Search Results (2,058)

This paper introduces a random activation framework for cure rate modeling that provides a novel latent mechanistic interpretation of the standard mixture cure model, utilizing a Waring-distributed number of latent causes. The proposed approach represents unobserved heterogeneity through a discrete latent variable interpreted as the number of potential risk factors, providing a flexible and biologically interpretable characterization of individual susceptibility. In contrast to classical competing risks models based on extremal operators or deterministic activation schemes, the event time is assumed to arise from a stochastic selection among latent causes. This random activation mechanism defines a unified probabilistic framework in which the cure fraction emerges naturally as the probability of having zero latent causes. The Waring distribution is adopted to model the latent count structure due to its hierarchical formulation, which accommodates overdispersion and heavy-tailed behavior strictly within the latent parametrization of individual risk factors. Under this framework, while the population survival function mathematically reduces to the classical mixture cure representation, the model provides an alternative structure where covariates directly impact the expected latent burden. Parameter estimation for the identifiable regression structure is performed via maximum likelihood, and the finite-sample performance of the estimators is assessed through Monte Carlo simulations, showing accurate parameter recovery and stable inferential properties. An application to real survival data illustrates the practical relevance and epidemiological interpretability of the proposed framework. Overall, this work extends the understanding of existing cure rate models by integrating latent count structures and stochastic activation within a coherent setting, providing a powerful interpretation tool for heterogeneous survival data with long-term survivors. Full article

RelA/SpoT homologue family enzymes participate in controlling the cellular levels of the alarmone (p)ppGpp, thereby activating the stringent response and promoting survival under stress conditions. These proteins contain an N-terminal catalytic domain and a C-terminal regulatory domain. They catalyze both the synthesis of ppGpp/pppGpp from ATP and GDP/GTP and their hydrolysis to GDP/GTP and pyrophosphate. Here, we report the crystal structure of the N-terminal domain of Rel from Streptococcus equisimilis in complex with pppGpp at 3.2 Å resolution. The asymmetric unit contains a dimer with asymmetric ligation: pppGpp occupies only the synthetase site in one monomer, whereas in the other monomer, it is bound in both the hydrolase and synthetase sites. The two monomers exhibit distinct conformational states, with pronounced rearrangements of the flexible loops surrounding the binding pockets, including the α2/α3 and α8/α9 loops that act as steric gates. Molecular dynamics simulations support the dual binding arrangement and reveal additional probable transient binding sites, including a region in the linker between hydrolase and synthetase subdomains. These findings provide a structural framework for understanding how pppGpp binding modulates the opposing catalytic activities of bifunctional Rel enzymes and suggest possible mechanisms for (p)ppGpp-mediated autoregulation. Full article

Background: While trefoil factor 3 (TFF3) has been linked to cardiovascular disease, its role in peripheral artery disease (PAD) remains largely unexplored. In this prospective study, we assessed three pre-selected circulating biomarkers and found that TFF3 demonstrated the strongest association with the presence of PAD. Building on this finding, we integrated plasma TFF3 concentrations with clinical characteristics to construct predictive models aimed at identifying individuals with PAD and estimating their risk of major adverse limb events (MALE) over a two-year follow-up period. Methods: A total of 476 individuals were prospectively recruited, including 312 patients with PAD and 164 controls without PAD. At study entry, circulating concentrations of TFF3, oncostatin M (OSM), and brain-derived neurotrophic factor (BDNF) were quantified, and all participants were subsequently monitored for a two-year period. The primary endpoint was the occurrence of MALE within two years, comprising acute limb ischemia, major amputation, or lower extremity revascularization by either open surgical or endovascular approaches. PAD diagnosis served as the secondary outcome and was established by an ankle–brachial index (ABI) ≤ 0.9 or toe–brachial index (TBI) ≤ 0.67 in the presence of reduced or absent pedal pulses. For predictive model development, the cohort was randomly divided into training (70%) and testing (30%) sets. A random forest algorithm incorporating clinical variables and plasma TFF3 levels was developed and optimized using 10-fold cross-validation. Model discrimination was quantified using the area under the receiver operating characteristic curve (AUROC). For prognostic evaluation, patients were classified into low- and high-risk groups based on the optimal ROC-derived probability threshold of 0.60, and MALE-free survival between groups was assessed using Cox proportional hazards regression. Results: Among the three candidate biomarkers evaluated, only TFF3 demonstrated a significant association with PAD. Patients with PAD exhibited higher circulating TFF3 concentrations than those without PAD (7.27 ± 3.36 vs. 5.89 ± 2.67 pg/mL; p < 0.001), whereas OSM and BDNF showed no significant differences between groups. Over the two-year follow-up period, MALE occurred in 28 patients (9%). Predictive models combining plasma TFF3 measurements with clinical variables achieved strong performance for both PAD detection and 2-year MALE risk estimation, yielding AUROCs of 0.79 and 0.85, respectively. Furthermore, patients classified as high risk by the model experienced a significantly increased hazard of MALE during follow-up (HR 1.12, 95% CI 1.10–1.19; p = 0.003). Variable importance analysis revealed that TFF3 was the most influential predictor of MALE, followed by age and smoking history. Conclusions: Combining plasma TFF3 levels with readily available clinical characteristics enabled the development of a predictive model with good discriminatory ability for both PAD diagnosis and estimation of 2-year MALE risk. Such an approach may enhance risk stratification by identifying patients at elevated risk earlier in their disease course, thereby informing decisions related to vascular testing, referral for specialist evaluation, and implementation of targeted treatment strategies. Full article

Advances in screening, surgical techniques, perioperative care, and multimodality treatment have progressively expanded the population of long-term survivors with early-stage non-small cell lung cancer (NSCLC). However, disease-free survival does not necessarily correspond to complete functional recovery after curative-intent treatment. Many patients continue to experience persistent fatigue, dyspnea, reduced physical activity, impaired exercise tolerance, muscle loss, and deterioration in health-related quality of life despite adequate oncologic control. This narrative review discusses functional recovery as a survivorship endpoint in early-stage NSCLC, focusing on recovery trajectories, physiologic vulnerability, frailty, sarcopenia, rehabilitation, symptom burden, and emerging biologic frameworks such as allostatic load. Increasing evidence suggests that survivorship after NSCLC should not be interpreted exclusively according to recurrence or survival metrics, but also according to the ability to recover physiologic reserve, autonomy, and daily functioning after treatment. Functional recovery appears heterogeneous and influenced by multiple interacting factors, including baseline reserve, systemic inflammation, physical inactivity, behavioral adaptation, and cumulative stress burden. Rehabilitation strategies, structured symptom surveillance, and patient-reported outcomes may help identify vulnerable patients and improve long-term survivorship trajectories. Future survivorship models should probably integrate oncologic outcomes with longitudinal functional assessment to better characterize recovery patterns after treatment. Full article

Introduction: Glioblastoma is the most aggressive primary brain tumor in adults, with limited survival despite multimodal therapy. Tumor-treating fields (TTFs) combined with temozolomide (TMZ) have emerged as a therapeutic option for newly diagnosed glioblastoma (nGBM), yet the magnitude, robustness, and generalizability of its benefit remain uncertain. This Bayesian meta-analysis aimed to determine whether the addition of TTFs to TMZ improves survival outcomes and safety profiles in patients with nGBM. Methods: We systematically searched PubMed, Scopus, and the Cochrane Library from inception to 5 April 2026, for studies comparing TTFs + TMZ with TMZ alone in nGBM (PROSPERO “CRD420261374813”). Outcomes included overall survival (OS; hazard ratio [HR]), progression-free survival (PFS; HR), and dermatologic adverse effects (proportions). A Bayesian random-effects model with vague priors for overall effects and informative/weakly informative priors for between-study heterogeneity was applied. Sensitivity analyses with alternative prior specifications were performed, and posterior probabilities (PPs), 95% credible intervals (CrIs), and posterior predictive probabilities (PPPs) were estimated. Results: Twelve studies (one randomized controlled trial and 11 observational studies) comprising 2797 patients were included (TTFs + TMZ: 1228; TMZ: 1569). TTFs + TMZ was associated with improved OS (HR 0.68; 95% CrI 0.57–0.80; 99% PP HR < 1) with a 96% PPP that future studies would also favor TTFs + TMZ. PFS was likewise improved (HR 0.67; 95% CrI 0.58–0.77; 99% PP HR < 1), with a 98% PPP favoring TTFs + TMZ in future studies. Subgroup analyses suggested that risk of bias contributed more to heterogeneity than study design. Among patients receiving TTFs + TMZ, the estimated proportion of dermatologic adverse effects was 57.8% (95% CrI 0.36–0.79), with high PPs of exceeding clinically meaningful thresholds. Conclusions: In this Bayesian meta-analysis, TTFs combined with TMZ was associated with improved OS and PFS in nGBM, although dermatologic toxicity was frequent. These findings support TTFs + TMZ as an effective adjunctive strategy, while emphasizing the importance of patient selection, adherence, and toxicity management. Full article

Background/Objectives: To evaluate the clinical outcomes and prognostic factors of Baerveldt glaucoma implant (BGI) surgery performed as a primary filtering procedure in eyes without prior glaucoma filtering surgery. Methods: This retrospective cohort study included 148 eyes of 148 patients who underwent BGI surgery with a 350-mm² endplate at a single tertiary center. Surgical success was defined using three intraocular pressure (IOP)-based criteria: IOP > 21 mmHg (criterion A), >17 mmHg (criterion B), or >14 mmHg (criterion C), failure to achieve ≥ 20% IOP reduction, need for additional glaucoma surgery, loss of light perception, or persistent hypotony. Kaplan–Meier survival analysis and multivariable Cox proportional hazards regression were used to evaluate surgical outcomes and prognostic factors. Results: The 5-year cumulative probability of surgical success was 70.6%, 49.8%, and 27.6% for criteria A, B, and C, respectively. Mean IOP decreased significantly from 33.5 ± 10.0 mmHg preoperatively to 13.9 ± 4.0 mmHg at 5 years (p < 0.01); number of glaucoma medications decreased from 4.0 ± 1.2 to 1.8 ± 1.9 (p < 0.01). Younger age was associated with a higher risk of surgical failure (criterion A: hazard ratio [HR] 0.97, p < 0.01; criterion B: HR 0.98, p = 0.011; criterion C: HR 0.97, p < 0.01). More previous intraocular surgeries were associated with failure under criterion B (HR 1.30, p = 0.048). Early and late postoperative complications occurred in 34.5% and 14.2% of eyes, respectively; 20.9% required additional postoperative interventions. Conclusions: BGI surgery performed as a primary filtering procedure demonstrated favorable long-term IOP control in eyes without prior glaucoma filtering surgery. Younger age was identified as a consistent risk factor for surgical failure. Full article

We develop a comparative synthesis of quantum-information geometry beyond complex numbers, with emphasis on what different algebraic frameworks contribute to information-processing structure rather than on their formal novelty alone. The organizing idea is a layer-by-layer test of the standard complex Hilbert-space formalism: each non-complex or deformed framework modifies the scalar field, phase group, projective state space, Born-probability semantics, composition rule, measurement geometry, symmetry algebra or representation category. The central thesis is that such frameworks are physically meaningful when they identify which assumptions make complex quantum mechanics operationally stable: positive probabilities, associative multipartite composition, reversible dynamics, experimentally testable phases, locality constraints, informationally complete measurements, error bases and clear operational semantics. Real quantum theory probes the necessity of complex phases and local tomography; quaternionic quantum mechanics probes non-Abelian phase while retaining associativity and admitting complex embeddings; octonionic proposals probe the boundary where exceptional geometry survives but generic circuit composition is obstructed by non-associativity; Jordan algebras test ordered probabilistic state spaces; Clifford algebras and Bott periodicity provide the spinorial and topological grammar connecting gates, Hopf maps and periodic dimensions; and quantum-group or q-deformed constructions probe coproducts, braiding and representation categories rather than scalar amplitudes. We distinguish three roles that are often conflated: genuine hypercomplex kinematics, Hopf-fibration coordinates for ordinary complex multipartite entanglement, and deformed algebraic or categorical structures. The resulting map separates established equivalence and experimental-constraint results from useful representation tools and speculative programs, while identifying concrete open problems for non-complex quantum information. Full article

Background and Objectives: Professional ballet dancers endure high occlusal loads, increasing cervical defect prevalence. Conventional composites fail frequently under such conditions. This randomized clinical trial (RCT) compared 24-month performance of a polymer-infiltrated ceramic network (PICN, VITA Enamic) versus a self-curing bioactive composite (Stela) for cervical restorations. Materials and Methods: Twenty professional ballet dancers (40 cervical defects: 21 carious, 19 abfraction) were enrolled in a paired split-mouth RCT. Each received one PICN inlay and one self-curing composite restoration on two non-adjacent defects. Restorations were assessed at 6, 12, and 24 months using United States Public Health Service (USPHS) criteria (primary: marginal integrity) and a dye penetration test. Secondary outcomes included secondary caries, hypersensitivity, and Oral Health Impact Profile-14 (OHIP-14). Statistical tests: McNemar, Fisher’s exact, Kaplan–Meier, log-rank (α = 0.05). Results: At 24 months, marginal integrity (USPHS Alpha) was maintained in 91% of PICN restorations for carious defects and 89% for abfraction defects, compared to 70% and 50% for self-curing composite, respectively. No PICN restoration failed (0%). Self-curing composite failures were 20% (carious) and 30% (abfraction) (exploratory uncorrected p = 0.031; non-significant after correction). Dye penetration was lower for PICN in abfraction defects (11% vs. 60%, adjusted p = 0.048) but not in carious defects (9% vs. 30%, adjusted p = 0.317). Kaplan–Meier survival favoured PICN (log-rank p = 0.001); 24-month survival probability: PICN 100% (95% CI: 83–100%), self-curing composite 75% (95% CI: 55–95%). No secondary caries or serious adverse events occurred. Conclusions: PICN hybrid ceramic provided superior marginal integrity and zero failures over 24 months in cervical restorations of professional ballet dancers, outperforming the self curing composite. Within this high-risk population, PICN inlays are recommended for abfraction defects. However, because the study was conducted exclusively in professional ballet dancers, direct extrapolation to the general population should be made with caution. The self-curing composite may be considered for carious defects when light curing is problematic, but patients should be informed of higher failure risk. Longer studies are needed. Full article

This study analyses the pharmacological profiles of medications administered to critically ill COVID-19 patients to evaluate their efficacy regarding recovery rates and duration of hospitalization. The results demonstrate a significant difference in clinical outcomes. While the administration of Ceftazidime, Ceftriaxone, and Oseltamivir was associated with negative survival trends, Dexamethasone and Favipiravir were associated with a fourfold higher probability of survival in severe cases. Notably, no pharmacological intervention significantly reduced the length of hospital stay; instead, recovery duration was primarily influenced by comorbidities such as obesity, cardiovascular disease, and diabetes. Furthermore, age and preexisting physiological conditions remained primary predictors of mortality. Observational analysis in our study for drug repurposing identified Amikacin, Remdesivir, and Rivaroxaban as potential therapeutic candidates. However, Dexamethasone was identified as the most effective treatment for recovery, likely due to a molecular structure with high potential binding affinity to the SARS-CoV-2 virus. These findings suggest that while specific repurposed drugs offer measurable benefits, patient history remains a critical determinant of outcomes, highlighting the necessity for further research to refine therapies against emerging viral pathogens. Full article

Background: Infection with HIV increases the risk of developing hepatocellular carcinoma, and the albumin–bilirubin grade assesses liver function and has been shown to be prognostic. We evaluated the albumin–bilirubin score/grade and the HIV status of hepatocellular carcinoma patients in Zimbabwe and explored the impact on median survival. Methods: A 10-year retrospective observational study of hepatocellular carcinoma patients was conducted at a single tertiary-level cancer center in Harare, Zimbabwe. Survival probabilities were estimated using the Kaplan–Meier method, and differences between groups were compared using the log-rank test and Cox proportional hazards regression. Results: A total of 95 participants were evaluated, of whom 72.6% were male. Most HCC cases were diagnosed using imaging and serum alpha-fetoprotein, with 59% presenting at Barcelona Clinic Liver Cancer stage C or D. Compared with patients who were HIV-negative, patients who were HIV-positive (OR 2.2; 95% CI 1.54–5.26, p = 0.0008) or had an unknown HIV status (OR 4.2; 95% CI 2.2–8; p < 0.0001) had higher odds of being at ALBI grade 3 at the time of HCC diagnosis. ALBI grade 1 patients had better median survival compared to grade 2 and 3 patients, though this result was statistically insignificant (grade 2: HR = 1.45, 95% CI: 0.30–7.13; grade 3: HR = 1.47, 95% CI: 0.28–7.60). Regarding HIV status, median survival was 2.4 months for HIV-positive patients and 2.6 months for HIV-negative patients (p = 0.51); HIV positivity was not significantly associated with median survival (HR = 1.50, 95% CI: 0.46–4.91). Only 30.5% of patients received cancer therapy, all of which was palliative, with no observed survival benefit. Conclusions: The majority of hepatocellular carcinoma patients in Zimbabwe were diagnosed at an advanced stage, with hepatitis B or C viral infections and alcohol consumption identified as primary risk factors. Median survival rates were low. Neither HIV infection nor ALBI score grading had a significant impact on median survival. Full article

Background: Percutaneous coronary intervention (PCI) during extracorporeal cardiopulmonary resuscitation (ECPR) before sustained return of spontaneous circulation (ROSC) is increasingly performed, yet most published reports fail to document ROSC status at the time of intervention—leaving this specific clinical phenotype poorly characterized. We aimed to clarify this ambiguity by systematically separating studies with explicit no-ROSC documentation from those in which the phenotype is only inferred and to describe selection, feasibility, and outcomes for the resulting cohorts. Methods: PubMed, Embase, and Cochrane CENTRAL were searched on 30 January 2026. Studies were pre-classified as DEFINITE (explicit no-sustained-ROSC documentation at PCI) or PROBABLE (workflow strongly implying no sustained ROSC). The 13 DEFINITE studies served as the primary analysis population; the 14 PROBABLE studies provided supportive evidence. Risk of bias was assessed using ROBINS-I (DEFINITE, primary) and JBI checklists (all studies). Sensitivity analyses excluded overlapping registries (ELSO, SAVE-J). Data were synthesized descriptively along three axes—selection, feasibility, and outcomes—without meta-analysis. Registered in PROSPERO (CRD420251252255); PRISMA 2020 compliant. Results: Twenty-seven studies encompassing 12,882 patients were included. In the DEFINITE primary cohort (13 studies, N = 3320), median survival to discharge was 30.3% (IQR 26.5–40.8; range 21.0–69.0; and n = 11) and favourable neurological outcome (CPC 1–2) 33.5% (IQR 16.8–45.8; range 10.4–92.0; and n = 12). Exclude-overlap sensitivity analysis (19 studies, N = 2741) yielded concordant estimates (survival 31.1%, IQR 27.2–37.0). PCI rates spanned 24–100% and post-procedural TIMI 3 flow 62.4–84.0%. ROBINS-I rated 9/13 DEFINITE studies at serious overall risk of bias and 4/13 at moderate (none low), predominantly from confounding by indication and selection bias—substantially more stringent than the JBI appraisal. Conclusions: PCI without sustained ROSC under ECPR is technically feasible, but the practice is widespread while remaining insufficiently standardized in ROSC reporting. Descriptive benchmarks from DEFINITE studies provide realistic outcome ranges for shared decision-making; no inference regarding comparative effectiveness is possible from observational data. Standardized documentation of ROSC status at PCI initiation is an immediate priority for future ECPR research. Full article

Given the current global agricultural system, honey bees are exposed to a complex network of stressors that can act simultaneously, making it challenging to maintain healthy colonies. Therefore, studies on natural products to improve colony health have increased in recent years. Among them, fungal extracts have been shown to be beneficial to honey bees. However, there remains a knowledge gap regarding lifespan and histomorphological studies in bees fed fungal extracts. Our current study aimed to assess the impacts of extracts from Ganoderma lucidum (GL), Hericium erinaceus (HE), Inonotus obliquus (IO), and Trametes versicolor (TV) on the lifespan and midgut of honey bees. Newly emerged Carniolan honey bees (Apis mellifera carnica) were fed 4% of each fungal extract until the death of the last individual to assess survival probability. For histomorphological analyses, bees were fed for 7, 14, and 21 days and sampled at these same time points. Then, the midguts were dissected and histologically processed for qualitative and semi-quantitative microscopic analyses. The results showed that the fungal extracts did not significantly affect honey bee survival, and that the histomorphology of the intestinal villi, digestive cells, and regenerative cells in bees treated with fungal extracts did not differ from that of untreated bees throughout the analyzed period. Similarly, no differences were observed in the midgut lesion index between bees treated with fungal extracts and the untreated group. Overall, the absence of harmful effects on lifespan and midgut suggests that feeding fungal extracts may be a potential alternative for supporting bee health. Full article

This study presents a new version of the ZLindly (ZL) model that improves modeling flexibility while maintaining ease of analysis, allowing for the simultaneous accommodation of redundant zeros, thick-tailed behavior, and complex failure rate dynamics within a unified probabilistic framework. Marshall–Olkin (MO) theory facilitates this advancement. The MOZL hazard rate can exhibit several patterns, including increasing, decreasing, bathtub, or upside-down bathtub-shaped. These features enable the model to capture diverse reliability phenomena such as early-life failures, random shocks, and wear-out effects. Comprehensive theoretical investigations were conducted and shown to be governed by an interpretable dual-parameter mechanism, where the Marshall–Olkin parameter controls tail behavior and dispersion, while the scale parameter regulates skewness and hazard evolution. A likelihood-based approach was developed under Type-II censoring conditions, and rigorous evidence is provided for the existence and uniqueness. To address inferential uncertainty, both classical asymptotic confidence intervals and log-normal approximations were constructed. Within a Bayesian framework, independent gamma priors were assumed, and posterior inference was performed via an efficient Metropolis–Hastings algorithm. Bayesian point and credible estimators were obtained and compared with their classical counterparts. An extensive simulation study demonstrates that Bayesian estimators, particularly with informative priors, consistently outperform likelihood-based estimators in terms of bias, mean squared error, interval length, and coverage probability, especially for moderate sample sizes and higher censoring levels. Three engineering applications are provided to assess the practical utility of the MOZL model, where it provides superior goodness-of-fit relative to 15 competing models, including MO–Exponential, MO–Gompertz, MO–Nadarajah–Haghighi, MO–Exponentiated Weibull, and Birnbaum–Saunders, among others. Overall, the proposed MOZL distribution emerges as a flexible, interpretable, and computationally efficient lifetime model whose structurally meaningful parameter interactions enhance distributional balance and flexible hazard behavior, thereby contributing to modern symmetry-oriented distribution theory while offering valuable applications in reliability engineering, survival analysis, and applied statistical modeling. Full article

Background/Objectives: Existing Alzheimer’s disease (AD) prediction studies often treat APOE ε4 as a binary carrier variable and emphasize classification rather than time-to-event progression. This study evaluated whether APOE ε4 allele dose predicts clinical conversion from mild cognitive impairment (MCI) to AD dementia/probable AD in a longitudinal survival framework adjusted for hippocampal volume and baseline cognition. Methods: We analyzed 1115 Alzheimer’s Disease Neuroimaging Initiative (ADNI) participants with baseline MCI, APOE genotype data, and at least one follow-up visit, grouped by APOE ε4 allele count (0, 1, or 2). Kaplan–Meier curves, Bonferroni-corrected log-rank tests, nested Cox models, interaction testing, and twelve sensitivity and robustness analyses were performed. Results: During 3.73 ± 3.38 years of mean follow-up, 399 participants (35.8%) clinically converted. Median conversion-free survival was 18.47 years for non-carriers, 4.32 years for heterozygotes, and 3.41 years for homozygotes, although the non-carrier median occurred late in follow-up. In the fully adjusted Cox model, APOE ε4 dose remained associated with conversion hazard (HR = 1.580, 95% CI 1.362–1.834, p < 0.0001). Intracranial Volume (ICV)-adjusted hippocampal volume was protective (HR = 0.620, 95% CI 0.566–0.680, p < 0.0001), and the model achieved a Concordance Index (C-index) of 0.805. The APOE ε4 × hippocampal volume interaction was not significant (likelihood ratio test p = 0.098). Sensitivity analyses supported robustness, although the APOE ε4 association was attenuated in the exploratory amyloid-positive CSF subgroup. Conclusions: These findings support APOE ε4 allele dose as a statistical marker of clinical progression risk in ADNI, not as evidence of biomarker-confirmed AD progression or distinct mechanisms. Full article

Background/Objectives: Type 2 respiratory failure (T2RF) is associated with significant morbidity and mortality, partly driven by cardiopulmonary interactions and right ventricular (RV) dysfunction. The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio has emerged as a non-invasive marker of RV–pulmonary arterial (RV–PA) coupling; however, its prognostic value in T2RF remains insufficiently explored. This study aimed to evaluate the association between TAPSE/sPAP and short-term clinical outcomes in hospitalized T2RF patients. Methods: In this retrospective cohort study, 182 adult patients hospitalized with T2RF between January 2024 and December 2025 were included. Patients were followed from hospital admission until discharge or death, and survival status was additionally evaluated up to 60 days after admission using hospital electronic medical records and follow-up databases for Kaplan–Meier survival analysis. Complete follow-up data were available for all included patients. Demographic, clinical, laboratory, and transthoracic echocardiographic data were analyzed. Patients were stratified into low and high TAPSE/sPAP groups. The primary outcome was in-hospital mortality; secondary outcomes included 60-day all-cause mortality, non-invasive ventilation (NIV) failure, intensive care unit (ICU) admission, and length of hospital stay. Statistical analyses included receiver operating characteristic (ROC) curves, multivariable logistic regression, calibration assessment, and decision curve analysis. Results: Patients with a low TAPSE/sPAP ratio had significantly higher in-hospital mortality (38.6% vs. 12.8%, p < 0.001), higher rates of NIV failure and ICU admission, and longer hospital stays. TAPSE/sPAP demonstrated the highest predictive performance for mortality (AUC: 0.82, 95% CI: 0.75–0.88), outperforming conventional echocardiographic parameters. In multivariable analysis, TAPSE/sPAP remained an independent predictor of mortality (OR: 1.48 per 0.1 decrease, p < 0.001). The model showed good calibration (Hosmer–Lemeshow p = 0.62), and decision curve analysis confirmed its clinical utility with a higher net benefit across a wide range of threshold probabilities. Conclusions: The TAPSE/sPAP ratio was independently associated with in-hospital mortality and adverse clinical outcomes in patients with T2RF, reflecting impaired RV–PA coupling. As a readily obtainable non-invasive echocardiographic parameter, it demonstrated promising prognostic value for risk stratification in this population. However, given the retrospective single-center design of the study, these findings should be considered hypothesis-generating and require confirmation in prospective multicenter studies before routine clinical implementation can be recommended. Full article