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The study protocol was approved by the Institutional Review Board (IRB) of The Fourth Hospital of Hebei Medical University (approval no.: 2021KY124), which waived the requirement for informed consent in accordance with the Declaration of Helsinki and relevant ethical guidelines. This waiver was granted as all specimens and data were fully de-identified and anonymized\u2014removing all personally identifiable information, such as names and medical record numbers\u2014prior to analysis. The research was conducted solely for scientific purposes, posed no risk to participants, and did not interfere with their clinical care or rights.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}