Search Results (8,185)

Background/Objectives: Behçet’s disease (BD) is a chronic multisystem inflammatory vasculitis associated with an increased risk of ventricular arrhythmias and sudden cardiac death. The index of cardiac electrophysiological balance (iCEB) and its corrected form (iCEBc) are novel electrocardiographic markers reflecting the balance between ventricular depolarization and repolarization and have been proposed as indicators of arrhythmic risk. This study aimed to evaluate iCEB and iCEBc in patients with BD and to investigate their associations with disease duration and inflammatory activity. Methods: This observational, cross-sectional study included 81 patients with clinically inactive BD (Behçet’s Disease Current Activity Form score 0–1) and 84 age- and sex-matched healthy controls. All participants underwent laboratory testing, transthoracic echocardiography and standard 12-lead electrocardiography. QT, QTc, QRS, iCEB (QT/QRS), and iCEBc (QTc/QRS) values were calculated. Correlation analyses were performed to evaluate the relationships between disease duration and QTc, iCEB, iCEBc, and CRP levels in the Behçet group. Disease duration, age, and CRP levels were subsequently entered into a multivariable linear regression model to identify independent predictors of iCEBc. Results: Patients with BD exhibited significantly higher QTc (431.41 ± 24.18 vs. 410.60 ± 18.65 ms, p < 0.001), iCEB (4.49 ± 0.33 vs. 4.36 ± 0.35, p = 0.016), and iCEBc (5.20 ± 0.47 vs. 4.93 ± 0.33, p < 0.001) values compared with healthy controls. CRP levels were also significantly elevated in the Behçet group (23.34 ± 34.05 vs. 6.07 ± 4.57 mg/L, p < 0.001). Disease duration demonstrated significant positive correlations with QTc (r = 0.539, p < 0.001), iCEB (r = 0.447, p < 0.001), iCEBc (r = 0.747, p < 0.001), and CRP levels (r = 0.419, p < 0.001). In multivariable linear regression analysis, disease duration emerged as the sole independent predictor of iCEBc (β = 0.077, 95% CI: 0.057–0.097, p < 0.001), whereas CRP was not independently associated with iCEBc (p = 0.286). Conclusions: Patients with BD have significantly increased iCEB and iCEBc values, indicating impaired cardiac electrophysiological balance. The strong association between disease duration and iCEBc suggests a relationship between disease duration and electrophysiological alterations associated with ventricular arrhythmia risk. iCEBc may serve as a simple and noninvasive electrocardiographic marker of electrophysiological alterations associated with ventricular arrhythmia risk in patients with BD. Full article

Background: Anatomical staging is often insufficient for predicting outcomes in stage I-IIIA non-small cell lung cancer (NSCLC) patients after curative resection due to inherent prognostic variability. In this study, we evaluated the prognostic value of the C-reactive protein–albumin–lymphocyte–monocyte (CALM) index as an integrative biomarker for overall survival (OS). Methods: This retrospective study included 533 patients with stage I-IIIA NSCLC. We assessed the association between the CALM index and OS using multivariable Cox proportional hazards models, adjusted for established clinicopathological factors. We employed LASSO-penalized regression to optimize variable selection and ensure model stability. Comprehensive performance metrics were calculated, including Harrell’s C-index, integrated area under the curve (iAUC), integrated discrimination improvement (IDI), and decision-curve analysis (DCA). Results: The CALM index was identified as a stable, independent predictor of OS across both conventional and LASSO-penalized models. The final multivariable model incorporated the CALM index alongside age, pathological stage, American Society of Anesthesiologists status, pleural invasion, and the modified Shine–Lal index. Incorporation of the CALM index significantly enhanced model discrimination and risk reclassification at 3 and 5 years, while consistently increasing net clinical benefit across a wide range of threshold probabilities. Conclusions: The CALM index is a biologically plausible, robust, and readily accessible prognostic biomarker that provides incremental prognostic information beyond established factors in patients with resected stage I-IIIA NSCLC. Its integration into postoperative assessment offers a framework for refined prognostic stratification and more individualized clinical decision-making. Full article

Background and Objectives: Breast cancer is the leading oncological diagnosis among women in Kazakhstan, yet a substantial proportion of cases are still detected beyond the earliest stages, particularly in peripheral regions such as Aktobe. Despite a national mammography screening programme covering women aged 40–70 years since 2018, structural differences in access to early diagnosis—related to geography, socioeconomic circumstances, and the diagnostic pathway—may compromise outcomes. We aimed to identify factors independently associated with early-stage presentation and to characterise the temporal pattern of early-stage presentation without assuming a monotonic trend. Methods and Materials: We conducted a retrospective, population-based analytical study of all confirmed breast cancer cases (ICD-10 C50) registered in the Aktobe regional cancer registry and diagnosed between 1 January 2015 and 31 December 2025 (n = 2232). The outcome was early-stage presentation, defined literally as Stages I–IIa at diagnosis, with Stages IIb–IV as the comparator; this is a stage-at-presentation classification and is not intended to indicate surgical operability or treatment sequence. Multivariable logistic regression estimated adjusted odds ratios (aORs). Two models were used: Model A included age, sex, residence, administrative nationality, employment/social status, and calendar year; Model B additionally included the diagnostic pathway, which may lie on the causal pathway between structural determinants and stage. Calendar year was modelled as a categorical variable, and a complementary phase-based model (2015–2017, 2018–2019, 2020–2022, 2023–2025) was fitted. A residence-by-year interaction; a multinomial sensitivity analysis separating Stages IIb, III, and IV; discrimination (AUC, Brier score); and calibration (Hosmer–Lemeshow test, calibration plot) were also assessed. Results: Of 2232 patients (99.1% female; mean age 57.0 ± 12.5 years), 1323 (59.3%) presented at Stages I–IIa. In Model A, rural residence (aOR 0.77, 95% CI 0.64–0.93; p = 0.006), unemployment relative to employment (aOR 0.69, 95% CI 0.52–0.90; p = 0.007), Russian administrative nationality (aOR 0.64, 95% CI 0.50–0.82; p < 0.001), and other non-Kazakh nationalities (aOR 0.73, 95% CI 0.58–0.94; p = 0.012) were independently associated with lower odds of Stage I–IIa presentation. In Model B, patient-initiated (self-referral) presentation was associated with lower odds relative to clinical examination room detection (aOR 0.46, 95% CI 0.30–0.72; p < 0.001), whereas organised screening was not significantly associated (aOR 1.52, 95% CI 0.95–2.43; p = 0.082). The calendar-year pattern was clearly non-linear (categorical vs. linear year: likelihood-ratio χ² = 76.1, df = 9, p < 0.001): odds of Stage I–IIa presentation peaked in 2018 (aOR 2.49, 95% CI 1.57–3.93 vs. 2015), were lowest in 2022 (aOR 0.64, 95% CI 0.42–0.97), and partially recovered thereafter. In the phase-based model (reference 2015–2017), the aORs were 1.62 (95% CI 1.22–2.15) for 2018–2019, 0.54 (95% CI 0.41–0.69) for 2020–2022, and 0.62 (95% CI 0.46–0.84) for 2023–2025. Model discrimination was limited (AUC 0.648, 95% CI 0.625–0.671; Brier score 0.226) with acceptable calibration (Hosmer–Lemeshow χ² = 8.38, df = 8, p = 0.40). Conclusions: In this registry-based cohort, rural residence, unemployment, non-Kazakh administrative nationality, and patient-initiated presentation were independently associated with lower odds of early-stage breast cancer presentation. The temporal pattern was non-monotonic, with the highest odds around the 2018 screening expansion, a marked reduction during 2020–2022, and only partial recovery thereafter. These are observational associations rather than causal or programme-evaluation findings; they should be interpreted as hypothesis-generating and require confirmation with screening-process, service-capacity, and patient-level access data. Full article

Background/Objectives: Patients with diabetes face increased risks during viral respiratory infections. While chronic glycemic control (HbA1c) is a known risk factor, it may fail to capture acute metabolic failure. This study aimed to evaluate the stress hyperglycemia ratio (SHR) at two time points (admission and 72 h) as a prognostic marker. Methods: We conducted a longitudinal analysis of 430 patients (211 with diabetes and 219 without diabetes) hospitalized with viral respiratory infections. The SHR was calculated at admission (SHR_z1) and at 72 h (SHR_z3). The primary outcome was severe clinical deterioration (defined as oxygen requirement >2–HFNO/OTI or mortality). Multivariate logistic regression and ROC curve analysis were used to determine independent predictors and clinical cut-off points. Results: In the global multivariable model (N = 430), continuous SHR_z3 emerged as an independent predictor of severe outcome (OR = 1.86, 95% CI 1.09–3.20, p = 0.0240) alongside chronic glycemic control (HbA1c: OR = 1.41, p < 0.0001) and age (OR = 1.05, p = 0.0001). After stratification, the independent SHR_z3 effect attenuated below statistical significance in both the non-diabetic (p = 0.6168) and diabetic (p = 0.1954) sub-cohorts, while HbA1c (p = 0.0404) and age (p = 0.0036) remained independent predictors within the diabetic subgroup. An exploratory longitudinal phenotype model classifying patients into Stable Normal, Resolvers, Persistent, and Late Spikers showed the highest in-sample discrimination of all models tested (AUC = 0.797, 95% CI 0.756–0.834). Within this model, the Persistent phenotype (SHR ≥ 1.1 sustained at admission and at 72 h) showed a non-significant trend toward higher adjusted odds of severe outcome compared with Stable Normal patients (OR = 1.81, 95% CI 0.91–3.60, p = 0.088) and was associated with a significantly longer hospital stay (Kruskal–Wallis p = 0.004 across phenotypes). Conclusions: Persistent stress hyperglycemia at 72 h is an independent predictor of severe outcome in the unstratified cohort after adjustment for chronic glycemic control, age, and other covariates. Within metabolic strata, the SHR_z3 signal attenuates, and long-standing suboptimal glycemic control (HbA1c) and age dominate, particularly among diabetic patients. Longitudinal SHR trajectories may therefore provide complementary, hypothesis-generating prognostic information when combined with chronic baseline markers, although these findings require external validation in independent cohorts before clinical use. Full article

Background: Postoperative complications after staging surgery for endometrial cancer often occur after discharge, and 30-day unplanned readmission is an important post-discharge outcome. Existing models lack same-day usability at discharge and sufficient validation, limiting discharge-time risk stratification and transitional care planning. This study aimed to develop and validate a discharge-time risk prediction model based on administrative data for 30-day unplanned hospital readmission among patients undergoing staging surgery for endometrial cancer. Methods: This retrospective cohort study was conducted in accordance with the TRIPOD reporting guidelines. We constructed a nationally representative adult cohort using the Healthcare Cost and Utilization Project Nationwide Readmissions Database (HCUP-NRD) from 2016 to 2022, including index hospitalizations discharged between January and November to ensure complete 30-day follow-up. Variables available at discharge (demographics, payer/income, presentation, inpatient course, discharge disposition, hospital characteristics, Elixhauser index) were included; age and length of stay were modeled with restricted cubic splines. Complex survey-weighted multivariable logistic regression was used for model development with 1000 bootstrap internal validations. Temporal validation within the NRD was performed using 2020–2021 and 2022 data. Decision curve analysis, subgroup, and sensitivity analyses were conducted. Results: A total of 89,627 hospitalizations were included; development and validation cohorts had balanced baselines. Internal validation showed moderate discrimination (AUC 0.719) and good calibration (Brier 0.045; intercept 0.014; slope 0.955). Discharge to home health or institutional care, non-elective or emergency admission, and a higher Elixhauser readmission index (a measure of comorbidity burden) were associated with increased risk. Age and length of stay showed nonlinear associations. Temporal validation yielded a similar performance (AUC 0.708–0.713; Brier 0.043–0.046), and decision curves indicated positive net clinical benefit. Conclusions: The model demonstrated stable discrimination and maintained good calibration after temporal validation and recalibration. It represents a candidate discharge-time decision-support tool, based on administrative data, for identifying patients at higher risk of 30-day unplanned readmission, and may support nurse-led transitional care planning. External validation and local recalibration are required before application in other healthcare settings. Full article

Background: Wound complications and unplanned revision surgery remain common after soft tissue sarcoma (STS) resection. Established risk models focus on patient- and tumour-related factors, while the role of operative and perioperative variables is less well defined. Methods: This retrospective single-centre study included 95 patients undergoing STS resection between 2021 and 2025. Associations with unplanned revision surgery were evaluated using univariate and exploratory multivariable logistic regression analyses. Receiver operating characteristic (ROC) analysis assessed the discriminatory performance of postoperative drainage output. Results: Unplanned revision surgery occurred in 23 patients (24%). On univariate analysis, several intraoperative and postoperative variables were associated with revision, whereas most patient- and tumour-related factors were not statistically significant. In multivariable analysis, intraoperative crystalloid administration was the only intraoperative factor associated with unplanned revision (OR 1.45 per 500 mL, 95% CI 1.05–2.02; p = 0.026). Among postoperative parameters, drainage output remained associated with revision (OR 1.45 per 100 mL, 95% CI 1.15–1.82; p = 0.005). In patients without planned secondary reconstruction, drainage output showed good exploratory discriminatory performance (AUC 0.927), with a cutoff of 925 mL providing high specificity (94.4%) with acceptable sensitivity (75%). Conclusions: In this cohort, unplanned revision was more frequently associated with markers of surgical complexity, including higher intraoperative crystalloid administration, and the early postoperative course, particularly drainage output. Drainage output appears to reflect an evolving complication rather than an independent predictor and may serve as an early clinical warning signal. Findings are hypothesis-generated and require external validation. Full article

Background/Objectives: Total parenteral nutrition (TPN) is essential for neonates unable to receive adequate enteral feeding, but its long-term metabolic effects remain uncertain. This study evaluated associations between neonatal TPN exposure, exposure duration, and later endocrinologic or metabolic disorders. Methods: This nationwide cohort included 2,424,716 infants born in South Korea between 2005 and 2010. TPN exposure was identified during the first 28 days of life. The primary outcome was the first occurrence of type 2 diabetes mellitus (T2DM), essential hypertension, dyslipidemia, or obesity during follow-up of up to 18 years. The primary analysis used inverse probability of treatment-weighted (IPTW) Cox models, whereas duration-based associations were evaluated using secondary exploratory multivariable Cox regression. Results: The final cohort included 2,303,567 infants, of whom 7656 received TPN. In the primary IPTW analysis, any neonatal TPN exposure was not associated with either the primary composite outcome (HR 1.01, 95% CI 0.94–1.09; p = 0.801) or T2DM (HR 1.12, 95% CI 0.93–1.35; p = 0.215). In secondary exploratory multivariable analyses, TPN exposure for ≥3 days was associated with T2DM (adjusted HR 2.14, 95% CI 1.34–3.41; p = 0.001), whereas exposure for 1–2 days was not. Conclusions: The primary IPTW analysis showed no significant association between any neonatal TPN exposure and the primary composite outcome or T2DM. The association observed for ≥3 days in secondary exploratory analyses should be regarded as hypothesis-generating. Full article

Background/Objectives: Endothelial dysfunction represents an early stage of vascular injury in type 2 diabetes mellitus (T2DM) and contributes to increased cardiovascular risk. Leptin, a hormone involved in metabolic and inflammatory regulation, has been implicated in vascular dysfunction. However, its association with digital thermal monitoring (DTM)-derived peripheral vascular reactivity in T2DM remains unclear. Methods: This cross-sectional study enrolled 88 patients with T2DM to investigate the association between serum leptin levels and peripheral vascular reactivity, assessed using the digital thermal monitoring-derived vascular reactivity index (VRI). Based on the VRI values, patients were categorized as having good (VRI ≥ 2.0), intermediate (VRI of 1.0–1.9), or poor (VRI < 1.0) vascular reactivity. Serum leptin levels were quantified using an enzyme immunoassay. Results: Patients with poor vascular reactivity were older and had higher total cholesterol, triglyceride, fasting glucose, glycated hemoglobin, urine albumin-to-creatinine ratio, and leptin levels. In the primary parsimonious multivariable logistic regression model adjusted for age, sex, body mass index (BMI) and eGFR, higher serum leptin levels were associated with vascular reactivity dysfunction. Linear regression analysis also showed that log-transformed leptin levels were negatively associated with VRI. Exploratory analyses, including poor vascular reactivity models and penalized regression models, showed generally consistent findings but were interpreted cautiously because of the limited number of outcome events. Conclusions: Higher serum leptin levels were associated with impaired DTM-derived peripheral vascular reactivity in clinically stable patients with T2DM after adjustment for age, sex, BMI, and eGFR. These findings should be interpreted cautiously and require validation in larger prospective studies. Full article

Background: Accurate preoperative prediction of lymph node metastasis (LNM) is essential for tailoring treatment strategies in T1 colorectal cancer (CRC). Although the neutrophil-to-lymphocyte ratio (NLR), an easily acquired inflammatory biomarker, correlates with tumor progression, its incremental value when incorporated into machine learning (ML) models for predicting LNM in T1 CRC remains unclear. Therefore, this study evaluated the independent predictive value of preoperative NLR for LNM and constructed interpretative ML models to stratify LNM risk in T1 CRC. Methods: We retrospectively enrolled 533 pathologically confirmed T1 CRC patients. NLR was calculated as the neutrophil–lymphocyte count ratio. Multivariable logistic regression identified NLR’s independent correlation with LNM. Features were screened via combined least absolute shrinkage and selection operator (LASSO) regression and the Boruta algorithm. Six ML models, including Logistic Regression (LR), Random Forest (RF), XGBoost, LightGBM, CatBoost, and Logistic Regression with Splines (LR-Spline), were developed and validated. Model performance was evaluated in terms of discrimination, calibration, and clinical utility. Shapley additive explanations (SHAP) were applied for feature interpretability. Results: Elevated preoperative NLR was independently associated with an increased risk of LNM (adjusted OR = 2.83, 95% CI: 1.48–5.41, p = 0.002), exhibiting stability across all clinical and pathological subgroups. The optimized LightGBM outperformed other models with an area under the receiver operating characteristic curve (AUC) of 0.768, alongside favorable clinical utility. Conclusions: An elevated preoperative NLR is a robust, independent predictor of LNM in patients with T1 CRC. An optimized LightGBM model integrating NLR with routine clinicopathological indicators offers accurate risk stratification, potentially refining surgical decision-making and sparing low-risk T1 CRC patients from unnecessary radical resections. Full article

Background: Prehospital return of spontaneous circulation (ROSC) is a widely used intermediate endpoint in out-of-hospital cardiac arrest (OHCA), but its downstream clinical meaning may differ according to when ROSC is achieved. Methods: We conducted a retrospective registry-based cohort study of adult non-traumatic OHCA patients treated with Smart Advanced Life Support (SALS) from 2015 to 2023 who achieved prehospital ROSC. The primary exposure was the low-flow interval, defined as the interval from CPR initiation to first prehospital ROSC, categorized a priori as <10, 10–14, 15–19, 20–24, 25–29, and ≥30 min. Multivariable logistic regression models estimated associations with good neurological recovery, prehospital rearrest, survival to hospital admission, and survival to discharge, adjusting for age, sex, witnessed arrest, bystander CPR, initial shockable rhythm, transport time interval, and region. Results: Among 19,156 adult SALS-treated OHCA patients, 4195 achieved prehospital ROSC; 3760 had valid low-flow interval values from 0 to 60 min and were included in the primary analysis. Good neurological recovery decreased from 582/1004 (58.0%) in the <10 min group to 17/249 (6.8%) in the ≥30 min group, while prehospital rearrest increased from 194/488 (39.8%) to 136/174 (78.2%). Compared with <10 min, the adjusted odds ratios for good neurological recovery were 0.368, 0.164, 0.135, 0.099, and 0.081 across progressively later ROSC categories. The adjusted odds ratio for rearrest in the ≥30 min group was 5.024. Conclusions: In this selected SALS-treated ROSC-positive OHCA cohort, later low-flow interval was associated with substantially lower odds of favorable neurological recovery and survival and higher odds of prehospital rearrest. These findings suggest that prehospital ROSC timing may serve as a prognostic marker but should not be interpreted as a standalone criterion for treatment termination or transport decisions. Full article

Background: Biotrauma from invasive mechanical ventilation (IMV) and extracorporeal membrane oxygenation (ECMO) drives systemic inflammation, metabolic dysregulation, and organ dysfunction in critically ill patients. Therefore, this study aimed to identify clinical and metabolomic features associated with ICU mortality in patients receiving IMV or ECMO, as these remain incompletely characterized. Methods: The retrospective analysis included 30 ICU patients on IMV and 22 on ECMO. Metabolomic and proteomic profiling were performed using ultra-high-performance liquid chromatography coupled with high-resolution mass spectrometry (UHPLC-HRMS), and serum spectral analysis by Fourier-transform infrared spectroscopy (FTIRS). Significant variables were incorporated into multivariate logistic regression models, ranked by AIC, AUC, and statistical significance. Model performance was evaluated using stratified 5-fold cross-validation. Final models were adjusted for relevant demographic and clinical covariates. Results: The IMV cohort showed discriminatory FTIRS wavenumbers across all preprocessings, and 155 metabolites plus 14 proteins were significantly altered, with unadjusted models achieving mean AUCs above 0.9. The ECMO cohort showed discriminatory FTIRS wavenumbers in one preprocessing, and 15 metabolites plus 3 proteins were highlighted. FTIRS, metabolomic, and proteomic models reached mean AUCs of 0.967, 0.867, and 0.783, respectively, with lower stability during cross-validation. Adjustment for demographic and clinical covariates reduced model robustness. Conclusions: Stronger and more reproducible molecular signatures related to ICU mortality were observed in the IMV cohort, whereas the ECMO cohort showed reduced model stability, likely reflecting increased biological heterogeneity and small sample size. These findings support the utility of integrated omics for characterizing critical illness and outcome stratification, while reinforcing the need for validation in larger and independent cohorts. Full article

Soybean grain yield across extended planting calendars depends on sowing date, cultivar maturity group, and plant population. We evaluated BRS 1061 IPRO (MG 6.1) and DM 66i68 IPRO (MG 6.6) sown from September to January in 2021/2022 and 2022/2023 in Londrina, Brazil, at 200,000, 280,000, 360,000, and 440,000 viable seeds ha⁻¹ in a split-plot randomised complete block design. Grain yield, final stand, and yield components were analysed using mixed-model ANOVA, mean comparisons, regressions, correlations, principal component analysis, clustering, and descriptive permutation-based predictor ranking. Sowing date produced the largest performance gradient: grain yield ranged from 314 to 5771 kg ha⁻¹, and January sowings were consistently low yielding. Final stands ranged from approximately 1.6 × 10⁵ to 4.2 × 10⁵ plants ha⁻¹. Grain yield was strongly associated with grains m⁻² (r = 0.92), while PC1 and PC2 explained 71.3% of multivariate variation. Higher seeding rates did not provide a uniform advantage; intermediate rates were beneficial only in specific sowing-date × cultivar contexts, whereas 440,000 seeds ha⁻¹ sometimes reduced early-sowing yield. Seeding-rate decisions should, therefore, be cultivar- and date-specific, and January sowing is not recommended in this environment. Full article

Background/Objectives: This study aimed to evaluate serum fibroblast growth factor-23 (FGF-23) and α-Klotho levels in patients with prolactinoma and patients with non-tumoral hyperprolactinemia and to explore their discriminatory performance for prolactinoma. Methods: Seventy-three participants were included in this single-center, cross-sectional comparative study: non-tumoral hyperprolactinemia (n = 14), prolactinoma (n = 29), and healthy controls (n = 30). All patients with prolactinoma had received dopamine agonist therapy for at least six months. Serum FGF-23 and α-Klotho were measured by ELISA, and between-group comparisons, correlation analyses, linear regression analyses, and receiver operating characteristic (ROC) analyses were performed. Results: FGF-23 concentrations differed significantly among the groups (overall p < 0.001). Post hoc analysis showed that FGF-23 concentrations were significantly higher in the prolactinoma group [236.10 (107.70–667.90) pg/mL] than in healthy controls [138.75 (49.40–253.60) pg/mL] (adjusted p < 0.001), whereas the difference between the prolactinoma and non-tumoral hyperprolactinemia groups [166.20 (100.30–327.20) pg/mL] was not statistically significant (adjusted p = 0.075). α-Klotho concentrations were significantly higher in the prolactinoma group [2.908 (1.376–6.257) ng/mL] than in both the non-tumoral hyperprolactinemia group [2.244 (1.432–5.139) ng/mL] (adjusted p = 0.038) and healthy controls [2.204 (0.149–4.917) ng/mL] (adjusted p < 0.001). In pooled analyses, both biomarkers showed positive correlations with prolactin and weak negative correlations with hemoglobin. However, prolactin and hemoglobin were not independently associated with either biomarker after multivariable adjustment. The non-tumoral hyperprolactinemia group did not differ significantly from healthy controls for either biomarker. For distinguishing prolactinoma from non-tumoral hyperprolactinemia, the AUCs were 0.741 for FGF-23, 0.732 for α-Klotho, and 0.862 for the exploratory combined model. Conclusions: Dopamine agonist-treated prolactinoma was characterized by higher circulating FGF-23 concentrations than those in healthy controls and by higher α-Klotho concentrations than those in both healthy controls and patients with non-tumoral hyperprolactinemia. Exploratory ROC analyses suggested moderate discriminatory performance for the individual biomarkers and higher apparent performance for the combined model; however, these findings should be interpreted cautiously and require validation in larger, treatment-naïve cohorts. Full article

Background/Objectives: Some patients with severe hypoxic–ischemic brain injury after out-of-hospital cardiac arrest (OHCA) progress toward brain death, a trajectory not adequately captured by the conventional classification of favorable versus unfavorable neurological outcomes. We developed and internally evaluated a multimodal model combining quantitative brain computed tomography (CT), serum neuron-specific enolase (NSE) at 48 h, and clinical variables to predict operationally defined progression toward brain death (PTBD). Methods: This multicenter retrospective secondary analysis used prospectively collected data from the Korean Hypothermia Network registry. Adult comatose OHCA survivors treated with targeted temperature management between October 2015 and December 2020 were included. Multivariable logistic regression models were developed in the total cohort and in patients with poor neurological outcomes. Model performance was assessed using discrimination, calibration, the Brier score, and bootstrap internal validation. Results: Of 468 patients assessed, 376 were included; their mean age was 58.7 years, and 269 (71.5%) were male. Seventy-four patients (19.7%) met the operational definition of PTBD. In the total cohort, younger age, non-shockable rhythm, low gray-to-white matter ratio (GWR ≤ 1.19), and higher NSE at 48 h were independently associated with PTBD. Among 288 patients with poor neurological outcomes, younger age, low GWR, and higher NSE at 48 h remained independent predictors. The total-cohort model had an AUC of 0.895 and an optimism-corrected AUC of 0.890. Its AUC was higher than that of NSE at 48 h (p < 0.001) but not significantly different from that of GWR alone (p = 0.054). In the poor-outcome subgroup, the model had an AUC of 0.864 and an optimism-corrected AUC of 0.858 and significantly outperformed both GWR (p = 0.012) and NSE at 48 h (p < 0.001). Conclusions: PTBD represents a clinically distinguishable trajectory among patients with poor neurological outcomes after OHCA. A multimodal model using information available within 48 h demonstrated good internally validated performance and may support early risk stratification before definitive neuroprognostication. External validation is required before clinical implementation. Full article

Background. Five-a-side soccer for the blind (F5) is a Paralympic sport that has been the subject of research aimed at identifying variables that influence performance. However, despite its growing popularity, there is limited scientific literature on quantitative analyses of offensive performance in this sport. Objective. To analyze 164 offensive plays by the Argentine men’s national team during the 2022 International Blind Sports Federation (IBSA) Copa América to determine the spatiotemporal progression and the decline in intra-match offensive performance. Materials and Methods. Each play was reconstructed with its progression vector, its finishing zone, and its absolute game minute. Multivariate logistic regression models and weighted trend analysis (Cochran–Armitage) were applied to examine the relationship between these variables and the offensive outcome (shot on-target and goal). Results. Plays originating from high-pressure recovery showed a favorable trend toward shooting on-target. The goal rate showed an empirical decline from 26.1% in the 6th–10th minutes to 6.7% in the final minutes, without reaching statistical significance. Conclusions. The results of this study suggest that the magnitude of the offensive progression vector and offensive effectiveness show an asymmetry toward the right side, as well as a pattern consistent with an intra-match decline toward the end of games. These variables appear to influence the offensive performance of the Argentine men’s national blind football (F5) in the 2022 Copa América. These findings provide one of the first integrated vector analyses of offensive performance in F5 and propose metrics applicable to coaching staff, the design of specific training programs, and the functional assessment of athletes with visual impairments; therefore, further studies are needed to analyze these metrics in different official competitions and to account for various competitive levels. It is recommended to design training exercises focused on recovery under high pressure near the right side of the offensive zone and maintain the intensity of play in the final minutes of the game. Full article