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Background and Objectives: Cementless total knee arthroplasty (TKA) has gained popularity but comparative outcome data across implant systems remain limited. This study compared survivorship and clinical outcomes of two cementless cruciate-retaining TKA implants from different manufacturers. Materials and Methods: We performed a retrospective, single-institution review of 220 patients who had a cementless cruciate-retaining TKA implant between 2019 and 2024; 110 patients received Implant A and 110 patients received Implant B. Baseline variables included demographics, comorbidities, and preoperative Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR). Clinical outcomes included 90-day readmission, all-time revision, reoperation, manipulation under anesthesia, and postoperative KOOS, JR scores. Propensity score-based overlap weighting was used to create a balanced pseudo-population for adjusted analyses. Adjusted outcomes included weighted logistic regression for two-year revision and a weighted Cox proportional hazards model for time to revision. Results: Crude revision rates were low and not significantly different (A: 0.9 versus B: 2.7%, p = 0.622). Overlap weighting achieved balance across all measured baseline covariates. Unadjusted rates of 90-day readmission, reoperation, and manipulation under anesthesia were similar between groups. In adjusted analyses, no statistically significant difference was observed for two-year revision in Implant B vs. A cohorts (OR 2.17, 95% CI 0.10 to 157, p = 0.621) or time to revision (HR 2.22, 95% CI 0.18 to 27.09, p = 0.533). Conclusions: Both cementless cruciate-retaining TKA systems demonstrated low early revision rates in this cohort. Propensity score-adjusted analyses reduced measured baseline imbalances and did not identify a significant difference in revision risk between implants; however, interpretation is limited by sparse revision events, potential residual confounding, and the retrospective observational design. Full article

Human metapneumovirus (hMPV) is associated with severe disease in young children, older adults, and medically high-risk individuals. The hMPV F protein is highly immunogenic and a well-established target of neutralizing antibodies. In-depth hMPV surveillance data remain limited and may provide valuable insight into therapeutic development. Here we assembled a contemporary dataset of F gene sequences acquired from hMPV-positive nasal swab specimens collected between 2022 and 2023, together with contemporary F gene sequences from public surveillance databases, collected between 2017 and 2025. All sequences were subtyped and evaluated for residue-level similarity to reference alleles. Of 724 sequences in the combined contemporary dataset, A2 was the most predominant subtype accounting for nearly half of all sequences (50.83%). The mean F gene sequence similarity to reference alleles was 99.90%, 99.95%, and 99.84% for A2, B1, and B2, respectively; the least conserved residues were the stalk residue 518 for A2 (88.52% similarity to reference allele); BinD residue 450 for B1 (96.60% similarity); and site III residue 36 for B2 (77.88% similarity). Structural analysis showed that observed mutations were predominantly surface-exposed, with no evidence of novel N-linked glycosylation sequons, and were not predicted to significantly alter F protein structure. Overall, these findings indicate that the F protein is highly conserved across subtypes, with sequence variation unlikely to result in meaningful structural differences, thereby supporting development of F-targeted therapeutics against hMPV infection. Full article

The rapid expansion of the lithium industry has generated large quantities of lithium refinery residue (LRR), whose stockpiling and landfilling cause environmental risks and the loss of potentially recoverable resources. This review critically examines LRR generated from the processing of spodumene and lepidolite, with particular emphasis on how differences in their mineralogical and chemical characteristics affect subsequent utilization and resource-recovery strategies. Current utilization pathways are classified into bulk utilization and selective fractionation followed by product-oriented valorization. Bulk utilization mainly includes direct incorporation into construction materials, activated cementitious materials, and sintered products, offering high residue-consumption capacity but generally limited added value. Selective fractionation employs leaching, flotation, magnetic separation, and gravity separation to separate Si-Al, Ca-S, and Fe-bearing fractions and to recover residual valuable elements, including Li, Ta, Nb, Rb, and Cs. The removal or stabilization of hazardous constituents, particularly F, Be, and Tl, is also evaluated as a prerequisite for safe valorization. The recovered fractions can subsequently be converted into products such as aluminosilicate powders, porous ceramics, zeolites, glass-fiber feedstocks, high-strength α-hemihydrate gypsum, and anhydrite II. Finally, the reviewed pathways are critically compared in terms of technical feasibility, resource efficiency, environmental risks, economic potential, technological maturity, and scale-up constraints. Priority is given to integrated processing strategies that combine hazardous-element control, selective recovery of valuable components, and large-volume utilization of bulk fractions to improve the overall sustainability and industrial viability of LRR valorization. Full article

Introduction: North Atlantic hurricanes have intensified over recent decades, contributing to excess mortality, particularly among lower-income populations residing in coastal regions. However, the differential impact of hurricane intensity on mortality rates by income and education levels remains poorly understood. Methods: A population-based study was conducted using the North Atlantic Accumulated Cyclone Energy (ACE) index to assess associations with annual region- and sex-specific all-cause mortality rates (ages 20–84 years) across 279 counties in the southeastern United States from 2014 to 2022. The analyses were carried out for nine years; the total number of observations in the model for the 279 counties was 5022 (i.e., 279 counties × 9 years × 2 sexes). Associations were adjusted for covariates and were conducted using negative binomial regression, with autocorrelative residuals. Counties were stratified by pairs of income and education levels (i.e., low income–low education; high income–high education; low income–high education and high income—low education). ACE periods were classified as normal, above normal (≥126 × 10⁴ kt²), and extreme (≥160 × 10⁴ kt²). Results: The adjusted relationship between ACE and mortality was linear. Without stratification of income and education, extreme ACE periods were associated with increased all-cause mortality [rate ratio (RR) 1.056; p < 0.001] compared to normal ACE periods. Stratified analyses revealed that all income and education levels exhibited significant associations between extreme ACE and mortality, with the strongest for the high-income and high-education group (RR 1.097; p < 0.001). Insignificant associations were observed in counties with other income–education combinations. This pattern may reflect the coastal concentration of high-income, high-education counties, leading to greater hurricane exposure. Conclusions: Hurricane-related mortality varies by combined income and education levels, with elevated risk in coastal counties with higher socioeconomic status. Further research is warranted to explore cause-specific mortality and refine public health interventions based on socioeconomic vulnerability. Full article

Background: Fimasartan is an angiotensin II receptor blocker (ARB) that was developed in Korea. Although ARBs and calcium channel blockers (CCBs) are both recommended first-line antihypertensive drug classes, real-world outcome data comparing fimasartan specifically with CCBs remain limited. Methods: We analyzed Korean National Health Insurance Service data for adults aged ≥20 years with hypertension and no prior cardiovascular disease. The primary inferential analysis was treatment-naïve new users of fimasartan or CCB monotherapy using a 30-day landmark design, with outcome follow-up beginning on day 31. The primary endpoint was 3-year major adverse cardiovascular events (MACEs), defined as all-cause death, cardiac death, nonfatal myocardial infarction, or nonfatal stroke. Multivariable Cox models were used for the primary analysis, while broader overall-cohort and propensity-score-matched analyses were considered secondary. Results: In the primary treatment-naïve new-user analysis, fimasartan was associated with a numerically lower MACE risk than CCBs, although the 95% confidence interval included the null value (adjusted HR 0.895, 95% CI 0.796–1.006; p = 0.0628). In secondary analyses of the broader overall cohort, fimasartan was associated with a lower adjusted MACE risk (HR 0.851, 95% CI 0.815–0.890), and the association remained evident after propensity-score matching (HR 0.675, 95% CI 0.653–0.699). Exploratory comparisons showed nearly identical crude MACE rates for fimasartan+CCB and fimasartan+thiazide regimens (3.46% vs. 3.47%). Conclusions: In this nationwide observational cohort, the primary treatment-naïve new-user analysis showed a numerically lower 3-year MACE risk with fimasartan than with CCBs, although the confidence interval included the null value. Stronger associations observed in secondary analyses of the broader cohort should be interpreted cautiously because residual confounding and selection bias cannot be excluded. Full article

Background: Because an uncovered arch scaffold does not provide a covered seal across an unresected arch tear, we evaluated a source-adjudicated sequential eligibility framework separating study-defined stop gates from residual-risk modifiers. Methods: We retrospectively analyzed 266 patients with acute DeBakey type I dissection treated by hemiarch repair alone (No. = 160) or hemiarch plus AMDS (No. = 106). Blinded preoperative CT-scan re-review validated Gate 1 (visible arch tear), and operative-report review confirmed Gate 2 (tear directly observed at open inspection). Supra-aortic false-lumen communication was assessed only after both gates were negative. Results: Sixty-nine patients (25.9%) passed both study-defined gates (AMDS = 32; hemiarch = 37). Twelve-month CT-scan was available in 45/69 (65.2%; AMDS 24/32, hemiarch 21/37). Among imaged patients, complete zone 2–3 false-lumen exclusion occurred in 20/24 (83.3%) after AMDS and 0/21 after hemiarch (risk difference +83.3 percentage points, 95% CI +58.7 to +93.3; p < 0.001). DANE occurred in 4/32 (12.5%) and 16/37 (43.2%), respectively (p = 0.007). Under the adverse opposing missingness scenario, the exclusion risk difference narrowed to +19.3 percentage points (95% CI −4.2 to +39.9; p = 0.148). Conclusions: These findings are hypothesis-generating and apply to a selected post hoc subgroup; treatment comparisons are non-causal. Prospective external validation of the study-defined hierarchy remains required. Full article

This study proposes a probabilistic data-driven ensemble framework for the remaining useful life (RUL) prognostics of lithium-ion batteries. This work addresses the limitations of single-model and deterministic methods by integrating Bayesian neural networks (BNNs), LSTM/Transformer architectures, Wiener process–based stochastic degradation modeling, and gradient boosting within a unified uncertainty-aware architecture. Unlike prior ensembles that fuse models with fixed weights, the proposed framework makes the fusion itself adaptive: each base model’s contribution is recomputed online from the degradation stage, operating-condition similarity, and recent residuals, and every prediction carries a decomposed epistemic and aleatoric uncertainty. Three primary contributions distinguish this work: (1) a novel dynamic ensemble weighting mechanism that adaptively adjusts each base model’s contribution as a function of degradation stage, operating-condition similarity, and recent prediction residuals; (2) a principled decomposition of total predictive uncertainty into epistemic and aleatoric components, combined with temperature scaling and an empirical analysis of when scalar calibration succeeds and fails; and (3) validation across four benchmark datasets (NASA PCoE, CALCE, MIT, and XJTU) comprising 197 cells and approximately 140,000 charge–discharge cycles (178 cells with an observed end of life). At these benchmarks, the proposed adaptive ensemble achieved a mean RMSE of 80.3 cycles, an MAE of 51.7 cycles, the best MAPE of all evaluated models (29.9%), and a CRPS of 40.4 cycles, reducing RMSE by 28.2% relative to a simple-average ensemble (Wilcoxon’s test: p < 0.001) and outperforming the LSTM, Transformer, BNN, and Wiener-PINN base learners individually; its point accuracy is statistically indistinguishable from the strongest single learner (gradient boosting, p = 0.20), while additionally providing decomposed epistemic/aleatoric uncertainty. Uncalibrated ensemble intervals were reliably conservative (PICP@95% = 99.1%); a single temperature-scaling parameter fitted on the small validation sets transferred imperfectly to unseen cells (PICP@95% = 78.1%), and this brittleness of scalar calibration under cell-level distribution shift is quantified and discussed. These results support adaptive ensembling for risk-aware battery management while identifying calibration under distribution shift as an open problem. Full article

The speciation of heavy metals in water and channel sediments was investigated along a 680 km reach of the lower Mekong River in Thailand, encompassing 17 sites on the Mekong River and 6 sites on the Mun River, a major tributary. Ten heavy metals—Mn, Fe, Cr, Co, Ni, Cu, Zn, As, Cd, and Pb—were quantified in surface water and riverbed sediments using a modified 4-stage sequential extraction protocol incorporating water-soluble (F1), exchangeable (F2), reducible (F3), and residual (F4) fractions. The resulting geochemical data were evaluated against quality standards, the Risk Assessment Code (RAC), a proposed Modified Risk Assessment Code (MRAC), and the Contamination Factor (CF). Water-soluble extraction (F1) was used to evaluate the proposed MRAC. The surface water quality complies with Thailand’s National Standard at all sites. However, localized sediment contamination was identified and can be categorized into five priority groups. The group with the highest priority consists of Cr, Ni, and Cu. The concentrations of these exceeded national sediment quality standards, and surpasses the Probable Effect Concentration (PEC) at several sites, indicating a high probability of adverse ecological effects. Furthermore, MRAC identified them as having a high risk of mobilizing at ambient conditions in the dry season. The Mun River shows no substantial effect on Mekong hydrochemistry, but it may contribute Cr and Ni loading downstream. Full article

Background/Objectives: Navigated intraoperative ultrasound (N-ioUS) compensates for brain shift, but its place within a multimodal workflow alongside neuronavigation, 5-aminolevulinic acid (5-ALA) fluorescence and neurophysiological monitoring is not well defined. We describe functional and surgical outcomes in a single-centre series of functional-eloquent tumours resected with N-ioUS within such a workflow. Methods: Retrospective descriptive cohort study, reported per STROBE, of 104 consecutive patients who underwent N-ioUS-assisted resection of functionally eloquent intracranial tumours between 2011 and 2023. N-ioUS was an inclusion criterion, so no comparison group was available; the same-institution 5-ALA cohorts are cited as context only. Results: The cohort comprised WHO grade 4 gliomas (n = 42), WHO grade 2–3 gliomas (n = 33), metastases (n = 21) and other tumours (n = 8); 5-ALA was used in 74.0% and neurophysiological monitoring in 94.2%. No residual tumour was described in 22.5% of grade 4 gliomas, 53.3% of grade 2–3 gliomas and 73.7% of metastases with a documented extent of resection. Among patients at risk with documented postoperative status, a new motor deficit occurred in 4/16 (25.0%) grade 4, 4/21 (19.0%) grade 2–3 and 1/7 (14.3%) metastases patients. Median overall survival was 12.7 months for grade 4 gliomas and 22.2 months for metastases and was not reached for grade 2–3 gliomas; within grade 4 gliomas, no difference by extent of resection was detected in an underpowered exploratory comparison (log-rank p = 0.593). Conclusions: In this single-arm series the resection endpoint in eloquent tumours was set by functional rather than anatomical boundaries, and rates of complete resection and new deficit were in keeping with that constraint. The design permits no inference about the independent effect of N-ioUS, whose contribution may be greatest where the endpoint is anatomical, as in metastases, and requires prospective controlled evaluation. Full article

Background and Objectives: Neoadjuvant chemoradiotherapy (nCRT) is standard care for locally advanced rectal cancer, yet whether benefit derives from treatment receipt or from response depth remains debated. We examined nCRT receipt and tumour regression against outcome, and whether poor response is predictable beforehand. Materials and Methods: Eighty-nine consecutive patients undergoing resection for rectal or rectosigmoid adenocarcinoma (2020–2022; median follow-up 16 months) were analysed; outcomes were described in patients receiving nCRT (n = 60) and in those undergoing upfront surgery (n = 29), two groups whose allocation depended on stage and location and which are therefore presented as distinct clinical populations rather than as directly comparable arms. Response was graded by modified Ryan tumour regression grade. An exploratory four-item Pre-treatment Response Risk (PRR) score was derived and internally validated by bootstrap optimism correction. Comparisons used the Student t-test or Mann–Whitney U test and the chi-square or Fisher exact test, with logistic (maximum likelihood and Firth-penalised) and Cox regression and receiver operating characteristic analyses. Results: nCRT exposure was not statistically associated with mortality during follow-up (21.7% vs. 24.1%, p = 0.792), metastatic recurrence (21.7% vs. 20.7%, p > 0.999) or textbook outcome (35.0% vs. 34.5%, p > 0.999); the association with mortality remained non-significant after covariate adjustment in the whole cohort (Cox hazard ratio 0.66, 95% CI 0.24–1.83) and in a sensitivity analysis restricted to rectal tumours (Charlson-adjusted Firth odds ratio 0.52, 95% CI 0.08–3.94). The median follow-up of 16 months was too short to assess disease-free survival. Among patients who received nCRT, mortality varied with the depth of pathological response rather than with treatment receipt itself, from 0% in complete responders to 62% in poor responders (p < 0.001), and each one-grade worsening of the tumour regression grade multiplied the odds of death (OR 6.26, 95% CI 1.74–22.5, p = 0.005), although response grade, residual ypT/ypN stage and comorbidity were closely collinear. Comorbidity was associated with mortality (Charlson index, Firth-penalised OR 3.41 per point, 95% CI 1.89–6.15, p < 0.001) whereas nCRT was not (OR 0.38, 95% CI 0.08–1.72). In the derivation cohort, the PRR score discriminated poor response (apparent AUC 0.95, optimism-corrected 0.89) and was associated with major morbidity, which rose from 0% in the lowest to 93% in the highest risk band, and with mortality, which rose from 0% to 71% (p < 0.001 for each outcome). Conclusions: Within this cohort, nCRT exposure was not statistically associated with the evaluated short-term outcomes, which does not establish equivalence between strategies; depth of pathological response and host comorbidity carried the prognostic information, and routine pre-treatment variables showed promise for anticipating poor response. External validation is required before any clinical use. Full article

Multi-year wildfire risk projection requires environmental drivers to be estimated beyond the observational period. This study develops a two-stage framework for Guangxi, China. FactorLSTM recursively estimates nine time-varying environmental factors, and an LSTM–Transformer combines these estimates with four projection-static factors to generate monthly wildfire probability estimates on a 1 km grid for 2019–2028. Observed-driver classification and recursive, predicted-driver evaluation are distinguished. An additional retrospective experiment using a separately trained classifier with a positive-class weight of 10 and Platt calibration yielded a pooled ROC-AUC of 0.7835 and average precision of 0.001475 for available valid observations in 2019–2025. However, its mean predicted probability was approximately 4.50 times the observed positive fraction, indicating residual overestimation. Seasonal maps summarise monthly outputs for January–April, May–September, and October–December. The ten-year outputs are conditional projections under extrapolated environmental drivers and fixed projection-stage land cover. The results identify limitations in probability calibration, rare-event detection, and observation coverage; they do not establish reliable monthly forecasting across the complete ten-year horizon. Full article

The concept of personalized medicine has tremendous appeal—tailoring diagnosis and treatment to an individual, rather than a “one-size-fits-all” approach. The management of non-small-cell lung cancer (NSCLC) has rapidly evolved toward strategies increasingly guided by tumor biology and precision oncology. The safety and significant efficacy of biomarker-directed therapies in metastatic disease have fueled interest in applying precision oncology to early-stage, operable NSCLC. Advances in molecular profiling have revealed that a substantial proportion of resected NSCLC harbor actionable driver mutations, enabling the integration of targeted therapies into the perioperative setting. The success of adjuvant epidermal growth factor receptor and anaplastic lymphoma kinase inhibition established a framework for biomarker-driven therapy and highlights the importance of comprehensive molecular testing at diagnosis. In parallel, perioperative immune checkpoint inhibitor-based strategies have expanded treatment options for appropriately selected patients, further emphasizing the importance of molecular profiling. Significant implementation gaps remain, including incomplete molecular testing, delayed results, inadequate tissue sampling, fragmented workflows, and disparities in access. Beyond clinically actionable driver mutations, emerging research highlights radiogenomics and advances in the use of circulating tumor DNA for minimal residual disease detection, with important implications for early recurrence detection and patient prognostication, although these technologies differ in clinical maturity. Collectively, these developments emphasize the molecular heterogeneity underlying early-stage NSCLC and the expanding role of biomarkers in guiding clinical decision-making. Integrating genomic, radiographic, and biologic markers into clinical workflows will be essential to refine risk stratification, personalize perioperative treatment strategies, and ultimately improve long-term oncologic outcomes. Full article

Background: Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis associated with substantial risks of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Scope: This comprehensive review examines the epidemiological and pathobiological links between PAD, polyvascular disease, and residual cardiovascular and limb risk. Evidence Synthesis: It summarizes contemporary evidence for integrated management through antithrombotic therapy, intensive lipid lowering, blood pressure and diabetes management, smoking cessation, structured exercise, revascularization when indicated, and longitudinal surveillance. Particular attention is given to dual-pathway inhibition, non-statin lipid-lowering agents, and cardiometabolic therapies, while distinguishing established PAD-specific benefits from subgroup or emerging evidence. Conclusions: A phenotype-based approach integrating ischemic, bleeding, metabolic, functional, and limb-related risk is proposed to support individualized treatment and sustained vascular protection. Full article

Extracellular protein disulfide isomerase (PDI) is a critical mediator of thrombus formation and a promising target for novel antithrombotic therapies aiming to overcome the bleeding risks associated with current antiplatelet agents. This study aimed to design and evaluate novel, targeted peptide-based PDI inhibitors with a safe physiological profile. We utilized a bioinformatics-driven rational design approach, based on the evolutionary conservation of the PDI active site, to generate a library of 34 targeted peptides. The inhibitory mechanism and biological efficacy of the lead candidate, peptide p23, were evaluated using 500 ns molecular dynamics (MD) simulations, flow cytometry, and in vitro microfluidic thrombosis models under arterial shear stress. Based on bioinformatic analyses, p23 is predicted to interact with the PDI catalytic cleft and potentially form a highly stable inhibitory complex. Functionally, p23 maintained consistent antiplatelet efficacy in the complex matrix of human platelet-rich plasma. Flow cytometry demonstrated that p23 selectively suppresses integrin GPIIb/IIIa conformational activation without impairing P-selectin and CD63 surface expression. Crucially, p23 significantly reduced collagen-dependent three-dimensional thrombus formation in whole blood under biomimetic arterial flow, while still allowing for necessary residual platelet adhesion. Unlike direct integrin antagonists, p23 preserved physiological clot retraction and did not prolong plasma coagulation parameters. These findings validate the rational design of covalent PDI inhibitors and highlight peptide p23 as a promising candidate for preclinical in vivo evaluation, offering a favorable preliminary hemostatic profile and the potential for a reduced impact on hemostasis. Full article

Human exposure to foodborne xenobiotics, including environmental contaminants that enter the food chain, is no longer adequately represented by isolated chemicals. Individuals encounter complex and dynamic mixtures of food additives, pesticide residues, veterinary drugs, mycotoxins, processing contaminants, packaging migrants, environmental pollutants, and other dietary chemicals that interact with genetics, metabolism, the gut microbiome, nutritional status, and lifestyle throughout life. The dietary exposome therefore represents a critical interface linking food contaminants, internal chemical exposure, molecular perturbation, and long-term human health. Conventional toxicology provides an indispensable foundation for food safety regulation through hazard characterization and population-based health guidance values but is less equipped to explain interindividual variability in biological response and chronic disease susceptibility. Precision toxicology provides an integrative and mechanism-informed framework that combines high-resolution analytical chemistry, human biomonitoring, exposomics, multiomics, new approach methodologies, and artificial intelligence. This integration enables the characterization of biologically effective exposure, the elucidation of exposure–response relationships, and the identification of interindividual variability in toxicological susceptibility. This perspective proposes a translational framework connecting external exposure → internal dose → biological response → individual susceptibility → health outcome. We position this framework relative to existing exposome, exposure-pathway, and adverse-outcome-pathway frameworks; specify the evidence required at each transition; make its life-course dimension explicit; illustrate it with a worked per- and polyfluoroalkyl substance (PFAS) example; and outline a stepwise route into food risk assessment together with its principal limitations. Such integration could advance food safety science beyond residue detection toward biologically informed exposure assessment, ultimately supporting more evidence-based regulatory decision-making, preventive strategies, and public health protection. Full article