Search Results (1,803)

Background: Autopsy pathology remains the reference standard for determining the cause of death, reconstructing disease and injury mechanisms, ensuring diagnostic quality, and supporting medical education and forensic investigations. However, declining autopsy rates, workforce shortages, biosafety concerns, increasing diagnostic complexity, and the rapid evolution of digital technologies have stimulated the development of complementary investigative approaches. This review critically examines whether artificial intelligence (AI) and emerging technologies are driving a genuine paradigm shift toward digitally integrated death investigation. Methods: A structured narrative review informed by a systematic literature search was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science, covering publications from January 2000 through June 2026. Evidence addressing postmortem imaging, virtopsy, digital pathology, computational pathology, molecular autopsy, robotics, artificial intelligence, machine learning, and emerging omics technologies was critically appraised. Owing to the methodological heterogeneity of the available literature, findings were synthesized qualitatively according to technological maturity, forensic applicability, validation status, and implementation readiness. Results: The reviewed evidence demonstrates substantial progress in postmortem computed tomography, postmortem CT angiography, postmortem magnetic resonance imaging, whole-slide imaging, molecular autopsy, robotic-assisted postmortem procedures, three-dimensional reconstruction, and AI-assisted forensic analysis. These technologies enhance trauma evaluation, vascular imaging, ballistic reconstruction, digital documentation, remote consultation, diagnostic reproducibility, and multimodal integration of forensic evidence. Nevertheless, the level of evidence varies considerably across technological domains. Postmortem imaging represents the most mature and extensively validated technology, whereas most AI applications remain supported predominantly by retrospective proof-of-concept studies with limited multicenter external validation. Current systematic evidence further indicates that AI should presently be regarded as an assistive technology that augments expert forensic interpretation rather than replacing conventional autopsy or autonomous medicolegal decision-making. Conclusions: Contemporary autopsy pathology is evolving toward a hybrid model of digitally integrated death investigation in which conventional autopsy, imaging, digital pathology, molecular diagnostics, robotics, and AI function as complementary components of a unified forensic workflow. Current evidence supports a conceptual paradigm shift characterized by transformation of evidence acquisition, preservation, interpretation, and integration, while reaffirming that conventional autopsy remains the indispensable biological reference standard for the development, validation, and medicolegal interpretation of all emerging technologies. Future implementation should prioritize multicenter validation, standardized forensic datasets, explainable AI, digital chain-of-custody procedures, and robust regulatory governance to ensure safe and scientifically reliable integration into forensic practice. Full article

Sharia and Law colleges in Saudi universities provide a distinctive educational setting in which classical Islamic jurisprudential discourse and contemporary statutory legal discourse coexist within the same curriculum. Despite this shared institutional context, the pragmatic characteristics of these coexisting normative genres remain largely unexplored from a corpus-based perspective. This study examines how genre differences influence the linguistic formulation of legal definitions and religious rulings across four officially prescribed texts: two classical Hanbali works—Rawḍat al-Nāẓir by Ibn Qudāma and Al-Rawḍ al-Murbiʿ by al-Buhūtī—and two contemporary Saudi statutes—the Civil Transactions Law and the Law of Criminal Procedure. A purpose-built corpus of approximately 480,000 words was analysed using a corpus-assisted discourse analysis design integrating quantitative frequency and keyword analysis with systematic manual pragmatic coding within a triangulated theoretical framework. The findings show that differences in disciplinary genre are systematically reflected in distinct pragmatic profiles. Rawḍat al-Nāẓir is characterised by assertive-definitional speech acts and methodological deontic expressions, whereas Al-Rawḍ al-Murbiʿ is dominated by directive speech acts associated with applied legal rulings. The statutory texts employ standardised legislative constructions, including negative-exceptive formulations, formal prohibition markers, and institution-specific obligation structures. The Civil Transactions Law further exhibits a hybrid pragmatic register through the incorporation of classical jurisprudential maxims into enacted statutory provisions. Based on the systematic literature review undertaken for this study, the findings provide what is, to the best of the authors’ knowledge, the first corpus-based pragmatic comparison of these coexisting curricular genres. The study thereby contributes to Arabic legal linguistics, corpus pragmatics, and the linguistic analysis of legal education, while offering empirically grounded insights for curriculum development in Sharia and Law programmes. Full article

Robotic-assisted minimally invasive esophagectomy (RAMIE) has emerged as an increasingly utilized approach for the surgical management of esophageal malignancies, offering potential advantages over conventional minimally invasive esophagectomy (MIE) and open esophagectomy (OE). Advances in robotic technology, enhanced visualization, instrument articulation, and surgeon ergonomics have facilitated wider adoption of RAMIE in thoracic surgical oncology. This review summarizes contemporary evidence regarding intraoperative, postoperative, oncologic, and patient-centered outcomes associated with RAMIE while highlighting emerging technologies and future directions in the field. Current literature, including randomized controlled trials, meta-analyses, propensity-matched studies, and international registry data, suggests that RAMIE is associated with reduced blood loss, improved lymph node harvest, and lower pulmonary morbidity compared with OE, while demonstrating outcomes comparable or favorable to conventional MIE. Oncologic outcomes, including R0 resection rates and overall survival, appear equivalent across approaches in most contemporary studies. In addition, robotic platforms may facilitate recurrent laryngeal nerve lymphadenectomy and complex mediastinal dissection. Despite these advantages, RAMIE is frequently associated with longer operative times and remains dependent on institutional expertise, surgeon experience, and resource availability. Current evidence is promising but remains limited by heterogeneity of surgical techniques, institutional expertise, and a relative scarcity of long-term randomized data. Emerging innovations including fluorescence-guided imaging, perfusion assessment technologies, artificial intelligence integration, augmented reality, and advanced robotic platforms may further enhance precision, safety, and personalization of esophageal cancer surgery. As robotic technology and perioperative systems continue to evolve, ongoing prospective investigation and long-term oncologic evaluation will remain essential to define the optimal role of RAMIE within multidisciplinary esophageal cancer care. Full article

Background and Objectives: Conversion therapy has expanded treatment options for patients with initially unresectable hepatocellular carcinoma (HCC), but the surgical literature remains focused more often on radiologic response than on the pathological, perioperative, and postoperative outcomes of patients who actually proceed to hepatectomy. This focused systematic review aimed to synthesize the available evidence on conversion hepatectomy after contemporary combination downstaging for initially unresectable HCC. Materials and Methods: A structured PubMed/MEDLINE search with backward reference-list screening was performed and last updated on 3 February 2026. The full Boolean strategy, field tags, and eligibility framework are now reported explicitly. Because the literature was observational and clinically heterogeneous, findings were synthesized narratively and complemented by structured assessments of reporting completeness, potential cohort overlap, and study-level bias. Results: Fourteen studies were included, nearly all retrospective and predominantly from East Asia. Treatment platforms clustered into systemic doublets, systemic plus HAIC strategies, and broader locoregional–systemic triplet or multimodal approaches. Across studies reporting pathological response, pathological complete response ranged from 28.0% to 50.0%, while R0 resection ranged from 85.7% to 100%, where stated. Postoperative morbidity ranged from 14.3% to 71.4%, and major complication rates from 9.5% to 16.9%; however, extent of resection, liver reserve, post-hepatectomy liver failure, transfusion, and perioperative mortality were not uniformly reported. Most studies carried moderate-to-high overall concerns for bias because of response-based surgical selection, heterogeneous denominators, incomplete perioperative reporting, and possible partial overlap among some cohorts. Conclusions: The available literature suggests that conversion hepatectomy can be feasible and oncologically meaningful in carefully selected patients treated in experienced centers, but current evidence remains hypothesis-generating rather than practice-standardizing because it is observational, heterogeneous, and incompletely reported. Full article

Background/Objectives: Emergency abdominal surgery is associated with substantial morbidity and mortality due to disease severity, physiological instability, and limited opportunities for preoperative optimization. Accurate risk stratification is therefore essential for guiding clinical decision-making and resource allocation. This review aims to provide a contemporary overview of predictive models and artificial intelligence (AI) applications for risk stratification in emergency abdominal surgery. Methods: A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, and Web of Science databases. Studies addressing conventional risk assessment tools, predictive modeling, machine learning, deep learning, radiomics, explainable AI, and clinical implementation in emergency abdominal surgery were evaluated. Relevant publications concerning acute appendicitis, acute cholecystitis, intestinal obstruction, emergency laparotomy, abdominal sepsis, and acute mesenteric ischemia were included. Results: Conventional risk assessment systems, including ASA, APACHE II, SOFA, POSSUM, SORT, and NELA, remain widely used but are limited by static risk calculations and restricted adaptability. Recent advances in artificial intelligence have enabled machine learning and deep learning models capable of integrating complex clinical, laboratory, and imaging data to improve prediction of disease severity, postoperative complications, and mortality. The strongest evidence has been reported for acute appendicitis, acute cholecystitis, intestinal obstruction, abdominal sepsis, and emergency laparotomy, where several studies demonstrated excellent discriminative performance, frequently reporting area under the receiver operating characteristic curve (AUC) values exceeding 0.85. Emerging applications of radiomics, computer vision, and explainable artificial intelligence further enhance predictive capability and model interpretability. However, most available models remain retrospective, single-center developments with limited external validation and inconsistent reporting of calibration, highlighting the need for prospective multicenter evaluation before routine clinical implementation. Conclusions: Artificial intelligence has the potential to significantly enhance risk stratification in emergency abdominal surgery by enabling more precise and individualized prediction of adverse outcomes. Although current evidence is encouraging, robust prospective validation and responsible clinical implementation are required before AI-driven predictive models can be routinely incorporated into emergency surgical practice. Full article

Inorganic scale deposition in crude oil–water transport trunklines is a formidable flow assurance challenge, uniquely exacerbated in extensive gathering networks where multiple production flowlines commingle multiphase fluids. As some fields experience progressively higher water cuts, the mixing of incompatible waters, characterized by diverse thermodynamic profiles and varying concentrations of scaling ions (Ca²⁺, Ba²⁺, Sr²⁺, ${\mathrm{SO}}_4^{2-}$, ${\mathrm{CO}}_3^{2-}$, etc.) triggers severe precipitation. This comprehensive literature review synthesizes seminal and contemporary studies to critically evaluate the state-of-the-art methodologies for assessing scaling risks in these intricate systems. Progressing chronologically and thematically, the analysis details the transition from static, bulk-fluid thermodynamic equilibrium calculations to dynamic, high-fidelity deterministic and probabilistic approaches. These advanced frameworks include Reactive Transport Modeling (RTM), Computational Fluid Dynamics (CFD), and Machine Learning (ML) architectures. Special emphasis is placed on the mathematical governing equations that dictate trunkline-specific phenomena: multi-stream commingling, non-isothermal gradients, probabilistic kinetic induction, and the profound impact of turbulent transport (turbophoresis) on crystal attachment and wall shear detachment. Finally, an integrated, multi-tier flow assurance workflow is proposed to guide future field-scale risk management and digital twin deployment. Full article

Background/Objectives: Surgical treatment of colorectal cancer (CRC) is associated with a substantial risk of postoperative complications and delayed recovery of functional capacity, particularly in older patients and those with multiple comorbidities. Preoperative prehabilitation has emerged as a strategy aimed at optimizing patients’ physical, nutritional, and psychological status prior to surgery; however, its clinical effectiveness and feasibility of implementation remain subjects of ongoing debate. The aim of this narrative review was to provide a clinically oriented synthesis of current evidence regarding multimodal prehabilitation in patients undergoing CRC surgery, with particular emphasis on perioperative outcomes, functional recovery, nutritional optimization, and implementation-related considerations. Methods: A targeted narrative review of the peer-reviewed literature indexed in PubMed (2015–2025) was conducted to identify contemporary review-type publications, including narrative reviews, systematic reviews, scoping reviews, and meta-analyses, addressing prehabilitation in CRC surgery. The findings were synthesized narratively and interpreted with emphasis on clinical applicability and translational relevance. Results: Twenty contemporary review publications were included in the analysis. Across the included publications, the most frequently reported favorable effects were observed for multimodal prehabilitation, incorporating physical exercise, nutritional support, and a psychological component. These interventions were associated with improvements in functional capacity and, in some meta-analyses, with a reduction in postoperative complication rates and shorter length of hospital stay, particularly in high-risk patients. Prehabilitation was assessed as safe and well tolerated. Conclusions: The current body of evidence indicates that multimodal prehabilitation may constitute a beneficial adjunct, particularly in improving functional capacity, while its impact on hard postoperative outcomes remains closely dependent on intervention quality, appropriate patient selection, and seamless integration with established perioperative care pathways. Future meta-analyses should address underexplored components of prehabilitation, including preparation for stoma formation and targeted educational and psychological support related to sexual health. Full article

Background and Objectives: Periodontal health represents a condition characterized by homeostasis between the teeth and the surrounding supporting tissues and implies the absence of inflammation, confirmed by the lack of bleeding, epithelial attachment loss, mobility, or periodontal pocket formation. Fixed prosthetic restorations may compromise periodontal health already during the fabrication phase, given that decisions made during their planning and placement affect long-term clinical outcomes. The aim of this manuscript was to provide insight into the interaction between periodontal tissues and fixed prosthetic restorations. Materials and Methods: A narrative literature review was conducted using a structured search of the PubMed/MEDLINE, Scopus, and Google Scholar databases to identify studies addressing periodontal health in relation to fixed dental prostheses. The impacts of tooth preparation, gingival retraction methods, supracrestal tissue attachment, periodontal phenotype, crown emergence profile, and marginal fit of various biomaterials were analyzed. Results: According to the literature data, subgingival margin placement and violation of the supracrestal tissue attachment (biological width) induce chronic inflammation, loss of epithelial attachment, and alveolar bone resorption. Gingival retraction agents, used in chemomechanical retraction procedures, particularly ferric sulfate-based agents, may lead to a transient but significant spike in inflammatory markers and dysbiosis of the subgingival microbiome. Contemporary approaches, such as the biologically oriented preparation technique and the use of CAD/CAM (Computer-Aided Design and Computer-Aided Manufacturing) technology, may improve the precision of marginal fit. Zirconia restorations exhibit significantly better biocompatibility and reduced microbial adhesion compared to metal–ceramic restorations. Conclusions: Biological response of the periodontium to fixed prosthetic restorations depends on the complex interaction between the material, position of the marginal line, and oral hygiene control. Regardless of the material used or the fabrication technique employed, adequate plaque control and regular maintenance remain key factors in preserving periodontal health. Full article

Background/Objectives: Acute coronary syndrome (ACS) remains one of the leading causes of cardiovascular mortality worldwide. Rapid diagnosis and timely initiation of reperfusion therapy are crucial for improving patient outcomes. The aim of this narrative review was to summarize current evidence on prehospital 12-lead ECG teletransmission in the diagnosis and management of ACS and to evaluate its impact on systems of care and clinical outcomes. Methods: A narrative literature review was conducted using the PubMed database. The literature search was completed on 15 May 2026 and included publications from 1998 onwards. The review included studies evaluating prehospital ECG teletransmission, ST elevation myocardial infarction (STEMI) networks, interpretation models, treatment delays, and organizational and logistics aspects of ECG teletransmission systems. Current guidelines from the European Society of Cardiology and the 2025 ACC/AHA/ACEP/NAEMSP/SCAI guidelines were also included. Results: Available evidence indicates that prehospital ECG teletransmission enables earlier STEMI diagnosis, direct referral to primary coronary intervention (PCI)-capable centers, and earlier activation of catheterization laboratories. Multiple observational studies and meta-analyses have demonstrated reductions in first medical contact-to-device and door-to-device times associated with teletransmission systems. Limitations include interpretation variability, false-positive catheterization laboratory activations, and infrastructure-related barriers. Conclusions: ECG teletransmission is an essential component of contemporary regional STEMI care systems and contributes to improved organization of care and shorter reperfusion delays. Further development and prospective validation of artificial intelligence-assisted ECG interpretation and integrated telemedicine systems may enhance diagnostic accuracy and the effectiveness of prehospital cardiac care. Full article

The modern multi-domain battlespace increasingly demands cost-effective, persistent platforms for Forward Air Control (Airborne) (FAC(A)) and Close Air Support (CAS) missions. While utilizing Commercial Derivative Aircraft (CDA) presents a viable alternative to high-maintenance military assets, the specific aerodynamic, ergonomic, and cognitive workload limitations encountered during the transition across the civil–military “airworthiness seam” remain a significantly underexplored gap in contemporary aerospace literature. To address this gap, a comprehensive empirical flight test campaign was executed on the LX7-135 turboprop to evaluate its tactical mission suitability. Employing the Cooper–Harper Handling Qualities Rating and Bedford Workload scales, and guided by military specifications (MIL-HDBK-516C, MIL-F-8785C), the study systematically assessed the aircraft’s pure performance, unaugmented flight dynamics, and human–machine interface during simulated combat scenarios, including dynamic 9-Line briefings and kinetic “Box Pattern” delivery profiles. Flight test data indicated 12 “SATISFACTORY” parameters, highlighting climb rates, extended endurance, and heavily damped short-period and Dutch roll modes optimal for target tracking. Conversely, the evaluation identified 4 “UNSATISFACTORY” and 10 “TOLERABLE” deficiencies—chiefly a single-door egress bottleneck, restricted stick clearance, degraded longitudinal static stability, and the absence of secure tactical communications. Although these constraints elevated pilot cognitive workload during multi-axis tasks, the LX7-135 demonstrates potential suitability for further development for the FAC(A) role, subject to the successful implementation and subsequent flight-test verification of the identified critical engineering modifications and specialized training syllabi. Full article

Tuberculosis (TB) continues to be a significant public health challenge in Europe, despite a sustained decline in disease incidence over recent decades. This narrative review briefly traces the historical development of TB diagnosis and focuses on the evolution of TB control protocols from the early twentieth century to the present across Europe, through a longitudinal comparative analysis of its geographical regions. A literature search was conducted using publications, guidelines, and surveillance reports from the World Health Organization (WHO), the European Centre for Disease Prevention and Control (ECDC), and national public health authorities. The analysis follows a geographical framework encompassing Eastern, Western, Northern, and Southern Europe, reflecting historical, socioeconomic, and healthcare system differences. This study presents the transition from traditional diagnostic approaches based on clinical assessment, chest radiography, and smear microscopy to modern molecular and immunological techniques, including Xpert MTB/RIF assays and interferon-gamma release assays (IGRAs). Similarly, treatment strategies have evolved from sanatorium-based supportive care to standardized, evidence-based short-course regimens employing first- and second-line anti-TB drugs. However, marked regional differences remain in the implementation of contemporary protocols. Western and Northern European countries have largely adopted advanced diagnostic technologies and comprehensive surveillance systems and are approaching TB elimination targets. In contrast, Eastern Europe continues to bear a disproportionate disease burden, driven by multidrug-resistant TB, HIV co-infection, and socioeconomic disparities. TB control protocols in Southern Europe are progressively converging with those of Western Europe through the adoption of modern diagnostic approaches, standardized treatment regimens, and WHO-endorsed guidelines. The findings of this study underscore the need for greater harmonization of TB control protocols across Europe through an initiative coordinated by the ECDC/WHO. Accelerating progress toward TB elimination in the European Region will depend on expanding access to modern diagnostic technologies, implementing targeted interventions in high-burden settings, and strengthening cross-border collaboration through coordinated public health policies. Full article

Fractures are among the most common injuries in childhood, yet the immature skeleton differs fundamentally from the adult skeleton. A thick periosteum, open physes, and a powerful capacity for remodeling mean that most pediatric fractures unite and realign without surgery. Despite this, national registries document an increasing use of operative fixation, including in some fracture groups with substantial remodeling potential. This narrative review synthesizes the contemporary evidence on the limits within which fractures throughout the growing skeleton can be treated conservatively. The literature was identified through structured searches of PubMed, Scopus, Web of Science, and the Cochrane Library. For each region we summarize the accepted thresholds of angulation, rotation, shortening, and displacement, together with the age- and site-specific modifiers that determine whether a deformity will remodel, and we present these thresholds in comparative tables. We also delineate the genuine indications for surgical treatment, so that the boundary between conservative and surgical management is defined rather than blurred. A secure command of these region-specific limits lets the treating physician exploit the child’s remarkable remodeling potential and avoid both under- and over-treatment. Full article

Background: Upper tract urothelial carcinoma (UTUC) is a rare malignancy representing approximately 5–10% of all urothelial cancers. Key risk factors include smoking, chemical exposures, selected metabolic conditions, and hereditary cancer syndromes. This narrative review summarises current knowledge on UTUC molecular pathogenesis, major risk determinants, and contemporary therapeutic strategies. Methods: This study was conducted as a narrative review with a structured literature search. PubMed, Web of Science, Embase, and Scopus were searched using predefined combinations of UTUC-related terms covering molecular pathogenesis, carcinogenic risk factors, and treatment strategies. The review was prepared according to SANRA principles to improve transparency and consistency; however, no formal systematic review methodology or meta-analysis was performed. Results: Available genomic studies indicate that UTUC has a molecular profile distinct from urothelial bladder carcinoma (UBC), with recurrent alterations involving FGFR3, HRAS, KMT2D, CDKN2A, KRAS, MYC, and BRIP1. Smoking, aristolochic acid exposure, Lynch syndrome, and possibly early-onset urolithiasis contribute to carcinogenesis through distinct but incompletely understood mechanisms. Surgical treatment remains the standard of care for high-risk localised disease, whereas perioperative chemotherapy, immunotherapy, and targeted agents are expanding treatment options, particularly in advanced disease. A substantial proportion of the therapeutic evidence, however, is derived from broader urothelial carcinoma populations rather than UTUC-specific studies. Conclusions: UTUC is biologically heterogeneous and shaped by both molecular alterations and environmental exposures. Although substantial progress has been made, important gaps remain in understanding UTUC-specific carcinogenic mechanisms and in defining evidence-based personalised treatment strategies. Better integration of molecular, environmental, and clinical data is needed to improve risk stratification and treatment selection. Full article

Gallbladder cancer (GBC) is the most common biliary tract malignancy and is among the most lethal gastrointestinal cancers. Since its inclusion in cancer staging manuals, the GBC Tumour–Node–Metastasis (TNM) classification has undergone repeated revisions intended to improve anatomical precision and prognostic discrimination. This narrative review traces the evolution of GBC staging across AJCC editions and the 2025 UICC TNM update and critically examines whether these refinements have translated into clinically meaningful risk stratification. In the 2025 UICC TNM 9 grouping, Stage IA corresponds to T1aN0M0 and Stage IB to T1bN0M0, while T2aN0M0 and T2bN0M0 remain Stage IIA and IIB, respectively. Structured literature searches were performed to identify historical staging documents, population-based analyses, validation studies, and prognostic reports relevant to stage migration, survival discrimination, and emerging staging modifiers. Successive changes, including T-category refinement and the transition from nodal location to nodal burden, have improved anatomical resolution. However, available validation studies suggest that gains in overall prognostic performance remain modest, with reported concordance indices often remaining near 0.66. Contemporary evidence increasingly shows that tumour location, adequacy of lymphadenectomy, number of positive lymph nodes, lymph node ratio, log odds of positive lymph nodes, obstructive jaundice, residual disease status, and selected molecular alterations may capture inter-patient heterogeneity beyond anatomy alone. Future staging refinement should therefore preserve TNM as a common anatomical language while developing validated parallel modifiers that support more individualized prognostication and treatment selection. Full article

Background: Tuberculosis remains a major public health challenge in Latin America, where social inequalities, fragmented health systems, and barriers to care continue to undermine disease control. Although effective treatment is available, treatment abandonment and loss to follow-up remain persistent obstacles to successful outcomes. Methods: A structured critical analysis of the contemporary literature on tuberculosis treatment abandonment and retention in care was conducted using a narrative evidence synthesis approach. Forty scientific documents published between 2018 and 2026 were included. Of these, 23 Latin American studies informed the results synthesis, while 13 international studies supported the comparative critical reflection. Results: Findings were organised into five domains: social vulnerability, clinical complexity, health system barriers, priority populations, and protective factors and innovation. The evidence indicates that treatment abandonment is not an isolated individual behaviour, but a phenomenon associated with the convergence of social, clinical, and institutional determinants across the care trajectory. Poverty, migration, drug resistance, incarceration, weak follow-up systems, and fragmented care were repeatedly associated with discontinuity, whereas social support, active follow-up, digital tools, and economic measures were linked to improved adherence and retention in care. Conclusions: From a biopsychosocial perspective, treatment abandonment should be understood as a systemic and preventable failure across the tuberculosis care continuum. The proposed Latin American Integrated Model for Retention in Tuberculosis Care (MILERTB) offers an anticipatory, equity-oriented, and person-centred framework to strengthen retention in care and guide future implementation research. Full article