Search Results (31)

Symmetry plays a crucial role in balancing production efficiency and energy consumption within distributed manufacturing systems. This study leverages symmetric decision-making structures in resource allocation and maintenance scheduling to achieve an equilibrium between productivity and sustainability. To address the multi-factory collaboration requirements for large-scale orders, a distributed dual-resource flexible job shop scheduling model considering multiple speeds and preventive maintenance on energy consumption is constructed. It aims to minimize the maximum completion time and total machine energy consumption. An artificial bee colony algorithm with adaptive scout bees is proposed to solve the model. An improved decoding method is designed according to the model characteristics to enhance convergence speed. Neighborhood structures based on preventive maintenance and machine speeds are designed, and a dynamic neighborhood search strategy is proposed to improve the local search capability. Three food source generation methods are defined as actions, and Q-learning is employed to dynamically select actions, ensuring population diversity while improving population quality. Extensive experiments are conducted to validate the effectiveness of the improved strategies, and the superiority of the proposed algorithm is verified through performance comparisons with state-of-the-art algorithms. Full article

Background: Tuberculosis (TB) remains a major global health challenge, with Mycobacterium tuberculosis (M. tuberculosis) causing significant morbidity and mortality mainly in high-burden countries. Following exposure to M. tuberculosis, individuals may become infected, developing TB infection (TBI) through inhalation of the bacillus: this affects approximately one-fourth of the global population and serves as a critical reservoir for potential disease reactivation and transmission. The risk of being infected with M. tuberculosis is shaped by bacterial load of people with TB, contact patterns, environmental factors, and host susceptibility, particularly in high-risk congregate settings. Elucidating these determinants is instrumental for optimising TB prevention and control strategies. Methods: A preliminary PubMed search was conducted on 25 August 2024, using the keywords “latent tuberculosis infection,” “risk factors,” and “systematic review.” Targeted reviews were then performed in November 2024 to examine factors influencing progression from exposure to M. tuberculosis to TBI. Systematic reviews published between January 2000 and November 2024 were included. Results: The scoping review analysed eight systematic reviews, grouping findings into three key themes: (1) proximity and behavioural risk factors; (2) environmental risk factors; and (3) host immune vulnerabilities. Close contact with people with TB in crowded settings, such as dormitories, healthcare facilities, and prisons, was strongly associated with an elevated risk of TBI. Healthcare workers travelling from low- to high-incidence regions faced the highest risk due to frequent exposure to M. tuberculosis, while military personnel and general travellers had lower risks. Environmental exposures, including second-hand smoke and inadequate ventilation, further heightened susceptibility among children and adults. Host immune risk factors, such as advanced age, low body mass index, lack of BCG vaccination, and metabolic disorders such as diabetes, markedly increase susceptibility to TBI. The interplay between proximity, behavioural and environmental risk factors, and host immune vulnerabilities highlights the multifactorial nature of TBI risk. Conclusion: Effective TBI control demands a multifaceted approach, combining robust infection prevention and control measures, comorbidity management, and mitigation of behavioural risk factors like smoking. Tailored strategies are crucial for high-risk settings such as healthcare facilities and prisons. Multisectoral collaboration is essential to address key risk factors and protect vulnerable populations from progressing to TBI. Full article

Background: Fibromyalgia (FM) and eating disorders (ED) represent distinct clinical entities traditionally managed within separate medical specialties, yet emerging evidence suggests significant comorbidity and potential shared pathophysiological mechanisms. Both conditions disproportionately affect women, involve complex multifactorial etiologies and substantially impair quality of life. Despite documented clinical overlaps, the mechanistic connections linking these conditions remain poorly characterized, and integrated treatment approaches are lacking. Objective: This narrative review examines the role of oxidative stress and nuclear factor erythroid 2-related factor 2 (Nrf2) pathway dysfunction as a unifying molecular mechanism connecting fibromyalgia and eating disorders, with emphasis on implications for integrated rehabilitation strategies. Methods: We synthesized current evidence on oxidative stress pathophysiology in fibromyalgia and eating disorders, focusing on Nrf2-Keap1 pathway function, clinical comorbidity patterns and rehabilitation interventions targeting antioxidant defense mechanisms. In PubMed, representative search strings included “(fibromyalgia [MeSH] OR fibromyalgia [Title/Abstract]) AND (“eating disorders” [MeSH] OR “anorexia nervosa” [MeSH] OR “bulimia nervosa” [MeSH])” and “fibromyalgia AND (“oxidative stress” OR Nrf2 OR “redox”)”. Articles in English published through December 2025 were considered, with additional records identified by manually screening reference lists. Results: Fibromyalgia patients exhibit elevated oxidative stress markers, impaired antioxidant enzyme function and compromised Nrf2 activity correlating with disease severity, with studies reporting approximately 30–50% reductions in coenzyme Q10 levels compared with healthy controls. Similarly, eating disorders demonstrate mitochondrial dysfunction and oxidative stress dysregulation, though patterns differ across eating disorder phenotypes. Nrf2 serves as the master regulator of cellular antioxidant defense, coordinating expression of over 500 genes involved in detoxification, cytoprotection, inflammation modulation and metabolic regulation. Evidence suggests Nrf2 activity is regulated by energy balance, potentially linking nutritional status with cellular stress responses. Rehabilitation interventions, including graduated exercise and nutritional optimization with Nrf2-activating foods (cruciferous vegetables, polyphenols, omega-3 fatty acids), offer mechanism-based therapeutic approaches through hormetic Nrf2 activation and direct Keap1 modification. Conclusions: Multidisciplinary rehabilitation programs integrating physical therapy, exercise prescription and nutritional strategies targeting Nrf2 activation offer evidence-based, mechanism-driven approaches to address shared oxidative stress pathophysiology. Nrf2 pathway dysfunction represents a promising and biologically plausible molecular target that may help to unify our understanding of fibromyalgia and eating disorders pending confirmation from prospective clinical studies in comorbid populations. Future research should prioritize prospective clinical trials testing Nrf2-targeted interventions in comorbid populations and collaborative patient-centered care models. Full article

The introduction of modern anticancer therapies, including targeted therapies (TTs), immune checkpoint inhibitors (ICIs), and antibody–drug conjugates (ADCs), has significantly improved survival across a wide range of malignancies. At the same time, these agents have expanded the spectrum of treatment-related adverse events, with ocular toxicities emerging as a clinically relevant and increasingly recognized complication. Ocular adverse events may affect multiple anatomical structures, including the ocular surface, cornea, anterior and posterior segments, and optic nerve, often reflecting drug class-specific biological mechanisms. The pathogenesis of ocular toxicity is multifactorial and includes on-target inhibition of signaling pathways expressed in ocular tissues, off-target effects on rapidly renewing epithelia, non-specific uptake of cytotoxic payloads in ADCs, immune-mediated inflammation associated with ICIs, and microvascular dysregulation observed with selected targeted agents, such as mitogen-activated protein kinase (MEK) inhibitors. Because ocular adverse events are inconsistently reported in clinical trials and frequently described through case reports or pharmacovigilance data, their true incidence is likely underestimated and management strategies remain heterogeneous. This narrative review provides an overview of the epidemiology, biological mechanisms, and clinical manifestations of ocular toxicities associated with contemporary anticancer therapies. In addition, it offers practical, mechanism-based recommendations for prevention, monitoring, and stepwise management, emphasizing the importance of multidisciplinary collaboration to preserve visual function while maintaining effective oncologic treatment. Full article

Diabetes mellitus is a multifactorial metabolic disorder associated with a number of chronic complications, including neuropathy, impaired wound healing, vascular dysfunction, and metabolic dysregulation. Despite advances in pharmacological treatments and lifestyle interventions, current therapies often fail to prevent or reverse these complications entirely. This narrative review examines the therapeutic potential of laser-based modalities, particularly low-level laser therapy (LLLT) and photobiomodulation therapy (PBMT), as complementary strategies in diabetes management. Analysis of experimental and clinical studies shows that laser therapy can enhance wound healing, alleviate neuropathic pain, improve glycaemic control and insulin sensitivity, modulate inflammatory and oxidative stress pathways, and support vascular function. These effects are primarily mediated through mitochondrial activation, nitric oxide release, angiogenesis, modulation of redox-sensitive transcription factors, and preservation of pancreatic β-cell function. Furthermore, laser therapy exhibits a favourable safety profile with minimal side effects. The review highlights the current challenges, such as the lack of standardised treatment parameters (e.g., wavelength, dosage, and duration) and the limited number of large-scale clinical trials. It emphasises the need for personalised protocols and integration of laser therapy with pharmacological and physiotherapeutic interventions. Continued research and interdisciplinary collaboration are needed to realise the potential of laser therapy as an integral component of comprehensive, evidence-based diabetes care. Full article

Stroke is a major global health concern, particularly among the elderly, who frequently present with multiple comorbidities, most notably cardiovascular diseases. Importantly, atrial fibrillation confers a nearly fivefold increase in stroke risk and accounts for up to one-quarter of ischemic strokes in older adults. Stroke is a neurological disease characterised by a strong cardiovascular interplay, and its multifactorial nature requires an integrated preventive approach. This review focuses on primary and secondary prevention in this population, with a frailty-informed perspective. We synthesise evidence on blood pressure control, lipid-lowering (including LDL-C targets), glycemic management, and antithrombotic strategies—particularly oral anticoagulation for atrial fibrillation—as well as the role of frailty indices in guiding individualised risk–benefit decisions. We also discuss practical care pathways, including structured post-discharge programs, continuity of care, and the need for multidisciplinary collaboration involving cardiologists, neurologists, and primary care. We highlight how frailty indices refine risk–benefit assessments without justifying therapeutic nihilism, and how sex- and age-related factors shape treatment effectiveness and safety. By narrowing scope and emphasising practical, multidisciplinary prevention strategies, this review aims to support clinicians in reducing recurrent events, disability, and mortality in very old patients. Future work should prioritise pragmatic trials, including those involving the oldest old and the use of standardised frailty metrics, to inform prevention decisions. Full article

Background/Objectives: Postoperative cognitive dysfunction (POCD) represents a significant and potentially preventable complication in elderly patients undergoing colorectal cancer surgery, with reported incidence ranging from 2.8% to 62.2% depending on perioperative management strategies and assessment methods. This narrative review synthesizes current evidence on the epidemiology, pathophysiology, risk factors, and prevention strategies for POCD in this vulnerable population. Methods: A comprehensive narrative review was conducted to examine the current literature on POCD in elderly colorectal cancer patients. Evidence was synthesized from published studies addressing epidemiology, assessment tools, risk factors, pathophysiological mechanisms, and prevention strategies, with a particular focus on Enhanced Recovery After Surgery (ERAS) protocols and multicomponent interventions. Results: Advanced age, pre-existing cognitive impairment, frailty, and surgical complexity emerge as key risk factors for POCD. ERAS protocols demonstrate substantial protective effects, reducing POCD incidence from 35% under conventional care to as low as 2.8% in optimized pathways. The pathophysiology involves multifactorial mechanisms, including neuroinflammation, blood–brain barrier disruption, neurotransmitter dysregulation, and oxidative stress, with surgical trauma triggering systemic inflammatory cascades that activate microglial responses within the central nervous system. Evidence-based prevention strategies include preoperative cognitive and frailty screening, minimally invasive surgical techniques, multimodal opioid-sparing analgesia, regional anesthesia, depth-of-anesthesia monitoring, and structured postoperative care bundles adapted from the Hospital Elder Life Program. Conclusions: The integration of comprehensive perioperative cognitive care protocols represents a critical priority as surgical volumes in elderly populations continue to expand globally. Emerging directions include biomarker development for early detection and risk stratification, precision medicine approaches targeting individual vulnerability profiles, and novel therapeutic interventions addressing neuroinflammatory pathways. Standardized assessment tools, multidisciplinary collaboration, and implementation of evidence-based preventive interventions offer substantial promise for preserving cognitive function and improving long-term quality of life in elderly colorectal cancer patients. Full article

Sepsis is a life-threatening syndrome characterized by marked clinical heterogeneity and complex host–pathogen interactions. Although traditional mechanistic studies have identified key molecular pathways, they remain insufficient to capture the highly dynamic, multifactorial, and systems-level nature of this condition. The advent of high-throughput omics technologies—particularly integrative multi-omics approaches encompassing genomics, transcriptomics, proteomics, and metabolomics—has profoundly reshaped sepsis research by enabling comprehensive profiling of molecular perturbations across biological layers. However, the unprecedented scale, dimensionality, and heterogeneity of multi-omics datasets exceed the analytical capacity of conventional statistical methods, necessitating more advanced computational strategies to derive biologically meaningful and clinically actionable insights. In this context, artificial intelligence (AI) has emerged as a powerful paradigm for decoding the complexity of sepsis. By leveraging machine learning and deep learning algorithms, AI can efficiently process ultra-high-dimensional and heterogeneous multi-omics data, uncover latent molecular patterns, and integrate multilayered biological information into unified predictive frameworks. These capabilities have driven substantial advances in early sepsis detection, molecular subtyping, prognosis prediction, and therapeutic target identification, thereby narrowing the gap between molecular mechanisms and clinical application. As a result, the convergence of AI and multi-omics is redefining sepsis research, shifting the field from descriptive analyses toward predictive, mechanistic, and precision-oriented medicine. Despite these advances, the clinical translation of AI-driven multi-omics approaches in sepsis remains constrained by several challenges, including limited data availability, cohort heterogeneity, restricted interpretability and causal inference, high computational demands, difficulties in integrating static molecular profiles with dynamic clinical data, ethical and governance concerns, and limited generalizability across populations and platforms. Addressing these barriers will require the establishment of standardized, multicenter datasets, the development of explainable and robust AI frameworks, and sustained interdisciplinary collaboration between computational scientists and clinicians. Through these efforts, AI-enabled multi-omics research may progress toward reproducible, interpretable, and equitable clinical implementation. Ultimately, the synergy between artificial intelligence and multi-omics heralds a new era of intelligent discovery and precision medicine in sepsis, with the potential to transform both research paradigms and bedside practice. Full article

Background and Objectives: Dry eye disease (DED) is a multifactorial ocular surface disease that markedly diminishes quality of life. Although diabetes mellitus is well-known for its retinal consequences, anterior segment symptoms including dry eye disease are often overlooked. Chronic hyperglycemia causes metabolic, neurovascular, and immunological changes that undermine tear film stability, corneal innervation, and ocular surface integrity. This review seeks to consolidate existing knowledge regarding the concealed impacts of diabetes on ocular surface homeostasis, highlighting processes, diagnostic difficulties, and treatment prospects. Materials and Methods: A narrative review of the literature was performed by searching PubMed for publications from January 2020 to July 2025 using the terms “diabetic dry eye,” “hyperglycemia AND ocular surface,” “tear proteomics AND diabetes,” “corneal nerves AND diabetes,” and “neurotrophic keratitis.” Eligible studies were experimental research, clinical trials, and translational investigations concerning tear film function, corneal neuropathy, inflammatory indicators, or lacrimal gland dysfunction in diabetes. The exclusion criteria were non-English language, lack of primary data, and inadequate methodological description. Results: Hyperglycemia compromises lacrimal gland functionality, modifies lipid secretion from Meibomian glands, and diminishes corneal nerve density, resulting in neurotrophic deficits. Inflammatory cytokines and oxidative stress compromise epithelial integrity, but proteome alterations in tears serve as sensitive indicators of disease. Diagnosis is impeded by corneal hypoesthesia, resulting in a disconnection between symptoms and findings. Progress in imaging, proteomics, and artificial intelligence may facilitate earlier detection and improved risk assessment. Novel therapeutics, such as neurotrophic drugs, antioxidants, and customized anti-inflammatory approaches, show promise but remain under clinical evaluation. Conclusions: Diabetes-related dry eye disease is a multifaceted and underappreciated condition influenced by systemic metabolic dysfunction. The ocular surface may act as an initial indicator for systemic disease load. Narrative synthesis emphasizes the necessity for customized diagnostic instruments, individualized treatment approaches, and collaborative management. Reconceptualizing diabetic dry eye disease within the context of systemic metabolic care presents prospects for precision medicine strategies that enhance both ocular and systemic results. Full article

Background: Sexual dysfunction (SD) is a common yet under-recognized consequence of traumatic brain injury (TBI), with significant implications for physical health, psychological well-being, interpersonal relationships and social reintegration. Although TBI research has largely focused on cognitive, motor and behavioral outcomes, the impact of SD remains insufficiently addressed in both clinical practice and rehabilitation programs. Objectives: This review aims to synthesize current evidence on the prevalence, mechanisms and management of SD following TBI, while emphasizing the importance of gender-sensitive and multidisciplinary approaches to care. Methods: A narrative review was conducted by searching PubMed, Scopus and Web of Science for English-language articles published between 2000 and 2025 using combinations of the following keywords: traumatic brain injury, sexual dysfunction, neuroendocrine dysfunction, psychological sequelae and rehabilitation. Priority was given to peer-reviewed clinical studies, systematic reviews and expert consensus guidelines that addressed neurological, endocrine, cognitive, psychological and social aspects of SD in TBI survivors. Exclusion criteria included case reports with insufficient clinical detail and non-peer-reviewed sources. Articles were screened for relevance to both pathophysiological mechanisms and therapeutic strategies. Results: The etiology of post-TBI SD is multifactorial, involving direct neurological injury, hypothalamic–pituitary dysfunction, emotional and cognitive impairments, as well as psychological challenges such as stigma and relationship strain. Men and women may present distinct symptom profiles; for instance, men more frequently report erectile dysfunction and hypogonadism, whereas women more commonly experience challenges with arousal, lubrication and psychological stress. Effective interventions include pharmacotherapy, hormone replacement therapy, psychotherapy and rehabilitative approaches designed to restore intimacy and quality of life. Optimal outcomes are achieved through multidisciplinary collaboration among neurology, endocrinology, psychiatry, psychology and rehabilitation medicine. Conclusions: Sexual dysfunction should be recognized as a critical component of TBI sequelae rather than a secondary concern. Routine screening, gender-sensitive assessment and the integration of individualized, multidisciplinary care pathways are essential to improving patient outcomes. Advancing clinical awareness and standardization in this area holds the potential to significantly enhance the holistic recovery and reintegration of TBI survivors. Full article

Cancer-induced cardiac dysfunction has become a major clinical challenge as advances in cancer therapies continue to extend patient survival. Once regarded as a secondary concern, cardiotoxicity is now recognized as a leading contributor to morbidity and mortality among cancer patients and survivors. Its pathophysiology is multifactorial, involving systemic inflammation (e.g., TNF-α, IL-6), oxidative stress driven by reactive oxygen species (ROS), neurohormonal imbalances (e.g., angiotensin II, endothelin-1), and metabolic disturbances. These mechanisms collectively promote cardiomyocyte apoptosis, atrophy, mitochondrial dysfunction, and impaired cardiac output. Cardiac complications may arise directly from cancer itself or as adverse effects of oncologic therapies such as anthracyclines, trastuzumab, and immune checkpoint inhibitors. These agents have been linked to heart failure (HF), systolic dysfunction, and cardiac atrophy, often progressing insidiously and underscoring the importance of early detection and careful monitoring. Current preventive and therapeutic strategies include pharmacological interventions such as ACE inhibitors, beta-blockers, statins, dexrazoxane, and endothelin receptor antagonists like atrasentan. Emerging compounds, particularly Withaferin A (WFA), have shown potential through their anti-inflammatory and cardiac protective properties. In addition, antioxidants and lifestyle modifications may provide supplementary cardioprotective benefits, while interventional cardiology procedures are increasingly considered in selected patients. Despite encouraging progress, standardized treatment protocols and robust long-term outcome data remain limited. Given the heterogeneity of cancer types and cardiovascular responses, a personalized and multidisciplinary approach is essential. Continued research and close collaboration between oncologists, cardiologists, and basic scientists will be the key to advancing care, reducing treatment-related morbidity, and ensuring that improvements in cancer survival are matched by preservation of cardiovascular health. Full article

The human gastrointestinal tract hosts a complex ecosystem known as the gut microbiota, which plays a crucial part in digestion and immune system function. Among the clinically recognized manifestations of dysbiosis in this system are Small Intestinal Bacterial Overgrowth (SIBO), Intestinal Methanogen Overgrowth (IMO), Small Intestinal Fungal Overgrowth (SIFO), and Large Intestinal Bacterial Overgrowth (LIBO). This study aims to investigate the complex pathophysiological mechanisms underlying these syndromes and their diagnostics and therapeutic options, focusing primarily on the roles of methane-producing archaea and fungal overgrowth. The methods employed in this study involve a comprehensive analysis and synthesis of peer-reviewed articles, systematic reviews, clinical trials, and meta-analyses. This review summarizes that methane production by Methanobrevibacter smithii was linked to altered fermentation, reduced microbial diversity, and slowed intestinal transit. Fungal species were associated with increased intestinal permeability, inflammation, and biofilm formation. Targeted interventions addressing microbial imbalances demonstrated potential therapeutic value. This review highlights the complex and multifactorial nature of gut dysbiosis, revealing its impact beyond the gastrointestinal tract. While emerging therapies targeting methanogens, fungi, and biofilms show promise, further research is essential to optimize their clinical application. The findings emphasize the need for interdisciplinary collaboration to refine diagnostic and therapeutic strategies. Full article

Managing transition cows and preventing diseases related to this period is challenging due to the latter’s multifactorial nature. The aim of this applied observational case study is to illustrate and discuss the different aspects involved and provide an approach to analysis and the resulting management solutions using a real-life case within a 500-cow herd. The initial assessment, involving the collection of data on the level of production, animal health and behaviour, and metabolic indicators, as well as management and housing key indicators, revealed key risk factors, including overcrowding, suboptimal feeding strategies, inadequate water supply, and insufficient disease monitoring. These factors contributed to increased cases of metabolic disorders such as hypocalcemia (annual incidence 7.8%), excessive lipomobilisation, and displaced abomasum (annual incidence 5.2%). A holistic approach combining feeding adjustments, disease monitoring, facility improvements, and long-term management strategies was implemented to address these challenges. Short-term interventions, such as optimizing the dietary cation–anion balance and enhancing disease detection protocols, led to noticeable improvements. However, structural constraints and external factors, such as extreme weather conditions (heat stress) and economic limitations, created significant hurdles in achieving immediate and sustained success. The farm ultimately opted for infrastructural improvements, including a new transition cow facility, to provide a long-term solution to these recurring issues. This case highlights the complexity of transition cow management, demonstrating that long-term success depends on continuous monitoring, interdisciplinary collaboration, and adaptability in response to evolving challenges in dairy production. Full article

Odontophobia, defined as the intense and persistent fear of dentists or dental care, is a widely underestimated, yet clinically significant, barrier to oral health. It affects individuals across all age groups, from children to the elderly, and is particularly prevalent among those with intellectual or developmental disabilities. Odontophobia is a multifactorial condition influenced by psychological, sensory, cognitive, and sociocultural factors. Left unaddressed, it contributes to poor oral health outcomes, avoidant behavior, and broader health disparities. This perspective paper explores the clinical manifestations and principles of management of odontophobia across populations and different age groups, highlighting the limitations of pharmacological sedation, especially when used in isolation. Instead, evidence supports the use of cognitive behavioral strategies, desensitization protocols, sensory-adaptive environments, and communication-based approaches, such as the “tell-show-do” method. Innovative technologies, including virtual reality, offer additional promise. This paper also addresses critical gaps in the research, the paucity of tailored interventions for vulnerable groups, and both ethical and legal complexities surrounding consent, autonomy, and equitable access. Ultimately, managing odontophobia requires a shift toward “person-centered” and “trauma-informed” dental care, supported by interdisciplinary collaboration, inclusive infrastructure, and policy-level commitment to reduce fear-based disparities in oral health. Full article

Pulmonary hemorrhage (PH) is a life-threatening complication predominantly affecting preterm infants, particularly those with very low birth weight (VLBW) and fetal growth restriction (FGR). Typically occurring within the first 72 h of life, PH is characterized by acute respiratory deterioration and significant morbidity and mortality. This review synthesizes current evidence on the multifactorial pathogenesis of PH, highlighting the roles of immature pulmonary vasculature, surfactant-induced hemodynamic shifts, and left ventricular diastolic dysfunction. Key risk factors include respiratory distress syndrome (RDS), hemodynamically significant patent ductus arteriosus (hsPDA), sepsis, coagulopathies, and genetic predispositions. Diagnostic approaches incorporate clinical signs, chest imaging, lung ultrasound, and echocardiography. Management strategies are multifaceted and include ventilatory support—particularly high-frequency oscillatory ventilation (HFOV)—surfactant re-administration, blood product transfusion, and targeted hemostatic agents. Emerging therapies such as recombinant activated factor VII and antifibrinolytics show promise but require further investigation. Preventive measures like antenatal corticosteroids and early indomethacin prophylaxis may reduce incidence, particularly in high-risk populations. Despite advancements in neonatal care, PH remains a major contributor to neonatal mortality and long-term neurodevelopmental impairment. Future research should focus on individualized risk stratification, early diagnostic tools, and optimized treatment protocols to improve outcomes. Multidisciplinary collaboration and innovation are essential to advancing care for this vulnerable population. Full article