Search Results (518)

Shallow groundwater in saline soils creates a self-reinforcing cycle where waterlogging-induced root hypoxia impairs the ATP-dependent sodium exclusion mechanisms that plants rely on for salt tolerance. We conducted a two-year field experiment to test whether subsurface drainage must precede root-zone aeration for oxygen delivery to be effective. The experimental site was located in Heyang County, Weinan City, on the Guanzhong Plain of Shaanxi Province, north-central China—a major alluvial agricultural region representative of shallow-groundwater-induced salinization. The site had saturated paste electrical conductivity of 6.0 dS m⁻¹ and groundwater depth fluctuating between 0.5 and 1.4 m. A randomized complete block design with 2 × 2 factorial arrangement compared four treatments: control (CK), subsurface drainage only (SD), root-zone aeration only (RA), and both interventions combined (SD + RA). Drainage increased air-filled porosity from 5.8% to 13.5%, crossing the 10.2% threshold (95% CI: 9.1–11.3%) where gas-phase continuity emerges according to segmented regression analysis. Without drainage, aeration achieved only 4.2 mg L⁻¹ dissolved oxygen with high spatial variability (CV 12.5%), while the combined treatment reached 6.8 mg L⁻¹ (CV 6.8%). Root ATP content increased by 89% in SD + RA compared to control, accompanied by 56% lower root Na⁺ and 185% higher K⁺/Na⁺ ratio. These physiological changes correlated with 31% higher grain yield (7580 vs. 5798 kg ha⁻¹). The synergy index of 1.40 (95% CI: 1.28–1.52) indicated that combined effects exceeded the sum of individual treatments by 40%. Methane emissions declined by 62%, and the system achieved a 2.9-year payback period with a benefit–cost ratio of 4.08. These results establish drainage as a physical prerequisite for effective oxygenation, providing a mechanistic explanation for the variable performance of aeration systems reported in previous studies. Full article

Inadequate drainage and the application of salty irrigation waterinduced salinity stress, poses a major constraint to agricultural productivity, especially in saline–arid regions. Shallow subsurface drainage has emerged as a potential technique for salinity management; however, its implications for crop physiological and biochemical responses remain unclear. Therefore, a two-year lysimetric study was undertaken in a split-split plot design investigating cut-soiler-based preferential shallow subsurface drainage (PSSD), soil type (saline sandy loam and normal silty clay loam), and irrigation water salinity levels (4, 8 and 12 dS m⁻¹) to evaluate the effectiveness of rice-residue-filled cut-soiler PSSD in mitigating salinity stress in pearl millet and mustard crops. The cut-soiler PSSD reduced root-zone salinity to around 60.0% by the end of experimentation. Lower root-zone salinity under cut-soiler PSSD alleviated osmotic and ionic stress by reducing hydrogen peroxide (11.0–14.6%), membrane injury (22.7–40.8%), lipid peroxidation (20.0–25.0%), proline accumulation (26.0–37.0%) and improving the Na⁺/K⁺ ratio (44.0%). Antioxidant enzyme activities were also significantly moderated under the cut-soiler PSSD. These physiological and biochemical improvements resulted in significant increases in grain and seed yield of pearl millet (23.5%) and mustard (31.4%), respectively. The findings of this study indicate that cut-soiler PSSD is an effective strategy to mitigate salinity stress at the physiological and biochemical level and offers sustainable management strategies for salt-affected agro-ecosystems. Full article

Groundwater sustains human activity in arid crystalline terrains where surface water is scarce and hydrogeological data are limited. However, most groundwater potential mapping approaches depend on deterministic weighting methods without quantifying model variability. This study describes an uncertainty-aware Remote Sensing and Geographic Information Systems (RS–GIS) framework to delineate groundwater potential zones in the Wadi Arab Watershed, Northeastern Sudan. Nine thematic factors—geology and lithology, rainfall, slope, drainage density, lineament density, soil, land use/land cover, topographic wetness index, and height above nearest drainage—were integrated using the Analytical Hierarchy Process (AHP), with acceptable consistency (Consistency Ratio (CR) < 0.1). To address subjectivity in weights, a Dirichlet-based Monte Carlo simulation (500 iterations) was implemented to perturb AHP weights whilst preserving compositional constraints. The resulting Groundwater Potential Index (GWPI) classified 32.69% of the watershed as high to very high potential, primarily associated with alluvial deposits and fractured crystalline rocks. Model validation using Receiver Operating Characteristic (ROC) analysis yielded an Area Under the Curve (AUC) of 0.704, indicating acceptable predictive performance. Uncertainty assessment showed low spatial variability (mean standard deviation (SD) = 0.215) and stable exceedance probabilities, verifying the robustness of predicted high-potential zones. The proposed probabilistic AHP framework augments decision reliability and provides a transferable, cost-effective tool for groundwater planning in data-limited arid basement environments. Full article

Background: Crohn’s disease complicated by intra-abdominal abscesses often requires surgery. Percutaneous drainage may prevent surgery, but optimal post-drainage management is unclear. We aimed to analyze the long-term outcomes of Crohn’s disease with intra-abdominal abscesses after intervention. Methods: Patients with penetrating Crohn’s disease and a single intra-abdominal abscess were enrolled in this multicenter, international, retrospective study after the detection of the abscess (baseline), with a minimum follow-up of 12 months. Those requiring urgent bowel resection were excluded. Patients were grouped by elective surgical need after successful (catheter insertion with effective drainage) percutaneous drainage (controls: no pre-resection drainage). The primary outcome was abscess recurrence. We also assessed stoma rate, post-procedural complications, hospitalizations, advanced treatment need, postoperative luminal recurrence, and need for re-drainage. Results: We studied 157 patients with Crohn’s disease (9 countries; males: 58%, median age: 32.4 [interquartile range: 25–39 years]); 89/157 underwent percutaneous drainage (median follow-up: 95.9 weeks [interquartile range: 58–104]). Abscess recurrence did not differ by drainage (p = 0.221). Abscess size was associated with advanced-treatment initiation (Odds ratio: 0.978; 95% confidence interval: 0.960–0.997, p = 0.023) and postoperative luminal recurrence (Odds ratio: 1.044, 95% confidence interval: 1.012–1.078, p = 0.007). Time to resection was longer after drainage, and ROC analysis raised predictive value for re-drainage (16.6 weeks post-drainage; AUC = 0.82, 95% confidence interval: 0.73–0.92). Patients without drainage had more post-procedural complications. Conclusions: Abscess size should guide management. Delayed resection may increase re-drainage odds, whereas surgery alone may have higher complication rates. Percutaneous drainage can safely postpone resection. Full article

Extended-solvent steam-assisted gravity drainage (ES-SAGD) has emerged as a promising advancement over conventional SAGD for improving the efficiency and sustainability of in situ heavy oil and bitumen recovery. By co-injecting light hydrocarbon or alternative solvents with steam, ES-SAGD integrates thermal and compositional mechanisms to reduce viscosity, accelerate chamber development, and reduce steam–oil ratios. This review synthesizes the current state of knowledge on ES-SAGD, encompassing fundamental transport mechanisms, solvent selection and phase behavior, mass transfer dynamics, laboratory and physical modeling studies, numerical simulation approaches, and field-scale operational experiences. Experimental evidence consistently demonstrates substantial mobility enhancement through solvent-induced dilution, while compositional thermal simulations highlight an improved sweep efficiency and reduced energy intensity relative to steam-only processes. Field pilots further validate accelerated early-time production and significant steam savings, though challenges related to solvent retention, asphaltene stability, and reservoir heterogeneity persist. Key research gaps are identified in solvent transport prediction, formation damage risk, long-term solvent recovery, and integrated economic–environmental optimization. Overall, ES-SAGD offers a viable pathway toward lower-emission, higher-efficiency bitumen production, provided that solvent chemistry, reservoir complexity, and operational controls are carefully managed through continued research and targeted field deployment. Full article

Hollow auxetic structures enable lightweight mechanical design by reducing mass while preserving architected deformation. However, hollow auxetic studies focus on LPBF metals. This study presents a manufacturing-constrained design and validation framework for a hollow hybrid re-entrant chiral lattice produced by stereolithography. The unit cell was parameterised by chiral angle, re-entrant strut length, and hollow internal diameter, with drainage features integrated into the CAD model to preserve hollow channels during printing and post-processing. A minimum internal diameter study defined the printable design window. Within these limits, a central composite design coupled with finite element analysis mapped the response surface and identified an optimised geometry of θ = 15°, L = 3.5 mm, and d = 1.68 mm, with a predicted unit-cell negative Poisson’s ratio of about −1.17. Compression testing confirmed that the printed unit cell and 3 × 3 × 3 lattice retained the intended rotation-dominated auxetic deformation mode. At the selected comparison strain, the unit cell showed a negative Poisson’s ratio of −0.68 and the 3 × 3 × 3 lattice showed −0.29. Relative to the solid lattice, the hollow lattice reduced density by 42.4% with only a 3.0% reduction in stiffness, increasing specific stiffness by 68.9% and specific peak strength by 5.2%, but reducing specific energy absorption by 25.6% due to earlier localisation and junction driven fracture. These results provide practical design guidance for manufacturable hollow SLA auxetic lattices, especially for lightweight and stiffness-limited applications where low mass and high specific stiffness are more important than energy absorption. Full article

Objectives: To evaluate extrusion-free survival following glaucoma drainage device (GDD) surgery using EverPatch Plus^® (EPP) and to compare outcomes with conventional scleral patch grafts using propensity score-based survival analysis. Methods: This retrospective case series included 19 eyes that underwent GDD implantation with EPP and 105 control eyes that received conventional scleral patch grafts. To adjust for baseline differences between groups, a propensity score for EPP use was estimated using multivariable logistic regression incorporating age, neovascular glaucoma, prior glaucoma surgery, preoperative intraocular pressure, number of glaucoma medications, quadrant of patch placement, and insertion site. Stabilized inverse probability of treatment weighting was applied. Because follow-up in the EPP group did not exceed 12 months, all survival analyses were performed with administrative censoring at 12 months. Extrusion-free survival was evaluated using Kaplan–Meier analysis and Cox proportional hazards modeling. Results: Within 12 months, patch extrusion occurred in 3 of 19 eyes in the EPP group and in 12 of 105 eyes in the scleral patch graft group. After inverse probability weighting, estimated 12-month extrusion-free survival was 83.5% in the EPP group and 88.4% in the scleral patch graft group, indicating no statistically significant difference between groups (log-rank test, p = 0.498). In an inverse probability-weighted Cox model, EPP use was not significantly associated with extrusion risk (hazard ratio ≈ 1.3; 95% confidence interval ≈ 0.4–4.0). Conclusions: After adjustment for baseline covariates and restriction of follow-up to 12 months, extrusion-free survival following glaucoma drainage device surgery using EPP was comparable to that achieved with conventional scleral patch grafts. Full article

Background/Objectives: Cervical drainage has traditionally been used after thyroidectomy to reduce postoperative fluid accumulation and mitigate bleeding-related complications. However, advances in surgical technique, perioperative hemostasis, and postoperative care pathways have led to an increase in the use of short-stay and outpatient thyroidectomy, prompting renewed evaluation of the role of routine drainage. The objective of this systematic review and meta-analysis was to examine the association between postoperative cervical drainage and postoperative outcomes following thyroidectomy. Methods: A systematic literature search was conducted across PubMed/MEDLINE, Google Scholar, Semantic Scholar, and the Cochrane Central Register of Controlled Trials to identify studies comparing thyroidectomy with versus without cervical drainage. Studies published between January 2005 and January 2026 were eligible for inclusion. Randomized controlled trials and non-randomized comparative studies involving adult patients were included. The outcomes of interest were cervical hematoma, surgical site infection (SSI), seroma formation, postoperative bleeding, reoperation, and length of hospital stay. Random-effects meta-analyses were performed using odds ratios for binary outcomes and mean differences for continuous outcomes. Sensitivity and influence analyses were conducted to assess robustness. The results were additionally examined in prespecified sensitivity analyses restricted to randomized trials, and study-design-stratified estimates are presented. Results: Thirty studies comprising 2810 patients were included. Drain use was not statistically significantly associated with postoperative cervical hematoma (OR 1.28, 95% CI 0.93–1.75; p = 0.124). In contrast, drain use was associated with a significantly increased risk of surgical site infection (OR 2.04, 95% CI 1.46–2.85; p = 0.0002) and a significantly longer postoperative length of hospital stay (mean difference 1.96 days, 95% CI 0.42–3.50; p = 0.016). No statistically significant associations were observed between drainage and seroma formation (OR 0.95, 95% CI 0.70–1.30; p = 0.750), postoperative bleeding (OR 1.26, 95% CI 0.85–1.86; p = 0.228), or reoperation (OR 0.89, 95% CI 0.59–1.32; p = 0.525). Sensitivity and influence analyses demonstrated consistent results across analytical approaches and study designs. Conclusions: In thyroidectomy, routine cervical drainage is not associated with a reduction in bleeding-related complications and is associated with adverse recovery-related outcomes, including increased risk of surgical site infection and prolonged hospitalization. Overall, the findings indicate that routine cervical drainage after thyroidectomy offers no clear advantage in preventing postoperative complications and may be associated with adverse postoperative outcomes. Routine cervical drainage after thyroidectomy was not associated with a protective effect on complications and showed associations with less favorable recovery-related outcomes. Full article

Dredged Fill Soil, as a primary foundation material in reclamation projects, exhibits complex physical and mechanical properties, characterized by a high plasticity index, high water content, low density, high compressibility, large void ratio, and low bearing capacity. Its creep behavior is highly sensitive to temperature changes. This study systematically investigates the temperature-dependent creep behavior of reclaimed soil from Humen Port through laboratory experiments, theoretical modeling, and experimental validation. Triaxial creep tests conducted at different temperatures (5 °C, 15 °C, 25 °C, 35 °C) show that increasing temperature significantly exacerbates creep deformation: under undrained conditions, creep strain at 35 °C is nearly 300% higher than at 5 °C, while drainage reduces the strain by approximately 29.3%. Based on these results, a Burgers-type creep constitutive model considering temperature effects is developed, incorporating the impact of temperature on viscosity and elastic modulus. The model’s predictions show good agreement with the experimental results (15 °C: R² = 0.9788; 35 °C: R² = 0.9890), confirming the model’s validity. The research findings provide theoretical and practical references for the long-term stability evaluation and engineering design of reclaimed foundations in complex marine environments. Full article

Acidic mine drainage (AMD) poses a severe global environmental threat due to its high acidity and elevated levels of toxic hexavalent chromium (Cr(VI)), for which biogenic iron sulfide (FeS) nanoparticles have emerged as a promising remediation agent; however, their practical application is hindered by aggregation and oxidative deactivation. This research synthesized biogenic FeS nanoparticles via sulfate-reducing bacteria (SRB) and employed humic acid (HA) as a stabilizing agent to enhance Cr(VI) removal performance in simulated AMD conditions. Single-factor experiments combined with response surface methodology identified the optimal biosynthetic conditions for FeS: yeast extract powder dosage of 2.2 g/L, Fe/S molar ratio of 0.8, and NH₄Cl dosage of 3.1 g/L. Under these conditions, the material achieved 84.25% Cr(VI) removal, with the Fe/S molar ratio identified as the most influential parameter governing synthesis and performance. Introducing HA at an optimal dosage of 2 mg/L drove marked improvements in both nanoparticle yield and reactivity: FeS yield increased to 1096.26 mg/L, Cr(VI) removal efficiency reached 99.62%, and residual Cr(VI) dropped from 15.75 mg/L to just 0.38 mg/L. Kinetic and isotherm analyses, paired with SEM/TEM imaging and zeta potential measurements, revealed that HA stabilization improved particle dispersion and reduced lamellar stacking, resulting in a surface-controlled Cr(VI) removal process. FTIR and 2D-COS analyses demonstrated that HA-derived oxygen-containing functional groups, including O–H/N–H, C=O, and C–O moieties, played a central role in interfacial interactions during Cr(VI) sequestration. XRD results confirmed that Cr(VI) was reduced to Cr(III) and primarily immobilized as low-solubility CrOOH and Cr₂S₃, while the formation of Fe–Cr spinel-like phases remains tentative without X-ray Photoelectron Spectroscopy (XPS) validation. Further investigation via surface-sensitive spectroscopy and dynamic leaching tests is needed to fully assess the long-term stability of the reaction products. Full article

Soil salinization is a major challenge affecting crop yield in arid and semi-arid regions. Amendments to agricultural soil under drip irrigation represent a potential strategy to ameliorate soil salinization. This study conducted a field experiment over two years to identify the impacts of desulfurized gypsum, biochar, and straw on sunflower yield and soil characteristics in salinized and alkalized soil. Soil amelioration significantly improved soil characteristics by reducing saline–alkali stress at a 0–15 cm soil depth. Increased and decreased surface soil moisture and density of soil bulk were achieved by the second year, respectively, through the application of straw and biochar. These soil amendments also significantly decreased soil electrical conductivity and pH, and the application of biochar significantly reduced the sodium adsorption ratio (SAR refers to the adsorption ratio of sodium ions to other ions in soil) and Na⁺ by 32.1% and 34.7%, respectively, compared with drip irrigation alone. Application of desulfurized gypsum combined with drip irrigation decreased soil pH, SAR, and Na⁺ by 0.25, 41.6%, and 38.1%, respectively, compared with drip irrigation alone. The three soil amendments significantly increased sunflower yields by 51.2–80.0% in the second year, with the biochar treatment showing the most significant impact. The results showed that combined biochar and drip irrigation could play an important role in ameliorating soil salinization in the Hetao Irrigation Area, thereby contributing to increased crop yields and sustainable agriculture. However, given the relatively short experimental duration and the single location of this study, as well as the lack of long-term monitoring of salt balance and drainage conditions, further research with extended timelines, expanded geographic coverage, and focused assessment of salt dynamics is needed to confirm and generalize these findings. Full article

The constituent elements of source-to-sink systems and their coupling relationships are key controls on the development of sedimentary systems and the spatial distribution of sand bodies. Taking the Paleogene strata in the southern Laizhouwan Sag of the Bohai Bay Basin as a case study, we integrate drilling, logging, core, thin-section, and high-resolution 3D seismic data to quantitatively characterize basement lithology and effective provenance area, drainage-unit subdivision, types and scales of sediment transport pathways, and geometric parameters of depositional fans, within a source-to-sink analytical framework. The results show that: (1) Two distinct provenance types are developed in the southern Laizhouwan Sag, including Proterozoic granitic–gneissic basement and Mesozoic volcanic–clastic basement. These provenance types exhibit pronounced differences in effective source area, vertical relief, and drainage-network configuration across different sequence stages. (2) Two main categories of sediment transport pathways are identified, namely paleo-valleys and fault-controlled troughs. V-shaped, U-shaped, and W-shaped paleo-valleys show systematic morphological transitions along topographic gradients. The width-to-depth ratio of transport channels exerts a significant control on depositional fan scale, with U-shaped valleys exhibiting the highest sediment transport efficiency. Finally, (3) the depositional domain is dominated by near-source fan-delta systems, whose scale shows a strong positive correlation with effective provenance area and transport-channel morphology. Overall, the southern Laizhouwan Sag is characterized by a typical fault-controlled, steep-slope source-to-sink system, in which sedimentary system distribution is jointly governed by effective provenance area, sediment transport pathway geometry, and fault-related slope-break zones. This study provides a quantitative example and methodological reference for source-to-sink system characterization and prediction of favorable sand body distribution in continental rift basins. Full article

Background/Objectives: Deep neck space abscesses (DNSAs), representing severe suppurative infections, continue to pose a significant global health challenge due to their morbidity, mortality, and evolving epidemiology. This review synthesizes existing knowledge regarding DNSA definitions, anatomic basis, epidemiological trends, microbiology, clinical presentation, diagnostic strategies, treatment paradigms, outcomes, health system challenges, and disparities to guide global efforts in DNSA prevention, management, and research. Methods: A structured narrative review was performed following SANRA guidelines. PubMed/MEDLINE and the Cochrane Library were searched from January 2000 to May 2025, retrieving 1102 records. After screening, 49 studies met the inclusion criteria. Data were extracted using standardized templates and synthesized thematically. Results: During the period 2004–2015, annual case increases were reported in a Finnish population-based retrospective cohort (n = 277), going from 14 to 24 subjects, and for a UK tertiary center retrospective series, going from 1 to 15 cases annually (2006–2015) (Pearson’s correlation, r = 0.9; p = 0.00019). The microbiological environment is mostly polymicrobial, composed of group streptococci and staphylococcus strains and anaerobes. Factors associated with poor outcomes include diabetes mellitus (adjusted hazard ratio of 10.7 [95% CI 6.0–19.1] in a retrospective, population-based cohort of 12,738 diabetic patients compared to 50,952 individuals without diabetes), immunosuppressed state, elderly age, and multispace involvement. Diagnosis relies on contrast-enhanced CT imaging (sensitivity > 90%), and treatment consists of early multidisciplinary intervention combining empiric broad-spectrum antibiotics with surgical drainage in 60–97% of cases. Mortality ranges from 1.6% to 7.6%, with higher rates in cases complicated by mediastinitis (up to 40%). Conclusions: DNSAs demonstrate a clear upward incidence trend across high-income and resource-limited settings. Establishing standardized DNSA registries, validating risk-stratification tools, reinforcing antimicrobial stewardship to address rising resistance, and implementing early detection protocols in primary care remain critical priorities. While emerging technologies, including rapid molecular diagnostics and AI-based decision support, represent promising research directions, current DNSA management relies fundamentally on conventional clinical assessment, prompt imaging, and coordinated multidisciplinary care. Full article

The Upper Mono Basin Valley (UMBV) in Togo faces recurrent flooding hazards. This study assesses spatial flood susceptibility using an integrated approach combining Geographic Information Systems (GISs), Multi-Criteria Decision Making (MCDM), and the Analytic Hierarchy Process (AHP). Eight factors were weighted according to their influence: accumulation flow, annual precipitation, soil permeability, land use/land cover, slope, elevation, distance from drainage networks, and drainage network density. With a consistency ratio of 0.052, the AHP method proved coherent and enabled the development of a normalized Flood Hazard Index (FHI). Results revealed accumulation flow (weight = 0.33), distance to drainage networks (0.18), and network density (0.16) as the most critical drivers, while precipitation and soil permeability are secondary. Spatial classification revealed heterogeneity: 55% (871,046 ha) of the UMBV has very low susceptibility, while 1% (10,034 ha) is highly vulnerable, mainly in Est-Mono, Ogou, Anié, Tchamba, and Tchaoudjo. In contrast, Blitta and Sotouboua show lower vulnerability due to higher altitudes. This reveals that the UMBV is relatively less prone to flooding. The comparison of data from 28 focus groups in 14 municipalities with the flood susceptibility map shows a strong concordance between local perceptions and the mapping (r = 0.805, p < 0.001). These findings highlight the need for differentiated territorial strategies integrating physical parameters, land use dynamics, and community risk perceptions to strengthen flood risk management in the UMBV. Full article

Background: After a failed endoscopic retrograde cholangiopancreatography (ERCP) for malignant biliary obstruction (MBO), second-line drainage is performed with endoscopic ultrasound-guided biliary drainage (EUS-BD) or percutaneous transhepatic biliary drainage (PTBD). We compared their effectiveness, safety, and short-term survival. Methods: We conducted a single-center retrospective cohort of 101 adults with MBO after they had experienced a failed ERCP (EUS-BD n = 37; PTBD n = 64). Allocation was non-randomized and driven by operational availability. Baseline laboratory tests (complete blood count, platelets, and C-reactive protein) and derived indices (neutrophil-to-lymphocyte ratio [NLR], platelet-to-lymphocyte ratio [PLR], lymphocyte-to-monocyte ratio [LMR], systemic immune-inflammation index [SII], systemic inflammation response index [SIRI], neutrophil-to-platelet score [NPS], and lymphocyte-to-CRP ratio [LCR]) were compared. Outcomes that were a technical success include: an early biochemical response (bilirubin reduction), complications (Clavien–Dindo), length of stay (LOS), and overall survival (OS). Between-group comparisons used the two-sided Mann–Whitney U test (continuous) and Fisher’s exact (binary) test. Survival was assessed by the Kaplan–Meier estimator using log-rank testing. To address later adoption of EUS-BD, we also estimated a restricted mean survival time of 180 days (RMST_0–180) with 95% confidence intervals (CIs). Results: Baseline inflammatory markers and composite indices were similar; baseline total bilirubin was higher in PTBD. The technical success was 100% in both groups. Early biochemical response was 86.5% after EUS-BD vs. 78.1% after PTBD (p = 0.43). Any complication occurred in 29.7% vs. 12.5% (p = 0.04); major complications (Clavien–Dindo ≥ III) occurred in 10.8% vs. 0% (p = 0.02), respectively; and the LOS did not differ (p = 0.21). OS favored EUS-BD (median 143 vs. 54 days and log-rank p = 0.012). RMST_0–180 was 111.1 days for EUS-BD vs. 71.4 days for PTBD (difference + 39.6 days; 95% CI 11.3–65.9). Conclusions: After a failed ERCP for MBO, EUS-BD and PTBD achieved universal technical success and similar early biochemical responses, but EUS-BD was associated with higher complication rates and a significantly longer six-month survival. These findings support the individualized selection balancing procedural risk with the anticipated survival benefit and highlight the need for prospective comparative studies. Full article