Search Results (6,670)

Background. Sepsis is a leading, time-dependent cause of in-hospital death, and guidelines now prioritize organized care such as code-sepsis protocols. Yet little is known about the long-term activity, organization and outcomes of permanent, hospital-scale programs. We characterized the activity of a hospital-wide multidisciplinary sepsis unit (MSU) over thirteen years and evaluated mortality trends. Methods. Retrospective cohort study using the registry of a hospital-wide MSU (2011–2023). The analysis unit was the sepsis event. Activity, referral pathways, interventions, follow-up and mortality were analyzed; temporal trends used multivariable logistic regression and standardized mortality ratios (SMR). Results. The unit attended 10,874 patients across 15,723 events and 50,925 consultations (median age 67; 59.3% men), referred mainly through the sepsis code (45.0%) and, increasingly, proactive early-warning detection (15.2%). An antibiotic change was recommended in 57.2% of events, and 89.8% of all suggested changes were implemented. Follow-up was sustained (median 3 visits; 61.8%). In-hospital mortality was 7.6%, and 11.8% in protocol-confirmed sepsis. Crude mortality did not fall, but severity rose (organ dysfunctions 1.67 to 2.72; septic shock 8 to 13%; both p < 0.001) with stable age; after adjustment the calendar-year effect disappeared (adjusted OR 1.00/year, p = 0.70) and the SMR stayed near 1.0, including pandemic years. Age, ICU admission (OR 2.65) and organ-dysfunction count (OR 1.37) independently predicted death. Conclusions. Over thirteen years, this hospital-wide MSU delivered large-scale, multi-channel, longitudinal care to an increasingly severe population while maintaining stable risk-adjusted mortality, supporting the long-term feasibility of a model integrating early detection, multidisciplinary decision-making, antimicrobial stewardship and follow-up. Full article

The Songnen region in northeastern China contains one of the world’s three largest area of soda saline–alkali soils. Its grasslands are experiencing severe salinization and nutrient impoverishment, which threaten regional ecological security. While nitrogen (N) and phosphorus (P) additions are widely applied to restore degraded grasslands, how the biomass stability of different dominant plant communities responds to such inputs remains unclear. Here, we compared two representative communities—one dominated by Leymus chinensis and the other by Puccinellia distans—under four treatments: control, N addition (15 g N m⁻²), P addition (15 g P₂O₅ m⁻²), and combined N + P addition. N and P additions increased species dominance in both communities, yet diversity and evenness declined in L. chinensis and increased in P. distans. Aboveground biomass peaked under N + P (increasing by 146.82% and 82.16%, respectively). Critically, biomass stability showed opposing trajectories: it rose by 27.69% in L. chinensis under N + P, but fell by 50.90% in P. distans under N alone. Mantel tests and random forest analyses linked biomass stability in L. chinensis to multiple soil enzymes, nutrients, and plant diversity, whereas P. distans biomass stability was primarily regulated by microbial nitrogen and phosphorus. Structural equation modeling further indicated that nutrient inputs in L. chinensis triggered a complex soil microbial–enzymatic cascade that positively coupled plant biomass and soil nutrients with biomass stability, while diversity exerted a negative effect. In P. distans, biomass stability was negatively driven by soil nutrients and biomass, with enzyme activity playing a mediating role. These findings reveal contrasting biomass stability-regulation mechanisms and provide a mechanistic basis for targeted restoration of saline–alkali grasslands. Full article

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly encountered in pain practice, but reported pain improvement may reflect direct antinociception, weight loss, metabolic change, or disease-specific effects. This structured narrative review examined these possibilities and relevant safety issues. Methods: PubMed/MEDLINE, Embase, and Web of Science Core Collection were searched through 15 May 2026. Peer-reviewed human studies, key mechanistic preclinical studies, systematic reviews and meta-analyses, and professional guidance relevant to pain outcomes or procedural safety were considered. Metabolic-only and non-peer-reviewed reports were excluded, and human pain-primary evidence was prioritized. Results: Preclinical data support plausible mechanisms involving spinal microglia, interleukin-10, beta-endorphin, neuroinflammation, and sensory-neuron signaling, but direct analgesic efficacy at systemic clinical doses has not been demonstrated. In STEP 9 (n = 407), mean WOMAC pain scores at 68 weeks changed from baseline by −41.7 points with semaglutide 2.4 mg and −27.5 points with a placebo; body weight changed by −13.7% and −3.2%, respectively. Liraglutide produced additional weight loss without superior knee-pain reduction. Diabetic peripheral neuropathy evidence was mainly structural or neurophysiologic; idiopathic intracranial hypertension and ROSE-010-treated irritable bowel syndrome showed disease-specific signals, whereas fibromyalgia- and opioid-related findings remained observational or hypothesis-generating. Gastrointestinal dysmotility, reduced intake, and lean-mass loss may offset functional benefits. Conclusions: GLP-1RAs are not established analgesics. Current human signals are best interpreted as indirect metabolic–functional or disease-specific effects. Future trials should use validated pain-primary outcomes, control for weight loss, and monitor treatment-related harms. Full article

Adenium obesum (Forssk.) Roem. & Schult (desert rose) is one of the most popular ornamental species cultivated in residential gardens and as a potted plant for balconies and verandas in Brazil. However, Neocosmospora keratoplastica has recently been identified as one of the causal agents of rot disease in this species. Therefore, this study evaluated the antifungal potential of Ocimum tenuiflorum L. essential oil (EO) as a preventive and curative treatment against this pathogen, while assessing its phytotoxicity and selectivity toward beneficial fungi. The EO was obtained by hydrodistillation and chemically characterized. In vitro mycelial growth inhibition assays, in vivo evaluations on A. obesum seedlings, and selectivity tests against Trichoderma asperellum were performed. In addition, in silico molecular docking analyses were conducted to investigate the interaction of the major EO constituents with fungal target proteins. Eugenol (47.04%) and 1,8-cineole (29.47%) were identified as the predominant compounds in the EO. Mycelial growth inhibition reached a maximum of 59% at 100 μL mL⁻¹, but strong phytotoxicity was evident; while a concentration of 50 μL mL⁻¹ yielded an 18% inhibition rate representing an approximately three-fold greater effect than that of thiophanate methyl (7.68%) at the recommended dose, with a slight phytotoxicity. The lowest Area Under the Disease Progress Curve (AUDPC) was recorded when the EO was applied preventively, and intermediate concentrations were selective toward T. asperellum. Molecular docking analyses indicated that eugenol and 1,8-cineole exhibited greater affinity for CYP51A than for α/β-tubulin, whereas dehydroaromadendrane and α-copaene showed the strongest interactions with these target proteins. Overall, O. tenuiflorum EO exhibits promising potential as a preventive treatment against N. keratoplastica in desert rose, while preserving beneficial fungi at moderate concentrations. Full article

This study employs the Kaya identity and Shapley value decomposition to analyse the main drivers of CO₂ emissions per capita in Australia and its states/territories from 2008–2009 to 2023–2024. This study extends the traditional three-factor Kaya model to a five-factor framework that explicitly incorporates renewable energy dynamics. Within this environment, we introduce an index for evaluating energy transition in each state over time, captured through the combined effects of renewable energy share and the fossil fuel-to-renewable ratio. The results indicate that energy intensity improvements are the dominant driver of emission reductions, contributing well over 100% of the total decline in most jurisdictions. However, this pattern does not hold universally: in the Northern Territory, energy intensity increased and contributed positively to emissions. In contrast, economic growth continues to exert upward pressure on emissions, partially offsetting these reductions and highlighting the ongoing challenge of decoupling. The Energy Transition Index (ETI) rose more than fivefold nationally (0.0018 to 0.0096), with Tasmania the highest among all states (0.185–0.291) and Western Australia and the Northern Territory the lowest. The Energy Transition Effect (ETE), defined as the natural logarithm of the ETI, follows the same regional pattern, while the Net Energy Transition Contribution (NETC) derived from the Shapley decomposition shows that the transition’s effect on emissions has been episodic rather than linear, turning negative in years when growth in fossil-fuel use outpaced renewable displacement. Marked regional variation is observed, with resource-intensive states such as Western Australia, Queensland, and the Northern Territory exhibiting distinct emissions patterns driven by mining and LNG activities, while more service-oriented states show more stable reductions. Full article

Synthetic nitrogen fertilizer underpins global cereal production, yet a substantial share of applied nitrogen escapes to the atmosphere as nitrous oxide, ammonia, and nitrogen oxides, with significant consequences for climate, air quality, ecosystems, and soil health. Despite extensive research on nitrogen losses and mitigation options, no synthesis has traced the historical intensification of cereal nitrogen use, current emission patterns, and the technological and policy responses to these losses as a single connected trajectory. This review provides that integrated synthesis. This review adopts a gloom-to-glory framing to trace nitrogen fertilizer use in cereal systems from its Green Revolution origins through current emission trends to the technological and policy responses now being deployed, treating these as a single continuous narrative rather than separate bodies of literature. Global nitrogen application in maize, wheat, and rice rose roughly tenfold between 1961 and 2010, and more than half of applied nitrogen across this period was never recovered in harvested grain. This unrecovered fraction partitions across mechanistically distinct loss pathways, i.e., nitrous oxide from soil nitrification and denitrification, ammonia from urea hydrolysis and volatilization, and indirect losses from residual soil nitrate, each carrying separate climate, air quality, and ecosystem consequences. Enhanced-efficiency fertilizers, precision nitrogen management, renewable hydrogen-based ammonia synthesis, and biologically mediated approaches such as nitrification inhibition each demonstrate mitigation potential without compromising yield, though field-scale evidence for the biological route remains limited. Regional case studies from China, India, and the European Union show that national policy has altered nitrogen use trajectories without closing the gap to demonstrated best-practice potential, for reasons specific to each jurisdiction’s regulatory design, price structure, and institutional capacity. The review concludes that the principal barriers to realising cereal production’s glory pathway are no longer primarily mechanistic but lie in measurement coverage, technology transfer to smallholder and developing-region producers, and the economic architecture needed to scale proven mitigation measures across cereal-growing regions. Full article

Ethylene–vinyl acetate (EVA) as a redispersible polymer can improve the workability, mechanical properties, and interfacial bonding of repair mortar, but the regulatory effect of different EVA dosages on underwater performance remains unclear. This study investigates EVA–polyacrylamide (PAM) composite-modified repair mortar and systematically evaluates the influence of varying EVA content on mortar performance. Multi-scale methods including setting time measurement, flowability test, flexural and compressive strength tests, underwater flexural bonding strength, water-to-air strength ratio, cement loss rate, porosity, and scanning electron microscopy (SEM) characterization were employed. The results indicate that mortar with 8% EVA exhibits the optimal overall performance. The initial setting time of the cement paste increased from 35 to 47 min, and the final setting time from 55 to 72 min, improving workability. In terms of mechanical properties, the 28-day flexural strength increased from 7.5 to 9.2 MPa, and the compressive strength from 44.4 to 50.6 MPa. Regarding underwater performance, the 28-day underwater flexural bonding strength rose from 5.1 to 6.5 MPa; the water-to-air strength ratio increased from 79.1% to 95.2%, and cement loss rate decreased from 3.18% to 0.32%; pH changes were maintained within a moderate range. Microstructural analysis shows that the total porosity at 28 d decreased from 16.8% to 13.5% for mortar containing 8% EVA, and SEM observations revealed that hydration products uniformly filled pores forming a dense network, consistent with the trends of mechanical and interfacial bonding performance enhancement. Full article

Background/Objectives: Improved preoperative prediction of nodal metastasis in prostate cancer could refine selection for extended pelvic lymph node dissection, a high-morbidity procedure. Sperm-associated antigen 1 (SPAG1) is a candidate marker of nodal status, but its incremental value beyond clinical staging and the associated transcriptional state remain unevaluated. Methods: In The Cancer Genome Atlas prostate adenocarcinoma (TCGA-PRAD) cohort (497 patients with matched clinical and RNA-sequencing data), we evaluated the association between SPAG1 expression and pathological N stage by logistic regression with 2000-resample bootstrap optimism correction and sensitivity analyses for missing nodal data and batch effects. Hallmark enrichment analysis compared SPAG1 expression extremes (quartile 4 vs. 1) and, separately, N1 versus N0 tumours adjusted for T stage, Gleason grade, and tissue source site; directional concordance was assessed. Results: N1 rates rose across SPAG1 quartiles from 7.6% to 39.0% (per-quartile odds ratio [OR], 1.83; p = 2.55 × 10⁻⁵). After adjusting for T stage and Gleason grade, SPAG1 remained an independent predictor (adjusted OR, 2.14; 95% confidence interval [CI], 1.50–3.13; p = 4.8 × 10⁻⁵), stable across both sensitivity analyses. Adding SPAG1 improved discrimination (area under the receiver-operating characteristic curve, 0.783 to 0.838; ΔAUC, 0.056; paired DeLong p = 3.03 × 10⁻⁵). The SPAG1 transcriptional programme showed cell-cycle, immune–inflammatory, and mTORC1/TGF-β signalling activation with suppressed differentiation and metabolism; all 15 overlapping Hallmark pathways were directionally concordant with the adjusted N1 signature. Conclusions: SPAG1 expression in primary prostate tumours is a candidate predictor of pathological lymph node metastasis with statistically robust incremental discrimination beyond clinical staging. Independent external validation and biopsy-based feasibility studies are required before clinical application. Full article

Chordoma is a rare notochordal malignancy of the axial skeleton, and distant cutaneous metastasis is among its rarest manifestations—an under-recognised mimic of benign and malignant skin tumours that often presents with an incomplete clinical history. Methods: We performed a systematic review and one-stage individual-participant-data (IPD) meta-analysis of all reported cases of distant cutaneous chordoma metastasis, following PRISMA 2020, and complemented it with an illustrative index case of cutaneous poorly differentiated chordoma in a young adult. Missing case-level data were handled by available-case analysis without imputation, with denominators reported throughout. Pooled prevalences were estimated by logistic-normal random-effects models (heterogeneity by I²); latency to cutaneous metastasis was modelled as a time-to-event outcome, and brachyury uptake over time by meta-regression. Results: Forty reports (52 cases) were included; individual data were analysable in 43. Median age was 59 years (range, 2 months–88), male-to-female ratio 2.3:1, sacrococcygeal primary 74% (31/42) and median latency 4.0 years (synchronous to 15). Physaliphorous cells, myxoid stroma and vacuolated cytoplasm dominated, yet brachyury and SMARCB1/INI1 were documented in only 6/52 and 1/52 cases. Pooled prevalences were 74% (95% CI 59–85) for a sacrococcygeal primary, 70% (55–82) for male sex and 77% (62–87) for physaliphorous morphology, with no between-report heterogeneity (I² = 0%)—expected when almost every report contributes one patient, so these values consolidate rather than extend the descriptive data. Patients younger than 40 years reached cutaneous metastasis far earlier (hazard ratio 17.2, 95% CI 4.7–62.9; p < 0.001), and brachyury use rose across eras (ρ = 0.43, p = 0.008). Conclusions: Distant cutaneous chordoma metastasis is a late event that usually signals disseminated disease and a limited life expectancy, commonly months to a few years. Its recognition rests on integrating morphology with nuclear brachyury and, in epithelioid or young presentations, SMARCB1/INI1. We provide a differential-diagnostic framework and algorithm, distinguishing cohort-supported findings from expert interpretation. Full article

In strong-flavor Baijiu brewing, surface spraying of recycled distillation tail liquor (TL) leads to volatile aroma loss, uneven substrate distribution and localized fermentation inhibition. A patented telescopic subsurface injector was adopted to deliver 0–30 kg TL per pit at a 50 cm depth on fermentation day 30, the critical transition point between acidogenesis and esterification. At the highest dosage (30 kg), total esters rose 14.8% (from 4.45 to 5.11 g/L), with ethyl hexanoate up 52.2% (to 1.72 g/L) and ethyl lactate up 69.8% (to 3.82 g/L). Fermentation temperature curves stayed unchanged, and grain-derived ethanol yield remained near 38.2% in all groups after correcting for the ethanol already present in the added TL. Subsurface injection of tail liquor-supplying ethanol and organic acid precursors-at the acidogenesis-to-esterification transition enhances ester synthesis without disrupting fermentation or reducing distillate yield. Acid profiles were also stable, suggesting that the added substrates were channeled into ester synthesis rather than acid accumulation. Targeted subsurface TL injection at this metabolic transition thus represents an industrially feasible strategy to boost ester biosynthesis, offering a recyclable TL valorization approach and verifying substrate-limited esterification in solid-state Baijiu fermentation. Full article

Business process reengineering (BPR) is usually remembered as one of the most visible management fashions of the 1990s. It rose rapidly, promised radical redesign and major performance gains, and later lost legitimacy as many implementations failed to match the rhetoric and became associated with disruption, downsizing, and managerial overreach. Yet the organizational problem to which BPR responded never disappeared: how should organizations redesign processes when new technologies alter what is possible? This paper revisits BPR in light of recent developments in generative and agentic artificial intelligence. This perspective article develops a conceptual interpretation rather than a systematic review or empirical test. Its purpose is to clarify an emerging pattern in management discourse and process-management research: the possible reactivation of BPR-style redesign logic under new technological and discursive conditions. Using management fashion theory as the main lens, it suggests that AI may be creating conditions under which elements of BPR’s underlying redesign logic become newly relevant. The argument is not that the BPR label has simply returned. Rather, aspects of its core ambition appear to be rearticulated through adjacent and more legitimate vocabularies such as business process management, AI-augmented business process management systems, Large Process Models, and agentic BPM. To capture this pattern, the paper introduces the concept of translated resurgence, referring to the renewed relevance of an older management idea through relabeling, reinterpretation, and mutation. The paper further argues that AI may alter the technical feasibility of radical process redesign while leaving many classic BPR risks intact. The result is best understood not as a simple revival, but as an emerging and still unsettled phase in the longer afterlife of a once-prominent management idea. Full article

Spatiotemporal differentiation and coupled driving mechanisms of urban ecological resilience in transboundary composite economic belts remain an understudied niche within human–land coupling system research. Taking 29 prefecture-level and county-level units of the Huaihe River Eco-Economic Belt from 2014 to 2023 as research samples, this study constructs an ecological resilience evaluation framework tailored to the pollution disturbance characteristics of the Huaihe River Basin under a three-dimensional theoretical framework encompassing resistance, adaptability, and recoverability. The entropy weight method is adopted to calculate comprehensive ecological resilience values, while the geographically and temporally weighted regression (GTWR) model is applied to identify spatiotemporal heterogeneous correlations among multiple influencing factors. This paper further characterizes the spatiotemporal evolutionary patterns of urban ecological resilience across the study area and unpacks the coupled associative effects of natural, economic, and social driving factors. The empirical results reveal three key findings: (1) Temporally, the overall comprehensive ecological resilience of the study region rose from 0.318 to 0.416, with a total growth rate of 30.91%. Its evolutionary trajectory follows three successive phases: rapid growth, steady improvement, and slow saturation. Adaptability, which is predominantly boosted by anthropogenic environmental governance, constitutes the primary contributor to resilience growth. The range of urban resilience values narrowed by 9.97%, indicating continuous advancement in balanced regional development. (2) Spatially, ecological resilience presents a prominent core-periphery pattern, with high-resilience zones concentrated in mountainous southwestern areas and low-resilience zones distributed across northeastern plains. All low-resilience county-level units were eliminated by 2023. (3) In terms of driving associations, topographic relief and environmental governance investment maintain persistent positive correlations with ecological resilience, while per capita GDP acts as the core economic supportive factor. The proportion of secondary industry and population density exhibit significant negative correlations with resilience. The normalized difference vegetation index (NDVI) shifts from a negative correlation to a weak positive correlation alongside progressive ecological restoration, whereas river network variables exert negligible long-term associative impacts. Collectively, the spatiotemporally heterogeneous coupling of natural endowments, industrial-economic conditions, and social governance factors shapes the evolutionary patterns of regional ecological resilience. This study fills the research gap regarding long-timescale resilience driving mechanisms for transprovincial composite river basins covering five provinces. It identifies novel human–land coupling mechanisms, including the temporal reversal of vegetation’s ecological benefits and the dual stress imposed by industrial agglomeration and dense human settlements in plain regions. The quantitative outputs of this research can provide data-based references for differentiated coordinated ecological governance across the Huaihe Ecological Economic Belt. Full article

Background/Objectives: Falls-prevention advice in primary care does not always lead to a practical next step. We evaluated a brief, non-clinical Falls Conversation package at one urban NHS general practice. Methods: During a 12-week quality improvement/service evaluation, patients aged 65 years or older were offered a baseline reflection survey, written information, a home-safety checklist and, in later Plan-Do-Study-Act (PDSA) cycles, a one-action prompt. The package did not include clinical assessment, treatment, referral or medication review. Matched pre-post outcomes were analysed, with actions and balancing outcomes recorded at four to six weeks. Results: Of 510 eligible patients, 442 were approached, 334 engaged, 295 provided matched pre-post data and 256 completed follow-up. The mean project-specific knowledge score was 1.83 (SD 1.02) before and 2.60 (SD 0.95) immediately after the package, a paired difference of 0.77 out of 4 (95% CI 0.65 to 0.88; Cohen’s d_z = 0.79; p < 0.001). Worry changed by −0.07 out of 5 (95% CI −0.13 to −0.01; d_z = −0.13), and activity avoidance by −3.4 percentage points (95% CI −7.5 to 0.7; p = 0.144). At follow-up, 157/256 participants reported at least one action (61.3%, 95% CI 55.2% to 67.1%); actions were heterogeneous and unverified. Action selection and completion rose descriptively across non-randomised PDSA cohorts. Conclusions: The package appeared feasible to embed in one practice and was associated with higher immediate knowledge scores and patient-reported action. It did not demonstrate reduced falls or clinically meaningful change in fear-related outcomes. Controlled studies using validated measures, objective outcomes and longer follow-up are required. Full article

Background: This study investigates the psychophysiological stress profiles of professional basketball players by simultaneously analyzing two distinct neuroendocrine pathways: the sympathetic–adrenal–medullary (SAM) system, via salivary alpha-amylase (AA), and the hypothalamic–pituitary–adrenal (HPA) axis, via salivary cortisol (C). While competitive environments are known to elicit significant stress, the interaction between game-specific variables—such as playing time (PT) and tactical position—and those biomarkers remains insufficiently explored in real-time, official match settings. Methods: Twelve professional male basketball players were monitored across four official matches. Salivary samples were collected, and stress biomarkers (AA and C) were analyzed at three timepoints: pre-match, half-time, and post-match. Results: Results indicate that stress responses are non-uniform and highly context-dependent. A significant spike in AA was observed during the first match (p < 0.001; ES = 0.82; 95% CI −0.01–1.66), where concentrations rose from a pre-match mean of 247.9 ± 232.59 U/mL to a post-match peak of 674.39 ± 693.33 U/mL. Cortisol responses did not vary significantly across matches but exhibited a strong positive correlation with PT (p = 0.01; R = 0.76), identifying that C may serve as a primary marker of individual physical workload. Positional analysis revealed significant divergence in HPA activation; guards (0.55 ± 0.31 µg/dL) and centers (0.51 ± 0.22 µg/dL) exhibited higher cortisol levels compared to forwards (0.24 ± 0.18 µg/dL), reflecting the high cognitive/decision-making load of guards and the mechanical/physical contact load of centers. Conclusions: The observed differences in AA and C liberation suggest that stress responses during matches are influenced by a complex interaction of physiological and psychological stimuli characteristic of competitive basketball. Consequently, these findings indicate the importance and value of a dual-biomarker approach which might provide a framework for optimized training load management and recovery protocols in elite basketball. Full article

Background/Objectives: The kinetics of blood volume and hemoglobin mass (Hbmass) adaptation in newcomers to moderate altitude and the time required to reach the hematological phenotype of long-term residents remain poorly defined. We aimed to characterize this trajectory over six months and to compare newcomers with established altitude residents. Methods: Thirty-seven healthy male sea-level newcomers were prospectively followed at baseline (within 48 h of arrival), two months, and six months after relocation to Abha, Saudi Arabia (2250 m). Hbmass, blood volume (BV), plasma volume (PV), and red blood cell volume (RBCV) were measured by CO rebreathing; lean body mass (LBM) was assessed by DXA. Six-month values were compared with 107 long-term male altitude residents. Linear mixed-effects models with Holm–Bonferroni correction were used. Results: Adaptation followed a biphasic trajectory. At two months, RBCV and Hbmass rose significantly from baseline (RBCV + 186 mL, Hbmass + 65 g; both p ≤ 0.005), confirmed by LBM-adjusted analysis. These gains partially regressed by six months, after which no volume parameter differed significantly from baseline. Hemoglobin (Hb) and hematocrit (Hct) remained persistently elevated (+6 g/L, +1.9%; both p < 0.001) due to sustained PV contraction. Compared with long-term residents, six-month newcomers had significantly lower LBM-adjusted Hbmass (15.7 vs. 18.0 g/kg), RBCV (48.0 vs. 54.2 mL/kg), and BV (98.9 vs. 109.8 mL/kg; all p < 0.001), yet Hb and Hct were not significantly different. Conclusions: Moderate altitude acclimatization follows a transient two-month erythropoietic increase, then partial regression. Six months is insufficient to attain the oxygen-carrying capacity of long-term residents’ deficit entirely masked by Hb and Hct. Direct Hbmass measurement normalized to LBM is required for accurate assessment of altitude adaptation. Full article