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Initial ethical approval was obtained in August 2024 (Ref: PJ-2024-08-83), and a subsequent extension for an expanded sample size was approved in January 2026 (Ref: PJ-2025-12-20). Due to the retrospective and observational nature of the study, which utilized anonymized clinical data and imposed no additional risk to the participants, the requirement for informed consent was formally waived by the Ethics Committee. This study was conducted in accordance with the principles of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"We confirmed the work presented is original research, has not been published previously, nor is it under review by any other journal. 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