Search Results (7,442)

Background/Objectives: Prostate cancer is a leading cause of cancer-related morbidity and mortality. While prostate-specific antigen (PSA) is crucial for monitoring, its static levels are limited in predicting outcomes precisely. The Kinetics of Elimination of PSA (KELIM PSA) has recently emerged as a dynamic biomarker of treatment response. This research sought to determine the predictive power of KELIM PSA in castration-resistant prostate cancer (CRPC) on androgen receptor pathway inhibitors (ARPI). Methods: This study retrospectively analyzed 98 CRPC patients treated with enzalutamide or abiraterone. The patients were categorized as either unfavorable (KELIM < 1) or favorable (KELIM ≥ 1). Demographic and clinical characteristics were compared, and survival outcomes were evaluated using Kaplan–Meier curves and Cox regression. Results: Of the cohort, 42 (42.9%) patients had favorable and 56 (57.1%) unfavorable KELIM values. The unfavorable group had a higher mortality rate (62.5% vs. 38.1%, p = 0.029). Univariate analysis showed that poor KELIM results increased mortality risk twofold (hazard ratio [HR]: 2.30, 95% confidence interval [CI]: 1.26–4.19, p = 0.006). In multivariable analysis, unfavorable KELIM remained independently associated with worse overall survival (HR: 2.09, 95% CI: 1.12–3.89, p = 0.020), together with second-line ARPI (HR: 3.19, 95% CI: 1.71–5.93, p < 0.001) and ADT + docetaxel during CSPC (HR: 2.14, 95% CI: 1.11–4.12, p = 0.022). Kaplan–Meier curves revealed that the unfavorable group had notably reduced overall survival and progression-free survival (log-rank p = 0.018). Conclusions: KELIM PSA is an independent predictor in ARPI-treated CRPC. By integrating PSA kinetics into prognostic models, risk stratification may be improved, and this may guide individualized treatment. Prospective multicenter validation is warranted. Full article

Background: Toxic shock syndrome (TSS) is a rare but potentially fatal condition most often caused by Staphylococcus aureus or Streptococcus pyogenes. However, other streptococcal species, including Streptococcus agalactiae (group B Streptococcus (GBS)), can also cause TSS, sometimes leading to severe complications, such as multiorgan failure. Case Description: We report the case of a 45-year-old woman who developed TSS associated with tampon use. She presented with fever, chills, hypotension, and leg pain, progressing rapidly to septic shock and multiorgan failure. Blood and urine cultures revealed S. agalactiae group B, while a gynecological examination identified Ureaplasma urealyticum and S. agalactiae. Imaging demonstrated bilateral pneumonic infiltrates and pleural effusion. The patient required intensive care, vasopressor support, and broad-spectrum antibiotic therapy, leading to full clinical recovery. Discussion: Despite advances in tampon design, menstrual TSS remains a significant clinical concern. Early symptoms may be nonspecific, but rapid progression highlights the need for timely recognition and intervention. Although S. agalactiae is an uncommon cause of TSS, it should be considered in relevant clinical scenarios. Prompt empirical antibiotic therapy, followed by targeted treatment based on culture results, along with supportive intensive care, is essential to improve outcomes. Conclusions: Menstrual TSS continues to pose a serious health risk. Physicians should maintain a high index of suspicion in tampon users presenting with fever, rash, and shock. Early diagnosis and rapid initiation of appropriate therapy are crucial to reducing morbidity and mortality. Full article

Background: Post-pneumonectomy bronchopleural fistula (PPBPF), although infrequent, represents one of the most devastating complications after pneumonectomy, carrying high morbidity and mortality. Accurate risk stratification is essential for timely management. Systemic inflammation-based hematologic indices—such as neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SIII), prognostic immune-inflammation index (PIII), and platelet-to-lymphocyte ratio (PLR)—serve as accessible, low-cost biomarkers reflecting host immune status and inflammatory burden. This study aimed to evaluate their association with mortality risk in patients with PPBPF. Methods: A multicenter retrospective cohort of 33 PPBPF patients (2014–2023) was analyzed. Demographic, clinical, and laboratory data at diagnosis were retrieved. Inflammatory indices were calculated from hematologic parameters. Associations with mortality were assessed using receiver operating characteristic (ROC) curves and univariate logistic regression. Post hoc power analyses were performed for key biomarkers. Results: Nine patients (27.3%) died during follow-up. Non-survivors had significantly higher levels of all biomarkers (p < 0.05). ROC analysis identified NLR as the most powerful discriminatory marker (AUC: 0.862), while SIII, SIRI, and CAR also demonstrated high accuracy (AUC > 0.83). Optimal thresholds of NLR ≥ 12 and CAR ≥ 10 yielded 88.9% sensitivity, >80% specificity, and excellent negative predictive values (NLR: 94.4%; CAR: 94.7%). Post hoc power analysis demonstrated robust statistical power for SIRI (94.9%), CAR (87.2%), and SIII (84.5%). Conclusions: Systemic inflammation-based biomarkers, particularly NLR and CAR, show strong associations with mortality in PPBPF. Incorporating these indices into clinical practice may help identify patients at increased risk and facilitate tailored surveillance and management strategies. Full article

Introduction/Background: Treatment of localized prostate cancer includes radical prostatectomy (RP) with or without pelvic lymph node dissection (PLND). While multiple guidelines recommend PLND for staging purposes, recent data has shown questionable therapeutic benefit. Thus, understanding the morbidity associated with PLND is important for counseling patients. We used the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) targeted prostatectomy database to quantify real-world 30-day postoperative outcomes of patients undergoing contemporary robot-assisted PLND at the time of RP for prostate cancer to quantify the incremental morbidity. Methods: We conducted a retrospective cohort study using the NSQIP database of adult patients undergoing radical prostatectomy from 2019 to 2022. The primary outcomes were procedure-specific outcomes such as lymphocele and rectal injury. Secondary outcomes included a composite of any of the following 30-day major postoperative outcomes: mortality, reoperation, cardiac or neurologic event, as well as the individual components of this outcome, as well as infectious and other complications. We also analyzed yearly trends associated with PLND. Groups were balanced using propensity score matching (PSM) with a 1:1 ratio using demographic characteristics, prior medical history, and cancer staging data. Likelihood of complications was assessed by conditional logistic regression. Results: We identified 13,413 patients between 2019 and 2022 who underwent robotic prostatectomy: 11,341 (85%) had PLND while 2072 (15%) did not. After PSM, our cohort included 2071 matched pairs of patients with and without PLND. Patients who underwent PLND were more likely to be diagnosed with lymphocele (2.14% vs. 0.68%, OR 4.17; 95% CI 2.00, 8.68), have unplanned readmission (4.22% vs. 3.27%, OR 1.31; 95% CI 1.03, 1.65), and develop organ-site/space SSI (1.18% vs. 0.60%) (OR 1.97, 95% CI 1.20, 3.23). There was no significant association between the receipt of PLND and the likelihood of urinary leak or fistula, or ureteral obstruction. There were no significant differences between the two groups with respect to secondary outcomes of interest. Conclusion: Contemporary robotic PLND is associated with a 3-fold increased likelihood of lymphocele, as well as increased likelihood of unplanned readmission and organ-site SSI, though no significant differences in major postoperative complications were identified. We found that the odds of lymphoceles, readmission, and SSI in our study are lower than previously reported. These data provide real-world data to guide patient counseling and optimize patient selection for PLND at the time of RALP. Full article

Background: Non-melanoma skin cancer (NMSC) is the most frequent cancer in fair-skinned populations and represents a growing public health concern due to its impact in terms of morbidity and treatment costs. While some meta-analyses have investigated cigarette smoking as a risk factor for NMSC, less is known about its prognostic implications in patients with NMSC. This systematic review and meta-analysis aims to fill this gap by assessing the association between smoking habits and survival in patients with NMSC. Methods: A systematic search was conducted in PubMed and EMBASE up to 25 February 2025, to identify prospective studies of patients with histologically confirmed NMSC that evaluated the association between smoking habits and survival. Study-specific hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were pooled using random effects meta-analysis models. Results: A total of five studies published between 2015 and 2022 were included. The meta-analysis revealed that being a current or ever smoker at diagnosis was associated with a worse overall survival (summary HR 2.42, 95% CI 1.91–3.06). A similar result was observed when smoking exposure was assessed in terms of pack-years or number of cigarettes per day (summary HR 2.44, 95% CI 2.02–2.93). Conclusions: Our findings indicate that cigarette smoking is a negative prognostic factor in these patients, despite the generally excellent prognosis of NMSC. It is reasonable to assume that this unfavourable effect is largely due to the increased risk of developing other life-threatening conditions, in which smoking plays a causal role. These results underscore the clinical relevance of systematically integrating smoking cessation counselling into the routine management of patients with NMSC. Full article

Background/Objectives: Treatment of childhood ependymoma evolved from 1970 to 1999 by reducing radiation volumes and incorporating chemotherapy. The impact of these changes on long-term health outcomes remains unknown. In this report, we evaluated temporal changes in all-cause and cause-specific late mortality, chronic health conditions (CHCs), and subsequent neoplasms (SNs) in the Childhood Cancer Survivor Study (CCSS) cohort of adult survivors of pediatric ependymoma, diagnosed between 1970 and 1999. Methods: A total of 404 five-year survivors of ependymoma (47.5% female, 80.7% non-Hispanic White, median 6 (range 0–20) years at diagnosis, 22 (5–49) years from diagnosis) diagnosed between 1970 and 1999 and enrolled in the Childhood Cancer Survivor Study were evaluated for late (>5 years from diagnosis) mortality, SNs, and CHCs. Outcomes were analyzed by diagnosis decade, radiotherapy, and chemotherapy exposure. Gray’s test compared cumulative incidences. Multivariable piecewise exponential models estimated relative risks (RRs). Results: Whole-brain radiation exposure decreased over time (42.9% (1970s) to 2.7% (1990s)), while focal radiation (21.4% to 68.9%), and chemotherapy (29.5% to 50.2%) use increased. Fifteen-year all-cause late mortality (incidence, 95% CI) remained similar across decades: 1970s (9.3%, 3.4–18.8%), 1980s (14.7%, 9.4–21.2%), 1990s (10.3%, 6.7–14.9%). All-cause late mortality was higher after treatment with whole-brain radiation (22.5%, 11.2–36.5%) compared to focal radiation (11.4%, 7.5–16.1%) or no brain radiation (3.5%, 0.9–9.1%) (p < 0.001), and with chemotherapy (14.4%, 9.6–20.0%) versus without (6.8%, 3.8–11.0%) (p = 0.004). Compared to no brain radiation, the RR (95% CI) of grade 3–4 CHCs increased among survivors treated with focal (2.6, 1.3–5.4) and whole-brain radiation (3.5, 1.5–8.1), while chemotherapy was not associated with CHCs or SNs. Conclusions: Despite reduced radiation volumes and increased use of chemotherapy, late mortality and morbidity among pediatric ependymoma survivors remained largely unchanged across treatment decades. Full article

Background: Varicella zoster virus (VZV) remains a significant cause of pediatric morbidity in populations in Lebanon, yet comprehensive data on population immunity and vaccination uptake are limited. This study aimed to estimate VZV seroprevalence and identify factors associated with immunity and vaccine uptake among children and adolescents in Northern Lebanon. Methods: A cross-sectional study was conducted among 180 participants aged 1–18 years recruited from urban and rural settings in North Lebanon. After receiving informed parental consent, sociodemographic and clinical information were collected via structured questionnaires. Anti-VZV IgG and IgM antibodies were measured using validated Enzyme-Linked Immunosorbent Assays (ELISA). Associations with seropositivity and vaccination uptake were analyzed using multivariable logistic regression. Results: IgG seroprevalence was 79.4% (95% CI: 72.7–85.1), indicating prior exposure or immunization, while IgM antibodies, reflecting recent infection, were detected in 5.0% (95% CI: 2.3–9.4) of participants. Among vaccinated participants, IgG seropositivity was 63.6% (95% CI: 43.5–83.7) in the one-dose group and 89.5% (95% CI: 83.0–96.0) in the two-dose group. Completing the two-dose regimen was significantly associated with a higher IgG seropositivity (OR = 0.110, 95% CI: 3.2–52.4, p = 0.002). Parental reporting of history of varicella showed high sensitivity (99.0%) and overall accuracy (90.8%) in predicting seropositivity. Primary vaccination barriers included preference for natural infection (67%), perceived non-necessity (19%), and cost (10%). Regular pediatric follow-up strongly predicted vaccination (OR = 15.239, p < 0.001), whereas low parental awareness was associated with decreased vaccine uptake (OR = 0.027, p = 0.015). Conclusions: Suboptimal VZV vaccination coverage and persistent susceptibility underscore the need to integrate varicella vaccination into Lebanon’s national immunization schedule. Targeted educational efforts and enhanced pediatric healthcare engagement are critical to increasing vaccine uptake and reducing disease burden. Full article

Background: Pediatric heart failure (PHF) is a heterogeneous syndrome with high morbidity, but existing classification systems inadequately capture its developmental and pathophysiological complexity due to reliance on adult-centric parameters. Using machine learning, we aimed to identify clinically distinct PHF phenotypes with unique outcomes and therapeutic implications. Methods: In this multicenter retrospective study, we analyzed 2903 consecutive PHF patients (≤18 years) from 30 Chinese tertiary centers from 20 provinces (2013–2022). Unsupervised machine learning (k-means clustering with PCA) evaluated 99 clinical, biomarker, and echocardiographic variables to derive phenotypes, which were compared for mortality, hospitalization, and treatment responses. Results: Three phenotypically distinct clusters emerged. Cluster 1 (Chronic Hypertensive and Cardiorenal Profile, 30.1%) predominantly affected older children (78%) with hypertension (54.4%), renal dysfunction (creatinine 45.8 μmol/L), and ventricular tachycardia (53.8%). This cluster showed the lowest in-hospital mortality (2.5%) but frequent 7–14 day hospitalizations (35.8%) and the highest beta-blocker use (54.5%). Cluster 2 (Preterm and CHD-Associated HF, 43.4%) comprised preterm infants (71.4%) with congenital heart disease (72.2%) and preserved LVEF (67%), demonstrating the highest mortality (5.1%) and prolonged stays (>30 days: 10.6%) with predominant diuretic (40.6%) and antibiotic use (54.3%). Cluster 3 (Fulminant Myocarditis Profile, 26.5%) exhibited cardiogenic shock with severely reduced LVEF (33%) and elevated BNP (3234 pg/mL), showing bimodal outcomes (4.8% LOS < 3 days vs. 32.2% LOS 15–30 days) and the highest IVIG utilization (46.5%) with intermediate mortality (3.8%). The majority of between-group differences were statistically significant (p < 0.001). Conclusions: Machine learning identified three PHF phenotypes with distinct in-hospital risk profiles and therapeutic implications, challenging current classification systems. These findings highlight the potential for phenotype-specific management strategies and provide a rationale for future research into arrhythmia prevention in hypertensive profiles and early immunomodulation in fulminant myocarditis, while highlighting the need for specialized care pathways for preterm/CHD patients. Prospective validation is warranted to translate this framework into clinical practice. Full article

Background and Objectives: Postoperative atrial fibrillation (POAF) remains one of the most frequent complications after cardiac surgery, increasing the risk of morbidity, prolonged hospitalization, and adverse long-term outcomes. Although several clinical and echocardiographic factors have been associated with POAF, the integrated contribution of atrial conduction delay, biatrial mechanics, and atrioventricular coupling to arrhythmogenesis remains unclear. Materials and Methods: This retrospective study included 131 adult patients undergoing coronary artery bypass grafting and/or aortic valve replacement. Preoperative echocardiography within one week before surgery provided detailed assessment of atrial phasic function, valvular motion, and total atrial conduction time (TACT). Univariate analysis was followed by multivariable modeling using penalized logistic regression (Elastic Net) to identify the most robust predictors of POAF. Discriminative performance and calibration were evaluated via receiver operating characteristic (ROC) and calibration analysis. An exploratory Extreme Gradient Boosting (XGBoost) model with SHapley Additive exPlanations (SHAP) analysis was used to confirm the stability and directionality of nonlinear feature interactions. Results: POAF occurred in 47 (36%) patients. The Elastic Net model identified prolonged TACT, reduced right atrial active emptying fraction (RAAEF), increased indexed minimal left atrial volume (MIN LA/BSA), and lower tricuspid annular plane systolic excursion (TAPSE) as the most informative predictors. The model demonstrated excellent internal discrimination (AUC = 0.95; 95% CI 0.91–0.99) and satisfactory calibration (Hosmer–Lemeshow p = 0.41). Exploratory XGBoost analysis yielded concordant feature hierarchies, confirming the physiological consistency of the results. Conclusions: POAF arises from an identifiable electromechanical substrate characterized by atrial conduction delay, biatrial mechanical impairment, and reduced atrioventricular coupling. A parsimonious, regularized statistical model accurately delineated this profile, while complementary machine-learning analysis supported its internal validity. These findings underscore the potential of echocardiographic electromechanical parameters for refined preoperative risk stratification, pending prospective multicenter validation. Full article

Background: Acute Kidney Injury (AKI) is characterized by rising morbidity and mortality rates, along with significant financial costs associated with its treatment, positioning it as a priority health challenge. Difficult access to accurate biomarkers for renal dysfunction poses challenges in identifying high-risk patients prone to progression to severe AKI. Therefore, this study aimed to identify clinical and laboratory variables that could contribute to future risk stratification approaches in AKI. Methods: This observational retrospective study included 106 patients diagnosed with AKI who were admitted to the emergency department of the HGZ05-IMSS Hospital between January 2020 and July 2023. Multivariate logistic regression was used to identify clinical and laboratory factors associated with in-hospital mortality. Results: Patients with AKI exhibited elevated inflammatory indices (NLR, MLR, and PLR), increased levels of glucose, urea, and C-reactive protein (CRP), and reduced lymphocyte counts, serum albumin, FiO₂, and BUN/creatinine (BCR) ratio. The hematological profile showed myeloid predominance, characterized by neutrophilia and lower eosinophil, erythrocyte, and monocyte counts, consistent with systemic inflammation. Multivariable analysis identified COVID-19 infection, thrombocytopenia, low eosinophil levels, and polypharmacy as independent predictors of mortality in AKI patients. Conclusions: These findings underscore the interplay between inflammatory, metabolic, and hematological alterations in AKI and highlight key prognostic factors that may contribute to future risk stratification. Full article

Background: Pyruvate kinase deficiency (PKD) is the most prevalent enzymatic defect of the glycolytic pathway, causing chronic congenital non-spherocytic hemolytic anemia. Clinical severity ranges from mild anemia to transfusion-dependent diseases. Severe neonatal presentations, including liver failure, have rarely been reported. Case presentation: We report a preterm female neonate with PKD who developed early-onset hemolytic anemia, conjugated hyperbilirubinemia, hepatosplenomegaly, coagulopathy, and progressive transaminitis. Imaging demonstrated hepatomegaly with diffuse parenchymal involvement. Whole-genome sequencing identified compound heterozygous pathogenic mutations in the PKLR gene, confirming the diagnosis of PKD. The patient required continuous transfusion support and was discharged following clinical stabilization. Discussion: Although PKD most often manifests as isolated hemolytic anemia, this case illustrates a rare neonatal phenotype with concurrent liver dysfunction. We investigated the potential underlying mechanism. Recognition of hepatic involvement in PKD is essential because liver failure is associated with considerable morbidity and mortality, and it may necessitate interventions such as liver transplantation. Conclusions: This case highlights the importance of considering PKD in neonates presenting with hemolysis and liver failure. Early genetic confirmation enables timely management, including transfusion support, iron overload surveillance, and anticipatory guidance for potential hepatic complications. Full article

Background/Objectives: Odontogenic keratocyst (OKC) is a benign yet locally aggressive intraosseous lesion with a high recurrence rate, posing significant challenges for clinical management. This present case report describes a combined surgical management approach for an OKC, involving enucleation with piezotome-assisted peripheral ostectomy, followed by adjunctive application of platelet-rich fibrin (PRF) to the osseous defect. Methods: A 54-year-old patient presented with a mandibular unilocular radiolucency that was diagnosed histopathologically as an OKC. The lesion was managed using a combined surgical approach involving enucleation and peripheral ostectomy with a piezotome. To optimize healing, PRF was applied to the bone defect. Results: At 18- and 36-month follow-up, the patient demonstrated complete postoperative bone remodeling of the cystic bone defect, with no evidence of recurrence. Conclusions: This case highlights the low morbidity associated with enucleation and piezotome-assisted peripheral ostectomy, which may be preferable to other aggressive OKC treatment modalities in selected cases. Additionally, PRF use was associated with favorable postoperative healing, with minimal pain, swelling, and inflammation. Radiographic stability at 36 months supports the feasibility of this approach; however, larger studies are needed to compare recurrence risk with other interventions. Full article

Background: Community-onset fungemia is a clinically significant syndrome frequently linked to recent healthcare exposure and significant morbidity and mortality. Methods: We performed a 21-year, single-centre retrospective cohort of consecutive yeast bloodstream infections diagnosed at the Emergency Department (2004–2024). Clinical/epidemiological data, species identification (MALDI-TOF MS), antifungal susceptibility (CLSI M27; Sensititre YO10), and whole-genome sequencing (WGS) were analyzed. Results: Forty-eight episodes (51 isolates) were included; 56.3% were male, median age 74 years (IQR 63–82). Acquisition was healthcare-associated in 38/48 (79.2%). Sources were unknown (36.7%), abdominal (22.4%), urological (22.4%), catheter-related (14.3%), and 2.1% was attributed to a cardiovascular and a joint focus; 18.8% were polymicrobial. Crude mortality was 20.8% at 7 days (10/48) and 29.2% at 30 days (14/48). Species distribution: Candida albicans 41.2%, Nakaseomyces glabratus 27.5%, Candida parapsilosis 11.8%, Candida tropicalis 11.8%, Pichia kudriavzevii 3.9%, Clavispora lusitaniae 1.9%, and Candida orthopsilosis 1.9%. No isolate was resistant to anidulafungin, micafungin, or amphotericin B; one N. glabratus showed reduced susceptibility to caspofungin. Azole resistance was observed in one C. albicans and one N. glabratus isolate. WGS (44 isolates) confirmed MALDI-TOF identifications and characterized resistance markers. All 12 sequenced N. glabratus carried ERG2 I207V, PDR15/PDH1 E839D, and PDR1 V91I/L98S. Notable cases included one N. glabratus caspofungin-intermediate with FKS2 F659C, N. glabratus fluconazole-resistant with multiple PDR1 substitutions including a unique novel G857V, and C. albicans fluconazole-resistant harbouring alterations in MRR1/MRR2, CDR1, and ERG11. Conclusions: In this 21-year cohort, community-onset fungemia was predominantly healthcare-associated, with C. albicans as the predominant species, followed by N. glabratus. Crude mortality reached 29.2% at 30 days. Echinocandin resistance was not observed; azole resistance was uncommon. WGS provided precise speciation and actionable insight into resistance mechanisms, including a putatively novel PDR1 G857V in N. glabratus. Full article

Background/Objectives: Treatment planning for stage III non–small cell lung cancer (NSCLC) presents dosimetric challenges due to the proximity of critical structures. RapidPlan (RP), a knowledge-based planning (KBP) system, offers the potential for improved plan consistency and organ-at-risk (OAR) sparing. The objective of this study was to compare dosimetric and clinical outcomes of RP-generated plans versus manually optimized plans in patients with stage III NSCLC undergoing IMRT or VMAT. Methods: In this retrospective analysis, 50 patients treated with concurrent chemoradiation for stage III NSCLC at Hadassah Medical Center (2015–2021) were analyzed. RP plans were generated using a lung-specific model in the Eclipse treatment planning system and compared with the original clinical manual plans. Dosimetric parameters for target volumes and OARs were evaluated, and subgroup analyses were performed by technique (IMRT vs. VMAT). Toxicity and survival outcomes were analyzed, and Normal Tissue Complication Probability (NTCP) modeling was conducted. Results: RP significantly reduced mean heart dose (Δ = −2.54 Gy, p < 0.001), spinal cord maximum dose (Δ = −4.08 Gy, p < 0.001), and esophageal mean dose (Δ = −3.89 Gy, p < 0.001) compared with manual plans. Lung doses were slightly higher in RP plans (V20 Δ = +2.12%, p < 0.001). VMAT-RP plans demonstrated greater cardiac and esophageal sparing than VMAT-manual plans. RP yielded significant NTCP reductions for the heart (0.34% → 0.20%) and esophagus (16.6% → 11.5%), but no improvement for lung or spinal cord. Lung toxicity ≥ grade 2 was associated with reduced overall survival (16.2 vs. 51.8 months, p < 0.001). Conclusions: RapidPlan-based knowledge-based planning enhances OAR sparing while maintaining target coverage in locally advanced NSCLC. Slight increases in lung dose highlight the need for ongoing model refinement. An association between lung toxicity and reduced survival was observed, underscoring the impact of treatment-related morbidity on outcomes. Full article

Background/Objectives: Studies have demonstrated significant morbidity and mortality associated with airway management, especially when provided outside of the operative setting. The goal of this study was to compare baseline measurements of airway management procedures between anesthesia providers (CRNAs and anesthesiologists) and respiratory therapists using high-fidelity manikins. Methods: This prospective study assessed anesthesia providers and respiratory therapists performing direct laryngoscopy (DL), video laryngoscopy (VL), and LMA placement. The same Laerdal SimMan high-fidelity manikin (Laerdal, Stavanger, Norway) was used in all assessments, with the detection of end-tidal “carbon dioxide” serving as evidence of success for each procedure. Each procedure was performed twice, once under “Healthy Patient” SimMan settings, and once under the “Limited Cervical Range of Motion (ROM)” (DL), “Pharyngeal Obstruction” (VL), and “Full Tongue Edema” (LMA) settings, respectively, to simulate a moderately difficult airway. The order in which the techniques were performed was randomized for each participant. Completion time and number of attempts were recorded for each procedure and compared between the groups. Results: Sixty-two providers (30 anesthesia providers and 32 respiratory therapists) were enrolled. There were no significant differences in average time to completion for any procedure, except respiratory therapists took longer than anesthesia providers in VL with simulated pharyngeal obstruction (p = 0.0004). There were no differences in number of attempts needed for successful completion. Conclusions: This study demonstrates that while completion times for DL and LMA placement were similar amongst provider groups, average time to completion of VL for respiratory therapists was longer under difficult simulated settings. These results reflect potential areas of improvement for other provider groups that may have airway privileges at their respective institutions. Full article