{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:43:35Z","timestamp":1791942215749,"version":"4.3.4"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"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":["BMC Complement Med Ther"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Breast cancer (BC) is the second most common cancer globally and the most prevalent among women. Chemotherapy, a primary treatment, frequently induces distressing side effects like nausea and vomiting. This study evaluated the efficacy of Citrus aurantium inhalation aromatherapy in reducing chemotherapy-induced nausea and vomiting (CINV) in women with BC.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In this CONSORT-compliant parallel-group randomized controlled trial (registered at IRCT: 20240305061177N1), 92 BC patients at Motahari Clinic were randomly allocated (between April to August 2024) to an aromatherapy group (<jats:italic>n<\/jats:italic>\u2009=\u200946) or a control group (<jats:italic>n<\/jats:italic>\u2009=\u200946). Alongside standard antiemetic medications, the aromatherapy group inhaled two drops of C. aurantium essential oil applied to the philtrum, while the control group received sunflower oil. The Rhodes Index assessed nausea, vomiting, and retching over five days.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Significant reductions in mean total scores for nausea, vomiting, and retching were observed in the aromatherapy group compared to the control group from days 3 to 5 (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.05), with no significant differences on days 1 and 2. Total symptom scores significantly decreased from Day 1 to Day 5 in the aromatherapy group while the control group showed no change.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>C. aurantium aromatherapy significantly alleviated CINV during the delayed phase (days 3\u20135). Given its safety, affordability, and accessibility, this intervention offers a promising complementary approach for managing CINV in BC patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>This trial was registered with the Iranian Registry of Clinical Trials (IRCT20240305061177N1, march 17, 2024).<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12906-025-05052-0","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T10:03:10Z","timestamp":1759831390000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The effect of Citrus aurantium inhalation aromatherapy on chemotherapy-induced nausea and vomiting in breast cancer patients: a randomized controlled trial"],"prefix":"10.1186","volume":"25","author":[{"given":"Parsa","family":"Tabei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Molazem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mozhgan","family":"Rivaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parvin Ghaem","family":"Maghami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niloofar","family":"Ahmadloo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"issue":"6","key":"5052_CR1","first-page":"394","volume":"68","author":"F Bray","year":"2018","unstructured":"Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394\u2013424.","journal-title":"CA Cancer J Clin"},{"key":"5052_CR2","doi-asserted-by":"publisher","first-page":"864","DOI":"10.3389\/fonc.2020.00864","volume":"10","author":"S Nardin","year":"2020","unstructured":"Nardin S, Mora E, Varughese FM, D\u2019Avanzo F, Vachanaram AR, Rossi V, et al. Breast cancer survivorship, quality of life, and late toxicities. Front Oncol. 2020;10:864.","journal-title":"Front Oncol"},{"issue":"1","key":"5052_CR3","first-page":"7","volume":"69","author":"RL Siegel","year":"2019","unstructured":"Siegel RL, Miller KD, Jemal A. Cancer statistics, 2019. CA Cancer J Clin. 2019;69(1):7\u201334.","journal-title":"CA Cancer J Clin"},{"issue":"D8","key":"5052_CR4","first-page":"530","volume":"1","author":"M Madaminov","year":"2022","unstructured":"Madaminov M, Shernazarov F. Breast cancer detection methods, symptoms, causes, treatment. Sci Innov. 2022;1(D8):530\u20135.","journal-title":"Sci Innov"},{"issue":"9","key":"5052_CR5","first-page":"3831","volume":"28","author":"A Uthaipaisanwong","year":"2020","unstructured":"Uthaipaisanwong A, Oranratanaphan S, Musigavong N. Effects of ginger adjunct to the standard prophylaxis on reducing carboplatin and paclitaxel-induced nausea vomiting: a randomized controlled study. Support Care Cancer. 2020;28(9):3831\u20138.","journal-title":"Support Care Cancer"},{"issue":"1","key":"5052_CR6","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1186\/s12885-024-12623-w","volume":"24","author":"H Tang","year":"2024","unstructured":"Tang H, Zhang W, Shen H, Tang H, Cai M, Wang T, et al. A protocol for a multidisciplinary early intervention during chemotherapy to improve dietary management behavior in breast cancer patients: a two-arm, single-center randomized controlled trial. BMC Cancer. 2024;24(1):859.","journal-title":"BMC Cancer"},{"issue":"2","key":"5052_CR7","volume":"26","author":"D Lorusso","year":"2017","unstructured":"Lorusso D, Bria E, Costantini A, Di Maio M, Rosti G, Mancuso A. Patients\u2019 perception of chemotherapy side effects: expectations, doctor\u2013patient communication and impact on quality of life \u2013 an Italian survey. Eur J Cancer Care (Engl). 2017;26(2): e12618.","journal-title":"Eur J Cancer Care (Engl)"},{"key":"5052_CR8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctarc.2020.100278","volume":"26","author":"K Gupta","year":"2021","unstructured":"Gupta K, Walton R, Kataria SP. Chemotherapy-induced nausea and vomiting: pathogenesis, recommendations, and new trends. Cancer Treatment and Research Communications. 2021;26: 100278.","journal-title":"Cancer Treatment and Research Communications"},{"key":"5052_CR9","first-page":"169","volume":"5","author":"C Vidall","year":"2011","unstructured":"Vidall C, Dielenseger P, Farrell C, Lennan E, Muxagata P, Fern\u00e1ndez-Ortega P, et al. Evidence-based management of chemotherapy-induced nausea and vomiting: a position statement from a European cancer nursing forum. Ecancermedicalscience. 2011;5:169.","journal-title":"Ecancermedicalscience"},{"issue":"7","key":"5052_CR10","doi-asserted-by":"publisher","first-page":"883","DOI":"10.6004\/jnccn.2017.0117","volume":"15","author":"MJ Berger","year":"2017","unstructured":"Berger MJ, Ettinger DS, Aston J, Barbour S, Bergsbaken J, Bierman PJ, et al. NCCN guidelines insights: antiemesis, version 2.2017. J Natl Compr Canc Netw. 2017;15(7):883\u201393.","journal-title":"J Natl Compr Canc Netw"},{"issue":"12","key":"5052_CR11","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1200\/JOP.2017.026351","volume":"13","author":"PJ Hesketh","year":"2017","unstructured":"Hesketh PJ, Bohlke K, Kris MG. Antiemetics. American society of clinical oncology clinical practice guideline update summary. J Oncol Pract. 2017;13(12):825\u201330.","journal-title":"J Oncol Pract"},{"issue":"5","key":"5052_CR12","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/j.jand.2015.10.020","volume":"116","author":"W Marx","year":"2016","unstructured":"Marx W, Kiss N, McCarthy AL, McKavanagh D, Isenring L. Chemotherapy-induced nausea and vomiting: a narrative review to inform dietetics practice. J Acad Nutr Diet. 2016;116(5):819\u201327.","journal-title":"J Acad Nutr Diet"},{"key":"5052_CR13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2020.102587","volume":"56","author":"NE Erturk","year":"2021","unstructured":"Erturk NE, Tasc\u0131 S. The effects of peppermint oil on nausea, vomiting and retching in cancer patients undergoing chemotherapy: an open label quasi-randomized controlled pilot study. Complement Ther Med. 2021;56: 102587.","journal-title":"Complement Ther Med"},{"key":"5052_CR14","doi-asserted-by":"publisher","DOI":"10.4103\/jrms.JRMS_833_20","volume":"26","author":"S Darvishpour","year":"2021","unstructured":"Darvishpour S, Avan R, Azadbakht M, Maham M, Akbari J, Janbabaei G, et al. Malus domestica reduces chemotherapy-induced nausea and vomiting: a randomized double-blind placebo-controlled clinical trial. J Res Med Sci. 2021;26: 72.","journal-title":"J Res Med Sci"},{"issue":"4","key":"5052_CR15","doi-asserted-by":"publisher","first-page":"229","DOI":"10.4103\/nms.nms_121_21","volume":"11","author":"M Alikamali","year":"2022","unstructured":"Alikamali M, Tadayonfar F, Salarfard M, Emadi SF. The effects of Citrus aurantium and lavender aromas on nausea and vomiting of pregnancy in nulliparous pregnant women: a randomized clinical trial. Nurs Midwifery Stud. 2022;11(4):229\u201333.","journal-title":"Nurs Midwifery Stud"},{"issue":"6","key":"5052_CR16","first-page":"2423","volume":"29","author":"SM Mihaila","year":"2021","unstructured":"Mihaila SM, Macovei LA, Petrariu FD, et al. The effectiveness of Romatherapy in alleviating Chemotherapy-Induced nausea and vomiting in breast Cancer patients: A clinical trial. Support Care Cancer. 2021;29(6):2423\u201331.","journal-title":"Support Care Cancer"},{"key":"5052_CR17","first-page":"5532193","volume":"2021","author":"VP Baldin","year":"2021","unstructured":"Baldin VP, Gambero A, Dalmagro AP, et al. Phytochemical composition and biological activities of essential oils from Citrus aurantium L. Evid Based Complement Alternat Med. 2021;2021:5532193.","journal-title":"Evid Based Complement Alternat Med"},{"issue":"3","key":"5052_CR18","first-page":"279","volume":"27","author":"SM Gu","year":"2019","unstructured":"Gu SM, Kim SY, Lamichhane S, Yun J. Limonene inhibits methamphetamine-induced sensitizations via the regulation of dopamine receptor super sensitivity. Biomol Ther (Seoul). 2019;27(3):279\u201386.","journal-title":"Biomol Ther (Seoul)"},{"issue":"3","key":"5052_CR19","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1159\/000096889","volume":"2","author":"T Komori","year":"1995","unstructured":"Komori T, Fujiwara R, Tanida M, et al. Effects of citrus fragrance on immune function and depressive states. Neuroimmunomodulation. 1995;2(3):174\u201380.","journal-title":"Neuroimmunomodulation"},{"key":"5052_CR20","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.cbi.2018.02.007","volume":"283","author":"AJ Vieira","year":"2018","unstructured":"Vieira AJ, Beserra FP, Souza M, Totti B, Rozza A. Limonene: aroma of innovation in health and disease. Chem Biol Interact. 2018;283:97\u2013106.","journal-title":"Chem Biol Interact"},{"issue":"8","key":"5052_CR21","first-page":"5625","volume":"53","author":"AM Sabogal-Gu\u00e1queta","year":"2016","unstructured":"Sabogal-Gu\u00e1queta AM, Osorio E, Cardona-G\u00f3mez GP. Linalool reverses neuropathological and behavioral impairments in old 3xTg-AD mice. Mol Neurobiol. 2016;53(8):5625\u201340.","journal-title":"Mol Neurobiol"},{"key":"5052_CR22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejphar.2022.175379","volume":"936","author":"W Chen","year":"2022","unstructured":"Chen W, Zhao Y, Dai Y, Nie K. Gastrointestinal inflammation plays a critical role in chemotherapy-induced nausea and vomiting. Eur J Pharmacol. 2022;936: 175379.","journal-title":"Eur J Pharmacol"},{"issue":"3","key":"5052_CR23","first-page":"34","volume":"18","author":"H Fathi","year":"2016","unstructured":"Fathi H, Mohammad Shahi N, Latifi A, Zamani A, Shaki F. Evaluation of antiemetic effect of metabolic, aesthetic and aqueous extracts of Citrus aurantium L. on chicken. J Gorgan Univ Med Sci. 2016;18(3):34\u20139.","journal-title":"J Gorgan Univ Med Sci"},{"key":"5052_CR24","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2022.843096","volume":"9","author":"C Zhao","year":"2022","unstructured":"Zhao C, Zhang Z, Nie D, Li Y. Protective effect of lemon essential oil and its major active component, D-limonene, on intestinal injury and inflammation of E. coli-challenged mice. Front Nutr. 2022;9: 843096. https:\/\/doi.org\/10.3389\/fnut.2022.843096.","journal-title":"Front Nutr"},{"key":"5052_CR25","doi-asserted-by":"publisher","DOI":"10.3390\/biom14030334","author":"SH Kathem","year":"2024","unstructured":"Kathem SH, et al. Limonene exerts anti-inflammatory effect on LPS-induced jejunal injury in mice by inhibiting NF-\u03baB\/AP-1 pathway. Biomolecules. 2024. https:\/\/doi.org\/10.3390\/biom14030334.","journal-title":"Biomolecules"},{"key":"5052_CR26","doi-asserted-by":"publisher","first-page":"3624094","DOI":"10.1155\/2018\/3624094","volume":"2018","author":"C Mannucci","year":"2018","unstructured":"Mannucci C, Calapai F, Cardia L, Inferrera G, D\u2019Arena G, Di Pietro M, et al. Clinical pharmacology of Citrus aurantium and Citrus sinensis for the treatment of anxiety. Evid Based Complement Alternat Med. 2018;2018:3624094.","journal-title":"Evid Based Complement Alternat Med"},{"issue":"1","key":"5052_CR27","doi-asserted-by":"publisher","DOI":"10.62435\/2965-7253.bjhae.2024.bjhae11","volume":"1","author":"GS Bisson","year":"2024","unstructured":"Bisson GS, Silva FRO, Gir\u00e3o DKFB. The anxiolytic potential of citrus aurantium essential oil: a focused critical review. Brazilian Journal of Health Aromatherapy and Essential Oil. 2024;1(1): bjhae11. https:\/\/doi.org\/10.62435\/2965-7253.bjhae.2024.bjhae11.","journal-title":"Brazilian Journal of Health Aromatherapy and Essential Oil"},{"issue":"5","key":"5052_CR28","first-page":"889","volume":"26","author":"VA Rhodes","year":"1999","unstructured":"Rhodes VA, McDaniel RW. The index of nausea, vomiting, and retching: a new format of the index of nausea and vomiting. Oncol Nurs Forum. 1999;26(5):889\u201394.","journal-title":"Oncol Nurs Forum"},{"issue":"24","key":"5052_CR29","doi-asserted-by":"publisher","first-page":"2782","DOI":"10.1200\/JCO.20.01296","volume":"38","author":"PJ Hesketh","year":"2020","unstructured":"Hesketh PJ, Kris MG, Basch E, et al. Antiemetics: ASCO guideline update. J Clin Oncol. 2020;38(24):2782\u201397. https:\/\/doi.org\/10.1200\/JCO.20.01296.","journal-title":"J Clin Oncol"},{"issue":"3","key":"5052_CR30","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1089\/acm.2015.0328","volume":"23","author":"YR Lee","year":"2017","unstructured":"Lee YR, Shin HS. Effectiveness of ginger essential oil on postoperative nausea and vomiting in abdominal surgery patients. J Altern Complement Med. 2017;23(3):196\u2013200.","journal-title":"J Altern Complement Med"},{"issue":"1","key":"5052_CR31","doi-asserted-by":"publisher","first-page":"157","DOI":"10.21608\/asalexu.2024.354353","volume":"26","author":"E Arafa Badr","year":"2024","unstructured":"Arafa Badr E, Mohamed Hassan H, Abd-Elsalam Gaafer Y, Youssef Kamal M. Effect of peppermint inhalation on chemotherapy induced-nausea and vomiting in children with leukemia. Alexandria Scientific Nursing Journal. 2024;26(1):157\u201369.","journal-title":"Alexandria Scientific Nursing Journal"},{"issue":"6 Suppl","key":"5052_CR32","doi-asserted-by":"publisher","first-page":"S59","DOI":"10.4097\/kjae.2007.52.6.S59","volume":"52","author":"TH Kim","year":"2007","unstructured":"Kim TH, Choi BM, Chin JH, Lee MS, Kim DH, Noh GJ. The reliability and validity of the Rhodes index of nausea, vomiting and retching in postoperative nausea and vomiting. Korean J Anesthesiol. 2007;52(6 Suppl):S59\u201365.","journal-title":"Korean J Anesthesiol"},{"issue":"4","key":"5052_CR33","first-page":"232","volume":"51","author":"VA Rhodes","year":"2001","unstructured":"Rhodes VA, McDaniel RW. Nausea, vomiting, and retching: complex problems in palliative care. CA Cancer J Clin. 2001;51(4):232\u201348.","journal-title":"CA Cancer J Clin"},{"issue":"2","key":"5052_CR34","first-page":"219","volume":"16","author":"NG Mahboubeh Soltani","year":"2017","unstructured":"Mahboubeh Soltani NG, Seyed Reza Mazloom. The effect of an educational intervention based on Ottawa guideline on nausea and vomiting at first trimester of pregnancy. Payesh. 2017;16(2):219\u201329.","journal-title":"Payesh"},{"issue":"1","key":"5052_CR35","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1186\/s12906-023-04047-z","volume":"23","author":"M Rambod","year":"2023","unstructured":"Rambod M, Pasyar N, Karimian Z, Farbood A. The effect of lemon inhalation aromatherapy on pain, nausea, as well as vomiting and neurovascular assessment in patients for lower extremity fracture surgery: a randomized trial. BMC Complement Med Ther. 2023;23(1):208.","journal-title":"BMC Complement Med Ther"},{"issue":"3","key":"5052_CR36","doi-asserted-by":"publisher","first-page":"186","DOI":"10.33371\/ijoc.v17i3.987","volume":"17","author":"I Istiroha","year":"2023","unstructured":"Istiroha I, Zahroh R, Wafiyah Q, Syaiful Y. Effect of inhaled peppermint aromatherapy on Chemotherapy-Induced acute nausea and vomiting among women with breast Cancer in Gresik regency. Indones J Cancer. 2023;17(3):186\u201390.","journal-title":"Indones J Cancer"},{"key":"5052_CR37","doi-asserted-by":"publisher","unstructured":"Heckroth M, Luckett R. T, Moser C, Parajuli D, & Abell T. L. Nausea and Vomiting in 2021: A Comprehensive Update. J Clin Gastroenterol. 2021;55(4): 279-299. https:\/\/doi.org\/10.1097\/MCG.0000000000001485.","DOI":"10.1097\/MCG.0000000000001485"},{"issue":"1","key":"5052_CR38","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1007\/s00520-021-06337-9","volume":"30","author":"M Li","year":"2022","unstructured":"Li M, Wang T, Chen J, Zhang Q, Liu Y. Non-pharmacological interventions for chemotherapy-induced nausea and vomiting in adult cancer patients: a systematic review and meta-analysis. Support Care Cancer. 2022;30(1):23\u201334. https:\/\/doi.org\/10.1007\/s00520-021-06337-9.","journal-title":"Support Care Cancer"},{"issue":"5","key":"5052_CR39","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1097\/NCC.0000000000000496","volume":"41","author":"P Zorba","year":"2018","unstructured":"Zorba P, Ozdemir L. The preliminary effects of massage and inhalation aromatherapy on chemotherapy-induced acute nausea and vomiting: a quasi-randomized controlled pilot trial. Cancer Nurs. 2018;41(5):359\u201366.","journal-title":"Cancer Nurs"},{"issue":"1","key":"5052_CR40","first-page":"53","volume":"12","author":"WD Sulistyarini","year":"2022","unstructured":"Sulistyarini WD, Handayani FN, Astobudi TE. Management of chemotherapy- induced nausea and vomiting using ginger aromatherapy in cancer patients: case study and literature review. Husada Mahakam J Kesehat. 2022;12(1):53\u201364.","journal-title":"Husada Mahakam J Kesehat"}],"container-title":["BMC Complementary Medicine and Therapies"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12906-025-05052-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12906-025-05052-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12906-025-05052-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T10:03:13Z","timestamp":1759831393000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccomplementalternmed.biomedcentral.com\/articles\/10.1186\/s12906-025-05052-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,7]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["5052"],"URL":"https:\/\/doi.org\/10.1186\/s12906-025-05052-0","relation":{},"ISSN":["2662-7671"],"issn-type":[{"value":"2662-7671","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,7]]},"assertion":[{"value":"18 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the ethics committee of the Shiraz University of Medical Sciences (IR.SUMS.NUMIMG.REC.1403.003) and conducted in accordance with the principles of the Declaration of Helsinki. This trial was registered with the Iranian Registry of Clinical Trials (IRCT20240305061177N1, march 17, 2024). Informed consent was obtained from all the participants.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"359"}}