Search Results (21,279)

Background/Objectives: Pneumonia remains a leading cause of emergency department visits worldwide, requiring rapid and objective risk stratification. While traditional scoring systems like CURB-65 and the Pneumonia Severity Index (PSI) are well-established, there is a constant need for dynamic biomarkers reflecting the underlying pathophysiology. This study aims to investigate the prognostic value of the hemoglobin-to-lactate ratio (HLR) in predicting mortality among pneumonia patients. Methods: This retrospective cohort study included 183 adult patients diagnosed with pneumonia at a tertiary training and research hospital between October 2024 and November 2025. Demographic data, clinical findings, laboratory parameters, and prognostic scores (CURB-65, PSI) were recorded. The impact of HLR on mortality was evaluated using univariate and multivariate logistic regression, while its predictive performance was assessed via Receiver Operating Characteristic (ROC) analysis and compared with clinical scores using DeLong’s method. Results: The overall mortality rate was 32.8%. HLR values were significantly lower in the exitus group compared to survivors (4.68 vs. 6.92, p < 0.001). Multivariate analysis revealed that an HLR ≤ 5.65 was an independent predictor of mortality, associated with a 10-fold increase in risk (OR: 10.0; 95% CI: 4.15–24.19; p < 0.001). HLR demonstrated high predictive power (AUC = 0.802), comparable to CURB-65 (AUC = 0.807) and PSI (AUC = 0.829). Notably, the combined HLR + CURB-65 model provided the highest diagnostic accuracy (AUC = 0.857, p = 0.037). Conclusions: HLR is a low-cost and easily accessible biomarker for predicting mortality in pneumonia. It effectively reflects the physiological balance between tissue oxygenation and metabolic failure. Integrating HLR into clinical practice, particularly when combined with traditional scores, can enhance risk (decision of discharge, admission unit [ward, ICU], evaluation of prognosis) in the emergency department. Full article

Background: Chronic pain remains a primary driver of global disability and impaired quality of life. While digital conversational agents (CAs) have emerged as scalable tools for symptom monitoring and self-management via patient-reported outcome measures, their clinical efficacy remains poorly synthesized. This systematic review and meta-analysis aimed to evaluate the impact of CA-based interventions on PROMs in adults with chronic pain. Methods: A systematic review and meta-analysis was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched from inception to 22 October 2025. Eligible studies were RCTs including adults with chronic pain and evaluating fully automated CA interventions, such as digital coaching or messaging programs. PROMs related to pain, well-being, disability, and work-related outcomes were extracted. Continuous outcomes were synthesized using standardized mean differences (SMDs) with 95% confidence intervals (CIs). Results: Five RCTs involving 572 participants were included. Interventions were self-guided, digitally delivered, and lasted 4 to 12 weeks. The overall pooled analysis suggested a potential benefit of CA-based interventions on PROMs (SMD = −0.43; 95% CI −0.55 to −0.31; p < 0.00001), although heterogeneity and risk of bias across studies warrant cautious interpretation. Improvements were observed particularly in pain intensity, although evidence for other outcomes was less consistent, with some studies reporting benefits in quality of life, fear of movement, and well-being. Conclusions: CA-based interventions may have potential as adjuncts in chronic pain management; however, the current evidence is limited and should be interpreted with caution due to heterogeneity and risk of bias across studies. These tools may represent a scalable solution for supporting remote symptom monitoring and self-management within digital health frameworks, although further high-quality evidence is required. Full article

Objective: Atherosclerotic renal artery stenosis (ARAS) is increasingly prevalent among aging populations and in patients with diabetes, hyperlipidemia, aortoiliac obstructive disease, coronary artery disease, and/or hypertension. Patients with severe ARAS are at a substantially elevated risk of cardiovascular disease, recurrent congestive heart failure, stroke, ischemic nephropathy, and chronic kidney disease. Therefore, the ARAS-TR study aims to evaluate the effect of renal artery stenting on the clinical outcomes in patients with severe ARAS and renovascular hypertension. Materials: This study was conducted as a multicenter, prospective study between July 2024 and September 2025. It encompassed 278 patients with angiographically confirmed severe ARAS who underwent renal artery stent implantation. Patients were subsequently monitored for 6 months. A paired-samples t-test was used to compare continuous variables pre- and post-intervention, while categorical variables were analyzed using the Pearson chi-square test and Fisher’s exact test. Results: The mean age of the patients was 63.6 [±13.4] years, and the male gender ratio was 52.5%. After renal artery stenting, systolic and diastolic blood pressures decreased significantly at the 6-month follow-up compared with the pre-procedure levels (SBP 166.99 [21.24] vs. 135.40 [15.69], p < 0.001; DBP 96.28 [13.03] vs. 80.39 [11.03], p < 0.001, respectively). GFR (61.23 [28.33] vs. 63.35 [26.36], p = 0.029) and creatinine (1.40 [0.93] vs. 1.29 [0.66], p = 0.004) levels improved compared to baseline. The mean number of antihypertensive drugs required for patients to remain normotensive decreased significantly (3.19 [1.04] vs. 2.48 [1.13], p < 0.001) during the follow-up period. Conclusions: Percutaneous renal artery intervention appears to be a promising and safe strategy for carefully selected high-risk patients presenting with severe ARAS, renovascular hypertension, and non-atrophic kidneys. In this specific clinical context, restoring renal artery patency through percutaneous stenting was associated with improved renal function and observed reduction in the burden of antihypertensive drugs required to sustain normotension. Full article

Metabolic reprogramming is closely linked to tumor proliferation, invasion, and immune escape. Despite its central role in amino acid metabolism, the regulatory mechanisms of asparagine metabolism in hepatocellular carcinoma (HCC) progression remain poorly characterized. Rather than focusing on canonical metabolic genes, prognostic markers were identified from co-expression modules associated with asparagine metabolism signatures. Using the TCGA database and asparagine metabolism-related gene sets, a prognostic risk-scoring model was developed through differential expression analysis, univariate Cox regression, and the LASSO algorithm and externally validated with the GEO dataset (GSE14620). Survival analysis, ROC curve evaluation, nomogram construction, scRNA-seq, GSEA, and drug sensitivity analysis were performed to systematically delineate the molecular mechanisms by which asparagine metabolism drives HCC progression. A three-gene signature comprising BOP1, SAC3D1, and PDE2A effectively stratified patients into high- and low-risk groups. High-risk patients exhibited markedly poorer overall survival, enrichment in tumor proliferation-associated pathways, increased tumor purity, reduced immune cell infiltration, and a substantially higher TP53 mutation rate (38% vs. 13%). In contrast, the low-risk group showed enrichment in pathways linked to hepatoblastoma suppression and liver function, alongside improved predicted response to immunotherapy. Single-cell analysis identified NK cells and endothelial cells as central mediators of asparagine metabolism-driven HCC progression, with BOP1, SAC3D1, and PDE2A displaying dynamic expression patterns during differentiation. Furthermore, the high-risk group was predicted to be more sensitive to chemotherapeutics such as cyclophosphamide and 5-fluorouracil. These findings highlight a potential interplay between nitrogen metabolism and asparagine metabolism in HCC and suggest mechanisms by which these pathways may influence NK cell and endothelial cell function to promote disease progression. This study establishes a novel prognostic model and identifies potential chemotherapeutic vulnerabilities in high-risk patients, warranting further experimental and clinical validation. Full article

Background: Lung adenocarcinoma is morphologically heterogeneous, composed of various histological patterns. The International Association for the Study of Lung Cancer (IASLC) grading system, based on the predominant pattern and the presence of high-grade components, underscores this heterogeneity’s prognostic relevance. However, the specific impact of the non-predominant “second component” on survival outcomes in early-stage disease remains inadequately characterized. Methods: We conducted a retrospective, single-center study including 95 patients with pathological stage 0, I, and II (TNM 8th edition) lung adenocarcinoma who underwent complete anatomical resection (lobectomy or segmentectomy) between January 2020 and December 2021. Histopathological evaluation followed the WHO 5th edition classification, with patterns quantified in 5% increments. The second predominant component was defined as the second most represented histological pattern, irrespective of a fixed percentage threshold. Overall survival (OS) and disease-free survival (DFS) were analyzed. Results: A second predominant component was identified in 55 patients (57.9%). The most common second components were lepidic (30.5%), solid (18.9%), and micropapillary (10.5%). With a median follow-up of 36 months, the presence of a lepidic second component was an independent factor for improved OS (Hazard Ratio [HR] 0.70, 95% CI 0.52–0.95, p = 0.022) and DFS (HR 0.62, 95% CI 0.41–0.93, p = 0.021). Conversely, a micropapillary second component was a strong independent predictor of worse OS (HR 1.81, 95% CI 1.24–2.64, p = 0.002) and DFS (HR 2.03, 95% CI 1.32–3.12, p = 0.001). The solid second component showed an intermediate adverse effect on DFS (HR 1.45, 95% CI 1.01–2.08, p = 0.043). Conclusions: The second predominant histological pattern provides additional prognostic information beyond the IASLC grading system and may improve postoperative risk stratification in early-stage lung adenocarcinoma. A lepidic second component portends a favorable prognosis, while micropapillary and solid components denote aggressive tumor biology and higher recurrence risk. Incorporating the evaluation of second components into routine pathological reporting and clinical decision-making could enhance postoperative risk stratification and personalize adjuvant therapy strategies. Full article

Peripheral artery disease (PAD) is found in 10.9% of patients with ischaemic stroke (IS). This cross-sectional study was performed to investigate the prevalence of PAD and its risk factors among acute IS patients in Singapore. Patients admitted for IS were recruited. Data was collected on sex, age, body mass index (BMI), history of hypertension, diabetes mellitus (DM), hypercholesterolaemia, cigarette smoking, prior stroke (PS) and ischaemic heart disease (IHD). IS was classified as a lacunar infarct (LI) or non-lacunar infarct (NLI) based on neuroimaging. Carotid intima–medial thickening (IMT) and carotid plaques (CP) were determined by ultrasonography. The ankle–brachial Index (ABI) was calculated in both lower limbs; PAD was diagnosed if the ABI was ≤0.9 in any limb. The estimated sample size was 150 subjects. In total, 150 subjects were recruited; the mean age was 62.7 ± 10.2 years, 44.7% were female, and the mean BMI was 24.1 ± 4.1. A total of 63.3% reported hypertension, 42.7% DM, 30.0% hypercholesterolaemia, 38.0% smoking, 18.7% PS, and 6.0% IHD. A total of 30.7% had IMT, 77.3% had CP, and 8.0% had carotid stenosis ≥50%. LI occurred in 64.7%. PAD was diagnosed in 22.0% (95% CI 16.1–29.3). On univariate analysis, based on vascular risk factors alone, PAD was associated with age (p = 0.03), hypercholesterolaemia (p = 0.03), and IHD (p = 0.004). On logistic regression, PAD was only associated with IHD (aOR 6.42, 95% CI 1.25–32.84; p = 0.03). When IMT and CP were added to the model, the association with IHD remained (aOR 5.45, 95% CI 1.03–28.71; p = 0.045). When the results of neuroimaging were added, the association was only with NLI (aOR 2.78, 95% CI 1.09–7.14; p = 0.03). This study found a high prevalence of PAD among Asian patients with IS. It was associated with a non-lacunar infarction. Full article

Background: Prehabilitation aims to optimise patients before cardiac procedures through interventions including exercise training, respiratory conditioning, nutritional support, psychological preparation and multimodal lifestyle programmes. Evidence from systematic reviews and meta-analyses is increasing but remains heterogeneous due to variation in intervention design, patient populations and overlap of primary studies. Methods: We conducted an umbrella review of 17 systematic reviews and meta-analyses evaluating prehabilitation prior to cardiac surgery and structural heart interventions in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality of included reviews was assessed using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Outcomes of interest were postoperative pneumonia, hospital length of stay (LOS), and mortality. Results: Across pooled analyses, the most consistent finding was a reduction in postoperative pneumonia, particularly in studies incorporating inspiratory muscle training (IMT), with relative risk reductions of approximately 55–62%, corresponding to a modest absolute risk reduction. Reductions in hospital LOS were also reported, although effect sizes were smaller and more variable. In contrast, no consistent reduction in short-term mortality was demonstrated, likely reflecting low event rates. The evidence base was limited by substantial overlap between reviews and predominantly low or critically low methodological quality. Conclusions: Prehabilitation, particularly when incorporating IMT, is consistently associated with a reduction in postoperative pneumonia and may contribute to modest reductions in hospital LOS. However, the evidence base is constrained by heterogeneity, study overlap and low methodological quality. Further high-quality, adequately powered randomised trials are required to define the role of prehabilitation in contemporary cardiac surgical and structural intervention practice. Full article

Background: Dysplasia or absence of anterior communicating artery (ACoA) is a common variation in the circle of Willis (COW) anomaly, and it may elevate the risks of cerebrovascular diseases. We aimed at investigating the association of ACoA dysplasia/absence with plaque imaging features of middle cerebral artery (MCA) atherosclerosis. Methods: We analyzed the prospective data from a vessel wall imaging cohort of adult patients suffering from acute ischemic stroke or transient ischemic attack due to intracranial atherosclerosis (2014 to 2020). Patients demonstrating MCA atherosclerotic plaques were included. The ACoA dysplasia/absence and other incomplete COW configurations were identified on magnetic resonance angiography. The MCA plaques were evaluated through high-resolution vessel wall imaging. Results: Of the 107 patients with MCA atherosclerosis, 29.9% showed ACoA dysplasia/absence. The patients with ACoA dysplasia/absence were more likely to have concomitant dysplasia/absence of anterior cerebral artery (71.9% vs. 18.7%, p < 0.001). For the 158 MCA plaques identified, those with ACoA dysplasia/absence exhibited a significantly higher prevalence of symptomatic status (58.7% vs. 31.3%, p = 0.001) and non-positive remodeling (58.7% vs. 26.8%, p < 0.001) than those without this variant. Regression analyses further demonstrated the robust association of ACoA dysplasia/absence with symptomatic status (odds ratio, 5.158; 95% confidence interval, 1.744–15.254; p = 0.003) and non-positive remodeling (odds ratio, 6.92; 95% confidence interval, 2.396–19.982; p < 0.001) of MCA atherosclerosis. Conclusions: As a common variation among patients with MCA atherosclerosis, ACoA dysplasia/absence may elevate the possibility to develop symptomatic MCA atherosclerosis, which showed non-positive remodeling. Stroke risk stratification based on the ACoA morphology needs further validation. Full article

Small-cell lung cancer (SCLC) is an aggressive neuroendocrine carcinoma characterized by poor survival. Despite a high tumor mutation burden, biomarker discovery in SCLC remains challenging due to rapid tumor plasticity and limited tissue availability, highlighting the promise of liquid biopsy-based approaches. Epigenetic dysregulation of DNA 5-hydroxymethylcytosine (5hmC) has emerged as a cancer hallmark. However, its role in SCLC remains largely unexplored. Here, we characterized the cell-free DNA (cfDNA) 5hmC landscape in SCLC and evaluated its potential applications. We profiled the cell-free hydroxymethylomes of 107 pre-treatment SCLC patients and 53 matched controls using the 5hmC selective chemical labeling (5hmC-Seal) assay. SCLC displayed higher global 5hmC levels and distinct enrichment at neurodevelopmental and synaptic pathways, consistent with the neuroendocrine identity of SCLC. Concordance between plasma and matched circulating tumor cell patient-derived xenograft (CDX) demonstrated that cfDNA 5hmC reflects tumor epigenetic states and correlates with transcriptomic-derived molecular subtypes. Elevated SCLC-specific 5hmC levels and extensive stage (ES) disease were associated with inferior survival, with ES disease showing enrichment of pathways linked to cellular plasticity and neurodevelopment. Together, these findings indicate that cfDNA 5hmC profiling has potential as a biologically informative and clinically relevant biomarker in SCLC, with possible applications in tumor subtyping and risk stratification. Full article

Background: Anticoagulation management in very elderly patients with atrial fibrillation (AF) is particularly challenging due to the coexistence of high thromboembolic and bleeding risks, often compounded by multiple comorbidities. Randomized clinical trials rarely include patients aged ≥85 years, leaving important gaps in our understanding of how anticoagulant therapies are selected in this growing population. Methods: We analyzed data from the CRAFT registry, including 2914 patients hospitalized with AF. Patients were stratified into two age groups: <85 years (n = 2322) and ≥85 years (n = 592). Baseline clinical characteristics, comorbidities, and laboratory parameters were compared between groups. Separate multivariable logistic regression analyses were performed for each age group to identify independent predictors of anticoagulant therapy selection. Results: Patients aged ≥85 years exhibited a distinct clinical profile, characterized by higher thromboembolic risk and a greater prevalence of heart failure, renal dysfunction, anemia, and structural heart disease. Renal function was significantly impaired (median eGFR 47.6 vs. 60.0 mL/min; p < 0.001), while NT-proBNP levels were higher and hemoglobin levels lower in this group. Multivariable analysis revealed clear age-related differences in determinants of treatment selection. In patients < 85 years, anticoagulant choice was influenced by multiple clinical factors, including CHA₂DS₂-VA score, renal function, bleeding risk, coronary artery disease, and prior revascularization. In contrast, in patients ≥ 85 years, only two independent predictors remained significant: thromboembolic risk (CHA₂DS₂-VA score; OR 1.34, 95% CI 1.11–1.64) and renal function (eGFR; OR 0.64, 95% CI 0.47–0.89). Anticoagulation in this group was predominantly based on reduced-dose DOACs, with apixaban used most frequently. Conclusions: Very elderly patients with AF represent a clinically distinct, high-risk population. While anticoagulant selection in younger elderly patients reflects a multifactorial decision process, treatment in those aged ≥85 years appears to rely primarily on thromboembolic risk and renal function, suggesting a more streamlined—and potentially oversimplified—approach. Full article

Background/Objectives: Percent achieved of predicted peak exercise oxygen uptake (%VO_2pred) is a prognostic factor for patients with Fontan circulation. The main purpose of this study was to determine predictors of higher %VO_2pred in a cohort of adult Fontan patients. Methods: Medical records of 50 adult Fontan patients who underwent cardiopulmonary exercise testing were reviewed. All patients were divided into two groups according to the mean value of %VO_2pred and, in separate analysis, according to the morphology of the systemic ventricle. Spearman’s rank correlation was used to examine the relationship between %VO_2pred and blood biomarkers. Regression analyses were used to identify predictors of %VO_2pred. Results: The median age of all patients was 22 years, and 50% were female. The systemic ventricle was dominant right in 23 patients. Negative correlations were found between %VO_2pred and N-terminal prohormone of brain natriuretic peptide, mean cell hemoglobin concentration, and ferritin, and positive correlations were found between %VO_2pred and total protein, total iron-binding capacity. Higher chronotropic index [CI] (β = 0.31; p = 0.009), higher maximal diastolic blood pressure during CPET [DBP_max] (β = 0.4; p = 0.001), and lower serum concentration of high-sensitivity troponin T [hsTnT] (β = −0.31; p = 0.007) were significantly and independently associated with %VO_2pred. Conclusions: Higher CI and DBP_max and lower hsTnT were identified as independent predictors of %VO_2pred in this cohort. These findings suggest that the absence of chronotropic incompetence is a positive predictor of exercise capacity. Furthermore, hsTnT shows potential as a useful biomarker in this population. Further studies are needed to validate these parameters for clinical assessment and risk stratification in Fontan patients. Full article

Background: Chronic lymphocytic leukemia (CLL) is a biologically heterogeneous disease characterized by variable clinical outcomes. The introduction of targeted therapies, particularly the BCL-2 inhibitor venetoclax, has significantly improved treatment outcomes in patients with relapsed/refractory (R/R) CLL. However, real-world data on the safety and effectiveness of venetoclax-based regimens remain limited. Methods: In this multicenter retrospective study, 147 adult patients with R/R CLL treated with venetoclax between April 2019 and August 2025 were analyzed. Venetoclax was administered as monotherapy or in combination with rituximab, obinutuzumab, or ibrutinib. Adverse events were graded according to CTCAE v4.0, and treatment responses were assessed based on IWCLL criteria. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were evaluated using Kaplan–Meier analysis. Results: The median age at venetoclax initiation was 64 years, and patients had received a median of two prior lines of therapy. Combination therapy was administered in 78.9% of patients. The overall response rate was 83.0%, including complete remission in 65.3% of patients. Grade ≥ 3 hematologic adverse events included neutropenia (18.4%), thrombocytopenia (14.3%), and anemia (7.5%). Tumor lysis syndrome (TLS) occurred in 28.6% of patients, predominantly during the dose ramp-up phase. At a median follow-up of 61 months, median OS and PFS were both 60 months. Bulky disease was associated with inferior survival outcomes. Conclusions: Venetoclax-based therapy is effective and well tolerated in patients with R/R CLL in a real-world setting. High response rates and durable survival outcomes were observed despite the inclusion of patients with high-risk clinical and biological features. These findings support the use of venetoclax as a key component of modern CLL treatment strategies and highlight the importance of real-world evidence in optimizing patient management. Full article

Background/Objectives: Neuroblastoma is the most frequent solid tumor outside the brain in children and is associated with unfavorable outcomes in high-risk patients. Tannic acid, a naturally occurring polyphenolic compound, has been reported to exhibit anticancer activity; however, its molecular effects in neuroblastoma remain incompletely characterized. The present study aimed to evaluate the antiproliferative effects of tannic acid in SH-SY5Y neuroblastoma cells and to explore its potential associations with Toll-like receptor (TLR) signaling and selected microRNAs in an exploratory and correlative manner. Methods: Cell viability was assessed using the CCK-8 assay, which showed that tannic acid was associated with reduced cell proliferation in a dose- and time-dependent manner. Changes in the expression of TLR-related genes and selected microRNAs were analyzed by real-time PCR. TLR-4, NF-κB, and Caspase-3 protein concentrations were determined using ELISA assays. Results: Tannic acid treatment was associated with decreased expression of several TLR genes, with statistically significant reductions observed in TLR2, TLR4, and TLR7. Consistently, protein analyses indicated reduced NF-κB levels. MicroRNA analysis revealed a tendency toward increased expression of hsa-miR-146a-5p, whereas no significant changes were detected in other examined microRNAs. Conclusions: Overall, these findings suggest that tannic acid exhibits antiproliferative activity in SH-SY5Y cells and is associated with alterations in TLR-related gene expression and microRNA profiles. However, these observations are descriptive and correlative in nature and do not establish direct mechanistic relationships. Further in vivo and functional studies are required to validate these findings and to clarify their potential biological and therapeutic relevance. Full article

Background: Dry eye disease (DED) is a multifactorial disease. Numerous risk factors might cause DED, including indoor air pollution, such as incense. Incense (Bakhoor) is widely used in many cultures, including Saudi Arabia, although its smoke contains toxic chemicals that pose serious health hazards. This research investigates the link between the Schirmer II test and tear fluid proteins in DED patients. The study focuses on identifying the ocular examinations, hypothesizing that incense smoke, particularly from synthetic types, exacerbates DED. Methods: This pilot cross-sectional study was conducted at King Abdulaziz Medical City (KAMC) in Jeddah, Saudi Arabia. Participants were recruited from the Cornea and Ophthalmology Clinics. Eye assessments analyzed tear protein concentrations, including tear collection using Schirmer II test strips and tear break-up time (TBUT). The study included DED patients who used incense. Tear fluid from the Schirmer test of 20 randomly selected patients was used for protein analysis of total protein, lactoferrin, and Immunoglobulin E. Inclusion criteria were male and female subjects aged 18 years or older, diagnosed with DED, and using incense. The sample size was 55 participants, selected via convenience sampling. Subjective data were collected through questionnaires, as well as objective data from the tear test and the sample and analyzed with SPSS. Descriptive and inferential statistics were used, with statistical significance set at p-value < 0.05. Results: The Ocular Comfort Index (OCI) categories showed that 21.8% had no symptoms, 40.0% had low symptoms, 30.9% had moderate symptoms, and 7.3% reported high symptoms. TBUT values and Schirmer test scores decreased with increasing OCI severity, with no statistical significance. The mean (SD) of total protein in the right and left eyes for high OCI was 7.19 (1.39) and 7.42 (0.91), respectively, with no statistical significance. The immunoglobulin E levels in the right and left eyes for high OCI were 301.71 (55.97) and 301.71 (47.14), respectively, with no statistical significance. The mean (SD) of lactoferrin in the right and left eyes for high OCI was 163.77 (10.42) and 159.43 (1.68), respectively, with no statistical significance. Conclusions: The study findings demonstrate alignment in incense-using patients between subjective OCI symptom scores and objective clinical diagnostic measures. Specifically, higher OCI scores are associated with lower TBUT and Schirmer II test values, as well as changes in tear biomarkers such as IgE and lactoferrin. These findings emphasize the potential of using simple screening methods combined with bioanalytical markers for early detection of ocular surface disease. This highlights the potential health risks associated with incense exposure, particularly for individuals predisposed to DED. The urgency for further research to explore the long-term effects of incense on ocular health and to raise awareness about its potential impact on populations with high incense usage cannot be overstated. Full article

Background/Objectives: Early progression (EP) occurs in a subset of patients with locally advanced pancreatic cancer (LAPC), limiting the clinical benefit of treatment, and it remains difficult to predict. Methods: We developed a multiparametric predictive model integrating baseline ¹⁸F-FDG PET/CT radiomic features with clinical and biological data. A total of 242 radiomic features were extracted from each imaging modality (CT and PET), including first-order, gray-level co-occurrence matrix (GLCM), and local binary pattern (LBP-TOP) features, and combined with PET-derived metrics and clinical variables. Model development included cross-validation procedures and rigorous feature selection, followed by the training of a two-level decision tree classifier. Results: The model achieved an accuracy of 80.7% and an area under the curve (AUC) of 0.83. Integrated analysis of CT and PET texture enabled the identification of patients at high risk of EP prior to treatment initiation. Conclusions: PET/CT-based radiomic biomarkers, combined with clinical data, can non-invasively capture tumor heterogeneity and improve risk stratification in LAPC, supporting more personalized therapeutic decision-making. Full article