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Author contribution form

Please complete the table by indicating tick marks for each author’s contribution. Please note that “authors” who do not meet all four ICMJE requirement should be listed in the acknowledgment.

Manuscript title:
_________________________________________________________________________________________ _________________________________________________________________________________________

Authors’ name ICMJE 1 ICMJE 2 ICMJE 3 ICMJE 4
Study conception or design Data acquisition Data analysis or interpretation Manuscript drafting Critical manuscript revision Final manuscript approval All authors are responsible for all aspects of the work

I confirm that all listed authors meet authorship criteria and that no other authors meeting the criteria have been omitted (Please check here).   [       ]

Corresponding author: name _______________________________ signature _______________________

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