Search Results (481)

Background: Eustachian tube dysfunction (ETD) is associated with several common otologic conditions but lacks standardized diagnostic thresholds in Taiwan. This study aimed to evaluate the diagnostic performance of the GSI TympStar Pro pressure-swallow test and to identify a ROC-derived maximal peak pressure difference (MPD) cutoff for distinguishing clinically diagnosed obstructive Eustachian tube dysfunction (oETD) from healthy controls. Methods: A total of 152 subjects were enrolled, including 100 healthy controls and 52 patients with clinically diagnosed oETD, confirmed by otolaryngologist assessment and supported by ETDQ-7 symptom scoring. Tympanometry and tympanometry-based Eustachian tube function testing using the GSI TympStar Pro ETF–Intact pressure-swallow module, a modified three-tympanogram pressure-swallow protocol, were performed. Group comparisons were conducted using Mann–Whitney U and Chi-square tests. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Results: The median MPD was 11 daPa (IQR 6–17) in the control group, compared to 0 daPa (IQR 0–2) in the ETD group (p < 0.001). ROC analysis demonstrated that a cutoff value of ≤4 daPa yielded a sensitivity of 100.0% and specificity of 91.0% in the per-person analysis, and a sensitivity of 97.5% and specificity of 95.5% in the per-ear analysis. In the Type A-only per-ear analysis, MPD retained discriminatory performance, with an AUC of 0.978 (95% CI, 0.961–0.994). Conclusions: When interpreted in conjunction with ETDQ-7 symptom assessment and routine clinical evaluation, pressure-swallow testing may provide complementary objective information for the functional assessment of patients with suspected obstructive Eustachian tube dysfunction, particularly when resting tympanometry is unremarkable. In this single-center Taiwanese cohort, lower MPD values may serve as an adjunctive indicator of impaired Eustachian tube pressure equalization, and the ROC-derived cutoff of ≤4 daPa showed discriminatory value for differentiating symptomatic obstructive ETD from healthy controls. This cutoff should be interpreted as an exploratory, protocol-specific threshold and requires prospective validation in larger multicenter populations before broader clinical application. Full article

Background: Gastrointestinal (GI) involvement is increasingly recognised in paediatric SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C), but severe GI bleeding remains rare. Its pathogenesis in this setting is multifactorial: direct viral injury, hyperinflammatory microvascular damage, treatment-related mucosal injury, and coagulopathy may all contribute, and the relative role of each is often difficult to disentangle. Case Presentation: A previously healthy 12-year-old boy underwent appendectomy for perforated appendicitis with peritonitis. On postoperative Day 1, he developed high fever and was found to be SARS-CoV-2 PCR-positive; SARS-CoV-2 IgM and IgG were also positive. He met the positive clinical elements of the CDC 2023 case definition for MIS-C (persistent fever, multisystem involvement—gastrointestinal, hepatic, haematological, and markedly elevated inflammatory markers), although perforated appendicitis with peritonitis is a sufficient alternative explanation and the diagnosis cannot be regarded as secure (see Discussion). Treatment included broad-spectrum antibiotics (meropenem, amikacin, metronidazole), methylprednisolone 2 mg/kg/day, and intravenous immunoglobulin (IVIG) 2 g/kg. On Day 4 in the paediatric intensive care unit (PICU), the patient developed sudden haematemesis with fresh blood through the nasogastric tube and haemodynamic collapse. Coagulation studies revealed prolonged INR (1.6) and reduced prothrombin activity (42%). The patient was stabilised with packed red blood cells, fresh frozen plasma, and intravenous vitamin K. Fibrogastroscopy demonstrated diffuse mucosal bleeding without ulcers or anatomical defects; histology showed mucosal hyperaemia, mixed basal inflammation with intraepithelial lymphocytes, and small erosions. Melena persisted for several days. The child recovered fully and was discharged after 20 days with substantially improved but not fully normalised laboratory values (residual mild anaemia, Hb 110 g/L, and elevated CRP 32.7 mg/L and D-dimer 5.88 mg/L). Conclusions: Severe upper GI bleeding is a rare but life-threatening event in children with severe SARS-CoV-2 infection and MIS-C. In our case, several mechanisms may have acted in combination, although none could be confirmed individually: possible direct viral enterocyte injury via ACE-2 receptors, hyperinflammatory microangiopathy, high-dose corticosteroid-related mucosal injury, possible broad-spectrum antibiotic-associated vitamin K deficiency, and postoperative critical-illness stress. Their relative contributions cannot be determined from a single retrospective case. Bleeding occurred despite continuous PPI prophylaxis, suggesting that PPI cover alone is insufficient when multiple risk factors coexist; the clinical implication is that risk-factor-based (rather than universal) PPI prophylaxis, together with monitoring of vitamin K-dependent coagulation, should be considered in critically ill children receiving high-dose corticosteroids and prolonged broad-spectrum antibiotics. Full article

Background: Isavuconazole, a broad-spectrum triazole antifungal, exhibits high lipophilicity and extensive plasma protein binding, properties that may predispose it to sequestration within extracorporeal membrane oxygenation (ECMO) circuits. This study aimed to characterize the pharmacokinetics (PK) of isavuconazole and to evaluate drug sequestration within the ECMO circuit in critically ill patients receiving ECMO support. Methods: We conducted a prospective, exploratory, single-center observational study including critically ill patients receiving ECMO (veno-venous (VV) or veno-arterial (VA)) and treated with intravenous isavuconazole. Serial blood samples were collected simultaneously from the patient’s arterial line and from pre- and post-membrane oxygenator sampling sites. Non-compartmental analysis was performed on arterial line samples to estimate PK measures, and concentration differences across sampling sites were analyzed to estimate circuit-related drug loss. PK/pharmacodynamic (PD) target attainment was assessed using established efficacy thresholds (AUC_0–24/MIC ≥ 25 and Cmin > 2 mg/L). Results: A total of 41 plasma samples from 3 critically ill patients (2 VV-ECMO, 1 VA-ECMO) were included in the analysis. Limited, component-specific isavuconazole loss was observed in tubing and connectors (6.62% ± 20.8%, p = 0.294) and across the entire ECMO circuit (7.74% ± 20.2%, p = 0.211). Likewise, no relevant concentration difference was detected across the membrane oxygenator (0.849% ± 6.15%, p = 0.642). Interindividual variability was observed across PK parameters, particularly in measures of elimination and distribution. All patients achieved predefined PK/PD efficacy targets, with mean Cmin and AUC_0–24/MIC of 3.07 ± 0.261 mg/L and 85.3 ± 4.03, respectively, and none exceeded the established toxicity threshold. Conclusions: Preliminary results showed variable concentration differences across ECMO sampling sites, with no consistent pattern of isavuconazole loss across the ECMO circuit under the conditions evaluated. All patients achieved predefined PK/PD efficacy targets using currently recommended dosing regimens; however, interindividual PK variability was observed, supporting the potential value of therapeutic drug monitoring (TDM) to guide individualized dosing decisions in this population. Larger population PK studies are warranted to further characterize determinants of isavuconazole exposure during ECMO support and refine evidence-based dosing strategies. Full article

Background/Objectives: The modified inflation–deflation test (MIDT) is a physiological test used to evaluate eustachian tube function in patients with tympanic membrane perforation. However, the clinical characteristics and diagnostic value of MIDT have not been fully established. This study aimed to investigate the characteristics of MIDT findings in normal function and patients with Eustachian tube dysfunction (ETD) classified by sonotubometry. Methods: We retrospectively assessed 192 ears of 181 patients with tympanic membrane perforation who underwent sonotubometry and MIDT. Based on sonotubometry findings, 117 ears were classified into the normal function group and 75 ears into the ETD group. The MIDT parameters of the groups, including the first opening pressure (OP1), first closing pressure (CP1), residual pressure after three openings (RP3), and pressure difference between OP1 and CP1 were compared. Correlation and receiver-operating characteristic (ROC) analyses were performed. Results: The ETD group had significantly higher OP1, CP1, and RP3 levels than the normal function group (all p < 0.001). The pressure difference between OP1 and CP1 was significantly greater for the normal function group. Failure of Eustachian tube opening was observed in 46.7% and 3.4% of ears in the ETD and normal function groups, respectively. Eustachian tube opening duration measured by sonotubometry was negatively correlated with OP1, CP1, and RP3 but positively correlated with the OP1–CP1 difference. ROC analysis identified an optimal cutoff value of 112.50 daPa for the OP1–CP1 difference, yielding a sensitivity of 92.3% and a specificity of 58.7%. Conclusions: MIDT was significantly associated with sonotubometry findings and effectively differentiated ETD from normal Eustachian tube function. These findings support the clinical utility of the MIDT as a physiological tool for assessing Eustachian tube function in patients with tympanic membrane perforation. Full article

Underwater wireless optical communication (UWOC) has emerged as a key technology for high-speed, low-latency data transmission in aquatic environments, enabling applications in autonomous underwater vehicles (AUVs), remotely operated vehicles (ROVs), subsea sensor networks, and the Internet of Underwater Things (IoUT). This paper reviews photodetector technologies that shape UWOC system performance, covering both mature and emerging detector classes. We discuss the operating principles, key parameters, and practical trade-offs of photomultiplier tubes (PMTs), p-i-n photodiodes (PINs), avalanche photodiodes (APDs), single-photon avalanche diodes (SPADs), and silicon photomultipliers (SiPMs/MPPCs). We also present emerging photodetector technologies, including perovskite-based structures, SiC photoelectrochemical devices, scintillating optical fibers, and photovoltaic solar cells. A comparative analysis of reported UWOC experiments reveals a clear sensitivity–bandwidth trade-off among detector technologies: PIN-based receivers achieve the highest data rates (up to 25 Gbps) but are generally restricted to short-range links, whereas SPAD- and SiPM-based receivers provide sensitivities below −80 dBm and support transmission distances exceeding 200 m, at the cost of moderate data rates. The findings indicate that SiPM/MPPC arrays currently offer the most promising compromise between sensitivity and data rate for long-range UWOC applications. Full article

Background/Objectives: Children with normal newborn hearing screening results can develop hearing loss from various causes during their first years of life. Since 2016, a hearing and speech-language pathology screening has been conducted annually in kindergartens in Upper Austria in children aged 4 to 5 years. If an abnormal result is found, further evaluation is recommended. Methods: Data from the kindergarten hearing screening from 2018 to 2025 and hearing and speech screening from 2022/2023 were retrospectively analyzed. In addition, a prospective questionnaire survey was conducted with the parents of children who had an abnormal hearing screening result in 2024/2025. The survey asked whether the parents followed the recommendation for further evaluation and what the outcome of that evaluation was. Results: From 2018 to 2025, between 14,975 (2024) and 17,101 (2020) children were screened annually. The prevalence of abnormal hearing screening results ranged from 5.89% (2020) to 8.17% (2022). Abnormal grammar and articulation were found in 18.68% and 68.28% of the in-depth analyzed screenings of 4–5-year-old children in 2022, respectively. A total of 209 questionnaires were evaluated in the prospective questionnaire study. Approximately 70% of the participating parents reported having their child undergo the recommended evaluation by an ORL specialist. According to the parents, the most frequent cause of hearing impairment was middle ear effusion or Eustachian tube dysfunction. No new cases of sensorineural hearing loss were diagnosed in this population of 209 children, according to the parents surveyed. Conclusions: Nationwide screening in kindergartens allows for the early detection of hearing loss in early childhood, enabling children to receive evaluation and treatment. This is supported by the fact that, according to their parents, almost a quarter of the children with abnormal hearing screening results received a diagnosis requiring treatment from an ORL specialist. Full article

The decarbonization of industrial heating systems is one of the major challenges of the current energy transition. Gas-fired radiant tubes dominate industrial heating in large-span, high-bay buildings due to their high efficiency and low operating costs; however, the absence of equivalent electric solutions capable of replacing them represents a significant technological and scientific gap. This paper presents the design, construction, and experimental characterization of an innovative electric radiant tube prototype developed within the INFRAEL research project. The prototype consists of a 100 mm diameter steel tube housing nickel–chromium resistive elements in various configurations, powered from a 230 V AC supply. Thermal measurements were performed using Type K thermocouples distributed along the tube, a non-contact infrared thermometer, and thermovision imaging, complemented by MATLAB R2025bTrial-based interpolation for mapping the thermal field on a receiving plane placed 2 m below the tube. Experimental results show that at a total power of ~1.2 kW (two resistors in parallel), the tube surface reaches temperatures exceeding 250 °C, corresponding to medium-wave infrared emission (~4 μm). A single 630 W resistor yields surface temperatures of approximately 136–160 °C. The temperature distribution on the receiving plane is relatively uniform. The study identifies key optimization directions—resistor geometry, thermal insulation, and integration with photovoltaic sources—with the goal of developing a competitive, zero-carbon alternative to gas-fired radiant heating systems in industrial environments. Full article

Background: No consensus guideline exists for double-lumen tube (DLT) size selection, which conventionally relies on height, sex, and chest radiography. Computed tomography (CT) has been proposed to refine sizing, particularly in women and patients of small stature. We examined whether high-resolution CT (HRCT) measurement of the trachea and main bronchi improves DLT size selection beyond a height- and sex-based estimate in patients undergoing minimally invasive coronary artery bypass (MICS-CABG). The aim of this study was to determine whether HRCT measurement of the trachea and main bronchi improves DLT size selection beyond a height- and sex-based estimate in patients undergoing MICS-CABG. Methods: A total of 140 patients were retrospectively analyzed who had undergone MICS-CABG and had HRCT within 30 days of surgery. Tracheal anteroposterior and transverse diameters and left and right main bronchus diameters were measured in lung, mediastinal, and bronchial windows (mean of six readings by two observers). The DLT size used was related to each parameter through Spearman correlation; the agreement between the height/sex estimate and the size used was determined using Cohen’s kappa; discrimination for a larger tube (≥39 Fr) was evaluated through receiver operating characteristic analysis; and the incremental value of imaging was assessed using leave-one-out cross-validation. Results: In total, 82.1% of patients were male (mean age 59.7 ± 10 years; height 171.7 ± 7.3 cm). The height- and sex-based estimates correlated most strongly with the size used (ρ = 0.885, p < 0.001), followed by height alone (ρ = 0.844, p < 0.001); the best imaging measure, the lung-window left main bronchus diameter, was weaker (ρ = 0.503, p < 0.001), and body mass index showed no association (ρ = −0.008, p = 0.926). The estimate matched the size used exactly in 85.7% of patients and was within one size for all patients (linear-weighted κ = 0.831). Height best discriminated a larger tube (AUC = 0.969). Adding the bronchial diameter to height and sex did not improve cross-validated prediction (exact match 80.7% with and without; AUC 0.972 versus 0.973). The mediastinal window yielded systematically larger calibers than the lung and bronchial windows. Conclusions: HRCT airway measurement did not improve the prediction of the double-lumen tube size selected in routine practice beyond a simple height- and sex-based formula. Because the reference standard was the size clinicians actually placed rather than an independently validated optimum, these data argue against routine preoperative HRCT undertaken solely to predict tube size; they do not exclude a benefit of HRCT when selection is judged against clinical outcomes. CT remains valuable when abnormal airway anatomy is suspected. Full article

Effective solar receiver design is pivotal to improving the efficiency of concentrated solar collectors, thereby advancing sustainable energy development. This study investigates the impact of receiver configuration on the thermal and exergy performance of parabolic trough collectors and proposes adopting a commercially available copper-finned tube as the receiver. Notably, thermal efficiency improved when the flat corrugated fin was redesigned into an arc-shaped thin-profile configuration. Specifically, the arc-shaped fin receiver outperformed its flat-fin counterpart, achieving thermal efficiencies of 75.8% and 68.5% at a mass flow rate of 0.1 kg/s, respectively. At a lower flow rate of 0.033 kg/s, peak water temperatures of 80 °C and 72 °C were recorded for the arc-shaped and flat-fin receivers, respectively. Comparative analysis further revealed that the arc-shaped fin yielded an average heat transfer coefficient 19–33.9% higher than that of the flat-fin receiver. Furthermore, at 0.033 kg/s, the arc-shaped fin demonstrated superior exergy efficiency, with peak and average values of 7.2% and 4.2%, respectively, compared with 5.2% and 3.0% for the flat-fin receiver. These findings highlight the potential of arc-shaped copper-finned tube receivers to optimize parabolic trough collector performance, offering a promising avenue for advancing sustainable energy development. Full article

Maintaining reliable communication while ensuring collision-free motion is a central challenge for mobile relay robots operating in indoor disaster environments, where abrupt non-line-of-sight (NLOS) degradation and narrow structural bottlenecks can severely disrupt multi-hop connectivity. To address this problem, this paper proposes a Gaussian Process-Driven Adaptive Tube Model Predictive Control (GP-ATMPC) framework for communication-preserving relay navigation. Gaussian process regression (GPR) is used to construct a probabilistic spatial radio map from sparse received signal strength indicator (RSSI) measurements, providing both the predicted channel mean and its uncertainty over unvisited regions. Motion uncertainty is represented by an adaptive ellipsoidal error tube whose radius varies with translational motion, angular motion, and localization uncertainty. Based on this tube model, both obstacle and communication constraints are tightened over the full closed-loop state tube via a tube-tightened lower confidence bound (LCB) that jointly accounts for radio-prediction and motion-tracking uncertainty. Across two indoor disaster environments and 50 Monte Carlo runs each, the proposed method attains the highest connectivity satisfaction rate among controllers that preserve a safe motion margin, with significantly fewer end-to-end connectivity violations than nominal and heuristic adaptive-margin MPC by a paired Wilcoxon test, while maintaining millisecond-level online solve times. A reactive connectivity-first baseline reaches slightly higher raw connectivity but at three to four times the near-collision rate and without feasibility or stability guarantees. The radio-prediction layer is further validated in a higher-fidelity Gazebo environment and on real indoor RSSI measurements, where it reconstructs the measured channel with a mean absolute error of about 2.1 dB. These results indicate that coupling spatial radio prediction with adaptive tube-based robust control provides an effective framework for resilient communication-aware relay navigation in degraded indoor environments. Full article

In the development of deep shale gas horizontal wells, precise geo-steering relies heavily on downhole sensor networks to acquire extensive formation and engineering parameters. Coiled tubing (CT) provides a promising acoustic waveguide for downhole sensing systems, but conventional acoustic sources rely on gravity-induced interfacial preload. Under highly deviated or horizontal well conditions, the loss of the axial gravity component may induce contact–nonlinearity instability, resulting in waveform distortion and spectral pollution. To address this limitation, a constant-stiffness preloading method based on elastic compliance control is proposed, together with a modal reconstruction strategy achieved by removing high-density tungsten blocks. A fluid–solid coupled dynamic model incorporating contact nonlinearity is established to reveal the dynamic separation mechanism of the acoustic source interface under varying gravity-vector conditions. Wave spring assemblies are then used to reconstruct the mechanical boundary and physically suppress time-domain clipping. Full-scale ground circulation experiments on a 1500 ft CT string show that the proposed method decouples acoustic-source performance from wellbore trajectory. Waveform asymmetry is reduced from 18.4% to 2.1%, and total harmonic distortion decreases from 12.5% to 1.8%. In addition, the first-order longitudinal natural frequency is shifted from 420 Hz to 2850 Hz, avoiding low-frequency pump noise and achieving a 12 dB SNR improvement. This physical-layer gain provides an optimized signal baseline for receiver-end demodulation algorithms. Ultimately, this study provides a robust physical-layer solution for acoustic telemetry in complex deep-earth environments, advancing the reliability of data interaction in downhole sensing systems. Full article

Oral health has significant implications for pulmonary outcomes, particularly among individuals with dysphagia who are at risk for aspiration. Moreover, oral health and condition affect nutrition accessibility and status. Inadequate oral hygiene promotes bacterial colonization, plaque accumulation, and aspiration-related respiratory complications. This narrative review aimed to explore current evidence and expert perspectives across palliative medicine, pulmonary and critical care, and dentistry on the role of oral hygiene in supporting pulmonary health and maintaining opportunities for oral nutrition. A comprehensive literature search was conducted through the Texas Tech University Health Sciences Center digital library using Cochrane Library (Wiley), EBSCO Discovery, Embase, Ovid databases, PubMed, SCOPUS, ScienceDirect, Web of Science, and Google Scholar between 14 January 2026 and 1 April 2026. From 1287 identified records, 70 studies were selected to be highlighted in the manuscript after duplicate removal and eligibility screening. Relevant literature was reviewed to examine associations among dysphagia, oral health and condition, oral hygiene and care protocols, feeding route, salivary composition and function, and respiratory outcomes. Emphasis was placed on studies addressing pneumonia, oral versus tube feeding, and evidence-based oral care practices. Findings indicate that pneumonia, depression, and mortality rates are higher in patients receiving tube feeding compared to oral feeding. Evidence-based oral care practices inclusive of mechanical plaque disruption, oral cleansing products (Chlorhexidine, hydrogen peroxide, and sodium bicarbonate), and structured oral hygiene protocols can reduce pulmonary consequences of aspiration and support safer/least risk oral intake. Saliva plays a pivotal role in plaque breakdown, microbial defense, and host immunity; oral feeding helps to preserve salivary function. Results of this review highlight the importance of oral hygiene in both restorative and palliative care contexts. This review establishes a framework for embedding oral cleansing agents and protocols into a nutrition-focused health care infrastructure. Based on the literature analysis and inter- and multidisciplinary clinical expertise of the author group, the manuscript proposes consensus statements intended as expert guidance rather than formal clinical practice guidelines. Adherence to best practices in oral care can mitigate pulmonary consequences of aspiration amid dysphagia, make oral nutrition more accessible and comfortable, sustain opportunities for least risk oral feeding across diagnoses and health care settings, and improve quality of life for patients with dysphagia amid life-limiting illness. Full article

Objectives: To prospectively compare the outcomes of external dacryocystorhinostomy (EX-DCR), endonasal dacryocystorhinostomy (EN-DCR), and laser-assisted transcanalicular dacryocystorhinostomy (TL-DCR) in patients with nasolacrimal duct obstruction (NLDO) and to evaluate the relationship between surgical outcomes and patient quality of life (QoL). Methods: This prospective comparative study included patients presenting with epiphora who were diagnosed with NLDO and scheduled for surgical treatment. Patients underwent EX-DCR, EN-DCR, or TL-DCR according to patient preference and nasal anatomical characteristics. All patients received bicanalicular silicone tube intubation. Follow-up examinations were performed on postoperative day 1, week 1, at month 1, and every three months thereafter. Anatomical success was defined as patency on nasolacrimal irrigation, and functional success was defined as a postoperative Munk score of ≤ 1 (complete or near-complete resolution of epiphora). QoL was assessed using the Lacrimal Symptom Questionnaire (Lac-Q) and the Glasgow Benefit Inventory (GBI). Statistical comparisons were performed between groups. Results: A total of 69 patients (45 women, 24 men; mean age 58.99 ± 14.86 years) were included, with a mean follow-up of 17.19 ± 4.07 months. The highest postoperative pain scores were observed in the EX-DCR group; with no significant intergroup differences. Anatomical success rates were 92% for EX-DCR, 90.5% for EN-DCR, and 91.3% for TL-DCR. Functional success rates were 88%, 90.5%, and 82.7%, respectively, with no statistically significant difference among techniques (p > 0.05). All groups showed postoperative improvement in Lac-Q and GBI scores. Numerically greater improvements were observed in the EN-DCR group, although intergroup differences were not statistically significant. Conclusions: EX-DCR achieved the numerically highest anatomical success rate, whereas EN-DCR demonstrated numerically greater improvement in patient-reported QoL outcomes. However, no statistically significant differences in anatomical success, functional success, or QoL measures were observed among the three techniques. Overall, all three procedures were effective surgical options for the treatment of NLDO. Full article

Background/Objectives: The advent of disease modifying therapies (DMTs) for Spinal Muscular Atrophy (SMA) has highlighted the need for reliable tools to assess bulbar function in type I individuals. The Oral and Swallowing Abilities Tool (OrSAT) was originally developed to evaluate swallowing and feeding abilities in infants with SMA type I during the first two years of life. This study aimed to assess the applicability of the OrSAT in a cohort of children with SMA type I older than 2 years. Methods: Fifty-two children with genetically confirmed SMA type I, aged 2 to 12.6 years, were included. All participants had received at least one DMT, administered either soon after diagnosis or when treatment became available. Bulbar and feeding abilities were assessed using the OrSAT and results were grouped according to clinical subtype and feeding modality. Given the small sample size of the subgroups and the ordinal nature of OrSAT scores, comparisons between groups were performed using the non-parametric Kruskal–Wallis test. Results: At follow-up, 27 children were orally fed, 19 were exclusively tube-fed, and 6 were tube-fed but were also able to eat some food by mouth. The OrSAT scores reflect a wide spectrum of bulbar function from severe to no impairment. Most children who required exclusive tube-feeding at follow-up had already been tube-fed at treatment initiation, while a small number showed improvement in swallowing abilities and the partial recovery of oral feeding during follow-up. Conclusions: Our results suggest that the OrSAT, previously used only in the first two years of life, may also be applicable in older children to describe bulbar involvement and monitor changes over time. However, further studies are needed to refine the tool for this age group and to formally validate its use in older children with SMA type I. Its use may contribute to the longitudinal assessment of swallowing abilities and support rehabilitative management. Full article

Background: Pancreatic ductal adenocarcinoma (PDAC) has dismal survival, and vascular invasion is strongly associated with dissemination and poor outcomes; however, its molecular basis remains unclear. Methods: Transcriptomic and clinical data from The Cancer Genome Atlas-Pancreatic Adenocarcinoma (TCGA-PAAD) cohort were integrated with Genotype-Tissue Expression (GTEx) normal pancreas data. Vascular invasion-associated candidate genes were identified using subgroup-specific differential expression filtering. A three-gene prognostic signature was constructed using Cox and least absolute shrinkage and selection operator (LASSO) regression and validated in an independent PACA-AU cohort. Nucleoporin 35 (NUP35) was functionally evaluated by shRNA knockdown, phenotypic assays, endothelial assays using conditioned medium, and Western blotting of extracellular signal-regulated kinase (ERK)-vascular endothelial growth factor A (VEGFA) signaling. Results: We identified 172 vascular invasion-associated candidate genes and developed a three-gene model comprising NUP35, GMNN, and KLK11. The model stratified TCGA patients into risk groups with significantly different overall survival (OS; log-rank p = 0.014) and good predictive performance, with areas under the receiver operating characteristic curve (AUC) of 0.659, 0.722, and 0.796 for 1-, 3-, and 5-year OS, respectively. Consistent trends were observed in PACA-AU. Risk group transcriptomes were enriched for proliferative and tumor progression programs. Among the signature genes, NUP35 was prioritized because higher NUP35 expression was associated with poorer survival and positively correlated with VEGFA expression. NUP35 knockdown suppressed malignant phenotypes, reduced endothelial migration and tube formation, and decreased phosphorylated ERK and VEGFA without altering total ERK levels. Conclusions: A vascular invasion-related three-gene signature enables prognostic stratification in PDAC. NUP35 is associated with malignant and pro-angiogenic phenotypes and may regulate angiogenic activity partly through ERK-VEGFA signaling, supporting its potential as a prognostic biomarker and candidate therapeutic vulnerability. Full article