{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T06:46:17Z","timestamp":1793774777478,"version":"4.6.1"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T00:00:00Z","timestamp":1641427200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T00:00:00Z","timestamp":1641427200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001809","name":"the Natural Science Foundation of China","doi-asserted-by":"crossref","award":["81802837"],"award-info":[{"award-number":["81802837"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Program for Ph.D. Starting Research Funding from Xinxiang Medical University","award":["XYBSKYZZ 201616"],"award-info":[{"award-number":["XYBSKYZZ 201616"]}]},{"name":"the Program for Innovative Research Team (in Science and Technology) in University of Henan Province","award":["20IRTSTHN030"],"award-info":[{"award-number":["20IRTSTHN030"]}]},{"name":"the Natural Science Foundation of Henan Province for Distinguished Young Scholars","award":["212300410013"],"award-info":[{"award-number":["212300410013"]}]},{"name":"the Key Scientific Research Projects of Higher Education Institutions in Henan Province","award":["19A320005"],"award-info":[{"award-number":["19A320005"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Virol J"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Human papillomavirus (HPV) infection can cause cervical and other cancers, including vulva, vagina, penis, anus, or oropharynx. However, in China's northern Henan Province, data on the prevalence and genotype distribution of HPV among women attending gynecology clinics is limited. This study aimed to investigate the current prevalence and genotype distribution of HPV among women attending gynecology clinics in northern Henan Province.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This study included 15,616 women aged 16\u201381\u00a0years old who visited the Xinxiang central hospital's gynecology department between January 2018 and December 2019. HPV DNA was detected by a conventional PCR method followed by HPV type-specific hybridization, which was designed to detect 17 high-risk HPV (HR-HPV) genotypes and 20 low-risk HPV (LR-HPV) genotypes. HPV prevalence and corresponding 95% confidence intervals (95% CI) were calculated using SPSS 18.0.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The overall HPV prevalence was 19.7% among women in northern Henan Province. Single, double, and multiple HPV infections accounted for 13.7%, 4.3%, and 1.8% of the total cases. Most infections were caused by HR-HPV (71.8%), and single genotype HPV infection (13.7%) was the most common pattern. The most common HR-HPV genotype was HPV16 (4.3%), followed by HPV52 (3.5%) and HPV58 (2.0%). The most common LR-HPV genotype was HPV6 (1.4%), followed by HPV61 (1.1%) and HPV81 (1.1%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>HPV infection is high among women attending gynecology clinics in northern Henan Province. The highest prevalence was found in women less than 20\u00a0years old. In northern Henan Province, the 9-valent HPV vaccine is strongly recommended for regular immunization.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12985-021-01732-8","type":"journal-article","created":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T13:03:00Z","timestamp":1641474180000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["Prevalence and distribution of human papillomavirus genotypes among women attending gynecology clinics in northern Henan Province of China"],"prefix":"10.1186","volume":"19","author":[{"given":"Xiangpeng","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofei","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanyu","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruili","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingyong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0906-8314","authenticated-orcid":false,"given":"Lijun","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,6]]},"reference":[{"issue":"13","key":"1732_CR1","doi-asserted-by":"publisher","first-page":"2404","DOI":"10.1002\/cncr.30667","volume":"123","author":"W Small Jr","year":"2017","unstructured":"Small W Jr, Bacon MA, Bajaj A, Chuang LT, Fisher BJ, Harkenrider MM, Jhingran A, Kitchener HC, Mileshkin LR, Viswanathan AN, Gaffney DK. Cervical cancer: a global health crisis. Cancer. 2017;123(13):2404\u201312.","journal-title":"Cancer"},{"issue":"2","key":"1732_CR2","doi-asserted-by":"publisher","first-page":"e191","DOI":"10.1016\/S2214-109X(19)30482-6","volume":"8","author":"M Arbyn","year":"2020","unstructured":"Arbyn M, Weiderpass E, Bruni L, de Sanjos\u00e9 S, Saraiya M, Ferlay J, Bray F. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191\u2013203.","journal-title":"Lancet Glob Health"},{"issue":"6","key":"1732_CR3","doi-asserted-by":"publisher","first-page":"622","DOI":"10.3390\/cells8060622","volume":"8","author":"P Olusola","year":"2019","unstructured":"Olusola P, Banerjee HN, Philley JV, Dasgupta S. Human papilloma virus-associated cervical cancer and health disparities. Cells. 2019;8(6):622.","journal-title":"Cells"},{"issue":"6","key":"1732_CR4","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1016\/j.jinf.2018.02.008","volume":"76","author":"HL Zhou","year":"2018","unstructured":"Zhou HL, Zhang W, Zhang CJ, Wang SM, Duan YC, Wang JX, Yang H, Wang XY. Prevalence and distribution of human papillomavirus genotypes in Chinese women between 1991 and 2016: a systematic review. J Infect. 2018;76(6):522\u20138.","journal-title":"J Infect"},{"key":"1732_CR5","doi-asserted-by":"publisher","first-page":"2896","DOI":"10.3389\/fmicb.2018.02896","volume":"9","author":"X Wang","year":"2018","unstructured":"Wang X, Huang X, Zhang Y. Involvement of human papillomaviruses in cervical cancer. Front Microbiol. 2018;9:2896.","journal-title":"Front Microbiol"},{"issue":"9","key":"1732_CR6","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1016\/j.cmi.2015.05.011","volume":"21","author":"BJ Kocian","year":"2015","unstructured":"Kocian BJ, Bzhalava D, Forslund O, Dillner J, Poljak M. Molecular methods for identification and characterization of novel papillomaviruses. Clin Microbiol Infect. 2015;21(9):808\u201316.","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"1732_CR7","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jinf.2020.11.030","volume":"82","author":"L Galati","year":"2021","unstructured":"Galati L, Brancaccio RN, Gupta P, Lohmann E, Robitaille A, Mandishora RSD, Cuenin C, Filotico R, Combes JD, Giuliano AR, Don\u00e0 MG, Tommasino M, Gheit T. Diversity of human papillomavirus in the anal canal of HIV-positive and HIV-negative men. J Infect. 2021;82(1):112\u20136.","journal-title":"J Infect"},{"issue":"4","key":"1732_CR8","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1002\/path.4405","volume":"234","author":"G Halec","year":"2014","unstructured":"Halec G, Alemany L, Lloveras B, Schmitt M, Alejo M, Bosch FX, Tous S, Klaustermeier JE, Guimer\u00e0 N, Grabe N, Lahrmann B, Gissmann L, Quint W, Bosch FX, de Sanjose S, Pawlita M. Pathogenic role of the eight probably\/possibly carcinogenic HPV types 26, 53, 66, 67, 68, 70, 73 and 82 in cervical cancer. J Pathol. 2014;234(4):441\u201351.","journal-title":"J Pathol"},{"issue":"10","key":"1732_CR9","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1093\/infdis\/jiy068","volume":"217","author":"KGJ Pollock","year":"2018","unstructured":"Pollock KGJ. Sustained cross-protection of the bivalent human papillomavirus vaccine. J Infect Dis. 2018;217(10):1515\u20136.","journal-title":"J Infect Dis"},{"issue":"2","key":"1732_CR10","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.jinf.2021.02.017","volume":"84","author":"HL Bao","year":"2021","unstructured":"Bao HL, Jin C, Wang S, Song Y, Xu ZY, Yan X, Li LM, Ning Y, Wang HJ. Prevalence of cervicovaginal human papillomavirus infection and genotypes in the pre-vaccine era in China: a nationwide population-based study. J Infect. 2021;84(2):75\u201383.","journal-title":"J Infect"},{"issue":"1","key":"1732_CR11","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1186\/s12985-020-01448-1","volume":"17","author":"AL Bogale","year":"2020","unstructured":"Bogale AL, Belay NB, Medhin G, Ali JH. Molecular epidemiology of human papillomavirus among HIV infected women in developing countries: systematic review and meta-analysis. Virol J. 2020;17(1):179.","journal-title":"Virol J"},{"key":"1732_CR12","doi-asserted-by":"publisher","first-page":"21039","DOI":"10.1038\/srep21039","volume":"6","author":"Z Li","year":"2016","unstructured":"Li Z, Liu F, Cheng S, Shi L, Yan Z, Yang J, Shi L, Yao Y, Ma Y. Prevalence of HPV infection among 28457 Chinese women in Yunnan Province, southwest China. Sci Rep. 2016;6:21039.","journal-title":"Sci Rep"},{"issue":"1","key":"1732_CR13","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1186\/s12879-021-06019-5","volume":"21","author":"L Luo","year":"2021","unstructured":"Luo L, He P, Liu Q, Jiang Y, Zhang Y, Li Q, Li Q, Li S, Yang F, Ling H, Dai X, Li Z, Chen H. Prevalence and genotype distribution of HPV infection among 214,715 women from Southern China, 2012\u20132018: baseline measures prior to mass HPV vaccination. BMC Infect Dis. 2021;21(1):328.","journal-title":"BMC Infect Dis"},{"issue":"1","key":"1732_CR14","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s12985-020-01352-8","volume":"17","author":"H Li","year":"2020","unstructured":"Li H, Li P, Huang L, Sun L, Ren H, Li P. Prevalence characteristics of cervical human papillomavirus (HPV) infection in Zhoupu District, Shanghai City, China. Virol J. 2020;17(1):84.","journal-title":"Virol J"},{"issue":"1","key":"1732_CR15","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1186\/s12879-018-3105-x","volume":"18","author":"P Zhang","year":"2018","unstructured":"Zhang P, Liu S, Zhong Z, Hou J, Lin L, Weng R, Su L, Lei N, Hou T, Yang H. Prevalence and genotype distribution of human papillomavirus infection among women in northeastern Guangdong Province of China. BMC Infect Dis. 2018;18(1):204.","journal-title":"BMC Infect Dis"},{"issue":"1","key":"1732_CR16","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1186\/s12889-019-6487-9","volume":"19","author":"Y Ge","year":"2019","unstructured":"Ge Y, Zhong S, Ren M, Ge Y, Mao Y, Cao P. Prevalence of human papillomavirus infection of 65,613 women in East China. BMC Public Health. 2019;19(1):178.","journal-title":"BMC Public Health"},{"issue":"6","key":"1732_CR17","doi-asserted-by":"publisher","first-page":"e014135","DOI":"10.1136\/bmjopen-2016-014135","volume":"7","author":"HH Xu","year":"2017","unstructured":"Xu HH, Lin A, Chen YH, Dong SS, Shi WW, Yu JZ, Yan WH. Prevalence characteristics of cervical human papillomavirus (HPV) genotypes in Taizhou area, China: a cross-sectional study of 37967 women from the general population. BMJ Open. 2017;7(6):e014135.","journal-title":"BMJ Open"},{"issue":"4","key":"1732_CR18","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1080\/21645515.2020.1805993","volume":"17","author":"Q Mai","year":"2021","unstructured":"Mai Q, Yang X, Cheng H, Wu G, Wu Z. Prevalence and genotype distribution of human papillomavirus among women with cervical lesions in Shenzhen city. China Hum Vaccin Immunother. 2021;17(4):965\u201371.","journal-title":"China Hum Vaccin Immunother"},{"issue":"1","key":"1732_CR19","doi-asserted-by":"publisher","first-page":"e0210311","DOI":"10.1371\/journal.pone.0210311","volume":"14","author":"L Jiang","year":"2019","unstructured":"Jiang L, Tian X, Peng D, Zhang L, Xie F, Bi C, Wang R, Wang J, Qi D. HPV prevalence and genotype distribution among women in Shandong Province, China: analysis of 94489 HPV genotyping results from Shandong\u2019s largest independent pathology laboratory. PLoS ONE. 2019;14(1):e0210311.","journal-title":"PLoS ONE"},{"issue":"1","key":"1732_CR20","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s12889-017-4651-7","volume":"18","author":"C Wu","year":"2017","unstructured":"Wu C, Zhu X, Kang Y, Cao Y, Lu P, Zhou W, Zhou H, Zhang Y, Song Y. Epidemiology of human papilloma virus infection among women in Fujian China. BMC Public Health. 2017;18(1):95.","journal-title":"BMC Public Health"},{"issue":"7","key":"1732_CR21","doi-asserted-by":"publisher","first-page":"1645","DOI":"10.1080\/21645515.2019.1689743","volume":"16","author":"J Yang","year":"2020","unstructured":"Yang J, Wang W, Wang Z, Wang Z, Wang Y, Wang J, Zhao W, Li D, Liu H, Hao M. Prevalence, genotype distribution and risk factors of cervical HPV infection in Yangqu, China: a population-based survey of 10086 women. Hum Vaccin Immunother. 2020;16(7):1645\u201352.","journal-title":"Hum Vaccin Immunother"},{"issue":"1","key":"1732_CR22","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s12985-019-1175-z","volume":"16","author":"C Zhang","year":"2019","unstructured":"Zhang C, Cheng W, Liu Q, Guang Q, Zhang Q. Distribution of human papillomavirus infection: a population-based study of cervical samples from Jiangsu Province. Virol J. 2019;16(1):67.","journal-title":"Virol J."},{"issue":"7","key":"1732_CR23","doi-asserted-by":"publisher","first-page":"1030","DOI":"10.1002\/cncr.32003","volume":"125","author":"K Li","year":"2019","unstructured":"Li K, Li Q, Song L, Wang D, Yin R. The distribution and prevalence of human papillomavirus in women in mainland China. Cancer. 2019;125(7):1030\u20137.","journal-title":"Cancer"},{"issue":"3","key":"1732_CR24","doi-asserted-by":"publisher","first-page":"e0230640","DOI":"10.1371\/journal.pone.0230640","volume":"15","author":"S Hao","year":"2020","unstructured":"Hao S, Wang C, Liu S, He J, Jiang Y. HPV genotypic spectrum in Jilin province, China, where non-vaccine-covered HPV53 and 51 are prevalent, exhibits a bimodal age-specific pattern. PLoS ONE. 2020;15(3):e0230640.","journal-title":"PLoS ONE"},{"key":"1732_CR25","doi-asserted-by":"publisher","first-page":"188","DOI":"10.3389\/fimmu.2020.00188","volume":"11","author":"AR Garbuglia","year":"2020","unstructured":"Garbuglia AR, Lapa D, Sias C, Capobianchi MR, Del Porto P. The use of both therapeutic and prophylactic vaccines in the therapy of papillomavirus disease. Front Immunol. 2020;11:188.","journal-title":"Front Immunol"},{"issue":"18","key":"1732_CR26","doi-asserted-by":"publisher","first-page":"4953","DOI":"10.1158\/1078-0432.CCR-20-2833","volume":"27","author":"L Ferrall","year":"2021","unstructured":"Ferrall L, Lin KY, Roden RBS, Hung CF, Wu TC. Cervical cancer immunotherapy: facts and hopes. Clin Cancer Res. 2021;27(18):4953\u201373.","journal-title":"Clin Cancer Res"},{"issue":"6","key":"1732_CR27","doi-asserted-by":"publisher","first-page":"720","DOI":"10.21147\/j.issn.1000-9604.2020.06.05","volume":"32","author":"S Zhang","year":"2020","unstructured":"Zhang S, Xu H, Zhang L, Qiao Y. Cervical cancer: epidemiology, risk factors and screening. Chin J Cancer Res. 2020;32(6):720\u20138.","journal-title":"Chin J Cancer Res"},{"issue":"7","key":"1732_CR28","first-page":"611","volume":"34","author":"J He","year":"2021","unstructured":"He J, Xu H, Dai Y, Zheng L, Sun L, Guo L, Hu X, Sun X, Meng L, Chen Q, Zhang S. Incidence and mortality of cervical cancer in Henan Province, 2016. J Cancer Control Treat. 2021;34(7):611\u20136.","journal-title":"J Cancer Control Treat"},{"issue":"1","key":"1732_CR29","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1002\/ijgo.13406","volume":"152","author":"Y Li","year":"2021","unstructured":"Li Y, Wang H, Zhang Y, Jing X, Wu N, Hou Y, Hao C. Correlation between multi-type human papillomavirus infections and viral loads and the cervical pathological grade. Int J Gynaecol Obstet. 2021;152(1):96\u2013102.","journal-title":"Int J Gynaecol Obstet"},{"issue":"11","key":"1732_CR30","doi-asserted-by":"publisher","first-page":"1816","DOI":"10.1158\/1055-9965.EPI-19-0239","volume":"28","author":"R Adcock","year":"2019","unstructured":"Adcock R, Cuzick J, Hunt WC, McDonald RM, Wheeler CM. Role of HPV genotype, multiple infections, and viral load on the risk of high grade cervical neoplasia. Cancer Epidemiol Biomark Prev. 2019;28(11):1816\u201324.","journal-title":"Cancer Epidemiol Biomark Prev"},{"issue":"3","key":"1732_CR31","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1002\/jmv.25331","volume":"91","author":"M Li","year":"2019","unstructured":"Li M, Du X, Lu M, Zhang W, Sun Z, Li L, Ye M, Fan W, Jiang S, Liu A, Wang M, Meng Y, Li Y. Prevalence characteristics of single and multiple HPV infections in women with cervical cancer and precancerous lesions in Beijing, China. J Med Virol. 2019;91(3):473\u201381.","journal-title":"J Med Virol"},{"issue":"1","key":"1732_CR32","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1186\/s12885-020-06946-7","volume":"20","author":"MT Bruno","year":"2020","unstructured":"Bruno MT, Scalia G, Cassaro N, Boemi S. Multiple HPV16 infection with two strains: a possible marker of neoplastic progression. BMC Cancer. 2020;20(1):444.","journal-title":"BMC Cancer"},{"issue":"6","key":"1732_CR33","doi-asserted-by":"publisher","first-page":"1329","DOI":"10.1007\/s00404-020-05787-w","volume":"302","author":"J Zhang","year":"2020","unstructured":"Zhang J, Cheng K, Wang Z. Prevalence and distribution of human papillomavirus genotypes in cervical intraepithelial neoplasia in China: a meta-analysis. Arch Gynecol Obstet. 2020;302(6):1329\u201337.","journal-title":"Arch Gynecol Obstet"},{"issue":"1","key":"1732_CR34","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1186\/s12879-019-3687-y","volume":"19","author":"XW Yuan","year":"2019","unstructured":"Yuan XW, Li YJ, Qiu Q, Luo Z, Zhao X. Prevalence and genotype distribution of human papillomavirus among 9945 women from the Nanhai area of Foshan. BMC Infect Dis. 2019;19(1):71.","journal-title":"BMC Infect Dis"},{"key":"1732_CR35","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.virusres.2016.12.017","volume":"231","author":"N Egawa","year":"2017","unstructured":"Egawa N, Doorbar J. The low-risk papillomaviruses. Virus Res. 2017;231:119\u201327.","journal-title":"Virus Res"}],"container-title":["Virology Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12985-021-01732-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12985-021-01732-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12985-021-01732-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,6]],"date-time":"2022-01-06T13:19:56Z","timestamp":1641475196000},"score":1,"resource":{"primary":{"URL":"https:\/\/virologyj.biomedcentral.com\/articles\/10.1186\/s12985-021-01732-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,6]]},"references-count":35,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["1732"],"URL":"https:\/\/doi.org\/10.1186\/s12985-021-01732-8","relation":{},"ISSN":["1743-422X"],"issn-type":[{"value":"1743-422X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,6]]},"assertion":[{"value":"10 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 January 2022","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 in Xinxiang Medical University. Informed consent was obtained from all participants before enrollment.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable. This manuscript does not contain any person's data in any form (including individual details, images, or videos.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6"}}