{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T18:18:41Z","timestamp":1785176321107,"version":"3.55.0"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82103861"],"award-info":[{"award-number":["82103861"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004761","name":"the Natural Science Foundation of Hunan Province, China","doi-asserted-by":"crossref","award":["2021JJ40809"],"award-info":[{"award-number":["2021JJ40809"]}],"id":[{"id":"10.13039\/501100004761","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Open project of Key Laboratory of Environment and Health, Ministry of Education","award":["2021GWKFJJ01"],"award-info":[{"award-number":["2021GWKFJJ01"]}]},{"name":"Hubei Key Laboratory of Food Nutrition and Safety","award":["FNS-HBKL2020A01"],"award-info":[{"award-number":["FNS-HBKL2020A01"]}]},{"name":"NHC Key Laboratory of Birth Defect for Research and Prevention","award":["KF2021013"],"award-info":[{"award-number":["KF2021013"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>The coexistence of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (HBsAb) represents an uncommon serological pattern observed in patients with hepatitis B virus (HBV) infection, and its underlying mechanism and clinical significance have not been well established. The aim of this study was to investigate the association between this serological profile and clinical treatment outcomes in children with chronic hepatitis B (CHB).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This retrospective cohort study included 372 treatment-na\u00efve CHB children from the Hunan Children\u2019s Hospital. The participants were categorized into HBsAb-positive group and HBsAb-negative group. The associations between HBsAb positive status to clinical outcomes were assessed using Cox proportional hazard regression. Receiver operating characteristic curve was conducted to evaluate the prediction ability in HBsAg loss.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The coexistence of HBsAg and HBsAb accounted for 23.39% (87\/372) of the participants. The crude incidence rates of HBsAg loss, hepatitis B e antigen (HBeAg) clearance, and HBV-DNA undetectability were higher in the HBsAb-positive group compared with the HBsAb-negative group (37.46 vs. 17.37, 49.51 vs. 28.66, 92.11 vs. 66.54 per 100 person-years, respectively, all <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). The Cox regression analysis revealed a significant association between this serological profile and an increased likelihood of HBsAg loss (HR\u2009=\u20091.78, <jats:italic>P<\/jats:italic>\u2009=\u20090.001), and HBeAg clearance (HR\u2009=\u20091.78, <jats:italic>P<\/jats:italic>\u2009=\u20090.001). In addition, a combination of HBsAb\u2009\u2265\u20090.84 log10 IU\/L and age\u2009\u2264\u20095\u00a0years can help identify patients likely to achieve HBsAg loss after antiviral therapy, with an AUC of 0.71.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Children who are positive for both HBsAg and HBsAb demonstrate a higher probability of favorable outcomes after antiviral treatment. Thus, children with HBsAb-positive CHB should be actively treated to achieve functional cure.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12916-024-03294-2","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T12:04:41Z","timestamp":1708430681000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Characteristics and clinical treatment outcomes of chronic hepatitis B children with coexistence of hepatitis B surface antigen (HBsAg) and antibodies to HBsAg"],"prefix":"10.1186","volume":"22","author":[{"given":"Yingping","family":"Gu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuangjie","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenzhen","family":"Yao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Lai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1713-4120","authenticated-orcid":false,"given":"Songxu","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"issue":"10003","key":"3294_CR1","doi-asserted-by":"publisher","first-page":"1546","DOI":"10.1016\/S0140-6736(15)61412-X","volume":"386","author":"A Schweitzer","year":"2015","unstructured":"Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546\u201355.","journal-title":"Lancet"},{"issue":"5","key":"3294_CR2","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1586\/17474124.2016.1139450","volume":"10","author":"MG Clemente","year":"2016","unstructured":"Clemente MG, Vajro P. An update on the strategies used for the treatment of chronic hepatitis B in children. Expert Rev Gastroenterol Hepatol. 2016;10(5):649\u201358.","journal-title":"Expert Rev Gastroenterol Hepatol"},{"issue":"6","key":"3294_CR3","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/S2468-1253(19)30042-1","volume":"4","author":"G Indolfi","year":"2019","unstructured":"Indolfi G, Easterbrook P, Dusheiko G, Siberry G, Chang M-H, Thorne C, et al. Hepatitis B virus infection in children and adolescents. Lancet Gastroenterol Hepatol. 2019;4(6):466\u201376.","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"10","key":"3294_CR4","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1016\/S2468-1253(23)00197-8","volume":"8","author":"OC Polaris","year":"2023","unstructured":"Polaris OC. Global prevalence, cascade of care, and prophylaxis coverage of hepatitis B in 2022: a modelling study. Lancet Gastroenterol Hepatol. 2023;8(10):879\u2013907.","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"5","key":"3294_CR5","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1111\/jgh.12550","volume":"29","author":"C Della Corte","year":"2014","unstructured":"Della Corte C, Nobili V, Comparcola D, Cainelli F, Vento S. Management of chronic hepatitis B in children: An unresolved issue. J Gastroenterol Hepatol. 2014;29(5):912\u20139.","journal-title":"J Gastroenterol Hepatol"},{"issue":"12","key":"3294_CR6","first-page":"1309","volume":"30","author":"Chinese Society of Hepatology CMA","year":"2022","unstructured":"Chinese Society of Hepatology CMA, Chinese Society of Infectious Diseases CMA. Guidelines for the prevention and treatment for chronic hepatitis B (2022 version) [in Chinese]. Chinese J Hepatol. 2022;30(12):1309\u201331.","journal-title":"Chinese J Hepatol"},{"issue":"3","key":"3294_CR7","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1097\/HEP.0000000000000430","volume":"78","author":"J Howell","year":"2023","unstructured":"Howell J, Seaman C, Wallace J, Xiao Y, Scott N, Davies J, et al. Pathway to global elimination of hepatitis B: HBV cure is just the first step. Hepatology. 2023;78(3):976\u201390.","journal-title":"Hepatology"},{"issue":"6","key":"3294_CR8","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1093\/infdis\/140.6.975","volume":"140","author":"AM Courouce-Pauty","year":"1979","unstructured":"Courouce-Pauty AM, Drouet J, Kleinknecht D. Simultaneous occurrence in the same serum of hepatitis B surface antigen and antibody to hepatitis B surface antigen of different subtypes. J Infect Dis. 1979;140(6):975\u20138.","journal-title":"J Infect Dis"},{"issue":"9","key":"3294_CR9","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1002\/jmv.21577","volume":"81","author":"JS Jang","year":"2009","unstructured":"Jang JS, Kim HS, Kim HJ, Shin WG, Kim KH, Lee JH, et al. Association of Concurrent Hepatitis B Surface Antigen and Antibody to Hepatitis B Surface Antigen With Hepatocellular Carcinoma in Chronic Hepatitis B Virus Infection. J Med Virol. 2009;81(9):1531\u20138.","journal-title":"J Med Virol"},{"key":"3294_CR10","doi-asserted-by":"crossref","unstructured":"Xiang Y, Chen P, Xia JR, Zhang LP. A large-scale analysis study on the clinical and viral characteristics of hepatitis B infection with concurrence of hepatitis B surface or E antigens and their corresponding antibodies. Genet Mol Res. 2017;16(1).","DOI":"10.4238\/gmr16019102"},{"issue":"6","key":"3294_CR11","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1016\/j.clinre.2019.08.005","volume":"44","author":"W Hou","year":"2020","unstructured":"Hou W, Huo Z, Du Y, Wang C, Syn WK. Characteristics of amino acid substitutions within the \u201ca\u201d determinant region of hepatitis B virus in chronically infected patients with coexisting HBsAg and anti-HBs. Clin Res Hepatol Gastroenterol. 2020;44(6):923\u201331.","journal-title":"Clin Res Hepatol Gastroenterol"},{"issue":"4","key":"3294_CR12","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.7150\/ijbs.55724","volume":"17","author":"X Jiang","year":"2021","unstructured":"Jiang X, Chang L, Yan Y, Wang L. Paradoxical HBsAg and anti-HBs coexistence among Chronic HBV Infections: Causes and Consequences. Int J Biol Sci. 2021;17(4):1125\u201337.","journal-title":"Int J Biol Sci"},{"key":"3294_CR13","doi-asserted-by":"publisher","first-page":"775461","DOI":"10.3389\/fimmu.2021.775461","volume":"12","author":"Y Wang","year":"2021","unstructured":"Wang Y, Xiao X, Chen S, Huang C, Zhou J, Dai E, et al. The Impact of HBV Quasispecies Features on Immune Status in HBsAg+\/HBsAb+ Patients With HBV Genotype C Using Next-Generation Sequencing. Front Immunol. 2021;12:775461.","journal-title":"Front Immunol"},{"issue":"1","key":"3294_CR14","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.virol.2007.05.012","volume":"367","author":"P Colson","year":"2007","unstructured":"Colson P, Borentain P, Motte A, Henry M, Moal V, Botta-Fridlund D, et al. Clinical and virological significance of the co-existence of HBsAg and anti-HBs antibodies in hepatitis B chronic carriers. Virology. 2007;367(1):30\u201340.","journal-title":"Virology"},{"issue":"11","key":"3294_CR15","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1007\/s10096-011-1240-z","volume":"30","author":"RA Pond\u00e9","year":"2011","unstructured":"Pond\u00e9 RA. The underlying mechanisms for the \u201csimultaneous HBsAg and anti-HBs serological profile.\u201d Eur J Clin Microbiol Infect Dis. 2011;30(11):1325\u201340.","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"1","key":"3294_CR16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.bjid.2015.08.014","volume":"20","author":"F Ding","year":"2016","unstructured":"Ding F, Miao XL, Li YX, Dai JF, Yu HG. Mutations in the S gene and in the overlapping reverse transcriptase region in chronic hepatitis B Chinese patients with coexistence of HBsAg and anti-HBs. Braz J Infect Dis. 2016;20(1):1\u20137.","journal-title":"Braz J Infect Dis"},{"issue":"1","key":"3294_CR17","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1002\/jmv.23779","volume":"86","author":"SI Seo","year":"2014","unstructured":"Seo SI, Choi HS, Choi BY, Kim HS, Kim HY, Jang MK. Coexistence of hepatitis B surface antigen and antibody to hepatitis B surface may increase the risk of hepatocellular carcinoma in chronic hepatitis B virus infection: A retrospective cohort study. J Med Virol. 2014;86(1):124\u201330.","journal-title":"J Med Virol"},{"issue":"37","key":"3294_CR18","doi-asserted-by":"publisher","first-page":"61719","DOI":"10.18632\/oncotarget.18682","volume":"8","author":"Y Qiao","year":"2017","unstructured":"Qiao Y, Lu S, Xu Z, Li X, Zhang K, Liu Y, et al. Additional N-glycosylation mutation in the major hydrophilic region of hepatitis B virus S gene is a risk indicator for hepatocellular carcinoma occurrence in patients with coexistence of HBsAg\/anti-HBs. Oncotarget. 2017;8(37):61719\u201330.","journal-title":"Oncotarget"},{"issue":"5","key":"3294_CR19","doi-asserted-by":"publisher","first-page":"343","DOI":"10.1016\/j.bjid.2019.08.007","volume":"23","author":"ZZ Jin","year":"2019","unstructured":"Jin ZZ, Jin FF, Liu X, Liu N, Wen F, Lou JL. Coexistence of low levels of HBsAg and high levels of anti-HBs may increase risk of hepatocellular carcinoma in chronic hepatitis B patients with high HBV load. Braz J Infect Dis. 2019;23(5):343\u201351.","journal-title":"Braz J Infect Dis"},{"issue":"6","key":"3294_CR20","doi-asserted-by":"publisher","first-page":"e2216485","DOI":"10.1001\/jamanetworkopen.2022.16485","volume":"5","author":"J Wang","year":"2022","unstructured":"Wang J, Ding W, Liu J, Liu Y, Yan X, Xia J, et al. Association of Coexistent Hepatitis B Surface Antigen and Antibody With Severe Liver Fibrosis and Cirrhosis in Treatment-Naive Patients With Chronic Hepatitis B. JAMA Net Open. 2022;5(6):e2216485.","journal-title":"JAMA Net Open."},{"issue":"3","key":"3294_CR21","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1016\/j.jhep.2013.12.001","volume":"60","author":"MR Brunetto","year":"2014","unstructured":"Brunetto MR. Chance and necessity of simultaneous HBsAg and anti-HBs detection in the serum of chronic HBsAg carriers. J Hepatol. 2014;60(3):473\u20135.","journal-title":"J Hepatol"},{"issue":"8","key":"3294_CR22","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1002\/jmv.23594","volume":"85","author":"BS Lee","year":"2013","unstructured":"Lee BS, Cho YK, Jeong SH, Lee JH, Lee D, Park NH, et al. Nationwide seroepidemiology of hepatitis B virus infection in South Korea in 2009 emphasizes the coexistence of HBsAg and anti-HBs. J Med Virol. 2013;85(8):1327\u201333.","journal-title":"J Med Virol"},{"issue":"2","key":"3294_CR23","first-page":"150","volume":"37","author":"YM Wang","year":"1996","unstructured":"Wang YM, Ng WC, Kang JY, Yap I, Seet BL, Teo J, et al. Serological profiles of hepatitis B carrier patients in Singapore with special reference to the frequency and significance of concurrent presence of HBsAg and anti-HBs. Singapore Med J. 1996;37(2):150\u20132.","journal-title":"Singapore Med J"},{"issue":"9","key":"3294_CR24","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1111\/jvh.13312","volume":"27","author":"WM Lee","year":"2020","unstructured":"Lee WM, King WC, Schwarz KB, Rule J, Lok ASF. Prevalence and clinical features of patients with concurrent HBsAg and anti-HBs: Evaluation of the hepatitis B research network cohort. J Viral Hepat. 2020;27(9):922\u201331.","journal-title":"J Viral Hepat"},{"key":"3294_CR25","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1016\/j.jcv.2014.11.015","volume":"62","author":"M Pancher","year":"2015","unstructured":"Pancher M, D\u00e9sir\u00e9 N, Ngo Y, Akhavan S, Pallier C, Poynard T, et al. Coexistence of circulating HBsAg and anti-HBs antibodies in chronic hepatitis B carriers is not a simple analytical artifact and does not influence HBsAg quantification. J Clin Virol. 2015;62:32\u20137.","journal-title":"J Clin Virol"},{"issue":"4","key":"3294_CR26","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1111\/jvh.12492","volume":"23","author":"Z Pu","year":"2016","unstructured":"Pu Z, Li D, Wang A, Su H, Shao Z, Zhang J, et al. Epidemiological characteristics of the carriers with coexistence of HBsAg and anti-HBs based on a community cohort study. J Viral Hepat. 2016;23(4):286\u201393.","journal-title":"J Viral Hepat"},{"issue":"7","key":"3294_CR27","doi-asserted-by":"publisher","first-page":"727","DOI":"10.3390\/pathogens11070727","volume":"11","author":"Q Zhan","year":"2022","unstructured":"Zhan Q, Chang L, Wu J, Zhang Z, Xu J, Yu Y, et al. T-Cell Receptor \u03b2 Chain and B-Cell Receptor Repertoires in Chronic Hepatitis B Patients with Coexisting HBsAg and Anti-HBs. Pathogens. 2022;11(7):727.","journal-title":"Pathogens"},{"issue":"1","key":"3294_CR28","doi-asserted-by":"publisher","first-page":"e0146980","DOI":"10.1371\/journal.pone.0146980","volume":"11","author":"Y Liu","year":"2016","unstructured":"Liu Y, Zhang L, Zhou J-Y, Pan J, Hu W, Zhou Y-H. Clinical and Virological Characteristics of Chronic Hepatitis B Patients with Coexistence of HBsAg and Anti-HBs. PLoS ONE. 2016;11(1):e0146980.","journal-title":"PLoS ONE"},{"issue":"1","key":"3294_CR29","doi-asserted-by":"publisher","first-page":"19417","DOI":"10.1038\/s41598-019-56015-8","volume":"9","author":"M-S Kwak","year":"2019","unstructured":"Kwak M-S, Chung G-E, Yang JI, Yim JY. Long-term outcomes of HBsAg\/anti-HBs double-positive versus HBsAg single-positive patients with chronic hepatitis B. Sci Rep. 2019;9(1):19417.","journal-title":"Sci Rep."},{"issue":"6","key":"3294_CR30","doi-asserted-by":"publisher","first-page":"427","DOI":"10.1080\/08830180802295757","volume":"27","author":"H-T Tsai","year":"2008","unstructured":"Tsai H-T, Tsai T-H, Lu T-M, Yang C-C. Immunopathology of Hepatitis B Virus Infection. Int Rev Immunol. 2008;27(6):427\u201346.","journal-title":"Int Rev Immunol"},{"issue":"1","key":"3294_CR31","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.jhep.2021.07.031","volume":"76","author":"H Xu","year":"2022","unstructured":"Xu H, Locarnini S, Wong D, Hammond R, Colledge D, Soppe S, et al. Role of anti-HBs in functional cure of HBeAg plus chronic hepatitis B patients infected with HBV genotype A. J Hepatol. 2022;76(1):34\u201345.","journal-title":"J Hepatol"},{"issue":"5","key":"3294_CR32","doi-asserted-by":"publisher","first-page":"727","DOI":"10.1111\/j.1478-3231.2007.01480.x","volume":"27","author":"B Frider","year":"2007","unstructured":"Frider B, Alessio A, Pozzati M, Cuestas ML, Mathet VL, Oubi\u00f1a JR. Successful interferon treatment in a patient chronically infected with hepatitis B virus carrying unusual S- (and P-) mutants in the presence of anti-HBs antibodies. Liver Int. 2007;27(5):727\u201330.","journal-title":"Liver Int"},{"issue":"1","key":"3294_CR33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1471-230X-14-94","volume":"14","author":"G Galati","year":"2014","unstructured":"Galati G, De Vincentis A, Vespasiani-Gentilucci U, Gallo P, Vincenti D, Solmone MC, et al. Coexistence of HBsAg and HBsAb in a difficult-to-treat chronic hepatitis B: loss of HBsAg with entecavir plus tenofovir combination. BMC Gastroenterol. 2014;14(1):1.","journal-title":"BMC Gastroenterol."},{"key":"3294_CR34","doi-asserted-by":"publisher","first-page":"29605","DOI":"10.1038\/srep29605","volume":"6","author":"YC Wang","year":"2016","unstructured":"Wang YC, Yang SS, Su CW, Wang YJ, Lee KC, Huo TI, et al. Predictors of response to pegylated interferon in chronic hepatitis B: a real-world hospital-based analysis. Sci Rep. 2016;6:29605.","journal-title":"Sci Rep"},{"issue":"3","key":"3294_CR35","doi-asserted-by":"publisher","first-page":"635","DOI":"10.1053\/j.gastro.2018.10.027","volume":"156","author":"YH Yeo","year":"2019","unstructured":"Yeo YH, Ho HJ, Yang HI, Tseng TC, Hosaka T, Trinh HN, et al. Factors Associated With Rates of HBsAg Seroclearance in Adults With Chronic HBV Infection: A Systematic Review and Meta-analysis. Gastroenterology. 2019;156(3):635-46.e9.","journal-title":"Gastroenterology"}],"container-title":["BMC Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-024-03294-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12916-024-03294-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-024-03294-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T12:11:55Z","timestamp":1708431115000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedicine.biomedcentral.com\/articles\/10.1186\/s12916-024-03294-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,20]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["3294"],"URL":"https:\/\/doi.org\/10.1186\/s12916-024-03294-2","relation":{},"ISSN":["1741-7015"],"issn-type":[{"value":"1741-7015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,20]]},"assertion":[{"value":"16 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2024","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 received approval from the ethics committees of Xiangya School of Public Health Central South University (XYGW-2023\u2013123), with a waiver of informed consent due to its retrospective nature.","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":"77"}}