Global trends and challenges in childhood caries: a 20-year bibliometric review

Introduction

Childhood caries is a significant global health issue, affecting about 50% of preschool children. The prevalence varies significantly, with rates in 12-year-old ranging from 27% to 64% in India, compared to 11.4% in Sweden and 3% to 6% in the United States. Caries development involves microbial dysbiosis, where an imbalance in the oral microbiome leads to increased acid production, demineralization of dental hard tissues, and eventual cavity formation (1). The disease progresses from discoloration to severe tooth structure deterioration, affecting dental and overall health and quality of life. Bacterial presence, host susceptibility, dietary choices, and exposure duration to risk factors influence the emergence of caries. Poor oral hygiene, family educational background, socioeconomic status, and malnutrition significantly contribute to caries development. Treatment varies with the caries stage, from preventive measures like non-invasive treatments and fissure sealants to invasive interventions such as fillings and root canals (2,3). The Hall technique, although not a recent advancement, has gained renewed interest due to its low intervention level and high durability in treating dental caries (4-6). These challenges underscore the importance of understanding research trends and hotspots, which forms the basis of our bibliometric analysis.

Bibliometrics, a quantitative research method, analyzes literature to reveal specific scientific domains’ evolution and knowledge structure. CiteSpace, a bibliometric software, identifies research trends, key authors, leading institutions, and their collaborative networks by analyzing citation networks, providing valuable insights for researchers (7). This study uses CiteSpace to analyze publications on childhood caries in the Web of Science (WOS) database from 2003 to 2023, aiming to uncover significant trends, research hotspots, and academic networks to enhance understanding of the field’s knowledge structure and evolution. The visual network analysis was conducted to explore childhood caries research through keyword co-occurrence, literature co-citation, and author collaboration networks. This method aids in understanding the etiology of childhood caries, improving treatment protocols, and developing prevention strategies. It addresses publication trends, leading countries/regions, and authors while identifying crucial research keywords and foundational literature. The study provides specific insights by analyzing two decades of literature and employing geographical and collaborative network analyses. Examining keyword distribution, temporal trends, and frequency reveals research focal points, evolving themes, and dynamics between research hotspots. The analysis enhances understanding of childhood caries pathogenesis and informs current treatment and prevention strategies, offering a scientific basis for addressing this global public health challenge.

Methods

The dataset was sourced from the WOS Core Collection and the Science Citation Index Expanded, covering 2003 to 2023. The search, conducted on November 10, 2023, was strategically refined through title headings to enhance the precision of the bibliometric analysis. Focusing exclusively on the literature type “Article”, the search query utilized was “((((TI=(child*)) AND TI=(caries)) AND PY=(2003-2023)) AND DT=(Article)) AND LA=(English)”. This meticulous selection process yielded 2,178 pertinent publications, the foundation for this study’s data analysis.

The CiteSpace supports bibliometric studies like collaborative network analysis, co-word analysis, author and document co-citation analysis, and textual and geospatial visualizations (8). It highlights trends and knowledge linkages, aiding the quick assimilation of critical field information (9). Researchers use quantitative calculations and cluster analysis based on term correlation strengths to understand research status and hotspots. CiteSpace (6.2.R6 Advanced) was used to construct a knowledge map from three perspectives: coupling, co-citation, and research collaboration.

Results

Publications trend

Figure 1 indicates that the analysis of 2,178 publications from 2003 to 2023 revealed a steady growth trend in childhood caries research. The trajectory includes an initial growth phase [2003–2008] with annual publications rising from 21 to 80, a stable development phase [2009–2015] with publication counts between 69 and 145, and a rapid growth phase [2016–2023] peaking at 188 and 195 publications in 2020 and 2021. Despite a slight decline in 2022 and 2023, publication numbers remained high, reflecting ongoing research interest and the impact of technological advancements.

Figure 1 Trends in the number of publications.

Cooperation networks

Country/region and institution cooperation networks

The analysis identified key countries/regions contributing significantly to childhood caries research by publication volume and impact. In this network, nodes are visualized as annual rings, with size indicating total publications and wider rings showing higher yearly publication numbers. Links illustrate collaborative ties and their intensity. Node centrality, highlighted by a purple circle for influential nodes, measures the extent of a node’s links (10). The collaborative networks map of countries/regions and institutions is shown in Figure 2. The country/region network includes 108 nodes and 149 links (density =0.026). The institutional network consists of 652 nodes and 1,010 links (density =0.005). In other words, 108 countries/regions and 652 institutions engaged in childhood caries research, forming a complex collaborative network.

Figure 2 Collaboration-network map of countries/regions (A) and institutions (B). US, United States; BR, Brazil; CN, China; UK, England; AU, Australia; CA, Canada; IN, India; JP, Japan; SE, Sweden; SA, Saudi Arabia; DE, Germany; TH, Thailand; TR, Turkey; NL, Netherlands; NO, Norway; UoL, University of London; USP, Universidade de Sao Paulo; HKU, University of Hong Kong; UoA, University of Adelaide; UC, University of California; HU, Harvard University; KCL, King’s College London; UoI, University of Iowa; UoM, University of Manitoba; EKB, Egyptian Knowledge Bank; UFMG, Federal University of Minas Gerais; UCPH, University of Copenhagen; UNC, University of North Carolina; UW, University of Washington; UQ, University of Queensland.

Figure 2A and Table 1 show that the US led researches cover dietary habits, genetic factors, and racial, ethnic, and geographic variations. Early studies explored how diet impacts caries risk, including sugary beverages and disparities in early childhood caries (ECC) across different races and ethnicities (11). Subsequent research broadened to include a variety of microorganisms beyond Streptococcus mutans. Researchers examined gene-environment interactions in ECC, identifying genetic markers related to enamel development and immune response (12). Notably, of the 2,178 studies analyzed, approximately 380 (17%) specifically focused on ECC, emphasizing its prevalence, associated risk factors, and preventive strategies. More recent studies have focused on differences in caries prevalence between urban and rural areas and the microbial profiles in severe ECC cases among indigenous populations (13-15).

BR is the second most prolific country in pediatric dental health research, with 285 publications focusing on ECC. Significant contributions include studies linking childhood underweight and socioeconomic status to caries prevalence. Research has provided critical insights into caries microbiology, notably Streptococcus mutans and Candida albicans. Nutritional studies have emphasized the impact of early feeding practices and sugar consumption on caries development (16). Evaluations of restorative treatment strategies targeted high-risk children and studies on caries’ effects on oral health-related quality of life (OHRQoL) and dental anxiety advocate for a comprehensive approach to ECC (17). However, these studies have had a low impact, indicating a need for further exploration to enhance the influence.

The UK leads in research impact on childhood caries, with a centrality of 0.69, reflecting extensive global citations. This highlights the exploration of links between dental caries and factors such as childhood obesity, development, quality of life, and early intervention. Research shows that timely caries treatment in preschoolers significantly improves the quality of life. Studies reveal regional disparities in caries prevalence and treatment among 5-year-old, identifying children with craniofacial disorders as particularly vulnerable (18). The progression of caries from childhood to adolescence has been examined, emphasizing the impact of pain and aesthetics daily (19). The effectiveness of supervised toothbrushing programs has been affirmed, and managing health risk behaviors is advocated to reduce untreated caries. Additionally, the cost-effectiveness of goal-directed talk interventions has been highlighted.

Figure 2B and Table 2 show the University of London (UoL) leading with 88 publications, followed by the Universidade de Sao Paulo (USP), the University of Hong Kong (HKU), the University of Adelaide (UoA), the University of California (UC), and Harvard University (HU). Despite this, the UoL has a centrality of 0.04. The University of Copenhagen, with a centrality of 0.19, demonstrates significant academic influence, and has conducted pivotal research on non-surgical treatments, delivery methods, probiotics, and preventive measures for dental caries (20,21). These studies have advanced the understanding and management of dental caries, mainly focusing on non-surgical treatments, delivery modes, ECC, and long-term dental health trends in Hungary. Other influential institutions include the UC (0.08), USP (0.05), HKU (0.05), and King’s College London (KCL) (0.05).

Author cooperation and cited networks

Author co-occurrence analysis highlights influential researchers and collaborative relationships within a specific field. This method identifies cooperation patterns, key contributors, and scholarly networks. Author co-citation analysis goes further by identifying highly cited authors and the knowledge structure of the field. Examining co-citation networks and author clustering reveals thematic and intellectual communities shaping the research domain. These analyses provide insights into scientific collaboration dynamics and expertise distribution. As shown in Figure 3A, the author collaboration network includes 5,041 nodes and 15,146 links (density =0.0012). The top 10 authors were led by Schroth RJ, followed by El Tantawi M, Folayan MO, Lo ECM, and Levy SM. El Tantawi M and Levy SM have the highest centrality (0.03), indicating their critical bridging roles.

Figure 3 Collaboration-network map of authors (A) and cited authors (B). WHO, World Health Organization.

Schroth’s research, since 2007, includes associations between severe ECC (S-ECC) and low vitamin D levels, the role of guardians in children’s oral health, higher ECC prevalence in children with cleft lip and palate, and correlations between higher BMI and S-ECC (22). Folayan MO, and El Tantawi M have linked ECC to poverty, malnutrition, and female empowerment in low- and middle-income areas, which emphasize the importance of economic empowerment, healthcare expenditure, and preventive oral health behaviors in reducing ECC (23). Lo ECM developed innovative ECC treatments, including trials on silver-diamond fluoride, glass ion applications, and parental guidance, assessed treatment effectiveness in halting caries progression and improving oral health (24). Levy SM examines factors affecting dental health in children and adolescents, exploring connections between tooth eruption and ECC, impacts of beverage consumption and brushing habits on caries, and the long-term correlation between caries risk factors and dental health (25).

In the author’s co-citation network, node size represents citation frequency. The network includes 449 co-cited authors, with the top 10 highlighted in Figure 3B. The World Health Organization (WHO) has the highest co-citation frequency, followed by Ismail AI, Petersen PE, Pitts NB, and Sheiham A. Ismail AI stands out with the highest centrality and second-highest citation frequency, highlighting his significant academic impact, focuses on social factors, dietary habits, and behavioral styles, demonstrating that motivational interventions can effectively alter childhood caries (26,27).

Keyword analysis

Keyword co-occurrences

Pruning parameters like pathfinder and network merging were applied to create the keyword co-occurrence network for childhood caries research. The resulting network comprises 664 nodes and 2,125 links (density =0.0097). Keywords closely related to “child*” and “caries” were excluded to avoid redundancy. Figure 4A shows the network based on keyword frequency. Red-filled nodes represent burst nodes, indicating a rapid increase in their use and identifying emerging trends in research focus.

Figure 4 Keyword co-occurrences network (A) and cluster (B).

Tables 3,4 highlight the top 15 keywords from a frequency and centrality perspective. The terms “prevalence” and “risk factors” lead in frequency, followed by “streptococcus mutans”, “experience”, and “association”. Keywords with the highest centrality scores include “bottle tooth decay” (0.19), “dentition” (0.18), “population” (0.17), “lesions” (0.16), and “water” (0.14), indicating the pivotal roles in the research network. Quality of life (142/0.02) intersects with broader health concerns like “obesity” (89/0.00) and “body mass index” (70/0.06), highlighting the multifaceted impact of childhood caries on overall health and well-being. Research has extensively examined microbial factors like “microflora” (12/0.10) and “plaque” (67/0.02), as well as the influence of “socioeconomic status” (56/0.01) on dental health. This comprehensive keyword analysis provides a nuanced understanding of the dominant themes and emerging trends, emphasizing the importance of a multidisciplinary approach to address this public health issue effectively.

The log likelihood ratio (LLR) algorithm was selected to cluster the keyword network, as shown in Figure 4B. The modularity of 0.8072 and mean silhouette of 0.9216 indicate a significant cluster structure and highly accurate clustering outcomes. An increase in burst nodes within a cluster highlights active research areas and suggests emerging trends. The first category focuses on ECC risk factors and incidence, including clusters: #0 (risk assessment), #1 (caries prevalence), #2 (streptococcus mutans), #7 (oral microbiome), #8 (actinomyces), #10 (socioeconomic factors), and #13 (candida albicans). ECC involves microbiological factors, dietary habits, and environmental/social factors. Studies emphasize understanding the risk factors, especially among vulnerable groups, to develop targeted public health strategies (28). The second category covers ECC diagnosis, monitoring, and treatment, with clusters #3 (program), #9 (silver diamine fluoride), #17 (visual examination), and #18 (dental enamel). Effective ECC management requires precise diagnosis and comprehensive treatment strategies integrating preventive, diagnostic, and restorative methods. Research shows that advancements in dental materials and techniques enhance treatment outcomes. Early detection and parental engagement are crucial for addressing ECC’s complexity (29). The third category addresses ECC’s broader impact, including clusters #5 (deciduous teeth), #6 (injury), #11 (quality of life), #12 (body mass index), and #14 (population). ECC affects children’s quality of life, nutrition, language development, and psychosocial health (30). The adverse effects of ECC severity on OHRQoL stress the need for timely intervention and holistic management.

Keyword trend analysis

Figure 5 presents the timeline view, revealing 20 prominent topics through analysis and summary of keywords in each cluster. The keywords within the same cluster are aligned horizontally, with appearance time at the top. Keywords further to the right indicate more recent appearances, providing insight into each cluster’s keyword count and research’s temporal scope. Comparing timelines of various keywords helps examine the phases of emergence, peak activity, and decline in childhood caries research. Clusters #0, #2, and #15 highlighting enduring focus areas from 2003 to 2023.

Figure 5 Keywords timeline view.

Cluster #0 focuses on risk assessment factors affecting children’s oral health, such as infant feeding practices, enamel defects, and oral hygiene practices. Current advances use deep sequencing and comprehensive assessment methodologies, emphasizing dietary habits, bacterial communities, and innovative therapeutic to address bacterial plaque retention and excessive sugar intake, moving towards personalized and precise treatments. Cluster #2 turns to streptococcus mutans, investigating the behavior and link to caries development. Since 2018, the research has shifted to streptococcus mutans’ interactions within oral biofilms, genetic diversity, and innovative antimicrobial methods. Advanced sequencing technologies promote the interest in phage therapies and small molecules for anticaries research. In cluster #15, the ECC prevalence and its correlation with nutritional status, guardianship, and caries treatment becomes a research priority to reveal the impact on oral health, overall development, and quality of life. From 2021 to 2023, ECC research has advanced toward predictive modeling, dietary impact studies, and epidemiological research, including machine learning algorithms to predict ECC and identify high-risk groups for targeted prevention (31,32).

Clusters #8 and #13, part of cluster #7, show varied activity over time; cluster #8 was more active from 2003–2006, while cluster #13 gained prominence around 2013. Cluster #7 has been studied throughout 2003–2023 but is relatively minor in scale compared to clusters #0, #2, and #15. Cluster #9, focused on silver diamine fluoride (SDF), first emerged in 2003 and saw increased research activity from 2006 through 2023. SDF has gained prominence for its noninvasive application and efficacy, becoming a preferred clinical treatment in pediatric dentistry (33). Clusters #11 and #12 emerged in 2004, with research continuing through 2023. Cluster #11 identified a complex relationship between BMI and caries risk in children, noting an increased risk among overweight and obese children due to unhealthy diets and poor oral hygiene (34). Cluster #12 explored the link between oral health and quality of life, emphasizing oral health’s critical role in overall well-being and the impact of dental care programs on improving children’s quality of life (35). Active between 2009 and 2019, Cluster #10 revealed a strong correlation between low socioeconomic status and elevated caries risk in children.

Burst detection in research topics reveals shifts and hotspots by analyzing clusters and keywords. Keywords with rapid frequency increase in CiteSpace highlight evolving research directions. Figure 6 shows the top 15 keywords with the highest citation bursts, mapping the evolution of childhood caries research through distinct phases marked by critical terms. The early phase [2004–2010] featured keywords like “nursing caries” and “infants” [2003], focusing on caries identification and prevention in young children, and also saw “prediction” [2004] and “experience” [2003], reflecting early detection and treatment interest (36). During the mid-term phase [2010–2017], research shifted to assessing the global burden and new treatments, marked by “global burden” [2015] and “silver diamine fluoride” [2016]. In the recent phase [2017–present], keywords such as “diseases”, “burden”, and “risk factors” saw bursts in 2017, indicating a comprehensive understanding of dental caries and its socioeconomic impacts (31,37). The progression from disease identification and prevention to global burden assessment and new treatments to risk assessment and integrated management shows the deepening research and public health focus on childhood caries.

Figure 6 Top 15 keywords with the strongest citation bursts (sorted by the beginning year).

Co-cited-reference analysis

Evolution analysis

Co-citation analysis is essential for examining the interconnectedness and thematic development within a research field. In the co-citation network, node size reflects a paper’s citation frequency, with larger nodes indicating more citations. The link between two nodes represents a co-citation relationship, and its color shows the time of their first co-citation. These color variations help analyze research trends and the field’s evolution. Figure 7 presents a co-citation clustering map of cited references featuring 1,080 nodes and 4,610 links (density =0.0079). The map identifies 19 distinct co-cited reference clusters labeled through the LLR criterion. This analysis focuses on the first five clusters to highlight their significance in childhood caries research.

Figure 7 Co-citation-cluster map of references.

A detailed overview derived from a co-citation clustering analysis is provided in Table 5, helping to understand each cluster’s research emphasis and temporal span and how various studies address factors associated with ECC. For instance, cluster 0 focuses on a study by Feldens CA, which examines the relationship between infant feeding practices and S-ECC at age four, along with topics like fluoride varnish and cross-sectional studies. Meanwhile, cluster 4 centers on a study by Hallett KB, exploring the associations of ECC with social and behavioral variables such as bottle feeding and maternal age, and covers aspects like rural communities and caregiver knowledge.

In Table 6, the leading co-cited reference is a review by Tinanoff et al., with 84 counts in the clustering and 686 citations on Google Scholar, which systematically evaluates socioeconomic inequality and dental caries, highlighting the link between lower socioeconomic status and higher caries prevalence (38). Next is a study by Peres et al. in the Lancet, with 54 citations and clustering in cluster #1, emphasizing the need for combined public health strategies and clinical interventions to address caries etiology (39). Another critical study by Kassebaum et al., with 54 citations and in cluster #3, calls for a reassessment of prevention and treatment paradigms, highlighting the need for inclusive health policies to mitigate the global caries burden, especially in lower and middle-income regions (40). A similar study by Anil et al. with 54 citations and in cluster #1 focuses on ECC prevalence and risk factors, emphasizing early preventive measures, parental education, and dietary patterns in reducing early caries onset (41). A systematic review by Schwendicke et al. in cluster #2 discusses socioeconomic disparities in caries prevalence, highlighting the disproportionate burden on lower socioeconomic groups and the broader social determinants of dental health (42). They collectively advocate for a comprehensive approach to caries management, integrating clinical treatment with social and economic considerations.

Trend analysis

Figure 8 shows the temporal evolution of the literature citation network into distinct co-citation clusters, highlighting clusters #1 and #5 as emerging research topics with notable citation increases from 2016 to 2022. Cluster #1 focuses on the severe consequences of untreated ECC, such as tooth loss, poor dental health, and negative impacts on nutrition, cognitive development, overall health, and quality of life (43). Untreated ECC can result in the destruction of tooth structure, severe pain, infection, and potential impacts on overall health and quality of life. It also affects eating habits, language development, and self-image and can result in severe pain, infections, and alveolar abscesses (44). Both clusters emphasize the importance of early intervention and management to prevent long-term dental and systemic health issues.

Figure 8 Co-citation-timeline map of cited references.

Publications in cluster #0 showed stable citations from 2004 to 2012, reflecting consistent research interest in “caries prevalence”. In contrast, cluster #2 saw a steady increase in citations from 2010 to 2015, peaking in 2015, indicating a growing focus. Cluster #3 had significant and sustained citation activity from 2013 to 2019, showing ongoing interest. Research in cluster #7 experienced a decline in citations starting in 2010, signaling a shift from “oral microbiota” to other areas. Clusters #4 and #9 had a uniform distribution of citations, maintaining relevance for about a decade. Cluster #8 is newer, with fewer citations, suggesting it is an emerging area with growth potential.

Discussion

The observed increase in articles between 2015 and 2023 can be attributed to heightened awareness of childhood caries as a critical public health issue and advancements in bibliometric tools. This period also saw increased funding for pediatric oral health research, particularly in high-income countries, which supported studies addressing caries prevention, microbiology, and treatment strategies. For instance, initiatives like the U.S. National Institute of Dental and Craniofacial Research (NIDCR) significantly expanded research opportunities during this period. The dominance of the United States and Brazil in childhood caries research is reflective of their respective contexts. The United States benefits from a well-established research infrastructure and public health programs targeting disparities in pediatric oral health. Conversely, Brazil’s significant contribution stems from its high disease burden, which necessitates focused research and academic collaboration in pediatric dentistry. These findings align with previous reviews, which also emphasize the role of socioeconomic factors in shaping research output.

The collaborative networks revealed by this study highlight the importance of international cooperation. The United States, Brazil, and China lead in fostering cross-border partnerships, demonstrating the value of shared expertise in addressing a global issue. Additionally, keyword trends such as socioeconomic status, quality of life, and Streptococcus mutans underline the multifaceted nature of childhood caries research, encompassing microbial, clinical, and social determinants of health. These findings underscore the critical need to address persistent inequities in disease burden and access to effective treatments, particularly in low- and middle-income countries. Targeted policies and increased funding for preventive care and education are essential to bridging these gaps and advancing global efforts to improve children’s oral health. These research trends highlight the multifaceted nature of childhood caries and the ongoing challenges in understanding its etiology and prevention. The following discussion examines the biological and environmental factors driving caries development and evaluates current treatment and prevention strategies.

Dental caries are influenced by bacteria, dietary sugars, host factors, and time, as shown in Figure 9. Streptococcus pyogenes, Lactobacillus, and Actinomyces ferment sugars, producing acids that demineralize enamel and dentin. S. pyogenes adheres to enamel and is transmitted vertically, while Lactobacillus exacerbates caries progression despite weaker adherence. Actinomyces primarily causes root caries. Free sugars in beverages and juices accelerate demineralization, with nocturnal consumption posing higher risks (45). Host factors, such as the morphology of primary teeth, saliva’s protective role, poor hygiene, and vitamin D deficiency, further influence caries risk. Socioeconomic and educational disparities also affect oral health, highlighting the multifaceted nature of caries.

Figure 9 Systematic mapping of childhood caries.

Prevention and management focus on early intervention and minimally invasive treatments. Fluoride, including 38% SDF, promotes remineralization, while sealants reduce bacterial access (46). Intermediate caries refers to the stage of caries progression between early enamel demineralization and advanced cavitation, often requiring intervention beyond preventive care but not as invasive as restorative treatment (47). Preventive strategies include fluoride, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), probiotics, and immunization targeting S. pyogenes (48). ECC prevention integrates oral health education, dietary adjustments, and regular dental visits, emphasizing a holistic approach to sustaining oral health (49).

Conclusions

This bibliometric review of childhood caries research from 2003 to 2023 identified significant trends and contributions in the field. The year 2021 recorded the highest number of publications globally, reflecting the continued interest and advancements in addressing childhood caries. The United States and Brazil emerged as the leading contributors, driven by their respective research infrastructure and high disease burden. Notably, the UoL and the USP were among the most prolific institutions, with Dr. Schroth RJ recognized as one of the most influential authors, focusing on associations between caries and systemic health factors such as vitamin D deficiency and socioeconomic disparities. Key research themes included socioeconomic determinants, quality of life impacts, and microbial pathogenesis, with Streptococcus mutans and socioeconomic status among the most cited keywords. Co-cited reference analysis highlighted Tinanoff N’s 2019 review on socioeconomic inequality and caries as the most frequently cited study. These references underscored the critical link between socioeconomic factors and childhood caries prevalence.

However, despite utilizing advanced bibliometric tools, the result is limited by its reliance on English-language publications, potentially excluding significant research in other languages and impacting the comprehensiveness of the findings and underrepresenting global efforts in childhood caries research. Additionally, the study’s focus on publications indexed in the Web of Science Core Collection may overlook relevant works in other databases. Building on these findings, future research could explore advanced diagnostic and preventive technologies, such as artificial intelligence and probiotics, to improve caries management. Investigating regional disparities in research funding and output could provide insights for equitable resource allocation. Assessing the long-term impact of international collaborations may help identify effective strategies for addressing childhood caries. Furthermore, examining the role of emerging public health interventions, such as oral vaccines and community-based fluoride programs, could contribute to reducing disease prevalence.

Acknowledgments

Funding: This work was supported by Nantong Science and Technology Plan Project (Impact of General Anesthesia Treatment for Childhood Dental Caries on Oral Health-Related Quality of Life from a Socio-Ecological Perspective).

Footnote

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-24-415/prf

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-24-415/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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