Search Results (4,773)

Over the past decade, Building Information Modelling (BIM) has become increasingly adopted across the Architecture, Engineering, Construction, and Operation (AECO) industry. As its use in practice has expanded, BIM has also received growing scholarly attention. Existing research has largely concentrated on specific applications of BIM, such as construction management, sustainable building design, infrastructure development, and facility management. However, comparatively limited attention has been given to examining BIM implementation from a global perspective. This study addresses this gap by applying a scientometric approach to analyse global BIM implementation research published between 2004 and 2023. The analysis is conducted using co-authorship, co-word, and co-citation analysis to map the structure and development of the research field. A total of 1349 published articles were obtained from the Scopus database for the analysis. The study identifies the most productive and influential contributors to BIM implementation research, including leading researchers, research institutions, countries, subject areas, and academic journals. In addition, the analysis highlights several key thematic domains within global BIM research. These include topics related to Industry Foundation Classes (IFC), Internet of Things (IoT), Geographic Information Systems (GIS), Historic Building Information Modelling (HBIM), and Digital Twin technologies, which appear as prominent keywords within the BIM implementation literature. Beyond mapping these trends, this paper integrates dispersed scientometric evidence into a coherent global perspective, revealing how BIM implementation research has evolved, matured, and diversified across regions and disciplines. It also establishes a structured knowledge base that can serve as a benchmark for future comparative studies, performance assessments, and policy development initiatives in the digital construction domain. These findings provide valuable insights for researchers, practitioners, and policymakers by illustrating landscape of BIM-related research and highlighting potential directions for future investigation. Full article

Introduction: Negative legal emotion refers to the affective component of negative orientations toward legal norms, institutions, and procedures. It is closely related to, but not synonymous with, the broader construct of legal cynicism, which more often emphasizes generalized skepticism toward the fairness, legitimacy, and effectiveness of the law. This study examined the association between negative legal emotion and prosocial behavior among university students, with peer attachment as a mediator and social exclusion as a moderator. Method: A total of 404 undergraduates from mainland Chinese universities were included in the final analysis after predefined data screening, including attention-check items and response-time cutoffs. Participants completed an online survey assessing negative legal emotion, prosocial behavior, peer attachment, and social exclusion. Descriptive statistics, correlation analyses, and Hayes’s PROCESS macro (Model 7) were used to test the moderated mediation model, controlling for gender, grade, and parental educational attainment. Results: Negative legal emotion was negatively associated with prosocial behavior. Peer attachment statistically accounted for this association, such that higher negative legal emotion was associated with lower peer attachment, which was in turn associated with lower prosocial behavior. Social exclusion moderated the first stage of the indirect pathway: the negative association between negative legal emotion and peer attachment was weaker at higher levels of social exclusion. Accordingly, the indirect association between negative legal emotion and prosocial behavior via peer attachment also varied across levels of social exclusion. Conclusions: The findings suggest that peer attachment is an important relational correlate linking negative legal emotion with prosocial behavior and that social exclusion is associated with variation in the strength of this indirect pathway. These results extend research on legal socialization and contribute to understanding prosocial behavior among university students. Full article

Large language model (LLM) chatbots, as a widely used form of generative artificial intelligence, have reduced the marginal cost of producing publication-style manuscripts and have expanded feasible routes for manipulating citation metrics within the publishing ecosystem. Citation-based indicators (e.g., the h-index, the i10-index, and total citation counts) remain embedded in research evaluation and are sensitive to indexing practices of bibliographic databases, with Google Scholar providing broad coverage combined with comparatively limited curation. In this study, a systematic literature review is conducted to synthesize reported mechanisms of citation-metric manipulation and to examine limitations of citation-metric use, including evidence reported in civil engineering. A Google Scholar proof-of-concept case study examines whether the indexing of LLM-assisted, non-peer-reviewed documents with concentrated references to a target author is associated with changes in author-level citation metrics under platform-specific conditions. After indexing, a stepwise increase in author-level metrics is observed, demonstrating the feasibility of citation-metric manipulation under the platform-specific conditions. Finally, this paper discusses the implications for research integrity and citation manipulation in the era of generative artificial intelligence. It also presents recommendations for researchers, academic institutions and evaluation committees, publishers and editors, bibliographic database providers, and funding institutions and policymakers. Full article

(1) Background: University food service establishments are complex environments, where high turnover and handling practices create conditions for microbial persistence. Food-contact surfaces (FCSs) and handlers’ hands (FHs) function as dynamic reservoirs, facilitating the circulation of contaminants within these institutional settings. This study aimed to characterise the microbiological contamination of FCSs and FHs in university food service establishments in Northern Portugal and to evaluate their role as interconnected environmental reservoirs within the indoor built environment. (2) Methods: A total of 590 samples were analysed from two universities in Northern Portugal (L1, L2), comprising 380 FCS and 210 FH samples. Aerobic colony counts (ACCs), Enterobacteriaceae, and Moulds and yeasts (MYs) were analysed according to ISO methods. FH samples were additionally screened for Escherichia coli and Staphylococcus spp. (3) Results: Overall, 35.5% of FCSs were classified as non-compliant, according to microbial criteria based on guideline values from the National Health Institute Dr. Ricardo-Jorge (INSA), with non-compliance primarily driven by elevated ACCs and MYs. Based on a Generalised Linear Model (GLM), establishment types (canteens vs. cafes) were associated with Enterobacteriaceae levels (p = 0.016), whereas ACCs and MYs were not significantly associated with district, establishment type, or functional surface category (p > 0.05). Differences between left and right hands showed small effect sizes, and location was a highly significant determinant of hand hygiene acceptability. (4) Conclusions: FCSs and FHs act as relevant contamination reservoirs in these settings. The results indicate that Enterobacteriaceae levels on FCSs differed between establishment types, while ACCs and MYs showed no significant variation across the evaluated environmental factors. Marked differences in hand hygiene acceptability between campuses support the implementation of targeted interventions, including the optimisation of cleaning and disinfection protocols, the structured training of food handlers, and the routine microbiological monitoring of surfaces and hands to improve institutional food safety. Full article

This study develops a new concept of computer-assisted exercises (CAX) on constructive simulation systems and how the proposed concept affects the strategy and teaching methods. The current state of affairs in the field of defense and security, both in Europe and in the world, requires the acquisition of competencies (European Qualifications Framework—EQF: knowledge, skills, independence, and responsibility), i.e., the education and training of a significantly larger number of personnel in the field of defense and security than has been the case in the last 70 years. In addition, an important specificity of today is that students need to acquire some competencies that were almost unknown until recently. Most of these competencies are the result of the rapid development of technology, which has significantly changed human life in all areas. In order to respond to the modern requirements of conducting operations, where the transfer of information both horizontally and vertically is exponentially accelerated, current concepts of preparation and implementation of education and training, of which exercises are often the most important part, need to be replaced with new concepts, and one such concept is developed in this paper. New information introduced is mostly related to the new weapons that are being introduced (unmanned systems, hypersonic missiles, weapons based on microwaves and lasers, etc.), which all result in necessary changes to the traditional approach to conducting war, i.e., tactics, techniques, and procedures (TTP). This novel exercise concept allows for the simultaneous implementation of training for up to three or four hierarchical levels (e.g., TF Div, brigade, battalion, and company) in one exercise, while in most countries, including the NATO alliance, it is still common for such exercises to be conducted according to a concept that is over 20 years old and, as a rule, is focused on the implementation of exercises for one or two hierarchical levels. This approach allows key personnel from the headquarters of units from four hierarchical levels to be simulated in real time, which is not provided by current concepts for preparing and conducting exercises. The new concept was applied as a multi-level, computer-assisted exercise (CAX) on constructive simulation systems. In addition, significant advantages of the new concept relate to the flexibility and adaptability of the proposed concept to be applied in addition to operational units and in training institutions such as academies and higher education institutions. In addition to the above, the new concept requires a shorter planning period as well as fewer total resources needed for the preparation and implementation of the exercise. The management, organizational, and technological components of the proposed exercise concept are implemented in the CAX model. The hypotheses in this paper will be tested in an applied study, which was evaluated through an external evaluation body. The implemented CAX model was tested in Croatia on the example of using exercises at the Croatian Defense Academy. Full article

Understanding why national decarbonization pathways diverge is essential for designing effective climate and energy policy. Using harmonized data for 1970–2022 from Our World in Data and the Maddison Project Database, this study examines long-run emission trends and electricity-mix transitions in four countries representing distinct energy regimes: Japan, Australia, India, and South Africa. We combine per-capita and total CO₂ trajectories with a Kaya–LMDI decomposition aligned with updated methodological guidelines. Results reveal persistent and deepening transition divergence. Japan experienced partial decoupling before a nuclear vulnerability shock in 2011 reversed progress and temporarily increased fossil dependence. Australia shows a recent erosion of long-standing coal lock-in, driven by policy reform and falling renewable costs. India and South Africa remain highly coal-dependent, with population and income growth overwhelming improvements in energy intensity. Across countries, efficiency gains contributed to emission mitigation, but only structural changes in fuel mix produced sustained reductions in carbon intensity. Taken together, these findings suggest that divergent institutional and infrastructural lock-in conditions—rather than income levels alone—shape the pace, direction, and resilience of decarbonization. The study also speaks to recent international policy debates emphasized by the IPCC and the IEA, as well as to justice-oriented discussions in the energy transition literature. The results highlight major implications for climate policy, energy-system resilience, and just transition strategies. Full article

Background/Objectives: Total neoadjuvant therapy (TNT), integrating systemic chemotherapy and radiotherapy before surgery or surveillance, has become a standard approach for locally advanced rectal cancer (LARC). However, optimal sequencing strategies and long-term outcomes of watch-and-wait (W&W) following sandwich TNT remain insufficiently characterized. We evaluated oncologic outcomes and treatment response in patients treated with an institutional sandwich TNT protocol. Methods: We conducted a retrospective cohort study of consecutive patients with LARC treated with sandwich TNT (induction chemotherapy followed by hypofractionated intensity-modulated radiotherapy with simultaneous integrated boost [IMRT-SIB] chemoradiotherapy and consolidation chemotherapy) at the Institute of Oncology Ljubljana between 2016 and 2023. The primary endpoint was an overall complete response (CR; pathological [pCR] and clinical [cCR]). Secondary endpoints included tumor regression grade (TRG), major pathological response (MPR), R0 resection rate, organ preservation, overall survival (OS), and disease-free survival (DFS). Results: Among 205 patients (median age 61 years), overall CR was 29.5% (pCR 19.3% and cCR 10.2%). Major pathological response (TRG 3–4) occurred in 37.6%. R0 resection was achieved in 94.5%. In the W&W cohort (n = 21), local regrowth occurred in 33.3% (95% CI, 14.6–57.0%) over a median follow-up of 4.96 years. Total mesorectal excision (TME)-free survival at 5 years was 73.1% (95% CI, 55.0–97.2%). Estimated 5-year OS was 81.1% (95% CI, 75.5–87.2%) and 5-year DFS was 75.2% (95% CI, 69.0–82.0). In multivariable analysis, non-R0 resection (HR 6.06, 95% CI, 1.99–18.42), MRI circumferential resection margin positivity (HR 3.11, 95% CI, 1.53–6.33), and MRI extramural vascular invasion positivity (HR 1.97, 95% CI, 1.05–3.91) remained independent predictors of DFS. Conclusions: Institutional sandwich TNT yields meaningful tumor response and durable survival in MRI-defined high-risk LARC. Structured W&W offers organ preservation with acceptable oncologic control under intensive surveillance. Full article

BIM is a key technology for the digital transformation and sustainable development of the construction industry through enhanced productivity, transparency, and fostered innovation. Although scholars have investigated the constructs driving BIM adoption intention, a comprehensive framework has seldom been adopted, and thus some vital factors have been overlooked, such as collaboration partner pressure. Meanwhile, the targeted group is usually practitioners of a certain type of company while a construction project requires the participation of multiple types of companies. To address these research gaps, the aim of this study is to explore the factors driving various stakeholders’ intention to adopt BIM by applying the TOE framework, considering nine factors across three dimensions. A total of 512 valid responses from owners, consulting firms, design firms, construction companies, suppliers, engineering surveying firms, and universities or research institutes were collected and analyzed through the structural equation modeling (SEM) method. The SEM results indicated that six factors were positively related to the intention to employ BIM, among which management commitment (β = 0.182, p < 0.001) and perceived ease of use (β = 0.180, p < 0.001) exhibited the strongest effects. However, three factors (perceived usefulness, supporting technical facilities, and mimetic pressure) exerted no significant influence. The findings of this study may provide a valuable reference for promoting the application of BIM technology in the construction industry. Full article

Freshwater demand for cementing operations in the Delaware Basin continues to increase with expanding unconventional development, creating a high demand for an alternative source of water. This study develops a chemistry screening and operational framework to evaluate the reusability potential in cementing operations in the Delaware Basin. A three-tier screening system for the produced-water samples was established by using the major-ion chemistry, total dissolved solids (TDS), pH, and saturation index (SI) thresholds derived from the cement literature and American Petroleum Institute (API) guidelines. The results of the geochemical screening aid in classifying the water samples into four suitability categories: Excellent/Preferred, Good/Suitable, Moderate/Marginal, and Poor/Unsuitable. The results suggest that the samples obtained from the Loving, Pecos, Reeves, Eddy and Lea counties meet the criteria for reuse in cementing operations with minimal conditioning. To assess the feasibility of operational use, a probabilistic forecasting model was developed to predict the cement water demand in 2026 for the basin. Linear regression of historical drilling trends between 2015 and 2025 showcased that approximately 3595 new wells will be drilled, with an average well depth of 21,778 ft. To evaluate whether the produced-water volumes in the basin are adequate for reuse in cementing, a Monte Carlo simulation (10,000 iterations) estimated an annual cementing water requirement centered at 6.16 MMbbl/year (P50). Produced-water availability from wells classified as Excellent/Preferred was also modeled probabilistically, using uncertainty in the water–oil ratio (WOR), estimated ultimate recovery (EUR), and forecast duration. These results demonstrate the potential for produced-water reuse to reduce freshwater demand for cementing operations in the Delaware Basin. Full article

To compare the genetic causes, prevalence, and clinical characteristics of syndromic and non-syndromic familial exudative vitreoretinopathy (FEVR). A total of 281 patients with FEVR who underwent clinical and genetic evaluation at five ophthalmological institutions in Japan between 2010 and 2023 were included. Whole-exome sequencing, Sanger sequencing, or karyotype analysis was performed using blood samples from probands and available family members. Clinical characteristics of FEVR probands were assessed according to the presence or absence of systemic abnormalities. Among the 281 FEVR probands, 42 (15%) had syndromic FEVR and 239 (85%) had non-syndromic FEVR. Syndromic FEVR was more frequently diagnosed during infancy (95% vs. 57%, p < 0.0001) and occurred more often in sporadic cases (69% vs. 50%, p = 0.028). Variants in Norrin/β-catenin signaling genes were less common in syndromic FEVR (29% vs. 54%, p = 0.0026), whereas symmetrical retinal severity was more frequently observed (67% vs. 39%, p = 0.001). Sex distribution did not differ between groups. Pathogenic variants were identified in 71% of syndromic cases, most commonly in KIF11, NDP, CTNNB1, DOCK6, TSPAN12, and LRP5. Syndromic FEVR exhibits distinct and heterogeneous genetic and clinical features compared with non-syndromic FEVR. Genotype–phenotype characterization may enable earlier diagnosis. Full article

This research-related study examines the relevance of mud pulse telemetry (MPT) systems and their intersection with drilling performance, focusing on data transmission signal propagation performance and overall operation under different drilling parameters conditions, with an additional focus on drilling fluid flow rate and downhole pressure conditions. The novelty of this study lies in the investigation of adjustments to drilling operating parameters that could potentially improve the transmission of telemetry signals during drilling, in real time, without requiring mechanical or functional modifications to the MPT system itself. Improvements on transmission performance in situations where the data rate may be limited are also addressed, presenting an alternative through possible propagation velocity improvements to counterbalance it. A detailed chronological technical scientific literature review details important parts on analyses of pressure pulse propagation velocities focused on data transmission. A systematic experimental approach was developed and put into practice to evaluate the MPT systems in regard to tendencies on transmission performances, emphasizing pressure pulse propagation velocity. The laboratory-scale experiments were conducted at the Institute of Drilling Engineering and Fluid Mining (IBF) from the Technical University Bergakademie Freiberg (TUBAF), namely the Flow-loop Research Facility, to assess the impact of fluid flow rate (and subsequent pressure) on data transmission efficiency. Experimental results demonstrate that increasing the flow rate significantly speeds up signal propagation. In the performed experiments, for the mud siren configuration, increasing the flow rate from 15 to 25 m³/h improved the data transmission performance by approximately, at minimum, 18%, while for the positive mud pulse system, an increase in flow rate from 11.5 to 14 m³/h resulted in a propagation velocity rise of about 19%. The results also showed that higher concentrations of glycerin in the working fluid reduced the propagation velocity, confirming the influence of the fluid’s rheological properties on telemetry performance. At the end, in the presented case study, for 6 bps data rate configurations and for a transmission of a 40-bit string, it was demonstrated that the propagation time from downhole to the surface could potentially represent approximately 40% of the total time demanded for transmitting the desired information (generation plus propagation time). It was verified that an increment of 0.02208 m³/s (350 gpm) could lead to shortening eventual surveying procedures by 1–2 s, and that it could equally represent 1.137 bps. This is a relevant outcome, since, without any physical or functional alteration to the MPT system, one could have the data transmission performance improved, an approach not yet analyzed in the literature nor at the industrial park. These results, added to the detailed literature investigation and interaction with field personnel, indicate that the drilling fluid flow rate is a critical operational parameter affecting both the telemetry signal transmission speed and the overall drilling efficiency. Increasing the flow rate can reduce survey transmission time and decrease operational exposure to drilling hazards, such as drill string sticking. The results provide quantitative information applicable in optimizing measurement-drilling telemetry and help support the development of integrated drilling optimization strategies that balance drilling performance with real-time data transmission assurance in deep drilling operations. Full article

Background: Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome, also known as Herlyn–Werner–Wunderlich syndrome (HWWS), is a rare Müllerian malformation. Gynaecologic malignancies reported in association with OHVIRA syndrome/HWWS are exceptional and scattered across isolated case reports and small case series, leading to significant challenges for screening, early diagnosis, and optimal management. The primary aim of this study was to comprehensively review and synthesize the clinicopathologic features, treatment approaches, and reported outcomes of patients with OHVIRA-associated gynaecologic neoplasms. Methods: A systematic review of published cases of gynecologic malignancies in OHVIRA/HWWS was conducted using PubMed/MEDLINE and Scopus from database inception through January 2026. To expand the current evidence, an illustrative novel institutional case is also presented and integrated into the analysis. Results: A total of 21 cases were identified and analysed; reported tumours predominantly involved the lower genital tract (vagina/cervix), with a recurrent representation of adenocarcinoma, particularly clear cell histology, and a frequent origin from the obstructed or non-visible compartment when side was described. Endometrial and ovarian involvement was uncommon. Conclusions: The anatomical complexity of OHVIRA syndrome creates a diagnostic blind spot that warrants heightened clinical suspicion, rigorous MRI-based anatomic delineation, and side-specific evaluation in symptomatic patients. By synthesizing the available literature, this review underscores the necessity for tailored, multidisciplinary management and proactive surveillance strategies in this rare population. Full article

Background/Objectives: Young women with breast cancer (aged ≤ 40 years) have distinct prognostic characteristics, yet little is known about how modifiable body composition factors influence outcomes in this age group. This study examined whether CT-derived body composition measures could identify thresholds that predict overall survival (OS). Methods: This was a single-center, 10-year, matched case–control study nested within a cohort, utilizing retrospectively collected data. Using an institutional database (2009–2018) and the initial cohort of 112 patients, we performed a subset analysis of patients with stage I–III breast cancer at diagnosis who had available pretreatment CT scans to estimate associations with body composition metrics and OS. The final analytic dataset included 89 individuals (49 survivors and 40 deceased). CT scans at the L3 level were analyzed using Slice-O-Matic software to quantify visceral (VAT), subcutaneous (SAT), intermuscular (IMAT), total adipose tissue (TAT), skeletal muscle density (SMD), skeletal muscle gauge (SMG), and skeletal muscle index (SMI). Cox proportional hazard models determined optimal cutpoints for OS. Multivariable models included adjustments for disease stage and hormone receptor status. Results: The median age was 35 (IQR, 32–38); 47% were White and 37% were Black. The majority (78%) were not Hispanic or Latina. Most (67%) were overweight/obese. Specific thresholds for IMAT index (>2.57), VAT (>31.38), and SMG (<2419.89) were associated with worse survival (all p < 0.05), while no cutpoints were identified for other variables. Conclusions: These findings show that muscle fat infiltration and reduced muscle quality have important prognostic value in young women with breast cancer. Exploratory cutpoints derived from routine staging CT scans may help inform risk stratification and generate hypotheses for targeted nutritional or exercise interventions, but require validation in larger, independent cohorts before clinical application. Full article

Background/Objectives: Poor bone quality is strongly associated with adverse surgical events. Although dual-energy X-ray absorptiometry (DXA) remains the gold standard for bone mineral density (BMD) assessment, logistical barriers may limit its preoperative application. The Endplate Bone Quality (EBQ) score is an MRI-derived metric quantifying subchondral bone quality at the vertebral endplate with demonstrated predictive value for cage subsidence following lumbar interbody fusion. However, EBQ has been measured exclusively at the operative level in surgical cohorts. This study aimed to assess level-specific EBQ scores across the entire lumbar spine and compare distributions across age, sex and osteoporosis subgroups. Methods: A single-institution retrospective review of T1-weighted lumbar MRI studies from patients evaluated for lower back pain from 2020 to 2025 was performed. EBQ was independently scored by two blinded raters at each disc space from L1–L2 to L5–S1 using 3 mm endplate ROIs normalized to a CSF ROI at L3. Interrater reliability was assessed via ICC, Pearson correlation, and RMSE. Patients were stratified by age (≤60 vs. >60 years), sex, and osteoporosis status, and subgroup comparisons were performed for overall and level-specific EBQ score. Results: A total of 96 patients with an average age of 61.0 ± 9.42 years were included in this study. The majority of patients included were female (87.5%), and 18.8% had been diagnosed with osteoporosis. EBQ scores demonstrated a progressive caudal increase across all subgroups from L2–L3 to L5–S1. Overall interrater reliability was acceptable (ICC = 0.76), with level-specific ICCs ranging from 0.70 to 0.83. No significant differences were observed between age or sex subgroups. Osteoporotic patients demonstrated significantly higher EBQ at L1–L2, L2–L3, and overall (all p < 0.05), with no significant differences at L3–L4 through L5–S1. Conclusions: This study provides normative, level-specific EBQ reference data throughout all levels of the lumbar spine. The increase in EBQ scores seen among caudal levels and reduced osteoporotic discriminatory power support the importance of level-specific context when interpreting EBQ thresholds. These findings may support future studies evaluating threshold development for EBQ. Full article

Background/Objectives: Since 2015, pulmonary arterial hypertension (PAH)-specific medications have been fully reimbursed in Lithuania. To describe the current situation of PAH treatment in the country and to determine survival during different PAH treatment regimens. Methods: The data from the Institute of Hygiene and the State Data Agency of Lithuania cases with administrative codes I27.0 and I27.8 have been evaluated. Results: In 2025, 225 confirmed cases of PAH were treated with PAH-specific medications in two PH centers. At least one PAH-specific medication was prescribed to 163 (72.4%) female and 62 (27.6%) male patients. Among these, 96 (42.7%) received sildenafil monotherapy, 82 (36.4%) received a combination of sildenafil and an ERA, 36 (16.0%) were on triple PAH-specific therapy (including selexipag or treprostinil), and 11 (4.9%) received other regimens due to specific medical considerations. The age of adults treated with sildenafil monotherapy vs. other therapies was 63.9 ± 14.8 (n = 117) and 51.5 ± 17.3 (n = 116) years, respectively (p < 0.05). A total of 191 PAH patients who received targeted therapy died during the observational period 2017–2025. Of these, 105 received monotherapy, 57 sildenafil and endothelin receptor antagonist and 29 triple therapies (treprostinil [n = 19], selexipag [n = 6], or inhaled iloprost [n = 4] were prescribed as the third drug). Patients who died and received triple therapy were younger than those on mono- and dual therapy (age at diagnosis 45.0 ± 21.6, 67.2 ± 14.7 and 61.6 ± 16.3 years, respectively, p < 0.01). Survival was longer in patients on dual therapy compared with monotherapy (43.1 ± 28.1 vs. 31.7 ± 25.0 months, p = 0.04), and the longest was in those receiving triple therapy (59.9 ± 29.4 months; p < 0.05). Conclusions: The availability of reimbursed medications dramatically increased the number of treated PAH cases in Lithuania. In 2025, most of the PAH patients received sildenafil monotherapy. Patients treated with sildenafil only were significantly older than the rest of cohort. In the survival analysis, combination PAH therapies were more often prescribed to younger patients and were associated with longer duration of life than monotherapy. Full article