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In accordance with institutional policies and national regulations, the Ethics Committee waived the requirement for informed consent to participate due to the retrospective design of the study and the use of fully anonymised clinical data, with no direct patient contact. As such, informed consent from participants or from parents or legal guardians of minors was not required. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki and its later amendments. 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