{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:50:37Z","timestamp":1791438637785,"version":"4.3.3"},"reference-count":45,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":85,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/501100002865","name":"Chongqing Municipal Science and Technology Bureau","doi-asserted-by":"publisher","award":["Grant No. CSTB2023NSCQ-MSX0567"],"award-info":[{"award-number":["Grant No. CSTB2023NSCQ-MSX0567"]}],"id":[{"id":"10.13039\/501100002865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["72474040"],"award-info":[{"award-number":["72474040"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Psychol"],"DOI":"10.1186\/s40359-026-05172-3","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:45:18Z","timestamp":1784087118000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sleep-related symptoms and cognitive fatigue are prominent in the multidimensional symptom network of children with malignant solid tumors: key targets and subgroup differences"],"prefix":"10.1186","volume":"14","author":[{"given":"Shuting","family":"Yuan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lin","family":"Mo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"issue":"1","key":"5172_CR1","first-page":"129","volume":"25","author":"M Shen","year":"2025","unstructured":"Shen M, Song R. Current status and influencing factors of fear of disease progression among caregivers of children with malignant solid tumors. Chin Nurs Manage. 2025;25(1):129\u201334.","journal-title":"Chin Nurs Manage"},{"issue":"1","key":"5172_CR2","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12887-024-05360-3","volume":"25","author":"T Li","year":"2025","unstructured":"Li T, Kong X, He D. Epidemiology and clinical features of childhood malignant solid tumors in a single center in southwest China over 24 years. BMC Pediatr. 2025;25(1):12.","journal-title":"BMC Pediatr"},{"issue":"10357","key":"5172_CR3","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1016\/S0140-6736(22)01796-2","volume":"400","author":"S Gupta","year":"2022","unstructured":"Gupta S. Using data to improve care: childhood cancer in China. Lancet. 2022;400(10357):977\u20139.","journal-title":"Lancet"},{"issue":"11","key":"5172_CR4","doi-asserted-by":"publisher","first-page":"611","DOI":"10.3390\/curroncol32110611","volume":"32","author":"AI Christou","year":"2025","unstructured":"Christou AI, Kalfadeli G, Tsermentseli S, et al. Neurocognitive and Emotional Outcomes in Childhood Cancer: A Developmental Perspective. Curr Oncol. 2025;32(11):611.","journal-title":"Curr Oncol"},{"issue":"2","key":"5172_CR5","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1093\/jnci\/djae209","volume":"117","author":"MC Janelsins","year":"2025","unstructured":"Janelsins MC, Van Dyk K, Hartman SJ, et al. The National Cancer Institute clinical trials planning meeting to address gaps in observational and intervention trials for cancer-related cognitive impairment. J Natl Cancer Inst. 2025;117(2):217\u201328.","journal-title":"J Natl Cancer Inst"},{"key":"5172_CR6","doi-asserted-by":"publisher","first-page":"106283","DOI":"10.1016\/j.neubiorev.2025.106283","volume":"176","author":"I Semendric","year":"2025","unstructured":"Semendric I, Barker TH, Haller OJ, et al. Prevalence of cancer-related cognitive impairment in pediatric patients and survivors of non-CNS cancers: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2025;176:106283.","journal-title":"Neurosci Biobehav Rev"},{"issue":"20","key":"5172_CR7","doi-asserted-by":"publisher","first-page":"3215","DOI":"10.1002\/cncr.30171","volume":"122","author":"NM D\u2019Agostino","year":"2016","unstructured":"D\u2019Agostino NM, Edelstein K, Zhang N, et al. Comorbid symptoms of emotional distress in adult survivors of childhood cancer. Cancer. 2016;122(20):3215\u201324.","journal-title":"Cancer"},{"issue":"8","key":"5172_CR8","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1001\/jamapediatrics.2023.2168","volume":"177","author":"ARYB Lee","year":"2023","unstructured":"Lee ARYB, Low CE, Yau CE, et al. Lifetime Burden of Psychological Symptoms, Disorders, and Suicide Due to Cancer in Childhood, Adolescent, and Young Adult Years: A Systematic Review and Meta-analysis. JAMA Pediatr. 2023;177(8):790\u20139.","journal-title":"JAMA Pediatr"},{"issue":"23","key":"5172_CR9","doi-asserted-by":"publisher","first-page":"e70502","DOI":"10.1002\/cam4.70502","volume":"13","author":"S Oberoi","year":"2024","unstructured":"Oberoi S, Huang B, Rabbani R, et al. Prevalence and Factors Associated With Cancer-Related Fatigue Among Children and Adolescents Undergoing Cancer Treatment: A Systematic Review and Meta-Analysis. Cancer Med. 2024;13(23):e70502.","journal-title":"Cancer Med"},{"issue":"6","key":"5172_CR10","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1002\/pon.5884","volume":"31","author":"KY Ho","year":"2022","unstructured":"Ho KY, Lam KKW, Xia W, et al. Sleep disruption and its contributing factors in Chinese survivors of childhood cancer: A cross-sectional study. Psychooncology. 2022;31(6):960\u20139.","journal-title":"Psychooncology"},{"key":"5172_CR11","doi-asserted-by":"publisher","first-page":"1236129","DOI":"10.3389\/fonc.2023.1236129","volume":"13","author":"J Fang","year":"2023","unstructured":"Fang J, Wong CL, Liu CQ, et al. Identifying central symptom clusters and correlates in children with acute leukemia undergoing chemotherapy: a network analysis. Front Oncol. 2023;13:1236129.","journal-title":"Front Oncol"},{"issue":"5","key":"5172_CR12","doi-asserted-by":"publisher","first-page":"163","DOI":"10.3390\/nursrep15050163","volume":"15","author":"LC Lopes-J\u00fanior","year":"2025","unstructured":"Lopes-J\u00fanior LC, Grassi J, Freitas MB, et al. Cancer Symptom Clusters in Children and Adolescents with Cancer Undergoing Chemotherapy: A Systematic Review. Nurs Rep. 2025;15(5):163.","journal-title":"Nurs Rep"},{"issue":"7","key":"5172_CR13","doi-asserted-by":"publisher","first-page":"411","DOI":"10.3390\/brainsci10070411","volume":"10","author":"MP Mogavero","year":"2020","unstructured":"Mogavero MP, Bruni O, DelRosso LM, et al. Neurodevelopmental Consequences of Pediatric Cancer and Its Treatment: The Role of Sleep. Brain Sci. 2020;10(7):411.","journal-title":"Brain Sci"},{"issue":"9","key":"5172_CR14","doi-asserted-by":"publisher","first-page":"1590","DOI":"10.1002\/pon.5736","volume":"30","author":"CR Bates","year":"2021","unstructured":"Bates CR, Pallotto IK, Moore RM, et al. Family rules, routines, and caregiver distress during the first year of pediatric cancer treatment. Psychooncology. 2021;30(9):1590\u20139.","journal-title":"Psychooncology"},{"issue":"4","key":"5172_CR15","first-page":"46","volume":"32","author":"Y Mao","year":"2025","unstructured":"Mao Y. Development and application of an effectiveness evaluation tool for multidisciplinary diagnosis and treatment models for cancer in China based on the TEAM criteria. Chin Health Qual Manage. 2025;32(4):46\u201352.","journal-title":"Chin Health Qual Manage"},{"issue":"1","key":"5172_CR16","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1080\/21642850.2019.1682587","volume":"7","author":"S Mkhitaryan","year":"2019","unstructured":"Mkhitaryan S, Crutzen R, Steenaart E, et al. Network approach in health behavior research: how can we explore new questions? Health Psychol Behav Med. 2019;7(1):362\u201384.","journal-title":"Health Psychol Behav Med"},{"key":"5172_CR17","doi-asserted-by":"publisher","first-page":"110324","DOI":"10.1016\/j.radonc.2024.110324","volume":"197","author":"ZJ Zhan","year":"2024","unstructured":"Zhan ZJ, Huang HY, Xiao YH, et al. Anxiety and depression in nasopharyngeal carcinoma patients and network analysis to identify central symptoms: A cross-sectional study from a high-incidence area. Radiother Oncol. 2024;197:110324.","journal-title":"Radiother Oncol"},{"issue":"1","key":"5172_CR18","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1038\/s43856-025-01105-0","volume":"5","author":"Y Zhou","year":"2025","unstructured":"Zhou Y, Deshpande S, Horan MR, et al. Estimating personal temporal symptom networks for childhood cancer survivors. Commun Med (Lond). 2025;5(1):377.","journal-title":"Commun Med (Lond)"},{"issue":"3","key":"5172_CR19","first-page":"472","volume":"10","author":"A Pancaldi","year":"2023","unstructured":"Pancaldi A, Pugliese M, Migliozzi C, et al. Neuropsychological Outcomes of Children Treated for Brain Tumors. Child (Basel). 2023;10(3):472.","journal-title":"Child (Basel)"},{"issue":"16","key":"5172_CR20","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1200\/JCO.20.02315","volume":"39","author":"SR Kesler","year":"2021","unstructured":"Kesler SR, Sleurs C, McDonald BC, Deprez S, van der Plas E, Nieman BJ. Brain Imaging in Pediatric Cancer Survivors: Correlates of Cognitive Impairment. J Clin Oncol. 2021;39(16):1775\u201385.","journal-title":"J Clin Oncol"},{"issue":"1","key":"5172_CR21","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1080\/21642850.2018.1521283","volume":"6","author":"D Hevey","year":"2018","unstructured":"Hevey D. Network analysis: a brief overview and tutorial. Health Psychol Behav Med. 2018;6(1):301\u201328.","journal-title":"Health Psychol Behav Med"},{"issue":"12","key":"5172_CR22","first-page":"1101","volume":"17","author":"Y Li","year":"2011","unstructured":"Li Y, Zhang H, Zhu J. Six-subtest short form of the Chinese version of the Wechsler Intelligence Scale for Children, Fourth Edition and its role in the assessment of intellectual disability. Chin J Rehabil Theory Pract. 2011;17(12):1101\u20134.","journal-title":"Chin J Rehabil Theory Pract"},{"key":"5172_CR23","doi-asserted-by":"publisher","first-page":"1101127","DOI":"10.3389\/fnins.2023.1101127","volume":"17","author":"S Wang","year":"2023","unstructured":"Wang S, Wang Y, Li Y, et al. Alternations of neuromagnetic activity across neurocognitive core networks among benign childhood epilepsy with centrotemporal spikes: A multi-frequency MEG study. Front Neurosci. 2023;17:1101127.","journal-title":"Front Neurosci"},{"issue":"1","key":"5172_CR24","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s12885-025-15374-4","volume":"26","author":"Z Chen","year":"2025","unstructured":"Chen Z, Zhang N, Liu Q, et al. Echoes of the struggle with cancer: cognitive impairment in Chinese children. BMC Cancer. 2025;26(1):24.","journal-title":"BMC Cancer"},{"issue":"10","key":"5172_CR25","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","volume":"166","author":"RL Spitzer","year":"2006","unstructured":"Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092\u20137.","journal-title":"Arch Intern Med"},{"issue":"12","key":"5172_CR26","first-page":"1709","volume":"9","author":"J Sun","year":"2021","unstructured":"Sun J, Liang K, Chi X, et al. Psychometric Properties of the Generalized Anxiety Disorder Scale-7 Item (GAD-7) in a Large Sample of Chinese Adolescents. Healthc (Basel). 2021;9(12):1709.","journal-title":"Healthc (Basel)"},{"issue":"3","key":"5172_CR27","doi-asserted-by":"publisher","first-page":"e12381","DOI":"10.1111\/appy.12381","volume":"12","author":"DYP Leung","year":"2020","unstructured":"Leung DYP, Mak YW, Leung SF, et al. Measurement invariances of the PHQ-9 across gender and age groups in Chinese adolescents. Asia Pac Psychiatry. 2020;12(3):e12381.","journal-title":"Asia Pac Psychiatry"},{"issue":"4","key":"5172_CR28","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1111\/j.1365-2869.1996.00251.x","volume":"5","author":"O Bruni","year":"1996","unstructured":"Bruni O, Ottaviano S, Guidetti V, et al. The Sleep Disturbance Scale for Children (SDSC). Construction and validation of an instrument to evaluate sleep disturbances in childhood and adolescence. J Sleep Res. 1996;5(4):251\u201361.","journal-title":"J Sleep Res"},{"issue":"8","key":"5172_CR29","doi-asserted-by":"publisher","first-page":"923","DOI":"10.1016\/j.sleep.2014.03.023","volume":"15","author":"MM Huang","year":"2014","unstructured":"Huang MM, Qian Z, Wang J, et al. Validation of the sleep disturbance scale for children and prevalence of parent-reported sleep disorder symptoms in Chinese children. Sleep Med. 2014;15(8):923\u20138.","journal-title":"Sleep Med"},{"issue":"7","key":"5172_CR30","doi-asserted-by":"publisher","first-page":"2090","DOI":"10.1002\/cncr.10428","volume":"94","author":"JW Varni","year":"2002","unstructured":"Varni JW, Burwinkle TM, Katz ER, et al. The PedsQL\u2122 in pediatric cancer: reliability and validity of the pediatric quality of life inventory\u2122 generic core scales, multidimensional fatigue scale, and cancer module. Cancer. 2002;94(7):2090\u2013106.","journal-title":"Cancer"},{"issue":"11","key":"5172_CR31","first-page":"72","volume":"13","author":"X Bu","year":"2014","unstructured":"Bu X, Ye Q, Liu K, et al. Translation of the Chinese version of the PedsQLTM Multidimensional Fatigue Scale. Mod Clin Nurs. 2014;13(11):72\u20135.","journal-title":"Mod Clin Nurs"},{"issue":"3","key":"5172_CR32","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1093\/biostatistics\/kxm045","volume":"9","author":"J Friedman","year":"2008","unstructured":"Friedman J, Hastie T, Tibshirani R. Sparse inverse covariance estimation with the graphical lasso. Biostatistics. 2008;9(3):432\u201341.","journal-title":"Biostatistics"},{"key":"5172_CR33","doi-asserted-by":"publisher","unstructured":"Huth KBS, Haslbeck JMB, Keetelaar S, et al. Statistical evidence in psychological networks. Nat Hum Behav Published online Oct. 2025;9. https:\/\/doi.org\/10.1038\/s41562-025-02314-2.","DOI":"10.1038\/s41562-025-02314-2"},{"issue":"1","key":"5172_CR34","doi-asserted-by":"publisher","first-page":"195","DOI":"10.3758\/s13428-017-0862-1","volume":"50","author":"S Epskamp","year":"2018","unstructured":"Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: A tutorial paper. Behav Res Methods. 2018;50(1):195\u2013212.","journal-title":"Behav Res Methods"},{"issue":"2","key":"5172_CR35","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1080\/00273171.2019.1614898","volume":"56","author":"PJ Jones","year":"2021","unstructured":"Jones PJ, Ma R, McNally RJ. Bridge Centrality: A Network Approach to Understanding Comorbidity. Multivar Behav Res. 2021;56(2):353\u201367.","journal-title":"Multivar Behav Res"},{"issue":"6","key":"5172_CR36","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1037\/met0000476","volume":"28","author":"CD van Borkulo","year":"2023","unstructured":"van Borkulo CD, van Bork R, Boschloo L, et al. Comparing network structures on three aspects: A permutation test. Psychol Methods. 2023;28(6):1273\u201385.","journal-title":"Psychol Methods"},{"key":"5172_CR37","doi-asserted-by":"publisher","first-page":"101089","DOI":"10.1016\/j.bbih.2025.101089","volume":"48","author":"D Vanrusselt","year":"2025","unstructured":"Vanrusselt D, Verschueren S, Van Meerbeeck L, et al. Biomarker-based profiling of fatigue in childhood cancer survivors: evidence for distinct inflammatory and glial-associated profiles. Brain Behav Immun Health. 2025;48:101089.","journal-title":"Brain Behav Immun Health"},{"issue":"5","key":"5172_CR38","doi-asserted-by":"publisher","first-page":"151955","DOI":"10.1016\/j.soncn.2025.151955","volume":"41","author":"KE Montgomery","year":"2025","unstructured":"Montgomery KE, Gerhardt CA, Hinds PS, et al. Pediatric Theory of Unpleasant Symptoms: A Multi-level Symptom Theory for Pediatric Cancer. Semin Oncol Nurs. 2025;41(5):151955.","journal-title":"Semin Oncol Nurs"},{"key":"5172_CR39","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1186\/s12916-020-01740-5","volume":"18","author":"TR Spiller","year":"2020","unstructured":"Spiller TR, Levi O, Neria Y, et al. On the validity of the centrality hypothesis in cross-sectional between-subject networks of psychopathology. BMC Med. 2020;18:297.","journal-title":"BMC Med"},{"issue":"1","key":"5172_CR40","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1007\/s12672-025-02837-0","volume":"16","author":"X Shao","year":"2025","unstructured":"Shao X, Wang N, Tang K, et al. Network analysis used to investigate the symptoms of cancer patients during chemotherapy: a scoping review. Discov Oncol. 2025;16(1):1011.","journal-title":"Discov Oncol"},{"key":"5172_CR41","doi-asserted-by":"publisher","first-page":"100641","DOI":"10.1016\/j.apjon.2024.100641","volume":"12","author":"H Hu","year":"2024","unstructured":"Hu H, Zhao Y, Luo H, et al. Network analysis of fatigue symptoms in Chinese patients with advanced cancer. Asia Pac J Oncol Nurs. 2024;12:100641.","journal-title":"Asia Pac J Oncol Nurs"},{"key":"5172_CR42","doi-asserted-by":"publisher","first-page":"100291","DOI":"10.1016\/j.tipsro.2024.100291","volume":"33","author":"I Vethe Hernes","year":"2024","unstructured":"Vethe Hernes I, Jansdatter A, Nordsteien A, et al. Illuminating the hidden cost: A systematic review of cognitive late effects regarding cancer-related fatigue in treated paediatric brain tumors. Tech Innov Patient Support Radiat Oncol. 2024;33:100291.","journal-title":"Tech Innov Patient Support Radiat Oncol"},{"issue":"4","key":"5172_CR43","doi-asserted-by":"publisher","first-page":"280","DOI":"10.1016\/S2352-4642(22)00380-7","volume":"7","author":"R van Litsenburg","year":"2023","unstructured":"van Litsenburg R, Kamara D, Irestorm E, et al. Sleep problems during and after paediatric brain tumours. Lancet Child Adolesc Health. 2023;7(4):280\u20137.","journal-title":"Lancet Child Adolesc Health"},{"issue":"5","key":"5172_CR44","doi-asserted-by":"publisher","first-page":"544","DOI":"10.24953\/turkjpediatr.2024.4769","volume":"66","author":"B G\u00fcneyda\u015f Y\u0131ld\u0131r\u0131m","year":"2024","unstructured":"G\u00fcneyda\u015f Y\u0131ld\u0131r\u0131m B, Aykutlu HC, Eren T. Sleep in hospitalized children with cancer: relationship with psychiatric disorders and hospital conditions. Turk J Pediatr. 2024;66(5):544\u201355.","journal-title":"Turk J Pediatr"},{"key":"5172_CR45","doi-asserted-by":"publisher","first-page":"1682455","DOI":"10.3389\/fpsyg.2025.1682455","volume":"16","author":"A Scriney","year":"2026","unstructured":"Scriney A, Gurren L, Gallagher P, et al. Pretreatment cancer related cognitive impairment and associated psychological factors: a systematic review. Front Psychol. 2026;16:1682455.","journal-title":"Front Psychol"}],"container-title":["BMC Psychology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40359-026-05172-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40359-026-05172-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40359-026-05172-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:02:46Z","timestamp":1791435766000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40359-026-05172-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5172"],"URL":"https:\/\/doi.org\/10.1186\/s40359-026-05172-3","relation":{},"ISSN":["2050-7283"],"issn-type":[{"value":"2050-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]},"assertion":[{"value":"29 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was designed and conducted in full compliance with the latest revision of the Declaration of Helsinki (\n                      \n                      declaration-of-helsinki\/), with particular attention to the protection of the rights, safety, and well-being of human participants. All participants were informed of the purpose, procedures, potential risks, and benefits of the study before participation and provided written informed consent. Participants retained the right to withdraw from the study unconditionally at any time. This study was approved by the Ethics Committee of Children\u2019s Hospital of Chongqing Medical University (approval no. [2025] Ethical Review [Clinical Research] No. 351), and written informed consent was obtained from all participants and their guardians before testing.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1452"}}