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Ethical approval was granted by the Institutional Review Boards (IRBs) of the four participating tertiary medical centers: The Second Affiliated Hospital of Chongqing Medical University (Approval No. 2025IIT234), The First Affiliated Hospital of Chongqing Medical University (Approval No. CY2025-602-01), The Affiliated Hospital of Southwest Medical University (Approval No. KY2025431), and The First Affiliated Hospital of University of South China (Approval No. 2025KS-GD-38-01). 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