Search Results (864)

Background/Objectives: Calcium and magnesium play a key role in musculoskeletal health and neuromuscular function. Mineral waters naturally rich in these elements provide a highly bioavailable dietary source. This study evaluated whether daily intake of naturally calcium and magnesium-rich mineral water compared with low-mineral water affects fall risk, muscle mass, and muscle function in adults aged ≥50 years, with or without osteosarcopenia. Methods: In this 12-month, randomized, double-blind, controlled trial, 98 participants (86.7% women, 13.3% men) were assigned to consume 1 L/day of either SG9 (mineral water with high calcium and magnesium content) or J66 (low-mineral water). Outcomes included incidence of falls (primary endpoint), appendicular skeletal muscle mass (ASMM), muscle strength, physical performance, biochemical markers, and patient-reported measures. Assessments were performed at baseline, 6 months, and 12 months following CONSORT guidelines. Results: Ninety-eight participants (mean age ~63 years) were randomized and completed the 12-month follow-up. At 6 months, the incidence of falls was significantly lower in the SG9 group compared with the J66 group (relative risk reduction 82%; RR = 0.18, 95% CI 0.04–0.88; p < 0.05), whereas no significant between-group difference was observed at 12 months. Appendicular skeletal muscle mass indexed to height (ASMM/h²) was significantly higher in the SG9 group at 12 months (p = 0.0002). In participants with osteosarcopenia, SG9 intake was associated with a consistent improvement in ASMM/h² at 6 and 12 months (p = 0.004 and p = 0.006, respectively). No significant between-group differences were detected in physical performance scores, biochemical markers, or quality-of-life measures. Conclusions: Daily consumption of calcium- and magnesium rich mineral water reduced fall risk and improved muscle mass in adults over 50 years, with or without osteosarcopenia. These findings support the role of calcium and magnesium-rich mineral water use as a complementary nutritional strategy for musculoskeletal health and fragility prevention. Full article

Growing renewable penetration increases deep peak-shaving demands, making stable wide-load operation of coal-fired boilers essential. A full-process CFD model of a 660 MW ultra-supercritical boiler was established, covering the furnace, heat-transfer surfaces, rear-pass duct, and selective catalytic reduction (SCR) system. Simulations at 25–100% boiler maximum continuous rating (BMCR) quantified load effects on combustion and emissions. Predicted furnace outlet temperature and major flue-gas species matched field data with deviations within ±6%. Lowering the load from 100% to 25% BMCR contracted the high-temperature core in the furnace and reduced mean temperature and mixing. Furnace nitrogen oxides (NO_x) formation decreased as the load decreased. However, NO_x at 25% BMCR increased because separated over-fire air (SOFA) was not applied. Reduced combustion intensity increased the level of unburned carbon in fly ash, which rose by approximately 3.5% at 25% BMCR, relative to the rated condition. Pronounced flow maldistribution also appeared at 25% BMCR. The SCR-inlet flow analysis indicated that the original guide vane design was not suitable for wide-load operation and that inlet-velocity uniformity deteriorated, especially at low loads. An optimized guide vane scheme is proposed, improving SCR-inlet uniformity over the full load range while mitigating ash deposition and erosion risks. Full article

Background: Congenital anomalies are influenced by genetic and environmental factors. While interventions including folic acid supplementation have reduced neural tube defects, data on modifiable socio-demographic risk factors remain limited. Aim: This study aimed to assess variation in the prevalence of selected congenital anomalies across the United States according to socio-demographic factors. Methods: A population-based analysis was conducted using CDC-WONDER natality data from 2016 to 2023. Included anomalies were anencephaly, spina bifida, cyanotic heart disease, diaphragmatic hernia, omphalocele, gastroschisis, limb reduction, cleft lip/palate, Down syndrome, chromosomal disorders, and hypospadias. Associations with maternal age, BMI, race, tobacco use, diabetes, and fertility treatments were analyzed. Prevalence rates were calculated per 1000 live births. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated. Joinpoint regression was used to assess annual percent changes (APCs), with p < 0.05 considered significant. Results: Among 3,482,944 singleton live births in 2023, the overall prevalence of the selected congenital anomalies was 3.3 per 1000. Compared to Caucasian mothers, risk was lower in Asian (RR 0.57; 95% CI: 0.52–0.63) and Black (RR 0.81; 95% CI: 0.76–0.85) infants and higher in American Indian/Alaska Native infants. Significant risk factors included pre-pregnancy diabetes (RR 2.41; 95% CI: 2.16–2.69), maternal age > 45 (RR 2.95; 95% CI: 2.36–3.69), and tobacco use (RR 1.78; 95% CI: 1.64–1.94). A significant decline in prevalence was observed from 2016 to 2023 (APC: –0.6%; 95% CI: –1.1 to –0.2; p = 0.006). Conclusions: Significant disparities and modifiable maternal risk factors were associated with the prevalence of selected congenital anomalies in the U.S. from 2016 to 2023. A modest statistically significant decline in overall prevalence was observed during the study period, supporting the importance of continued national surveillance and targeted preconception and prenatal interventions to reduce risk and address inequities. Full article

High platelet reactivity (HPR) in patients with coronary artery disease receiving P2Y12 inhibitors increases ischemic risk. Chronic kidney disease (CKD) is an established contributor to HPR during clopidogrel therapy. The objective of the study was to assess whether CKD influences platelet reactivity (PR) in patients treated with clopidogrel or ticagrelor. This double-blind, double-dummy study enrolled 106 stable patients more than one year after an acute coronary syndrome, with or without CKD. Participants were matched by age and sex and randomized to clopidogrel or ticagrelor. PR was measured using the VerifyNow™ P2Y12 assay, and HPR was defined as P2Y12 reaction units (PRU) ≥ 208. Median glomerular filtration rates were 80 mL/min/1.73 m² in non-CKD patients and 41 mL/min/1.73 m² in CKD patients (p < 0.01). Ticagrelor produced similarly low PR in both groups (36 vs. 35 PRU; p = 0.61). Clopidogrel resulted in a numerically higher PR in CKD patients (209 vs. 180 PRU; p = 0.07). The magnitude of PR reduction with ticagrelor relative to clopidogrel was greater in CKD patients (p-interaction = 0.09). HPR was markedly more common with clopidogrel, particularly in CKD (difference 37%; adjusted OR 4.42; p = 0.01). In conclusion, CKD significantly impairs clopidogrel responsiveness but does not affect ticagrelor, resulting in a greater relative advantage of ticagrelor in patients with CKD. Full article

Objective: This double-blind, parallel-group randomized controlled trial is the first to investigate the synergistic effects of interval resistance plus progressive aerobic training with fisetin supplementation on adipokines in obesity. Methods: Sixty sedentary men with obesity (BMI < 30 kg/m²) completed 12 weeks of thrice-weekly interval resistance training (eight exercises, 3 × 13 reps at 60% 1RM with 20% 1RM active rest), immediately followed by staged aerobic bouts (50–70% HRmax). Participants were randomized into the control-placebo (P), fisetin (F; 200 mg/day), training-placebo (TP), or training + fisetin (TF) groups. The primary outcomes were asprosin, MCP-1, and adiponectin; secondary outcomes included leptin and lipid profile. Data were analyzed via ANCOVA with Bonferroni post hoc tests. Results: Statistical analyses were conducted following the intention-to-treat (ITT) principle using an analysis of covariance (ANCOVA) model, which revealed extensive effects of the interventions on the participants’ anthropometric and biochemical indices. Regarding body composition, after adjusting for baseline values, a significant difference in mean body weight was observed between groups (F (3, 55) = 9.444, p < 0.001, ηp² = 0.340); Bonferroni post hoc tests confirmed that the training plus fisetin (TF), training-placebo (TP), and fisetin (F) groups all achieved significant weight loss compared to the placebo (P) group. Furthermore, body mass index (BMI) showed a significant inter-group difference (p = 0.021), with post hoc analysis revealing that only the TF group reached a statistically significant reduction compared to the placebo (p = 0.024; 95% CI [−3.760, −0.172]). In the assessment of biochemical and inflammatory variables, the interventions exerted a highly significant effect on asprosin (F (3, 55) = 36.047, p < 0.001; ηp² = 0.663) and MCP-1 (F (3, 55) = 29.570, p < 0.001; ηp² = 0.617). The findings indicated that the TF group experienced the most substantial reductions in both asprosin (−60.71%) and MCP-1 (−46.50%) levels. Regarding adipokines, significant increases in adiponectin levels were observed in the TP (29.38%) and TF (27.67%) groups (p < 0.05), whereas changes in leptin were statistically significant only in the TF group relative to the placebo (p = 0.049). The lipid profile results indicated a statistically significant difference in the TF group in improving all markers; this group achieved greater reduction compared to other groups, including reductions in LDL-C, triglycerides (TG), and total cholesterol (TC) (p < 0.001), while simultaneously showing a significant elevation in HDL-C. Post hoc analyses confirmed robust statistical differences in all lipid parameters for both the TF and TP groups compared to the placebo group (p < 0.05), whereas the placebo group experienced a deterioration in status characterized by a significant increase in LDL-C (p = 0.027) and a significant decline in HDL-C concentrations (p = 0.006). Conclusions: In conclusion, 12 weeks of combined interval resistance–aerobic training and fisetin supplementation significantly reduced pro-inflammatory adipokines and improved lipid profiles in obese men. These findings suggest that asprosin serves as a potential modulator in metabolic risk reduction; however, since direct mechanistic assays were not conducted, these implications remain hypothetical. Future research employing molecular readouts is warranted to confirm the underlying pathways involved. Full article

With the increase in mining intensity and scale, the damage to groundwater resources and surface ecology caused by coal mining has become the main problem facing coal development. Coal mining can cause a redistribution of stress field and stress concentration in local areas of overlying rock, resulting in varying degrees of movement and damage to the overlying rock. Quantitative analysis of the degree of migration and damage in different areas of overlying rock and zoning control is crucial for achieving loss reduction and green mining. In this paper, the overburden damage is divided into regions according to the different causes of formation, regional characteristics of severity, and other factors, and the specific calculation method is given. UDEC7.0 numerical simulation software is used to simulate the overlying rock damage, and the best mining parameters are provided through the area changes in different zones. The research conclusions are as follows: according to the different damage states of overburden rock, the damage of overburden rock can be divided into four parts: I, caving fracture zone, II, fracture development zone, III, sliding failure zone, and IV, slight failure zone. In the four zones, the damage in zones II and IV is relatively light. During the mining process, attention should be given to controlling the development of Zone I to prevent it from abnormally enlarging; for Zone II, hydraulic fracturing can be used when there is a thick, hard key layer that poses a water inrush risk; for Zone III, the focus should be on preventing surface step fractures caused by it. For example, when a thick, hard key layer is present in Zone II, hydraulic fracturing can be applied to avoid large area hanging roofs and severe rock pressure. When the mining height is low, it mainly affects the proportion of regions I and III. With the increase in mining height, the main affected region becomes the II region. The larger the mining height is, the larger the proportion of the II region. With the increase in propulsion speed, the impact range on the surface increases, but the area with severe damage is relatively reduced. With the increase in mining width, the proportion of relatively seriously damaged areas increased. On-site measurements have shown that when the speeds of 120,401 and 22,207 working faces are slow, the rock layer pressure shows a dense state, the overburden fracture is more fully developed, and the area proportion of I and II zones is increased, which reflects the phenomenon of dense surface fracture development on the surface. When the advancing speed is large, the area proportions of zones III and IV increase, and the damage scope decreases. The on-site testing verified the conclusions drawn from theoretical analysis and numerical simulation, which can guide other mines under similar conditions to achieve safe and green production. Full article

Metastasis is the leading cause of cancer-related mortality. Although aspirin has been associated with reduced metastatic risk, existing evidence is fragmented across experimental systems, and a comprehensive mechanistic synthesis remains lacking. In particular, the relative contributions of platelet aggregation, thromboxane A₂ (TXA₂) signaling, and epithelial–mesenchymal transition (EMT) to aspirin’s antimetastatic effects have not been systematically integrated across preclinical and clinical studies. This systematic review was conducted in accordance with PRISMA 2020 guidelines, with the protocol registered in PROSPERO (CRD420251231581). PubMed, Scopus, and Web of Science were searched for studies published between January 2015 and December 2025, alongside ClinicalTrials.gov for completed mechanistic clinical trials. Eligible studies included in vitro, in vivo, and clinical investigations evaluating aspirin or its active metabolite in cancer-related settings and reporting mechanistic outcomes related to metastasis. Clinical studies reporting only survival or incidence outcomes without mechanistic analysis were excluded. The included studies demonstrated that aspirin suppresses metastatic dissemination across multiple cancer types through coordinated platelet-dependent and tumor-intrinsic mechanisms. Aspirin consistently inhibited platelet aggregation and COX-1-dependent TXA₂ production, disrupting platelet–tumor cell interactions, intravascular metastatic niche formation, and platelet-mediated immune suppression. Clinical mechanistic studies confirmed inhibition of thromboxane biosynthesis and reductions in circulating tumor cells. Beyond platelet effects, aspirin suppressed EMT, migration, and invasion through modulation of EMT transcriptional regulators and inflammatory signaling pathways. Additional mechanisms included activation of AMPK, inhibition of c-MYC signaling, regulation of redox-responsive pathways and impairment of anoikis resistance. This review provides the first integrated mechanistic synthesis of aspirin’s antimetastatic actions across preclinical and clinical evidence, addressing a critical gap in understanding how platelet biology, TXA₂ signaling, EMT, and tumor-intrinsic survival pathways converge in metastatic suppression. By focusing exclusively on mechanistically informative studies, this work clarifies the biological basis of aspirin’s antimetastatic effects and highlights unresolved questions regarding pathway hierarchy, cancer-type specificity, and translational biomarkers, thereby informing future mechanistic and clinical investigations. Full article

The quality of high-density lipoproteins (HDLs) is characterized by lipid and protein composition, oxidation and glycation extent, and particle size, while the quantity of HDL-C is just the cholesterol amount in HDL. The inverse association between HDL-C and cardiovascular disease (CVD) and hypertension has been well established; however, the U-shaped mortality risk observed from HDL-C underscores that HDL quality and function are equally important. The present cross-sectional study assessed the correlations of serum lipid and glucose profiles, and low-density lipoprotein (LDL) and HDL characteristics, with blood pressure (BP) distribution in ordinary middle-aged Korean participants (n = 50; mean age 47.0 ± 11.7 years; males: n = 25, 49.2.0 ± 11.7 years; females: n = 25, 44.8 ± 11.5 years), with particular focus on HDL quality and its antioxidant capacity. This study observed that serum elevated triglyceride (TG) and glucose levels were directly proportional to elevated systolic BP (SBP) and diastolic BP (DBP), whereas serum total cholesterol (TC), LDL-C, and HDL-C were not correlated with BP. However, HDL-C/TC (%) was negatively associated with SBP (p = 0.036), while TG/HDL-C and glucose/HDL-C ratios were positively associated with both SBP and DBP, suggesting that TG and glucose proportions relative to HDL-C are probable predictors of hypertension. Elevations of TG, oxidation, and glycation in LDL were positively associated with elevations of BP, whereas LDL particle size was negatively correlated with BP. Similarly, elevations of TG and glycation in HDL₂ and HDL₃ were positively correlated with elevations of BP, while the particle size of HDL₂ was negatively correlated with BP. The heightened HDL₂-associated paraoxonase (PON) activity and ferric ion reduction ability (FRA) negatively correlated with LDL oxidation and particle size, whereas elevated HDL₃-associated PON and FRA activities were inversely related to LDL glycation. An enhanced glycation in HDL₂ was negatively correlated with HDL₂-associated PON activity and FRA, while an increase in HDL₂ particle size was only dependent on the associated PON activity but not on FRA. In conclusion, observational outcomes demonstrated that improved HDL quality and functionality (characterized by large particle size, reduced glycation, and higher FRA and PON activities) were inversely correlated with LDL oxidation, glycation, particle shrinkage, and the risk of hypertension. Full article

Despite the growing recognition of heritage risk reduction, a comprehensive framework for multi-risk assessment remains notably absent within the context of historic urban landscapes (HULs) across diverse global contexts. This paper aims to fill this gap by developing an assessment framework to address multiple emerging risks in HUL management, considering climate-related, human-induced, and mixed hazards in UNESCO World Heritage properties. A four-step process is established—hazard identification, exposure categorisation, adaptation capacity-building, and vulnerability monitoring and evaluation. Using content analysis, this framework is applied to official reports from 33 World Heritage HUL cases across 33 countries. The results show that, although various hazards have been acknowledged by state parties, local governments prioritise human-induced or natural hazards more often than mixed hazards, leading to a shortage of comprehensive risk management plans and practical actions in most cases. Regarding heritage adaptation, the factors of capacity and governance are widely addressed, demonstrating the commitment of state parties to formulate strategies and solve problems. However, public participation and education practices remain insufficiently implemented, resulting in a relatively low degree of adaptation capacity-building. The proposed multi-risk assessment framework offers a crucial reference for global urban heritage management and risk reduction. Full article

This study investigates the structural evolution and projected trajectory of greenhouse gas (GHG) emissions across the EU27 from 1990 to 2030, with a particular focus on their implications for the effectiveness of European climate policy. Drawing on official sectoral data and employing a multi-method framework combining time series modelling (ARIMA), machine learning (Random Forest), regime-switching analysis, and segmented linear regression, we assess past dynamics, detect structural shifts, and forecast future trends. Empirical findings, based on Markov-switching models and segmented regression analysis, indicate a statistically significant regime change around 2014, marking a transition to a new emissions pattern characterised by a deceleration in reduction rates. While the energy sector experienced the most significant decline, agriculture and industry have gained relative prominence, underscoring their growing strategic importance as targets for policy interventions. Hybrid ARIMA–ML forecasts indicate that, under current trajectories, the EU is unlikely to meet its 2030 Fit for 55 targets without adaptive and sector-specific interventions, with a projected shortfall of 12–15 percentage points relative to 1990 levels, excluding LULUCF. The results underscore critical weaknesses in the EU’s climate policy architecture and reveal a clear need for transformative recalibration. Without accelerated action and strengthened governance mechanisms, the post-2014 regime risks entrenching a plateau in emissions reductions, jeopardising long-term climate objectives. Full article

PM_2.5 pollution has become one of the major environmental issues in Shandong Province in recent years. High concentrations of PM_2.5 not only reduce atmospheric visibility but also induce respiratory and cardiovascular diseases, and significantly increase health risks. Source apportionment of PM_2.5 is important for policy makers to determine control strategies. This study analyzed regional and sectoral PM_2.5 sources across 17 Shandong cities during the 2017–2018 winter heating season, which is selected because it is representative of severe air pollution with an average PM_2.5 of 65.75 μg/m³ and hourly peak exceeding 250 μg/m³. This air pollution episode aligned with key control policies, where seven major cities implemented steel capacity reduction and coal-to-gas/electric heating, as a baseline for evaluating emission reduction effectiveness. The particulate matter source apportionment technology in the Comprehensive Air Quality Model with extensions (CAMx) was applied to simulate the source contributions to PM_2.5 in 17 cities from different regions and sectors including industry, residence, transportation, and coal-burning power plants. The meteorological fields required for the CAMx model were generated using the Weather Research and Forecasting (WRF) model. The results showed that all cities besides Dezhou city in Shandong Province contributed PM_2.5 locally, varying from 39% to 53%. The emissions from Hebei province have a large impact on the PM_2.5 concentrations in Shandong Province. The non-local industrial and residential sources in Shandong Province accounted for the prominent proportion of local PM_2.5 in all cities. The contribution of non-local industrial sources to PM_2.5 in Heze City was up to 56.99%. As for Zibo City, the largest contribution of PM_2.5 was from non-local residential sources, around 56%. Additionally, the local industrial and residential sources in Jinan and Rizhao cities had relatively more contributions to the local PM_2.5 concentrations compared to the other cities in Shandong Province. Finally, the emission reduction effects were evaluated by applying different reduction ratios of local industrial and transportation sources, with decreases in PM_2.5 concentrations ranging from 0.2 to 26 µg/m³ in each city. Full article

Background: Prostate cancer in the Middle East and North Africa (MENA) region is shaped by a complex interplay of behavioral and environmental risk factors, yet comprehensive estimates of preventable cases remain scarce. To address this gap, we estimated population-attributable fractions (PAFs) for a range of modifiable exposures among men aged 50 years and older and assessed potential reductions in incidence under feasible intervention scenarios. Methods: Regional prevalence data were combined with relative risks from meta-analyses to compute closed-form PAFs for tobacco smoking, obesity, physical inactivity, high dairy and calcium intake, heavy alcohol use, drinking water nitrates, trihalomethanes, arsenic, lead, selenium status, ambient PM_2.5 and NO₂, and occupational diesel exhaust, covering an estimated 47 million men. Estimates were validated using a synthetic cohort simulation of 100,000 individuals, with uncertainty quantified through Monte Carlo sampling. Results: Results showed that drinking water nitrate exposure accounted for the largest single fraction (17.4%), followed by tobacco smoking (9.5%), physical inactivity (6.7%), and trihalomethane exposure (5.0%), while other exposures contributed smaller but meaningful shares. Joint elimination of all exposures projected a 45.5% reduction in incidence, and simultaneous feasible reductions in four targeted exposures yielded a combined potential impact fraction of 12.1%. Conclusions: These findings suggest that integrated water quality management, tobacco control, lifestyle interventions, and targeted environmental surveillance should be prioritized to reduce prostate cancer burden in the MENA region. However, estimates of drinking-water nitrate exposure rely on limited evidence from a single case–control study with a relatively small sample size, and should therefore be considered exploratory and primarily hypothesis-generating. Full article

The tomato leafminer, Tuta absoluta (Meyrick) (Lepidoptera: Gelechiidae), is one of the most destructive pests of tomato crops worldwide. Its high reproductive potential and increasing resistance to conventional insecticides have made the development of sustainable management strategies essential. Biological control using entomopathogenic fungi (EPF), particularly when established as endophytes, has emerged as a promising approach. This study investigated the endophytic colonization capacity and greenhouse performance of three commercially available EPF formulations: Beauveria bassiana (Velifer^®), Lecanicillium lecanii (Lecan^®), and a Beauveria bassiana–Metarhizium anisopliae mixture (Metab^®), for the suppression of T. absoluta in tomato. Our experiment was conducted under commercial greenhouse conditions using soil drench applications at manufacturer-recommended doses. Endophytic colonization was assessed through surface-sterilized leaf assays, while pest suppression was evaluated via weekly measurements of larval mine length, infestation incidence, and survival dynamics. B. bassiana (Velifer^®) exhibited the highest endophytic colonization frequency and consistently reduced mine length and infestation levels compared with untreated plants. Survival analysis using Cox proportional hazards revealed significant reductions in infestation risk for Velifer^® (hazard ratio, HR = 0.420), Metab^® (HR = 0.480), and Lecan^® (HR = 0.599), relative to the negative control, whereas the chemical positive control provided the strongest overall suppression (HR = 0.287). Our findings demonstrate that commercial EPF formulations can significantly reduce T. absoluta infestation under greenhouse conditions and represent a valuable component of integrated pest management programs. Full article

Background/Objectives: (P)rehabilitation, comprising structured exercise, nutritional optimisation, and/or psychological support delivered pre- or postoperatively, has demonstrated efficacy in improving outcomes across the cancer care continuum. However, access remains limited. Technology-enabled (p)rehabilitation offers a novel solution with the potential to enhance equity and continuity of care. This systematic review aimed to evaluate the efficacy of technology-enabled (p)rehabilitation on perioperative and patient-reported outcomes among individuals undergoing thoracic and/or abdominopelvic cancer surgery. Methods: Six databases were search from inception to October 2024. Eligible studies were randomised controlled trials (RCTs) comparing technology-enabled (p)rehabilitation with usual care, placebo, or non-technology-based interventions in adults undergoing thoracic and/or abdominopelvic cancer surgery. Outcomes included postoperative complications, hospital readmissions, hospital length of stay (LOS), quality of life (QoL), pain, anxiety, depression, fatigue, distress, and satisfaction. Higher scores indicated improved QoL or worse symptom severity. Risk of bias was assessed using the revised Cochrane tool, and evidence strength was determined using GRADE methodology. Relative risks (RR) and mean differences (MD) were calculated using random-effects meta-analysis. Results: Seventeen RCTs (18 publications, n = 1690) were included. Trials most commonly evaluated application-based platforms (n = 8) and the majority exhibited some risk of bias. Technology-enabled (p)rehabilitation was associated with a significant reduction in LOS (MD = 1.33 days; 95% CI: 0.59–2.07; seven trials), and improvements in pain (MD = 6.12; 95% CI: 3.40–8.84; four trials), depression (MD = 2.82; 95% CI: 0.65–4.99; five trials), fatigue (MD = 10.10; 95% CI: 6.97–13.23; three trials) and distress (MD = 1.23; 95% CI: 0.30–2.16; single trial) compared with controls. Conclusions: Technology-enabled (p)rehabilitation shows promise in reducing LOS and improving selected patient-reported outcomes following thoracic and abdominopelvic cancer surgery. Although evidence is limited due to the small number of studies, modest sample sizes, methodological heterogeneity, and intervention variability, the overall findings justify further investigation. Large-scale, adequately powered clinical trials are required to confirm efficacy and guide clinical effectiveness and implementation studies. Full article

Background: In adult spinal deformity (ASD) surgery, appropriate rod length determination is crucial, as excessive cranial rod length can lead to skin problems, especially in thin elderly patients if proximal junctional kyphosis (PJK) develops. In adolescent idiopathic scoliosis (AIS), correction is primarily performed in the coronal plane, and rod length changes are relatively predictable. Moreover, PJK is uncommon in AIS, making excess rod length rarely a clinical concern. In contrast, ASD correction involves more complex three-dimensional realignment, including restoration of lumbar lordosis (LL), which makes it challenging to predict postoperative changes in rod trace length (RTL). Furthermore, because PJK occurs more frequently in ASD surgery, appropriate rod length selection becomes clinically important. This study aimed to quantitatively evaluate changes in RTL before and after posterior correction. Method: Thirty patients with ASD who underwent staged lateral lumbar interbody fusion (LLIF) followed by posterior corrective fusion from T9 to the pelvis were retrospectively analyzed. RTL before posterior correction (Pre-RTL) was estimated from the planned screw insertional point on axial CT after LLIF, and postoperative RTL (Post-RTL) was measured from screw head centers on post-operative CT. LL and Cobb angle were assessed before and after posterior correction. Correlations between RTL change and alignment change were evaluated. Results: Postoperative RTL was shortened in all patients, with an average reduction of approximately 16–17 mm. RTL shortening demonstrated significant correlations with LL correction (R = 0.51, p = 0.003) and Cobb angle correction (R = 0.70, p = 0.00001). Greater shortening of RTL was observed on the convex side in patients with preoperative Cobb angle ≥ 10° (p = 0.04). Conclusions: Greater coronal deformity, particularly on the convex side, was associated with increased RTL shortening. These findings suggest that routine preparation of excessively long rods may be unnecessary. Consideration of anticipated RTL shortening may help avoid excessive cranial rod length and potentially reduce the risk of skin complications associated with PJK, particularly in thin elderly patients. Full article