{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:55:53Z","timestamp":1781639753701,"version":"3.54.5"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002460","name":"Chung-Ang University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002460","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Gastric Cancer"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gastric cancer is a major global burden, yet evidence linking respiratory diseases to gastric cancer is limited. This study examined whether genetic susceptibility to respiratory diseases including asthma, chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and lung diseases due to external agents (LDEA) was associated with gastric cancer and Helicobacter pylori infection, given shared immune and inflammatory pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a two-sample Mendelian randomization analysis using genetic variants as instrumental variables to assess causal associations between respiratory diseases and risk of gastric cancer and\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infection. GWAS summary statistics for respiratory diseases were obtained from FinnGen, and for gastric cancer and\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infection from the UK Biobank. Analyses were adjusted for confounders such as smoking and alcohol consumption. Sensitivity analyses evaluated robustness and assessed potential pleiotropy and heterogeneity among genetic variants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No significant direct causal associations were found between respiratory diseases and gastric cancer risk. However, asthma and LDEA were significantly associated with increased risk of\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infection. No associations were observed for COPD or IPF with either outcome. Sensitivity analyses indicated minimal pleiotropic or heterogeneity effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study investigated genetic susceptibility to respiratory diseases and their potential links to gastric cancer and\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infection. While direct genetic evidence linking respiratory disease susceptibility to gastric cancer was limited, significant associations with\n                      <jats:italic>H. pylori<\/jats:italic>\n                      infection suggest possible indirect pathways involving respiratory diseases.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10120-026-01729-8","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:02:03Z","timestamp":1772802123000},"page":"519-526","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A two-sample Mendelian randomization study of the causal relationship between respiratory diseases, gastric cancer risk, and Helicobacter pylori infection"],"prefix":"10.1007","volume":"29","author":[{"given":"Youjin","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seunghyun","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jongin","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Young","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeehee","family":"Min","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxue","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maiko Hajime","family":"Sumikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Ha","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6408-7668","authenticated-orcid":false,"given":"Wanhyung","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"issue":"1","key":"1729_CR1","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1159\/000518483","volume":"103","author":"M Sekiguchi","year":"2022","unstructured":"Sekiguchi M, et al. Epidemiological trends and future perspectives of gastric cancer in Eastern Asia. Digestion. 2022;103(1):22\u20138.","journal-title":"Digestion"},{"issue":"4","key":"1729_CR2","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1007\/s10120-024-01499-1","volume":"27","author":"D Huang","year":"2024","unstructured":"Huang D, et al. Family history and gastric cancer incidence and mortality in Asia: a pooled analysis of more than half a million participants. Gastric Cancer. 2024;27(4):701\u201313.","journal-title":"Gastric Cancer"},{"issue":"1","key":"1729_CR3","doi-asserted-by":"publisher","first-page":"8617","DOI":"10.1038\/s41598-020-65312-6","volume":"10","author":"W Lee","year":"2020","unstructured":"Lee W, et al. External airborne-agent exposure increase risk of digestive tract cancer. Sci Rep. 2020;10(1):8617.","journal-title":"Sci Rep"},{"issue":"11","key":"1729_CR4","first-page":"794","volume":"73","author":"W Lee","year":"2016","unstructured":"Lee W, et al. Occupational exposure to crystalline silica and gastric cancer: a systematic review and meta-analysis. Occup Environ Med. 2016;73(11):794\u2013801.","journal-title":"Occup Environ Med"},{"issue":"20","key":"1729_CR5","doi-asserted-by":"publisher","first-page":"5164","DOI":"10.3390\/cancers14205164","volume":"14","author":"S Shin","year":"2022","unstructured":"Shin S, et al. Risk and status of gastrointestinal cancer according to the international standard industrial classification in Korean workers. Cancers. 2022;14(20):5164.","journal-title":"Cancers"},{"issue":"1","key":"1729_CR6","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1007\/s10120-023-01439-5","volume":"27","author":"S Lee","year":"2024","unstructured":"Lee S, Park SK. Ethnic-specific associations between body mass index and gastric cancer: a Mendelian randomization study in European and Korean populations. Gastric Cancer. 2024;27(1):19\u201327.","journal-title":"Gastric Cancer"},{"issue":"1","key":"1729_CR7","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1038\/s43586-021-00092-5","volume":"2","author":"E Sanderson","year":"2022","unstructured":"Sanderson E, et al. Mendelian randomization. Nat Rev Methods Primers. 2022;2(1):6.","journal-title":"Nat Rev Methods Primers"},{"issue":"6","key":"1729_CR8","doi-asserted-by":"publisher","first-page":"1301","DOI":"10.1016\/j.chest.2018.07.002","volume":"154","author":"A Singh","year":"2018","unstructured":"Singh A, et al. Predictors of asthma\/COPD overlap in FDNY firefighters with World Trade Center dust exposure: a longitudinal study. Chest. 2018;154(6):1301\u201310.","journal-title":"Chest"},{"issue":"5","key":"1729_CR9","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1097\/MCP.0000000000000894","volume":"28","author":"CT Lee","year":"2022","unstructured":"Lee CT, Feary J, Johannson KA. Environmental and occupational exposures in interstitial lung disease. Curr Opin Pulm Med. 2022;28(5):414\u201320.","journal-title":"Curr Opin Pulm Med"},{"issue":"1","key":"1729_CR10","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1007\/s12016-020-08830-5","volume":"62","author":"J Chatkin","year":"2022","unstructured":"Chatkin J, Correa L, Santos U. External environmental pollution as a risk factor for asthma. Clin Rev Allergy Immunol. 2022;62(1):72\u201389.","journal-title":"Clin Rev Allergy Immunol"},{"issue":"2","key":"1729_CR11","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/j.shaw.2025.04.005","volume":"16","author":"D Dansran","year":"2025","unstructured":"Dansran D, et al. Artisanal gold mining in Mongolia: silica exposure and silicosis risk factors-field survey. Saf Health Work. 2025;16(2):187\u201392.","journal-title":"Saf Health Work"},{"key":"1729_CR12","doi-asserted-by":"crossref","unstructured":"Andrup L, Hadrup N, Madsen AM. Occupational health issues in the seafood industry due to biological exposures: a narrative review. Saf Health Work; 2025.","DOI":"10.1016\/j.shaw.2025.08.001"},{"key":"1729_CR13","doi-asserted-by":"publisher","first-page":"e2","DOI":"10.35371\/aoem.2025.37.e2","volume":"37","author":"H Song","year":"2025","unstructured":"Song H, et al. List of occupational diseases among farmers in Korea: a literature review. Annals Occup Environ Med. 2025;37:e2.","journal-title":"Annals Occup Environ Med"},{"issue":"4","key":"1729_CR14","doi-asserted-by":"publisher","first-page":"326","DOI":"10.1097\/CEJ.0000000000000710","volume":"31","author":"Z Ante","year":"2022","unstructured":"Ante Z, Ernst P, Brassard P. Risk of gastric cancer in chronic obstructive pulmonary disease. Eur J Cancer Prev. 2022;31(4):326\u201332.","journal-title":"Eur J Cancer Prev"},{"issue":"9","key":"1729_CR15","doi-asserted-by":"publisher","first-page":"2013","DOI":"10.1002\/ijc.22566","volume":"120","author":"K Sj\u00f6dahl","year":"2007","unstructured":"Sj\u00f6dahl K, et al. Airborne exposures and risk of gastric cancer: a prospective cohort study. Int J Cancer. 2007;120(9):2013\u20138.","journal-title":"Int J Cancer"},{"issue":"16","key":"1729_CR16","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1001\/jama.2021.18236","volume":"326","author":"VW Skrivankova","year":"2021","unstructured":"Skrivankova VW, et al. Strengthening the reporting of observational studies in epidemiology using Mendelian randomization: the STROBE-MR statement. JAMA. 2021;326(16):1614\u201321.","journal-title":"JAMA"},{"issue":"11","key":"1729_CR17","doi-asserted-by":"publisher","first-page":"e1007081","DOI":"10.1371\/journal.pgen.1007081","volume":"13","author":"G Hemani","year":"2017","unstructured":"Hemani G, Tilling K, Davey Smith G. Orienting the causal relationship between imprecisely measured traits using GWAS summary data. PLoS Genet. 2017;13(11):e1007081.","journal-title":"PLoS Genet"},{"key":"1729_CR18","doi-asserted-by":"publisher","first-page":"e34408","DOI":"10.7554\/eLife.34408","volume":"7","author":"G Hemani","year":"2018","unstructured":"Hemani G, et al. The MR-base platform supports systematic causal inference across the human phenome. eLife. 2018;7:e34408.","journal-title":"eLife"},{"issue":"5","key":"1729_CR19","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1038\/s41588-018-0099-7","volume":"50","author":"M Verbanck","year":"2018","unstructured":"Verbanck M, et al. Detection of widespread horizontal pleiotropy in causal relationships inferred from Mendelian randomization between complex traits and diseases. Nat Genet. 2018;50(5):693\u20138.","journal-title":"Nat Genet"},{"issue":"7944","key":"1729_CR20","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1038\/s41586-022-05473-8","volume":"613","author":"MI Kurki","year":"2023","unstructured":"Kurki MI, et al. FinnGen provides genetic insights from a well-phenotyped isolated population. Nature. 2023;613(7944):508\u201318.","journal-title":"Nature"},{"issue":"7845","key":"1729_CR21","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1038\/s41586-021-03205-y","volume":"590","author":"D Taliun","year":"2021","unstructured":"Taliun D, et al. Sequencing of 53,831 diverse genomes from the NHLBI TOPMed Program. Nature. 2021;590(7845):290\u20139.","journal-title":"Nature"},{"key":"1729_CR22","doi-asserted-by":"crossref","unstructured":"Butler-Laporte G, et al. Genetic determinants of antibody-mediated immune responses to infectious diseases agents: a genome-wide and HLA association study. Open forum infectious diseases. Oxford University Press US; 2020.","DOI":"10.1093\/ofid\/ofaa450"},{"issue":"15","key":"1729_CR23","doi-asserted-by":"publisher","first-page":"e032814","DOI":"10.1161\/JAHA.123.032814","volume":"13","author":"A Zhong","year":"2024","unstructured":"Zhong A, et al. There is no direct causal relationship between coronary artery disease and Alzheimer disease: a bidirectional Mendelian randomization study. J Am Heart Association. 2024;13(15):e032814.","journal-title":"J Am Heart Association"},{"key":"1729_CR24","doi-asserted-by":"crossref","unstructured":"Cao W, et al. Use of bidirectional Mendelian randomization to unveil the association between antibody-mediated immune responses to infectious agents and allergic rhinitis, vol 21. Human Vaccines & Immunotherapeutics; 2025. p. 2523090.","DOI":"10.1080\/21645515.2025.2523090"},{"issue":"18","key":"1729_CR25","doi-asserted-by":"publisher","first-page":"3426","DOI":"10.1016\/j.cell.2022.08.004","volume":"185","author":"M Byrska-Bishop","year":"2022","unstructured":"Byrska-Bishop M, et al. High-coverage whole-genome sequencing of the expanded 1000 Genomes Project cohort including 602 trios. Cell. 2022;185(18):3426\u201340. e19.","journal-title":"Cell"},{"key":"1729_CR26","doi-asserted-by":"crossref","unstructured":"Zheng-Bradley X et al. Alignment of 1000 genomes project reads to reference assembly GRCh38. GigaScience. 2017;6(7).","DOI":"10.1093\/gigascience\/gix038"},{"issue":"2","key":"1729_CR27","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1093\/ije\/dyv080","volume":"44","author":"J Bowden","year":"2015","unstructured":"Bowden J, Davey Smith G, Burgess S. Mendelian randomization with invalid instruments: effect estimation and bias detection through Egger regression. Int J Epidemiol. 2015;44(2):512\u201325.","journal-title":"Int J Epidemiol"},{"issue":"1","key":"1729_CR28","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1097\/EDE.0000000000000559","volume":"28","author":"S Burgess","year":"2017","unstructured":"Burgess S, et al. Sensitivity analyses for robust causal inference from Mendelian randomization analyses with multiple genetic variants. Epidemiology. 2017;28(1):30\u201342.","journal-title":"Epidemiology"},{"issue":"8","key":"1729_CR29","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1080\/1354750X.2018.1485057","volume":"23","author":"A Straumfors","year":"2018","unstructured":"Straumfors A, et al. Pneumoproteins and markers of inflammation and platelet activation in the blood of grain dust exposed workers. Biomarkers. 2018;23(8):748\u201355.","journal-title":"Biomarkers"},{"key":"1729_CR30","doi-asserted-by":"crossref","unstructured":"Yu H, Yu Z. Occupational risk of COPD: insights from a large cohort study. Safety and Health at Work; 2025.","DOI":"10.1016\/j.shaw.2025.08.003"},{"key":"1729_CR31","doi-asserted-by":"crossref","unstructured":"Oz HS, Yeh S-L, Neuman MG. Gastrointestinal inflammation and repair: role of microbiome, infection, and nutrition. Gastroenterol Res Pract. 2016, p. 6516708.","DOI":"10.1155\/2016\/6516708"},{"key":"1729_CR32","doi-asserted-by":"crossref","unstructured":"Tufail A, Jiang Y, Cui X. A review on the mucus dynamics in the human respiratory airway. Biomech Model Mechanobiol. 2024; 8:1\u201317.","DOI":"10.1007\/s10237-024-01898-4"},{"issue":"4","key":"1729_CR33","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1111\/cea.12723","volume":"46","author":"MK Tulic","year":"2016","unstructured":"Tulic MK, Piche T, Verhasselt V. Lung\u2013gut cross-talk: evidence, mechanisms and implications for the mucosal inflammatory diseases. Clin Exp Allergy. 2016;46(4):519\u201328.","journal-title":"Clin Experimental Allergy"},{"issue":"12","key":"1729_CR34","doi-asserted-by":"publisher","first-page":"2520","DOI":"10.1017\/S0950268814003938","volume":"143","author":"W Krueger","year":"2015","unstructured":"Krueger W, et al. Environmental risk factors associated with Helicobacter pylori seroprevalence in the United States: a cross-sectional analysis of NHANES data. Epidemiol Infect. 2015;143(12):2520\u201331.","journal-title":"Epidemiol Infect"},{"issue":"1","key":"1729_CR35","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s13223-024-00870-2","volume":"20","author":"M Liu","year":"2024","unstructured":"Liu M, Wang Y, Du B. Update on the association between Helicobacter pylori infection and asthma in terms of microbiota and immunity. Allergy Asthma Clin Immunol. 2024;20(1):4.","journal-title":"Allergy Asthma Clin Immunol"},{"issue":"5","key":"1729_CR36","doi-asserted-by":"publisher","first-page":"e12356","DOI":"10.1002\/clt2.12356","volume":"14","author":"XL Song","year":"2024","unstructured":"Song XL, et al. Gut-lung axis and asthma: A historical review on mechanism and future perspective. Clin Translational Allergy. 2024;14(5):e12356.","journal-title":"Clin Translational Allergy"},{"key":"1729_CR37","doi-asserted-by":"crossref","unstructured":"Maspero J, et al. Type 2 inflammation in asthma and other airway diseases. ERJ Open Res. 2022; 8:3.","DOI":"10.1183\/23120541.00576-2021"},{"issue":"1","key":"1729_CR38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12026-025-09606-9","volume":"73","author":"J Meng","year":"2025","unstructured":"Meng J, et al. Systemic barrier dysfunction in type 2 inflammation diseases: perspective in the skin, airways, and gastrointestinal tract. Immunol Res. 2025;73(1):1\u201317.","journal-title":"Immunol Res"},{"key":"1729_CR39","doi-asserted-by":"crossref","unstructured":"Burr AC et al. Lung inflammatory response to environmental dust exposure in mice suggests a link to regional respiratory disease risk. J Inflamm Res. 2021; 4035\u201352.","DOI":"10.2147\/JIR.S320096"},{"key":"1729_CR40","doi-asserted-by":"crossref","unstructured":"Hosseininia S et al. Association of Helicobacter pylori infection with chronic obstructive pulmonary disease. Immunopathol Persa. 2022;8:8211.","DOI":"10.34172\/ipp.2022.32412"},{"issue":"1","key":"1729_CR41","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1177\/00236772221123184","volume":"57","author":"H Kim","year":"2023","unstructured":"Kim H, et al. Evaluation of exhaust air dust polymerase chain reaction as a supplement method for soiled bedding sentinel monitoring in specific pathogen free mouse facility using two different individually ventilated cage racks. Lab Anim. 2023;57(1):40\u20139.","journal-title":"Lab Anim"},{"issue":"2","key":"1729_CR42","doi-asserted-by":"publisher","first-page":"S10","DOI":"10.1378\/chest.117.2_suppl.10S","volume":"117","author":"PJ Barnes","year":"2000","unstructured":"Barnes PJ. Mechanisms in COPD: differences from asthma. Chest. 2000;117(2):S10\u20134.","journal-title":"Chest"},{"key":"1729_CR43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12931-018-0864-2","volume":"19","author":"L Zhang","year":"2018","unstructured":"Zhang L, et al. Macrophages: friend or foe in idiopathic pulmonary fibrosis? Respir Res. 2018;19:1\u201310.","journal-title":"Respir Res"},{"issue":"11","key":"1729_CR44","doi-asserted-by":"publisher","first-page":"1026","DOI":"10.1002\/ccr3.687","volume":"4","author":"B Stenstr\u00f6m","year":"2016","unstructured":"Stenstr\u00f6m B, et al. Helicobacter pylori overcomes natural immunity in repeated infections. Clin Case Rep. 2016;4(11):1026.","journal-title":"Clin Case Rep"},{"issue":"1","key":"1729_CR45","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2188\/jea.JE20200618","volume":"33","author":"S Tanaka","year":"2023","unstructured":"Tanaka S, et al. Long-term response of Helicobacter pylori antibody titer after eradication treatment in middle-aged Japanese: JPHC-NEXT study. J Epidemiol. 2023;33(1):1\u20137.","journal-title":"J Epidemiol"}],"container-title":["Gastric Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10120-026-01729-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10120-026-01729-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10120-026-01729-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T19:30:23Z","timestamp":1781638223000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10120-026-01729-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,6]]},"references-count":45,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["1729"],"URL":"https:\/\/doi.org\/10.1007\/s10120-026-01729-8","relation":{},"ISSN":["1436-3291","1436-3305"],"issn-type":[{"value":"1436-3291","type":"print"},{"value":"1436-3305","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,6]]},"assertion":[{"value":"20 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 2026","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 authors declare no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Institutional Review Board (IRB) of Chung-Ang University (IRB number: 1041078-20250227-BR-049).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}}]}}