Search Results (461)

Background: Systemic inflammation contributes to the pathobiology of multiple sclerosis (MS), yet serum biomarker data from Middle Eastern populations remain limited. This study evaluated serum levels of IL-6, IL-16, IL-18, and IL-36 in Saudi adults with MS compared with matched healthy controls and examined associations with disease duration, phenotype, treatment, and disability. Methods: This single-center, cross-sectional, matched case–control study enrolled 26 MS patients and 26 age- and sex-matched controls. Serum cytokines were measured by ELISA. Disability was assessed using EDSS and the Timed 25-Foot Walk (T25FW). Matched comparisons used Wilcoxon signed-rank tests; subgroup comparisons used Wilcoxon rank-sum or Kruskal–Wallis tests; associations used Spearman’s correlation. Results: No correction for multiple comparisons was applied given the exploratory design. All four interleukins were higher in MS patients than in controls (p < 0.001). Age correlated with EDSS (r = 0.573, p = 0.002) and T25FW (r = 0.464, p = 0.014). Only IL-6 showed a notable correlation with disability, with T25FW (r = 0.53, p = 0.008) and, weaker, EDSS (r = 0.38, p = 0.052); IL-18 showed a weak, non-significant correlation with T25FW (r = 0.35, p = 0.126); IL-16 and IL-36 showed no relevant associations. IL-16 was higher in newly diagnosed than in long-standing cases (p = 0.012); no differences by phenotype or treatment were observed for any marker. Conclusions: Serum IL-6, IL-16, IL-18, and IL-36 were elevated in Saudi MS patients versus controls. IL-6 alone showed a modest, unadjusted association with disability, supporting its evaluation as a candidate biomarker in larger, longitudinal, covariate-adjusted cohorts. These findings are hypothesis-generating and should not be interpreted as evidence of independent or clinically actionable biomarker utility. Full article

Markerless video-based motion capture is a fast-developing, low-burden and versatile alternative to marker-based stereophotogrammetry, yet independent validation evidence for several commercial solutions is still scarce. This study validates the markerless software CapturyStudio (The Captury GmbH, Saarbrücken, Germany) for the reconstruction of upper- and lower-limb joint kinematics, comparing it with a validated Xsens (Movella, Henderson, NV, USA) inertial measurement unit system. Ten healthy subjects (five females and five males) performed two standardized clinical tasks, a Reach-To-Grasp gesture for the upper limb and a Timed-Up and Go test for the lower limb, recorded simultaneously with eight BTS SMART EVO-DX 2 (BTS Bioengineering S.p.A., Garbagnate Milanese, Italy) cameras operating in markerless mode and a 17-sensor Xsens system. Elbow, shoulder, knee and hip flexion–extension angles were reconstructed from three-dimensional anatomical keypoints provided by CapturyStudio and compared with the Xsens angles through root mean square error in absolute and percentage terms, range-of-motion accuracy, intraclass correlation coefficient (ICC), Spearman’s coefficient (ρ), Bland–Altman analysis and non-parametric Wilcoxon Rank-Sum tests. CapturyStudio reproduced the temporal pattern of all four angles faithfully (ICC ≥ 0.87; ρ ≥ 0.89), with median discrepancies of about 12° for the elbow and below 8° for shoulder, knee and hip and with the best agreement for the upper limb; the main weakness was a systematic overestimation of hip range of motion. Since both systems are indirect measurement techniques, these values represent the discrepancy between two methods and an upper bound on the error of the markerless system rather than its absolute accuracy. Their magnitude is comparable to the changes regarded as clinically meaningful in goniometric assessment, so the system is presently suited to the analysis of movement patterns rather than to the measurement of absolute joint angles. The study is to be read as a technical comparison of two measurement systems, delimiting the conditions under which future clinical, rehabilitation and sports applications may be pursued. Full article

Background/Objectives: Medical liability litigation in Romania has risen steadily over the past decade, yet the quantification of moral (non-pecuniary) damages remains entirely at the discretion of each judge, with no standardized reference. This raises concerns about consistency and predictability, with direct implications for healthcare professionals, who are increasingly exposed to this form of liability—a potential source of occupational stress—and to financial awards they cannot anticipate. The present pilot study analyzed Romanian court practice regarding the amount of moral damages awarded in cases of medical negligence resulting in the patient’s death. Methods: In a retrospective observational study, we examined ten final rulings (2018–2024; rejust.ro) convicting medical personnel for involuntary manslaughter (27 civil parties awarded). We computed the Claim-to-Award Ratio (CTAR), Claim Reduction Rate (CRR), Appeal Adjustment Rate (AAR), and Appeal Ratio (AR), Spearman correlation, the Wilcoxon signed-rank test, and linear regression. Results: Courts awarded on average only 18% of the amounts claimed (CRR 82%); claimed and awarded sums were correlated (ρ = 0.84, 95% CI 0.34–0.97, p = 0.0025; R² = 0.59). Appellate adjustments varied widely (AAR −84% to +79%; AR 0.16–1.79), with no systematic difference between instances (Wilcoxon p = 0.463; R² = 0.01). Comparable cases yielded substantially different awards. Conclusions: Moral damages in fatal malpractice show no recognizable pattern of quantification. This structural unpredictability leaves physicians without a reliable benchmark for their financial risk and may amplify the occupational stress and impaired well-being already linked to litigation, supporting the need for guiding reference standards. Full article

Background: Gender disparities have been reported in Emergency Medicine (EM) residency milestone attainment, with some studies showing male residents achieving higher competency-based ratings than female residents despite similar clinical exposure. Prior research suggests subjective faculty evaluation and implicit bias may contribute to these differences. The influence of resident self-assignment of patients on milestone attainment remains unclear, and the potential contribution of differential patient exposure through self-selection has not been directly investigated. Objectives: To determine whether gender differences exist in the types of patients or acuity levels that EM residents self-assign to determine if this could potentially explain the differences seen in EM milestone achievement across genders. Methods: Design and Setting: Retrospective chart review of EM resident patient selection at the Mayo Clinic Arizona Emergency Department from September 2018 through December 2022. Patients: The study was conducted at a single academic emergency department with resident and attending physician staffing. The study was determined to be IRB exempt. Data Collection: Epic electronic medical record data included resident and attending gender, patient demographics, chief complaint, Emergency Severity Index (ESI) triage level, vital signs, method of arrival, and procedures performed. Statistical Analysis: Continuous variables were compared using Student’s t-test or Wilcoxon rank-sum test; categorical variables were compared using chi-square test. Significance was set at p < 0.05. Analyses were performed using SAS version 9.4. Results: A total of 14,279 cases were analyzed. No significant differences were observed between female and male residents in patient chief complaint, age, race, gender, means of arrival, attending gender (p = 0.10872), or total procedures performed (p = 0.23102). Female residents saw patients with higher initial respiratory rates (p = 0.04313) and trended non-significantly toward higher-acuity ESI levels 1–2 (p = 0.07214). Conclusion: When residents self-assign patients in the emergency department, no meaningful gender differences exist in patient selection, procedural exposure, or gender attending assignment. These findings suggest that observed gender disparities in milestone attainment are unlikely driven by clinical exposure or patient selection, supporting that other factors may contribute to these differences. Full article

Introduction: delayed abdominal closure following congenital diaphragmatic hernia (CDH) repair is required in patients with large defects in whom primary fascial closure would risk abdominal compartment syndrome. Several strategies have been described, but most require prolonged time to definitive closure. We present a novel technique based on a Gore-Tex^® abdominal patch with dynamic traction under intra-abdominal pressure monitoring. Methods: retrospective observational study of 41 neonates undergoing CDH repair at a tertiary referral center (2015–2023). Patients were divided into primary closure (n = 27) and delayed dynamic abdominal wall closure (DDAC) (n = 14) groups. Baseline characteristics, surgical outcomes, and mortality were compared between groups using Fisher’s exact test and the Wilcoxon rank-sum test. Results: patients requiring DDAC had more severe baseline disease, including lower O/E LHR (26.30 [21.40–31.00] vs. 42.00 [34.00–46.00], p < 0.001), higher rates of liver herniation (13/14 vs. 4/27, p < 0.001), more advanced defect type (p < 0.001) and greater need of ECMO (9/14 vs. 3/27, p < 0.001). Definitive fascial closure was achieved at a median of 6 days. In-hospital mortality after diaphragmatic repair was 19.5% (8/41), with 7 deaths occurring in the DDAC group. Mortality was strongly associated with the gradient of disease severity across prenatal and anatomical markers, although an independent contribution of the abdominal closure strategy cannot be excluded. Conclusions: DDAC achieves early definitive fascial closure and appears technically feasible in CDH patients unsuitable for primary closure. Higher mortality in this group was strongly associated with baseline disease severity, though its independent relationship with the closure technique remains to be established. Full article

Background/Objectives: Wastewater-based antimicrobial resistance (AMR) surveillance typically relies on treatment plant influent as a single integrated matrix, obscuring source-specific signals. In arid settings where treated effluent is reused, understanding how resistomes and virulomes are structured across wastewater compartments is essential for One Health monitoring. Methods: Shotgun metagenomic sequencing was applied to 57 wastewater samples collected in Dubai, United Arab Emirates, between October 2024 and January 2025. Samples represented nine community sewer nodes, two tertiary-care hospital outflows, and influent and effluent from two wastewater treatment plants (WWTP). Datasets were used for taxonomic, resistome, and virulome profiling. Alpha diversity was compared using Wilcoxon rank-sum tests, beta-diversity differences were assessed using permutational multivariate analysis of variance, and source-associated AMR genes were identified using linear discriminant analysis effect size analysis. Results: A total of 1470 bacterial species, 822 antimicrobial resistance genes (ARGs), and 1554 virulence factor genes were identified. Bacterial diversity was significantly lower in WWTP effluent than in other compartments. Hospital wastewater was enriched for class D β-lactamases, including multiple bla_OXA variants, whereas community wastewater and WWTP influent shared dominant macrolide and aminoglycoside resistance genes including msr(E), mph(E), strB and aadA1. Despite marked reductions in bacterial diversity after treatment, no significant difference in ARG diversity was observed between WWTP influent and WWTP effluent (p = 0.558), with resistance genes such as bla_VEB, msr(E), mph(E) detected in the latter. Virulome profiles shifted from fimbrial gene dominance in untreated sources toward biofilm- and persistence-associated genes in WWTP effluent. ARG alpha diversity varied over time, whereas taxonomic and virulome diversity remained stable. Conclusions: Community and influent wastewater capture population-level AMR carriage, hospital outflows concentrate clinically relevant resistance determinants, and WWTP effluent retains resistance markers despite microbial biomass reduction. Compartment-resolved metagenomic surveillance provides a practical One Health framework for identifying high-value monitoring points. Full article

Background: Impaired lumbopelvic control and inefficient bending mechanics are associated with low back pain and functional limitations. The Founder Exercise is a movement retraining strategy intended to promote hip-dominant movement, trunk control, and postural awareness during forward bending. However, empirical evidence examining movement performance following Founder Exercise instruction is limited. This study examined immediate pre-to-post differences in hip hinge kinematics and movement confidence surrounding a standardized Founder Exercise instructional session in healthy adults. Methods: A within-subject pretest-posttest design was used. Thirty-three healthy adults (72.7% female; mean age, 25.1 ± 2.9 years) completed assessments of foot orientation, sagittal-plane joint kinematics, and movement confidence before and after a single Founder Exercise instructional session. Joint kinematics were assessed using two-dimensional video analysis. Paired-samples t-tests or Wilcoxon signed-rank tests, as appropriate based on the distributions of the paired differences, were used to evaluate the kinematic outcomes. The exploratory summed confidence score and individual ordinal confidence items were evaluated using Wilcoxon signed-rank tests. Holm adjustments were applied separately to the 11 kinematic comparisons and the 10 individual-item comparisons. Results: Statistically significant immediate pre-to-post differences were observed in several kinematic variables. Hip flexion increased from 80.7° ± 18.1° at pretest to 104.6° ± 14.3° at posttest, shoulder flexion increased from 62.8° ± 23.9° to 145.3° ± 13.9°, and craniovertebral angle decreased from 25.7° ± 12.9° to 11.2° ± 10.0° (all p < 0.001). The summed score from the unvalidated, study-specific confidence scale was higher at posttest (median = 49.0, IQR = 40.0–50.0) than at pretest (median = 40.0, IQR = 36.0–50.0; p < 0.001). After Holm adjustment of the individual ordinal-item analyses, statistically significant differences remained for five of the 10 items; all confidence findings were considered exploratory. No statistically significant differences were observed in knee flexion or ankle motion after Holm adjustment. Conclusions: A brief Founder Exercise instructional session was followed by immediate differences in selected two-dimensional hip hinge angles and higher exploratory movement-confidence scores in healthy adults. These findings do not establish changes in lumbopelvic control, muscle activation, spinal loading, movement efficiency, or clinical outcomes. Controlled studies incorporating direct measures of lumbar and pelvic motion, muscle activity, external forces, and clinically relevant outcomes are needed before biomechanical or clinical conclusions can be drawn. Full article

Dendrobium polysaccharide is an important indicator for evaluating the quality of Dendrobium huoshanense. To improve the prediction accuracy of polysaccharide content, this study proposes an improved Artificial Lemming Algorithm (IALA) optimized BP neural network model. In IALA, a periodic mutation strategy and a fast hybrid opposition learning strategy (FHOBL) are introduced to enhance population diversity, improve global search ability, and avoid premature convergence. The proposed IALA was first evaluated on CEC2017 and CEC2020 benchmark functions. Experimental results show that IALA achieves better or competitive performance compared with seven other algorithms in terms of mean fitness, best fitness, and standard deviation. Statistical tests, including Wilcoxon rank-sum and Friedman tests, further verify the significant superiority and robustness of IALA. Then, IALA was used to optimize the initial weights and thresholds of BP neural networks for Dendrobium polysaccharide content prediction. The results show that IALA-BP achieves the best overall prediction performance, with an R² of 0.8731, RMSE of 2.1581, and MSE of 4.6683. Compared with standard BP and other optimized BP models, IALA-BP provides more accurate and stable prediction results. Therefore, the proposed IALA-BP model is effective for rapid prediction of Dendrobium polysaccharide content. Full article

Campus waste-sorting mobile manipulators operate in cluttered environments. This paper presents a task-oriented framework decoupling mobile-base navigation from manipulator motion. Its contribution is the safety-verified integration of goal-biased sampling, adaptive step-size adjustment, artificial potential field (APF)-guided directional correction, collision-recovery direction selection, and collision-checked bidirectional tree connection within Improved-BiRRT. After obtaining a feasible path, visibility-based pruning and piecewise cubic Hermite interpolating polynomial (PCHIP) smoothing are applied, followed by segment-wise collision verification with fallback to the verified pruned path. MATLAB R2024b simulations cover simple campus, complex campus, and narrow-passage environments. RRT, GoalBias-RRT, BiRRT, and Improved-BiRRT are evaluated under identical settings and post-processing. In the narrow-passage environment, Improved-BiRRT achieves a mean raw feasible-path length of $32.155\pm 1.935\mathrm{m}$, a mean final collision-verified path length of $27.041\pm 0.327\mathrm{m}$, and $39.25\pm 12.64$ iterations. Holm-adjusted Wilcoxon rank-sum tests show significantly lower final path lengths and iteration counts than baselines in the complex campus and narrow-passage environments ($p_{\mathrm{adj}}<0.05$). A five-target validation yields a cumulative collision-verified path length of $136.171\mathrm{m}$ and a cumulative MATLAB online planning time of $0.1305\mathrm{s}$. The results demonstrate feasibility for static two-dimensional campus waste-sorting tasks with predefined target ordering. Full article

Background: This study evaluated the use of circulation time (Tcirc) calculated from polysomnogram (PSG) with pulse oximetry to identify poor cardiac function with low left ventricular ejection fraction (EF). Methods: Subjects over 18 years of age with sleep apnea (apnea-hypopnea index (AHI) > 5/h diagnosed by PSG who had transthoracic echocardiography (TTE) within 1 year of PSG were included in this retrospective study. Tcirc of each sleep stage (N2, N3, and REM) were measured and averaged and EF was recorded. Statistical analysis was carried out using the Wilcoxon rank sum test, logistic regression and Youden index. Results: There were 89 subjects who met the inclusion criteria, 14 with EF ≤ 45% (Group A) and 75 with EF ≥ 50% (Group B). The normal Tcirc is <20 s, but Group A subjects had a prolonged overall Tcirc with a median time of 27.8 s (range 14.1–39.6 s), compared to Group B subjects with a median Tcirc of 23.5 s (range 14.3–37.6 s), p = 0.311. The optimal cut-point for overall sleep Tcirc with moderate discrimination (AUC = 0.6) was 28.6 s. Those with total sleep Tcirc ≥ 28.6 s were 2.5× more likely to have low EF with OR = 2.56 (95% CI, 0.55–11.16). Conclusions: In sleep apnea patients, total sleep Tcirc > 28.6 s is associated with low ejection fraction with specificity = 0.78. Full article

Visual art and graphic design tasks, such as generating a harmonious color palette or arranging the elements of a page, can be naturally formulated as mathematical optimization problems whose objective functions are non-convex, multimodal, and non-differentiable. Metaheuristic algorithms are well-suited to such problems. The secretary bird optimization algorithm (SBOA) is a recently proposed bio-inspired metaheuristic that mimics the hunting and predator-escaping behaviors of secretary birds, and it has shown competitive performance. However, SBOA still suffers from insufficient population diversity, premature convergence, and an unbalanced transition between exploration and exploitation, which limits its accuracy on complex design problems. To overcome these limitations, this paper proposes a multi-strategy secretary bird optimization algorithm (MSSBOA) that integrates three improvement strategies. First, a good point set initialization is employed to generate a low-discrepancy initial population that covers the search space more uniformly and enriches population diversity. Second, a lens opposition-based learning strategy is applied to the inferior individuals to help the population escape local optima while preserving the elite. Third, an adaptive Cauchy–Gaussian mutation is imposed on the best individual to balance global exploration and local exploitation throughout the search. The performance of MSSBOA is comprehensively examined on the CEC2017 benchmark suite in 10, 30, 50, and 100 dimensions and compared with the basic SBOA and nine state-of-the-art algorithms; the results are analyzed by the Friedman test, the Nemenyi post hoc test and the Wilcoxon rank-sum test. MSSBOA is then applied to two representative visual-design optimization problems: aesthetic color-harmony palette generation and graphic-layout aesthetics optimization. In all cases, MSSBOA outperforms the basic SBOA and the competing algorithms in terms of convergence speed, stability, and solution quality, confirming its effectiveness for computational-aesthetics applications in art design. Full article

Introduction: Congenital heart defects (CHD) occur in 1% of live births, with an estimated at least 33% of affected infants having genetic defects. It has become standard to screen children with CHD for genetic findings that could aid clinical decision-making, yet modern testing yields large volumes of information without understanding clinical utility. Genome-wide studies have identified associations between large copy number variants and neurocognitive outcomes in patients with CHD. Still, little research exists on the prognostic power of screening tests such as microarrays. The goal of this study was to determine if abnormal microarray results in infants with CHD were associated with worse clinical outcomes in the cardiac intensive care unit (CICU). Method: This was a single-center retrospective cohort study. The Society of Thoracic Surgery (STS) and Pediatric Cardiac Critical Care (PCICU) registries (PC4) were queried for all surgical admissions of neonates and infants between 1 January 2014 and 31 December 2019. Patient demographics, surgical details, and post-operative outcomes were collected for surgical admissions related to the patient’s index operation. A chart review was performed to ascertain microarray results, further genetic testing, and longitudinal outcomes. Patients without microarray results or long-term institutional follow-up were excluded. Wilcoxon rank-sum and chi-square tests were used to compare outcomes defined and collected in the PC4 registry between patients with normal and abnormal microarray results. Subgroup analysis was then performed using the same outcome measures to compare normal and abnormal microarray groups in children who required cardiac surgeries within 30 days of life and in children who presented with ventricular septal defect (VSD), atrioventricular septal defect (AVSD), aortic stenosis (AS), or Tetralogy of Fallot (TOF). Results: Of the 412 infants with surgical admissions to the CICU between 2014 and 2019, 43 infants had no longitudinal follow-up, and 65 infants had no microarray results. Three hundred and four infants were included in this study, of which 196 children had normal microarrays and 108 infants had abnormal microarrays. Both groups had similar distributions of gestational age and birth weight, but fundamental diagnoses and primary procedures differed significantly between groups (p < 0.005). STS score, deep hypothermic circulatory arrest (DHCA) time, and bypass time were each significantly lower in children with abnormal microarrays than in those with normal microarrays across the study. The patients with abnormal microarrays had a higher incidence of gastrostomy (G)-tube placement during their lifetime than infants with normal microarrays. On subgroup analysis, despite the differences in fundamental diagnoses and the fact that primary procedures differed significantly between normal and abnormal microarray groups that required cardiac surgery within 30 days of life, there were no detectable differences in the surgical and PCICU outcomes. DHCA time was once again significantly lower in the abnormal microarray subgroup in the second subgroup analysis. Conclusions: Our data indicate that microarray results have limited value in predicting immediate post-operative outcomes, but children with copy number variants should be included in future CHD research. Full article

Background/Objectives: Brain arteriovenous malformations (bAVMs) are complex cerebrovascular lesions that carry a substantial risk of intracranial hemorrhage, yet the biological mechanisms underlying vascular remodeling remain incompletely understood. As increasing evidence suggests that inflammatory processes contribute to vascular remodeling and bAVM progression, this study aimed to characterize the cellular composition of the immune microenvironment in human bAVMs at single-cell resolution and to identify immune cell populations associated with transcriptional programs related to angiogenesis and extracellular matrix remodeling. Methods: Publicly accessible single-cell RNA sequencing data from five human bAVM samples and five control brain specimens were analyzed. After quality control and data integration, immune cell types were annotated based on canonical marker gene expression. To assess biological processes relevant to vascular remodeling, the expression of predefined gene sets associated with angiogenesis and extracellular matrix remodeling, derived from the Molecular Signatures Database (MSigDB), was quantified across cell populations using rank-based gene set scoring (UCell). Differences between bAVM and control samples were evaluated at the sample level using the Wilcoxon rank-sum test. For each immune cell type, mean UCell scores were calculated per biological sample and compared between groups. To account for multiple comparisons across cell types, p-values were adjusted using the Benjamini–Hochberg procedure. Results: After quality control, 46,360 immune cells were analyzed. Compared with control tissue, bAVMs showed numerically higher proportions of lymphoid (activated T cells and CD8 T cells) and myeloid populations (M1-like macrophages, monocytes, and dendritic cells). Angiogenesis-related transcriptional activity was highest in myeloid cells and significantly increased in bAVMs, particularly in M1-like macrophages (UCell score 0.22 vs. 0.13), dendritic cells (0.16 vs. 0.10) and monocytes (0.20 vs. 0.15), whereas proliferating CD8 T cells showed a lower score (0.04 vs. 0.05; adjusted p = 0.040 for all four). Extracellular matrix-related programs showed a similar but weaker and non-significant pattern in myeloid populations (e.g., monocytes, dendritic cells, microglia-like cells; adjusted p = 0.09). Conclusions: Our findings identify myeloid cells, particularly M1-like macrophages, monocytes and dendritic cells, as important immune populations associated with angiogenesis in bAVMs. These findings highlight a potential role of immune-driven vascular remodeling in the pathophysiology of bAVMs. Full article

Coordinated management of drip irrigation water demand and lateral canal supply is a critical strategy for improving water use efficiency in arid irrigation districts; however, under water-deficit conditions, the efficient and equitable allocation of limited canal water among multiple drip irrigation systems remains largely unresolved. This study developed a bi-objective cooperative water allocation and scheduling model for a lateral canal serving 11 subordinate drip irrigation systems. Subject to canal diversion flow balance and total deficit constraints, the model simultaneously minimized (i) the mean coefficient of variation (CV) of water allocation duration within rotation irrigation groups, targeting temporal uniformity, and (ii) the sum of squared deviations of the water supply satisfaction rate across systems, targeting distributional equity. Water demand inputs were derived from a localized FAO-56 Penman–Monteith irrigation schedule for Jinghe County with stage-specific crop coefficients. A hybrid binary–continuous NSGA-II encoding with a dynamic intra-group flow allocation mechanism was employed. For the baseline deficit scenario (Early May, supply-to-demand ratio β = 67.76%), the model partitioned the 11 systems into four rotation groups with a mean CV of 3.15 × 10⁻³, while the sum of squared deviations of the satisfaction rate decreased from 4.366 under the empirical scheme to 1.50 × 10⁻⁴, confining all systems to 67.38–68.45% and eliminating the coexistence of over-supply and complete deprivation (Wilcoxon signed-rank test, p < 0.001; Cohen’s d = −1.698). The Pareto front revealed a significant efficiency–equity trade-off (Spearman’s ρ = −0.9999), and NSGA-II outperformed SPEA2 by approximately 29-fold and 22-fold in the two objectives. Robustness was confirmed across three deficit scenarios and algorithm parameter sensitivity analyses (CV < 2%). The study offers methodological support for refined water allocation management of terminal canal systems in arid regions. Full article

Background: Sarcomatoid carcinoma of the upper urinary tract (SCUT) is a rare and aggressive malignancy. Due to its rarity, the molecular landscape and the prevalence of potentially targetable alterations are poorly characterized. We aimed to compare the clinical, pathological, and genomic profiles of SCUT and upper tract urothelial carcinoma (UTUC). Methods: We leveraged the Tempus Lens clinically annotated genomic dataset to extract clinicopathologic and somatic genomic alteration data from patients with UTUC and SCUT. Patients with any-stage disease who underwent either blood- or tissue-based next-generation sequencing were included. Baseline clinical and demographic characteristics were summarized using descriptive statistics. Comparisons between groups were performed using Wilcoxon rank-sum test for continuous variables and the Chi-square test/Fisher’s exact test for categorical variables. Mutational frequencies and pairwise comparisons were performed to assess significant differences between groups. Results: In total, 1721 patients were included, of which 1600 (93%) had UTUC and 121 (7%) had SCUT. Patients with SCUT were younger at diagnosis, 61 years (interquartile range (IQR) 54, 70), compared to UTUC, 71 years (IQR 64, 77) (p < 0.001), and were more likely to have node-positive disease at presentation (all p < 0.001). SCUT patients were more likely to show visceral metastases to the lung (44% vs. 21%), bone (31% vs. 17%), and brain (7% vs. 1%), compared to UTUC (all p < 0.05). Among SCUT patients, the most common genomic alterations were TERT (30%), TP53 (29%), NF2 (19%), PTEN (13%), SETD2 (12%), PBRM1 (12%), and BAP1 (8%). Among UTUC patients, the most common were TERT (52%), TP53 (52%), KMT2D (30%), FGFR3 (25%), ARID1A (20%), and KDM6A (18%). Compared to UTUC, SCUT was significantly enriched with NF2, SETD2, PBRM1, PTEN, and BAP1 (all p < 0.05). SCUT was depleted in FGFR3 (0% vs. 25%) and FGF4 (0% vs. 8%) mutations compared to UTUC (both p < 0.05). Targetable alterations were observed in SCUT, including NF2, SETD2, and PTEN. Conclusion: Compared with UTUC, SCUT exhibits a more aggressive clinical and genomic phenotype, characterized by enrichment in NF2, SETD2, PBRM1, and PTEN. These findings underscore the divergent molecular landscape of SCUT and highlight potentially targetable genomic alterations. Full article