Search Results (3,196)

Background and objectives: Cardiac surgery with cardiopulmonary bypass (CPB) is associated with endothelial glycocalyx injury and perioperative endothelial dysfunction. Syndecan-1 is commonly used as a biomarker of glycocalyx shedding, but data on its perioperative changes and their relationship with operative and patient-related factors remain limited. The aim of this study was to evaluate perioperative Syndecan-1 dynamics during coronary artery bypass grafting (CABG) with CPB and to assess associations with ischemia–reperfusion exposure and patient characteristics. Materials and methods: This prospective observational study included 147 patients undergoing elective CABG with CPB. Syndecan-1 concentrations were measured at five time points: before induction of anaesthesia, immediately after aortic cross-clamp application, immediately after aortic declamping, on arrival at the ICU and 24 h after surgery. Perioperative changes were analysed using non-parametric tests, Spearman’s rank correlation analysis and mixed-effects modelling. The study was registered at ClinicalTrials.gov (NCT03491163; registered on 29 March 2018). Results: Syndecan-1 concentrations changed significantly over time (p < 0.001), increasing from a baseline median of 49.74 ng/mL to a peak of 147.78 ng/mL at ICU admission, followed by a partial decline to 65.26 ng/mL at 24 h. Aortic cross-clamp duration was weakly but significantly associated with Syndecan-1 concentration at ICU admission (r_s = 0.243, p = 0.003) and with perioperative increases from baseline to ICU admission (ΔS4-1: r_s = 0.196, p = 0.017) and from aortic clamping to ICU admission (ΔS4-2: r_s = 0.207, p = 0.012). No significant associations were observed between CPB duration and Syndecan-1 concentrations in univariable analyses. In the mixed-effects model, a significant non-linear temporal pattern of Syndecan-1 concentrations was observed (both linear and quadratic time terms, p < 0.001). Male sex (β = 0.247, p = 0.009) and aortic cross-clamp duration (β = 0.016, p = 0.005) were independently associated with higher Syndecan-1 concentrations, whereas smoking status, age, BMI, diabetes status, EuroSCORE II, and CPB duration were not independently associated. Conclusions: Syndecan-1 concentrations increase significantly during cardiac surgery with cardiopulmonary bypass, peaking at ICU admission and partially declining within 24 h. Aortic cross-clamping duration, but not total CPB duration, showed weak associations with glycocalyx shedding. Male sex was independently associated with higher Syndecan-1 concentrations. These findings support ischemia–reperfusion injury as an important contributor to endothelial glycocalyx shedding during cardiac surgery. Full article

The marine capture fisheries sector of the Philippines employs approximately 2.3 million Filipinos, yet recent declines (including a 15.3% drop in Q1 2026 production relative to Q1 2025) underscore the need for forecasting systems resolved at the regional and sectoral level. Existing Philippine approaches rely on univariate classical time-series methods and seldom integrate multivariate oceanographic predictors. This study addresses three questions: (RQ1) How do nine candidate machine learning algorithms compare in forecasting regional fish production from environmental predictors? (RQ2) Which environmental predictors most strongly drive model output, as quantified by explainable AI (XAI) SHAP-based feature attribution? (RQ3) To what extent do model performance and predictor importance vary across regions? Across 32 region–sector panels spanning 2002–2025, kernel and neural network models were selected as the best-performing architecture in 26 of 32 panels (81.3%), achieving a mean composite score 12.7% higher than tree-based ensembles, a gap attributable to extrapolation along trending physical predictors. Feature attribution identified the partial pressure of CO${}_2$ as the leading driver in both sectors, exceeding the second-ranked variable by factors of 2.5 (commercial) and 3.4 (marine municipal). Regional heterogeneity in retained predictors, winning algorithms, and SHAP attribution rankings supports region-specific forecasting as a necessary design choice. Mean absolute percentage error of 22–25% and directional accuracy of 0.62–0.66 indicate operational utility for early-warning applications, establishing a basis for evidence-driven priority-setting in Philippine fisheries governance. Full article

This study investigates the relationship between Environmental, Social, and Governance (ESG) ratings and firm financial performance across a comprehensive global sample of over 10,000 companies from more than 80 countries observed in 2015–2022. Using panel data analysis, we examine how overall ESG scores and their components affect the Return on Assets (ROA), Return on Equity (ROE), and Weighted Average Cost of Capital (WACC). We employ several econometric approaches designed for panel data, including the univariate approaches; static (Pooled OLS; Fixed Effects) and a multivariate approach (Panel Vector Autoregression; PVAR) to address potential endogeneity concerns and provide robust findings. Our results revealed a complex relationship between ESG performance and financial outcomes. While OLS models generally show positive associations between ESG scores and profitability measures, Fixed Effects models indicate some negative relationships, suggesting that unobserved firm-specific factors are crucial. PVAR results highlight important dynamic interactions between ESG performance and financial metrics over time. These findings contribute to stakeholder theory by demonstrating that the financial implications of ESG performance are contingent on methodological approaches, time horizons, and specific contexts. Our research has important implications for corporate managers, investors, and policymakers seeking to understand the financial consequences of sustainability practices. Full article

Background/Objectives: Cognitive impairment, frailty, and systemic comorbidity burden are common in elderly patients with glaucoma and may influence both visual field (VF) performance and glaucoma severity. This study investigated the associations of comprehensive geriatric assessment (CGA) parameters, including Mini-Cog, G8, and Age-Adjusted Charlson Comorbidity Index (ACCI), with VF sensitivity and VF reliability indices in glaucoma patients. Methods: This retrospective cross-sectional study included 1125 eyes of 622 glaucoma patients who underwent Humphrey VF testing and CGA at a tertiary referral center. Associations between CGA parameters and VF indices, including mean deviation (MD), pattern standard deviation (PSD), foveal sensitivity, fixation loss rate (FL), false-negative rate (FN), and false-positive rate (FP), were evaluated. Generalized linear mixed models were used to assess independent associations after adjustment for demographic, systemic, and ocular covariates. Results: In univariate analyses, lower Mini-Cog and G8 scores and higher ACCI scores were associated with several VF sensitivity and reliability indices. After multivariable adjustment, ACCI remained independently associated with lower MD (estimate = −0.52, p = 0.004), higher PSD (estimate = 0.27, p = 0.04), and lower foveal sensitivity (estimate = −0.36, p = 0.01). Lower G8 scores and higher ACCI scores were independently associated with increased FN rates, whereas higher G8 scores were associated with increased FP rates. Conclusions: Systemic comorbidity burden, assessed using ACCI, was independently associated with both glaucomatous functional impairment and selected VF reliability indices. Frailty, assessed using G8, was associated with VF reliability but not VF sensitivity. Although cognitive function measured by Mini-Cog was associated with VF parameters in univariate analyses, these associations were not retained after multivariable adjustment. Consideration of systemic health status and geriatric vulnerability may improve interpretation of VF results in patients with glaucoma. Full article

Background: Infant wheezing is a common respiratory condition with a significant healthcare burden, yet data from the Middle East remain limited. This study aimed to identify predictors of any wheezing and recurrent wheezing during the first year of life in a Saudi Arabian birth cohort. Methods: This retrospective birth cohort study included infants born at King Saud University Medical City, Riyadh, in 2020. Data were collected from electronic medical records and a structured parental questionnaire administered via WhatsApp at 12 months of age, assessing wheezing episodes, parental atopy, household smoking, pets, home humidity, and nearby pollution sources. Any wheezing was defined as ≥1 wheezing episode during the first year, and recurrent wheezing as ≥3 episodes. Variables with p < 0.25 in univariable logistic regression were entered into multivariable models; adjusted odds ratios (aOR) with 95% confidence intervals are reported. Results: Of 594 infants, 135 (22.7%) experienced any wheezing and 85 (14.3%) had recurrent wheezing. NICU admission was independently associated with both any wheezing (aOR 2.65, 95% CI 1.49–4.73; p < 0.001) and recurrent wheezing (aOR 2.34, 95% CI 1.21–4.56; p = 0.012). Parental allergic rhinitis was independently associated with both outcomes (any wheezing: aOR 1.55, 95% CI 1.01–2.37; recurrent wheezing: aOR 1.67, 95% CI 1.00–2.78), while parental eczema was specifically associated with recurrent wheezing (aOR 1.74, 95% CI 1.00–3.03). Conclusions: NICU admission and parental atopy were associated with infant wheezing in this cohort. These findings provide region-specific data from Saudi Arabia but should be regarded as hypothesis-generating and require confirmation in prospective multicentre studies before informing clinical follow-up strategies. Full article

Background: While pediatric obesity prevalence is rising, the association between ICD-coded obesity, healthcare resource utilization, and inpatient outcomes in middle-income countries remains poorly quantified. This study examined inpatient diagnostic patterns, resource utilization, and in-hospital mortality among hospitalized pediatric patients with ICD-coded obesity in Thailand’s Universal Coverage scheme during a 9-year period. Methods: We analyzed nationwide inpatient administrative data from January 2015 to December 2023 for children aged 1 month to <18 years. ICD-coded obesity was defined using ICD-10-TM codes recorded as either a principal diagnosis or a comorbidity. Outcomes included length of stay, hospital costs, and in-hospital mortality. Univariable and multivariable regression models were used to estimate associations between ICD-coded obesity and inpatient outcomes, with adjustment for age, sex, region, hospital level, admission year, and disease categories. Results: Among 14,483,566 hospitalized children, 42,168 had ICD-coded obesity. Notably, 95.7% of children with ICD-coded obesity were recorded as a comorbidity rather than the primary reason for admission. Children with ICD-coded obesity as a comorbidity had 156.8% higher median hospital costs. Across all major categories of common acute diseases (respiratory, intestinal, digestive), children with ICD-coded obesity had significantly higher median costs and longer length of stay compared to children without ICD-coded obesity. In regression analyses, ICD-coded obesity remained associated with longer length of stay (adjusted ratio, 1.21; 95% CI, 1.16–1.26; p < 0.001) and higher hospitalization cost (adjusted cost ratio, 1.42; 95% CI, 1.32–1.53; p < 0.001). The association with in-hospital mortality was observed in the unadjusted model but was attenuated after adjustment and was not statistically significant (adjusted odds ratio, 1.14; 95% CI, 0.89–1.45; p = 0.303). Conclusions: In Thailand’s national universal coverage scheme, ICD-coded obesity was associated with greater inpatient resource utilization, especially longer length of stay and higher hospitalization costs. These findings support the need for weight-aware inpatient management and adjusted funding models for hospitals treating this higher-resource-utilization subgroup. Full article

Background: Psychological distress, particularly anxiety and depression, is highly prevalent among cancer patients, and is associated with impaired quality of life, reduced treatment adherence, and increased mortality risk. Standardized screening instruments, such as the Hospital Anxiety and Depression Scale (HADS), are effective, but face implementation barriers in busy oncology outpatient settings. This cross-sectional study investigated whether BERT-based Natural Language Processing (NLP) analysis of brief patient-generated free texts would correlate with HADS scores in a consecutive cohort of cancer outpatients. Material and Methods: A total of 165 consecutive adult cancer outpatients were enrolled at a tertiary oncology center in Turkey. All participants completed the HADS questionnaire and were asked to write freely about their current emotional state in Turkish. Patient-generated texts were analyzed using a pre-trained Turkish BERT model to derive a continuous BERT Sentiment Score (BSS) and a categorical BERT Sentiment Cluster (BSC) via unsupervised hierarchical clustering. Univariate and multivariate linear regression analyses were performed to examine associations between clinical, demographic, and NLP-derived variables and the logarithmically transformed HADS score. Results: The mean total HADS score was 10.46 (range, 0–33), consistent with a moderate level of psychological distress. In multivariate analysis, two variables were independently associated with HADS scores: female sex (β = 0.20, t = 2.14, p = 0.034), associated with higher HADS scores, and BERT Sentiment Score (BSS) (β = −0.18, t = −2.43, p = 0.016), with higher values corresponding to lower HADS scores. Hierarchical clustering identified two distinct thematic groups: ‘Coping and Fighting Spirit’ (74%), and ‘Hope and Negative Feelings’ (26%); however, cluster membership (BSC) was not independently associated with HADS scores (β = −0.02, p = 0.789). Clinical variables, including cancer stage, diagnosis type, treatment status, and time since diagnosis, also were not independently associated with HADS scores. Conclusions: BERT-based sentiment analysis of brief patient-generated free texts yielded a continuous measure that independently correlated with HADS scores in cancer outpatients, alongside female sex. These findings provide proof-of-concept evidence that NLP-derived sentiment scoring may offer a practical, scalable, and complementary approach to standardized psychological screening in routine oncology care. Full article

Background and Objectives: Prolonged intensive care unit (ICU) stay following coronary artery bypass grafting (CABG) remains a major clinical challenge. The aim of this study was to identify preoperative and intraoperative factors that may predict prolonged ICU requirement in patients undergoing isolated CABG and to evaluate the impact of minimally invasive extracorporeal circulation (MiECC) utilization on this outcome. Materials and Methods: Patients who underwent isolated CABG between January 2024 and April 2025 were retrospectively analyzed. Prolonged ICU stay was defined as a postoperative intensive care duration exceeding 72 h. Predictors of prolonged ICU stay were evaluated using univariate logistic regression and four multivariable logistic regression models. Receiver operating characteristic (ROC) curve analyses were performed to assess the discriminative performance of significant and clinically relevant variables as well as the multivariable models. Results: A total of 82 patients were included and stratified into a prolonged ICU stay group (n = 32) and a non-prolonged ICU stay group (n = 50). The preoperative left ventricular ejection fraction (LVEF) was significantly lower (52.5% vs. 60%, p = 0.012) and preoperative leukocyte counts significantly elevated (8.4 vs. 7.97 × 10³/µL, p = 0.049) in the prolonged stay group. MiECC was employed in 28.1% of patients with a prolonged ICU stay and 30% of those with a non-prolonged stay (p = 0.530). Across four multivariable logistic regression models, lower preoperative ejection fraction and higher preoperative leukocyte count were identified as independent predictors of prolonged ICU stay, whereas MiECC utilization was not independently associated with this outcome. Conclusions: Lower preoperative ejection fraction and higher baseline leukocyte count were independently associated with prolonged ICU stay. No independent association between MiECC utilization and prolonged ICU stay could be demonstrated. These findings suggest that preoperative cardiac function and inflammatory status may contribute to ICU requirements following isolated CABG. Further prospective studies are warranted to validate these findings. Full article

Objectives: To assess the prevalence of high-risk human papillomavirus (hrHPV) infection and selected genitourinary pathogens and to examine their co-detection patterns in sexually active adolescent females. Methods: In this single-center cross-sectional study, 167 consecutive outpatients aged 13–17 years with self-reported sexual initiation underwent multi-pathogen polymerase chain reaction (PCR) testing for hrHPV, Chlamydia trachomatis (CT), Ureaplasma urealyticum (UU), Ureaplasma parvum (UP), and Mycoplasma genitalium (MG). Prevalence estimates are reported with 95% confidence intervals (CIs). Associations with hrHPV positivity were explored using univariable and parsimonious multivariable logistic regression; sensitivity analyses examined alternative age parameterization and exclusion of sparse variables. Results: The prevalence of hrHPV was 28.1% (47/167; 95% CI: 21.5–35.6). The prevalence of CT, UU, UP, and MG was 3.0%, 28.1%, 25.1%, and 0.6%, respectively. Any bacterial pathogen was detected in 61/167 participants (36.5%), while hrHPV–bacterial co-detection was observed in 24/167 (14.4%). In univariable analysis, UU was associated with hrHPV positivity (OR 2.55, 95% CI: 1.24–5.24; p = 0.013); this signal remained in the primary multivariable model (adjusted OR 2.46, 95% CI: 1.07–5.93; p = 0.035). A graded increase in hrHPV positivity was observed with increasing bacterial burden (p for trend = 0.018). Conclusions: Sexually active adolescent girls attending gynecologic outpatient care showed a substantial burden of hrHPV and bacterial genitourinary pathogen detection. This Central and Eastern European adolescent outpatient cohort contributes integrated multi-pathogen PCR-based epidemiologic data from a clinically relevant and underreported population. An exploratory association between UU and hrHPV positivity was observed; this signal is best interpreted as reflecting shared sexual exposure or the cervicovaginal microbial milieu rather than as evidence of an independent causal role for UU. The absence of vaccination status, behavioral, and longitudinal data represents a principal limitation. Prospective studies incorporating these variables are needed to clarify the epidemiology of hrHPV and co-detected pathogens in adolescents. Full article

Human Bocavirus 1 (HBoV1) is one major pathogen that has been associated with wheezing illnesses. However, there is still a lack of effective clinical predictive indicators for wheezing illnesses in children infected with HBoV1. A retrospective cohort study was conducted among pediatric patients with single-HBoV1 infection from September 2016 to August 2023. Then, univariate logistic regression was used to screen potential predictors for wheezing illness, and Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to minimize overfitting and select key predictors. Finally, a multivariate logistic regression model was constructed in a training dataset comprising 80% of patients and validated in an independent test dataset comprising 20% of patients. Then, its performance was evaluated using the Area Under the Curve (AUC). A total of 330 pediatric patients were enrolled, including 228 in the wheezing-illness group and 102 in the non-wheezing group. Three independent predictors, including abnormal NK cell percentage (OR = 1.101, 95 %CI 1.03–1.27), preterm birth (OR = 1.65, 95 %CI 1.49–1.82) and personal history of allergy (OR = 1.25, 95 %CI 1.11–1.41), were identified. The model achieved AUCs of 0.904 and 0.876 in the training and test sets, respectively. Using a Youden-derived threshold (0.382), the high-risk group in the test set had an observed wheezing rate of 85.3%, compared with 18.7% in the low-risk group (p < 0.001). Calibration was satisfactory (Hosmer–Lemeshow p = 0.324 and 0.576). A validated predictive model incorporating abnormal NK cell percentage, preterm birth and personal history of allergy accurately stratifies the risk of wheezing illness after HBoV1 infection in children, facilitating early clinical intervention. Full article

Background and Objectives: Metastatic pancreatic ductal adenocarcinoma (PDAC) continues to carry a poor prognosis despite advances in treatment, underscoring the need for simple and accessible biomarkers that reflect tumor–host interactions. The Global Immune–Nutrition–Inflammation Index (GINI), which combines inflammatory, immune, and nutritional parameters, may offer improved prognostic stratification compared with conventional indices. Materials and Methods: This retrospective cohort study included 126 patients with metastatic PDAC treated between 2015 and 2024. GINI, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated using baseline laboratory data. Discriminative ability was evaluated by receiver operating characteristic (ROC) analysis. Survival outcomes were assessed using Kaplan–Meier curves and Cox proportional hazards models. Results: Among the evaluated indices, GINI showed the best discriminative performance (AUC, 0.769; 95% CI, 0.637–0.900), with a sensitivity of 78.8% and specificity of 76.9%. Patients with lower GINI values had significantly longer overall survival than those with higher values (median OS, 11.0 vs. 7.0 months; p = 0.014). Although progression-free survival differed statistically (p = 0.006), median PFS was the same in both groups (5.0 months). In univariable analysis, higher GINI was associated with worse OS (HR, 1.67; p = 0.022) and PFS (HR, 1.75; p = 0.012). However, in multivariable analysis, ECOG performance status remained the only consistent independent predictor, and GINI was no longer significant. Conclusions: GINI is a practical and biologically meaningful biomarker that improves risk discrimination in metastatic PDAC. While it does not retain independent prognostic significance, its ability to capture the overall tumor–host interaction  supports its use as a complementary tool for baseline risk assessment. Full article

Accurate prediction of effluent total nitrogen (TN) is important for early exceedance warning and operational control in wastewater treatment plants. Existing decomposition-based models may overestimate performance when full-series decomposition is performed before data splitting, causing potential temporal information leakage. To address this issue, this study compares noncausal and strictly causal Improved Complete Ensemble Empirical Mode Decomposition with Adaptive Noise combined with Long Short-Term Memory (ICEEMDAN-LSTM) and Variational Mode Decomposition–Long Short-Term Memory network (VMD-LSTM) settings, and proposes a Level–Trend Persistence-Residual LSTM (LT-PR-LSTM) for univariate effluent TN prediction. The model uses Persistence as the short-term state baseline, extracts level features from historical TN, and introduces first- and second-order differences to learn residual corrections relative to the current state. Multi-model comparison, ablation experiments, stability tests, SHapley Additive exPlanations (SHAP) interpretation, supplementary dataset validation, and efficiency analysis were conducted. Results show that noncausal decomposition inflates predictive performance. LT-PR-LSTM achieves the best main-test performance, with RMSE 1.1273, MAE 0.6082, MAPE 7.5455%, and $R^2$ 0.8512, reducing RMSE, MAE, and MAPE by 6.73%, 7.64%, and 8.56% compared with Persistence. SHAP identifies $TN(t-2h)$ as the dominant predictor, and the model requires only 0.5348 ms/sample, indicating potential for online TN early warning. Full article

Background/Objectives: Although outcomes in Hodgkin lymphoma (HL) have improved substantially, patients with advanced-stage disease, comorbidities, or relapsed/refractory presentations can still fare poorly. Blood-based indices of systemic inflammation and nutrition are derived from routine tests, but their value beyond established prognostic models is uncertain. We examined the association of the baseline Gustave Roussy Immune Score (GRIm) and Glasgow Prognostic Score (GPS) with treatment response, progression-free survival (PFS), and overall survival (OS) in HL, focusing on their performance relative to the seven-factor International Prognostic Score (IPS-7). Methods: We retrospectively analysed 110 adults with histologically confirmed HL treated at a tertiary haematology centre between January 2015 and December 2025. GPS, GRIm, and IPS-7 were calculated from data recorded at diagnosis. Treatment response was classified as complete versus non-complete. Outcomes were assessed with Kaplan–Meier analysis, log-rank tests, Cox regression, Harrell’s C-index, and likelihood-ratio testing. Results: Most patients had advanced-stage disease (69.1%) and received ABVD-based treatment (94.5%); complete response was achieved in 90 (81.8%). GPS and GRIm were not significantly associated with non-complete response, whereas IPS-7 was. Over a median follow-up of 39.5 months, 28 patients (25.5%) progressed or died and 17 (15.5%) died. In univariable Cox analysis, high GRIm risk (HR = 2.68, 95% CI 1.17–6.14), higher GPS (HR = 2.18 per point, 95% CI 1.23–3.89), and higher IPS-7 (HR = 2.10 per point, 95% CI 1.59–2.77) predicted shorter PFS. For OS, GPS and IPS-7 were significant, whereas GRIm was not. After adjustment for IPS-7, neither GPS nor GRIm remained independently associated with PFS or OS, and adding either score to IPS-7 produced only small, non-significant gains in discrimination. Conclusions: Baseline GPS and GRIm were associated with survival on univariable analysis, particularly for PFS, but their incremental value beyond IPS-7 was limited. These scores may help describe baseline inflammatory and nutritional risk and should not be regarded as alternatives to established HL prognostic models. In particular, GPS and GRIm were not significantly associated with treatment response and should be viewed as supportive markers requiring external validation, rather than as tools that can independently guide treatment decisions. Full article

Background/Objectives: Tricuspid valve surgery carries a high risk of postoperative acute kidney injury (AKI) due to pre-existing right ventricular dysfunction and congestive end-organ remodeling. We aimed to evaluate the incidence and predictors of postoperative AKI, with particular focus on the prognostic value of the TAPSE/sPAP index. Methods: This retrospective, single-center study evaluated adult patients who underwent tricuspid valve surgery (isolated/concomitant) between 2010 and 2025. The primary outcome was postoperative AKI of any stage, defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Predictors were identified using a pre-specified multivariable logistic regression model including baseline estimated glomerular filtration rate (eGFR), cardiopulmonary bypass time, and EuroSCORE II; TAPSE/sPAP associations with severe renal outcomes were assessed univariably and presented as exploratory. Results: Of 80 patients, postoperative AKI occurred in 32 (40.0%), with 16 (20.0%) requiring renal replacement therapy. The pre-specified multivariable model discriminated any-stage AKI (AUC 0.86, 95% CI 0.77–0.94). Lower baseline eGFR (adjusted OR 1.82 per 10 mL/min/1.73 m² decrease, p < 0.001) and higher EuroSCORE II (adjusted OR 1.53 per point, p = 0.03) were independent predictors. The TAPSE/sPAP index was not associated with any-stage AKI (p = 0.42), but lower values predicted advanced renal outcomes, including KDIGO stage ≥ 2 AKI (OR 2.11, p = 0.03) and the requirement for renal replacement therapy (OR 2.71, p = 0.01). Outcomes did not differ between isolated (n =14) and combined procedures (n = 66; AKI 35.7% vs. 40.9%, p = 0.77). Conclusions: Lower preoperative eGFR and higher EuroSCORE II independently predict any-stage postoperative AKI. In univariable analysis, the TAPSE/sPAP index identified the subgroup with severe renal outcomes; this exploratory finding requires prospective validation. Whether perioperative renal protection depends on addressing right-sided filling pressures rather than augmenting forward flow alone requires prospective testing. Full article

Background: Statins have pleiotropic anti-inflammatory, antifibrotic, and potential antineoplastic effects. Although several studies have linked statin exposure to lower hepatocellular carcinoma (HCC) incidence, their effect on survival after HCC diagnosis remains uncertain. We evaluated whether statin therapy before HCC diagnosis was associated with overall survival in a real-world cohort. Methods: We performed a retrospective single-center cohort study of consecutive patients with HCC managed at a tertiary referral center between January 2000 and January 2025. Demographic, clinical, laboratory, tumor-related, and treatment variables were collected at diagnosis and during follow-up. Patients were classified according to statin use before HCC diagnosis. Overall survival (OS) was assessed using Kaplan–Meier analysis and Cox proportional hazards regression. Results: Overall, 190 patients were included; 172 (90.5%) were male, 136 (71.6%) had cirrhosis, and 42 (22.1%) received statins. Statin users more frequently had diabetes mellitus, elevated body mass index and arterial hypertension, but baseline liver function, alpha-fetoprotein levels, tumor burden, and treatment allocation were broadly comparable between groups. Among 159 patients with available survival data, statin users had longer OS than non-users (mean 82.5 vs. 41.7 months; median 57 vs. 31 months; log-rank p < 0.001). In univariate Cox analysis, statin therapy was associated with reduced mortality risk (HR 0.45, 95% CI 0.28–0.70, p < 0.001). This association remained significant across multivariable models adjusting for baseline liver function, tumor stage, vascular invasion, and diagnostic era. Conclusions: Pre-diagnostic statin therapy was independently associated with improved OS in patients with HCC. These hypothesis-generating findings warrant prospective multicenter validation and careful assessment of confounding by indication. Full article