Search Results (8,578)

The agricultural sector is increasingly confronted with numerous challenges, including declining prices for agricultural products, escalating production costs, intensified globalization, rapid industrialization, urban expansion and growing competition in global markets. To promote rural development and improve farmers’ livelihoods through diversified sources of income, agritourism has been identified as a viable alternative strategy. This study aims to determine the factors influencing farmers’ willingness to participate in agritourism in Mpumalanga Province, South Africa. Primary data were collected from November 2022 to June 2023 using a structured questionnaire and a simple random sampling technique to select 100 farmers. A logistics regression model was used to analyse data. The findings revealed that profitability, non-farm employment, the number of labourers, and access to information positively influence WTP. Age also positively influenced WTP, while marital status showed a negative but significant effect. The findings imply that farmers with stronger financial capacity, labour availability and access to information are more likely to consider agritourism as a diversification strategy. The study suggests strengthening extension services, improving farm profitability and enhancing access to information to increase readiness to engage in agritourism. Full article

Silage is a fundamental component of cattle feed, and its microbiological quality is critical for animal health and human safety. Improper ensiling conditions, such as oxygen exposure or inadequate acidification, can promote the growth of pathogens like Listeria monocytogenes, Clostridium botulinum, and Bacillus cereus. This study aimed to evaluate the microbial status of maize silages and identify pre-ensiling factors influencing its hygienic safety. Over a four-year period, 406 silage samples were collected from cattle farms across Poland. The research evaluated general hygiene indicators and screened for specific pathogens using standard culture methods, polymerase chain reaction toxotyping, and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The impact of agricultural practices, including soil quality, organic fertilization, and microbial inoculation, was also analyzed. The analysis revealed that 32.1% of silages fell outside the reference pH range, indicating potential aerobic instability. While Salmonella and Campylobacter were not detected, Clostridium spp. were highly prevalent (81.0%), and C. perfringens was confirmed in 24.9% of samples. Listeria species occurred in 2.9% of silages, with L. innocua being the most frequent isolate. Statistical analysis showed that organic fertilization was significantly linked to specific C. perfringens toxotypes, though it did not increase the overall microbial burden. Conversely, microbial inoculation generally reduced the counts of several undesirable bacteria, although these differences were not statistically significant across all parameters. High pH values and significant contamination with Clostridium, B. cereus, and fungi remain critical challenges for silage safety. The results underscore the necessity for improved agricultural practices—specifically the minimization of soil and manure contamination during harvest—and the broader adoption of microbial inoculation to ensure the microbiological stability of fermented forage. Full article

This study compared intestinal polyamine metabolism and barrier function between Ningxiang (NX) and Duroc × Landrace × Yorkshire (DLY) piglets under baseline conditions and following ETEC challenge. Experiment 1 (baseline, n = 12/breed) assessed colonic barrier integrity, immune status, polyamines, and microbiota. Experiment 2 (ETEC challenge, n = 8/group/breed) evaluated responses to oral ETEC (10⁹ CFU) over 3 days. Under baseline conditions, NX piglets showed superior barrier integrity, higher goblet cell numbers and mucin 2 (MUC2) protein expression, and lower plasma levels of intestinal permeability markers—diamine oxidase (DAO), D-lactate (DLA), and endotoxin (ET)—compared with DLY piglets. NX piglets also exhibited reduced colonic pro-inflammatory cytokine levels (IL-6 and IL-1β) and higher expression of immune-related markers (CD3, CD68, and IgA) versus DLY piglets. In contrast, DLY piglets displayed more active microbial polyamine metabolism in the colon, with higher concentrations of putrescine, spermidine, and spermine, as well as increased ornithine decarboxylase (ODC) expression. 16S rRNA sequencing revealed greater microbial diversity and enrichment of taxa (Muribaculaceae_unclassified, Prevotella) in NX piglets, whereas DLY piglets showed enrichment of polyamine-associated genera (Collinsella, Veillonella). Following the ETEC challenge, DLY piglets displayed pronounced polyamine upregulation, including elevated polyamine levels and ODC1 expression. Conversely, NX piglets maintained more stable polyamine metabolism, higher expression of tight junction proteins (ZO-1 and occludin), lower plasma permeability markers, reduced pro-inflammatory cytokine expression (IL-6, IL-1β, IL-22), and increased anti-inflammatory IL-10 expression. Collectively, these findings demonstrate that NX piglets possess superior intestinal barrier integrity and immune maturity, while DLY piglets exhibit a more active but stress-responsive polyamine metabolic phenotype. The divergent metabolic and immune responses to ETEC challenge underscore the distinct strategies employed by these two breeds in maintaining gut homeostasis. These findings provide preliminary insights that may inform future breeding strategies aimed at enhancing intestinal health and disease resistance in pigs, pending validation in broader genetic backgrounds and mechanistic studies. Full article

Despite the productivity and economic limitations imposed by environmental and climatic conditions, livestock systems play a fundamental role in preserving habitats and high-conservation-value species, while delivering a broad spectrum of ecosystem services to rural populations. Breeders need timely information to produce safe, inexpensive, environmentally, and welfare-friendly food products. Information on feeding and nutrition is of particular importance since it represents a significant percentage of animal breeding costs. Automating the collection, analysis, and use of production-related information on livestock feeding systems represents one of the central challenges facing the sector. Precision feeding systems (PFSs) have deeply changed farm management by providing new information on the health status of animals, their welfare, and nutritional requirements. PFSs encompass modern electronic and ICT-related (information and communication technologies) technologies that facilitate the electronic measurement of critical components, ensuring optimum efficiency of both resource use and animal productivity. This review analyzes the current state and potential applications of precision feeding systems for sustainable livestock production. The implementation and feasibility of PFSs have been investigated across the major animal production species and contexts. Based on the available literature, real-time monitoring and control systems can improve the production efficiency of livestock farms. However, further research is needed, as several components of PFSs are still at different stages of development and commercial readiness. Full article

Background/Objectives: Swift achievement of an optimal functional status after stroke may substantially reduce patients’ stay in a medical facility and enable their return home. The study aimed to assess the functional status in patients after their first stroke, depending on the time after stroke incident and the patient’s length of stay in the stroke rehabilitation ward. Methods: The data from 229 patients, aged 69.4 ± 11.3 years (120 men and 109 women), formed part of the analysis. Based on medical records, basic socio-demographic, clinical data, and the results of the tests—Mini Mental State Examination (MMSE), Barthel Index (BI), Time Walk Test 10 m (TWT), Trunk Control Test (TCT), Up and Go Test (TUG), and Berg Balance Scale (BBS)—were collected. Results: The risk groups for patients with longer post-stroke rehabilitation stays and poorer rehabilitation outcomes included women, older adults, those with poorer functional status, and patients admitted to the stroke rehabilitation ward after a longer period of time after stroke. Conclusions: The functional status and the length of stay in the post-stroke rehabilitation ward should be monitored and analyzed to find and support groups of patients who may rehabilitate more slowly and stay longer in the ward. A shorter patient stay can allow for more effective management of beds in the post-stroke rehabilitation wards. Full article

Objective: To develop machine learning models by integrating transvaginal ultrasound (TVUS) with clinical indicators, conduct visual analysis of the models, and systematically assess their diagnostic efficacy in differentiating early cervical neoplastic lesions. Methods: A total of 144 eligible patients (84 cases of early cervical cancer and 60 cases of cervical myoma) admitted to the First Affiliated Hospital of Chongqing Medical University from January 2018 to August 2025 were retrospectively enrolled in this study. Their clinical data, human papillomavirus (HPV) test results, Thinprep Cytologic Test (TCT) findings, TVUS images and magnetic resonance (MR) imaging data were collected and subjected to comprehensive statistical analysis. Univariate and multivariate Logistic Regression analyses were performed to identify independent differentiating factors for lesion classification. Eleven machine learning models were subsequently constructed, and their diagnostic performance was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and the DeLong test. Finally, a nomogram was developed based on the optimal-performing model for clinical visualization. Results: The TVUS–clinical indicator integration model identified five independent differentiating factors: HPV status, TCT findings, menopausal status, ultrasonic tumor blood supply, and ultrasonic tumor morphology. In contrast, the MR–clinical indicator integration model screened out three independent factors: HPV status, TCT findings, and intratumoral signal intensity on MR T2-weighted imaging (T2WI). The TVUS integration model demonstrated marginally superior diagnostic performance, with a sensitivity of 0.988, specificity of 0.983, and an area under the ROC curve (AUC) of 0.991, compared with the MR integration model (sensitivity: 0.952, specificity: 0.950, AUC: 0.975); however, this difference in AUC values was not statistically significant (p = 0.911). Among the 11 machine learning models, the Logistic Regression model exhibited optimal classification performance and stability. DCA curves confirmed that all constructed models outperformed single-index diagnostic strategies in clinical decision-making for lesion differentiation. A nomogram was further established based on the Logistic Regression model for intuitive clinical application. Conclusions: Multiple machine learning models integrating TVUS with clinical indicators are successfully developed, and a corresponding nomogram is constructed in this study. Full article

Background: Obstructive jaundice is a common clinical condition, often caused by malignant tumors such as hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCA). Percutaneous transhepatic cholangiodrainage (PTCD) is a widely used intervention method to relieve biliary obstruction in patients with obstructive jaundice; however, the impact of PTCD on hepatitis B virus (HBV) reactivation has not been thoroughly studied. Methods: A retrospective analysis was conducted from January 2016 to December 2024 on 235 patients with obstructive jaundice who underwent PTCD. Demographic, clinical, and procedural data were collected, and multivariate logistic regression was used to identify risk factors for HBV reactivation. Additionally, Cox regression was used to evaluate the time-to-reactivation variables. Results: The HBV reactivation rate in the PTCD group was 21.7%, significantly higher than the 8.9% in the non-PTCD group. Key risk factors for HBV reactivation in the PTCD group included the absence of antiviral prophylaxis, postoperative infection, elevated preoperative HBV-DNA levels, and multiple biliary punctures. Moreover, Cox regression revealed that a lack of antiviral therapy and postoperative infection were associated with earlier HBV reactivation. Conclusions: PTCD significantly increases the risk of HBV reactivation in patients with obstructive jaundice, especially in those with high preoperative HBV-DNA levels and without antiviral prophylaxis. Early detection of HBV reactivation and the initiation of antiviral therapy are critical to improving patient outcomes. These findings underscore the need for careful monitoring of HBV status in patients undergoing PTCD. Full article

Background: Malnutrition and systemic inflammation are increasingly recognized as important determinants of prognosis in patients with heart failure. Several immunonutritional indices, including the Prognostic Nutritional Index (PNI), the Controlling Nutritional Status (CONUT) score, and the C-reactive protein–albumin–lymphocyte (CALLy) index, have been proposed as markers of nutritional and inflammatory status. However, their prognostic value in elderly patients with heart failure with preserved ejection fraction (HFpEF) remains incompletely defined. This study aimed to evaluate the prognostic significance of these immunonutritional indices in elderly patients with HFpEF over a long-term follow-up period. Methods: This retrospective observational study included 200 elderly patients hospitalized with HFpEF (mean age 86.6 ± 6.5 years). Clinical, laboratory, and echocardiographic parameters were collected at admission. Nutritional status was assessed using PNI, CONUT score, and CALLy index. Patients were followed for mortality during long-term follow-up. Survival analyses were performed using Cox regression models, receiver operating characteristic (ROC) curves, and Kaplan–Meier analysis. Median follow-up was 3.8 years (IQR 2.1–5.9). Results: During follow-up, 123 patients (61.5%) died, while 77 patients (38.5%) were alive at the end of observation. In univariate analysis, PNI, CONUT score, left ventricular ejection fraction (LVEF), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio were significantly associated with mortality. In multivariate analysis, the CONUT score, LVEF, and the TAPSE/sPAP ratio remained independent predictors of mortality. ROC analysis showed strong prognostic performance for the TAPSE/sPAP ratio (AUC 0.932), CONUT score (AUC 0.925), and LVEF (AUC 0.897). Optimal cut-off values for mortality prediction were CONUT ≥ 6, LVEF ≥ 65%, and TAPSE/sPAP ≤ 0.55 mm/mmHg. Kaplan–Meier analysis confirmed significantly reduced survival among patients with higher CONUT scores, higher LVEF, and an impaired TAPSE/sPAP ratio. Conclusions: In elderly patients with HFpEF, nutritional status and cardiopulmonary functional parameters are important determinants of long-term prognosis. The CONUT score emerged as the most informative immunonutritional index, while echocardiographic parameters reflecting ventricular function and right ventricular–pulmonary arterial coupling provided additional prognostic information. Integrating nutritional assessment with echocardiographic evaluation may improve risk stratification in elderly patients with HFpEF. Full article

Shellfish aquaculture can alter sediment conditions and affect benthic ecosystem functioning, so dredging is widely applied as a management strategy to mitigate sediment deterioration. However, its ecological effectiveness remains uncertain. This study evaluated ecological quality under the disturbance of dredging in shellfish farming areas of Gamak Bay, South Korea, using multiple macrobenthic indices. Macrobenthic samples and environmental data were collected before (May 2025) and after dredging (August 2025). Five macrobenthic indices, including the AZTI Marine Biotic Index (AMBI), BENTIX, Benthic Polychaete/Amphipod ratio (BPA), Benthic Pollution Index (BPI), and Multivariate AMBI (M-AMBI), along with a composite index, were used to assess ecological quality. Temporal changes within groups were tested using Wilcoxon signed-rank tests, and differences between dredged and control stations were examined using Mann–Whitney U tests. Multivariate analyses were used to explore environmental gradients and community responses. Results showed clear seasonal variation in environmental conditions and macrobenthic community structure. Most indices indicated a decline in ecological quality after dredging, with higher AMBI values and lower BENTIX, BPI, and M-AMBI values at dredged stations. However, these changes were not statistically significant (p > 0.05), suggesting limited short-term effects of dredging. The proportion of stations with acceptable ecological status decreased slightly from May to August. Seasonal factors, particularly temperature and salinity, played a dominant role in structuring benthic communities. Overall, the findings indicate that the short-term dredging effects were weaker than seasonal environmental variability. A multi-index approach is recommended for robust ecological assessment, and long-term monitoring is necessary to fully evaluate the effectiveness of dredging in shellfish aquaculture systems. Full article

Syphilis and HIV are sexually transmitted disease (STDs) that interact synergistically. However, data on HIV–syphilis co-infection in Romania remain limited. We conducted a retrospective cohort study at a single Romanian HIV/AIDS Day Clinic, including 439 adult people living with HIV (PLWH) monitored between 2020 and 2025. Demographic, epidemiological, clinical, and laboratory data were collected, including HIV staging and syphilis history. Syphilis co-infection was identified in 81 patients (18.5%), and 61.5% met criteria for AIDS. Viral suppression was achieved in 82.2%, and 78.4% achieved CD4 counts >350 cells/mm³. Male sex, urban residence, unmarried status, sexual HIV transmission, genital condyloma, and other STIs were independently associated with syphilis. First episodes of syphilis were predominantly secondary (61%), neurosyphilis was present in 5%, and serofast evolution occurred in 12%, more frequently after reinfection. Among deceased patients, 20.9% had a history of syphilis, but co-infection was not significantly associated with mortality. Nine of 28 patients lost to follow-up had prior syphilis, suggesting a potential impact on retention in care. These findings indicate that HIV–syphilis co-infection is increasingly prevalent in Romania, driven primarily by behavioral factors, and highlight the need for targeted STD screening and prevention strategies among high-risk PLWH. Full article

Background/Objectives: This study analyzes the relationship between obesity phenotypes and sleep apnea risk in the Korean population. Methods: This study utilized data from the Korean National Health and Nutrition Examination Survey (KNHANES) collected between 2019 and 2021 (n = 10,970 adults; age ≥ 40 years). Obesity phenotypes were classified into four groups based on body mass index (BMI) and the presence of metabolic syndrome: metabolically healthy normal weight (MHNW), metabolically abnormal normal weight (MANW), metabolically healthy obese (MHO), and metabolically abnormal obese (MAO). Sleep apnea risk was assessed using the STOP-Bang questionnaire, and multivariate logistic regression analyses were performed to evaluate the association between obesity phenotypes and sleep apnea. Results: Among the 10,970 participants, the phenotypes were as follows: MHNW, 51.1%; MANW, 10.3%; MHO, 15.8%; and MAO, 21.8%. Baseline characteristics differed significantly across phenotypes, with the metabolically unhealthy groups (MANW and MAO) being older and exhibiting more cardiometabolic risk factors than the metabolically healthy groups. The prevalence of STOP-Bang questionnaire components differed significantly across phenotypes (all p < 0.001), and the mean STOP-Bang score increased from MHNW to MAO. In multivariate logistic regression analyses, the odds (adjusted odds ratio [95% CI]) of high sleep apnea risk were significantly elevated in all non-MHNW phenotypes: MAO (10.27 [7.71–13.68]), MHO (6.17 [4.35–8.75]), and MANW (1.91 [1.22–2.98]). Notably, MAO conferred a significantly higher risk than MHO (OR 1.69 [1.34–2.13]), highlighting the synergy of obesity and metabolic dysfunction. Obesity phenotypes, defined by BMI and metabolic health status, were differentially associated with sleep apnea risk in Korean adults. The highest risk was observed in individuals with both obesity and metabolic syndrome, while metabolically abnormal normal-weight adults also showed a significantly increased risk. Conclusions: Metabolic dysfunction may contribute to sleep apnea risk beyond body size alone and may be considered in risk stratification strategies. Full article

Background: Measles remains a significant occupational hazard in healthcare settings. In the context of the 2017–2018 measles outbreak in Greece and amid an outbreak at the study hospital, this seroprevalence study aimed to identify gaps in measles serologic status among healthcare workers in a tertiary hospital in central Greece. Methods: We conducted a seroprevalence study among hospital employees between February and December 2017. Blood samples and data on sociodemographic and work-related characteristics were collected from a convenience sample of participants. Measles IgG and IgM antibodies were measured using the ELISA method to determine seropositivity. The 95% CIs for measles IgG seronegativity proportions were calculated using the Clopper–Pearson exact method. Associations between participant characteristics and measles antibody status were assessed using Firth’s penalized logistic regression models. Results: A total of 336 healthcare workers participated in the study (response rate: 24.9%). Overall, 5.4% (95% CI: 3.2–8.3) tested negative for measles IgG antibodies. No significant associations were observed between participants’ characteristics and measles IgG antibody status. Male participants had 15.8 times higher adjusted odds of testing positive for measles IgM antibodies compared with female participants (aOR: 15.8; 95% CI: 2.33–107.54; p = 0.005). Conclusions: Our results indicate a low—but not negligible—proportion of IgG measles seronegativity among participants. The detection of seronegative individuals born prior to 1970 challenges the assumption of universal natural immunity based solely on year of birth. Given the recent rise in measles outbreaks and the limited seroprevalence data among healthcare workers in Greece, these findings provide valuable data to support ongoing efforts to achieve full vaccination coverage in this group. Further research is warranted to investigate the observed sex differences in susceptibility to measles infection. Full article

Milk production in dairy herds is determined by both intrinsic and extrinsic factors, with reproductive efficiency serving as a primary determinant. Infectious, nutritional, and management-related challenges can reduce this efficiency. Following parturition, cows are more susceptible to clinical disorders due to a temporary loss of integrity in the cervix, vagina, and vulva, which allows environmental bacteria to ascend and alter the vaginal microbiota. These microbial changes may disrupt endocrine responses related to conception and contribute to repeat breeder cow syndrome (RBCS), which is defined as failure to conceive after three or more inseminations. This study investigated associations among cultivable vaginal bacteria, circulating progesterone and glucose concentrations, and reproductive performance in 30 fourth-parity Holstein cows with a body condition score of 3.5. Cows were classified by reproductive history as repeat breeders (RBCS; n = 14) or controls (CTL; n = 16). Vaginal mucosal samples were collected at insemination and cultured on blood agar and MacConkey media under aerobic and microaerobic conditions. Bacterial identification was conducted using Gram staining and standard biochemical assays. Blood samples were collected at insemination, on day 5 post-insemination, and every two days thereafter to measure progesterone and glucose concentrations. Fertility outcomes were analyzed using PROC GLIMMIX, and hormonal data were analyzed using mixed models with repeated measures. The bacterial genera identified included Bacillus, Escherichia coli, Staphylococcus, Klebsiella, Proteus, Streptococcus, and Actinomyces. Progesterone and glucose concentrations did not differ significantly between groups (p > 0.05). However, the fertility rate (p < 0.05; CTL:87.50% vs. RBCS:57.14%) and number of attempts to conceive (p < 0.001; CTL:2.5 vs. RBCS:6.7) differed statistically between treatments. A higher prevalence of S. hyicus was detected in RBCS cows, and E. coli, S. hyicus, and Proteus spp. were more frequently detected in non-pregnant cows. These findings suggest that the identified cultivable vaginal bacteria are associated with reproductive status in dairy cows. Full article

Background: Trace elements function as essential micronutrients involved in oxidative balance, mitochondrial activity, and cardiovascular metabolism. Cigarette smoking represents a significant source of toxic metals and may disrupt systemic trace element homeostasis. Alterations in micronutrient and metal balance may contribute to oxidative stress, endothelial dysfunction, and myocardial remodeling, which are central mechanisms in the pathogenesis of heart failure with preserved ejection fraction (HFpEF). This study aimed to investigate whether smokers with HFpEF exhibit distinct hair trace element profiles compared with smokers without HFpEF. Methods: In this prospective pilot study, scalp hair samples were collected from adults undergoing clinical evaluation for suspected cardiovascular disease. Trace element concentrations were determined using inductively coupled plasma mass spectrometry (ICP-MS). Participants were first stratified according to smoking status and subsequently, within the smoker subgroup, according to HFpEF diagnosis based on the Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide score (HFA-PEFF) algorithm. Differences in trace element concentrations were analyzed using appropriate statistical tests, with multiple-comparison correction using the Benjamini–Hochberg false discovery rate (FDR). Active smoking was defined as ≥10 cigarettes per day for at least 1 year, and cumulative exposure was quantified in pack-years. Results: Fifty-eight participants were included, including 27 active smokers. In unadjusted analyses, several trace elements differed between smokers with HFpEF and those without HFpEF, including vanadium, lithium, aluminum, and copper. However, after FDR correction, only copper remained significantly elevated in smokers with HFpEF (q = 0.004). Hair copper concentrations were markedly higher in the HFpEF group compared with smokers without HFpEF. These differences were observed alongside echocardiographic features consistent with diastolic dysfunction and structural cardiac remodeling. Conclusions: In this hypothesis-generating pilot study, smokers with HFpEF demonstrated elevated hair copper concentrations, suggesting disturbances in trace element and micronutrient homeostasis. Altered copper metabolism may reflect oxidative stress-related cardiometabolic remodeling associated with HFpEF. These findings raise the hypothesis that cardiometabolic phenotype, rather than smoking exposure alone, may modulate trace element homeostasis in HFpEF; however, causal relationships cannot be established. Full article

Thyroid cancer is the most common malignancy of the endocrine system and represents a biologically heterogeneous disease driven by the interplay between endocrine regulation, oncogenic signaling pathways, and tumor microenvironment dynamics. Although most follicular cell-derived thyroid cancers follow an indolent clinical course, a subset progresses toward aggressive, therapy-refractory phenotypes, underscoring the need for refined molecular understanding and improved biomarkers. This review comprehensively examines the molecular determinants of thyroid cancer progression, with particular emphasis on Thyroid Hormone (TH) signaling, the Mitogen-Activated Protein Kinase (MAPK) and Phosphoinositide 3-Kinase (PI3K)/AKT pathways, and the emerging role of microRNAs (miRNAs). We discuss how oncogenic alterations, most notably the ^V600EBRAF mutation, act as central drivers of tumor initiation and aggressiveness by sustaining MAPK/ERK signaling, promoting dedifferentiation, metabolic reprogramming, immune evasion, and resistance to targeted therapies. The cooperative role of PI3K/AKT signaling in reinforcing survival, invasion, and treatment resistance is highlighted, emphasizing the network-level integration of oncogenic pathways rather than linear dependency on single drivers. In parallel, thyroid hormones exert context-dependent effects on tumor biology through both genomic actions mediated by nuclear thyroid hormone receptors and non-genomic mechanisms initiated at the integrin αvβ3 receptor, linking endocrine status to cancer progression and therapeutic response. Finally, we review the expanding evidence supporting miRNAs as critical regulators of thyroid carcinogenesis and as promising diagnostic, prognostic, and predictive biomarkers. The clinical validation of miRNA-based panels and circulating miRNAs offers new opportunities to improve preoperative risk stratification, reduce overtreatment, and guide personalized therapeutic strategies. Collectively, these insights support a multidimensional framework for understanding thyroid cancer progression and highlight future directions for precision oncology. Full article