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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">dan</journal-id><journal-title-group><journal-title xml:lang="ru">Доклады Национальной академии наук Беларуси</journal-title><trans-title-group xml:lang="en"><trans-title>Doklady of the National Academy of Sciences of Belarus</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1561-8323</issn><issn pub-type="epub">2524-2431</issn><publisher><publisher-name>The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.29235/1561-8323-2023-67-3-231-241</article-id><article-id custom-type="elpub" pub-id-type="custom">dan-1133</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>МЕДИЦИНА</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>MEDICINE</subject></subj-group></article-categories><title-group><article-title>Характеристика генома Mycobacterium tuberculosis генотипа Beijing кластера 100-32 с пре-широкой лекарственной устойчивостью</article-title><trans-title-group xml:lang="en"><trans-title>Characteristic of the Mycobacterium tuberculosis genome of Beijing genotype of cluster 100-32 displaying pre-extended drug resistance</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-1846-6100</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Слизень</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Slizen</surname><given-names>V. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Слизень Вероника Вячеславовна – канд. мед. наук, доцент, докторант</p><p>Долгиновский тракт, 157, 220080, Минск, Республика Беларусь</p></bio><bio xml:lang="en"><p>Slizen Veronika V. – Ph. D. (Medicine), Associate Professor, Doctoral Candidate</p><p>157, Dolginovski tract, 220080, Minsk, Republic of Belarus</p></bio><email xlink:type="simple">veronal@tut.by</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Охремчук</surname><given-names>А. Э.</given-names></name><name name-style="western" xml:lang="en"><surname>Akhremchuk</surname><given-names>A. E.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Oхремчук Артур Эдуардович – науч. сотрудник</p><p>ул. Купревича, 2, 220114, Минск, Республика Беларусь</p></bio><bio xml:lang="en"><p>Akhremchuk Artur E. – Researcher</p><p>2, Kuprevich Str., 220114, Minsk, Republic of Belarus</p></bio><email xlink:type="simple">okhrem4uartur@gmail.com</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Суркова</surname><given-names>Л. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Surkova</surname><given-names>L. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Суркова Лариса Константиновна – д-р мед. наук, профессор, заведующий отделом</p><p>Долгиновский тракт, 157, 220080, Минск, Республика Беларусь</p></bio><bio xml:lang="en"><p>Surkova Larisa K. – D. Sc. (Medicine), Professor, Head of the Department</p><p>157, Dolginovski tract, 220080, Minsk, Republic of Belarus</p></bio><email xlink:type="simple">niipulm@tut.by</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5683-2322</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гуревич</surname><given-names>Г. Л.</given-names></name><name name-style="western" xml:lang="en"><surname>Gurevich</surname><given-names>G. L.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гуревич Геннадий Львович – член-корреспондент, д-р мед. наук, профессор, директор</p><p>Долгиновский тракт, 157, 220080, Минск, Республика Беларусь</p></bio><bio xml:lang="en"><p>Gurevich Gennady L. – Corresponding Member, D. Sc. (Medicine), Professor, Director</p><p>157, Dolginovski tract, 220080, Minsk, Republic of Belarus</p></bio><email xlink:type="simple">niipulm@tut.by</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4524-3730</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Титов</surname><given-names>Л. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Titov</surname><given-names>L. P.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Титов Леонид Петрович – академик, д-р мед. наук, профессор, заведующий лабораторией</p><p>ул. Филимонова, 23, 220114, Минск, Республика Беларусь</p></bio><bio xml:lang="en"><p>Titov Leonid P. – Academician, D. Sc. (Medicine), Professor, Head of Laboratory</p><p>23, Filimonov Str., 220114, Minsk, Republic of Belarus</p></bio><email xlink:type="simple">leonidtitov@tut.by</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Республиканский научно-практический центр пульмонологии и фтизиатрии</institution></aff><aff xml:lang="en"><institution>Republican Scientific and Practical Center of Pulmonology and Phthisiatry</institution></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Институт микробиологии Национальной академии наук Беларуси</institution></aff><aff xml:lang="en"><institution>Institute of Microbiology of the National Academy of Sciences of Belarus</institution></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Республиканский научно-практический центр эпидемиологии и микробиологии</institution></aff><aff xml:lang="en"><institution>Republican Research and Practical Center for Epidemiology and Microbiology</institution></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>06</day><month>07</month><year>2023</year></pub-date><volume>67</volume><issue>3</issue><fpage>231</fpage><lpage>241</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Слизень В.В., Охремчук А.Э., Суркова Л.К., Гуревич Г.Л., Титов Л.П., 2023</copyright-statement><copyright-year>2023</copyright-year><copyright-holder xml:lang="ru">Слизень В.В., Охремчук А.Э., Суркова Л.К., Гуревич Г.Л., Титов Л.П.</copyright-holder><copyright-holder xml:lang="en">Slizen V.V., Akhremchuk A.E., Surkova L.K., Gurevich G.L., Titov L.P.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://doklady.belnauka.by/jour/article/view/1133">https://doklady.belnauka.by/jour/article/view/1133</self-uri><abstract><p>Проведено полногеномное секвенирование штамма М. tuberculosis 11502 (база биообразцов NCBI, код доступа SAMN17832565), отнесенного, на основании структуры MIRU-VNTR локусов (n = 24), к генотипу Beijing подтипу B0/W148 кластеру 100-32 и проявлявшего пре-широкую лекарственную устойчивость. Штамм М. tuberculosis 11502 был резистентен к изониазиду, рифампицину, этамбутолу, левофлоксацину, этионамиду, что коррелировало с присутствием в резистоме мутаций в соответствующих генах: к рифампицину – мутации в генах rpoB (p.S450L), rpoC (p.I491T), к изониазиду – в промоторе гена fabG1 (g.-8T&gt;C), промоторе katG (p.S315T), к этионамиду – в ethA (делеция Т в положении 4 335 027 (gatgc-gagc)); к фторхинолонам – в гене gyrA (p.D94G); к этамбутолу – в embB (p.M306I), к стрептомицину – в rpsL (p.K43R). Геном М. tuberculosis 11502 (код доступа GenBank NCBI – CP070338) содержит 4 420 561 пару оснований, 4 104 гена, 4 053 кодирующие последовательности (кодирующие белки – 3 874) и отличается от референтного штамма М. tuberculosis H37Rv присутствием 2 055 мутаций, при этом зарегистрирован незначительный дрейф мутаций в сторону накопления G+C, что свидетельствует о важности поддержания высокого содержания G+C в геноме микобактерий. Геном М. tuberculosis 11502 имеет большее количество мутаций в сравнении с ранее секвенированным штаммом М. tuberculosis 4860 (код доступа в GenBank, NCBI: CP053092.1), относящимся к генотипу LAM (2055 против 1577 мутаций), что может быть результатом более длительной или более активной циркуляции М. tuberculosis 11502, или существования биологических особенностей, обеспечивающих промутагенный эффект.</p></abstract><trans-abstract xml:lang="en"><p>A whole genome sequencing was performed of strain M. tuberculosis 11502 (NCBI biosamples database, access code SAMN17832565) that was assigned to the Beijing genotype subtype B0/W148 of cluster 100-32, based on the MIRU- VNTR loci (n = 24) structure, a nd t hat exhibited pre-extended d rug resistance. M. tuberculosis 11502 was resistant to isoniazid, rifampicin, ethambutol, levofloxacin, and ethionamide, which correlated with the presence of mutations in the genes: resistance to isoniazid – the mutations in the fabG1 promoter (p.-8T&gt;C), the katG promoter (p.S315T), to ethionamide – the mutations in ethA (deletion of T at position 4 335 027 (gatgc-gagc)); to fluoroquinolones – in the gyrA gene (p.D94G); to ethambutol – in the embB gene (p.M306I); to streptomycin – in the rpsL gene (p.K43R). M. tuberculosis 11502 genome (Gen- Bank NCBI access code – CP070338) contained 4 420 561 base pairs, 4 104 genes, 4 053 CDSs (coding proteins – 3 874) and differed from reference strain M. tuberculosis H37Rv by the presence of 2 055 mutations. A slight drift of mutations towards the G+C accumulation was revealed, which indicates the importance of maintaining a high G+C content in the Mycobacterium spp.genome Strain M. tuberculosis 11502 has a higher number of mutations in comparison to previously sequenced M. tuberculosis 4860 (GenBank Access Code, NCBI: CP053092) belonging to the LAM genotype (2055 vs. 1577 mutations), which may be a consequence of a longer circulation of M. tuberculosis 11502, or some biological features providing the promutagenic effect.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>геном микобактерий туберкулеза</kwd><kwd>генотип Beijing подтип B0/W148</kwd><kwd>кластер 100-32</kwd><kwd>пре-широкая лекарственная устойчивость</kwd></kwd-group><kwd-group xml:lang="en"><kwd>Mycobacterium tuberculosis genome</kwd><kwd>genotype Beijing subtype B0/W148 cluster B100-32</kwd><kwd>pre-extended drug resistance</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Allué-Guardia, A. Evolution of drug-resistant Mycobacterium tuberculosis strains and their adaptation to the human lung environment / А. Allué-Guardia, J. I. García, J. B. Torrelles // Front. Microbiol. – 2021. – Vol. 12. – Art. 612675. https://doi.org/10.3389/fmicb.2021.612675</mixed-citation><mixed-citation xml:lang="en">Allué-Guardia A., García J. I., Torrelles J. B. Evolution of drug-resistant Mycobacterium tuberculosis strains and their adaptation to the human lung environment. Frontiers in Microbiology, 2021, vol. 12, art. 612675. https://doi.org/10.3389/fmicb.2021.612675</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Deciphering the biology of Mycobacterium tuberculosis from the complete genome sequence / S. T. Cole [et al.] // Nature. – 1998. – Vol. 393. – P. 537–544. https://doi.org/10.1038/31159</mixed-citation><mixed-citation xml:lang="en">Cole S., Brosch R., Parkhill J., Garnier T., Churcher C., Harris D., Gordon S. V. [et al.]. Deciphering the biology of Mycobacterium tuberculosis from the complete genome sequence. Nature, 1998, vol. 393, no. 6685, pp. 537–544. https://doi.org/10.1038/31159</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Biofilm formation in the lung contributes to virulence and drug tolerance of Mycobacterium tuberculosis / P. Chakraborty [et al.] // Nat. Commun. – 2021. – Vol. 12, N 1. – Art. 1606. https://doi.org/10.1038/s41467-021-21748-6</mixed-citation><mixed-citation xml:lang="en">Chakraborty P., Bajeli S., Kaushal D., Radotra B. D., Kumar A. Biofilm formation in the lung contributes to virulence and drug tolerance of Mycobacterium tuberculosis. Nature Communications, 2021, vol. 12, no. 1, art. 1606. https://doi.org/10.1038/s41467-021-21748-6</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Evolution and diversity of clonal bacteria: the paradigm of Mycobacterium tuberculosis / T. Dos Vultos [et al.] // PloS One. – 2008. – Vol. 3, N 2. – Art. e1538. https://doi.org/10.1371/journal.pone.0001538</mixed-citation><mixed-citation xml:lang="en">Dos Vultos T., Mestre O., Rauzier J., Golec M., Rastogi N., Rasolofo V., Tonjum T., Sola C., Matic I., Gicquel B. Evolution and diversity of clonal bacteria: the paradigm of Mycobacterium tuberculosis. PloS One, 2008, vol. 3, no. 2, art. e1538. https://doi.org/10.1371/journal.pone.0001538</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">Rapid detection of Mycobacterium tuberculosis Beijing genotype strains by real-time PCR / D. Hillemann [et al.] // J. Clin. Microbiol. – 2006. – Vol. 44, N 2. – P. 302–306. https://doi.org/10.1128/jcm.44.2.302-306.2006</mixed-citation><mixed-citation xml:lang="en">Hillemann D., Warren R., Kubica T., Rüsch-Gerdes S., Niemann S. Rapid detection of Mycobacterium tuberculosis Beijing genotype strains by real-time PCR. Journal of Clinical Microbiology, 2006, vol. 44, no. 2, pp. 302–306. https://doi.org/10.1128/jcm.44.2.302-306.2006</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Russian “successful” clone B0/W148 of Mycobacterium tuberculosis Beijing genotype: a multiplex PCR assay for rapid detection and global screening / I. Mokrousov [et al.] // J. Clin. Microbiol. – 2012. – Vol. 50, N 11. – P. 3757–3759. https://doi.org/10.1128/jcm.02001-12</mixed-citation><mixed-citation xml:lang="en">Mokrousov I., Narvskaya O., Vyazovaya A., Otten T., Jiao W.-W., Gomes L. L., Suffys P. N., Shen A.-D., Vishnevsky B. Russian “successful” clone B0/W148 of Mycobacterium tuberculosis Beijing genotype: a multiplex PCR assay for rapid detection and global screening. Journal of Clinical Microbiology, 2012, vol. 50, no. 11, pp. 3757–3759. https://doi.org/10.1128/jcm.02001-12</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">JSpeciesWS: a web server for prokaryotic species circumscription based on pairwise genome comparison / M. Richter [et al.] // Bioinformatics. – 2016. – Vol. 32, N 6. – P. 929–931. https://doi.org/10.1093/bioinformatics/btv681</mixed-citation><mixed-citation xml:lang="en">Richter M., Rosselló-Móra R., Glöckner F. O., Peplies J. JSpeciesWS: a web server for prokaryotic species circumscription based on pairwise genome comparison. Bioinformatics, 2016, vol. 32, no. 6, pp. 929–931. https://doi.org/10.1093/bioinformatics/btv681</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Hershberg, R. Evidence that mutation is universally biased towards AT in bacteria / R. Hershberg, D. Petrov // PLoS Genetics. – 2010. – Vol. 6, N 9. – Art. e1001115. https://doi.org/10.1371/journal.pgen.1001115</mixed-citation><mixed-citation xml:lang="en">Hershberg R., Petrov D. A. Evidence that mutation is universally biased towards AT in bacteria. PLoS Genetics, 2010, vol. 6, no. 9, art. e1001115. https://doi.org/10.1371/journal.pgen.1001115</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">Seward, E. A. Dietary nitrogen alters codon bias and genome composition in parasitic microorganisms / E. A. Seward, S. Kelly // Genome Biology. – 2016. – Vol. 17, N 1. – Art. 226. https://doi.org/10.1186/s13059-016-1087-9</mixed-citation><mixed-citation xml:lang="en">Seward E. A., Kelly S. Dietary nitrogen alters codon bias and genome composition in parasitic microorganisms. Genome Biology, 2016, vol. 17, no. 1, art. 226. https://doi.org/10.1186/s13059-016-1087-9</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Restricted structural gene polymorphism in the Mycobacterium tuberculosis complex indicates evolutionarily recent global dissemination / S. Sreevatsan [et al.] // Proceedings of the National Academy of Sciences. – 1997. – Vol. 94, N 18. – P. 9869–9874. https://doi.org/10.1073/pnas.94.18.9869</mixed-citation><mixed-citation xml:lang="en">Sreevatsan S., Pan X. I., Stockbauer K. E., Connell N. D., Kreiswirth B. N., Whittam T. S., Musser J. M. Restricted structural gene polymorphism in the Mycobacterium tuberculosis complex indicates evolutionarily recent global dissemination. Proceedings of the National Academy of Sciences, 1997, vol. 94, no. 18, pp. 9869–9874. https://doi.org/10.1073/pnas.94.18.9869</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Relationship between Mycobacterium tuberculosis genotype and the clinical phenotype of pulmonary and meningeal tuberculosis / G. Thwaites [et al.] // J. Clin. Microbiol. – 2008. – Vol. 46, N 4. – P. 1363–1368. https://doi.org/10.1128/jcm.02180-07</mixed-citation><mixed-citation xml:lang="en">Thwaites G., Caws M., Chau T. T. H., D’Sa A., Lan N. T. N., Huyen M. N. T., Gagneux S. Relationship between Mycobacterium tuberculosis genotype and the clinical phenotype of pulmonary and meningeal tuberculosis. Journal of Clinical Microbiology, 2008, vol. 46, no. 4, pp. 1363–1368. https://doi.org/10.1128/jcm.02180-07</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">Tuberculous spondylitis in Russia and prominent role of multidrug-resistant clone Mycobacterium tuberculosis Beijing B0/W148 / A. Vyazovaya [et al.] // Antimicrob. Agents Chemother. – 2015. – Vol. 59, N 4. – P. 2349–2357. https://doi.org/10.1128/aac.04221-14</mixed-citation><mixed-citation xml:lang="en">Vyazovaya A., Mokrousov I., Solovieva N., Mushkin A., Manicheva O., Vishnevsky B., Zhuravlev V., Narvskaya O. Tuberculous spondylitis in Russia and prominent role of multidrug-resistant clone Mycobacterium tuberculosis Beijing B0/ W148. Antimicrobial Agents and Chemotherapy, 2015, vol. 59, no. 4, pp. 2349–2357. https://doi.org/10.1128/aac.04221-14</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">A marked difference in pathogenesis and immune response induced by different Mycobacterium tuberculosis genotypes / B. Lopez [et al.] // Clinical Experimental Immunology. – 2003. – Vol. 133, N 1. – P. 30–37. https://doi.org/10.1046/j.1365-2249.2003.02171.x</mixed-citation><mixed-citation xml:lang="en">Lopez B., Aguilar D., Orozco H., Burger M., Espitia C., Ritacco V., Barrera L., Kremer K., Hernandez-Pando R., Huygen K., Van Soolingen D. A marked difference in pathogenesis and immune response induced by different Mycobacterium tuberculosis genotypes. Clinical and Experimental Immunology, 2003, vol. 133, no. 1, pp. 30–37. https://doi.org/10.1046/j.1365-2249.2003.02171.x</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Emergence of multidrug-resistant Mycobacterium tuberculosis of the Beijing lineage in Portugal and Guinea-Bissau: a snapshot of moving clones by whole-genome sequencing / J. Perdigão [et al.] // Emerging Microbes Infections. – 2020. – Vol. 9, N 1. – P. 1342–1353. https://doi.org/10.1080/22221751.2020.1774425</mixed-citation><mixed-citation xml:lang="en">Perdigão J., Silva C., Maltez F., Machado D., Miranda A., Couto I., Rabna P. [et al.]. Emergence of multidrug-resistant Mycobacterium tuberculosis of the Beijing lineage in Portugal and Guinea-Bissau: a snapshot of moving clones by whole-genome sequencing. Emerging Microbes and Infections, 2020, vol. 9, no. 1, pp. 1342–1353. https://doi.org/10.1080/22221751.2020.1774425</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Population structure of drug-resistant Mycobacterium tuberculosis in Central Asia / A. Engström [et al.] // BMC Infectious Diseases. – 2019. – Vol. 19, N 1. – Art. 908. https://doi.org/10.1186/s12879-019-4480-7</mixed-citation><mixed-citation xml:lang="en">Engström A., Antonenka U., Kadyrov A., Kalmambetova G., Kranzer K., Merker M., Kabirov O. [et al.]. Population structure of drug-resistant Mycobacterium tuberculosis in Central Asia. BMC Infectious Diseases, 2019, vol. 19, no. 1, art. 908. https://doi.org/10.1186/s12879-019-4480-7</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
