonnam Med J. 2013;49:50\u20133. https:\/\/doi:10.4068\/ cmj.2013.49.1.50.","journal-title":"Chonnam Med J"},{"key":"3374_CR28","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1080\/00365519850186454","volume":"58","author":"G Lilienberg","year":"1998","unstructured":"Lilienberg G, Venge P. Platelet adhesion in patients prone to arterial and venous Thrombosis: the impact of gender, Smoking and heredity. Scand J Clin Lab Invest. 1998;58:279\u201386. https:\/\/doi.org\/10.1080\/00365519850186454.","journal-title":"Scand J Clin Lab Invest"},{"key":"3374_CR29","doi-asserted-by":"publisher","first-page":"91","DOI":"10.24920\/11809","volume":"33","author":"PM Zou","year":"2018","unstructured":"Zou PM, Li H, Cai JF, Chen ZJ, Li C, Xu P, Li MX, Chen LM, Li XM, Li XW. A Cohort Study of incidences and Risk factors for thromboembolic events in patients with idiopathic membranous Nephropathy. Chin Med Sci J. 2018;33:91\u20139. https:\/\/doi.org\/10.24920\/11809.","journal-title":"Chin Med Sci J"},{"key":"3374_CR30","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1016\/j.nephro.2016.07.454","volume":"13","author":"R Arrab","year":"2017","unstructured":"Arrab R, Bourrahouate A, Sbihi M, Ait Sab I. Lower limb arterial Thrombosis in a Nephrotic Syndrome. Nephrol Ther. 2017;13:248\u201350. https:\/\/doi.org\/10.1016\/j.nephro.2016.07.454.","journal-title":"Nephrol Ther"},{"key":"3374_CR31","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1055\/a-0998-4204","volume":"192","author":"F Fluck","year":"2020","unstructured":"Fluck F, Augustin AM, Bley T, Kickuth R. Current treatment options in Acute Limb Ischemia. Rofo. 2020;192:319\u201326. https:\/\/doi.org\/10.1055\/a-0998-4204.","journal-title":"Rofo"},{"key":"3374_CR32","doi-asserted-by":"publisher","first-page":"234","DOI":"10.23736\/s0026-4725.18.04770-9","volume":"67","author":"F Stanek","year":"2019","unstructured":"Stanek F, Ouhrabkova R, Prochazka D. Could mechanical thrombectomy replace thrombolysis in the treatment of acute and subacute limb ischemia? Minerva Cardioangiol. 2019;67:234\u201345. https:\/\/doi.org\/10.23736\/s0026-4725.18.04770-9.","journal-title":"Minerva Cardioangiol"},{"key":"3374_CR33","unstructured":"Schena FP. (1999) Primary glomerulonephritides with nephrotic syndrome. Limitations of therapy in adult patients. J Nephrol 12 Suppl 2:S125-130. PMID: 10688412."},{"key":"3374_CR34","doi-asserted-by":"publisher","first-page":"e930097","DOI":"10.12659\/msm.930097","volume":"27","author":"L Wu","year":"2021","unstructured":"Wu L, Lai J, Ling Y, Weng Y, Zhou S, Wu S, Jiang S, Ding X, Jin X, Yu K, Chen Y. A review of the current practice of diagnosis and treatment of idiopathic membranous Nephropathy in China. Med Sci Monit. 2021;27:e930097. https:\/\/doi.org\/10.12659\/msm.930097.","journal-title":"Med Sci Monit"},{"key":"3374_CR35","doi-asserted-by":"publisher","unstructured":"Emmi G, Silvestri E, Squatrito D, Amedei A, Niccolai E, D\u2019Elios MM, Della Bella C, Grassi A, Becatti M, Fiorillo C, Emmi L, Vaglio A, Prisco D. (2015) Thrombosis in vasculitis: from pathogenesis to treatment. Thromb J 2015;13:15. https:\/\/doi.org\/10.1186\/s12959-015-0047-z.","DOI":"10.1186\/s12959-015-0047-z"},{"key":"3374_CR36","doi-asserted-by":"publisher","first-page":"462","DOI":"10.3816\/clm.2007.n.027","volume":"7","author":"JJ Auwerda","year":"2007","unstructured":"Auwerda JJ, Sonneveld P, de Maat MP, Leebeek FW. Prothrombotic coagulation abnormalities in patients with paraprotein-producing B-cell disorders. Clin Lymphoma Myeloma. 2007;7:462\u20136. https:\/\/doi:10.3816\/ clm.2007.n.027.","journal-title":"Clin Lymphoma Myeloma"},{"key":"3374_CR37","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1007\/s40620-022-01528-1","volume":"36","author":"M Allinovi","year":"2023","unstructured":"Allinovi M, Lugli G, Rossi F, Palterer B, Almerigogna F, Caroti L, Antognoli G, Cirami C. Accuracy of serum PLA2R antibody detected by indirect immunofluorescence in diagnosing biopsy-proven primary membranous Nephropathy: a single-center experience and a systematic review of the literature. J Nephrol. 2023;36:281\u20133. https:\/\/doi.org\/10.1007\/s40620-022-01528-1.","journal-title":"J Nephrol"},{"key":"3374_CR38","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1055\/s-0035-1549850","volume":"41","author":"E Niccolai","year":"2015","unstructured":"Niccolai E, Emmi G, Squatrito D, Silvestri E, Emmi L, Amedei A, Prisco D. Microparticles: bridging the gap between autoimmunity and Thrombosis. Semin Thromb Hemost. 2015;41:413\u201322. https:\/\/doi.org\/10.1055\/s-0035-1549850.","journal-title":"Semin Thromb Hemost"}],"container-title":["BMC Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-023-03374-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12882-023-03374-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12882-023-03374-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T13:02:36Z","timestamp":1698325356000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcnephrol.biomedcentral.com\/articles\/10.1186\/s12882-023-03374-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,26]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["3374"],"URL":"https:\/\/doi.org\/10.1186\/s12882-023-03374-0","relation":{},"ISSN":["1471-2369"],"issn-type":[{"value":"1471-2369","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,26]]},"assertion":[{"value":"15 March 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 October 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":"All procedures performed involving human participants according to the declaration of Helsinki principles. The Ethics Committee of Binzhou Medical University Hospital approved the study (No. LW-23), and informed consent was obtained from all subjects and\/or their legal guardian(s).","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 that they have no conflict of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"318"}}