Search Results (1,742)

The Oncotype DX^® 21-gene recurrence score (RS) guides adjuvant chemotherapy decisions in estrogen receptor-positive, human epidermal growth factor receptor 2-negative (ER+/HER2−) breast cancer, yet requires invasive tissue sampling and involves substantial costs. This study evaluated intratumoral tumor ecological diversity (iTED), a habitat imaging approach, as a non-invasive complement for predicting Oncotype DX^® high-risk classification (RS > 25). This retrospective multi-center study included 312 patients with ER+/HER2− invasive breast cancer who underwent Oncotype DX^® testing (development: n = 168; external validation: n = 144). The iTED framework employed superpixel-based habitat determination using Gaussian mixture models on pretreatment dynamic contrast-enhanced MRI. Four predictive models were compared: clinical, conventional whole-tumor radiomics (C-radiomics), iTED, and combined (Clinical + iTED). The iTED model achieved higher discriminative performance compared with C-radiomics in both development (area under the curve [AUC]: 0.868 ± 0.068 vs. 0.730 ± 0.112) and external validation (AUC: 0.811 vs. 0.587) sets. The combined model further improved performance (development AUC: 0.908 ± 0.043; external AUC: 0.889). Habitat imaging-based iTED features achieved numerically higher performance than conventional radiomics in predicting Oncotype DX^® high-risk classification. These findings suggest the potential of iTED as a non-invasive imaging biomarker to support molecular testing in clinical decision-making. Full article

The non-invasive determination of live weight and body composition of ewes is an important element in ensuring precision livestock management and animal well-being. Traditional practices tend to be subjective, labor-intensive, or rely on expensive medical imaging such as Computed Tomography (CT). This paper proposes a new hybrid deep learning method to predict live weight and carcass traits in Coopworth ewes. The dataset of 1184 images taken from 156 ewes was analyzed and compared using a hybrid model (ResNet18 with Multi-Layer Perceptron through simple concatenation) and two more advanced models: Attention-Guided Feature Fusion Network (AGFF-Net) based on cross-modal attention and a Vision Transformer-based Hybrid Regressor (ViT-HR). Auxiliary tabular variables are the Body Condition Score (BCS) and size category. The Transformer architecture predicts (R² = 0.93) the live weight of ewes by dynamically ranking each visual patch and asking it to query the self-attention sequence. This technique treats the BCS as a distinct token in the self-attention sequence. Data partitioning at the animal level was stringent, thereby giving strong generalization. Findings indicate that the best advanced fusion systems are far better than baseline concatenation, with a high accuracy confirmed with gold standards obtained by CT. Grad-CAM visual explainability makes sure that models are able to localize biologically relevant anatomical locations successfully. The study closes the gap between complex deep learning models and real-world agriculture implementation to provide a correct, interpretable and scalable solution to real-time livestock measurements. Full article

Background. Preoperative risk stratification of pancreatic neuroendocrine tumors (PNETs) is constrained by the unavailability of histologic grade before resection. We hypothesized that a panel of biologically informed CT-radiomic signatures, combined with patient-level Δ-radiomics referenced to the contralateral pancreas, would support preoperative discrimination of progression and grade in a two-center pilot cohort. Methods. Forty-four patients with histologically confirmed PNET who underwent contrast-enhanced preoperative CT and surgical resection at two academic centers were analyzed. Lesion and contralateral non-tumor-bearing pancreatic parenchyma regions of interest were revised in 3D Slicer by a board-certified pancreatic surgeon and verified intraoperatively against surgical pathology. PyRadiomics v3.0 features were extracted with IBSI-concordant settings. Parametric ComBat batch correction was applied across the two centers (biological-covariate balance verified beforehand), and Δ-radiomic features (lesion combat–pancreas combat) were computed for the 106 intensity/texture primitives. We constructed a panel of biology-informed hybrid signatures partitioned into a preoperative lesion-only family (Family A; seven signatures) and a preoperative Δ-radiomic family (Family B; three signatures). Candidate features were filtered through correlation clustering, baseline-adjusted likelihood-ratio testing with Benjamini–Hochberg FDR control, and 100-bootstrap stability selection. Three predictor blocks were compared per target with three classifiers each (Logistic Regression, Random Forest, Gradient Boosting): M0 (five-variable clinical baseline), MA (M0 + Family A), and MB (M0 + Family B). Discrimination was reported as AUC with bootstrap 95% CI; calibration was assessed using the Brier score and TRIPOD-recommended calibration intercept and slope; and cross-center generalization was evaluated with leave-one-center-out (LOCO) cross-validation. Univariable Cox regression with bootstrap and permutation inference was used for progression-free survival (PFS). Results. The cohort had 16 progression events and eight deaths (median follow-up was 38 months, IQR 14–59). Prespecified clinical–radiomic and Δ-radiomic signatures were associated with progression-free survival, including B2 = ΔBusyness × Ki-67 (HR 0.38, 95% CI 0.19–0.76, p = 0.006). For progression prediction, the Δ-radiomic model achieved the strongest discrimination, with a nested cross-validation AUC of 0.85 and leave-one-center-out AUC of 0.87. For higher-grade disease, radiomic models also demonstrated high discrimination, with AUCs up to 0.93. Conclusions. Radiomics-derived shape and texture features, especially when combined with clinical markers, may noninvasively identify aggressive PNET phenotypes and support preoperative risk stratification. Prospective validation in larger multicenter cohorts is warranted. Full article

Accurate monitoring of heart rate (HR) is critical for assessing cardiac functions in a wide range of health and wellness applications. Seismocardiography (SCG), which captures subtle chest vibrations using wearable accelerometers, provides a non-invasive and cost-effective approach for resting and nocturnal HR monitoring. This study presents a deep learning-based approach for accurate heartbeat detection and HR estimation from three-dimensional SCG signals. The model was trained on a large-scale dataset of resting SCG signals collected from 6600 subjects and evaluated on an independent cohort of 947 individuals. For short-term (≤5 min) resting SCG recordings, the model achieved robust performance in heartbeat detection (PPV: 0.979, sensitivity: 0.916, F1-score: 0.946). HR estimation showed high accuracy, with a mean absolute error (MAE) of 0.27 bpm, root mean square error (RMSE) of 1.02 bpm, and correlation of 0.996 with the reference HR. To assess real-world applicability, the model was further evaluated on 28 nocturnal recordings acquired using Apple Watch accelerometer, yielding an MAE of 1.10 bpm, an RMSE of 1.88 bpm, and a correlation of 0.982. The proposed SCG-based deep learning model demonstrates robust and highly accurate HR monitoring in both resting and nocturnal conditions, highlighting its potential for integration with consumer-grade wearable devices in a server-based analysis pipeline. Full article

Background: Noninvasive echocardiographic markers are widely used to estimate left ventricular filling pressure, but their relationship with directly measured left ventricular end-diastolic pressure (LVEDP) is often modest and context-dependent. Whether routinely available noninvasive findings reflect elevated LVEDP through an intermediate invasive pulmonary hemodynamic phenotype remains insufficiently characterized. Objective: To evaluate the relationship of noninvasive echocardiographic and laboratory markers with directly measured LVEDP and to determine whether invasive pulmonary artery diastolic pressure (dPAP) functions as a hemodynamic bridge linking upstream noninvasive findings to elevated left ventricular filling pressure in a routine catheterization cohort. Methods: This retrospective single-center observational study included patients undergoing routine cardiac catheterization with available direct LVEDP measurement and invasive pulmonary artery pressure data. Elevated LVEDP was defined as LVEDP ≥ 15 mmHg, and elevated dPAP as dPAP ≥ 24 mmHg. Noninvasive, bridge, and invasive validation models were evaluated using logistic regression, receiver operating characteristic analysis, calibration assessment, and bootstrap internal validation. Results: A total of 75 patients had direct LVEDP data, 94 had invasive dPAP data, 83 had echocardiographic systolic pulmonary artery pressure (echo-sPAP), and 37 had pulmonary capillary wedge pressure (PCWP) measurements. Patients with elevated LVEDP had significantly higher creatinine (p = 0.026), dPAP (p = 0.043), and PCWP (p = 0.004). Echo-sPAP showed good discrimination for elevated dPAP, with an AUC of 0.791 (95% CI 0.695–0.888), supporting its role as an upstream noninvasive marker of invasive pulmonary hemodynamic burden. A noninvasive model combining echo-sPAP and creatinine showed modest discrimination for elevated LVEDP (AUC 0.664, 95% CI 0.522–0.806; Brier score 0.198), whereas an invasive validation model combining dPAP and creatinine showed better performance (AUC 0.734, 95% CI 0.617–0.850; Brier score 0.176). In bootstrap validation, the optimism-corrected AUCs were approximately 0.624 and 0.711, respectively. Although the invasive model performed numerically better, DeLong comparison did not show a statistically significant difference between the two models (p = 0.459). Conclusions: Routinely available noninvasive echocardiographic and laboratory findings appear to relate to directly measured left ventricular filling pressure through an intermediate invasive pulmonary hemodynamic pattern. Echo-sPAP showed its strongest signal at the level of elevated dPAP, whereas dPAP combined with creatinine provided the most informative model for elevated directly measured LVEDP. These findings support a hypothesis-generating hemodynamic framework linking noninvasive assessment to directly measured filling pressure and may help inform noninvasive hemodynamic triage and physiological risk enrichment in selected clinical settings. Full article

Background/Objectives: Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder causing progressive heterotopic ossification. The dental phenotype has never been systematically characterised. We quantified dental pathologies and oral health-related quality of life across three age groups of genetically confirmed FOP patients and compared them with 156 matched healthy controls (2022–2025). Methods: A total of 52 FOP patients (Group I: 1–5 y, n = 14; Group II: 6–17 y, n = 21; Group III: 18–35 y, n = 17) underwent standardised dental examination (Decayed, Missing, and Filled Teeth index (DMFT), Oral Hygiene Index Simplified (OHI-S), Angle classification, temporomandibular joint (TMJ) assessment), computed tomography (CT) densitometry, sialometry, salivary crystal analysis, and Oral Health Impact Profile-14 (OHIP-14). Statistical analysis used Kruskal–Wallis, Mann–Whitney U, Benjamini–Hochberg false discovery rate (FDR) correction, and effect sizes. Results: Caries (DMFT ≥ 4) was highly prevalent across all FOP groups (82–86%) and significantly higher than in controls (84.6% vs. 38.5%, p < 0.001). Chronic stomatitis showed large age-group differences: 7.1% in Group I vs. 100% in Group III (p < 0.001); it was universal in FOP adults vs. 6.4% in controls. Enamel hypoplasia (21.4% → 58.8%) and Angle class II malocclusion (0% → 47.1%) also showed large age-group differences. Total TMJ disorders were observed in 7.1% of Group I and 100% of Group III (p < 0.001); maximal mouth opening was lower by 17.4 mm in Group III (Cohen’s d = 2.1). Salivary flow rate was 20% lower in adults (0.35 → 0.28 mL/min, p = 0.01). Calcium phosphate crystals were detected in 3/17 adults (17.6%) and showed a preliminary correlation with CT calcification grade (ρ = 0.67, p = 0.003); given the small number of crystal-positive patients, this finding should be considered hypothesis-generating. OHIP-14 total score was higher (worse) in Group III (48.9 vs. 12.4 in Group I, Cohen’s d = 1.95). Conclusions: This cross-sectional study provides a systematic characterisation of the dental phenotype in FOP across three age groups. It shows that chronic stomatitis and TMJ dysfunction become nearly universal by early adulthood, severely impairing quality of life. The correlation between salivary calcium phosphate crystals and CT calcification generates the hypothesis of a non-invasive biomarker, requiring prospective validation. The proposed clinical phenotype and minimally invasive recommendations provide a framework for safer dental management of FOP patients. Full article

Cognitive impairment is common in Post-COVID-19 Condition (PCC), yet full neuropsychological testing remains resource-intensive. Because eye movements are known to be altered in certain cognitive disorders, Eye-Tracking (ET) offers a fast, non-invasive complementary approach for large-scale screening. This study aimed to predict neuropsychological test scores of participants with PCC from ET metrics using machine and deep learning models. ET data was collected from 172 participants performing a battery of visual tasks designed to elicit smooth pursuit and fixational eye movements, as well as pupil responses to light. Cognitive performance was assessed through established neuropsychological tests. We applied regression and classification models (e.g., Random Forest, XGBoost, and deep neural networks) to predict neuropsychological performance. Models were trained using ET data alone and in combination with the Montreal Cognitive Assessment (MoCA) scores, a widely used neuropsychological test for global cognitive screening. Although predicting individual test scores was challenging, combining them into a global composite measure improved performance. Model sensitivity and specificity reached 88% and 34% using ET data alone, and 87% and 60% when integrating ET with MoCA. This last trained model outperformed the conventional MoCA, highlighting the potential of ET as a rapid screening support tool for cognitive assessment. Full article

Accurate prediction of invasive species diffusion is essential for effective management and ecological conservation. Existing spatio-temporal Cox process models face limitations due to the separability assumption, which fails to capture spatio-temporal coupling dynamics inherent in biological diffusion processes. This study proposes a Spatio-Temporal Interaction Kernel Cox (STIK-Cox) model that constructs a non-separable conditional intensity function integrating baseline intensity, spatial and temporal proximity kernels, seasonal fluctuation, and a spatio-temporal interaction term. The model employs maximum likelihood estimation with Limited-memory Broyden–Fletcher–Goldfarb–Shanno with Bounds (L-BFGS-B) optimisation and incorporates SHapley Additive exPlanations (SHAP) for interpretability analysis. Using the Vespa mandarinia (Hymenoptera, Vespidae) monitoring dataset from Washington State, the model achieves a comprehensive accuracy score of 0.957, a capture rate of 98.74% at a 0.5° threshold, and a mean prediction error of 0.0802°. K-function analysis confirms effective capture of spatial clustering patterns, while SHAP analysis reveals longitude as the primary predictive driver. The non-separable design outperforms conventional methods including inverse distance weighting and Poisson point processes. This framework demonstrates the potential of non-separable spatio-temporal point processes for invasive species early warning, providing a scientific basis for targeted monitoring and resource allocation in ecological management. Full article

Background/Objectives: Visit-to-visit glycated hemoglobin A1c (HbA1c) variability is associated with cardiovascular diseases (CVDs) and all-cause mortality, independent of mean HbA1c levels. Metabolic dysfunction–associated steatotic liver disease (MASLD) is associated with CVDs and mortality. We aimed to clarify the association between annual HbA1c variability and MASLD development in individuals with type 2 diabetes (T2D). Methods: A retrospective cohort study was conducted in 402 Japanese patients (219 men, 183 women) with T2D. The participants’ HbA1c levels were measured every 2 months, and their HbA1c coefficient of variation (HbA1c-CV) was calculated from the HbA1c in the past year. We statistically evaluated the association between HbA1c-CV and noninvasive clinical indices of MASLD, including the hepatic steatosis index (HSI), fibrosis-4 (FIB-4) index, aspartate aminotransferase-to-platelet ratio index (APRI), and non-alcoholic fatty liver disease fibrosis score (NFS). Results: Multiple regression analysis of clinical variables and each MASLD index showed that all liver fibrosis indices, including the FIB-4 index (p < 0.001), APRI (p = 0.005), and NFS (p < 0.001), were positively correlated with HbA1c-CV, whereas the HSI was not (p = 0.148). These associations remained even after adjusting for the medications used in the participants. Conclusions: The development of liver fibrosis, estimated using noninvasive blood biochemical indices, is independently and positively associated with annual HbA1c-CV in individuals with T2D. This result suggests that a comprehensive approach, including early MASLD risk stratification, may be beneficial for optimal diabetes management. Full article

Background: Postoperative ileus (POI) remains a leading driver of delayed recovery and prolonged length of stay (LOS) after colorectal surgery. Although ERAS is well established, less is known about how pathway adherence and implementation fidelity relate to bowel recovery in pragmatic minimally invasive practice. Objectives: To evaluate whether a structured ERAS pathway, delivered in routine care, was associated with lower POI and improved early recovery compared with contemporaneous standard care after elective minimally invasive colorectal surgery. Methods: In a prospective, non-randomized pragmatic comparative study conducted from January 2022 to September 2024, 123 adults undergoing elective laparoscopic colorectal resection were managed with either an ERAS pathway (n = 62) or standard care (n = 61). POI was operationalized prospectively using predefined clinical criteria and daily team assessment. Primary outcome was POI. Secondary outcomes included time to flatus, LOS, 48 h opioid use (morphine milligram equivalents, MME), complications (Clavien–Dindo), 30-day readmission, and Quality of Recovery (QoR-15). Multivariable logistic regression and propensity score–adjusted sensitivity analyses were performed to address baseline imbalance. Results: POI occurred in 7/62 (11.3%) in ERAS vs. 22/61 (36.1%) in standard care (p = 0.002). ERAS patients had earlier flatus (38.6 ± 15.2 h vs. 60.0 ± 20.1 h, p < 0.001), shorter LOS (4.2 [3.4–5.0] vs. 5.4 [4.5–6.8] days, p < 0.001), lower 48 h opioids (35.4 [25.2–47.8] vs. 61.1 [41.5–88.6] MME, p < 0.001), and higher QoR-15 at POD2 (113.9 ± 14.9 vs. 104.8 ± 15.5, p = 0.001). In the primary multivariable model, ERAS was independently associated with lower POI odds (adjusted OR 0.2; 95% CI 0.1–0.7; p = 0.013); the association remained directionally similar in propensity-adjusted sensitivity analysis (adjusted OR 0.31; 95% CI 0.12–0.79; p = 0.015). Higher adherence was associated with lower POI and lower opioid exposure. Conclusions: In this prospective cohort, ERAS implementation was associated with lower POI incidence and faster early recovery; however, findings should be interpreted as observational and hypothesis-generating rather than causal. Full article

Background/Objectives: Although intravesical Bacillus Calmette–Guérin (BCG) is an established adjuvant therapy for non-muscle-invasive bladder cancer (NMIBC), chronic global shortages and adverse events (AEs) can occur. Thus, intravesical gemcitabine has been used as an alternative. We compared the long-term oncological outcomes and safety profiles of BCG and gemcitabine in treatment-naïve patients with intermediate- and high-risk NMIBC. Methods: Patients with intermediate- and high-risk NMIBC (n = 477) received adjuvant intravesical induction and maintenance therapy with intravesical BCG (n = 361) or gemcitabine (n = 116) and their data were collected retrospectively. Results: Compared with the gemcitabine group, the BCG group had significantly higher proportions of patients with T1 stage, high-grade tumors, high-risk tumors, and longer median follow-up duration. Over a median 36-month observation period, the BCG group exhibited significantly better recurrence-free survival (RFS) and high-grade RFS (HG-RFS) than the gemcitabine group. In the propensity score–matched high-risk population, BCG also outperformed gemcitabine in RFS and HG-RFS. BCG therapy was identified as a potent protective predictor, reducing the risk of recurrence and high-grade recurrence by 65% and 66%, respectively, in the total cohort, and by 69% and 71%, respectively, in the propensity score-matched high-risk subgroup. No significant differences were observed in the frequency of grade ≥ 3 AEs between BCG and gemcitabine. Conclusions: Intravesical BCG is strongly associated with superior oncological outcomes over gemcitabine in intermediate- and high-risk NMIBC. The results of this study offer pivotal practice-based insights to guide clinical strategies for managing NMIBC. Full article

Background/Objectives: To explore potential dry eye-related ocular surface functional alterations in women at the time of first diagnosis of endometriosis or adenomyosis in a real-world clinical setting. Methods: This was a cross-sectional case–control study. Patients were evaluated at the time of initial diagnosis, prior to initiation of any hormonal therapy, to reflect real-world clinical conditions. Participants underwent a standardized ocular surface assessment comprising the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer test, and multimodal TearCheck^® analysis, including Non-Invasive Break-Up Time (NIBUT), Tear Film Stability Evaluation (TFSE), Meibography, and Abortive Blinking^®. Results: A total of 71 women were included: 41 with endometriosis or adenomyosis and 30 without known gynecological disease. Patients reported significantly higher OSDI scores than controls (p < 0.05). Objective testing demonstrated lower Schirmer values, reduced tear film stability, and more pronounced Meibomian gland dropout in the patient group (all p < 0.05). Differences were consistently observed across both subjective and objective parameters. Conclusions: Women with endometriosis and/or adenomyosis exhibited significantly altered ocular surface parameters compared with women without known gynecological disease. These findings suggest a possible association between gynecological disease and ocular surface dysfunction. Greater awareness of potential ocular involvement may encourage closer collaboration between gynecology and ophthalmology in the care of affected patients. Full article

At present, the gold standard for gastric cancer (GC) confirmation relies mostly on histopathology, an invasive procedure. Noninvasive detection methods using serum for large-scale screening may be useful for the early diagnosis of GC. Helicobacter pylori (HP) infection and chronic atrophic gastritis are major GC risk factors. We recently developed a noninvasive test called the DSC test-based on the patient’s age, sex, their serum PGI and PGII, anti-HP immunoglobulin (IgG), and gastrin G17 levels-predicting GC risk as low (score 0, S0) or high (score 2, S2). The comparative investigation at the serum protein level of the two different patient groups detected by our DCS test (S0 and S2) may undoubtedly help to identify gastric disease-dependent proteins, resulting from bacterial infection or gastric mucosa inflammation, as well as get better insight into the molecular scenario associated with pre-cancerous conditions. We used an untargeted liquid chromatography–tandem mass spectrometry (LC-MS/MS)-based proteomic profiling approach, followed by univariate statistical analysis to compare the different DSC groups across two patient cohorts (exploratory and validation). Significantly differentially abundant proteins differing more than 1.5-fold between S0 and S2 groups were selected and validated, and their putative role(s) in gastritis and GC were discussed. In both the exploratory and the validation cohorts, four proteins (beta-2-microglobulin, EGF-containing fibulin-like extracellular matrix protein 1, complement factor D, and cystatin-C) were more abundant, while two (sex hormone-binding globulin and pregnancy zone protein) were less abundant in the sera of S2 individuals (|fold change| ≥ 0.6, p < 0.05, t-test). The higher presence of beta-2-microglobulin (B2M) and the lower content of pregnancy zone protein (PZP) in S2 sera were validated by immunoblotting. Replacing age and sex in our DSC model with two specific candidate biomarkers can lead to a refined, albeit modest, improvement in classification accuracy. This study identified a proteomic signature that was differentially associated with the sera of patients with a different risk to develop advanced atrophy/GC according to the DSC test. Moving from a demographic model to a proteomic-driven model can better reflect the personalized biology of pathological processes associated with DSC. Full article

Background: Knee osteoarthritis (OA) is one of the leading causes of disability in older adults. As definitive treatment often involves knee replacement surgery, effective non-invasive approaches capable of alleviating symptoms and preserving mobility are needed to delay surgical intervention or bridge waiting periods for surgery. Methods: Thirty-two patients with knee OA were included in this pilot comparative study. Patients underwent either a standardized physical therapy program (10 sessions) or the same program supplemented with vacuum-compression therapy (VCT), according to treatment received during routine clinical care. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS), and the Physical and Mental Component Summary scores of the SF-12 questionnaire (PCS, MCS). Assessments were performed at baseline and at 1-month follow-up, with WOMAC additionally evaluated immediately after treatment. Responder analysis based on minimal clinically important difference (MCID) thresholds was also performed. Results: Both groups demonstrated significant improvement across most outcomes. Between-group analysis showed greater improvements in the intervention group, with statistically significant differences observed for functional outcomes (WOMAC and PCS). Conclusions: In this pilot comparative study, the addition of VCT to standard physical therapy was associated with greater functional improvement in patients with knee OA. Full article

Background/Objectives: Histologic mucosal healing is an increasingly recognized therapeutic target in inflammatory bowel disease (IBD), yet reliable non-invasive correlates remain limited. This study aimed to evaluate circulating cytokine patterns as detectability-based immune signals across the spectrum of histologic disease activity. Methods: In this prospective cross-sectional study, 59 patients with IBD and 36 healthy controls were enrolled. Serum interleukin-10 (IL-10) and interleukin-23 (IL-23) were quantified by ELISA. Histologic activity was graded using the Geboes score. Associations were assessed using non-parametric methods and multivariable logistic regression with Firth penalization. Results: IL-10 demonstrated apparent separation across histologic states, primarily driven by reduced detectability in active inflammation, and was inversely associated with histologic severity. IL-10 remained associated with histologic status, although estimates should be interpreted cautiously. Detectable IL-23 was confined to moderate-to-severe inflammation and did not show graded discrimination, with interpretation limited by the small number of detectable observations. Conclusions: IL-10 and IL-23 exhibit complementary patterns, reflecting detectability-based regulatory signaling and a severity-dependent inflammatory threshold, respectively, without evidence of independent clinical utility for IL-23 in the present dataset. These findings are exploratory and require validation in larger prospective cohorts. Full article