ICMJE DISCLOSURE FORM
ICMJE 披露表
Date:________________________________________________________________________________________
日期：________________________________________________________________________________________
Your Name:__________________________________________________________________________________
您的姓名：__________________________________________________________________________________
Manuscript Title:______________________________________________________________________________
稿件标题：______________________________________________________________________________
Manuscript number (if known):__________________________________________________________________
稿件编号（如已知）：__________________________________________________________________
In the interest of transparency, we ask you to disclose all relationships/activities/interests listed below that are
为了透明起见，我们要求您披露以下列出的所有关系/活动/利益
related to the content of your manuscript. “Related” means any relation with for-profit or not-for-profit third
与您稿件内容相关。“相关”意味着与营利性或非营利性第三方有任何关联
parties whose interests may be affected by the content of the manuscript. Disclosure represents a commitment
可能受稿件内容影响的各方。披露代表了一种承诺
to transparency and does not necessarily indicate a bias. If you are in doubt about whether to list a relationship/activity/interest, it is preferable that you do so.
关于透明度，并不一定表明存在偏见。如果您对是否列出关系/活动/利益存在疑虑，最好是列出。
The following questions apply to the author’s relationships/activities/interests as they relate to the current
以下问题适用于作者与当前的关系/活动/兴趣相关的方面
manuscript only
手稿仅.
The author’s relationships/activities/interests should be defined broadly. For example, if your manuscript pertains
作者的关系/活动/兴趣应广泛定义。例如，如果您的稿件涉及
to the epidemiology of hypertension, you should declare all relationships with manufacturers of antihypertensive medication, even if that medication is not mentioned in the manuscript.
关于高血压的流行病学，您应声明与抗高血压药物制造商的所有关系，即使该药物在稿件中未提及。
In item #1 below, report all support for the work reported in this manuscript without time limit. For all other items,
在以下第 1 项中，无需时间限制地报告本手册中报告工作的所有支持。对于其他所有项目，
the time frame for disclosure is the past 36 months.
披露的时间范围是过去 36 个月。
Name all entities with whom you have this relationship or indicate none (add rows as needed) | Specifications/Comments (e.g., if payments were made to you or to your institution) | |||
Time frame: Since the initial planning of the work | ||||
1 | All support for the present manuscript (e.g., funding, provision of study materials, medical writing, article processing charges, etc.) No time limit for this item. | ____None | ||
Time frame: past 36 months | ||||
2 | Grants or contracts from any entity (if not indicated in item #1 above) | ____None | ||
3 | Royalties or licenses | ____None | ||
4 | Consulting fees | ____None | ||
5 | Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events | ____None | ||
6 | Payment for expert testimony | ____None | ||
7 | Support for attending meetings and/or travel | ____None | ||
8 | Patents planned, issued or pending | ____None | ||
9 | Participation on a Data Safety Monitoring Board or Advisory Board | ____None | ||
10 | Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid | ____None | ||
11 | Stock or stock options | ____None | ||
12 | Receipt of equipment, materials, drugs, medical writing, gifts or other services | ____None | ||
13 | Other financial or non-financial interests | ____None | ||
Please place an “X” next to the following statement to indicate your agreement:
请在该陈述旁边放置一个“X”以表示您同意：
___ I certify that I have answered every question and have not altered the wording of any of the questions on this
我证明我已经回答了每一个问题，并且没有更改本页上任何问题的措辞
form.
表单