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Article History

Received: 3 November 2025

Accepted: 25 March 2026

First Online: 6 April 2026

Declarations

:

: This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and all relevant national regulations and institutional guidelines. Ethical approval was obtained from the Shimonoseki City University Research Ethics Committee (No. 2513–0806) and the Tohoku University Graduate School of Medicine Ethics Committee (rapid review dated March 26, 2025; protocol 2024-1-1035). All participants were provided with an information sheet describing the study procedures, potential risks, data handling, and their right to withdraw at any time without penalty. Participants who agreed to take part in the study provided electronic informed consent by checking the consent box prior to participation. No personally identifiable information was included in the analytical dataset.

: Not applicable.

: The authors declare that they have no conflicts of interest directly related to this study. Within the past 36 months, Dr. Takahiro Tabuchi has received research funding, consulting fees, or lecture honoraria from Daiichi Sankyo Healthcare Co., Ltd.; Johnson & Johnson K.K.; Data Seed Inc.; Workout-Plus LLC; and EMMA Co., Ltd. These organizations had no involvement in the study design; data collection, analysis, or interpretation; manuscript preparation; or the decision to submit the article for publication.