{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T16:28:57Z","timestamp":1783182537662,"version":"3.54.6"},"reference-count":41,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["OBES SURG"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Ectopic fat accumulation plays a significant role in obesity-related metabolic dysfunction, and few studies have reported an association between ectopic gastric fat and metabolic risk factors. We aim to fulfill this need by assessing the degree of gastric submucosal fat accumulation in pathologic sections of 190 sleeve gastrectomy specimens.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Study patients were divided into two groups (D1 and D2) based on whether fat accumulation exceeded 1\/3 of the submucosa of the stomach. Demographic and metabolic risk factors were compared between the two groups. Metabolic risk variables that might be associated with the degree of fat accumulation were screened in the original cohort. After balancing for possible confounders, the robustness of the correlations was assessed using binary and conditional logistic regression analyses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>All study patients had fat accumulation in the submucosa of the stomach. C-reactive protein (CRP), body mass index (BMI), visceral fat area (VFA), and insulin resistance (IR) were higher in the D2 group than in the D1 group in the original cohort (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Logistic regression analysis showed that BMI and IR may be associated with increased fat accumulation. After balancing variables other than obesity indicators and IR using propensity score matching, BMI and IR remained significantly different between the two groups (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05). Further analysis of the matched cohort using two logistic regression analyses showed that IR was an independent risk factor for increased fat accumulation.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This study indicated that gastric submucosal fat accumulation was prevalent in patients with obesity and was associated with IR.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical Abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1007\/s11695-023-07014-2","type":"journal-article","created":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T18:02:35Z","timestamp":1704736955000},"page":"534-541","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Gastric Submucosal Fat Accumulation Is Associated with Insulin Resistance in Patients with Obesity"],"prefix":"10.1007","volume":"34","author":[{"given":"Tao","family":"Lu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianxun","family":"Kan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialai","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"Sheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yating","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0148-6474","authenticated-orcid":false,"given":"Lijian","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"issue":"1","key":"7014_CR1","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1056\/NEJMoa1614362","volume":"377","author":"GBDO Collaborators","year":"2017","unstructured":"Collaborators GBDO, Afshin A, Forouzanfar MH, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13\u201327.","journal-title":"N Engl J Med"},{"issue":"6","key":"7014_CR2","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.amepre.2011.10.026","volume":"42","author":"EA Finkelstein","year":"2012","unstructured":"Finkelstein EA, Khavjou OA, Thompson H, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;42(6):563\u201370.","journal-title":"Am J Prev Med"},{"issue":"6","key":"7014_CR3","doi-asserted-by":"publisher","first-page":"e277","DOI":"10.1016\/S2468-2667(17)30074-9","volume":"2","author":"M Kivimaki","year":"2017","unstructured":"Kivimaki M, Kuosma E, Ferrie JE, et al. Overweight, obesity, and risk of cardiometabolic multimorbidity: pooled analysis of individual-level data for 120 813 adults from 16 cohort studies from the USA and Europe. Lancet Public Health. 2017;2(6):e277\u201385.","journal-title":"Lancet Public Health"},{"issue":"4","key":"7014_CR4","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/S2213-8587(22)00033-X","volume":"10","author":"M Kivimaki","year":"2022","unstructured":"Kivimaki M, Strandberg T, Pentti J, et al. Body-mass index and risk of obesity-related complex multimorbidity: an observational multicohort study. Lancet Diabetes Endocrinol. 2022;10(4):253\u201363.","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"6","key":"7014_CR5","doi-asserted-by":"publisher","DOI":"10.1111\/obr.13562","volume":"24","author":"FM Delpino","year":"2023","unstructured":"Delpino FM, Dos Santos RAP, Petarli GB, et al. Overweight, obesity and risk of multimorbidity: a systematic review and meta-analysis of longitudinal studies. Obes Rev. 2023;24(6): e13562.","journal-title":"Obes Rev"},{"issue":"10","key":"7014_CR6","doi-asserted-by":"publisher","first-page":"e490","DOI":"10.1016\/S2468-2667(18)30139-7","volume":"3","author":"ST Nyberg","year":"2018","unstructured":"Nyberg ST, Batty GD, Pentti J, et al. Obesity and loss of disease-free years owing to major non-communicable diseases: a multicohort study. Lancet Public Health. 2018;3(10):e490\u20137.","journal-title":"Lancet Public Health"},{"issue":"10046","key":"7014_CR7","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1016\/S0140-6736(16)30175-1","volume":"388","author":"BMIMC Global","year":"2016","unstructured":"Global BMIMC, Di Angelantonio E, Bhupathiraju ShN, et al. Body-mass index and all-cause mortality: individual-participant-data meta-analysis of 239 prospective studies in four continents. Lancet. 2016;388(10046):776\u201386.","journal-title":"Lancet"},{"issue":"13","key":"7014_CR8","doi-asserted-by":"publisher","first-page":"1391","DOI":"10.1161\/CIRCULATIONAHA.117.029617","volume":"137","author":"IJ Neeland","year":"2018","unstructured":"Neeland IJ, Poirier P, Despres JP. Cardiovascular and metabolic heterogeneity of obesity: clinical challenges and implications for management. Circulation. 2018;137(13):1391\u2013406.","journal-title":"Circulation"},{"issue":"1","key":"7014_CR9","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1097\/MOL.0b013e328321b3a8","volume":"20","author":"J Szendroedi","year":"2009","unstructured":"Szendroedi J, Roden M. Ectopic lipids and organ function. Curr Opin Lipidol. 2009;20(1):50\u20136.","journal-title":"Curr Opin Lipidol"},{"issue":"11","key":"7014_CR10","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1161\/CIRCRESAHA.120.316101","volume":"126","author":"ME Piche","year":"2020","unstructured":"Piche ME, Tchernof A, Despres JP. Obesity phenotypes, diabetes, and cardiovascular diseases. Circ Res. 2020;126(11):1477\u2013500.","journal-title":"Circ Res"},{"issue":"1","key":"7014_CR11","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.jacc.2016.03.597","volume":"68","author":"E Levelt","year":"2016","unstructured":"Levelt E, Pavlides M, Banerjee R, et al. Ectopic and visceral fat deposition in lean and obese patients with type 2 diabetes. J Am Coll Cardiol. 2016;68(1):53\u201363.","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"7014_CR12","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1210\/jc.2012-3190","volume":"98","author":"M Graner","year":"2013","unstructured":"Graner M, Siren R, Nyman K, et al. Cardiac steatosis associates with visceral obesity in nondiabetic obese men. J Clin Endocrinol Metab. 2013;98(3):1189\u201397.","journal-title":"J Clin Endocrinol Metab"},{"issue":"9","key":"7014_CR13","doi-asserted-by":"publisher","first-page":"3490","DOI":"10.1210\/jc.2007-0482","volume":"92","author":"A Kotronen","year":"2007","unstructured":"Kotronen A, Westerbacka J, Bergholm R, et al. Liver fat in the metabolic syndrome. J Clin Endocrinol Metab. 2007;92(9):3490\u20137.","journal-title":"J Clin Endocrinol Metab"},{"issue":"1\u20132","key":"7014_CR14","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/S0344-0338(81)80006-4","volume":"173","author":"P Schmitz-Moormann","year":"1981","unstructured":"Schmitz-Moormann P, Pittner PM, Heinze W. Lipomatosis of the pancreas A morphometrical investigation. Pathol Res Pract. 1981;173(1\u20132):45\u201353.","journal-title":"Pathol Res Pract"},{"issue":"8","key":"7014_CR15","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1038\/sj.ki.5002796","volume":"73","author":"A Serra","year":"2008","unstructured":"Serra A, Romero R, Lopez D, et al. Renal injury in the extremely obese patients with normal renal function. Kidney Int. 2008;73(8):947\u201355.","journal-title":"Kidney Int"},{"issue":"7","key":"7014_CR16","doi-asserted-by":"publisher","first-page":"1065","DOI":"10.1177\/2050640618766926","volume":"6","author":"S Wada","year":"2018","unstructured":"Wada S, Yasunaga Y, Oka K, et al. Submucosal fat accumulation in human colorectal tissue and its association with abdominal obesity and insulin resistance. United Eur Gastroenterol J. 2018;6(7):1065\u201373.","journal-title":"United Eur Gastroenterol J"},{"issue":"24","key":"7014_CR17","doi-asserted-by":"publisher","first-page":"e837","DOI":"10.1161\/CIRCULATIONAHA.111.077602","volume":"124","author":"KA Britton","year":"2011","unstructured":"Britton KA, Fox CS. Ectopic fat depots and cardiovascular disease. Circulation. 2011;124(24):e837\u201341.","journal-title":"Circulation"},{"issue":"2","key":"7014_CR18","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1159\/000454714","volume":"26","author":"A Djuric-Stefanovic","year":"2017","unstructured":"Djuric-Stefanovic A, Ebrahimi K, Sisevic J, et al. Gastroduodenal lipomatosis in familial multiple lipomatosis. Med Princ Pract. 2017;26(2):189\u201391.","journal-title":"Med Princ Pract"},{"issue":"4","key":"7014_CR19","doi-asserted-by":"publisher","first-page":"254","DOI":"10.5230\/jgc.2010.10.4.254","volume":"10","author":"IH Jeong","year":"2010","unstructured":"Jeong IH, Maeng YH. Gastric lipomatosis. J Gastric Cancer. 2010;10(4):254\u20138.","journal-title":"J Gastric Cancer"},{"issue":"7","key":"7014_CR20","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1007\/BF00280883","volume":"28","author":"DR Matthews","year":"1985","unstructured":"Matthews DR, Hosker JP, Rudenski AS, et al. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28(7):412\u20139.","journal-title":"Diabetologia"},{"issue":"18","key":"7014_CR21","doi-asserted-by":"publisher","first-page":"1996","DOI":"10.1161\/CIR.0b013e318233bc6a","volume":"124","author":"MA Cornier","year":"2011","unstructured":"Cornier MA, Despres JP, Davis N, et al. Assessing adiposity: a scientific statement from the American Heart Association. Circulation. 2011;124(18):1996\u20132019.","journal-title":"Circulation"},{"issue":"6","key":"7014_CR22","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.1093\/ajcn\/51.6.1106","volume":"51","author":"RB Mazess","year":"1990","unstructured":"Mazess RB, Barden HS, Bisek JP, et al. Dual-energy x-ray absorptiometry for total-body and regional bone-mineral and soft-tissue composition. Am J Clin Nutr. 1990;51(6):1106\u201312.","journal-title":"Am J Clin Nutr"},{"issue":"4","key":"7014_CR23","doi-asserted-by":"publisher","first-page":"973","DOI":"10.2214\/ajr.181.4.1810973","volume":"181","author":"PJ Pickhardt","year":"2003","unstructured":"Pickhardt PJ, Asher DB. Wall thickening of the gastric antrum as a normal finding: multidetector CT with cadaveric comparison. AJR Am J Roentgenol. 2003;181(4):973\u20139.","journal-title":"AJR Am J Roentgenol"},{"issue":"4","key":"7014_CR24","doi-asserted-by":"publisher","first-page":"734","DOI":"10.2214\/AJR.15.15185","volume":"206","author":"A Gervaise","year":"2016","unstructured":"Gervaise A, Naulet P, Gervaise-Henry C, et al. Gastric wall fatty infiltration in patients without overt gastrointestinal disease. AJR Am J Roentgenol. 2016;206(4):734\u20139.","journal-title":"AJR Am J Roentgenol"},{"issue":"9","key":"7014_CR25","doi-asserted-by":"publisher","first-page":"2467","DOI":"10.1111\/j.1572-0241.1999.01377.x","volume":"94","author":"EM Brunt","year":"1999","unstructured":"Brunt EM, Janney CG, Di Bisceglie AM, et al. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94(9):2467\u201374.","journal-title":"Am J Gastroenterol"},{"key":"7014_CR26","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.clinimag.2018.11.013","volume":"54","author":"A Kupeli","year":"2019","unstructured":"Kupeli A, Danisan G, Kocak M, et al. Gastric wall fat halo sign in patients without intestinal disease. Clin Imaging. 2019;54:31\u20136.","journal-title":"Clin Imaging"},{"issue":"6","key":"7014_CR27","doi-asserted-by":"publisher","first-page":"1805","DOI":"10.1007\/s11695-019-03740-8","volume":"29","author":"V Chumbalkar","year":"2019","unstructured":"Chumbalkar V, Fu Z, Boguniewicz A, et al. Gastric lipohyperplasia presenting as gastric polyposis: the first case report and morphometric study of additional 127 bariatric specimens with a proposal for diagnostic criteria. Obes Surg. 2019;29(6):1805\u20139.","journal-title":"Obes Surg"},{"issue":"4","key":"7014_CR28","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1007\/s11892-010-0122-6","volume":"10","author":"K Cusi","year":"2010","unstructured":"Cusi K. The role of adipose tissue and lipotoxicity in the pathogenesis of type 2 diabetes. Curr Diab Rep. 2010;10(4):306\u201315.","journal-title":"Curr Diab Rep"},{"issue":"1","key":"7014_CR29","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1038\/s41392-022-01073-0","volume":"7","author":"M Li","year":"2022","unstructured":"Li M, Chi X, Wang Y, et al. Trends in insulin resistance: insights into mechanisms and therapeutic strategy. Signal Transduct Target Ther. 2022;7(1):216.","journal-title":"Signal Transduct Target Ther"},{"issue":"7121","key":"7014_CR30","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1038\/nature05482","volume":"444","author":"SE Kahn","year":"2006","unstructured":"Kahn SE, Hull RL, Utzschneider KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature. 2006;444(7121):840\u20136.","journal-title":"Nature"},{"issue":"12","key":"7014_CR31","doi-asserted-by":"publisher","first-page":"1131","DOI":"10.1056\/NEJMra1011035","volume":"371","author":"GI Shulman","year":"2014","unstructured":"Shulman GI. Ectopic fat in insulin resistance, dyslipidemia, and cardiometabolic disease. N Engl J Med. 2014;371(12):1131\u201341.","journal-title":"N Engl J Med"},{"issue":"9","key":"7014_CR32","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1111\/obr.12298","volume":"16","author":"R Stinkens","year":"2015","unstructured":"Stinkens R, Goossens GH, Jocken JW, et al. Targeting fatty acid metabolism to improve glucose metabolism. Obes Rev. 2015;16(9):715\u201357.","journal-title":"Obes Rev"},{"issue":"2","key":"7014_CR33","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1053\/j.gastro.2007.04.068","volume":"133","author":"A Gastaldelli","year":"2007","unstructured":"Gastaldelli A, Cusi K, Pettiti M, et al. Relationship between hepatic\/visceral fat and hepatic insulin resistance in nondiabetic and type 2 diabetic subjects. Gastroenterology. 2007;133(2):496\u2013506.","journal-title":"Gastroenterology"},{"issue":"10","key":"7014_CR34","doi-asserted-by":"publisher","first-page":"2506","DOI":"10.1007\/s00125-011-2204-7","volume":"54","author":"EL Lim","year":"2011","unstructured":"Lim EL, Hollingsworth KG, Aribisala BS, et al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia. 2011;54(10):2506\u201314.","journal-title":"Diabetologia"},{"issue":"3","key":"7014_CR35","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1038\/ijo.2011.117","volume":"36","author":"B Gaborit","year":"2012","unstructured":"Gaborit B, Kober F, Jacquier A, et al. Assessment of epicardial fat volume and myocardial triglyceride content in severely obese subjects: relationship to metabolic profile, cardiac function and visceral fat. Int J Obes (Lond). 2012;36(3):422\u201330.","journal-title":"Int J Obes (Lond)"},{"issue":"4","key":"7014_CR36","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1038\/ajg.2014.1","volume":"109","author":"VW Wong","year":"2014","unstructured":"Wong VW, Wong GL, Yeung DK, et al. Fatty pancreas, insulin resistance, and beta-cell function: a population study using fat-water magnetic resonance imaging. Am J Gastroenterol. 2014;109(4):589\u201397.","journal-title":"Am J Gastroenterol"},{"issue":"7","key":"7014_CR37","doi-asserted-by":"publisher","first-page":"804","DOI":"10.1038\/nm.4350","volume":"23","author":"MP Czech","year":"2017","unstructured":"Czech MP. Insulin action and resistance in obesity and type 2 diabetes. Nat Med. 2017;23(7):804\u201314.","journal-title":"Nat Med"},{"issue":"4","key":"7014_CR38","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1152\/physrev.00063.2017","volume":"98","author":"MC Petersen","year":"2018","unstructured":"Petersen MC, Shulman GI. Mechanisms of insulin action and insulin resistance. Physiol Rev. 2018;98(4):2133\u2013223.","journal-title":"Physiol Rev"},{"issue":"3","key":"7014_CR39","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1038\/s41575-018-0082-x","volume":"16","author":"K Kazankov","year":"2019","unstructured":"Kazankov K, Jorgensen SMD, Thomsen KL, et al. The role of macrophages in nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Nat Rev Gastroenterol Hepatol. 2019;16(3):145\u201359.","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"9","key":"7014_CR40","doi-asserted-by":"publisher","first-page":"593","DOI":"10.1038\/s41569-022-00679-9","volume":"19","author":"G Iacobellis","year":"2022","unstructured":"Iacobellis G. Epicardial adipose tissue in contemporary cardiology. Nat Rev Cardiol. 2022;19(9):593\u2013606.","journal-title":"Nat Rev Cardiol"},{"issue":"7","key":"7014_CR41","doi-asserted-by":"publisher","first-page":"671","DOI":"10.1016\/S2468-1253(23)00064-X","volume":"8","author":"MS Petrov","year":"2023","unstructured":"Petrov MS. Fatty change of the pancreas: the Pandora\u2019s box of pancreatology. Lancet Gastroenterol Hepatol. 2023;8(7):671\u201382.","journal-title":"Lancet Gastroenterol Hepatol"}],"container-title":["Obesity Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-023-07014-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11695-023-07014-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11695-023-07014-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T15:33:09Z","timestamp":1706196789000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11695-023-07014-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,8]]},"references-count":41,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["7014"],"URL":"https:\/\/doi.org\/10.1007\/s11695-023-07014-2","relation":{},"ISSN":["0960-8923","1708-0428"],"issn-type":[{"value":"0960-8923","type":"print"},{"value":"1708-0428","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,8]]},"assertion":[{"value":"25 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 December 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 December 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 January 2024","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study has been approved by the Ethics Committee of the Second Affiliated Hospital of Nanjing Medical University.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval"}},{"value":"Since the data was de-identified and was archival in nature, no patient consent was required.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}