{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:46:29Z","timestamp":1791960389713,"version":"4.3.4"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Clin Oncol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Locomotive syndrome (LS) is a clinical condition used to describe reduced mobility caused by musculoskeletal dysfunction and is highly prevalent among patients with cancer. The fat-free mass index (FFMI) is an indicator of nutritional status and muscle mass, and has been associated with malnutrition and prognosis in this population. This study investigated the relationship between FFMI and LS in patients with cancer and determined sex-specific FFMI cutoff values associated with severe LS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study included patients hospitalized for cancer treatment who were referred for rehabilitation therapy. Patient characteristics, laboratory data, body composition, and grip strength were collected. LS was assessed using the stand-up test, two-step test, and 25-Geriatric Locomotive Function Scale. FFMI was measured using bioelectrical impedance analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, 144 patients (102 men and 42 women; mean age, 63.9\u2009\u00b1\u200915.8 years) were analyzed. Ordinal logistic regression analysis demonstrated that FFMI was independently associated with LS severity (odds ratio [OR], 0.597; 95% confidence interval [CI], 0.434\u20130.821). The optimal FFMI cutoff values associated with severe LS (grade\u2009\u2265\u20092) were 16.99\u00a0kg\/m\u00b2 in men and 15.25\u00a0kg\/m\u00b2 in women, with areas under the curves of 0.806 (95% CI, 0.720\u20130.890) and 0.760 (95% CI, 0.596\u20130.925), respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FFMI was associated with mobility function in patients with cancer. The proposed sex-specific cutoff values may help identify patients with impaired mobility who could be considered for referral to rehabilitation therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10147-026-03217-6","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:55:04Z","timestamp":1791939304000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between fat-free mass index and severe locomotive syndrome in patients with cancer: sex-specific cutoff values"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7363-655X","authenticated-orcid":false,"given":"Ryoga","family":"Kashima","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4123-0286","authenticated-orcid":false,"given":"Ryo","family":"Yoshikawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2076-9770","authenticated-orcid":false,"given":"Wataru","family":"Saho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3452-5557","authenticated-orcid":false,"given":"Yasumitsu","family":"Fujii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0466-2744","authenticated-orcid":false,"given":"Risa","family":"Harada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5256-1780","authenticated-orcid":false,"given":"Junichiro","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1058-7066","authenticated-orcid":false,"given":"Daisuke","family":"Makiura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9642-0852","authenticated-orcid":false,"given":"Katsuya","family":"Fujiwara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4601-5570","authenticated-orcid":false,"given":"Mayu","family":"Mizuta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0435-8398","authenticated-orcid":false,"given":"Yoshitada","family":"Sakai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"3217_CR1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33588","author":"J Ferlay","year":"2021","unstructured":"Ferlay J, Colombet M, Soerjomataram I et al (2021) Cancer statistics for the year 2020: An overview. Int J Cancer. https:\/\/doi.org\/10.1002\/ijc.33588","journal-title":"Int J Cancer"},{"key":"3217_CR2","doi-asserted-by":"publisher","first-page":"426","DOI":"10.2188\/jea.JE20200416","volume":"31","author":"K Katanoda","year":"2021","unstructured":"Katanoda K, Hori M, Saito E et al (2021) Updated trends in cancer in Japan: Incidence in 1985\u20132015 and mortality in 1958\u20132018-A sign of decrease in cancer incidence. J Epidemiol 31:426\u2013450. https:\/\/doi.org\/10.2188\/jea.JE20200416","journal-title":"J Epidemiol"},{"key":"3217_CR3","doi-asserted-by":"publisher","first-page":"12","DOI":"10.3322\/caac.21820","volume":"74","author":"RL Siegel","year":"2024","unstructured":"Siegel RL, Giaquinto AN, Jemal A (2024) Cancer statistics, 2024. CA Cancer J Clin 74:12\u201349. https:\/\/doi.org\/10.3322\/caac.21820","journal-title":"CA Cancer J Clin"},{"key":"3217_CR4","doi-asserted-by":"publisher","first-page":"1784","DOI":"10.1093\/jnci\/djae135","volume":"116","author":"E Tonorezos","year":"2024","unstructured":"Tonorezos E, Devasia T, Mariotto AB et al (2024) Prevalence of cancer survivors in the United States. J Natl Cancer Inst 116:1784\u20131790. https:\/\/doi.org\/10.1093\/jnci\/djae135","journal-title":"J Natl Cancer Inst"},{"key":"3217_CR5","doi-asserted-by":"publisher","first-page":"409","DOI":"10.3322\/caac.21731","volume":"72","author":"KD Miller","year":"2022","unstructured":"Miller KD, Nogueira L, Devasia T et al (2022) Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin 72:409\u2013436. https:\/\/doi.org\/10.3322\/caac.21731","journal-title":"CA Cancer J Clin"},{"key":"3217_CR6","doi-asserted-by":"publisher","first-page":"60","DOI":"10.5535\/arm.22036","volume":"46","author":"RS Mayer","year":"2022","unstructured":"Mayer RS, Engle J (2022) Rehabilitation of individuals with cancer. Ann Rehabil Med 46:60\u201370. https:\/\/doi.org\/10.5535\/arm.22036","journal-title":"Ann Rehabil Med"},{"key":"3217_CR7","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1007\/s10147-022-02194-w","volume":"27","author":"H Kawano","year":"2022","unstructured":"Kawano H, Hirahata M, Imanishi J (2022) Locomotive syndrome in cancer patients: A new role of orthopaedic surgeons as a part of comprehensive cancer care. Int J Clin Oncol 27:1233\u20131237. https:\/\/doi.org\/10.1007\/s10147-022-02194-w","journal-title":"Int J Clin Oncol"},{"key":"3217_CR8","doi-asserted-by":"publisher","first-page":"100703","DOI":"10.1016\/j.jbo.2025.100703","volume":"53","author":"R Yoshikawa","year":"2025","unstructured":"Yoshikawa R, Fujii Y, Kashima R et al (2025) Effectiveness of rehabilitation treatment for bone metastasis patients without surgical intervention: A propensity score matching analysis. J Bone Oncol 53:100703. https:\/\/doi.org\/10.1016\/j.jbo.2025.100703","journal-title":"J Bone Oncol"},{"key":"3217_CR9","doi-asserted-by":"publisher","first-page":"906","DOI":"10.3390\/medicina60060906","volume":"60","author":"Y Fujii","year":"2024","unstructured":"Fujii Y, Yoshikawa R, Kashima R et al (2024) Evaluation of changes in activities of daily living and quality of life of patients with bone metastasis who underwent conservative therapy through bone metastasis cancer boards. Med (Kaunas) 60:906. https:\/\/doi.org\/10.3390\/medicina60060906","journal-title":"Med (Kaunas)"},{"key":"3217_CR10","doi-asserted-by":"publisher","first-page":"20240032","DOI":"10.2490\/prm.20240032","volume":"9","author":"R Kashima","year":"2024","unstructured":"Kashima R, Yoshikawa R, Saho W et al (2024) Multidisciplinary treatment for breast cancer-related multiple bone metastases during pregnancy using bone metastasis cancer boards: A case report. Prog Rehabil Med 9:20240032. https:\/\/doi.org\/10.2490\/prm.20240032","journal-title":"Prog Rehabil Med"},{"key":"3217_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s00776-007-1202-6","volume":"13","author":"K Nakamura","year":"2008","unstructured":"Nakamura K (2008) A super-aged society and the locomotive syndrome. J Orthop Sci 13:1\u20132. https:\/\/doi.org\/10.1007\/s00776-007-1202-6","journal-title":"J Orthop Sci"},{"key":"3217_CR12","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10147-023-02312-2","volume":"28","author":"M Hirahata","year":"2023","unstructured":"Hirahata M, Imanishi J, Fujinuma W et al (2023) Cancer may accelerate locomotive syndrome and deteriorate quality of life: A single-centre cross-sectional study of locomotive syndrome in cancer patients. Int J Clin Oncol 28:603\u2013609. https:\/\/doi.org\/10.1007\/s10147-023-02312-2","journal-title":"Int J Clin Oncol"},{"key":"3217_CR13","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1007\/s00776-015-0737-1","volume":"20","author":"T Ogata","year":"2015","unstructured":"Ogata T, Muranaga S, Ishibashi H et al (2015) Development of a screening program to assess motor function in the adult population: A cross-sectional observational study. J Orthop Sci 20:888\u2013895. https:\/\/doi.org\/10.1007\/s00776-015-0737-1","journal-title":"J Orthop Sci"},{"key":"3217_CR14","doi-asserted-by":"publisher","first-page":"3980","DOI":"10.3390\/jcm14113980","volume":"14","author":"R Kashima","year":"2025","unstructured":"Kashima R, Yoshikawa R, Saho W et al (2025) Usefulness of the phase angle in evaluating locomotive syndrome in cancer patients. J Clin Med 14:3980. https:\/\/doi.org\/10.3390\/jcm14113980","journal-title":"J Clin Med"},{"key":"3217_CR15","doi-asserted-by":"publisher","first-page":"e88699","DOI":"10.7759\/cureus.88699","volume":"17","author":"Y Katayama","year":"2025","unstructured":"Katayama Y, Nakata E, Itano T et al (2025) Prevalence of locomotive syndrome in perioperative patients with localized cancer. Cureus 17:e88699. https:\/\/doi.org\/10.7759\/cureus.88699","journal-title":"Cureus"},{"key":"3217_CR16","doi-asserted-by":"publisher","first-page":"e0319511","DOI":"10.1371\/journal.pone.0319511","volume":"20","author":"MY Yang","year":"2025","unstructured":"Yang MY, Chen Y, Su H et al (2025) The prevalence and correlation of cancer-related fatigue and locomotive syndrome in geriatric cancer patients. PLoS ONE 20:e0319511. https:\/\/doi.org\/10.1371\/journal.pone.0319511","journal-title":"PLoS ONE"},{"key":"3217_CR17","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1038\/sj.ijo.0802037","volume":"26","author":"Y Schutz","year":"2002","unstructured":"Schutz Y, Kyle UUG, Pichard C (2002) Fat-free mass index and fat mass index percentiles in Caucasians aged 18\u201398 y. Int J Obes Relat Metab Disord 26:953\u2013960. https:\/\/doi.org\/10.1038\/sj.ijo.0802037","journal-title":"Int J Obes Relat Metab Disord"},{"key":"3217_CR18","doi-asserted-by":"publisher","first-page":"567085","DOI":"10.3389\/fnut.2021.567085","volume":"8","author":"X Pan","year":"2021","unstructured":"Pan X, Liu H, Feng G et al (2021) Role of muscle mass and nutritional assessment tools in evaluating the nutritional status of patients with locally advanced nasopharyngeal carcinoma. Front Nutr 8:567085. https:\/\/doi.org\/10.3389\/fnut.2021.567085","journal-title":"Front Nutr"},{"key":"3217_CR19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.clnu.2018.08.002","volume":"38","author":"T Cederholm","year":"2019","unstructured":"Cederholm T, Jensen GL, Correia MITD et al (2019) GLIM criteria for the diagnosis of malnutrition\u2014A consensus report from the global clinical nutrition community. Clin Nutr 38:1\u20139. https:\/\/doi.org\/10.1016\/j.clnu.2018.08.002","journal-title":"Clin Nutr"},{"key":"3217_CR20","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1002\/jpen.2756","volume":"49","author":"GL Jensen","year":"2025","unstructured":"Jensen GL, Cederholm T, Correia MITD et al (2025) GLIM consensus approach to diagnosis of malnutrition: A 5-year update. JPEN J Parenter Enter Nutr 49:414\u2013427. https:\/\/doi.org\/10.1002\/jpen.2756","journal-title":"JPEN J Parenter Enter Nutr"},{"key":"3217_CR21","doi-asserted-by":"publisher","first-page":"714051","DOI":"10.3389\/fnut.2021.714051","volume":"8","author":"X Zhang","year":"2021","unstructured":"Zhang X, Zhang Q, Feng L-J et al (2021) The application of fat-free mass index for survival prediction in cancer patients with normal and high body mass index. Front Nutr 8:714051. https:\/\/doi.org\/10.3389\/fnut.2021.714051","journal-title":"Front Nutr"},{"key":"3217_CR22","doi-asserted-by":"publisher","first-page":"808","DOI":"10.1002\/hed.27628","volume":"46","author":"C Talani","year":"2024","unstructured":"Talani C, Astradsson T, Farnebo L et al (2024) Pretreatment fat-free mass index correlates with early death in patients with head and neck squamous cell carcinoma. Head Neck 46:808\u2013818. https:\/\/doi.org\/10.1002\/hed.27628","journal-title":"Head Neck"},{"key":"3217_CR23","doi-asserted-by":"publisher","first-page":"1172610","DOI":"10.3389\/fnut.2023.1172610","volume":"10","author":"W Ji","year":"2023","unstructured":"Ji W, Liu X, Liu P et al (2023) The efficacy of fat-free mass index and appendicular skeletal muscle mass index in cancer malnutrition: A propensity score match analysis. Front Nutr 10:1172610. https:\/\/doi.org\/10.3389\/fnut.2023.1172610","journal-title":"Front Nutr"},{"key":"3217_CR24","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1007\/s00268-021-06435-3","volume":"46","author":"A Yago","year":"2022","unstructured":"Yago A, Ohkura Y, Ueno M et al (2022) Identification of preoperative fat-free mass index for the prognosis of curatively resected esophageal cancer. World J Surg 46:845\u2013854. https:\/\/doi.org\/10.1007\/s00268-021-06435-3","journal-title":"World J Surg"},{"key":"3217_CR25","doi-asserted-by":"publisher","first-page":"111508","DOI":"10.1016\/j.nut.2021.111508","volume":"94","author":"X Zhang","year":"2022","unstructured":"Zhang X, Li X, Shi H et al (2022) Association of the fat-free mass index with mortality in patients with cancer: A multicenter observational study. Nutrition 94:111508. https:\/\/doi.org\/10.1016\/j.nut.2021.111508","journal-title":"Nutrition"},{"key":"3217_CR26","doi-asserted-by":"publisher","first-page":"10513","DOI":"10.3390\/nu7125548","volume":"7","author":"D-H Lee","year":"2015","unstructured":"Lee D-H, Park KS, Ahn S et al (2015) Comparison of abdominal visceral adipose tissue area measured by computed tomography with that estimated by bioelectrical impedance analysis method in Korean subjects. Nutrients 7:10513\u201310524. https:\/\/doi.org\/10.3390\/nu7125548","journal-title":"Nutrients"},{"key":"3217_CR27","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1186\/s12877-021-02440-2","volume":"21","author":"M Taniguchi","year":"2021","unstructured":"Taniguchi M, Ikezoe T, Tsuboyama T et al (2021) Prevalence and physical characteristics of locomotive syndrome stages as classified by the new criteria 2020 in older Japanese people: Results from the Nagahama study. BMC Geriatr 21:489. https:\/\/doi.org\/10.1186\/s12877-021-02440-2","journal-title":"BMC Geriatr"},{"key":"3217_CR28","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.3390\/cancers15051507","volume":"15","author":"D Hui","year":"2023","unstructured":"Hui D, Ahmed S, Nortje N et al (2023) Differential impact of a multicomponent goals-of-care program in patients with hematologic and solid malignancies. Cancers 15:1507. https:\/\/doi.org\/10.3390\/cancers15051507","journal-title":"Cancers"},{"key":"3217_CR29","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.1016\/j.clnu.2024.05.041","volume":"43","author":"N Kiss","year":"2024","unstructured":"Kiss N, Prado CM, Curtis AR et al (2024) Risk factors for low muscle mass, malnutrition, and (probable-) sarcopenia in adults with or without a history of cancer in the UK Biobank. Clin Nutr 43:1736\u20131746. https:\/\/doi.org\/10.1016\/j.clnu.2024.05.041","journal-title":"Clin Nutr"},{"key":"3217_CR30","doi-asserted-by":"publisher","first-page":"644","DOI":"10.1016\/j.clnu.2018.04.007","volume":"38","author":"KM Marshall","year":"2019","unstructured":"Marshall KM, Loeliger J, Nolte L et al (2019) Prevalence of malnutrition and impact on clinical outcomes in cancer services: A comparison of two time points. Clin Nutr 38:644\u2013651. https:\/\/doi.org\/10.1016\/j.clnu.2018.04.007","journal-title":"Clin Nutr"},{"key":"3217_CR31","doi-asserted-by":"publisher","first-page":"697","DOI":"10.3390\/jcm13030697","volume":"13","author":"T Ohba","year":"2024","unstructured":"Ohba T, Oda K, Tanaka N et al (2024) Impact of skeletal muscle mass on physical function and locomotive syndrome of pre- and postoperative adult spinal deformity. J Clin Med 13:697. https:\/\/doi.org\/10.3390\/jcm13030697","journal-title":"J Clin Med"},{"key":"3217_CR32","doi-asserted-by":"publisher","first-page":"610","DOI":"10.3390\/jcm11030610","volume":"11","author":"S Ito","year":"2022","unstructured":"Ito S, Nakashima H, Ando K et al (2022) Nutritional influences on locomotive syndrome. J Clin Med 11:610. https:\/\/doi.org\/10.3390\/jcm11030610","journal-title":"J Clin Med"},{"key":"3217_CR33","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1186\/s12891-020-03469-x","volume":"21","author":"R Tokida","year":"2020","unstructured":"Tokida R, Ikegami S, Takahashi J et al (2020) Association between musculoskeletal function deterioration and locomotive syndrome in the general elderly population: A Japanese cohort survey randomly sampled from a basic resident registry. BMC Musculoskelet Disord 21:431. https:\/\/doi.org\/10.1186\/s12891-020-03469-x","journal-title":"BMC Musculoskelet Disord"},{"key":"3217_CR34","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1016\/S1470-2045(10)70218-7","volume":"12","author":"K Fearon","year":"2011","unstructured":"Fearon K, Strasser F, Anker SD et al (2011) Definition and classification of cancer cachexia: An international consensus. Lancet Oncol 12:489\u2013495. https:\/\/doi.org\/10.1016\/S1470-2045(10)70218-7","journal-title":"Lancet Oncol"},{"key":"3217_CR35","doi-asserted-by":"publisher","first-page":"3004","DOI":"10.3390\/ijms23063004","volume":"23","author":"GD Mangano","year":"2022","unstructured":"Mangano GD, Fouani M, D\u2019Amico D et al (2022) Cancer-related cachexia: The vicious circle between inflammatory cytokines, skeletal muscle, lipid metabolism and the possible role of physical training. Int J Mol Sci 23:3004. https:\/\/doi.org\/10.3390\/ijms23063004","journal-title":"Int J Mol Sci"}],"container-title":["International Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10147-026-03217-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10147-026-03217-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10147-026-03217-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T06:02:56Z","timestamp":1791957776000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10147-026-03217-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,13]]},"references-count":35,"alternative-id":["3217"],"URL":"https:\/\/doi.org\/10.1007\/s10147-026-03217-6","relation":{},"ISSN":["1341-9625","1437-7772"],"issn-type":[{"value":"1341-9625","type":"print"},{"value":"1437-7772","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,13]]},"assertion":[{"value":"26 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Kobe University Graduate School of Medicine (November 22, 2021; B210225).Informed consent was obtained from all individual participants included in the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no relevant financial or non-financial interests to disclose.","order":2,"name":"Ethics","label":"Competing interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}