{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T14:14:17Z","timestamp":1793110457913,"version":"4.5.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T00:00:00Z","timestamp":1615939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Oral Health"],"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 effect of rapid maxillary expansion (RME) on the upper airway (UA) has been studied earlier but without a consistent conclusion. This study aims to evaluate the outcome of RME on the UA function in terms of aerodynamic characteristics by applying a computational fluid dynamics (CFD) simulation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study consists of seventeen cases with two consecutive CBCT scans obtained before (T0) and after (T1) RME. Patients were divided into two groups with respect to patency of the nasopharyngeal airway as expressed in the adenoidal nasopharyngeal ratio (AN): group 1 was comprised of patients with an AN ratio\u2009&lt;\u20090.6 and group 2 encompassing those with an AN ratio\u2009\u2265\u20090.6. CFD simulation at inspiration and expiration were performed based on the three-dimensional (3D) models of the UA segmented from the CBCT images. The aerodynamic characteristics in terms of pressure drop (\u0394P), maximum midsagittal velocity (V\n                      <jats:sub>ms<\/jats:sub>\n                      ), and maximum wall shear stress (P\n                      <jats:sub>ws<\/jats:sub>\n                      ) were compared by paired t-test and Wilcoxon test according to the normality test at T0 and T1.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The aerodynamic characteristics in UA revealed no statistically significant difference after RME. The maximum V\n                      <jats:sub>ms<\/jats:sub>\n                      (m\/s) decreased from 2.79 to 2.28 at expiration after RME (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.057).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The aerodynamic characteristics were not significantly changed after RME. Further CFD studies with more cases are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12903-021-01488-1","type":"journal-article","created":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T05:06:25Z","timestamp":1615957585000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["The effect of rapid maxillary expansion on the upper airway\u2019s aerodynamic characteristics"],"prefix":"10.1186","volume":"21","author":[{"given":"Xin","family":"Feng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yicheng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Hell\u00e9n-Halme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihua","family":"Cai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xie-Qi","family":"Shi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,17]]},"reference":[{"key":"1488_CR1","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1016\/j.smrv.2017.06.001","volume":"38","author":"L Pereira","year":"2018","unstructured":"Pereira L, Monyror J, Almeida FT, Almeida FR, Guerra E, Flores-Mir C, Pacheco-Pereira C. Prevalence of adenoid hypertrophy: a systematic review and meta-analysis. Sleep Med Rev. 2018;38:101\u201312.","journal-title":"Sleep Med Rev"},{"issue":"3","key":"1488_CR2","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1002\/lary.22508","volume":"122","author":"A Tatlipinar","year":"2012","unstructured":"Tatlipinar A, Biteker M, Meric K, Bayraktar GI, Tekkesin AI, Gokceer T. Adenotonsillar hypertrophy: correlation between obstruction types and cardiopulmonary complications. Laryngoscope. 2012;122(3):676\u201380.","journal-title":"Laryngoscope"},{"issue":"12","key":"1488_CR3","doi-asserted-by":"publisher","first-page":"2137","DOI":"10.1016\/j.ijporl.2015.09.035","volume":"79","author":"F Pagella","year":"2015","unstructured":"Pagella F, De Amici M, Pusateri A, Tinelli G, Matti E, Benazzo M, Licari A, Nigrisoli S, Quaglini S, Ciprandi G, et al. Adenoids and clinical symptoms: epidemiology of a cohort of 795 pediatric patients. Int J Pediatr Otorhinolaryngol. 2015;79(12):2137\u201341.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"3","key":"1488_CR4","doi-asserted-by":"publisher","first-page":"401","DOI":"10.2214\/ajr.133.3.401","volume":"133","author":"M Fujioka","year":"1979","unstructured":"Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal\u2013nasopharyngeal ratio. AJR Am J Roentgenol. 1979;133(3):401\u20134.","journal-title":"AJR Am J Roentgenol"},{"key":"1488_CR5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijporl.2019.01.011","volume":"119","author":"H Duan","year":"2019","unstructured":"Duan H, Xia L, He W, Lin Y, Lu Z, Lan Q. Accuracy of lateral cephalogram for diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a meta-analysis. Int J Pediatr Otorhinolaryngol. 2019;119:1\u20139.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1","key":"1488_CR6","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/0194599818801757","volume":"160","author":"RB Mitchell","year":"2019","unstructured":"Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, Friedman NR, Giordano T, Hildrew DM, Kim TW, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngol Head Neck Surg. 2019;160(1):S1\u201342.","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"10","key":"1488_CR7","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.1016\/j.ijporl.2015.07.009","volume":"79","author":"A Chohan","year":"2015","unstructured":"Chohan A, Lal A, Chohan K, Chakravarti A, Gomber S. Systematic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children. Int J Pediatr Otorhinolaryngol. 2015;79(10):1599\u2013608.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"2","key":"1488_CR8","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1177\/0194599819841882","volume":"161","author":"G Baik","year":"2019","unstructured":"Baik G, Brietzke SE. Cost benefit and utility decision analysis of turbinoplasty with adenotonsillectomy for pediatric sleep-disordered breathing. Otolaryngology Head and Neck Surgery. 2019;161(2):343\u20137.","journal-title":"Otolaryngology Head and Neck Surgery"},{"issue":"2","key":"1488_CR9","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s11325-010-0419-3","volume":"15","author":"C Guilleminault","year":"2011","unstructured":"Guilleminault C, Monteyrol PJ, Huynh NT, Pirelli P, Quo S, Li K. Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study. Sleep Breath. 2011;15(2):173\u20137.","journal-title":"Sleep Breath"},{"issue":"4","key":"1488_CR10","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/0002-9416(76)90112-3","volume":"70","author":"SA Schendel","year":"1976","unstructured":"Schendel SA, Eisenfeld J, Bell WH, Epker BN, Mishelevich DJ. The long face syndrome: vertical maxillary excess. Am J Orthod. 1976;70(4):398\u2013408.","journal-title":"Am J Orthod"},{"issue":"3","key":"1488_CR11","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1111\/j.1601-6343.2012.01540.x","volume":"15","author":"AT Macari","year":"2012","unstructured":"Macari AT, Bitar MA, Ghafari JG. New insights on age-related association between nasopharyngeal airway clearance and facial morphology. Orthod Craniofac Res. 2012;15(3):188\u201397.","journal-title":"Orthod Craniofac Res"},{"issue":"2","key":"1488_CR12","doi-asserted-by":"publisher","first-page":"e477","DOI":"10.1542\/peds.2014-0620","volume":"135","author":"SL Garetz","year":"2015","unstructured":"Garetz SL, Mitchell RB, Parker PD, Moore RH, Rosen CL, Giordani B, Muzumdar H, Paruthi S, Elden L, Willging P, et al. Quality of life and obstructive sleep apnea symptoms after pediatric adenotonsillectomy. Pediatrics. 2015;135(2):e477-486.","journal-title":"Pediatrics"},{"key":"1488_CR13","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.smrv.2015.02.002","volume":"25","author":"NT Huynh","year":"2016","unstructured":"Huynh NT, Desplats E, Almeida FR. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and meta-analysis. Sleep Med Rev. 2016;25:84\u201394.","journal-title":"Sleep Med Rev"},{"issue":"2","key":"1488_CR14","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.chest.2017.06.005","volume":"153","author":"MM Hamoda","year":"2018","unstructured":"Hamoda MM, Kohzuka Y, Almeida FR. Oral appliances for the management of OSA: an updated review of the literature. Chest. 2018;153(2):544\u201353.","journal-title":"Chest"},{"key":"1488_CR15","doi-asserted-by":"publisher","first-page":"5460429","DOI":"10.1155\/2017\/5460429","volume":"2017","author":"G Di Carlo","year":"2017","unstructured":"Di Carlo G, Saccucci M, Ierardo G, Luzzi V, Occasi F, Zicari AM, Duse M, Polimeni A. Rapid maxillary expansion and upper airway morphology: a systematic review on the role of cone beam computed tomography. Biomed Res Int. 2017;2017:5460429.","journal-title":"Biomed Res Int"},{"issue":"11","key":"1488_CR16","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.1016\/j.ijporl.2008.07.014","volume":"72","author":"N Kilic","year":"2008","unstructured":"Kilic N, Oktay H. Effects of rapid maxillary expansion on nasal breathing and some naso-respiratory and breathing problems in growing children: a literature review. Int J Pediatr Otorhinolaryngol. 2008;72(11):1595\u2013601.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"1 Suppl","key":"1488_CR17","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/0194599811409837","volume":"145","author":"PS Roland","year":"2011","unstructured":"Roland PS, Rosenfeld RM, Brooks LJ, Friedman NR, Jones J, Kim TW, Kuhar S, Mitchell RB, Seidman MD, Sheldon SH, et al. Clinical practice guideline: polysomnography for sleep-disordered breathing prior to tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;145(1 Suppl):S1-15.","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"16","key":"1488_CR18","doi-asserted-by":"publisher","first-page":"3708","DOI":"10.1016\/j.jbiomech.2007.06.022","volume":"40","author":"JW De Backer","year":"2007","unstructured":"De Backer JW, Vanderveken OM, Vos WG, Devolder A, Verhulst SL, Verbraecken JA, Parizel PM, Braem MJ, Van de Heyning PH, De Backer WA. Functional imaging using computational fluid dynamics to predict treatment success of mandibular advancement devices in sleep-disordered breathing. J Biomech. 2007;40(16):3708\u201314.","journal-title":"J Biomech"},{"issue":"1","key":"1488_CR19","doi-asserted-by":"publisher","first-page":"5322","DOI":"10.1038\/s41598-020-61467-4","volume":"10","author":"A Mart\u00ednez","year":"2020","unstructured":"Mart\u00ednez A, Mu\u00f1iz AL, Soudah E, Calvo J, Su\u00e1rez A\u00c1, Cobo J, Cobo T. Physiological and geometrical effects in the upper airways with and without mandibular advance device for sleep apnea treatment. Sci Rep. 2020;10(1):5322\u20135322.","journal-title":"Sci Rep"},{"issue":"3","key":"1488_CR20","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.ajodo.2011.08.025","volume":"141","author":"T Iwasaki","year":"2012","unstructured":"Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kanomi R, Hayasaki H, Yamasaki Y. Improvement of nasal airway ventilation after rapid maxillary expansion evaluated with computational fluid dynamics. Am J Orthod Dentofac Orthop. 2012;141(3):269\u201378.","journal-title":"Am J Orthod Dentofac Orthop"},{"issue":"8","key":"1488_CR21","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1016\/j.ijporl.2014.05.004","volume":"78","author":"T Iwasaki","year":"2014","unstructured":"Iwasaki T, Takemoto Y, Inada E, Sato H, Suga H, Saitoh I, Kakuno E, Kanomi R, Yamasaki Y. The effect of rapid maxillary expansion on pharyngeal airway pressure during inspiration evaluated using computational fluid dynamics. Int J Pediatr Otorhinolaryngol. 2014;78(8):1258\u201364.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"issue":"2","key":"1488_CR22","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.jobcr.2020.03.006","volume":"10","author":"SS Rana","year":"2020","unstructured":"Rana SS, Kharbanda OP, Agarwal B. Influence of tongue volume, oral cavity volume and their ratio on upper airway: a cone beam computed tomography study. J Oral Biol Craniofac Res. 2020;10(2):110\u20137.","journal-title":"J Oral Biol Craniofac Res"},{"issue":"11","key":"1488_CR23","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1007\/s11517-015-1399-z","volume":"53","author":"J Cisonni","year":"2015","unstructured":"Cisonni J, Lucey AD, King AJ, Islam SM, Lewis R, Goonewardene MS. Numerical simulation of pharyngeal airflow applied to obstructive sleep apnea: effect of the nasal cavity in anatomically accurate airway models. Med Biol Eng Comput. 2015;53(11):1129\u201339.","journal-title":"Med Biol Eng Comput"},{"issue":"10","key":"1488_CR24","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1016\/j.sleep.2011.08.004","volume":"12","author":"NB Powell","year":"2011","unstructured":"Powell NB, Mihaescu M, Mylavarapu G, Weaver EM, Guilleminault C, Gutmark E. Patterns in pharyngeal airflow associated with sleep-disordered breathing. Sleep Med. 2011;12(10):966\u201374.","journal-title":"Sleep Med"},{"issue":"2","key":"1488_CR25","doi-asserted-by":"publisher","first-page":"70","DOI":"10.2500\/ar.2014.5.0090","volume":"5","author":"M Faramarzi","year":"2014","unstructured":"Faramarzi M, Baradaranfar MH, Abouali O, Atighechi S, Ahmadi G, Farhadi P, Keshavarzian E, Behniafard N, Baradaranfar A. Numerical investigation of the flow field in realistic nasal septal perforation geometry. Allergy Rhinol (Providence). 2014;5(2):70\u20137.","journal-title":"Allergy Rhinol (Providence)"},{"issue":"5","key":"1488_CR26","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.pcad.2006.11.001","volume":"49","author":"D Katritsis","year":"2007","unstructured":"Katritsis D, Kaiktsis L, Chaniotis A, Pantos J, Efstathopoulos EP, Marmarelis V. Wall shear stress: theoretical considerations and methods of measurement. Prog Cardiovasc Dis. 2007;49(5):307\u201329.","journal-title":"Prog Cardiovasc Dis"},{"issue":"9","key":"1488_CR27","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1007\/s00380-019-01389-y","volume":"34","author":"N Murata","year":"2019","unstructured":"Murata N, Hiro T, Takayama T, Migita S, Morikawa T, Tamaki T, Mineki T, Kojima K, Akutsu N, Sudo M, et al. High shear stress on the coronary arterial wall is related to computed tomography-derived high-risk plaque: a three-dimensional computed tomography and color-coded tissue-characterizing intravascular ultrasonography study. Heart Vessels. 2019;34(9):1429\u201339.","journal-title":"Heart Vessels"},{"issue":"2","key":"1488_CR28","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1159\/000222508","volume":"78","author":"JA Verbraecken","year":"2009","unstructured":"Verbraecken JA, De Backer WA. Upper airway mechanics. Respiration. 2009;78(2):121\u201333.","journal-title":"Respiration"},{"issue":"2","key":"1488_CR29","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1093\/sleep\/27.2.240","volume":"27","author":"R Tamisier","year":"2004","unstructured":"Tamisier R, Pepin JL, Wuyam B, Deschaux C, Levy P. Expiratory changes in pressure: flow ratio during sleep in patients with sleep-disordered breathing. Sleep. 2004;27(2):240\u20138.","journal-title":"Sleep"},{"issue":"2","key":"1488_CR30","doi-asserted-by":"publisher","first-page":"20170238","DOI":"10.1259\/dmfr.20170238","volume":"47","author":"H Chen","year":"2018","unstructured":"Chen H, Li Y, Reiber JH, de Lange J, Tu S, van der Stelt P, Lobbezoo F, Aarab G. Analyses of aerodynamic characteristics of the oropharynx applying CBCT: obstructive sleep apnea patients versus control subjects. Dentomaxillofac Radiol. 2018;47(2):20170238.","journal-title":"Dentomaxillofac Radiol"},{"issue":"1","key":"1488_CR31","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.jbiomech.2012.10.033","volume":"46","author":"M Zhao","year":"2013","unstructured":"Zhao M, Barber T, Cistulli P, Sutherland K, Rosengarten G. Computational fluid dynamics for the assessment of upper airway response to oral appliance treatment in obstructive sleep apnea. J Biomech. 2013;46(1):142\u201350.","journal-title":"J Biomech"},{"issue":"6","key":"1488_CR32","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1016\/j.medengphy.2006.08.017","volume":"29","author":"S-J Jeong","year":"2007","unstructured":"Jeong S-J, Kim W-S, Sung S-J. Numerical investigation on the flow characteristics and aerodynamic force of the upper airway of patient with obstructive sleep apnea using computational fluid dynamics. Med Eng Phys. 2007;29(6):637\u201351.","journal-title":"Med Eng Phys"},{"key":"1488_CR33","doi-asserted-by":"publisher","first-page":"1821","DOI":"10.1152\/japplphysiol.00233.2018","volume":"125","author":"C Lambeth","year":"2018","unstructured":"Lambeth C, Wang Z, Kairaitis K, Moshfegh A, Jabbarzadeh A, Amis TC. Modelling mucosal surface roughness in the human velopharynx: a computational fluid dynamics study of healthy and obstructive sleep apnea airways. J Appl Physiol. 2018;125:1821\u201331.","journal-title":"J Appl Physiol."},{"key":"1488_CR34","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1016\/j.cmpb.2019.05.031","volume":"177","author":"H Mortazavy Beni","year":"2019","unstructured":"Mortazavy Beni H, Hassani K, Khorramymehr S. In silico investigation of sneezing in a full real human upper airway using computational fluid dynamics method. Comput Methods Programs Biomed. 2019;177:203\u20139.","journal-title":"Comput Methods Programs Biomed"}],"container-title":["BMC Oral Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-021-01488-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12903-021-01488-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12903-021-01488-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,17]],"date-time":"2021-03-17T05:07:56Z","timestamp":1615957676000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcoralhealth.biomedcentral.com\/articles\/10.1186\/s12903-021-01488-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,17]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1488"],"URL":"https:\/\/doi.org\/10.1186\/s12903-021-01488-1","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-129339\/v1","asserted-by":"object"}]},"ISSN":["1472-6831"],"issn-type":[{"value":"1472-6831","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,17]]},"assertion":[{"value":"15 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 March 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":"The study was approved by the ethics committee of China (DLKQLL201604, Dalian Stomatological Hospital) as well as the ethics committee of Norway (2018\/1547 REK Vest, University of Bergen). Written informed consent was obtained from all participants or their legal guardians.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable as there are no participants\u2019 identifiable data, picture or illustrations that require consent to publish in this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"123"}}