{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:32:37Z","timestamp":1787020357507,"version":"build-2736575974"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T00:00:00Z","timestamp":1617926400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T00:00:00Z","timestamp":1617926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81871124"],"award-info":[{"award-number":["81871124"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Musculoskelet Disord"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The plate-to-disc distance (PDD) is an important factor affecting the degeneration of adjacent segments after anterior cervical discectomy and fusion (ACDF). However, the most suitable PDD is controversial. This study examined the adjacent intervertebral disc stress, bone graft stress, titanium plate stress and screw stress to evaluate the biomechanical effect of different PDD on surgical segment and adjacent segment following C5\/C6 ACDF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We constructed 10 preoperative finite element models of intact C4\u2013C7 segments and validated them in the present study. We simulated ACDF surgery based on the 10 intact models in software. We designed three different distance of plate-to-disc titanium plates: long PDD (10\u2009mm), medium PDD (5\u2009mm) and short PDD (0\u2009mm). The changes in C4\/C5 and C6\/C7 intervertebral disc stress, bone graft stress, titanium plate stress and screw stress were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The von Mises stress of C4\/C5 and C6\/C7 intervertebral discs had no significant differences (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&gt;\u20090.05) in three different PDD groups. Titanium plate stress increased as the PDD decreased. The bone graft stress and screws stress decreased as the PDD decreased. The maximum stress of each part occurred was mostly in the conditions of rotation and lateral bending.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The PDD has no effect on adjacent intervertebral disc stress, but it is an important factor that affecting the bone graft stress, titanium plate stress and screws stress after ACDF. Shorter PDD plate can provide better stability to reduce stress on screws and bone graft, which may be helpful to prevent cage subsidence, pseudarthrosis and instrument failure. This can serve as a reference for clinical choice of plate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12891-021-04218-4","type":"journal-article","created":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T11:03:11Z","timestamp":1617966191000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Biomechanical effect of different plate-to-disc distance on surgical and adjacent segment in anterior cervical discectomy and fusion - a finite element analysis"],"prefix":"10.1186","volume":"22","author":[{"given":"Xing","family":"Guo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaming","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueyang","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3371-7994","authenticated-orcid":false,"given":"Yuan","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,9]]},"reference":[{"issue":"4","key":"4218_CR1","doi-asserted-by":"publisher","first-page":"811","DOI":"10.3174\/ajnr.A4173","volume":"36","author":"W Brinjikji","year":"2015","unstructured":"Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811\u20136. https:\/\/doi.org\/10.3174\/ajnr.A4173.","journal-title":"AJNR Am J Neuroradiol"},{"issue":"1","key":"4218_CR2","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.joca.2013.10.019","volume":"22","author":"M Teraguchi","year":"2014","unstructured":"Teraguchi M, Yoshimura N, Hashizume H, Muraki S, Yamada H, Minamide A, et al. Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama spine study. Osteoarthr Cartil. 2014;22(1):104\u201310. https:\/\/doi.org\/10.1016\/j.joca.2013.10.019.","journal-title":"Osteoarthr Cartil"},{"issue":"24","key":"4218_CR3","doi-asserted-by":"publisher","first-page":"2674","DOI":"10.1097\/00007632-199812150-00005","volume":"23","author":"D Grob","year":"1998","unstructured":"Grob D. Surgery in the degenerative cervical spine. Spine. 1998;23(24):2674\u201383. https:\/\/doi.org\/10.1097\/00007632-199812150-00005.","journal-title":"Spine."},{"issue":"4","key":"4218_CR4","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1007\/BF01322448","volume":"6","author":"LC Persson","year":"1997","unstructured":"Persson LC, Moritz U, Brandt L, et al. Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study. Eur Spine J. 1997;6(4):256\u201366. https:\/\/doi.org\/10.1007\/BF01322448.","journal-title":"Eur Spine J"},{"issue":"2","key":"4218_CR5","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/j.ncl.2007.01.012","volume":"25","author":"DW Polston","year":"2007","unstructured":"Polston DW. Cervical radiculopathy. Neurol Clin. 2007;25(2):373\u201385. https:\/\/doi.org\/10.1016\/j.ncl.2007.01.012.","journal-title":"Neurol Clin"},{"key":"4218_CR6","doi-asserted-by":"crossref","unstructured":"Radhakrishnan K, Litchy W, O'Fallon W, Kurland L. Epidemiology of cervical radiculopathy. A population-based study from Rochester, Minnesota, 1976 through 1990. Brain J Neurol. 1994;117(Pt 2):325\u201335.","DOI":"10.1093\/brain\/117.2.325"},{"issue":"1","key":"4218_CR7","doi-asserted-by":"publisher","DOI":"10.3171\/2013.4.FOCUS13122","volume":"35","author":"J Wu","year":"2013","unstructured":"Wu J, Ko C, Yen Y, et al. Epidemiology of cervical spondylotic myelopathy and its risk of causing spinal cord injury: a national cohort study. Neurosurg Focus. 2013;35(1):E10. https:\/\/doi.org\/10.3171\/2013.4.FOCUS13122.","journal-title":"Neurosurg Focus"},{"issue":"2","key":"4218_CR8","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1056\/NEJMra2003558","volume":"383","author":"N Theodore","year":"2020","unstructured":"Theodore N. Degenerative cervical spondylosis. N Engl J Med. 2020;383(2):159\u201368. https:\/\/doi.org\/10.1056\/NEJMra2003558.","journal-title":"N Engl J Med"},{"issue":"16","key":"4218_CR9","doi-asserted-by":"publisher","first-page":"1796","DOI":"10.1097\/00007632-199808150-00014","volume":"23","author":"V Heidecke","year":"1998","unstructured":"Heidecke V, Rainov NG, Burkert W. Anterior cervical fusion with the Orion locking plate system. Spine. 1998;23(16):1796\u2013802discussion 803. https:\/\/doi.org\/10.1097\/00007632-199808150-00014.","journal-title":"Spine."},{"issue":"9","key":"4218_CR10","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1097\/00007632-199905010-00005","volume":"24","author":"CB Tribus","year":"1999","unstructured":"Tribus CB, Corteen DP, Zdeblick TA. The efficacy of anterior cervical plating in the management of symptomatic pseudoarthrosis of the cervical spine. Spine. 1999;24(9):860\u20134. https:\/\/doi.org\/10.1097\/00007632-199905010-00005.","journal-title":"Spine."},{"issue":"1","key":"4218_CR11","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1097\/00007632-200001010-00009","volume":"25","author":"JC Wang","year":"2000","unstructured":"Wang JC, McDonough PW, Endow KK, et al. Increased fusion rates with cervical plating for two-level anterior cervical discectomy and fusion. Spine. 2000;25(1):41\u20135. https:\/\/doi.org\/10.1097\/00007632-200001010-00009.","journal-title":"Spine."},{"issue":"2","key":"4218_CR12","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1097\/BSD.0b013e318274148e","volume":"26","author":"CH Lee","year":"2013","unstructured":"Lee CH, Hyun SJ, Kim MJ, Yeom JS, Kim WH, Kim KJ, et al. Comparative analysis of 3 different construct systems for single-level anterior cervical discectomy and fusion: stand-alone cage, iliac graft plus plate augmentation, and cage plus plating. J Spinal Disord Tech. 2013;26(2):112\u20138. https:\/\/doi.org\/10.1097\/BSD.0b013e318274148e.","journal-title":"J Spinal Disord Tech"},{"issue":"26","key":"4218_CR13","doi-asserted-by":"publisher","first-page":"2886","DOI":"10.1097\/BRS.0b013e3181b64f2c","volume":"34","author":"KJ Song","year":"2009","unstructured":"Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP. The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine. 2009;34(26):2886\u201392. https:\/\/doi.org\/10.1097\/BRS.0b013e3181b64f2c.","journal-title":"Spine."},{"issue":"10","key":"4218_CR14","doi-asserted-by":"publisher","first-page":"2290","DOI":"10.1016\/j.spinee.2014.01.027","volume":"14","author":"JY Chung","year":"2014","unstructured":"Chung JY, Kim SK, Jung ST, Lee KB. Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up. Spine J. 2014;14(10):2290\u20138. https:\/\/doi.org\/10.1016\/j.spinee.2014.01.027.","journal-title":"Spine J"},{"issue":"1","key":"4218_CR15","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1097\/BRS.0b013e3181b8a80d","volume":"35","author":"M Matsumoto","year":"2010","unstructured":"Matsumoto M, Okada E, Ichihara D, Watanabe K, Chiba K, Toyama Y, et al. Anterior cervical decompression and fusion accelerates adjacent segment degeneration: comparison with asymptomatic volunteers in a ten-year magnetic resonance imaging follow-up study. Spine. 2010;35(1):36\u201343. https:\/\/doi.org\/10.1097\/BRS.0b013e3181b8a80d.","journal-title":"Spine."},{"issue":"47","key":"4218_CR16","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000008663","volume":"96","author":"F Wang","year":"2017","unstructured":"Wang F, Hou HT, Wang P, Zhang JT, Shen Y. Symptomatic adjacent segment disease after single-lever anterior cervical discectomy and fusion: incidence and risk factors. Medicine. 2017;96(47):e8663. https:\/\/doi.org\/10.1097\/MD.0000000000008663.","journal-title":"Medicine."},{"issue":"4","key":"4218_CR17","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1007\/s00586-017-4988-8","volume":"26","author":"BW Burkhardt","year":"2017","unstructured":"Burkhardt BW, Brielmaier M, Schwerdtfeger K, Sharif S, Oertel JM. Smith-Robinson procedure with and without Caspar plating as a treatment for cervical spondylotic myelopathy: a 26-year follow-up of 23 patients. Eur Spine J. 2017;26(4):1246\u201353. https:\/\/doi.org\/10.1007\/s00586-017-4988-8.","journal-title":"Eur Spine J"},{"issue":"15","key":"4218_CR18","doi-asserted-by":"publisher","first-page":"1756","DOI":"10.1097\/01.brs.0000172148.86756.ce","volume":"30","author":"D Samartzis","year":"2005","unstructured":"Samartzis D, Shen FH, Goldberg EJ, An HS. Is autograft the gold standard in achieving radiographic fusion in one-level anterior cervical discectomy and fusion with rigid anterior plate fixation? Spine. 2005;30(15):1756\u201361. https:\/\/doi.org\/10.1097\/01.brs.0000172148.86756.ce.","journal-title":"Spine."},{"issue":"4","key":"4218_CR19","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1007\/s005860000243","volume":"10","author":"A Katsuura","year":"2001","unstructured":"Katsuura A, Hukuda S, Saruhashi Y, Mori K. Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels. Eur Spine J. 2001;10(4):320\u20134. https:\/\/doi.org\/10.1007\/s005860000243.","journal-title":"Eur Spine J"},{"key":"4218_CR20","doi-asserted-by":"publisher","first-page":"4902","DOI":"10.12659\/MSM.902179","volume":"22","author":"C Yu","year":"2016","unstructured":"Yu C, Mu X, Wei J, Chu Y, Liang B. In-depth analysis on influencing factors of adjacent segment degeneration after cervical fusion. Med Sci Monit. 2016;22:4902\u201310. https:\/\/doi.org\/10.12659\/MSM.902179.","journal-title":"Med Sci Monit"},{"issue":"7","key":"4218_CR21","doi-asserted-by":"publisher","first-page":"E388","DOI":"10.1097\/BRS.0000000000000800","volume":"40","author":"H Yang","year":"2015","unstructured":"Yang H, Lu X, He H, Yuan W, Wang X, Liao X, et al. Longer plate-to-disc distance prevents adjacent-level ossification development but does not influence adjacent-segment degeneration. Spine. 2015;40(7):E388\u201393. https:\/\/doi.org\/10.1097\/BRS.0000000000000800.","journal-title":"Spine."},{"issue":"6","key":"4218_CR22","doi-asserted-by":"publisher","first-page":"672","DOI":"10.1177\/0954411913480668","volume":"227","author":"M Nikkhoo","year":"2013","unstructured":"Nikkhoo M, Hsu YC, Haghpanahi M, Parnianpour M, Wang JL. A meta-model analysis of a finite element simulation for defining poroelastic properties of intervertebral discs. Proc Inst Mech Eng H. 2013;227(6):672\u201382. https:\/\/doi.org\/10.1177\/0954411913480668.","journal-title":"Proc Inst Mech Eng H"},{"issue":"14","key":"4218_CR23","doi-asserted-by":"publisher","first-page":"2342","DOI":"10.1016\/j.jbiomech.2013.07.014","volume":"46","author":"H Schmidt","year":"2013","unstructured":"Schmidt H, Galbusera F, Rohlmann A, Shirazi-Adl A. What have we learned from finite element model studies of lumbar intervertebral discs in the past four decades? J Biomech. 2013;46(14):2342\u201355. https:\/\/doi.org\/10.1016\/j.jbiomech.2013.07.014.","journal-title":"J Biomech"},{"issue":"4","key":"4218_CR24","doi-asserted-by":"publisher","first-page":"766","DOI":"10.1016\/j.jbiomech.2004.07.039","volume":"39","author":"G Denoziere","year":"2006","unstructured":"Denoziere G, Ku DN. Biomechanical comparison between fusion of two vertebrae and implantation of an artificial intervertebral disc. J Biomech. 2006;39(4):766\u201375. https:\/\/doi.org\/10.1016\/j.jbiomech.2004.07.039.","journal-title":"J Biomech"},{"issue":"12","key":"4218_CR25","doi-asserted-by":"publisher","first-page":"1926","DOI":"10.1016\/j.spinee.2017.07.009","volume":"17","author":"X Rong","year":"2017","unstructured":"Rong X, Wang B, Ding C, Deng Y, Chen H, Meng Y, et al. The biomechanical impact of facet tropism on the intervertebral disc and facet joints in the cervical spine. Spine J. 2017;17(12):1926\u201331. https:\/\/doi.org\/10.1016\/j.spinee.2017.07.009.","journal-title":"Spine J"},{"key":"4218_CR26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0268-0033(00)00074-7","volume":"16","author":"N Yoganandan","year":"2001","unstructured":"Yoganandan N, Kumaresan S, Pintar FA. Biomechanics of the cervical spine part 2. Cervical spine soft tissue responses and biomechanical modeling. Clin Biomech (Bristol, Avon). 2001;16:1\u201327.","journal-title":"Clin Biomech (Bristol, Avon)"},{"issue":"9","key":"4218_CR27","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1007\/s10439-008-9534-8","volume":"36","author":"JA Wheeldon","year":"2008","unstructured":"Wheeldon JA, Stemper BD, Yoganandan N, Pintar FA. Validation of a finite element model of the young normal lower cervical spine. Ann Biomed Eng. 2008;36(9):1458\u201369. https:\/\/doi.org\/10.1007\/s10439-008-9534-8.","journal-title":"Ann Biomed Eng"},{"key":"4218_CR28","doi-asserted-by":"publisher","first-page":"103519","DOI":"10.1016\/j.compbiomed.2019.103519","volume":"116","author":"XY Cai","year":"2020","unstructured":"Cai XY, Sang D, Yuchi CX, Cui W, Zhang C, du CF, et al. Using finite element analysis to determine effects of the motion loading method on facet joint forces after cervical disc degeneration. Comput Biol Med. 2020;116:103519. https:\/\/doi.org\/10.1016\/j.compbiomed.2019.103519.","journal-title":"Comput Biol Med"},{"key":"4218_CR29","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.clinbiomech.2018.09.008","volume":"60","author":"L Zhao","year":"2018","unstructured":"Zhao L, Chen J, Liu J, et al. Biomechanical analysis on of anterior transpedicular screw-fixation after two-level cervical corpectomy using finite element method. Clin Biomech (Bristol, Avon). 2018;60:76\u201382.","journal-title":"Clin Biomech (Bristol, Avon)"},{"issue":"8","key":"4218_CR30","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1080\/10255842.2010.493517","volume":"14","author":"UM Ayturk","year":"2011","unstructured":"Ayturk UM, Puttlitz CM. Parametric convergence sensitivity and validation of a finite element model of the human lumbar spine. Comput Methods Biomech Biomed Engin. 2011;14(8):695\u2013705. https:\/\/doi.org\/10.1080\/10255842.2010.493517.","journal-title":"Comput Methods Biomech Biomed Engin"},{"issue":"10","key":"4218_CR31","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1016\/j.medengphy.2008.09.006","volume":"30","author":"AC Jones","year":"2008","unstructured":"Jones AC, Wilcox RK. Finite element analysis of the spine: towards a framework of verification, validation and sensitivity analysis. Med Eng Phys. 2008;30(10):1287\u2013304. https:\/\/doi.org\/10.1016\/j.medengphy.2008.09.006.","journal-title":"Med Eng Phys"},{"issue":"24","key":"4218_CR32","doi-asserted-by":"publisher","first-page":"2692","DOI":"10.1097\/00007632-200112150-00012","volume":"26","author":"MM Panjabi","year":"2001","unstructured":"Panjabi MM, Crisco JJ, Vasavada A, Oda T, Cholewicki J, Nibu K, et al. Mechanical properties of the human cervical spine as shown by three-dimensional load-displacement curves. Spine. 2001;26(24):2692\u2013700. https:\/\/doi.org\/10.1097\/00007632-200112150-00012.","journal-title":"Spine."},{"issue":"5","key":"4218_CR33","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1007\/s00264-007-0369-y","volume":"32","author":"X Ning","year":"2008","unstructured":"Ning X, Wen Y, Xiao-Jian Y, Bin N, de-Yu C, Jian-Ru X, et al. Anterior cervical locking plate-related complications; prevention and treatment recommendations. Int Orthop. 2008;32(5):649\u201355. https:\/\/doi.org\/10.1007\/s00264-007-0369-y.","journal-title":"Int Orthop"},{"key":"4218_CR34","doi-asserted-by":"publisher","first-page":"e249","DOI":"10.1016\/j.wneu.2019.10.042","volume":"134","author":"KJ Song","year":"2020","unstructured":"Song KJ, Choi BW, Ham DH, Kim HJ. Prognosis of hardware-related problems in anterior cervical discectomy and fusion with cage and plate constructs. World Neurosurg. 2020;134:e249\u2013e55. https:\/\/doi.org\/10.1016\/j.wneu.2019.10.042.","journal-title":"World Neurosurg"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-021-04218-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-021-04218-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-021-04218-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,9]],"date-time":"2021-04-09T11:03:18Z","timestamp":1617966198000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmusculoskeletdisord.biomedcentral.com\/articles\/10.1186\/s12891-021-04218-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,9]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["4218"],"URL":"https:\/\/doi.org\/10.1186\/s12891-021-04218-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-78742\/v1","asserted-by":"object"}]},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,9]]},"assertion":[{"value":"15 September 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 April 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 April 2021","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 article contains a study with human participants, and the study protocol was approved by the Investigation and Ethics Committee of the Tianjin Medical University General Hospital (reference number IRB2019-WZ-145). Informed consent for this study was obtained from all patients by both written and verbal.","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 competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"340"}}