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19 pages, 1434 KB  
Article
Interpreting Performance Metrics in Semi-Automated Shark Photo-Identification: Applying IDENTIFIN to Bronze Whaler Shark (Carcharhinus brachyurus, Günther 1870) and White Shark (Carcharodon carcharias, Linnaeus 1758)
by Giorgia Pascolo, Francesca Romana Reinero, Fausto Tinti, Francesca Ellero, Antonio Pacifico and Primo Micarelli
Conservation 2026, 6(3), 77; https://doi.org/10.3390/conservation6030077 (registering DOI) - 26 Jun 2026
Abstract
Monitoring large elasmobranchs can employ standardized photo-identification protocols to manage diverse and progressively expanding photographic datasets. This study examines the interpretation of performance metrics generated by a dorsal fin–based photo-identification protocol implemented using the semi-automated IDENTIFIN software. The protocol was applied to dorsal [...] Read more.
Monitoring large elasmobranchs can employ standardized photo-identification protocols to manage diverse and progressively expanding photographic datasets. This study examines the interpretation of performance metrics generated by a dorsal fin–based photo-identification protocol implemented using the semi-automated IDENTIFIN software. The protocol was applied to dorsal fin photographs of bronze whaler shark collected along the South African coast between 2024 and 2025, facilitating the creation of a structured, individual-specific database. Archival photographic data of white shark (2012–2019) served as a methodological reference, providing context for software outputs under different dataset conditions. Analyses focused on the behavior of similarity scores associated with validated matches and on their relationship with image ranking position, a common metric for assessing software performance. Results indicate that similarity scores exhibit comparable distributions across species-specific datasets, supporting their potential use as an operationally complementary metric for interpreting IDENTIFIN outputs. While operator-based visual validation remains essential, this study provides preliminary methodological insights into the interpretation of similarity scores as supportive information within the individual identification process. Full article
16 pages, 496 KB  
Article
Urinary Albumin-to-Creatinine Ratio Across Phenotypes of Polycystic Ovary Syndrome: A Phenotype-Based Evaluation
by Oznur Oner, Canan Akkus, Doga Demircioglu, Ilhan Karanlık and Cevdet Duran
Metabolites 2026, 16(7), 448; https://doi.org/10.3390/metabo16070448 - 25 Jun 2026
Abstract
Background/Aim: Albuminuria is a clinical marker associated with microvascular involvement and an independent predictor of cardiovascular risk. Polycystic ovary syndrome (PCOS) is associated with early metabolic and vascular abnormalities; however, whether albumin excretion differs across PCOS phenotypes remains unclear. This study aimed to [...] Read more.
Background/Aim: Albuminuria is a clinical marker associated with microvascular involvement and an independent predictor of cardiovascular risk. Polycystic ovary syndrome (PCOS) is associated with early metabolic and vascular abnormalities; however, whether albumin excretion differs across PCOS phenotypes remains unclear. This study aimed to evaluate the urinary albumin-to-creatinine ratio (U-ACR) across PCOS phenotypes and to examine its association with metabolic parameters. Materials and Methods: In this cross-sectional study, 180 women aged 18–35 years with PCOS and 51 age-matched healthy controls were included. PCOS phenotypes were classified according to the Rotterdam criteria as Phenotype A (n = 96), Phenotype B (n = 19), Phenotype C (n = 35), and Phenotype D (n = 30). Insulin resistance was assessed using the homeostasis model assessment for insulin resistance (HOMA-IR). Urinary albumin and creatinine levels were measured in morning urine samples, and U-ACR was calculated. Results: Age was comparable across all groups. Body mass index, waist circumference, diastolic blood pressure, and HOMA-IR were significantly higher in Phenotype A compared with controls and other phenotypes, reflecting a more adverse metabolic profile. Serum creatinine levels were similar across all groups. Despite this metabolic profile in Phenotype A, U-ACR was significantly elevated only in Phenotype B compared with controls (p = 0.018), and Phenotype D (p = 0.016). No significant correlations were observed between U-ACR and age, body mass index, or HOMA-IR. When participants were categorized according to U-ACR levels (<30, 30–299.9, and ≥300 mg/g creatinine), no significant differences in category distribution were observed between the total PCOS cohort, phenotype subgroups, and controls. Conclusion: Among PCOS phenotypes, U-ACR elevation was observed exclusively in Phenotype B despite similar renal function markers. This finding, in the presence of a more adverse metabolic profile in Phenotype A, suggests a dissociation between metabolic burden and early microvascular involvement across PCOS phenotypes. These findings suggest a potential phenotype-specific pattern that warrants further investigation. Full article
28 pages, 10255 KB  
Article
Bayesian Spatial Partitioning with Feature Fusion for Wide-Beam SAR Altimeter Localization Using Delay-Doppler Maps
by Huangen Meng, Yanxi Lu, Yao Wang, Fang Li, Longlong Tan, Bo Huang, Wen Jing and Ge Jiang
Remote Sens. 2026, 18(13), 2087; https://doi.org/10.3390/rs18132087 - 25 Jun 2026
Abstract
Terrain-aided navigation (TAN) enables autonomous positioning through fusing prior terrain databases with real-time sensor measurements in GNSS-denied environments. Typical factors, including wide beam width and terrain elevation variations, introduce inaccuracies in elevation measurements, degrading the performance of classical elevation-based TAN methods. The SAR [...] Read more.
Terrain-aided navigation (TAN) enables autonomous positioning through fusing prior terrain databases with real-time sensor measurements in GNSS-denied environments. Typical factors, including wide beam width and terrain elevation variations, introduce inaccuracies in elevation measurements, degrading the performance of classical elevation-based TAN methods. The SAR altimeter operates in nadir-looking mode to acquire range–Doppler projection images with inherent cross-track ambiguity for positioning based on image information, yet its accuracy is limited by single-feature and fixed-grid approaches. In this paper, we introduce an adaptive positioning framework for the SAR altimeter that combines XGBoost-based multi-feature fusion with Bayesian particle filtering. First, a fast DDM template generation algorithm is employed to improve computational efficiency. Then, an ensemble learning framework integrating complementary similarity features is introduced to achieve robust single-frame matching. Additionally, a Bayesian filtering-based dynamic grid construction method is developed to concentrate particles in high-probability regions, eliminating boundary truncation errors inherent to fixed approaches. The proposed method’s primary advantage is the reliable three-dimensional localization under extreme radar configurations, such as wide beam width and high-altitude maneuvering platforms. Experimental results based on both simulated and real data validate the method, demonstrating superior positioning performance under wide-beam conditions. Full article
14 pages, 1077 KB  
Article
Comparative Real-World Outcomes of OnabotulinumtoxinA and CGRP Monoclonal Antibodies in Chronic Migraine
by Chun-Fu Lin, Chen-Chih Chung, Jia-Hung Chen, Nai-Fang Chi, Chaur-Jong Hu, Hung-En Huang, Chih-Chung Chen, Tu-Hsueh Yeh, James Cheng-Chung Wei and Hsun-Hua Lee
J. Clin. Med. 2026, 15(13), 4963; https://doi.org/10.3390/jcm15134963 - 25 Jun 2026
Abstract
Background: OnabotulinumtoxinA and calcitonin gene-related peptide (CGRP) monoclonal antibodies are widely used for chronic migraine prevention, but comparative real-world evidence on healthcare utilization remains limited. This study aimed to compare the association of onabotulinumtoxinA versus CGRP monoclonal antibodies with acute triptan prescription and [...] Read more.
Background: OnabotulinumtoxinA and calcitonin gene-related peptide (CGRP) monoclonal antibodies are widely used for chronic migraine prevention, but comparative real-world evidence on healthcare utilization remains limited. This study aimed to compare the association of onabotulinumtoxinA versus CGRP monoclonal antibodies with acute triptan prescription and migraine-related return visits in patients with chronic migraine. Methods: We conducted a retrospective cohort study using the TriNetX global federated electronic health record database from 2018 to 2024. Adults with chronic migraine who initiated onabotulinumtoxinA or a CGRP monoclonal antibody were matched 1:1 by propensity score. The primary outcomes were time to acute triptan prescription and time to first migraine-related return visit during follow-up. Results: After propensity score matching, 10,140 patients were included in each treatment group. OnabotulinumtoxinA was associated with a lower hazard of acute triptan prescription than CGRP monoclonal antibodies (hazard ratio 0.513, 95% confidence interval 0.481–0.546; p < 0.001), whereas migraine-related return visits were similar between groups (hazard ratio 1.008, 95% confidence interval 0.977–1.039; p = 0.69). Conclusions: In this multicenter real-world analysis, onabotulinumtoxinA was associated with a lower hazard of acute triptan prescription than CGRP monoclonal antibodies, while migraine-related return visits were comparable. These findings reflect treatment-related healthcare utilization patterns in routine practice and should be interpreted considering the limitations of retrospective electronic health record data. Full article
(This article belongs to the Special Issue Advances and Updates in Migraine)
24 pages, 5519 KB  
Review
Material Systems and Applicability Evaluation of Transparent Soil: Toward Transparent Model Testing in Geotechnical Engineering
by Shifu Wang, Changxing Zhang, Biao Xia, Meiqian Wang, Zhiyi Tang and Wei Xu
Infrastructures 2026, 11(7), 212; https://doi.org/10.3390/infrastructures11070212 - 24 Jun 2026
Viewed by 91
Abstract
Transparent soil technology provides a non-invasive experimental approach for visualizing internal processes in geotechnical infrastructure systems, where soil deformation, seepage, erosion, and failure evolution are often difficult to observe using conventional model tests. This review examines the material systems and applicability of transparent [...] Read more.
Transparent soil technology provides a non-invasive experimental approach for visualizing internal processes in geotechnical infrastructure systems, where soil deformation, seepage, erosion, and failure evolution are often difficult to observe using conventional model tests. This review examines the material systems and applicability of transparent soil with emphasis on infrastructure-related applications, including foundation engineering, underground construction, seepage and grouting, internal erosion, slope failure, disaster mitigation, and thermal monitoring. The discussion focuses on transparent sand and transparent clay, comparing their engineering relevance, typical application scenarios, and main limitations rather than treating transparency as the sole criterion for material selection. Based on the reviewed studies, a four-dimensional applicability framework is proposed, consisting of mechanical similarity, optical measurability, system compatibility, and scenario matching. This framework is used to clarify how transparent soil can support mechanism interpretation, model calibration, and scheme comparison in infrastructure-related geotechnical experiments. The review indicates that transparent soil is particularly useful for revealing displacement fields, flow paths, localized deformation, and progressive failure processes in foundations, tunnels, slopes, and other geotechnical systems. However, direct extrapolation of model test results to engineering design parameters remains constrained by material equivalence, optical measurement conditions, model scale, and similarity calibration. Overall, the proposed framework and synthesis provide a systematic reference for transparent soil material selection, infrastructure-oriented scenario matching, and the assessment of applicability boundaries in transparent soil model tests. Full article
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16 pages, 3551 KB  
Article
Heart Transplantation Requiring Permanent Pacemaker: Risk Factors and Outcomes
by Michael Keller, Ye In Christopher Kwon, Yashar Haghighi, Vigneshwar Kasirajan and Zubair Hashmi
J. Clin. Med. 2026, 15(13), 4895; https://doi.org/10.3390/jcm15134895 - 24 Jun 2026
Viewed by 99
Abstract
Background/Objectives: Following heart transplantation (HT), a subset of patients will require an early or late permanent pacemaker (PPM). We explored risk factors and outcomes associated with PPM implantation in this population. Methods: Using the United Network for Organ Sharing (UNOS) database, [...] Read more.
Background/Objectives: Following heart transplantation (HT), a subset of patients will require an early or late permanent pacemaker (PPM). We explored risk factors and outcomes associated with PPM implantation in this population. Methods: Using the United Network for Organ Sharing (UNOS) database, we identified all adult patients undergoing HT from 2013 to 2023 who received a PPM early (prior to discharge) or late (>6 months post transplant). Propensity score matching (PSM) was used for control cohorts was. Primary outcomes included recipient survival at 30 days and 1 and 5 years. Predictors of early and late PPM, as well as post-PPM mortality, were assessed using Cox and logistic regression models. Kaplan–Meier survival curves were compared using a log-rank test. Results: Following PSM, the early PPM cohort included 354 patients, and the late PPM cohort included 554 patients. Early PPM patients showed similar 30-day and 1- and 5-year survival (p = 0.582, 0.421, and 0.2844 respectively) but lower rates of graft failure (1.1% vs. 4%, p = 0.017) and primary graft dysfunction (PGD) (1.7% vs. 4.2%, p = 0.046). Late PPM patients had reduced survival at 30 days and 1 year but not at 5 years (p < 0.001, p = 0.0023, 0.050 respectively). Neither early nor late PPM was independently associated with increased risk of mortality after HT. Donation after Circulatory Death (DCD) organs were associated with a lower risk of early PPM (aOR = 0.409, p = 0.020). Late PPM patients showed higher rates of PGD (2.5% vs. 0.5%, p = 0.007). Conclusions: Early or late PPM is not an independent risk factor for mortality after HT, but differing short-term morbidity and mortality are observed. Full article
(This article belongs to the Special Issue Clinical Updates in Heart Transplantation)
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23 pages, 4917 KB  
Article
Halotolerant Nitrogen-Fixing Mesorhizobium ciceri Modulates Antioxidant Homeostasis and Growth Performance in Chickpea Cultivars Under Salt Stress
by Imen Hemissi, Hasna Ellouzi, Amira Hachana, Walid Zorrig, Souhir Amraoui, Hanen Arfaoui, Mohsen Hnana and Mohamed Annabi
Nitrogen 2026, 7(3), 67; https://doi.org/10.3390/nitrogen7030067 - 23 Jun 2026
Viewed by 147
Abstract
Soil salinity inhibits biological nitrogen fixation (BNF) in legumes, compromising nitrogen nutrition and crop productivity. This study evaluated whether two halotolerant Mesorhizobium ciceri strains (S1, S2) can sustain BNF and alleviate moderate salt stress (100 mM NaCl) in three Tunisian chickpea (Cicer [...] Read more.
Soil salinity inhibits biological nitrogen fixation (BNF) in legumes, compromising nitrogen nutrition and crop productivity. This study evaluated whether two halotolerant Mesorhizobium ciceri strains (S1, S2) can sustain BNF and alleviate moderate salt stress (100 mM NaCl) in three Tunisian chickpea (Cicer arietinum L.) cultivars (Amdoun, Béja 1, and Nour). Inoculated and non-inoculated plants were grown under controlled conditions. Salinity reduced shoot dry weight by 37.5–42% and severely impaired nodulation (≈60% reduction) in non-inoculated plants. Bacterial inoculation significantly increased germination rate, shoot and root biomass, and nodule number compared to non-inoculated salt-stressed controls. Improved nodulation corresponded to better nitrogen nutrition, reflected by higher leaf chlorophyll content (a proxy for nitrogen status). However, direct measurements of nitrogenase activity (e.g., acetylene reduction assay) are needed to confirm enhanced BNF. Inoculated seedlings also exhibited lower oxidative stress markers (hydrogen peroxide and malondialdehyde) and enhanced antioxidant enzyme activities (superoxide dismutase and glutathione peroxidase), indicating reduced reactive oxygen species damage. Cultivar-specific responses were observed: Amdoun responded best to S1, Béja 1 to S2 for biomass recovery, while Nour showed strong antioxidant induction but limited growth gain. We conclude that halotolerant M. ciceri strains improve chickpea performance under salt stress primarily by sustaining BNF and nodulation, thereby maintaining nitrogen nutrition. Strain–cultivar compatibility is critical for optimizing this bio-inoculant strategy in saline agroecosystems. Our findings identify the combination of cultivar Béja 1 with strain S2 as the most promising for biomass recovery under moderate salinity, providing a practical, strain–cultivar matching framework that can guide the development of effective bio-inoculants for chickpea production in salt-affected areas of Tunisia and similar Mediterranean regions. Full article
(This article belongs to the Special Issue Nitrogen: Advances in Plant Stress Research)
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25 pages, 68864 KB  
Article
A Morpho-Phase Feature-Based Method for Geometric Error Mitigation in InSAR Image Matching
by Yanming Chen, Fan Zhang, Yanfang Liu, Fei Ma and Bingnan Wang
Remote Sens. 2026, 18(13), 2060; https://doi.org/10.3390/rs18132060 - 23 Jun 2026
Viewed by 195
Abstract
Interferometric Synthetic Aperture Radar (InSAR) is a promising payload for Unmanned Aerial Vehicle (UAV) scene matching navigation due to the rich textures in interferogram images compared to SAR intensity images. However, geometric parameter estimation errors during reference interferogram image generation cause significant textural [...] Read more.
Interferometric Synthetic Aperture Radar (InSAR) is a promising payload for Unmanned Aerial Vehicle (UAV) scene matching navigation due to the rich textures in interferogram images compared to SAR intensity images. However, geometric parameter estimation errors during reference interferogram image generation cause significant textural discrepancies with real-time data. Compounded by inherent non-local similarity of InSAR images, these issues render conventional matching algorithms ineffective, degrading navigation accuracy. To address these challenges, this paper proposes a Morpho-Phase feature-based InSAR image matching method to mitigate the impact of parameter errors. Firstly, a Phase-Robust Keypoint (PRK) detection method is proposed, which overcomes the impact of parameter errors on keypoint detection by introducing a compensated phase and extracting phase extrema. Secondly, a Hierarchical Morphological-Phase Descriptor (HMPD) is constructed to resolve the feature ambiguity caused by the non-local similarity of interferograms by combining morphological features with phase statistics. Experimental results based on real-world InSAR data demonstrate that the proposed matching method effectively mitigates the impact of parameter errors on InSAR image matching, enhances navigation positioning accuracy, and provides stable, high-precision positioning capabilities in practical scene matching navigation tasks. Full article
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15 pages, 1311 KB  
Article
Hybrid Metaheuristic Feature Selection for Breast Cancer Detection in Digital Mammography: A Feasibility Study with Nested Validation, Benchmarking, and External Stress Testing
by Bandar S. Alshreef and Yousif A. Kariri
J. Clin. Med. 2026, 15(12), 4846; https://doi.org/10.3390/jcm15124846 - 22 Jun 2026
Viewed by 118
Abstract
Background/Objectives: The “small-n-large-p” dilemma in mammography artificial intelligence (AI)—where the number of candidate imaging features far exceeds the number of labeled cases—commonly results in model overfitting, unstable feature selection, and poor generalization across clinical settings. This study aims to reassess the internal performance [...] Read more.
Background/Objectives: The “small-n-large-p” dilemma in mammography artificial intelligence (AI)—where the number of candidate imaging features far exceeds the number of labeled cases—commonly results in model overfitting, unstable feature selection, and poor generalization across clinical settings. This study aims to reassess the internal performance of the HiTopology-GOA-CSA (Grasshopper Optimization Algorithm–Crow Search Algorithm) feature-selection framework for mammography using a larger real Curated Breast Imaging Subset of Digital Database for Screening Mammography (CBIS-DDSM) cohort and a stricter leakage-aware evaluation strategy. Methods: In this retrospective computational study using public anonymized datasets, an expanded internal cohort of 98 CBIS-DDSM mass cases (49 benign, 49 malignant) was assembled from digital imaging and communications in medicine (DICOM) region of interest (ROI) series. A total of 1074 features were extracted per case, including 88 handcrafted radiomic descriptors and 986 EfficientNet-B5 deep features. HiTopology-GOA-CSA selected 102 features, corresponding to 91% feature reduction. Two internal evaluation modes were compared: Mode A, which matched the original pilot methodology by performing feature selection once on the full cohort before cross-validation, and Mode B, which used strict nested feature selection within training folds. Performance was assessed with 5-fold stratified cross-validation using a multilayer perceptron (MLP) classifier. Results: On the expanded cohort, Mode A achieved an area under the receiver operating characteristic curve (AUC) of 0.726 (95% CI: 0.594–0.858), sensitivity of 0.658, specificity of 0.651, and F1-score of 0.644. Under the stricter nested evaluation, Mode B achieved AUC of 0.683 (95% CI: 0.549–0.817), sensitivity of 0.598, specificity of 0.631, and F1-score of 0.595. Mean pairwise Jaccard similarity across nested folds was 0.604, indicating moderate feature stability. Benchmark comparisons showed that the proposed method was competitive but did not outperform standard baselines; LASSO logistic regression achieved the highest AUC of 0.739, while the proposed HiTopology-GOA-CSA + MLP achieved an AUC of 0.683. Real external validation on the locked VinDr-Mammo subset (n = 25) remained near-random (AUC of 0.500 [95% CI: 0.304–0.696]), with complete prediction collapse (sensitivity of 1.000, specificity of 0.000). Conclusions: The framework demonstrated feasibility for structured feature selection and stress testing in a small-cohort mammography AI setting; however, external validation revealed near-random discrimination and prediction collapse, indicating limited generalizability. These findings emphasize the need for benchmark comparisons, transparent uncertainty reporting, patient-level validation, and larger multicenter datasets before clinical translation. Full article
(This article belongs to the Special Issue Clinical Advances in Cancer Imaging)
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14 pages, 577 KB  
Article
Pattern Separation and Related Cognitive Functions in Combat and Contact Sports Athletes: Working Memory, Attention, and Processing Speed
by Alessandro Santirocchi, Clelia Rossi-Arnaud, Dario Benelli, Christian Barbato, Antonio Minni and Vincenzo Cestari
Appl. Sci. 2026, 16(12), 6245; https://doi.org/10.3390/app16126245 (registering DOI) - 22 Jun 2026
Viewed by 125
Abstract
Repetitive head impacts (RHIs) in combat and contact sports are associated with long-term neuropsychological consequences. The present study explores episodic memory performance, with a focus on pattern separation, a memory process associated with hippocampal function, in athletes characterized by different exposure profiles to [...] Read more.
Repetitive head impacts (RHIs) in combat and contact sports are associated with long-term neuropsychological consequences. The present study explores episodic memory performance, with a focus on pattern separation, a memory process associated with hippocampal function, in athletes characterized by different exposure profiles to RHIs. The study included 26 fighters (boxing, Mixed Martial Arts, Muay Thai), 20 rugby players, and 26 age-matched controls. Participants completed the Mnemonic Similarity Task (MST) and additional cognitive measures (Digit Span, Digit Symbol Substitution Test, Attentional Matrices, and N-back tasks). Group differences were assessed using ANCOVAs. Results indicated that fighters exhibited significantly poorer pattern separation performance compared to both rugby players and controls. Rugby players also performed worse than controls on the pattern separation measure, revealing a graded pattern of performance across groups. Additionally, fighters demonstrated slower reaction times during the MST and lower performance on the N-back tasks relative to both comparison groups. Overall, athletes participating in sports characterized by different exposure profiles to RHIs showed distinct patterns of cognitive performance, with the most pronounced differences observed in fighters. These findings highlight pattern separation as a potentially sensitive cognitive marker in athletes participating in combat and contact sports and underscore the need for longitudinal studies incorporating objective measures of head-impact exposure. Full article
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14 pages, 577 KB  
Article
Tracheostomy and Ventilator-Associated Pneumonia in Mechanically Ventilated ICU Patients: A Retrospective Matched Cohort Study
by Marie Nicoline Ordaz-Kücks, Iván Alejandro Arteaga-Martínez, Hugo Alfredo Funes-González, Fernando Martín Guerra-Infante, Roberto Montes-de-Oca-Jiménez, Martha Elba Ruiz-Riva-Palacio, Javier Morales-Fabian, Enrique Rojano-Lastra, Heberto Hernández-Miranda, José Carlos Aguilar-Carrasco and Gabriel Arteaga-Troncoso
J. Clin. Med. 2026, 15(12), 4811; https://doi.org/10.3390/jcm15124811 - 21 Jun 2026
Viewed by 123
Abstract
Background/Objectives: Ventilator-associated pneumonia (VAP) remains a major complication in patients requiring prolonged mechanical ventilation. The effect of tracheostomy on VAP risk remains controversial, particularly when differences in duration of mechanical ventilation are considered. This study evaluated the association between tracheostomy, VAP occurrence, [...] Read more.
Background/Objectives: Ventilator-associated pneumonia (VAP) remains a major complication in patients requiring prolonged mechanical ventilation. The effect of tracheostomy on VAP risk remains controversial, particularly when differences in duration of mechanical ventilation are considered. This study evaluated the association between tracheostomy, VAP occurrence, and clinical outcomes in mechanically ventilated ICU patients. Methods: We conducted a retrospective matched exposed–unexposed cohort study in a tertiary-care ICU in Mexico City. Patients undergoing tracheostomy were compared with an age- and sex-matched subcohort of intubated patients receiving invasive mechanical ventilation for ≥48 h. VAP incidence was assessed using cumulative incidence, incidence density, and multivariable generalized linear models. Results: A total of 218 patients were included (55 tracheostomized and 163 intubated). VAP incidence density was similar between groups (31.5 vs. 30.3 per 1000 ventilator-days; RR 1.04, 95% CI 0.7–1.7), whereas cumulative incidence was higher among tracheostomized patients (61.8% vs. 22.7%; RR 2.7, 95% CI 1.9–3.9). Broad-spectrum antibiotics, mechanical ventilation ≥ 5 days, chronic pulmonary disease, and ICU stay remained associated with VAP occurrence in an exploratory multivariable model. Gram-negative microorganisms predominated, and antimicrobial resistance was more frequent among tracheostomized patients. Conclusions: Tracheostomy was associated with higher cumulative incidence of VAP, but a similar incidence density compared with endotracheal intubation. The crude association between tracheostomy and VAP disappeared after adjustment for confounding factors, suggesting that prolonged mechanical ventilation and ICU exposure are more important determinants of VAP risk than tracheostomy itself. Full article
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13 pages, 460 KB  
Article
Preoperative Intra-Articular Corticosteroid Injection Is Not Associated with Inferior Reoperation or Patient-Reported Outcomes Following Meniscal Allograft Transplantation
by Rushani K. Cameron, Isabella Jazrawi, Cody Perskin, Vishal Sundaram, Guillem Gonzalez-Lomas, Eric J. Strauss, Laith M. Jazrawi and Kirk A. Campbell
Surgeries 2026, 7(2), 75; https://doi.org/10.3390/surgeries7020075 (registering DOI) - 20 Jun 2026
Viewed by 161
Abstract
Background/Objectives: This investigation was performed because corticosteroid injections are commonly used for symptomatic relief in patients with meniscal deficiency, yet their effect on graft survivorship and postoperative outcomes following meniscal allograft transplantation (MAT) remains poorly understood, with limited literature specifically addressing this [...] Read more.
Background/Objectives: This investigation was performed because corticosteroid injections are commonly used for symptomatic relief in patients with meniscal deficiency, yet their effect on graft survivorship and postoperative outcomes following meniscal allograft transplantation (MAT) remains poorly understood, with limited literature specifically addressing this topic. The aim of this study is to evaluate whether preoperative intra-articular corticosteroid injections (ICS) are associated with reoperation after MAT. Secondary aims included comparing reoperation-free survival, patient-reported outcome measures (PROMs), and patient acceptable symptom state (PASS) achievement. Methods: A retrospective review of 130 adults undergoing meniscal allograft transplantation (MAT) between 2011 and 2023 was performed. Patients with documented corticosteroid injection (CSI) status and ≥2 years of follow-up were included. Exclusion criteria included prior meniscal allograft transplantation, receipt of non-corticosteroid injections (e.g., hyaluronic acid or platelet-rich plasma), concomitant osteotomy procedures, multi-ligament knee reconstruction or inadequate follow-up. Propensity score matching (2:1 no steroid: steroid) based on age, sex, body mass index, fixation technique, operative compartment, and concomitant procedures yielded 54 matched patients (35 no steroid, 19 steroid). The primary outcome was ipsilateral knee reoperation, categorized as major reoperation (revision MAT, anterior cruciate ligament reconstruction, osteochondral allograft transplantation, conversion to total knee arthroplasty, meniscectomy and meniscus repair). Minor reoperations included irrigation and debridement, lysis of adhesions or manipulation under anesthesia, hardware removal, chondroplasty, and synovectomy. Reoperation-free survival was assessed using Kaplan–Meier analysis. PROMs and PASS were compared using adjusted regression models. Statistical significance was set at p < 0.05. Results: Baseline characteristics and follow-up were comparable between groups (7.6 ± 3.5 vs. 6.6 ± 3.2 years; p = 0.30). Overall reoperation occurred in 37.1% of patients in the no-steroid group and 31.6% in the steroid group (p = 0.771). Major reoperation rates were similar (17.1% vs. 15.8%; p = 1.000. There was no significant difference in minor reoperations between groups (20.0% vs. 10.5%; p = 0.468). Kaplan–Meier analysis demonstrated no difference in reoperation-free survival (p = 0.903), with comparable survival at the 1-, 2-, and 5-year time points. No individual subtypes differed significantly between groups. PROMs and PASS achievement were also similar, with no statistically significant differences observed. Conclusions: Preoperative corticosteroid injection was not associated with increased reoperation risk, inferior reoperation-free survival, or worse patient-reported outcomes following meniscal allograft transplantation. However, given the study’s limited power, lack of detailed injection characteristics, and the use of a heterogeneous complication outcome, these findings should be interpreted cautiously, as further investigation is warranted. Full article
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10 pages, 315 KB  
Article
Unhealthy Alcohol Use and Sudden Death Among Working-Age Adults
by Shannon Parness, Jordan Besh, Ryan Sappington, Thibaut Davy-Mendez, Sirui Wu, Andreas Koehler and Ross J. Simpson
Hearts 2026, 7(2), 20; https://doi.org/10.3390/hearts7020020 - 20 Jun 2026
Viewed by 131
Abstract
Background: Unhealthy alcohol use may lead to arrhythmia and cardiomyopathy, but its impact on sudden death is not well understood. Objective: To investigate the association of unhealthy alcohol use with sudden death. Methods: We conducted a case-control study in Wake [...] Read more.
Background: Unhealthy alcohol use may lead to arrhythmia and cardiomyopathy, but its impact on sudden death is not well understood. Objective: To investigate the association of unhealthy alcohol use with sudden death. Methods: We conducted a case-control study in Wake County, a large (~1 million inhabitants), diverse county in North Carolina. We screened and adjudicated victims of sudden, unexpected, out-of-hospital deaths in adults aged 18–64 years reported by emergency medical services between 2013 and 2015. We randomly selected sex- and age-matched control patients from a university health system from the same county and time period. Characteristics of sudden death victims and controls were ascertained via standardized chart reviews. Unhealthy alcohol use was identified via chart review and was defined as any evidence of excessive alcohol use, such as it being stated in the social history or medical history, alcohol abuse being listed as a possible contributor to death, or alcohol-related diagnoses. We used logistic regression to estimate odds ratios (ORs) for the association of unhealthy alcohol use and sudden death, adjusting for age, sex, race, and other psychiatric diagnoses, including depression, anxiety, schizophrenia, bipolar disorder, and substance use disorders other than tobacco and alcohol. We also calculated the E-value to estimate the impact of any unmeasured confounders. Results: We identified 399 sudden death victims, of whom 374 (94%) had alcohol use data available. Among these 374 included victims, 256 (68%) were male, and 239 (62%) were White, with a median age at death of 55 years (IQR 48, 60). The demographic characteristics of the 1114 matched controls were similar to those of sudden death victims. Unhealthy alcohol use was present in 115 (31%) sudden death victims and 27 (2%) controls. In analyses adjusted for demographics only, unhealthy alcohol use was associated with a higher incidence of sudden death, with an OR of 17.5 (95% CI 11.4, 27.8). When further adjusted for other psychiatric diagnoses, the OR was 11.2 (95% CI 7.1, 18.0). The calculated E-value was 21.8, meaning an unmeasured confounder would need to be associated with both unhealthy alcohol use and sudden death by 21.8-fold to explain away the observed OR. Conclusions: Unhealthy alcohol use was strongly associated with higher sudden death risk in working-age adults. Our calculated E-value indicates it is unlikely that any unmeasured confounders alone would account for the observed association. Our findings suggest that interventions to reduce unhealthy alcohol use may be an effective strategy to prevent sudden death in working-age adults. Full article
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25 pages, 2164 KB  
Article
Designing a National Household Travel Survey for Saudi Arabia: A Framework for Understanding Urban Mobility and Infrastructure Development
by Thaar Alqahtani and Fawzan Alfawzan
Vehicles 2026, 8(6), 139; https://doi.org/10.3390/vehicles8060139 - 20 Jun 2026
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Abstract
Saudi Arabia currently lacks a nationally representative, multi-day National Household Travel Survey comparable to the US, UK, or New Zealand programmes; existing official data products focus on aggregate road-transport indicators or general household statistics rather than detailed day-to-day travel diaries. This study develops [...] Read more.
Saudi Arabia currently lacks a nationally representative, multi-day National Household Travel Survey comparable to the US, UK, or New Zealand programmes; existing official data products focus on aggregate road-transport indicators or general household statistics rather than detailed day-to-day travel diaries. This study develops a benchmark-driven framework for NHTS–KSA by comparing Saudi demographic, geographic, infrastructure, climate, and mobility indicators with those of the United States, United Kingdom, and New Zealand, and by systematically assessing 15 survey-design indicators across their national household travel surveys. Context benchmarking identifies the United States as the closest for highway-oriented interurban structure and motorisation level, New Zealand for geography and demographic structure (in particular, near-identical physiological density on limited arable land), and the United Kingdom as the most aspirationally aligned benchmark for the multimodal mobility patterns Saudi Arabia aims to develop under Vision 2030. Design benchmarking shows that the three surveys are closely matched in aggregate similarity but lead on distinct elements: New Zealand on diary length and integrated passive tracking, the US on digital tools and emerging-behaviour modules, and the UK on interviewer-led recruitment and multimodal analysis, a pattern that proves robust to plausible variation in individual scores. The resulting NHTS–KSA blueprint specifies a statistically justified, stratified multistage annual household sample, a two-day diary with rolling 12-month fieldwork, interviewer-assisted recruitment, a digital-first diary with optional GPS tracking, and modules on long-distance travel, telework, e-commerce, gendered mobility, accessibility, safety, and environmental attitudes. While preserving international comparability, the framework provides the data foundation required to steer public-transport investment, demand-management measures, and land-use policies in line with Saudi Arabia’s Vision 2030 objectives for sustainable, inclusive, and smart mobility. Full article
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18 pages, 1102 KB  
Article
Draft Genome and Comparative Analysis of a Cutaneotrichosporon jirovecii-Related Yeast Recovered from a Human Fecal Sample
by Yuyan Huang, Rongchen Dai, Feiyi Liu, Xiaoyan Gou, Renyuan Zhu, Shuying Yu, Zhengyu Luo, Dan Guo, Tianshu Sun, Meng Xiao, Yingchun Xu and Lina Guo
J. Fungi 2026, 12(6), 450; https://doi.org/10.3390/jof12060450 - 20 Jun 2026
Viewed by 265
Abstract
Background: Cutaneotrichosporon jirovecii is an under-characterized basidiomycetous yeast within the family Trichosporonaceae. Its taxonomic placement, ecological distribution, and functional potential remain incompletely understood because genome-scale resources for C. jirovecii and closely related lineages are limited. Methods: We characterized strain H0426_7, a C. jirovecii [...] Read more.
Background: Cutaneotrichosporon jirovecii is an under-characterized basidiomycetous yeast within the family Trichosporonaceae. Its taxonomic placement, ecological distribution, and functional potential remain incompletely understood because genome-scale resources for C. jirovecii and closely related lineages are limited. Methods: We characterized strain H0426_7, a C. jirovecii-related yeast recovered from a human fecal sample, using ITS-based type-strain comparison, ITS phylogenetic analysis, whole-genome sequencing, average nucleotide identity analysis, read-level assessment of public C. jirovecii-labeled datasets, and comparative functional annotation. Antifungal susceptibility was assessed using the Sensititre YeastOne plate. Results: The ITS sequence of H0426_7 closely matched type-strain material of C. jirovecii, including CBS 6864 and its equivalent deposits. The ITS-based tree placed H0426_7 adjacent to CBS 6864 with bootstrap support of 87%. The final draft genome comprised 38.66 Mb in 1974 contigs, with a GC content of 63.76% and BUSCO completeness of 80.0%. ANI analysis showed that H0426_7 was genomically distinct from the recognized Cutaneotrichosporon species included in the ANI analysis but highly similar to two unclassified feces-derived strains, P10-008 and PK4640, with ANI values exceeding 98.8%. Two public datasets labeled as C. jirovecii showed anomalously low ANI values with H0426_7; read-level taxonomic profiling indicated low target-fungal read proportions, suggesting that these datasets are unsuitable as definitive genome-level references. CAZyme annotation identified 285 family assignments in H0426_7, representing 278 non-redundant predicted proteins, including relatively high GH5 and GH31 counts, suggesting candidate carbohydrate-utilization features shared with the H0426_7/P10-008/PK4640 lineage. Conclusions: H0426_7 is best described as a C. jirovecii-related Cutaneotrichosporon isolate pending availability of a high-quality genome assembly from the C. jirovecii type strain. This study expands genome-scale resources for underrepresented basidiomycetous yeasts and provides a comparative framework for future taxonomic, ecological, and functional studies of feces-associated Cutaneotrichosporon lineages. Full article
(This article belongs to the Special Issue Fungal Metabolomics and Genomics, 2nd Edition)
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