Search Results (2,370)

Background: Since 2014, all Australian jurisdictions have progressively amended legislation to authorise pharmacists to administer vaccines, evolving from restricted pilots to an essential public health pillar. Objective: This review analyses the longitudinal evolution of pharmacist-administered vaccinations (PAVs), documenting changes in authorised vaccines, age eligibility, and regulatory frameworks across all Australian jurisdictions. Methods: A retrospective review of Australian jurisdictional legislation, regulations, and policy documents was undertaken. Searches included official legislative registers, Government Gazettes, Health Department protocols, and professional guidance published by Pharmaceutical Society of Australia (PSA) and The Pharmacy Guild of Australia between 2014 to 2026. Documents were independently reviewed by five authors, followed by secondary verification and consensus-based adjudication to resolve discrepancies and confirm findings. Results: PAVs scope was expanded from a single influenza pilot in 2014 to include over 21 vaccine-preventable diseases by 2026. The COVID-19 pandemic catalysed rapid reform, leading to the standardisation of age eligibility (largely ≥5 years). A landmark milestone occurred in 2025 when South Australia enabled pharmacists to administer any vaccine within their professional scope. Conclusion: Legislative reforms have significantly enhanced vaccine accessibility. However, jurisdictional fragmentation persists. National harmonisation, using a competency-based model similar to South Australia, is recommended to streamline delivery and optimise public health outcomes. Full article

Aspartame is a widely used artificial sweetener, but its possible relationship with rheumatoid arthritis (RA) remains insufficiently understood. This study aimed to explore, rather than prove, potential molecular links between aspartame-related targets and RA-associated gene networks. Three public RA transcriptomic datasets (GSE55235, GSE55457, and GSE77298) from the Gene Expression Omnibus (GEO) database were integrated as discovery/training data. Because these datasets included different tissue origins, batch correction was used to reduce dataset-level technical variation, whereas tissue-origin-related biological variation was not assumed to be fully removable. After differential expression analysis, RA-associated differentially expressed genes (DEGs) were identified. The single-cell dataset GSE200815 was used for cell annotation and cellular expression visualization; because its comparator group consists of psoriatic arthritis (PsA) samples rather than healthy controls, single-cell results were interpreted as RA-vs-PsA observations and were not treated as disease-versus-healthy-control evidence. Potential targets of aspartame were retrieved from ChEMBL, SwissTargetPrediction, and the Similarity Ensemble Approach (SEA), and were intersected with RA-related DEGs to construct an aspartame-gene-RA regulatory network. Diagnostic models were developed using 113 machine-learning algorithm combinations to determine an optimal multigene model and its core genes. HLA-DRB1 was selected for exploratory scTenifoldKnk-based virtual knockout mainly because it was included in the optimal model and has a well-established role in RA immunogenetics; the single-cell analysis was used only to describe cellular distribution in the RA/PsA dataset. Molecular docking was then used to evaluate the possible interaction between aspartame and HLA-DRB1. Forty-four intersected genes linked the predicted aspartame targets with RA DEGs. The random forest plus partial least-squares generalized linear model (RF + plsRglm) identified 16 core genes. Network-level interpretation indicated that these genes were distributed across immune/antigen-processing, inflammatory-signaling, protease/extracellular-matrix-remodeling, adhesion, metabolic, and proliferation-related modules; therefore, HLA-DRB1 was treated as a prioritized immune-module candidate rather than as the sole driver of the network. Following virtual knockout of HLA-DRB1, affected genes were enriched in extracellular matrix organization, extracellular structure organization, extracellular matrix, collagen trimer, extracellular matrix structural constituent, and collagen binding. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways included integrin signaling, focal adhesion, proteoglycans in cancer, cytoskeleton in muscle, and phosphoinositide 3-kinase/protein kinase B (PI3K/AKT) signaling. Molecular docking showed a minimum binding energy of −6.7 kcal/mol, which was more negative than the preset stability criterion of −5.0 kcal/mol, and the docking pose suggested contacts around ARG-146. This integrative analysis suggests a hypothesis-generating association between aspartame-related predicted targets and RA-relevant molecular networks involving HLA-DRB1 and other core genes. The findings do not establish causality and require experimental, epidemiological, biophysical, and tissue-stratified validation before any causal or clinical inference can be made. Full article

Dietary factors, including the consumption of isoflavones-rich foods of plant origin, may contribute to the reduced incidence of prostate cancer. Isoflavones, natural phytoestrogens often found in legumes, can modulate estrogen and androgen receptor signaling. This study aimed to evaluate the biological potential of isoflavone-rich extracts obtained from twelve species from the Fabaceae family, targeting prostate cancer cell viability, proliferation, inflammatory markers, prostate-specific antigen secretion, and 5α-reductase activity. The tested extracts showed moderate cytotoxic activity against prostate cancer cell lines, apart from highly susceptible PC3 cells, and only weak toxicity to normal prostate epithelial cells. Significant antiproliferative activity was observed, especially for Cytisus scoparius, Ononis arvensis, and Genista tinctoria, while most extracts reduced prostate-specific antigen (PSA) secretion in normal prostate cells. Furthermore, the extracts showed anti-inflammatory properties by reducing the pro-inflammatory cytokine interleukin 6 (IL-6) and improving cytokine balance indices. Multivariate analyses revealed correlations between total isoflavone content and antiproliferative activity. Full article

Background: Cardiovascular (CV) risk is increased in psoriatic arthritis (PsA), yet vascular assessment has largely focused on carotid arteries, potentially underestimating systemic atherosclerosis. Objective: The objective of this study was to characterize the distribution and concordance of atherosclerotic plaques across carotid, femoral, and aortic territories in PsA and evaluate their incremental value over SCORE2. Methods: In this cross-sectional study, 250 unselected patients with PsA underwent carotid and femoral ultrasound and abdominal X-ray. Plaque prevalence and multiterritorial involvement (≥2 vascular beds) were assessed. Agreement between territories was evaluated using Cohen’s κ. In patients aged 50–69 years, the incremental value of vascular territories over SCORE2 was evaluated using ROC curves, bootstrap-corrected decision curve analysis (DCA), and reclassification metrics (IDI and continuous NRI). Results: Plaques were detected in carotid (36.0%), femoral (62.8%), and aortic (31.6%) territories, with multiterritorial involvement in 43.2%. Agreement between vascular beds was moderate (κ ≈ 0.35). Notably, 48.1% of patients without carotid plaques had femoral involvement. SCORE2 categories showed a strong gradient with plaque prevalence (p < 0.0001). In patients aged 50–69 years, adding vascular imaging improved discrimination for multiterritorial disease (AUC 0.73 vs. 0.86–0.90). Reclassification analyses demonstrated that carotid plaque substantially improved the identification of multiterritorial atherosclerosis (IDI 0.32, 95% CI 0.18–0.50; continuous NRI 1.33, 95% CI 1.08–1.60), with similar results observed for aortic plaque (IDI 0.33, 95% CI 0.20–0.50; continuous NRI 1.24, 95% CI 0.99–1.48). Femoral plaque provided a more modest improvement (IDI 0.26, 95% CI 0.16–0.37; continuous NRI 1.11, 95% CI 0.80–1.33). Conversely, when the outcome was defined as the presence of any plaque, femoral plaque provided the greatest incremental value over SCORE2 (AUC 0.96, 95% CI 0.93–0.99). Bootstrap-corrected DCA confirmed improved net benefit. Conclusions: The incremental value of vascular imaging over SCORE2 appears to be phenotype-dependent. Femoral plaque provided the greatest improvement for detecting the presence of subclinical atherosclerosis, whereas carotid and aortic plaques offered greater incremental value for identifying multiterritorial vascular involvement. These findings support a tailored, multiterritorial approach to cardiovascular risk assessment in patients with PsA. Full article

Background and Objectives: Metastatic castration-resistant prostate cancer (mCRPC) remains a clinically heterogeneous condition despite ongoing advances in systemic treatment. Androgen receptor pathway inhibitors (ARPIs), including abiraterone acetate and enzalutamide, have been associated with improved clinical outcomes; however, early identification of patients deriving limited benefit continues to be challenging. Prostate-specific antigen (PSA) kinetics may serve as a practical indicator of treatment response over time. This study aimed to examine the prognostic significance of achieving a ≥50% reduction in PSA levels at three months in patients with mCRPC treated with ARPIs in routine clinical practice. Materials and Methods: In this retrospective single-center study, patients with mCRPC who received abiraterone acetate or enzalutamide between February 2015 and March 2024 were included. Patients were stratified according to PSA decline at three months (≥50% vs. <50%). Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared with the log-rank test. Prognostic variables were subsequently examined using univariate and multivariate Cox proportional hazards models. Results: A total of 60 patients were included. At three months, 44 patients (73.3%) achieved a ≥50% decline in PSA levels. Patients reaching this level had longer PFS and OS than those with <50% decline, and the differences between groups were statistically significant. In multivariate analysis, early PSA decline remained significantly associated with improved survival outcomes. Conclusions: A ≥50% decline in PSA levels at three months represents a simple and clinically meaningful indicator of treatment response in patients with mCRPC receiving ARPIs. Early PSA kinetics may assist in timely risk stratification and closer clinical monitoring in routine clinical practice. Full article

Background/Objectives: Lymph node metastasis within the prostatic anterior fat pad (PAFP) is uncommon but may refine nodal staging when pelvic lymph node dissection and PSMA PET/CT are negative. Case Presentation: A 58-year-old man with PSA 59 ng/mL, negative digital rectal examination, and a PI-RADS 5 anterior lesion underwent transperineal MRI/US fusion biopsy, showing an acinar adenocarcinoma (Gleason score 5 + 5 = 10, ISUP grade group 5) confined to anterior cores. 18F-PSMA-1007 PET/CT showed intense intraprostatic uptake (SUVmax 55.2) without nodal or distant disease. Retropubic radical prostatectomy, bilateral extended pelvic lymph node dissection (ePLND), and separate PAFP submission were performed. Final pathology showed a 38 mm bilateral anterior tumor involving 35% of the prostate, focal anterior extraprostatic extension, negative margins, absent seminal vesicle and bladder neck invasion, perineural and lymphovascular invasion, and no cribriform or intraductal carcinoma. All 15 pelvic nodes were negative. One of two PAFP nodes contained a 3 mm PSA-positive metastasis without extranodal extension, resulting in pT3aN1 staging. Postoperative PSA persistence prompted radiotherapy plus androgen deprivation therapy; PSA was 0.01 ng/mL at 6 months. Conclusions: In very-high-risk anterior prostate cancer, separate PAFP evaluation may provide clinically relevant staging information when PSMA PET/CT and pelvic lymph nodes are negative. This case highlights the PAFP as a potential site of occult regional nodal disease. Full article

Prostate cancer (PCa) is the most prevalent cause of cancer-related deaths worldwide. This review aims to synthesize the contemporary literature (2018–2026) on various diagnostic approaches of PCa for clinicians. Currently, the standard approach to PCa diagnosis includes (1) prostate-specific antigen (PSA) testing, (2) its derivatives, and (3) digital rectal examination (DRE). This approach is readily available and cost-effective but lacks specificity, thus resulting in a high incidence of overdiagnosis and overtreatment of PCa patients. This review aims to compare the traditional approaches with the newly developed approaches to PCa diagnosis and investigate their suitability for research purposes, including urine-based markers, liquid biopsy, and histopathology. Each of these approaches has advantages and disadvantages. Advanced imaging techniques like multiparametric magnetic resonance imaging (mpMRI) are helpful in the localization of PCa and can prevent unnecessary biopsies. Histopathology remains the gold standard in the confirmation of PCa diagnosis. Newly developed blood-based markers and advanced imaging techniques are more sensitive and specific in the diagnosis of PCa and are likely to result in a better clinical outcome than the traditional approaches. However, the cost of these approaches remains a global challenge in developing and developed countries alike. PCa diagnosis tools and strategies are presented in a clinical and cost-effective manner and are integrated in a tiered approach with the aim of controlling and managing PCa and its diagnosis. Full article

Objective: This study aims to explore new hematological indicators with differential diagnostic significance for clinically significant prostate cancer (csPCa) by conducting comprehensive hematological tests, and to construct a novel discrimination index (DI) (csPCa-DI) to improve the diagnostic accuracy of csPCa. Methods: A total of 542 patients suspected of prostate cancer who were admitted to Beijing Tsinghua Changgung Hospital from November 2014 to May 2025 were enrolled in this study. All patients underwent complete blood count, coagulation testing, full biochemical analysis, and prostate biopsy. According to the biopsy results, patients were divided into the csPCa group and the non-csPCa group. The differences in hematological indicators between the two groups were compared, and multivariate logistic regression analysis was used to screen independent risk factors for csPCa. Two scoring systems (Fib-PLT Score and Fib-PLT-DD Score) were constructed based on coagulation-related parameters, and a csPCa discrimination index (csPCa-DI) was further established by integrating independent risk factors. The diagnostic efficacy of these scores, csPCa-DI, and traditional PSA-related indicators was evaluated by receiver operating characteristic (ROC) curves. Stratified validation was performed in the PSA gray zone (4–10 ng/mL) population. Results: Multivariate logistic regression identified prostate-specific antigen density (PSAD) (OR = 18.063, 95% CI: 7.125–45.792, p < 0.001), age (OR = 1.062, 95% CI: 1.024–1.102, p = 0.001), and Fib-PLT-DD Score (OR = 0.388, 95% CI: 0.251–0.599, p < 0.001) as independent predictors of csPCa. Based on the regression coefficient (β) weights of the independent predictors, the csPCa-DI was formulated as: csPCa-DI = 2.894 × PSAD + 0.060 × Age − 0.946 × Fib-PLT-DD Score (Fib-PLT-DD Score = 0.672 × Fib + 0.008 × PLT − 0.028 × DD). In the overall cohort, the area under the ROC curve (AUC) of csPCa-DI for diagnosing csPCa was 0.821 (95% CI: 0.773–0.868, p < 0.001), higher than that of total PSA (0.701) and f/t PSA ratio (0.727), and slightly higher than PSAD (0.797). The optimal cut-off value of csPCa-DI in the overall cohort was 1.46 points, with a sensitivity of 87.4% and specificity of 61.8%. In the PSA gray zone population, csPCa-DI exhibited superior diagnostic efficacy with an AUC of 0.736 (95% CI: 0.634–0.838, p < 0.001), significantly higher than total PSA (0.465) and f/t PSA ratio (0.638), and slightly higher than PSAD (0.720). A csPCa-DI cut-off value of 0.92 points in the PSA gray zone achieved a high sensitivity of 96.0% (specificity = 48.0%), effectively reducing missed diagnosis, while the cut-off of 1.46 points balanced sensitivity (68.0%) and specificity (70.7%). Conclusions: The novel csPCa-DI constructed by integrating PSAD, age, and coagulation-derived Fib-PLT-DD Score based on β weights has higher diagnostic efficacy for csPCa than traditional single PSA-related parameters, especially in the PSA gray zone, which can provide a new clinical tool for the screening and differential diagnosis of csPCa. This study also clarifies the correlation between local coagulation abnormalities and csPCa, providing a new perspective for understanding the pathological mechanism of csPCa. Full article

Prostate disease diagnostics increasingly integrate PSA-derived parameters, molecular assays, risk calculators, and multiparametric MRI, yet important limitations remain in distinguishing benign inflammatory changes from clinically significant prostate cancer and in capturing biological heterogeneity. This narrative review summarizes current evidence on inflammatory and epigenetic biomarkers in prostate disease, focusing on YKL-40, mannose-binding lectin, and global DNA methylation/hydroxymethylation. The reviewed evidence indicates that chronic inflammation, innate immune variability, tumor microenvironment remodeling, and epigenetic dysregulation contribute to prostate disease progression and may provide biological information not fully reflected by conventional diagnostic tools. YKL-40 may reflect inflammatory stromal remodeling and angiogenic activity, mannose-binding lectin may represent innate immune variability, while DNA methylation and hydroxymethylation may indicate systemic molecular adaptation and long-term inflammatory imprinting. However, these biomarkers remain largely investigational and should currently be considered adjunctive biological layers rather than validated standalone diagnostic tools. Future studies should prioritize analytical standardization, prospective prostate-specific validation, and assessment of incremental clinical utility beyond PSA, molecular assays, and mpMRI within clearly defined contexts of use. Full article

Background/Objectives: We aimed to evaluate temporal changes in patient selection, surgical practice, and postoperative outcomes of radical prostatectomy in Switzerland (2020–2025) using a national registry. Methods: Data from 7687 patients undergoing radical prostatectomy were extracted from a prospective national registry (January 2020–March 2025). Preoperative, operative, and postoperative variables were compared descriptively using the Mann–Whitney U test for continuous variables and the chi-square test for categorical variables. Temporal trends were assessed using locally estimated scatterplot smoothing. Multivariable logistic regression analyses were performed for positive surgical margins and PSA persistence. Results: Baseline patient characteristics remained stable over time. The use of MRI-targeted biopsy increased from 46% to 84% (p < 0.001). The proportion of low-risk diseases being treated decreased from 7.1% to 4.0% (p = 0.040). Minimally invasive surgery increased from 81% to 95% (p < 0.001); pelvic lymph node dissection declined from 83% to 63% (p < 0.001). Operative time (205 vs. 185 min, p = 0.002) and blood loss (300 vs. 200 mL, p < 0.001) decreased over time. Lymph node invasion decreased from 11% to 6.0% (p = 0.001), positive surgical margins from 27% to 22% (p = 0.044), and prostate-specific antigen persistence from 18.5% to 11.3% (p = 0.001). Severe postoperative complications decreased from 2.5% to 0.8% (p = 0.014). After multivariable adjustment, surgery performed in 2024 remained independently associated with lower rates of positive surgical margins (OR 0.73, 95% CI 0.57–0.93) and PSA persistence (OR 0.26, 95% CI 0.19–0.37) compared with 2020. Conclusions: Using the Swiss national registry, we demonstrate that radical prostatectomy has evolved toward more risk-adapted patient selection, near-universal minimally invasive surgery, and more selective pelvic lymph node dissection. Despite a shift away from low-risk disease, perioperative and early oncological outcomes improved, likely reflecting a combination of evolving diagnostic pathways, increasing surgical experience, and broader changes in perioperative management. Full article

Vertebral compression fractures (VCFs) are one of the most common spinal disorders encountered clinically. Untimely diagnosis or inaccurate classification often leads to prolonged pain and functional impairment in patients. To enhance diagnostic accuracy and efficiency, this study addressed the high cost and limited applicability of computed tomography (CT) and magnetic resonance imaging (MRI) examinations by leveraging the universality and convenience of X-ray imaging. We proposed a multi-stage deep learning-based method for identifying vertebral compression fractures. The method first employs Discrete Wavelet Transform-YOLOv5 (DWT-YOLOv5) for preliminary vertebral region localization, followed by Polarized Self-Attention-UNet (PSA-UNet) for precise segmentation. Finally, a ResNet50 network incorporating a Convolutional Block Attention Module (CBAM) performs graded classification, categorizing vertebrae into four types: Non-fracture, Mild fracture, Moderate fracture, and Severe fracture. The experimental results demonstrate that the proposed method achieved average accuracy, precision, recall, specificity, and F1-score of 83.7%, 88.1%, 86.2%, 97.7%, and 87.2%, respectively. The proposed method fully leverages the cost-effectiveness and convenience of X-ray imaging, providing clinicians with an efficient and economical auxiliary diagnostic tool. It enables rapid and accurate identification of vertebral compression fractures in emergency and initial screening scenarios. Full article

Introduction: Lymph nodes (LN) in the anterior periprostatic fat (APPF) may harbour metastatic disease in patients with Prostate Cancer (PCa). We investigated the incidence and significance of LN in APPF tissue removed during robotic and laparoscopic radical prostatectomy (RP). Patients and Methods: We retrospectively analysed RP performed by a single surgeon from 2013 to 2023. A total of 670 patients underwent RP, with 407 procedures conducted laparoscopically and 263 robotically. Histological results were available for 509 patients, who were examined for the presence of LN and any evidence of metastatic involvement. Results: LN were detected in the periprostatic fat of eighty patients; however, only twelve had lymph node metastasis. Seven of the twelve patients presented with prostate-specific antigen (PSA) levels greater than 10 ng/mL. All LN-positive patients had a Gleason score of seven or higher. On MRI, all patients had a PIRADS score of four or higher, and eleven were staged at T3 or higher. Additionally, all twelve patients had a Briganti score exceeding twenty. Conclusions: Our series indicates that the APPF contains LN that can harbour metastatic disease. Patients can have LN involved in APPF without the involvement of pelvic LN. Therefore, our study suggests that routine excision of APPF should be considered for appropriate LN staging and to avoid missing any metastasis, and that scoring systems like Briganti should be used to help identify this high-risk group. Full article

Background/Objectives: Prostate cancer (PCa) detection via a conventional systematic biopsy (SB) may miss cancer lesions, promoting the exploration of alternative methods. Multiparametric MRI demonstrates high sensitivity and specificity for the detection of clinically significant prostate cancer and an MRI-directed three-dimensional fusion biopsy (MFB) strategy may improve cancer detection rates. There are limited data available in Taiwan regarding this novel technique. This study aimed to compare the accuracy of cancer detection rates between MFB and SB. Methods: From January, 2021 through October, 2023, patients with PSA levels of 4–20 ng/mL and no palpable prostate nodules were retrospectively reviewed. They were categorized into the MFB and SB groups. Clinical parameters and PCa detection rates were compared between the two groups. Multivariable logistic regression analyses were performed to identify independent predictors of cancer detection. A separate subgroup analysis was conducted within the MFB cohort to evaluate the association between the PI-RADS category and biopsy outcomes. Results: A total of 262 patients (89 in MFB and 173 in SB) were included in the final analysis. MFB demonstrated significantly a higher detection rate in detecting PCa compared to SB (45.0% vs. 31.8%, p = 0.036). Furthermore, MFB exhibited superior rates in detecting clinically significant PCa (csPCa) and high-grade PCa compared to SB (40.4% vs. 22.5%, p = 0.002; 20.2% vs. 5.8%, p ≤ 0.001, respectively). The MRI PIRADS score exhibited a positive correlation with the detection of PCa, csPCa, and high-grade PCa (p ≤ 0.001, p ≤ 0.001, and p = 0.015, respectively). After an adjustment for age, PSA level, and PSAD, MFB remained independently associated with overall PCa detection (adjusted OR 2.01, 95% CI 1.16–3.48, p = 0.013), csPCa detection (adjusted OR 2.83, 95% CI 1.58–5.08, p < 0.001), and high-grade PCa detection (adjusted OR 6.15, 95% CI 2.49–15.19, p < 0.001). PSAD was also independently associated with all cancer outcomes. Within the MFB cohort, PI-RADS 5 lesions demonstrated significantly higher odds of overall PCa (adjusted OR 7.38, 95% CI 2.18–24.98, p = 0.001), csPCa (adjusted OR 8.42, 95% CI 2.49–28.49, p < 0.001), and high-grade PCa detection (adjusted OR 6.93, 95% CI 1.82–26.41, p = 0.005) compared with PI-RADS 3 lesions. Conclusions: In this retrospective cohort, the MFB strategy was associated with higher detection rates of PCa, csPCa, and high-grade PCa compared with conventional SB. PSAD and MRI findings independently contributed to cancer prediction, supporting the integration of clinical and imaging parameters in prostate biopsy decision-making. These findings support the clinical value of MRI-directed biopsy strategies but should be interpreted cautiously because of the non-randomized allocation and the differences in biopsy route and sampling strategy. Full article

Background: Robot-assisted radical prostatectomy (RARP) is the predominant surgical approach for localized prostate cancer in high-volume centers worldwide. However, comprehensive real-world data describing complete institutional transition from open to robotic surgery remain limited. This study evaluated perioperative and early oncological outcomes of a contemporary RARP cohort and characterized the transition from open radical prostatectomy (ORP) to RARP in a European center. Methods: We analyzed 520 consecutive patients who underwent RARP between January 2023 and December 2025. Perioperative, pathological, and biochemical outcomes were assessed. Biochemical recurrence was defined as prostate-specific antigen ≥0.2 ng/mL. Institutional data from 2011 to 2025 were reviewed to evaluate procedural trends and the transition from ORP to RARP. Surgeon-specific and institutional learning curves were analyzed using operative time and linear regression models. Results: Following the introduction of robotic surgery in 2018, annual RARP volume increased from 37 procedures to 205 in 2025. Since 2023, RARP accounted for more than 99% of all radical prostatectomies. Median operative time decreased from 185 min in 2023 to 165 min in 2025, with consistent downward trends observed across all surgeons. Linear regression confirmed progressive improvement in operative efficiency, with learning rates ranging from −0.22 to −0.92 min per case. Estimated blood loss was minimal, no patients required transfusion, and major complications occurred in four patients (0.8%). Hospital stay decreased from 2 days to predominantly 1 day. During follow-up, 36 patients developed biochemical recurrence or PSA persistence. Biochemical recurrence-free survival differed significantly according to pathological stage (log-rank p < 0.001), with 24-month estimates of 93.7%, 91.5%, and 82.1% for pT2, pT3a, and pT3b disease, respectively. Conclusions: RARP provides favorable perioperative safety, minimal morbidity, and favorable early oncological outcomes in a high-volume setting. The complete institutional transition from ORP to RARP, together with demonstrated surgeon-specific and institutional learning effects, supports the feasibility and safety of implementing RARP as the institutional standard within a structured robotic program. Full article

To address the poor detection performance in low-light underground coal mine belt conveyors caused by information entropy degradation and high background noise, as well as the difficulty in multi-scale target extraction due to uneven entropy distribution, this paper proposes an efficient foreign object detection model named SIRI-YOLO based on an improved YOLOv11n architecture. First, a Self-Calibrating Illumination Network (SCINet) is introduced to restore image information entropy and enhance low-light adaptability. Second, the C2PSA module is enhanced to C2PSA-IRMB by incorporating an Inverted Residual Mobile Block (IRMB), improving multi-scale feature utilization and reducing ineffective entropy increase. Third, an improved Reparameterized Generalized Feature Pyramid Network (RepGFPN) is adopted to strengthen the fusion of high-level semantics and low-level spatial features, reducing information entropy loss during feature pyramid transfer. Finally, the Inner-MPDIoU loss function is introduced to replace CIoU, achieving more accurate entropy minimization from a KL divergence perspective. Experimental results on a dataset containing large coal chunks and anchor rods show that SIRI-YOLO achieves 92.8% mAP@50, 59.4% mAP@50:95, 89.5% precision, and 87.2% recall, with only 2.92M parameters and 70.01 FPS, outperforming mainstream YOLO models. Furthermore, on the public ExDark low-light dataset, SIRI-YOLO improves mAP@50 by 4.2% over YOLOv11n, demonstrating strong generalization across different low-light and complex scenarios. The proposed method effectively handles uneven illumination, scale variation, and complex backgrounds, offering a practical solution for coal mine safety through system entropy reduction. Full article