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Article History

Received: 28 June 2026

Accepted: 21 August 2026

First Online: 24 August 2026

Declarations

Ethics approval and consent to participate: This study was approved by the Ethics Committee of Unnan City Hospital, Japan, with the approval number 20260001. All participants received written and verbal explanations of the study purpose, methods, voluntary nature of participation, use of audio recording, data management procedures, potential risks, and plans for publication. Written informed consent was obtained from all participants before participation.

Consent for publication: Not applicable. No identifiable personal information, images, or individual-level clinical details that would allow participant identification are included in this manuscript. Representative quotations were anonymized and translated into English with attention to protecting participant confidentiality.

Competing interests: The authors declare no competing interests.