Search Results (30,194)

Background: Emerging evidence highlights the importance of the MIF–sCD74 axis in health and disease, including its role in regulating cell death. While studies in routine cardiac surgery suggest perioperative relevance, its role in end-stage heart failure (ESFH) patients undergoing left ventricular assist device (LVAD) implantation remains unexplored. Moreover, although MIF and sCD74 induce necroptosis in neonatal cardiac myofibroblasts, the effects of MIF, its paralog D-DT, and sCD74 on adult cardiac myofibroblasts (CMFs) are unknown. Methods: Plasma concentrations of sCD74, MIF and D-DT were measured perioperatively in a small cohort of patients with ESHF undergoing LVAD implantation (n = 20). As a preclinical model of ESHF, primary adult CMFs were treated with recombinant MIF, D-DT and sCD74 to evaluate their effects on cellular viability and health. Results: In LVAD patients, sCD74 and D-DT levels were significantly increased 24 h postoperatively, whereas MIF levels were reduced compared to baseline. ROC curve analysis demonstrated a good discriminatory power of 24 h post-OP sCD74 (AUC = 0.83), sCD74/MIF ratio (AUC = 0.82), and D-DT levels (AUC = 0.88) for acute kidney injury, composite outcome, and right heart failure (RHF), respectively. In adult CMFs, MIF and sCD74 synergistically reduced viable cell counts (p = 0.0083), whereas D-DT reduced cell counts in an sCD74-independent manner (p = 0.0004). Yet, measures of metabolism, proliferation, apoptosis and necrosis along with inflammatory gene expression remained unchanged. Conclusions: Our findings indicate that the balance of MIF, D-DT, and sCD74 during LVAD implantation may be clinically relevant. In particular, an imbalance characterized by elevated sCD74 or D-DT and reduced MIF levels 24 h post-surgery was associated with unfavorable clinical outcomes. Yet, the current findings are exploratory and hypothesis-generating because of a small sample size. Thus, the prognostic value of plasma levels for postoperative complications after LVAD implantation, and the effects of MIF/D-DT/sCD74 imbalance on cardiac myofibroblasts, need to be validated in larger cohorts and in advanced human experimental models. Full article

Bamboo plantations are increasingly recognized as significant terrestrial carbon sinks, yet accurate estimation of biomass and carbon stocks requires species-specific, regionally validated allometric models. Bambusa emeiensis L.C.Chia & H.L.Fung (ci bamboo) is among the most ecologically and economically important clump-forming bamboo species in southwestern China, but robust multi-regional allometric models are lacking. Using destructive sampling data from 127 culms across two major production areas—Sichuan Province (n = 82) and Guizhou Province (n = 45)—we developed additive biomass and carbon storage model systems enforcing mathematical additivity via nonlinear seemingly unrelated regression (NSUR). Allometric equations used diameter at breast height (D), culm height (H), and compound variables (DH, D²H) as predictors. Regional models achieved R_a² of 0.0879–0.8320 total relative error (TRE): −0.99% to 0.04% for biomass and R_a² of 0.0923–0.8282 (TRE: −1.01% to 0.03%) for carbon storage; culm and total aboveground models attained R_a² ≥ 0.52. Organ-level carbon content (40.79%–44.46%) was significantly lower than the intergovernmental panel on climate change (IPCC) default of 50% (one-sample t-test, p < 0.01 for all organs), with Sichuan values exceeding Guizhou values (independent-samples t-test, p < 0.01), indicating that use of the default would overestimate carbon stocks by 12%–22%. Cross-regional validation revealed prediction biases of up to ±19.24% when applying single-region models outside their training area, whereas the combined model held errors within ±11.36% for biomass and ±8.49% for carbon storage. External validation using 32 independent culms from Hunan, Yunnan, and Chongqing confirmed the robustness of the combined model (TRE: −6.30% to 4.27%). A key limitation is that belowground biomass was not measured. The established models provide scientifically rigorous and practically applicable tools for regional carbon accounting of B. emeiensis plantations under China’s national greenhouse gas inventory framework and for informing sustainable bamboo management planning, and demonstrate that species- and region-specific carbon fractions are essential for accurate carbon stock assessments. Full article

To address the emerging multidrug-resistance crisis caused by Klebsiella pneumoniae, we expressed the endolysin Lys59 derived from phage VB_KpP_HS106 and performed a comprehensive analysis of its antibacterial activity and structural features. Molecular modeling revealed that Lys59 carries a highly positively charged N-terminus and an amphipathic helix at the C-terminus. In vitro antibacterial assays showed that Lys59 exhibited significant bactericidal activity against K. pneumoniae with an approximately 4 log reduction at 50 µg/mL in 2 h. Meanwhile, Lys59 exhibited potent, broad-spectrum activity against both Gram-negative and Gram-positive bacteria. Stability analysis indicated that Lys59 retained high activity over a pH range of 3–9 and a temperature range of 4–55 °C. Notably, the antibacterial activity of Lys59 was found to be regulated by metal ions. Molecular docking indicated that K⁺ can enhance binding stability by interacting with ASN35 and VAL57. In contrast, Mg²⁺ and Ca²⁺ suppressed catalytic function by binding to the essential GLU17 residue. Furthermore, treatment with 200 µg/mL of Lys59 resulted in a 44.6% reduction in K. pneumoniae biofilm biomass. Overall, this study identified a phage-derived endolysin with broad-spectrum antimicrobial activity and demonstrated its potential as an antibacterial agent against multidrug-resistant K. pneumoniae. Full article

Background/Objective: Intermittent fasting (IF) shows promise for metabolic and mental health benefits, but evidence in older adults remains limited. This study systematically evaluated the safety and effectiveness of IF in adults aged ≥60 years, comparing different protocols using network meta-analysis. Methods: Systematic review and network meta-analysis following Cochrane and PRISMA guidelines were conducted, producing a literature search until June 2025 across PubMed, Scopus, and ScienceDirect databases, with inclusion criteria comprising randomized controlled trials, clinical trials, and observational studies evaluating IF in adults ≥60 years. Network meta-analysis compared time-restricted eating (TRE), IF 5:2 method, Islamic Sunnah fasting (ISF), Healthy Living Diet and usual diet. The NMA was conducted exclusively using randomized controlled trials (RCTs; n = 7); pre–post trials and observational studies were included solely in the narrative systematic review component and did not contribute to any pooled NMA estimates. Observational data contributed exclusively to the narrative synthesis. Results: Thirty-one studies were included; seven RCTs were eligible for network meta-analysis. ISF and TRE 16:8 were most effective for weight (ISF: −2.36 kg; TRE 16:8: −1.92 kg) and BMI reduction (−0.81 and −1.01 kg/m²) without lean mass loss. Findings on cardiometabolic parameters, mental health, and cognitive function are based on the narrative synthesis of individual studies. Long-term structured IF was associated with improvements in standardized cognitive performance assessed via validated instruments. However, very restrictive eating windows (≤10 h) and prolonged fasting (>12.38 h) were associated with adverse outcomes, including lower cognitive scores and 58% increased cardiovascular mortality. Conclusions: TRE 16:8 and ISF showed the strongest comparative evidence for weight reduction in the RCT-based NMA, with acceptable short-term safety profiles in the included trials. In the narrative review, these protocols were associated with clinically meaningful improvements in body weight, metabolic markers, and blood pressure while generally preserving lean muscle mass in older adults. The cardiovascular mortality risk associated with very restrictive eating windows may emphasize the importance of moderate fasting approaches in this vulnerable population. Further long-term research is needed to confirm optimal protocols and identify at-risk subgroups. Full article

Groundwater contamination by dissolved metals and metalloids in the Chiang Mai Basin is an important drinking-water concern, yet the coupled depth patterns, hydrogeochemical controls, composite contamination status, and screening-level health implications have not previously been assessed in an integrated basin-scale framework. This study evaluated 120 groundwater samples from alluvial wells classified by depth as shallow (≤30 m, n = 40), intermediate (31–60 m, n = 35), and deep (>60 m, n = 45). Samples were analyzed for nine dissolved metals and metalloids (Fe, Mn, As, Cd, Pb, Cr, Zn, Hg, and Se) together with pH, Eh, and total dissolved solids (TDS). The highest exceedance frequencies were observed for Fe (72.5% of samples, >0.3 mg/L acceptability threshold), Mn (65.0%, >0.08 mg/L), and As (45.8%, >10 μg/L). Fe and Mn increased significantly with depth, whereas As was enriched in deep wells but showed no statistically significant depth dependence. Pearson correlation and principal component analysis consistently identified a dominant redox-associated component in which Fe, Mn, and As covaried negatively with Eh, supporting redox-sensitive co-enrichment in deeper groundwater. Contamination factors calculated relative to selected global groundwater background values were >6 for all seven evaluated metals (Fe, Mn, As, Cd, Pb, Cr, and Zn), and the overall pollution load index (PLI) was 9.11, with the highest depth-specific PLI in deep wells (10.42). These indices are interpreted here as background-relative screening tools rather than stand-alone regulatory measures. A screening-level ingestion risk assessment identified arsenic as the dominant toxicological driver, with hazard quotients (HQ) of 1.97 for adults and 4.60 for children, and an estimated lifetime cancer risk (LCR) of 8.87 × 10^–4. The results support targeted monitoring of deeper wells, routine screening for As and Mn, and treatment strategies that can address the co-occurring Fe–Mn–As assemblage in alluvial groundwater. Full article

Background: Extracorporeal membrane oxygenation (ECMO) is lifesaving in pediatric patients with respiratory and/or cardiovascular failure. Cardiac catheterization is an important diagnostic and therapeutic tool in patients with congenital heart disease supported by ECMO, allowing the assessment of residual lesions, hemodynamically significant anatomical abnormalities, and unexplained indications for ongoing ECMO support. The timing and clinical contribution of cardiac catheterization in these patients are still debated. Objective: This study aimed to evaluate the indications, safety, and impact of cardiac catheterization on clinical management in pediatric patients receiving postoperative ECMO support. Methods: This single-center, retrospective study examined 39 pediatric patients under the age of 18 who underwent postoperative cardiac catheterization with ECMO support between January 2022 and December 2025. Demographic data, procedure characteristics, and clinical outcomes were analyzed. Results: Of the 190 patients under postoperative ECMO support, 39 underwent catheterization. The median age of the patients was 2.5 months (range, 6 days–180 months) and median weight was 4.2 kg (range, 2.8–57 kg). The most frequent diagnoses were ventricular septal defect-pulmonary atresia (VSD-PA) in 20.5% (n = 8) and transposition of the great arteries (TGA) in 15.3% (n = 6). The indication for catheterization was to investigate the reason for ECMO placement in 26 patients (66.6%). Most patients underwent catheterization within the first 24 h after ECMO initiation. Patients who underwent catheterization represented a higher-risk subgroup, with a greater proportion of STAT 4-5 procedures (59% vs. 40%) compared with the overall ECMO cohort. Cardiac catheterization resulted in a change in clinical management in 25.6% of patients through catheter-based intervention or surgical revision. Survival in the catheterized subgroup was 12.8%, reflecting the high-risk nature of this population. Conclusions: Cardiac catheterization in pediatric patients on postoperative ECMO support can be performed with a low complication rate and can significantly alter clinical management. Cardiac catheterization should be considered an important diagnostic and therapeutic modality, particularly in the presence of suspected residual lesions or unexplained hemodynamic instability. Additionally, we recommend that cardiac catheterization be performed promptly within the first 24–48 h in this patient group on ECMO support. Full article

The overuse of antibiotics has led to their widespread environmental residues, posing a significant threat to the ecological environment. In this study, a flower-like spherical CoFe-layered double hydroxide (CoFe-LDH) catalyst was prepared using a hydrothermal method. The degradation performance of the CoFe-LDH/peroxymonosulfate (PMS) system was systematically investigated using tetracycline (TC) as a model pollutant. The CoFe-LDH exhibited a three-dimensional nanoflower-like spherical structure formed by interlaced nanosheets, featuring smooth surfaces and well-defined edges. This hierarchical porous structure facilitates the exposure of active sites. The CoFe-LDH/PMS system demonstrated remarkable degradation efficiency, achieving over 90.17% TC removal within 10 min. As the dosage of CoFe-LDH and PMS increases, the degradation rate of TC improves significantly, but the marginal improvement effect decreases. TC degradation efficiency increased with pH up to an optimum at pH 5.0, beyond which it declined. The anions—Cl⁻, $\mathrm{N}{\mathrm{O}}_3^{-}$, and $\mathrm{S}{\mathrm{O}}_4^{2-}$—all exhibited inhibitory effects on TC degradation; the TC removal rates decreased to 77.88%, 80.58%, and 82.78%, respectively. The removal experiments of different organic pollutants, such as oxytetracycline (88.91%), methylene blue (98.36%), and ciprofloxacin (84.52%), as well as actual water experiments, such as lake water (92.48%) and tap water (80.86%), have demonstrated the good universality of the CoFe-LDH/PMS system. Radical quenching experiments confirmed that ^•OH and $\mathrm{S}{\mathrm{O}}_4^{\text{•}-}$ were the dominant reactive species. Full article

Tuberculosis (TB), caused by Mycobacterium tuberculosis (Mtb), remains a major cause of morbidity and mortality worldwide, particularly due to the emergence of drug-resistant strains. Membrane-active antimicrobial peptides (AMPs) represent attractive therapeutic candidates because they target bacterial envelope integrity and disrupt essential cellular processes. We evaluated two rationally designed LL-37-derived peptides: a truncated C-terminally amidated analog (LL37-1) and a modified variant incorporating N-terminal acetylation and a single D-amino acid substitution (D-LL37). Dose–response analysis demonstrated that D-LL37 exhibited greater antimycobacterial potency, with lower inhibitory concentrations of 90% (IC₉₀) and 50% (IC₅₀) values (18.40 ± 0.39 μM and 10.11 ± 0.60 μM, respectively) compared with LL37-1 (25.44 ± 0.36 μM and 15.45 ± 1.40 μM). Fluorescence-based permeability assays revealed partial membrane disruption (36% and 44% at IC₉₀ for LL37-1 and D-LL37, respectively), which was supported by ultrastructural alterations observed by scanning electron microscopy, including bacillary shortening, rough surface formation, cell clusters, and the presence of cellular debris, all of which are consistent with membrane damage. RT-qPCR analysis demonstrated significant upregulation of the P-type ATPase genes ctpF, ctpA, and ctpH following D-LL37 exposure. Collectively, these findings indicate that optimized LL-37-derived peptides exert antitubercular activity associated with envelope perturbation and coordinated activation of ion transport-related stress responses. Full article

The H5N1 subtype of highly pathogenic avian influenza (HPAI) poses a major zoonotic threat due to its high fatality rate and capacity for cross species transmission. In early 2025, Argentina detected a novel triple reassortant A(H5N1) virus in Chaco Province, combining Eurasian, North American, and South American lineage segments. Genomic analyses of subsequent outbreaks in Buenos Aires and Entre Ríos confirmed persistence of this reassortant and additional HA substitutions (T204K, P251S) potentially linked to increased mammalian receptor affinity. Although PB2 sequences lacked canonical mammalian-adaptive markers (E627K, Q591K, D701N), all contained I292M, a mutation associated with human adaptation. Phylogenetic analyses revealed distinct genotypes and increasing divergence. These findings indicate ongoing viral evolution and adaptation within Argentina, emphasizing the urgent need for sustained genomic surveillance, timely data sharing, and integrated One Health strategies to mitigate zoonotic and socioeconomic risks associated with H5N1 spread in South America. Full article

Let $1\ne 0$ be the identity of the commutative ring R. The cozero-divisor graph of a ring R is an undirected simple graph, represented by ${\mathsf{\Gamma }}^{\prime }\left(R\right)$, where two different vertices g and h are adjacent if and only if $g\notin Rh$ and $h\notin Rg$. The vertices of this graph are given by the set of all non-zero and non-unit elements of R. The definition of a graph G’s $A_{\alpha }$ matrix is $A_{\alpha }\left(G\right)=\alpha D\left(G\right)+(1-\alpha )A\left(G\right)$, where $\alpha \in [0,1],D\left(G\right)=diag(deg\left(c_1\right),deg\left(c_2\right),\dots ,deg\left(c_n\right))$ is the diagonal matrix and $A\left(G\right)$ is the adjacency matrix of graph G. In this article, we calculate the sum-connectivity F-index, product-connectivity F-index of ${\mathsf{\Gamma }}^{\prime }\left({\mathbb{Z}}_n\right)$, when $n={\zeta }_1{\zeta }_2,{\zeta }_1^2{\zeta }_2,{\zeta }_1{\zeta }_2{\zeta }_3$, and the $A_{\alpha }$ eigenvalues of ${\mathsf{\Gamma }}^{\prime }\left({\mathbb{Z}}_n\right)$ for $n={{\zeta }_1}^{u_1}{\zeta }_2{\zeta }_3$, where ${\zeta }_1,{\zeta }_2$, ${\zeta }_3$ are distinct primes. Full article

Background and Objectives: Diazepam, a GABA_A receptor agonist with sympatholytic properties, is sometimes co-administered with antiarrhythmic agents in the emergency management of atrial fibrillation (AF), yet evidence supporting this practice is remarkably limited. Given the established role of sympathetic activation in the initiation and maintenance of AF, we investigated whether adjunctive diazepam influences treatment outcomes. Materials and Methods: This single-centre retrospective cohort study included 72 hemodynamically stable patients presenting with AF to the emergency department of University Hospital Centre Split, Croatia. Patients were stratified by treatment strategy into a rhythm control group (n = 33, receiving any Class IC/III antiarrhythmic) and a rate control only group (n = 39, beta-blockers and/or digoxin). Diazepam was administered orally at the physician’s discretion (median dose 5 mg). Primary outcomes were rhythm conversion and achievement of a heart rate < 110 bpm. Secondary outcomes included changes in heart rate, blood pressure, and time to therapeutic goal. Results: Diazepam was administered to 32 patients (44.4%). In the rate control stratum, spontaneous rhythm conversion was significantly higher with diazepam (40.0% vs. 9.5%; OR 6.33, 95% CI 1.06–37.78, p = 0.046), corresponding to a model-predicted increase in conversion probability from 8% to 33%. This effect was absent in the rhythm control group (64.3% vs. 64.7%; OR 0.98, p = 1.000). Diazepam increased the odds of achieving HR < 110 bpm by 3.46-fold (95% CrI 0.63–23.1, posterior probability of benefit 92%) in the rate control group. Diazepam-treated patients in the rate control group had longer median time to therapeutic goal (4.2 vs. 2.8 h, p = 0.005). In the rhythm control group, diazepam was associated with reduced variability in diastolic blood pressure response (p = 0.006). Conclusions: Adjunctive diazepam was associated with a significantly higher rate of spontaneous rhythm conversion in AF patients receiving rate control therapy only, consistent with sympatholysis removing a key factor sustaining the arrhythmia. This effect was not observed when Class IC/III antiarrhythmics were co-administered, suggesting that diazepam’s benefit is context-dependent. These hypothesis-generating findings warrant prospective validation, with attention to thromboembolic risk in patients who convert unexpectedly. Full article

Plasma-assisted ammonia (NH₃) decomposition is a promising strategy for hydrogen production. However, reactor geometry remains a key factor limiting its hydrogen yield per energy input (${\mathrm{Y}}_{{\mathrm{H}}_2}$). This study systematically investigates H₂ production in outer-dielectric (OD), inner-dielectric (ID), and double-dielectric (DD) coaxial DBD reactors. The results show that the ammonia decomposition performance of OD- and ID-coaxial DBDs is significantly higher than that of the DD-coaxial DBD. OD- and ID-coaxial DBDs generate abundant micro-discharge pulses, enabling effective discharge energy deposition at lower peak voltages. Consequently, the reduced electric fields E/N are maintained within the optimal kinetic window for NH₃ dissociation and H₂ production. Moreover, by balancing residence time and energy density, the 8 cm length electrode achieves a peak ${\mathrm{Y}}_{{\mathrm{H}}_2}$ of 1.22–1.24 gH₂/kWh in the OD-coaxial DBD. For the ID-coaxial DBD, a 1 mm dielectric thickness yields a maximum capacitance of 86 pF, achieving a peak ${\mathrm{Y}}_{{\mathrm{H}}_2}$ of ~1.35 gH₂/kWh at the optimum E/N. In contrast, the DD-coaxial DBD exhibits the lowest ${\mathrm{Y}}_{{\mathrm{H}}_2}$ (≤0.82 gH₂/kWh) with minimal temperature rise. This is caused by the reduced current pulse numbers and the deviation of E/N from the optimal range with elevated operating voltages. This work provides guidance for the optimization of DBD reactors in plasma-assisted NH₃ decomposition for efficient H₂ production. Full article

To achieve autonomous ultrasound scanning skill transfer across different physical equipment instances and address the limitations of traditional imitation learning methods—which struggle with cross-instance generalization due to their reliance on specific manipulator parameters—this study proposes a physical-parameter-decoupled imitation learning method based on waypoint representation. This approach utilizes a greedy algorithm to automatically extract key nodes within the task space from expert demonstration trajectories, constructing a trajectory representation decoupled from low-level kinematic parameters and base calibration errors. Simultaneously, a velocity-aware adaptive error precision adjustment mechanism is introduced to dynamically modulate waypoint extraction thresholds, simulating the speed-accuracy strategies employed by sonographers across different scanning phases. Cross-validation across two mainstream generative architectures—Action Chunking Transformer (ACT) and Diffusion Policy—on an offline dataset confirms the plug-and-play capability of waypoint representation in suppressing long-horizon error accumulation, with both architectures achieving significant reductions in prediction errors. For physical deployment, a complete ACT-waypoint system featuring low-level triple safety redundancy was validated. In kidney long-axis standard plane scanning tasks, the system achieved a 92% success rate on the source domain manipulator and maintained an 84% success rate on the target deployment manipulator, despite incompatible low-level kinematic parameters and base coordinates. Force control accuracy remained stable around the target value of 12 N. The results demonstrate that the proposed method effectively overcomes base coordinate and D-H parameter discrepancies to achieve cross-instance zero-shot skill transfer, significantly enhancing the adaptability across physical instances and the scanning success rate of imitation learning models. Full article

Background: Surgery and the perioperative management for periampullary carcinomas are translated from the more frequent ductal adenocarcinoma of the pancreatic head (hPDAC). After implementation of the pathological circumferential resection margin (CRM), true margin negativity dropped dramatically for hPDAC patients. The frequent infiltration of the mesopancreas (MP) is a causative factor for incomplete resection. It remains unknown if the oncological relevance of the MP remains exclusive for the hPDAC or if it can be translated into the operative management for periampullary carcinomas as well. Material and methods: Patients who received oncological pancreatoduodenectomies (PD) for dCCAs and ACs from 2015 to 2025 at our department were included in this study (n =100). The MP status was retrieved from the histopathological reporting. Results: MP infiltration was evident in 36.4% and 62.2% of the AC and dCCA patients respectively (p = 0.015). Across both tumour entities, mesopancreatic involvement emerged as a marker of significantly worse overall survival (AC: p = 0.002; dCCA: p = 0.013). Conclusion: Distal cholangiocarcinomas presented with a frequent infiltration into the mesopancreas. A positive infiltration status of the MP significantly correlated with incomplete resection status in ampullary carcinoma. In addition, MP infiltration proved to be an adverse prognostic factor for overall survival in periampullary carcinoma patients, underscoring its potential role in perioperative staging and its possible relevance for surgical decision-making. This is the first study revealing insights into the infiltrative prevalence of the MP in periampullary carcinomas. Mesopancreatic involvement may not be exclusive to pancreatic cancer and warrants further investigation in other periampullary malignancies. Full article

Background: Non-thyroidal illness syndrome is frequent in critically ill patients, but the prognostic value of dynamic changes in thyroid function tests remains unclear. This study evaluated whether serial measurements of thyroid-stimulating hormone (TSH) and free triiodothyronine (FT3) provide additional predictive value for 30-day mortality beyond conventional severity scores in ICU patients. Methods: This single-center retrospective observational study included 74 adult patients treated for ≥72 h in a general ICU who had TSH and FT3 measured within 24 h of admission and repeated at 48–72 h. Patients aged 18 years or above admitted to the intensive care unit were included in the study. Demographic characteristics, comorbidities, APACHE II, SOFA, modified NUTRIC (mNUTRIC) scores, and routine laboratory data (including albumin, CRP, and lactate) were recorded. The primary outcome was 30-day mortality. Between-group comparisons were performed using t-tests, Mann–Whitney U, and Chi-square tests. Variables significant in univariate analyses were entered into binary logistic regression models, and predictive performance was assessed using receiver operating characteristic (ROC) curves and the Youden index. Results: The mean age was 68.7 ± 14.7 years, and 41.9% (n = 31) of the patients died within 30 days. Non-survivors had higher APACHE II, SOFA, and mNUTRIC scores and lower albumin, lymphocyte count, and second FT3 levels compared with survivors (all p ≤ 0.003). Baseline FT3 and TSH were not associated with mortality, whereas both the subsequent FT3 measurements and the ΔT3 (variance in former to latter FT3) were remarkably predictive. The latter FT3 < 1.63 pg/mL produced an AUC of 0.835 (sensitivity: 77%, specificity: 74%), and a ΔT3 log ratio threshold of −0.09 (≈20% early FT3 decline) produced an AUC of 0.835 (sensitivity: 71%, specificity: 81%). The APACHE II + ΔT3 (numeric) model showed the best discrimination (AUC: 0.921; sensitivity: 87.1%, specificity: 81.4%), outperforming APACHE II alone (AUC: 0.861). Conclusions: In critically ill adult patients, dynamic T3 kinetics—particularly premature decline in FT3 within the first 72 h—provide incremental prognostic value for 30-day mortality beyond APACHE II. Serial FT3 monitoring may help identify high-risk patients whose endocrine adaptation to critical illness is failing. Full article