Search Results (16,101)

This study aimed to evaluate bone regeneration in critical-size rat calvarial defects treated with a xenogeneic bone graft alone or combined with autologous platelet concentrates prepared using two distinct centrifugation protocols, one based on horizontal centrifugation to produce horizontal platelet-rich fibrin (H-PRF) and the other based on vertical fixed-angle centrifugation to produce leukocyte–platelet-rich fibrin (L-PRF). Calvarial defects were created in 24 rats and allocated to four groups: blood clot (C), xenograft (XEN), xenograft plus L-PRF (XEN+L-PRF), and xenograft plus H-PRF (XEN+H-PRF) (n = 6/group). Calcein and alizarin were administered at 14 and 30 days, respectively. After 35 days, specimens were analyzed by micro-computed tomography, confocal laser scanning microscopy, histomorphometry, and histopathology. Data were analyzed using ANOVA and Tukey’s post hoc test (p < 0.05). All treated groups showed higher bone volume and lower trabecular separation than group C. The XEN+L-PRF group showed significantly higher bone volume than the XEN group. The XEN+H-PRF group showed higher bone volume, connectivity density, alizarin labeling, mineral apposition rate, and newly formed bone area, as well as lower trabecular separation, than the other groups (p < 0.05). Under the experimental conditions evaluated, both PRF protocols improved bone regeneration when combined with a xenogeneic bone graft, whereas the H-PRF protocol was associated with superior structural and histomorphometric bone regeneration outcomes and with more favorable spatiotemporal mineralization kinetics. Full article

This study develops an empirical audit framework for assessing the explainability–reliability gap in fraud detection: whether stable model explanations remain consistent with performance-based feature reliance under distribution shift. Using the Bank Account Fraud dataset suite, including a Base dataset and five biased variants, the study examines group-size disparity, fraud-prevalence disparity, separability bias, and temporal shift. Logistic Regression, Linear SVC, and Random Forest are benchmarked using standard classification metrics, followed by cross-variant evaluation with Logistic Regression as the interpretable baseline. SHAP is used to assess explanation stability, while permutation importance measures performance-based feature reliance. The results show that accuracy and ROC-AUC can overstate practical effectiveness under severe class imbalance; notably, Random Forest retained useful discrimination while producing near-zero recall at the evaluated threshold. SHAP feature rankings remained relatively stable across variants, particularly for address-history, identity-similarity, credit-risk, device, and behavioral variables. However, permutation importance revealed weaker and more variable reliance on several SHAP-ranked features. The limited agreement between the two measures indicates a partial explainability–reliability gap. The findings show that explanation stability alone is insufficient for evaluating trustworthy fraud detection models and should be complemented by performance-based validation under biased and shifted deployment conditions. Full article

Background: In this study, two cocrystals of diclofenac acid (DCA) with the coformers theophylline (THEO) and isonicotinamide (ISNT) were prepared. Subsequently, nanococrystals were generated from these cocrystals using a top-down wet media milling approach. Methods: Critical process parameters such as milling time, milling volume, drug loading percentage, bead volume, and dispersion media were optimized to achieve the desired particle size distribution. The nanococrystals were characterized using dynamic light scattering (DLS), polarized light microscopy (PLM), differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Results: In vitro dissolution studies revealed that nanococrystals of DCA-ISNT (DE_0–120 = 22.5% at pH 1.2 and DE_0–120 = 58.7% at pH 4.5) and DCA-THEO (DE_0–120 = 18.5% at pH 1.2 and DE_0–120 = 48.2% at pH 4.5) exhibited superior dissolution performance compared to DCA nanocrystals (DE_0–120 = 12.5% at pH 1.2 and DE_0–120 = 39.0% at pH 4.5), with the dissolution advantage decreasing as the pH of the medium increased. The improved dissolution behaviour was a complex interplay of factors including particle size distribution, surface wetting kinetics, exposure of hydrophilic/hydrophobic functional groups during dissolution, nanococrystal microenvironmental pH, DCA’s ionization behaviour, lattice energy, and intermolecular interaction strengths. Additionally, nanococrystals exhibited a significantly higher flux rate in simultaneous gastric transfer dissolution and flux studies compared with DCA, likely due to higher apparent solubility and superior diffusion through the unstirred water layer (UWL). Pharmacokinetic studies confirmed that nanococrystals DCA-ISNT NCC (AUC_0–∞ = 3062.65 ± 526.91 ng/mL·h) outperformed DCA nanocrystals (AUC_0–∞ = 2352.53 ± 537.78 ng/mL·h), DCA-THEO NCC (AUC_0–∞ = 2222.96 ± 151.19 ng/mL·h) and the cocrystals in terms of pharmacokinetic performance. Conclusions: The findings indicate that DCA-ISNT NCC exhibited superior pharmacokinetic performance and, together with the enhanced dissolution and flux properties of the nanococrystals, demonstrates their potential for enhanced therapeutic efficacy. Full article

Conservation subdivisions cluster residences in smaller lots compared to conventional subdivisions in order to protect common open spaces (COS) with the assumption that clustering and open space preservation will provide increased ecosystem services. However, the guidelines and regulations for conservation subdivisions typically lack direction on how COS should be designed and maintained. The primary objective of our study was to examine the landscape structure of COS across 54 conservation subdivisions developed in Waukesha County, Wisconsin, USA, and our secondary objective was to evaluate whether COS landscape structure is associated with bird occurrence. We selected seven FRAGSTATS landscape metrics relevant for assessing biophysical processes in urbanized areas in the categories of area/size (PLAND, MPS, LPI), edge/shape (ED, PD), and fragmentation/isolation/aggregation (LSI, IJI). Our k-means clustering and non-metric multidimensional scaling analysis found that the landscape structure of COS varies across the conservation subdivisions and that there are three distinct categories of COS (i.e., intact large-patch COS, fragmented medium-patch COS, and small, dispersed COS) in these subdivisions. Analysis of bird occurrences using eBird data did not show conclusive results but suggested that future systematic wildlife observation in the three groups of conservation subdivisions may provide evidence of the importance of COS composition and configuration, as COS landscape structure may influence ecosystem services. Full article

Background/Objectives: Sleep duration and physical activity are important lifestyle behaviors that may influence adolescents’ academic and Physical Education (PE) performance. However, evidence regarding their associations with Physical Education (PE) performance remains limited, particularly in North African populations. This study aimed to examine the relationships between sleep duration, physical activity, and academic and PE performance among Moroccan adolescents. Methods: A cross-sectional study was conducted among 439 Moroccan adolescents aged 14–20 years. Data were collected using the Arab Teens Lifestyle Study (ATLS) questionnaire. Sleep duration, physical-activity level (metabolic equivalent minutes per week [MET-min/week]), overall academic average, average grade in science subjects, and final PE grade were assessed. Pearson correlation analyses and multivariate analysis of variance (MANOVA) with follow-up univariate analyses were performed, with Games–Howell post hoc comparisons used for PE performance. Results: Sleep duration was positively associated with overall academic average (r = 0.147, p = 0.002) and final PE grade (r = 0.167, p = 0.001), but not with average grade in science subjects (r = 0.080, p = 0.099). Physical activity was positively associated with overall academic average (r = 0.169, p < 0.001) and final PE grade (r = 0.166, p = 0.001), but not with average grade in science subjects (r = −0.009, p = 0.851). Overall academic average was strongly correlated with science average (r = 0.809, p < 0.001) and moderately correlated with final PE grade (r = 0.474, p < 0.001). multivariate analysis of variance (MANOVA)revealed a significant but small overall difference in combined academic and PE performance across the four sleep-duration and physical-activity groups (Pillai’s Trace = 0.034, F(6, 870) = 2.522, p = 0.020, partial η² = 0.017). Follow-up analyses showed no significant group differences in overall academic average (F(3, 435) = 1.460, p = 0.225, partial η² = 0.010), whereas PE performance differed significantly across groups (F(3, 435) = 4.040, p = 0.007, partial η² = 0.027). Conclusions: Sleep duration and physical activity showed weak but significant positive associations with overall academic average and PE performance among Moroccan adolescents, whereas neither was significantly associated with average grades in science subjects. Combined sleep-duration and physical-activity groups differed significantly in PE performance, but not in overall academic average, with small effect sizes. These findings suggest that sleep duration and physical activity are associated with adolescent performance, although the magnitude of these associations is modest and should not be interpreted as causal. Further longitudinal research using objective measures of sleep and physical activity is warranted to clarify these relationships. Full article

Background: Platinum resistance remains a major therapeutic challenge in epithelial ovarian cancer (EOC). The tumour–stroma ratio (TSR) has emerged as a potential histopathological marker of tumour biology, but its clinical significance in different clinical settings remains unclear. We evaluated the association between stromal proportion, assessed using the TSR methodology, platinum resistance, and survival outcomes in patients undergoing primary debulking surgery (PDS) or neoadjuvant chemotherapy followed by interval debulking surgery (NACT+IDS). Methods: This retrospective study included 83 patients with epithelial ovarian cancer (EOC) who underwent either primary debulking surgery (PDS) or neoadjuvant chemotherapy followed by interval debulking surgery (NACT+IDS) between 2017 and 2024. Patients were analysed separately according to treatment strategy. Stromal proportion was assessed on primary surgical specimens in the PDS cohort and on pretreatment diagnostic biopsy specimens in the NACT+IDS cohort. For this retrospective analysis, platinum resistance was operationally defined as recurrence within six months after completion of first-line platinum-based chemotherapy. Survival outcomes were analysed using the Kaplan–Meier method, and univariable binary logistic regression was performed separately within the PDS and NACT+IDS cohorts to explore the association between stromal category and platinum resistance. Results: Platinum resistance occurred in 25.3% of patients. In the PDS cohort, stromal category was not associated with clinicopathological characteristics, platinum resistance, disease-free survival (DFS), or overall survival (OS). In the NACT+IDS cohort, patients in the stroma-high group had a numerically higher rate of platinum resistance than those in the stroma-low group (57.9% vs. 22.2%; Fisher’s exact p = 0.114). Based on univariable logistic regression analysis, the stroma-high group had higher estimated odds of platinum resistance (OR 4.81, 95% CI 0.78–29.40), although this finding did not reach statistical significance (p = 0.090). No significant association was observed between stromal category and survival outcomes in either cohort. Conclusions: In the NACT+IDS cohort, patients in the stroma-high group had a numerically higher rate of platinum resistance than those in the stroma-low group; however, this difference did not reach statistical significance. These results should be interpreted with caution due to the retrospective study design and limited sample size; however, they nonetheless support further investigation of pretreatment TSR as a simple and easily applicable histopathological parameter in EOC. Larger prospective multicentre studies are required to determine whether this exploratory signal is reproducible and clinically relevant. Full article

Background/Objectives: Uterine leiomyosarcoma (uLMS) shares clinical and radiological similarities with benign uterine leiomyoma (LM), while validated discriminatory markers remain scarce. We compared cyclin E1 (CCNE1) expression in uLMS and LM tissue samples. Methods: This retrospective case-control study included 61 patients (16 uLMS, 45 LM) treated at a single institution (2017–2023). Of 22 eligible uLMS cases, six were excluded because suitable tissue was unavailable and they had significantly higher FIGO stages than the included cases. CCNE1 immunoreactivity was assessed using an adapted Allred score in five non-overlapping high-power fields selected from regions of highest expression. Two blinded pathologists independently scored each field, and the patient-level median was used for primary analysis. Results: The median CCNE1 Allred score was 6 (IQR 5–6) in uLMS versus 2 (IQR 0–3) in LM (p < 0.001), with excellent interobserver agreement (ICC 0.94). The AUC was 0.941 (95% CI 0.875–0.990). A data-derived cut-off ≥4 yielded 93.8% sensitivity and 84.4% specificity. A conservative minimum-expression analysis yielded an AUC of 0.882. Postmenopausal status was strongly associated with uLMS but was nearly completely confounded with the diagnostic group (12/16 uLMS vs. 0/45 LM). A premenopausal-only analysis was directionally consistent but underpowered. Clinical symptoms and tumor size did not differ between the groups. Conclusions: CCNE1 immunoexpression was substantially higher in uLMS than LM, with excellent reproducibility. Diagnostic-performance estimates remain exploratory and were influenced by tumor-region sampling, menopausal imbalance, and under-representation of advanced-stage uLMS. Independent multicenter validation, particularly in premenopausal and advanced-stage disease, is required before clinical application. Full article

Objectives: The rapid digitalization of health communication has made electronic health (e-health) literacy an essential competency, while also increasing concerns about cyberchondria. This descriptive–correlational study examined perceived e-health literacy and cyberchondria among students enrolled in a Faculty of Sports Sciences and evaluated their associations with selected socio-demographic and behavioral factors. Methods: Data were collected between February and May 2025 using a Socio-Demographic Information Form, the e-Health Literacy Scale (eHEALS), and the Short-Form Cyberchondria Severity Scale (CSS-12). Quantitative data were analyzed using group comparison tests, correlation analyses, effect size estimates, and multivariable linear regression. Results: Students demonstrated eHEALS scores close to the upper end of the possible range, together with considerable cyberchondria severity scores. Cyberchondria severity was positively associated with perceived e-health literacy; this association remained statistically significant but weak after adjustment for daily internet use, gender, age, academic year, and department. Significant differences were also observed according to daily internet use, gender, academic year, and department. Conclusions: These findings highlight the dual role of digital health platforms among students engaged in health- and performance-related fields. Educational interventions should promote critical appraisal of online health information and psychologically safe digital health behaviors. Full article

Aim: This study addressed two research questions. First, which sociodemographic, behavioral, and psychological factors are independently associated with elevated depressive symptoms among Korean women aged 20–59 years? Second, does subjective perception of one’s own body size retain an independent association with depressive symptoms after these factors are taken into account, and does this pattern differ between younger and midlife women? The primary outcome was elevated depressive symptoms, defined as a PHQ-9 score of 5 or above. Design: This cross-sectional study used pooled data from the four Korea National Health and Nutrition Examination Survey cycles in which the PHQ-9 was administered (2014, 2016, 2018, and 2020). All estimates incorporate the complex survey design and therefore refer to the national population of Korean women aged 20–59 years. Methods: We analysed data from Korean women aged 20–59 years who completed the PHQ-9 (n = 7595). Elevated depressive symptoms were defined as a PHQ-9 score of 5 or above, indicating mild or greater symptomatology. Design-based multivariable logistic regression models were constructed in sequential blocks: demographic variables (Model 1); behavioural and psychological factors added (Model 2); and perceived body size, entered as indicator contrasts against average body size, added (Model 3). Analyses were stratified by age group (20–39 and 40–59 years), and age-group interaction terms were fitted in a pooled model to test formally whether associations differed across the female lifespan. Results: The weighted prevalence of elevated depressive symptoms (PHQ-9 ≥ 5) was 24.1% (95% CI 22.8–25.3). In bivariate analyses, perceived body size differed significantly between women with and without elevated depressive symptoms (p < 0.001). After adjustment for behavioural and psychological factors, neither perceived thinness nor perceived obesity was associated with depressive symptoms in either age group (20–39 years, thin: OR 1.25, 95% CI 0.92–1.69; obese: OR 1.05, 95% CI 0.85–1.30; 40–59 years, thin: OR 1.21, 95% CI 0.84–1.73; obese: OR 0.99, 95% CI 0.80–1.22), and the joint two-degree-of-freedom test was non-significant in both groups. Perceived stress (OR 5.15 and 4.93), poor subjective health (OR 2.11 and 2.55), and lifetime smoking experience (OR 1.75 and 1.79) showed the strongest and most consistent associations in both groups (all p < 0.001). Lower household income was associated with depressive symptoms among women aged 40–59 years and heavy episodic drinking among those aged 20–39 years; in formal interaction testing, household income showed only a non-significant trend towards effect modification by age (p = 0.060), so the age differences are described rather than established. Conclusions: The crude association between perceived body size and depressive symptoms did not persist after adjustment for behavioral and psychological factors. Because perceived stress and subjective health may lie on a causal pathway from body size perception to depressive symptoms, this attenuation is consistent with either confounding or an indirect pathway, and the present cross-sectional design cannot distinguish between them. Perceived stress and subjective health showed the strongest associations across age groups, while lower household income remained an independent correlate in midlife. This finding points to a material condition that individual-level screening cannot by itself address. Full article

Starch, a natural source of energy in the form of glucose chains, is widely utilized in various industrial and scientific fields. In its native state, starch is thermally unstable and undergoes gelatinization. Physicochemical modifications of starch aim to increase its thermal and structural stability while simultaneously enhancing its reactivity by introducing new functional groups. The primary objective of this study was to develop thermally stable and economically viable starch-based drug carriers capable of the controlled release of a negatively charged component sourced from aronia extract. Potato starch underwent a series of chemical modifications, specifically quaternary amine etherification, citric acid esterification, and/or hydrothermal modification. The characterization involved determining several parameters: the degree of amino substitution groups; starch particle size using a laser particle size analyzer; viscosity and pH; gelation temperature and heat capacity measured by scanning calorimetry (DSC); mass degradation analyzed via thermogravimetric analysis (TG); crystallinity determined by X-ray diffraction (XRD); potential intermolecular interactions studied by Fourier-Transform Infrared Spectroscopy with Attenuated Total Reflectance (FTIR-ATR); and the rate of chlorogenic acid release from aronia extract tablets quantified by spectrophotometry. The highest cationization results were achieved using citrate starches, reaching up to 86%. The combined application of citric acid esterification and cationization, coupled with an annealing process, resulted in increased viscosity, amorphousness, and enzyme resistance of the starch. Citric acid esterification significantly improved the thermal stability of the starch. Furthermore, FTIR studies revealed the formation of electrostatic interactions between the functional groups of the starch and the components of aronia extract. The amount of chlorogenic acid released showed significant variation (70–100%) depending on the type of starch modification. Collectively, these studies confirmed that both hydrothermal and chemical modifications influence the thermal and structural stability of the starch. Utilizing all combination modification strategies ensured the production of highly promising carriers for active substances. Full article

With the rise of artificial intelligence (AI), an increasing number of AI-based diagnostic tools are being developed. Before clinical implementation, these tools must be validated against existing gold standards. This requires trials that quantify the agreement between AI predictions and reference measurements. However, designing such agreement studies poses methodological challenges that differ substantially from classical superiority trials. This paper aims to provide statistical methods for assessing diagnostic agreement. Methods were categorized according to the measurement scale of the data (nominal, ordinal, continuous)—with a separate group for methods that apply across several scales—and according to the number of raters or measurements involved. A decision tree is provided as a simplified educational framework for method selection rather than as a general method-selection algorithm: design features such as repeated measurements, clustering, spectrum effects, dependence between raters, and an imperfect reference method are not encoded in it and are discussed separately, together with the circularity and confounding issues specific to the validation of AI-based tools. For each method, we summarized assumptions, appropriate use cases, interpretation of results, and available open-source software for sample size calculation and analysis, and we illustrate the sample size calculations in three fully worked examples covering binary, ordinal, and continuous outcomes. We further distinguish conditional inference about one fixed, frozen model version from the broader generalization to a class of algorithms or to future model versions, which require additional sources of algorithmic and dataset variability to be represented in the design and analysis. We conclude by outlining open methodological questions—including Bayesian approaches to agreement estimation, methods for complex AI outputs, agreement models for clustered and repeated-measures designs, and the limited software support for Gwet’s AC1/AC2 sample size planning—that warrant further work as diagnostic technologies and statistical methodology continue to evolve. Full article

Financial vulnerability in agriculture is shaped by both enterprise-specific factors and the agricultural systems in which firms operate, challenging financial distress prediction models based exclusively on firm-level financial metrics. This study assesses the predictive performance of logistic regression (LR), extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and category boosting (CatBoost), examines whether country-level agricultural environment characteristics improve prediction beyond traditional financial indicators, and uses Shapley additive explanations (SHAP) to analyze predictor contributions. The empirical analysis is based on 28,745 firm-year observations of agricultural enterprises in the Visegrad Group (V4) countries over 2019–2024. Adding agricultural environment variables produced a modest but consistent improvement in predictive performance, increasing AUC from approximately 0.854–0.855 in firm-level boosting models to 0.864–0.865 in integrated specifications. All three gradient boosting algorithms outperform conventional LR, although differences among XGBoost, LightGBM, and CatBoost remain statistically insignificant. SHAP analysis identifies liquidity, leverage, profitability, and firm size as the primary predictors while revealing nonlinear and threshold-dependent relationships not captured by conventional linear models. Integrating agricultural environment characteristics with explainable machine learning (ML) therefore supports more comprehensive, transparent, and context-aware early-warning systems for agricultural financial distress. Full article

Yaks (Bos grunniens) are important livestock on the Qinghai–Tibetan Plateau, but the relationship between Blastocystis positivity, fecal bacterial communities, and microbial metabolites remains unclear. This cross-sectional study compared fecal bacterial profiles and short-chain fatty acid (SCFA) concentrations in six Blastocystis-positive and six Blastocystis-negative diarrheic yaks from Lhasa, Tibet Autonomous Region, China. Bacterial communities were characterized by 16S rRNA gene amplicon sequencing, and fecal SCFAs were quantified by gas chromatography–mass spectrometry. Compared with negative yaks, positive yaks had lower concentrations of acetic acid (p < 0.01), propionic acid (p < 0.01), butyric acid (p = 0.000381), valeric acid (p < 0.01), caproic acid (p = 0.00359), and isobutyric acid (p < 0.01), whereas isovaleric acid did not differ between groups (p = 0.310). A total of 2,751,028 raw sequences were generated, of which 2,620,949 passed quality filtering. ACE (p = 0.0068), Chao1 (p = 0.0071), Faith’s phylogenetic diversity (p = 0.0019), observed ASVs (p = 0.0064), Pielou’s evenness (p = 0.011), Shannon diversity (p = 0.008), and Simpson diversity (p = 0.037) were lower in positive yaks. The groups also differed in bacterial community composition, and several taxa previously associated with fiber degradation or SCFA formation had lower relative abundances in positive yaks. PICRUSt2 indicated differences in predicted microbial functional potential. These findings indicate that Blastocystis positivity was associated with altered fecal bacterial communities and reduced concentrations of several SCFAs in diarrheic yaks. Because of the small sample size, cross-sectional design, and potential confounding by diarrhea and other unmeasured factors, causal relationships cannot be established. Full article

Background/Objectives: Person-centered care (PCC) and the Technological Competency as Caring in Nursing (TCCN) theory are increasingly emphasized in nursing leadership, but no published study has evaluated a PCC/TCCN training program among Mongolian nurse managers. This uncontrolled, single-group pilot pre–post study examined immediate changes in nurse managers’ self-reported PCC and TCCN perceptions following a one-day collective training program. Methods: The program was delivered on 30 October 2025 during the 2nd International Nursing Symposium in Mongolia. Using convenience sampling, hospitals were invited to send nurse managers who were currently in post or senior nurses who had been formally nominated for such a role. Of 50 attendees, 30 met a pre-specified role-eligibility criterion and formed the matched pre–post analytic sample. Participants completed Mongolian versions of the Person-Centered Care Instrument (PCCI) and the Perceived Technological Competency as Caring in Healthcare Providers Instrument (TCCHI) immediately before and after the program. Pre–post differences were assessed with Wilcoxon signed-rank tests, effect sizes for the Wilcoxon signed-rank test (r = z/√N), and Holm–Bonferroni correction across 16 comparisons. Results: Total and all concept-level PCCI and TCCHI scores were higher after the program than before it, all 16 comparisons remained significant after correction, and the effect sizes were moderate to large (r = 0.41–0.61). The median within-person change was +22.0 points (95% CI 7.0 to 35.5) for the total PCCI score and +24.0 points (95% CI 10.5 to 38.0) for the total TCCHI score (Hodges–Lehmann estimates). Conclusions: In this small convenience sample of Mongolian nurse managers and senior nurses formally nominated for managerial roles, self-reported PCCI and TCCHI scores increased immediately after a one-day training program. Because the study used a single-group design without a control group, employed instruments not yet fully validated in Mongolian, and included no follow-up, these findings are preliminary evidence of an association rather than proof of program effectiveness. Larger, controlled studies with follow-up are needed. Trial Registration: TCTR20260513001, registered retrospectively on 13 May 2026, after data collection had been completed. Full article

Background/Objectives: Clazosentan reduces cerebral vasospasm and delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage (aSAH). However, concerns that clazosentan may cause cerebral edema and increase intracranial pressure (ICP) have discouraged its use in patients with poor-grade aSAH. Methods: This single-center retrospective study included 59 patients with aSAH who underwent continuous direct ICP monitoring, of whom 23 received clazosentan and 24 received fasudil. Most clazosentan-treated patients had poor-grade aSAH (WFNS 4–5, 95.7%). The primary outcome was the change in mean daily ICP in the clazosentan group between the pre-treatment and full treatment periods, with a secondary analysis restricted to the first 7 days and stratified by the presence of intracerebral hematoma (ICH). Cerebral perfusion pressure (CPP) changes were assessed as secondary outcomes, and the fasudil group served as an exploratory comparator. Results: Among 21 clazosentan-treated patients available for primary analysis, median ICP did not change significantly between the pre-treatment and treatment periods (6.4 vs. 8.4 mmHg; median ΔICP +0.5 mmHg, 95% CI −1.74 to +2.64; p = 0.708), a finding consistent in the first 7 days and across subgroups by ICH status. In contrast, CPP increased significantly between the pre-treatment and treatment periods (69.1 vs. 84.5 mmHg; median ΔCPP +14.0 mmHg, 95% CI +8.93 to +17.44; p < 0.001). Conclusions: In this retrospective single-center cohort, no statistically significant ICP elevation was observed during clazosentan administration under standard neurosurgical management. Although the small sample size limits statistical power and a false-negative result cannot be excluded, these findings may help inform clinical decision-making regarding clazosentan use in patients with poor-grade aSAH. Full article