Search Results (1,756)

Background/Objectives: Postoperative intensive care unit (ICU) disposition after anatomical lung resection is usually planned preoperatively, but the final care pathway may be substantially influenced by intraoperative events. We evaluated actual postoperative ICU admission among patients with a documented preoperative ICU monitoring recommendation and compared preoperative-only and perioperative triage approaches. Methods: In this retrospective single-centre cohort study, 1060 adults undergoing elective anatomical lung resection for non-small cell lung cancer (NSCLC) between January 2019 and December 2025 were screened; 159 patients with a documented preoperative ICU monitoring recommendation constituted the analytical cohort. A clinically pre-specified primary perioperative model incorporating operative duration, intraoperative complication, chronic obstructive pulmonary disease (COPD), and pre-existing arrhythmia was compared with a preoperative-only model and with an exploratory perioperative ICU triage score. Results: Actual postoperative ICU admission occurred in 45 patients (28.3%). Operative duration (adjusted odds ratio [OR] 1.012 per minute; 95% confidence interval [CI], 1.005–1.018; p < 0.001) and intraoperative complication (adjusted OR 15.002; 95% CI, 3.738–60.210; p < 0.001) were significantly associated with actual postoperative ICU admission. The primary perioperative model achieved an AUC of 0.802 (95% CI, 0.717–0.876), compared with 0.759 for the exploratory perioperative triage score and 0.665 for the preoperative-only model. Conclusions: Fewer than one-third of patients with a documented preoperative ICU monitoring recommendation underwent actual postoperative ICU admission. In this selected cohort, perioperative reassessment incorporating intraoperative information showed higher apparent discriminative performance than the preoperative-only approach while the exploratory score showed intermediate, hypothesis-generating performance. Because the outcome reflected observed institutional ICU disposition rather than independently adjudicated ICU-level care requirement, prospective multicentre validation using predefined ICU admission criteria is required before clinical implementation. Full article

This study addresses maritime traffic risks in the Labuan Bajo–Komodo marine tourism corridor, a spatially constrained archipelagic environment characterized by mixed vessel traffic, intensive tourism activity, and high ecological sensitivity. An integrated decision-support framework was developed by combining the Analytic Network Process (ANP) with stakeholder-supported grid-based spatial risk analysis. Expert pairwise comparisons from eight respondents were used to evaluate eight interdependent criteria: Natural Conditions, Navigational Channel, Vessel Factors, Maritime Traffic Conditions, Port Control, Authority/Stakeholders, Tourism, and Environmental Impact. The ANP calculation was conducted using geometric mean group aggregation, consistency ratio assessment, and targeted follow-up clarification for matrices requiring refinement. The final ANP results show that Port Control received the highest priority weight (0.172), followed by Natural Conditions (0.148), Maritime Traffic Conditions (0.144), Environmental Impact (0.135), Vessel Factors (0.121), Navigational Channel (0.120), Authority/Stakeholders (0.104), and Tourism (0.0566). At the global subcriteria level, communication effectiveness, channel complexity, environmental compliance, local traffic density, and seasonal traffic variation emerged as the dominant contributors to risk. A stakeholder-supported partial spatial risk index (SRI) was then calculated for 21 grid cells using spatially mappable ANP criteria. The highest-risk cells were grids 3, 5, 6, 8, 9, 10, and 14, while sensitivity analysis confirmed that grids 3, 5, 6, 9, 10, and 14 remained high risk across all tested spatial-weight scenarios. The findings indicate that maritime traffic risk in Komodo National Park is not driven by environmental exposure alone, but by the interaction of traffic control capacity, natural hazards, traffic concentration, environmental sensitivity, and institutional coordination. The proposed framework supports spatially informed traffic management, environmental compliance, and emergency preparedness planning in marine protected tourism corridors. Full article

Hybrid additive manufacturing (HAM) integrates additive and subtractive processes within a unified production system, combining the geometric flexibility and material efficiency of additive manufacturing with the dimensional accuracy and surface quality of conventional machining. This review provides a comprehensive analysis of HAM technologies through a proposed four-criterion classification framework encompassing process integration strategy, additive manufacturing process type, machine architecture, and application domain. DED-based, PBF-based, and polymer-based hybrid systems are examined alongside integrated hybrid machines, retrofit solutions, and robotic architectures. A comparative analysis of representative commercial platforms evaluates build envelope, integration strategy, and monitoring capability. Documented performance outcomes across aerospace, automotive, energy, and biomedical sectors confirm substantial improvements in surface quality, fatigue performance, dimensional accuracy, and material efficiency relative to conventional manufacturing routes. Current limitations are critically assessed across technical, process integration, and economic dimensions, and a structured near-to-long-term research roadmap is proposed, prioritising in-process sensing and toolpath standardisation, digital twin-based adaptive process planning, and ultimately autonomous hybrid manufacturing cells with lifecycle certification. These findings position HAM as a central enabling technology for intelligent, flexible, and sustainable production within Industry 4.0 and Industry 5.0 paradigms. Full article

B-cell maturation antigen (BCMA), G protein-coupled receptor class C group 5 member D (GPRC5D)-directed immunotherapies, chimeric antigen receptor T-cell (CAR-T) products, bispecific T-cell engagers (BsAbs), and antibody–drug conjugates (ADCs), have transformed the management of MM. Their adoption is now extending beyond tertiary centers following FDA modifications for CAR-T safety and the rapid uptake of off-the-shelf bispecifics suitable for community delivery. Clinicians outside specialist hubs must therefore be conversant with the full toxicity spectrum, including rare but high-consequence events, both for informed consent and for the work-up of post-therapy complications. In this narrative review, we report on the published literature around toxicities of approved and investigational BCMA- and GPRC5D-directed therapies, drawing on pivotal trial data, real-world cohorts, pharmacovigilance studies, and consensus management recommendations, with emphasis on practical recognition and risk mitigation. This review presents toxicities by a temporal pattern including acute (CRS, ICANS, infection, ocular, mucocutaneous), subacute (cranial nerve palsies, parkinsonism, myelitis, peripheral neuropathies IEC-associated enterocolitis and cardiovascular events), and long-term (prolonged cytopenias, second primary malignancies). We discuss validated risk stratification tools, such as the CAR-HEMATOTOX score, EASIX index, and multidisciplinary geriatric assessment, which predicts severe ICANS, infection, and resource utilization, supporting individualized pre-treatment planning. Safe delivery of immune therapies in community settings requires infrastructure for acute critical care, neurology, ophthalmology, infectious disease and long-term surveillance, but is achievable when paired with validated risk stratification and clear referral pathways. Full article

Background/Objectives: Human papillomavirus (HPV) is a well-established prognostic marker in oropharyngeal squamous cell carcinoma (OPSCC); however, the short-term treatment response remains heterogeneous, particularly among HPV-positive patients. Given the high prevalence of malnutrition in head and neck cancer, this study examined whether baseline nutritional status, body composition and functional status were associated with early treatment response in OPSCC according to HPV status. Methods: A prospective observational multicenter cohort study of newly diagnosed OPSCC patients eligible for curative-intent treatment was conducted at three tertiary hospitals in Barcelona, Spain. Baseline assessments comprised anthropometry, computed tomography (CT)-based body composition at L3, functional performance tests, systemic inflammatory biomarkers and nutritional diagnosis by the Patient-Generated Subjective Global Assessment (PG-SGA). Early treatment response, assessed around 12 weeks post-therapy, was classified as complete remission (CR) or non-complete remission (NCR). Classification tree analyses were performed separately by HPV status. Results: Of 101 enrolled patients, 97 completed post-treatment assessment, of whom 51% were HPV-positive. Among HPV-positive patients, PG-SGA score was the main discriminating variable for early response within the classification tree model, with CR achieved in 74% of patients scoring <6 versus 33% of those scoring ≥6 (AUC 0.68, 95% CI 0.55–0.82). Conversely, Eastern Cooperative Oncology Group Performance Status (ECOG PS) and age were the primary discriminating variables in HPV-negative patients (AUC 0.81, 95% CI 0.70–0.93). In both HPV subgroups, body composition and inflammatory markers were not retained in the analysis once nutritional and functional status were considered. Conclusions: PG-SGA-defined nutritional status was associated with early treatment response in HPV-positive patients, while functional status was the main variable retained in HPV-negative patients. These findings support the potential clinical value of standardized nutritional assessment in OPSCC and suggest that early identification of poor nutritional status or functional impairment may help refine supportive care planning at treatment initiation. Full article

Background: Neuroendocrine tumors—are relatively rare but increasingly diagnosed malignancies originating from diffuse neuroendocrine cells, most commonly affecting the gastroenteropancreatic system. Due to their long asymptomatic development and low incidence, pose a diagnostic and therapeutic challenge for physicians. Recently, the role of nuclear medicine has been growing not only in the diagnostic stage but also in treatment. Systemic radionuclide therapy using somatostatin analogs labelled with the radioisotope lutetium-177 is becoming increasingly common in patients with advanced-stage disease. Currently, most patients receive a standard activity of therapeutic radiopharmaceuticals. Recent clinical studies provide increasing evidence of a close relationship between the absorbed radiation dose in pathological lesions and the therapeutic effect of radioisotope therapy. Internal dosimetry is used to measure the doses of ionising radiation absorbed by the patient after administration of the radiopharmaceutical. The lack of individual internal dosimetry prior to therapy means that only a small fraction of patients receive optimal doses of radioactivity, which is markedly different from external beam radiotherapy planning. Methods: A narrative literature review was conducted using the PubMed/MEDLINE and Embase databases, focusing primarily on publications from the last years. The search strategy included combinations of keywords related to peptide receptor radionuclide therapy and dosimetry, such as “Lutetium-177”, “neuroendocrine tumors”, “dosimetry”, “PRRT”, “systemic radionuclide therapy” and “artificial intelligence”. Particular emphasis was placed on recent prospective clinical studies, multicenter investigations, systematic reviews and consensus documents published by major nuclear medicine societies, including the European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI). Seminal earlier publications considered essential for understanding the development of dosimetry concepts and clinical implementation were also included. Results: This study confirms the existence of a clinically significant dose-response relationship in ¹⁷⁷Lu-PRRT. Higher absorbed doses to tumour lesions are associated with longer progression-free survival. The lack of individualized internal dosimetry prior to therapy means that only a small proportion of patients receive optimal radiation doses. Simplified dosimetric approaches with a reduced number of imaging time points, together with emerging artificial intelligence–based tools, appear promising for reducing the complexity of the dosimetry process. Conclusions: The aim of this study was to analyse the current literature on the role of internal dosimetry in the treatment of neuroendocrine tumors using the radioisotope lutetium-177. Available data support the clinical relevance of individualized dosimetry and highlight its potential to optimize both therapeutic efficacy and treatment safety. Full article

Background/Objectives: Evidence on spinal versus general anesthesia in unilateral total knee arthroplasty (TKA) may not extend to one-week-staged bilateral surgery, where older patients receive two anesthetics in a short interval and intra-operative spinal-to-general conversion is common but rarely reported transparently. We compared peri-operative acute kidney injury (AKI) and transfusion between strategies in this setting. Methods: We retrospectively analyzed 207 patients (414 surgeries) undergoing one-week-staged bilateral primary TKA at one center. Co-primary endpoints were creatinine-based AKI (patient level) and packed-red-blood-cell transfusion (surgery level). Because 42 general-anesthesia-classified surgeries had an attempted spinal injection, the primary analysis used the initial anesthetic plan (an intention-to-treat analogue), reclassifying these as spinal, with as-treated classification as a sensitivity analysis; AKI was modeled at the patient level (any general anesthesia versus spinal–spinal) and transfusion per surgery. Results: Median age was 75 years and 82.6% were female; AKI affected 74 of 207 patients (35.7%) and transfusion 185 of 414 surgeries (44.7%). The adjusted any-general-anesthesia versus spinal–spinal estimate was not statistically significant and opposite the spinal-protective hypothesis (adjusted odds ratio 0.49, 95% confidence interval 0.23–1.01, p = 0.054), and no pre-specified sensitivity scenario survived Benjamini–Hochberg correction. Transfusion did not differ between strategies; among secondary endpoints, length of stay, hemoglobin drop, peak C-reactive protein, and intra-operative hypotension likewise showed no significant difference after multiplicity correction. Conclusions: These hypothesis-generating findings do not support changing anesthetic practice; the choice should remain individualized. Approximately 12% of attempted spinal anesthetics converted intra-operatively to general anesthesia—a record-based observation, not a validated failure rate. Full article

Aging is a systemic degenerative process that can lead to functional decline in multiple organs, such as skeletal muscles and the heart, and accelerates the overall aging process through organ-to-organ interactions mediated by metabolites such as short-chain fatty acids (SCFAs). SCFAs serve as a crucial link connecting intestinal health and anti-aging, and their levels and functions undergo significant changes with aging. However, current research lacks understanding of the downstream molecular mechanisms of SCFAs, and intervention methods are mostly limited to simple regulation. This article clarifies the intrinsic relationship between SCFAs and aging from a systemic perspective, analyzes their regulatory mechanisms through key signaling pathways, examines their roles in tissue barrier protection, the improvement of metabolic disorders, and immune regulation, and summarizes their therapeutic potential and diversified intervention strategies in aging-related diseases. The detailed molecular mechanisms by which SCFAs regulate aging are still unclear, and there are no precise intervention plans for different aging stages and organ damage. In the future, we need to utilize techniques such as single-cell sequencing and organ models to explore the regulation of aging cell fates, providing support for the development of metabolite-mediated personalized anti-aging intervention measures. Full article

The prognostic value of post-radiotherapy (RT) lymphocyte recovery remains unclear in locally advanced esophageal squamous cell carcinoma (ESCC), and tools to predict recovery are lacking. This study evaluated lymphocyte recovery as a survival predictor and developed a prediction model. We analyzed 233 patients (2019–2024; training:validation = 7:3). Lymphocyte recovery was assessed at 1 and 3 months post-RT (ΔALC₁ > 0.41 and ΔALC₃ > 0.25 × 10⁹/L, calculated as ALC at each time point minus ALC at the end of RT). Patients were stratified into three groups by recovery status: no recovery (Group 0), recovery at both time points (Group 2), or at only one time point (Group 1). Multivariate logistic regression identified predictors of lymphocyte recovery, and a nomogram was developed and internally validated. Median overall survival (OS) was 26.4 months and median progression-free survival (PFS) was 13.9 months. OS differed significantly among groups: 16.0 months (Group 0), 26.0 months (Group 1), and 50.0 months (Group 2) (p < 0.001). Median PFS was 10.2, 12.0, and 36.6 months, respectively (p < 0.001). Independent predictors included ECOG 0 and thoracic spine V₅ < 57.3%; planning target volume < 210 cm³ showed a trend toward association (p = 0.051). The nomogram demonstrated AUCs of 0.77 and 0.75 in the training and validation cohorts. Superior lymphocyte recovery appears to be associated with improved survival. The model, if externally validated, may facilitate individualized risk stratification. Full article

Sublobar pulmonary resection has become an increasingly adopted approach for early-stage non-small cell lung cancer, driven by evidence that anatomical segmentectomy can achieve oncological outcomes comparable to lobectomy in selected patients. Safe execution of sublobar resection depends on accurate preoperative identification of segmental bronchovascular anatomy, which demonstrates substantial variability. Conventional two-dimensional (2D) computed tomography (CT) imposes significant limitations on anatomical interpretation, particularly at the segmental and subsegmental level. Three-dimensional (3D) bronchovascular modelling provides patient-specific representations of segmental anatomy and relationships that address these limitations. This narrative review examines the current and emerging roles of 3D modelling in personalised thoracic surgery. It discusses the anatomical basis for its application, the limitations of conventional imaging, and the contribution of 3D modelling to preoperative planning and intraoperative decision making. It also considers broader applications, current limitations, and future directions, with emphasis on how patient-specific 3D modelling can support more tailored operative strategies and more individualised surgical care. Full article

Mucopolysaccharidosis (MPS) are a group of inherited lysosomal storage genetic disorders that affect the body’s ability to break down glycosaminoglycans (GAGs) due to the deficiency of required enzymes. This leads to depositions of these GAGs in various tissues and organs resulting in multi-systemic manifestations including pulmonary and sleep related issues. In recent years, there have been significant advancements in therapeutic options and supportive management which have led to the overall improvement in respiratory care, culminating in improved quality of life for MPS patients. Management of pulmonary and sleep disorders in mucopolysaccharidosis requires a multidisciplinary approach due to the multi-systemic affectation of the genetic disorders. Therapeutic options such as enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation (HSCT) have yielded varying success in mitigating respiratory complications. Emerging treatments such as gene therapies have shown exciting and promising results thus far. Supportive therapies such as airway clearance, regular vaccination and use of positive airway pressure devices are also essential. Pre-operative airway and anesthesia planning is critical to mitigate peri-operative and post-operative complications. Early diagnosis, close monitoring and a patient focused individualized approach are essential for respiratory optimization and overall improvement in clinical outcomes. This review article aims to discuss these advancements in a comprehensive format, making it accessible to medical providers who care for this subset of patients. Full article

Chronic kidney disease (CKD) is common in older cats, but cortical transcript-level relationships among hypoxia response, iron handling, and lipid oxygenation are poorly defined. This analysis-plan-guided, hypothesis-generating secondary analysis used public feline renal RNA-seq data (GSE303653). The internal plan fixed the gene panel, composite construction, primary inferential test, and quality-control thresholds before the review of the present expression results, but was not publicly registered. After technical quality control, 21 renal cortex samples from control, CKD 1/2, and CKD 3/4 cats were analyzed. A 23-gene panel and whole-transcriptome differential expression were evaluated using likelihood ratio testing as the primary panel-level screen, with pairwise DESeq2 contrasts, Spearman summaries, enrichment, medulla, composite, and marker-set analyses as secondary or exploratory context. VEGFA, FTL, and NCOA4 decreased with ordinal disease group, whereas ALOX5 and HIF1A increased; eight panel genes were stage-associated by likelihood ratio testing. The equal-weight composite was nonmonotonic. Advanced CKD enrichment was dominated by immune and inflammatory terms, while GPX4 and ferroptosis-pathway enrichment were not stage-significant. The findings support heterogeneous transcript-level remodeling, including ALOX5-associated inflammatory/lipid-oxygenation signal and HIF1A–VEGFA divergence, rather than evidence of ferroptotic cell death, pathway activation, or cell-specific mechanism. Full article

The Jabal Ali Marine Sanctuary, Dubai, is one of the most important marine protected areas (MPAs) in the UAE. The Arabian Gulf is characterised by extreme environmental conditions, including high temperatures and hypersaline waters. These conditions, combined with increasing anthropogenic pressures from coastal development projects such as desalination plants, energy plants and the Palm Jebel Ali development, may influence the pelagic ecosystems of MPAs. This study examined seasonal variability in phytoplankton communities and environmental conditions between summer (June 2017) and winter (December 2017), with particular emphasis on the interactions between temperature-driven stratification, hypersaline conditions, and phytoplankton community structure, abundance, and diversity. The AZTI (AZTI Tecnalia Marine Research Centre) Marine Biotic Index indicated predominantly “Good” to “High” ecological status of the pelagic ecosystem, indicating favourable environmental conditions. Potentially harmful algal bloom taxa, including Pseudo-nitzschia and Dinophysis, were detected at low abundances. Summer surveys recorded higher total species richness (44 vs. 34 species) and greater phytoplankton abundance (mean 68.6 vs. 49.8 cells/L) compared to those in winter. Diatoms dominated the assemblages in both seasons, accounting for 62–69% of the recorded species, while distinct spatial zonation patterns reflected habitat heterogeneity. The observed seasonal and spatial variability highlight the importance of incorporating temporal and spatial dimensions into management strategies. As the first pelagic phytoplankton assessment conducted in an MPA, this study provides important baseline data for understanding phytoplankton ecology in one of the world’s most environmentally extreme marine ecosystems. The findings contribute to evidence-based management under increasing climate change and anthropogenic pressures. However, because sampling was limited to the two principal climatic seasons, the study characterises inter-seasonal variability rather than a complete annual succession cycle. Additional surveys during spring and autumn are recommended to fully resolve seasonal succession dynamics. Overall, the findings support the continued protection of the sanctuary as an important biodiversity reservoir and a potential reference site for assessing marine ecosystem responses to environmental conditions. These findings are directly relevant to the environmental sustainability agenda of the Dubai 2040 Urban Master Plan, which prioritises the protection and expansion of the emirate’s nature reserves and the safeguarding of marine and coastal biodiversity. By establishing the first pelagic phytoplankton baseline for the sanctuary, this study provides an evidence base for monitoring and managing marine protected areas in line with this long-term framework. Full article

In many orographically complex monsoon basins, rain gauge networks are sparse and lack the long-term continuous records required for reliable precipitation probability analysis. Traditional regional frequency analysis assumes spatially uniform precipitation across the analysis zone, which is inadequate for basins with steep rainfall gradients and strong seasonal variability. Gridded precipitation products (GPPs) provide spatially continuous, long-term records that enable grid-cell-level probability distribution fitting. However, GPPs may exhibit local biases and errors, and statistical evaluation against gauge observations is necessary before application. This study was conducted in the Phetchaburi–Prachuap Khiri Khan River Basin, western Thailand, a region with steep orographic and coastal rainfall gradients. Four GPPs, namely CHIRPS, CHELSA, WorldClim, and PERSIANN-CCS-CDR, were evaluated against gauge observations. The best-performing product, after monthly bias correction, was then used to generate spatially continuous monthly exceedance probability maps using grid-cell gamma distribution fitting. CHELSA showed the best overall performance across all evaluation metrics (correlation coefficient (r) = 0.908, percent bias (PBIAS) = 7.0%, root mean square error (RMSE) = 48.3 mm), passing the Kolmogorov–Smirnov (KS) goodness-of-fit test at all 96 station-months. CHIRPS and WorldClim showed satisfactory overall performance but exhibited localized biases in complex terrain, whereas PERSIANN-CCS-CDR substantially overestimated wet-season rainfall, limiting its suitability for this basin. Spatial precipitation patterns varied markedly between monsoon regimes, shifting from a dominant west-to-east orographic gradient during the southwest monsoon to a less differentiated advective pattern during the northeast monsoon. Furthermore, analysis at the 75% exceedance probability level showed that mean-based effective rainfall overestimated reliable water supply in high-variance months, leading to underestimation of supplemental irrigation demand. The generated maps provide spatially explicit dependable rainfall estimates across the basin, supporting probabilistic agricultural water management at multiple planning scales in orographically complex monsoon basins. Full article

Rapid urbanization reshapes urban land systems and intensifies surface thermal heterogeneity, yet nonlinear day–night land surface temperature (LST) responses to grey–green spatial organization and building morphology remain insufficiently understood, particularly in thermally stressed areas across the urban–rural gradient. Using Xi’an, China, as a case study, this study develops a priority-area-based land–climate interaction framework. Priority areas were defined as grid cells where elevated LST coincided with relatively strong local explanatory relationships between LST and land-cover or morphological variables. Multiscale geographically weighted regression (MGWR), gradient boosting decision trees (GBDTs), SHAP-based interpretation, and threshold sensitivity analysis were combined to identify dominant drivers, nonlinear response patterns, and interaction structures of daytime and nighttime LST. The results show pronounced day–night differentiation: daytime hotspots were concentrated in the built-up core, whereas nighttime hotspots extended toward the urban–rural fringe. Daytime LST was mainly associated with building coverage and grey-space organization, while nighttime LST was more strongly related to mean building height and the cooling contribution of green-space coverage. The analysis further identified localized empirical response ranges for built-up intensity, grey-space connectivity, building height, and green-space coverage within the priority areas. These findings clarify how land-cover configuration and building morphology jointly shape day–night surface thermal responses and provide context-specific evidence for land-use planning and targeted urban heat mitigation. Full article