Search Results (3,221)

In post-prostatectomy prostate cancer, combining androgen deprivation therapy (ADT) with salvage radiotherapy (SRT) significantly improves clinical outcomes, though the absolute benefit varies based on baseline PSA, pathological risk, and treatment design. This review synthesizes findings from key randomized trials and contemporary meta-analyses—including RTOG 9601, SPPORT, GETUG-AFU 16, GETUG-AFU 22, and RADICALS-HD—evaluating the integration and duration of ADT with postoperative irradiation. While systemic therapy consistently enhances biochemical and clinical progression-free survival, a universal overall survival benefit remains uncertain or limited to high-risk cohorts with elevated pre-treatment PSA values. Concurrently, data from the prospective phase II OLIGOPELVIS (GETUG P07) and PEACE V-STORM trials are redefining the standard of care for pelvic nodal oligorecurrent disease detected via next-generation imaging (NGI). Transitioning away from exclusive lifelong ADT or isolated focal metastasis-directed therapy, emerging evidence strongly supports a multimodal paradigm: combining prostate bed RT, whole-pelvis elective nodal irradiation, and a high-dose boost to PET-positive nodes, complemented by a short course of systemic therapy. Ultimately, this narrative review provides clinicians with evidence-based guidance on integrating ADT to maximize regional disease control and delay systemic progression, while successfully sparing the majority of patients from the toxicities of continuous ADT. Full article

Urban heat exposure is one of the most critical and rapidly intensifying impacts of climate change in metropolitan areas. Reliable measurement of outdoor thermal comfort is therefore essential not only for long-term climate-adaptation planning but also for real-time heat-risk management. However, conventional approaches for measuring the Universal Thermal Climate Index (UTCI) rely either on computationally demanding radiative models or on dense in situ monitoring networks, both of which limit scalability and operational deployment at city scale. This study introduces an innovative data-driven framework for urban-scale measurement of mean radiant temperature (t_r) and UTCI using exclusively open-access reanalysis and real-time meteorological data. A supervised Multi-Layer Perceptron (MLP) model is trained to estimate t_r without requiring detailed urban morphology inputs or demanding radiometric instrumentation. The framework achieves high predictive performance (R² = 0.99; RMSE = 1.4 °C for t_r) and computational efficiency suitable for real-time applications. Another key innovation of this study lies in the comfort–vulnerability integration. The estimated outdoor thermal comfort (i.e., UTCI) is combined with socio-demographic vulnerability measurements within a unified Urban Heat Risk Index (UHRI). Applied to the Besòs district in Barcelona, the framework identifies hotspots where thermal stress and social vulnerability converge, supporting urban resilience and adaptation strategies. A Monte Carlo sensitivity and uncertainty-propagation analysis further showed limited error propagation across the framework, with standard uncertainties of 0.88 °C for MLP-based t_r, 0.67 °C for UTCI, and 0.017 for UHRI. Full article

Background/Objectives: Selecting appropriate analgesic therapy in patients with multimorbidity is increasingly challenging because clinicians must balance pain management against comorbidities, polypharmacy, and medication-related risks. However, evidence describing how analgesic prescribing patterns vary across patients with different multimorbidity profiles in routine outpatient practice remains limited. This retrospective cross-sectional study examined associations between multimorbidity and prescribing patterns across paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids, and identified clinical characteristics associated with different hierarchical analgesic exposure groups among adults aged ≥40 years in Saudi Arabia. Methods: Electronic health record data were analyzed for adults aged ≥40 years attending multiple clinics in the Eastern Region of Saudi Arabia between January 2020 and December 2021. Analgesic exposure at the index outpatient visit was classified using a hierarchical framework into mutually exclusive paracetamol-only, NSAID-priority, opioid-priority, or non-use groups. Multinomial logistic regression was performed to identify clinical characteristics associated with assignment to the hierarchical analgesic exposure groups. Results: Among 41,083 patients, 29,383 (71.5%) received at least one analgesic prescription at the index visit. The NSAID-priority group was the largest exposure category, followed by opioid-priority and paracetamol-only groups. Hierarchical analgesic prescribing patterns differed across patient clinical profiles, with prescribing observed across patients with cardiovascular, metabolic, gastrointestinal, respiratory, and neuropsychiatric disorders. In adjusted analyses, arthritis-related disease was associated with slightly higher odds of NSAID-priority assignment, whereas ischemic heart disease, gastritis-related disease, and respiratory disorders were associated with lower odds of NSAID-priority assignment. Constipation and urinary incontinence were associated with lower odds of opioid-priority assignment. Conclusions: Analgesic prescribing was common among medically complex adult outpatients aged ≥40 years, and hierarchical prescribing patterns differed across patient clinical and comorbidity profiles. The hierarchical framework provided a pragmatic approach for characterizing prescribing across major analgesic classes while accounting for concurrent exposure. Most disease-specific associations were attenuated after multivariable adjustment, and the remaining associations were generally modest in magnitude. Owing to the cross-sectional design and absence of detailed treatment-indication and pain-related information, these findings represent prescribing associations and should not be interpreted as evidence of causal prescribing decisions or treatment appropriateness. Full article

The Snow Ablation Optimizer (SAO) uses ranked solutions to generate candidates but accepts every evaluated candidate, even when it degrades its source state. We examined whether this unconditional migration rule created a systematic risk for the individuals that contributed most to search progress. On 12 representative CEC2017 functions, current leaders produced a median 82.51% of generation-best improvements. Their median candidate-degradation rate was 64.26%, compared with 35.72% for followers, and the difference remained significant on all functions after Holm correction. This contribution–risk concentration identifies candidate acceptance and protection target as the relevant correction points. A unified retention rule compared fitness-ranked leader retention (LR), random retention (R), full retention (ALL), and the original SAO without changing candidate generation or the evaluation budget. A 30-seed, five-percentage-point diagnostic grid selected LR-70% and nominal R-95% for the complete benchmark. Across 84 CEC2017 and CEC2022 function–dimension blocks and 19 algorithms, R-95% achieved the lowest overall mean-error rank (3.0476). Its global rank was better than every comparator after Holm correction, including LR-70% and ALL. Median-error ranking and exclusion of CEC2017 F2 preserved this CEC result. Full article

Traditional consumer credit scoring models frequently fail to identify rising default risks in transition economies because they rely almost exclusively on formal macroeconomic indicators and unchanging demographic data. This paper offers a preliminary empirical assessment of digital gambling participation and utility payment arrears as stand-in risk indicators in Kazakhstani consumer credit scoring. Using a unique survey-derived dataset from Kazakhstan (N = 41 survey respondents, yielding a finalized modeling cohort of N = 233 active borrowers), we develop, tune, and evaluate five predictive models—Logistic Regression (LR), Decision Trees, Artificial Neural Networks (ANNs), Random Forests, and Extreme Gradient Boosting (XGBoost). Models were optimized using stratified 5-fold cross-validation on the training partition (N ≈ 163) and benchmarked across both a SMOTE-balanced evaluation pool (D_eval, N = 473) and an empirical 30% holdout test set (D_emp, N ≈ 70). The results provide localized baseline evidence on incorporating non-traditional behavioral data into credit evaluation frameworks in data-constrained emerging economies. While the raw empirical cohort (𝒟_emp) exhibits a dominant majority distribution with an 88.84% default/late-payment rate, a balanced resampled evaluation pool (𝒟_eval, N = 473) was constructed to ensure unbiased model optimization. The empirical results show that tree-based ensemble structures considerably outperform conventional methods, establishing a clear performance hierarchy. With an accuracy of 83.1% and an Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.854, the classical LR baseline has the lowest predictive power and is unable to map complex, interactive behavioral hazards. On the other hand, the best architecture is the improved XGBoost ensemble engine, which achieves an AUROC of 0.976 on the balanced evaluation pool (𝒟_eval). The XGBoost framework successfully reduces institutional asymmetric loss constraints, according to a micro-structural audit of the underlying confusion matrix. Evaluated on 𝒟_eval, the model achieves a specificity of 97.4% (TN = 228) and a sensitivity of 96.2% (TP = 230), reducing catastrophic FNR underwriting errors while preserving high loan onboarding efficiency. Furthermore, comparative testing directly on the unadjusted empirical cohort (𝒟_emp) confirms strong diagnostic robustness, demonstrating that high class-separation performance generalizes effectively to skewed real-world credit distributions. These findings demonstrate that incorporating real-time behavioral abnormalities into regularized ensemble pipelines offers a very reliable method of reducing risk. In conclusion, this research provides emerging market financial institutions and regulators with an empirical guide to enhance credit underwriting accuracy, strike a compromise between inclusive lending and capital preservation, and shield the retail banking portfolio from localized default contagion. Although the size of the available dataset does not allow us to attain a definitive conclusion, these results point to a promising direction to further investigate with the same methods proposed in this work and larger datasets. Indeed, they suggest that behavioral data has the potential to enhance traditional credit-scoring techniques when properly vetted and integrated with machine-learning techniques. Full article

Background/Objectives: We examined nine biomarkers for acute mesenteric ischemia (AMI) detection, necrosis and postoperative prediction. Methods: PubMed/MEDLINE, the Cochrane Library and indexed citation links were searched on 10 October 2026 without a lower publication-year limit. PubMed and citation searches used an October 2026 publication cutoff. English- and Russian-language clinical reports with at least 10 participants were eligible. Narrative synthesis used QUADAS-2 and diagnostic GRADE. Results: Twenty-nine primary reports were included, with reported cohorts of 18–1479 participants. Cohort overlap and varying tested denominators precluded an unduplicated participant total. Among 28 diagnostic reports, 22 had high index-test risk and 25 had high flow/timing risk. Certainty was very low for eight markers. I-FABP, α-GST and citrulline findings depended on population, assay and timing. D-dimer, lactate, procalcitonin and ischemia-modified albumin lacked intestinal specificity. Urinary I-FABP estimates were imprecise. SM22 supplied association data without diagnostic-performance estimates. Conclusions: No evaluated marker supports reliable stand-alone exclusion of AMI or determination of bowel viability. Complementary panels require prospective validation. The injury diagrams are unvalidated research models. Full article

Background/Objectives: International guidelines recommend risk-adapted postoperative management in early-stage cervical cancer; however, the extent to which these recommendations are implemented in routine clinical practice remains incompletely characterized, particularly among patients without high-risk pathological features. This study evaluated real-world concordance with the 2023 European Society of Gynecological Oncology/European Society for Radiotherapy and Oncology/European Society of Pathology (ESGO/ESTRO/ESP) recommendations and investigated the clinical implications of potential overtreatment. Methods: We retrospectively evaluated a single-center cohort of 135 patients treated with primary radical hysterectomy for early-stage cervical cancer at our institution. Postoperative pathological risk factors were used to stratify patients in accordance with the 2023 ESGO/ESTRO/ESP guidelines. Postoperative management was classified as guideline-concordant or potential overtreatment. Disease-free survival (DFS) and overall survival (OS) were assessed by Kaplan–Meier analysis and univariable Cox proportional hazards regression. Results: The high-risk group comprised 50 patients (37.0%), and the non-high-risk group comprised the remaining 85 patients (63.0%). Among non-high-risk patients, 28 (32.9%) received guideline-concordant postoperative management, whereas 57 (67.1%) received treatment classified as potential overtreatment. The distribution of postoperative treatment intensity differed significantly according to guideline-concordance status (p < 0.001). However, DFS did not differ significantly between the guideline-concordant and potential overtreatment groups (log-rank p = 0.62; hazard ratio [HR] = 1.38, 95% confidence interval [CI] 0.38–5.06), nor did OS (log-rank p = 0.85; HR = 1.09, 95% CI 0.42–2.84). Conclusions: Postoperative management showed substantial variation among patients without high-risk pathological features, with potential overtreatment observed in approximately two-thirds of this cohort. No statistically significant differences in DFS or OS were observed between the groups; however, the limited number of events and wide confidence intervals preclude exclusion of clinically meaningful treatment effects. Full article

Urban UAV route planning requires an explicit connection between spatial inputs, route restrictions, and evaluation criteria. This study presents a single-case demonstration of risk-map-based adaptive ant colony optimization (RMA-ACO) within an OD-based spatial routing framework. Building geometry and origin–destination activity supply receiver-related inputs under a common trip-generation-rate assumption. The method combines spatial exclusions, a local distance–noise heuristic, backtracking, early stopping, and geometric postprocessing. One origin–destination pair in a residential area of Changzhou, China, is examined at a fixed altitude of 10 m. History-dependent local scores guide route selection, whereas final routes are evaluated by geometric length and an unscaled noise-related model index on a common field. Across 30 fixed-seed runs at 5 m, RMA-ACO versus ACO means are 2763.6 versus 3190.1 m for route length, 143.2 versus 202.9 s for runtime, and 59.2 versus 60.9 for the noise index (paired difference: −1.7; 95% CI: −2.26 to −1.14). These results compare the complete tested configurations under the prescribed proxy settings. They do not isolate component effects or establish measured exposure reductions, transferability to other delivery connections, or operational flight feasibility. Full article

Objective: This study compared the relative effects of distinct nutritional strategies on muscle mass, muscle strength, and physical performance in older adults with sarcopenia or at high risk of sarcopenia. Methods: PubMed, Embase, the Cochrane Library, Web of Science, and CNKI were systematically searched for randomized controlled trials (RCTs). Random-effects pairwise meta-analysis and network meta-analysis (NMA) were performed. The surface under the cumulative ranking curve (SUCRA) was used to summarize relative rankings, and CINeMA was applied to assess the certainty of evidence. Results: Twenty RCTs involving 2160 participants were included, forming 17 network nodes. Nutritional interventions collectively improved appendicular skeletal muscle mass index (ASMI), grip strength, and gait speed, whereas the pooled effect on the five-times sit-to-stand test (5STS) was not statistically significant. In the NMA, whey protein + vitamin D + leucine improved ASMI (SMD = 0.29, 95% CI: 0.06 to 0.52) and grip strength (SMD = 0.82, 95% CI: 0.13 to 1.50), and it reduced 5STS completion time (SMD = −1.41, 95% CI: −2.63 to −0.18). Omega-3 fatty acids + leucine + Lactobacillus paracasei PS23 improved ASMI (SMD = 0.67, 95% CI: 0.10 to 1.25) and grip strength (SMD = 1.84, 95% CI: 0.39 to 3.28), although this node was supported by a single RCT. Leucine + vitamin D + medium-chain triglycerides improved gait speed (SMD = 1.28, 95% CI: 0.13 to 2.43), although this node was also supported by a single RCT. Sensitivity analyses indicated that the magnitude and precision of some formulation-specific estimates varied with the exclusion of individual trials or restriction to participants with confirmed sarcopenia. The certainty of evidence for the principal comparisons ranged from low to very low. Conclusions: Nutritional supplementation showed overall benefits for ASMI, grip strength, and gait speed, while formulation-specific effects varied across outcomes. Whey protein + vitamin D + leucine showed favorable effects across several outcomes, whereas omega-3 fatty acids + leucine + Lactobacillus paracasei PS23 and leucine + vitamin D + medium-chain triglycerides showed additional formulation-specific signals based on single-study nodes. Given the sparse network and very low certainty of evidence for the principal comparisons, these findings should be regarded as candidate signals rather than evidence of a definitive treatment hierarchy. Full article

Background and Clinical Significance: Bow Hunter’s syndrome is an uncommon cause of vertebrobasilar insufficiency caused by dynamic vertebral artery narrowing during head rotation or extension. It is classically described at the atlantoaxial level, whereas subaxial compression is less recognised. Thyroid cartilage-related vertebral artery compression is particularly rare and may mimic vertebral artery dissection on static imaging. This case highlights the need to distinguish anatomical conflict from clinically causal haemodynamic compression. Case Presentation: A 51-year-old man with vascular risk factors and a well-anticoagulated mechanical aortic valve presented with three transient ischaemic attacks within two hours, including left-hand paraesthesia, right hemianopia, transient aphasia, and right-hand paraesthesia. Symptoms occurred spontaneously, without clear relation to head or neck movement or trauma. Doppler ultrasound showed normal carotid and vertebral flow. CT angiography demonstrated focal stenosis of the right vertebral artery at the V1–V2 junction caused by an osteocartilaginous “pincer” between the right thyroid cartilage ala and the C5 transverse process. The axial appearance mimicked vertebral artery dissection, but multiplanar CTA and contrast-enhanced MRA supported external indentation without mural haematoma, intimal flap, pseudoaneurysm, or double lumen. Perfusion CT showed no focal hypoperfusion, and diffusion-weighted MRI showed no acute infarct. Because symptoms were not positional and competing embolic risk factors were present, conservative management was chosen. Conclusions: Thyroid cartilage-related subaxial vertebral artery compression is a rare diagnostic pitfall. Static imaging may suggest dissection or Bow Hunter’s syndrome, but causality should not be inferred without compatible symptoms, exclusion of alternative mechanisms, and, when needed, dynamic confirmation. Full article

Poverty and social exclusion remain major challenges to social sustainability, social cohesion and quality of life in Europe, and their reduction is a central objective of Sustainable Development Goal (SDG) 1. The present study examines the relationship between macroeconomic factors and poverty and social exclusion across the EU-27 and Türkiye. The analysis employs the EU’s headline at-risk-of-poverty-or-social-exclusion (AROPE) indicator and its three components: relative income poverty (AROP), severe material and social deprivation (SMSD), and very low work intensity (VLWI). Whilst the majority of cross-country studies utilise the composite rate or a single component and exclude Türkiye, this study estimates the comparative sensitivity of all three components to the same regressors within a panel that treats Türkiye as a structurally distinct case. Utilizing two-way fixed-effects models with country-clustered standard errors across 28 countries from 2015 to 2024, in conjunction with a range of robust checks, our study identifies three salient findings. First, Gross Domestic Product (GDP) per capita is the sole factor with a robust association with the headline rate. In particular, a 10% increase in GDP per capita is associated with a reduction in the AROPE rate of approximately 1.7 percentage points (an approximate semi-elasticity). Conversely, inequality and employment emerge as significant factors only under classical inference. Secondly, the associations demonstrated in this study are dimension-specific. Income is associated with material deprivation, inequality with relative income poverty, labour market conditions with work intensity, and social spending with material deprivation. Thirdly, the exclusion of Türkiye results in the reversal of the signs of the inflation and early-school-leaving coefficients, indicating a poverty dynamic that is structurally distinct. The analysis suggests that strengthening social sustainability requires not only economic growth, but also inclusive labour markets, effective social protection and reduced inequality. Full article

Background: Psychological frailty may describe reduced capacity to adapt to stress in later life, but definitions vary and its added clinical value is unknown. Methods: We conducted a critical narrative review of MEDLINE via PubMed (1 January 2015 to 29 August 2026), citation chains, and selected guidance. The original core query returned 114 records; the focused reconciliation added construct-specific reports. Forty-nine sources inform this synthesis. Results: Trials have measured psychological-frailty domains, and D-SCOPE permitted a psychological-domain threshold as one of several enrollment routes. Freitag and Schmidt reported small short-term improvements in frailty and mental health; D-SCOPE reported no significant six-month within-group change in psychological frailty; and MIND-STEP reported a psychological-frailty risk difference of −13.87 percentage points at 12 weeks (95% CI −25.04 to −2.69). These measures are not interchangeable with our proposed affective–adaptive definition. We found no trial that exclusively recruited participants using a validated version of that proposed construct. Adjacent evidence concerns defined symptoms and functional outcomes. We propose RESERVE-7 as an unvalidated heuristic for identifying goals, reversible drivers, an initial feasible intervention, treatment burden, and follow-up. Conclusions: Construct-specific intervention findings deserve explicit consideration, but they do not validate psychological reserve or RESERVE-7. Prospective validation is needed before adoption. Full article

Programmed frozen embryo transfer (FET) cycles are an integral part of assisted reproductive technologies (ARTs). They rely exclusively on the administration of exogenous estrogens and progesterone to prepare the endometrium, and they are characterized by the absence of a functional corpus luteum (CL). Pregnancies resulting from FET cycles have been associated with an increased risk of complications related to placental dysfunction, such as preeclampsia and fetal growth restriction (FGR). Besides progesterone production, the CL secretes vasoactive and angiogenic factors essential for the regulatory mechanisms that occur during the early stages of pregnancy. Its absence results in a different endocrine environment, which may be associated with differences in normal maternal cardiovascular remodeling. In pregnant women without CL function, reduced vasodilation, increased systemic vascular resistance, altered cardiac output, and inadequate renal adaptation have been reported. In addition, disturbances in angiogenic balance and trophoblast invasion may contribute to abnormal placentation and the development of preeclampsia. Accordingly, the absence of the CL in programmed FET cycles may represent a critical endocrine disorder, predisposing patients to maternal cardiovascular disturbance and adverse obstetric outcomes. Recognition of this potential endocrine and vascular interaction has important implications for cycle selection, risk stratification, and preventive strategies in the implementation of assisted reproduction protocols. Full article

Gender research in vocational education has primarily examined women’s exclusion, while male students’ experiences of privilege and masculinity-related pressure remain underexplored. This study examined how male vocational students experienced gender-based privilege, encountered psychological and pedagogical burdens, and interpreted their relationship during manufacturing internships. The study employed a qualitative design informed by a constructivist–interpretivist paradigm and Masculinity Studies, particularly Connell’s relational approach to masculinities. The study analyzed semi-structured interviews with 61 male students from two vocational secondary schools in Bekasi, Indonesia, using reflexive thematic analysis. Participants reported that gendered expectations associating men with strength, readiness, courage, and independence facilitated early access to core technical tasks, supervisory trust, and valuable learning opportunities. The same expectations intensified performance demands, physical workloads, risk exposure, restricted help-seeking, and limited pedagogical support. Participants interpreted this position through normalization, ambivalence, and critical reflection. Some proposed competency-based task allocation, equitable supervision, and safer learning environments. The study introduces conditional access privilege as a gendered position in which access to valuable technical learning resources must be maintained through masculine performance, generating psychological pressure and pedagogical vulnerability. The findings support internship practices that separate competency assessment, task allocation, supervision, and learning support from gendered expectations. Full article

Background: Environmental contamination of hospital surfaces, especially in high-risk clinical areas, partly sustains healthcare-associated infections. The detection of microbiological contamination in hospital settings using culture-based methods remains fundamental, even though these methods are not rapid, show moderate sensitivity in areas with low microbial loads, and are unsuitable for some microbial species. This multicentre study evaluated the performance of loop-mediated isothermal amplification (LAMP) for the rapid detection of major nosocomial pathogens on hospital surfaces. Methods: A multicentre observational method–comparison study was conducted in three Italian hospital centres. Overall, 298 environmental surface samples were collected from clinical areas included in local infection-prevention monitoring plans. For each sampling point, LAMP swab sampling was paired with an adjacent contact plate culture. LAMP assays targeted Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Manual and automated nucleic acid extraction workflows were analysed separately. Diagnostic performance, agreement metrics, and discordant paired results were assessed using a contact plate culture as the microbiological comparator. Results: No LAMP-negative/RODAC-positive pairs were observed. Positive percent agreement (PPA) relative to contact plate culture was therefore 100% in the subgroups evaluated. Relative specificity ranged from 90.9% to 98.6%, while overall accuracy ranged from 93.8% to 98.6%. Discordant results were exclusively LAMP-positive/contact plate-negative and were more frequent for S. aureus and P. aeruginosa. Selective culture verification supported several LAMP-positive findings not recovered by routine contact plates. Conclusions: LAMP showed high negative agreement, high specificity, and rapid target-specific detection of selected nosocomial pathogens on hospital surfaces. It may complement conventional cultures in environmental surveillance, particularly when timely feedback is needed to guide infection-prevention and sanitation-monitoring strategies. Full article