Search Results (2,547)

The widespread use of tetracycline (TC) has resulted in its frequent occurrence in aquatic environments because of incomplete metabolism and continuous release, raising increasing concerns regarding water quality and environmental safety. Reliable determination of trace TC in real water samples remains challenging owing to its low concentration and the complex sample matrix. In this work, an aptamer-functionalized extended-gate ion-sensitive field-effect transistor (EG-ISFET) was developed for sensitive TC detection. The sensing interface was constructed by immobilizing a TC-specific aptamer on a Ta₂O₅ extended gate. Upon target recognition, aptamer folding redistributes the interfacial charge, thereby modulating the surface potential of the extended gate and producing a measurable field-effect response. The proposed sensor exhibits a broad linear detection range from 1 pM to 1 μM with a detection limit of 0.33 pM. To facilitate practical applications, a compact plug-and-play point-of-care testing (POCT) platform integrating the EG-ISFET sensor was further developed for rapid on-site analysis. The portable system demonstrated satisfactory accuracy and reliability for the determination of TC in river water samples, highlighting its potential for environmental monitoring and point-of-use water quality assessment. Full article

Background/Objectives: This study aimed to develop and internally validate the RIN-IM model, which integrates routinely measured biomarkers reflecting renal dysfunction, systemic immune-inflammatory activation, albumin-related alterations during acute illness, and metabolic stress, for prediction of 28-day mortality in critically ill adults. Methods: This retrospective cohort study included 1000 adults admitted to the intensive care unit (ICU) between January 2020 and June 2025. The first available demographic, clinical, and laboratory measurements obtained within 24 h of ICU admission were analyzed. The five prespecified RIN-IM predictors—serum creatinine, serum albumin, SII, PIV, and the TyG index—were initially evaluated as continuous variables; SII and PIV were natural-log-transformed, and potential nonlinear associations were examined using restricted cubic splines. Ridge-penalized logistic regression was used to address coefficient instability arising from correlation between SII and PIV. After evaluation of the primary continuous model, a simplified point-based score was derived by assigning 0–2 points to clinically ordered categories for each component, producing a total score of 0–10. Scores were categorized as low- (0–3), intermediate- (4–6), or high-risk (7–10). The primary outcome was 28-day all-cause mortality. Model performance was assessed using discrimination, calibration, Brier score, formal paired AUC comparisons, incremental-value testing, and decision-curve analysis. The complete development procedure was internally validated using 1000 bootstrap resamples. Results: Overall, 300 of 1000 patients (30.0%) died within 28 days. Mortality increased across the RIN-IM risk categories, from 7.6% (32/420) in the low-risk group to 27.2% (98/360) in the intermediate-risk group and 77.3% (170/220) in the high-risk group (p < 0.001). After adjustment for the clinical reference variables, each one-point increase in the simplified RIN-IM Score was associated with higher odds of 28-day mortality (adjusted OR, 1.68; 95% CI, 1.54–1.84; p < 0.001). The primary continuous model had an apparent AUC of 0.907 (95% CI, 0.885–0.929) and an optimism-corrected AUC of 0.898. The corresponding values for the simplified score were 0.890 (95% CI, 0.861–0.919) and 0.878, respectively. The apparent difference between the continuous and simplified models was 0.017 (95% CI, 0.007–0.028; p = 0.001). The simplified RIN-IM Score had higher discrimination than APACHE II (ΔAUC, 0.070; 95% CI, 0.038–0.102; p < 0.001) and SOFA (ΔAUC, 0.090; 95% CI, 0.057–0.123; p < 0.001). Adding RIN-IM to the clinical reference model increased the apparent AUC from 0.821 to 0.923 (ΔAUC, 0.102; 95% CI, 0.078–0.126; p < 0.001) and improved the Brier score from 0.160 to 0.112. Conclusions: In this single-center cohort, the RIN-IM model showed good discrimination and calibration for predicting 28-day mortality. The simplified score retained most of the predictive information of the continuous model and may complement established clinical severity scores using routinely available early laboratory measurements. External validation and clinical-impact studies are required before routine implementation. Full article

Background: Bedside prognostication after acute ischemic stroke remains challenging despite the availability of several composite scores, which often demand variables not routinely obtained at admission. Whether the combination of baseline neurological severity and early non-contrast computed tomography findings can support parsimonious, contemporaneous prediction of 3-month functional outcome is an open question, particularly given the well-documented overlap between clinical and imaging measures of stroke extent. Methods: We retrospectively analyzed 432 consecutive adults admitted with confirmed anterior-circulation acute ischemic stroke to a Turkish tertiary care university hospital between January 2022 and December 2025. The primary outcome was a poor functional outcome, defined as modified Rankin Scale (mRS) score 3–6 at 3 months. A prespecified multivariable logistic regression model incorporated three admission variables: baseline National Institutes of Health Stroke Scale (NIHSS) per five-point increment, Alberta Stroke Program Early CT Score (ASPECTS) per one-point increment, and age dichotomized at 65 years. Model performance was assessed with the area under the receiver operating characteristic curve (AUC), five-fold stratified cross-validation, and calibration testing. We additionally performed DeLong tests, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) analyses to evaluate the incremental contribution of ASPECTS, and compared the parsimonious model against a comprehensive multivariable model containing ten predictors. Results: At 3 months, 252 patients (58.3%) had poor functional outcome, with 177 deaths (41.0%). Baseline NIHSS emerged as the dominant predictor (adjusted odds ratio [aOR] 4.16 per five-point increase, 95% confidence interval [CI] 2.79–6.22, p < 0.001), whereas ASPECTS retained no independent prognostic value after adjustment (aOR 0.99 per point, 95% CI 0.73–1.34, p = 0.952). Age ≥ 65 years was likewise non-significant (aOR 0.79, 95% CI 0.46–1.37, p = 0.405). The parsimonious model achieved excellent discrimination (AUC 0.904, 95% CI 0.876–0.932; cross-validated AUC 0.899, 95% CI 0.873–0.926) and good overall calibration on internal validation (calibration slope 0.958; calibration-in-the-large 0.009), although the Hosmer–Lemeshow test was significant (p = 0.001), reflecting localized miscalibration in the intermediate-risk range. Adding ASPECTS to a reduced model containing only NIHSS and age produced no meaningful discrimination gain (ΔAUC + 0.0003, DeLong p = 0.50; IDI ≈ 0), consistent with substantial variance sharing between NIHSS and ASPECTS (Spearman ρ = −0.89). A comprehensive model including infarct volume, Glasgow Coma Scale, reperfusion therapy, and comorbidities did not improve discrimination (AUC 0.905) and yielded a worse Akaike information criterion, supporting the sufficiency of the parsimonious model. Conclusions: In this Turkish tertiary center cohort, baseline NIHSS captured most of the prognostic information available at admission, and early ASPECTS added minimal independent value once neurological severity was accounted for. Findings should be interpreted in the context of the high case-mix severity of this referral population; external validation in independent, multicenter cohorts is required before clinical implementation is considered. Full article

Cardiac myosin-binding protein C (cMyBP-C) is a cardiac-restricted sarcomeric protein; after cardiomyocyte injury, circulating intact cMyBP-C and/or cMyBP-C fragments, collectively referred to here as the cMyC biomarker signal, appear rapidly in blood. In suspected acute coronary syndrome (ACS), its most important potential role is not as another marker of injury but as a decision-enhancing biomarker beyond symptoms, electrocardiography, cardiac troponin T and I concentrations measured with high-sensitivity assays (hs-cTnT and hs-cTnI), time from pain onset, and pre-test probability. This narrative review separates three clinical tasks frequently conflated in the biomarker literature: diagnosis of acute myocardial infarction, emergency-department triage, and prediction of short-term or post-infarction risk. We integrate cMyBP-C sarcomeric architecture, N-terminal regulatory biology, phosphorylation, proteolysis, circulating fragments, assay epitopes, analytical stability, diagnostic algorithms, point-of-care testing, ST-segment elevation myocardial infarction reperfusion biology, and major confounders including renal dysfunction, heart failure, age, sex, and chronic ventricular remodeling. Current evidence supports further evaluation of cMyC as an adjunct in early presenters and accelerated diagnostic pathways. However, diagnostic safety and efficacy have not been consistently reproduced across platforms and populations, and external validation—particularly of rule-out performance—remains insufficient for routine clinical use. Recurrent injury assessment and post-infarction risk phenotyping remain promising but incompletely validated applications. Before guideline adoption, cMyC needs phenotype-specific, multicenter implementation trials demonstrating incremental net benefit, cost-effectiveness, and patient-level safety compared with contemporary hs-cTnT- and hs-cTnI-based clinical decision algorithms. Full article

Background/Objectives: Romania’s National Health Insurance House (CNAS) reimbursement basket is the principal public financial-protection mechanism, yet whether it reflects the therapeutic services patients actually seek has not been tested against private-market offerings. This study compared the public basket with the private dental service portfolio, using the latter as an indirect, supply-side signal of expressed need rather than a direct measure of demand. Methods: In this cross-sectional study (November 2024–February 2025), the publicly listed portfolios of 420 private dental practices in Bucharest (n = 256), Cluj-Napoca (n = 104), and Iași (n = 60) were analyzed, stratified by size (0–3 vs. >3 employees). Practices were identified from CAEN 8623 records on listafirme.ro; portfolios were extracted from official websites displaying prices. Services were classified as functional or aesthetic by two independent raters (Cohen’s κ = 0.91), with disagreements resolved by consensus. Results: Across all municipalities and strata, approximately 53–68% of private services fell outside the CNAS basket. Critically, about 95–96% of private services were functional rather than aesthetic (4–5%), indicating that the gap reflects functional treatments patients seek and providers offer yet that remain unfunded—not elective demand. No statistically significant geographic differences emerged. Geographic location was not associated with portfolio breadth, whereas in multivariable models larger practices (>3 employees) independently offered approximately 33% more services. Conclusions: Because the analysis reflects advertised portfolio breadth rather than utilization, and a documented Romanian orientation toward reactive over preventive care, these hypothesis-generating findings make private supply a pragmatic, supply-side reference point for evidence-based revision of the CNAS basket, pointing to two directions directly supported by the data—aligning coverage with observed demand and administrative simplification of contracting. To our knowledge, this is the first benchmarking of the CNAS basket against private supply, relevant to other predominantly private European dental systems. Full article

Background: Rural older women in China face intersecting disadvantages including eroded family support, limited pension coverage, and high social isolation that elevate depressive symptoms. Although Long-Term Care Insurance (LTCI) has expanded rapidly since 2016 to provide both financial protection and formal care services for older adults, whether it can compensate for depleted informal support and protect mental health among this vulnerable population remains unknown. Methods: We used five waves of CHARLS (2011–2020) with 2193 rural women aged ≥60. We employed a staggered difference-in-differences design, complemented by moderation analysis, heterogeneity tests, and time-dependent survival analysis. Robustness checks included Callaway-Sant’Anna DID, placebo permutation and baseline exclusion sensitivity. Results: LTCI reduced depression scores by 0.45 points (β = −0.447, p = 0.028) and depression onset hazard by 36.1% (HR = 0.639, p = 0.009). Benefits were compensatory, concentrated among women lacking regular emotional and financial support from children and those with high social isolation. Heterogeneity analyses demonstrated a pronounced age gradient and a significant education gradient, while care-need and disability subgroups showed directionally consistent but underpowered effects. These findings were robust to supplementary sensitivity checks, including Callaway-Sant’Anna DID, placebo permutation, and baseline-depressed exclusion. Conclusions: LTCI confers meaningful mental health protection for rural older women through compensatory pathways that substitute for depleted informal support. However, benefits are concentrated among younger-old and more-educated women, raising equity concerns. Gender-sensitive implementation with mental health screening, targeted outreach for less-educated women, and community-based enrollment assistance is essential to ensure policy equity. Full article

Urinary urea is a key biomarker for tracking protein oxidation and nitrogen balance. A persistent analytical limitation is that conventional total-nitrogen assays do not deconvolute urinary urea from urinary ammonia, and direct measurement still requires capital-intensive clinical analyzers. Here, we implement and independently validate two cost-effective methods that resolve urinary urea by pairing the presence and absence of urease: Method 1 is a urease-coupled potentiometric assay using an ammonium ion-selective electrode (ISE method); Method 2 is a microplate Berthelot–salicylate colorimetric assay employing a repurposed consumer-grade aquarium ammonia test kit (API^®) (API method). Each method was validated against the Roche Cobas C311 clinical analyzer (ISE for urinary ammonia and API for urinary urea) in healthy adult volunteers (n = 10 each), and API–ISE were then compared head-to-head for urinary urea. ISE vs. Cobas yielded R² = 0.967, slope 95% CI [0.867, 1.173], and Bland–Altman bias of −1.02 mM (95% LoA [−7.40, +5.36] mM). API vs. Cobas yielded R² = 0.973, slope 95% CI [0.790, 1.039], and bias of −1.55 mM (95% LoA [−11.56, +8.46] mM). API–ISE urinary urea comparison confirmed mutual agreement (R² = 0.9976, slope 95% CI [0.946, 1.024]; bias of +3.47 mM; 95% LoA [−14.60, +21.53] mM), with mean recoveries near 100% (API: 100.7 ± 2.9%; ISE: 100.6 ± 5.4%; 20–350 mM). Both methods agreed with the clinical analyzer, supporting their potential for decentralized, resource-limited testing; clinical and point-of-care validations are needed. Full article

Burkholderia gladioli pv. cocovenenans (B. gladioli pv. cocovenenans), the most representative pathovar of B. gladioli, is capable of producing thermostable and highly virulent bongkrekic acid, which can result in multiple organ failure and an extremely high case fatality rate in humans. This research aims to mine specific targets for B. gladioli pv. cocovenenans and develop a rapid and accurate assay for the detection of B. gladioli pv. cocovenenans in food. Two novel specific target genes (group_0918 and group_0110) were successfully screened through pan-genome analysis, and the excellent specificity and sensitivity of both targets were verified in comparison to PCR assays. Based on these targets, a loop-mediated isothermal amplification (LAMP) method was developed to specifically identify B. gladioli pv. cocovenenans. In pure culture and spiked fresh black fungus samples, the LAMP assay achieved a limit of detection (LOD) of 4.1 × 10¹ CFU/mL and 4.1 × 10² CFU/g for the detection of B. gladioli pv. cocovenenans, respectively. To enable point of care testing, a LAMP-based lateral flow dipstick(LFD) assay was established with a detection sensitivity of 4.1 × 10³ CFU/g in fresh black fungus. Tests on naturally infected food samples demonstrated that the developed LAMP and LAMP-assisted visual detection assays can serve as an effective alternative for the accurate identification of B. gladioli pv. cocovenenans. The novel molecular detection technology established in this study offers an efficient and reliable detection method for the prevention and control of B. gladioli pv. cocovenenans contamination in food, which holds significant application value and promotion prospects. Full article

The coronavirus disease 2019 (COVID-19) pandemic highlighted the critical need for rapid, accessible, and accurate diagnostic tools to support timely clinical decision-making, outbreak control, and public health surveillance. Point-of-care testing (POCT) has emerged as an essential component of decentralized healthcare by enabling diagnostic testing outside conventional laboratory settings. This review was based on a structured literature search of PubMed, Scopus, and Web of Science databases covering studies published between January 2020 and January 2026. The review evaluates current advances in COVID-19 POCT technologies, including molecular assays, antigen-based tests, antibody-based assays, biosensor platforms, and artificial intelligence (AI)-assisted diagnostic approaches. Molecular POCT methods, including rapid reverse transcription polymerase chain reaction (RT-PCR), loop-mediated isothermal amplification (LAMP), and CRISPR-based technologies, provide high analytical sensitivity and specificity and are increasingly suitable for decentralized diagnostic applications. Antigen-based assays offer rapid and cost-effective screening solutions, although diagnostic performance may vary depending on viral load, symptom onset, and circulating variants. Antibody-based POCT remains valuable for seroprevalence studies, retrospective diagnosis, and immune-response monitoring rather than acute infection detection. Emerging biosensor technologies and AI-enabled diagnostic systems demonstrate promising analytical capabilities and operational advantages; however, many remain at the prototype or early-validation stage and require further clinical evaluation before widespread implementation. The findings indicate that no single POCT modality is optimal for all clinical scenarios. Instead, molecular, antigen, antibody, biosensor, and AI-assisted approaches provide complementary strengths that support different diagnostic and public health objectives. Continued advances in assay design, digital connectivity, multiplex testing, and variant-resilient detection strategies are expected to further enhance the role of POCT in COVID-19 management and future infectious disease preparedness. Full article

Background/Objectives: Children with medical complexity (CMC) often suffer from chronic or evolving conditions that require increasingly complex treatment regimens over time, resulting in increased therapeutic and care burdens, costs, and the risk of adverse effects and medication errors. The study aimed to describe the variation in healthcare needs, medication regimens and medication burden over time and to describe the relationship between the number of drugs and healthcare needs. Methods: In this cohort study, conducted at the Pediatric Palliative Care Center of Padua, Italy, two repeated assessments were performed, respectively, in October 2021 (t₀) and in February 2023 (t₁). A total of 169 patients aged ≤23 years receiving at least one prescribed medication were enrolled. Longitudinal analyses were performed in the 147 patients with complete assessments at both time points. Data were collected from medical records and caregiver interviews. Drug costs were collected from the Italian Medicines Agency. Changes between baseline and follow-up were assessed using paired statistical tests (Wilcoxon signed-rank test for continuous variables and McNemar test for categorical variables). The associations between the number of drugs and the ACCAPED scale (Accertamento dei Bisogni Clinico Assistenziali Complessi in Cure Palliative Pediatriche) were assessed using linear regression models. Results: The study analyzed treatment regimens of 147 patients with a median age of 12.1 years at t₀ and 14.1 at t₁. The prevalence of patients with medication burden (42% vs. 50%, p = 0.022), do-not-resuscitate order (20% vs. 27%, p = 0.027) and an ACCAPED score > 50 (57% vs. 66%, p = 0.012) significantly increased on the second assessment. Also, the number of total daily administrations (5 [3–12] vs. 6 [3–14], p = 0.019) and the number of medications (4 [2–7] vs. 5 [3–8], p = 0.013) significantly increased. However, polypharmacy and the median daily cost per patient did not significantly increase between t₀ and t₁. The association between the number of drugs and the ACCAPED score showed that each additional prescribed drug is associated with an average increase of 3.2 points in the ACCAPED score (95% CI: 2.6, 3.9; p < 0.001). Conclusions: Over time, the degree of complexity in our population increased significantly, as evidenced by the increased healthcare needs, treatment regimens and burden on families. The number of prescribed drugs showed a strong and statistically significant relationship with patient care complexity. Treatment regimen characteristics were strongly associated with patient care complexity. Future studies should evaluate whether these pharmacological variables may have a role in supporting clinical assessment. Full article

Continuous and noninvasive body fluid monitoring has attracted increasing attention in personalized healthcare, chronic disease management, and wearable point-of-care testing. Fiber-optic surface plasmon resonance (SPR) biosensors are particularly promising for this purpose because they combine label-free and real-time with miniaturization and low sample volume requirements. However, current body fluid sensing technologies and conventional bare metal SPR interfaces still face critical challenges, including insufficient analytical accuracy in complex biofluids, broad resonance linewidths, weak signal readability for trace biomarkers, and mechanical perturbations during wearable operation. These limitations highlight the need for nanomaterial-engineered fiber-optic SPR platforms that can convert interfacial molecular events into stable and sensitive signals. The review summarizes recent progress in nanomaterial-enabled fiber-optic SPR biosensors for continuous body fluid monitoring. Emphasis is first placed on nanomaterial mediated local electromagnetic field enhancement and plasmonic mode regulation. Subsequent discussion focuses on their functions in interfacial recognition, analyte enrichment, rapid mass transport, antifouling protection, and flexible integration for continuous operation. On this basis, representative sensing targets, material strategies, and device architectures for tears, urine, exhaled breath condensate, saliva and sweat are systematically analyzed. Finally, current challenges and future opportunities are discussed from the perspective of sensing reliability, wearable integration, and real sample validation. Full article

Background: Older adults commonly experience a progressive decline in functional capacity and exercise tolerance, particularly among residents of residential care homes. Advanced age is associated with a higher prevalence of coronary heart disease (CHD) and arterial hypertension, both of which further reduce physical activity levels. Evidence indicates that regular, structured physical activity can improve physical functioning and cardiovascular parameters. This study aimed to assess functional capacity and exercise tolerance in residential care home residents with treated arterial hypertension and CHD compared with individuals without cardiovascular disease. Methods: The study included 74 men aged 65–80 years residing in residential care homes. Participants were divided into two groups: Group I consisted of 44 men without diagnosed cardiovascular disease, and Group II included 30 men with diagnosed CHD and arterial hypertension. Functional capacity was assessed using the Short Physical Performance Battery (SPPB), and exercise tolerance was evaluated using the 6-Minute Walk Test (6MWT). Results: The mean SPPB score was 8.7 ± 2.1 points in Group I and 5.2 ± 2.5 points in Group II (p < 0.001). In the 6 MWT, participants in Group I covered a mean distance of 312.7 ± 89.4 m, whereas those in Group II covered 168.4 ± 84.4 m (p < 0.001). Multivariable regression analysis confirmed that group allocation remained an independent predictor of both SPPB and 6MWT outcomes after adjusting for age and somatic parameters (p < 0.001). Conclusions: Residential care home residents with CHD and arterial hypertension demonstrate significantly lower functional capacity and exercise tolerance compared with individuals without cardiovascular disease. Both groups achieved results markedly below national reference values for the Polish older adult population. These findings highlight the need for targeted physical activity programs in residential care homes, with particular emphasis on individuals with cardiovascular disease. Full article

This paper presents an experimental evaluation of side-channel leakage in an FPGA-based implementation of the AES-256 encryption algorithm operating in ECB mode, with a focus on identifying data-dependent information leakage through power consumption and electromagnetic emissions. The implementation was deployed on a Xilinx Artix-7 FPGA using the ChipWhisperer CW305 platform, while measurements were acquired with the ChipWhisperer Husky system under controlled laboratory conditions. The analysis follows the Test Vector Leakage Assessment methodology in accordance with ISO/IEC 17825, using Welch’s t-test to compare trace sets obtained from fixed and random input data. A dataset of 20,000 traces per configuration was collected, with careful synchronization, interleaving, and preprocessing to ensure statistical reliability. The results show multiple instances where the t-statistic exceeds the threshold of |t| > 4.5 within the defined region of interest, indicating significant leakage. In particular, 84 leakage points were detected in the power consumption channel and 10 in the electromagnetic channel. These findings demonstrate that the evaluated implementation does not satisfy the resistance criteria defined by the standard and remains vulnerable to side-channel analysis, highlighting the need for appropriate countermeasures in FPGA-based cryptographic designs. Full article

Hemorrhagic shock is a leading cause of preventable death following multiple trauma, driven by a cascade of interacting cellular and molecular disturbances that extend well beyond simple volume loss. Acute blood loss initiates tissue hypoperfusion and cellular hypoxia, setting in motion the lethal triad of hypothermia, acidosis, and coagulopathy through several converging pathways: complement activation with excessive C3a and C5a production; neutrophil-mediated tissue injury; NADPH-oxidase-driven reactive oxygen species (ROS) overproduction that overwhelms superoxide dismutase defenses; mitochondrial respiratory chain impairment; dysregulation of the pro-inflammatory cytokine network; and endothelial apoptosis with degradation of the endothelial glycocalyx and disruption of interendothelial junctions, with consequent vascular hyperpermeability. These mechanisms provide the biological rationale for the resuscitation strategy. Each class of fluid acts on these pathways in a distinct way: crystalloids modulate acid–base homeostasis, chloride-mediated renal vasoconstriction, and coagulation factor activity; colloids influence oncotic pressure, endothelial integrity, and microvascular perfusion; and blood products, particularly plasma and whole blood, actively modulate mitochondrial metabolism, endothelial permeability, and pro-apoptotic signaling beyond their volume-expanding role. Translating this biology to the bedside requires a multimodal monitoring framework that converts molecular endpoints into real-time therapeutic targets, integrating lactate and base excess as markers of cellular oxygen debt, dynamic preload indices such as pulse pressure and stroke volume variation, advanced hemodynamic platforms, point-of-care ultrasonography, viscoelastic coagulation testing, and near-infrared spectroscopy of tissue oxygenation. This review synthesizes the biological basis of hemorrhagic shock and its translation into an individualized, goal-directed resuscitation strategy for the critically ill polytrauma patient. Full article

Background/Objectives: In patients without clinically anticipated difficulty, an unexpected difficult airway carries the greatest potential for harm, yet routine bedside tests exclude difficulty poorly, and evidence for point-of-care ultrasonography remains heterogeneous, with difficult mask ventilation rarely studied as a distinct outcome. We evaluated three rapid anterior-neck ultrasonographic parameters—tongue thickness (TT), skin-to-hyoid-bone distance (SHBD), and cricothyroid membrane length (CTML)—for their diagnostic performance and independent association with a difficult airway in adults without anticipated difficulty. Methods: In this prospective, single-center, diagnostic-accuracy study reported per STARD 2015 and STROBE, 713 adults (ASA I–III) underwent neutral-position measurement of TT, SHBD, and CTML by a sonographer blinded to the clinical assessment and airway-management outcomes. A composite difficult airway (difficult mask ventilation, laryngoscopy, or intubation) was assessed independently. Discrimination was evaluated by ROC analysis with DeLong comparisons, multivariable logistic regression, and bootstrap internal validation; p-values used Benjamini–Hochberg correction. Results: A difficult airway occurred in 197/713 patients (27.6%). TT and SHBD were associated with the composite outcome and all components (AUC 0.68–0.73) and remained independent after adjustment for age, sex, BMI, and Mallampati class; CTML discriminated poorly (AUC ≈ 0.55), with only marginal significance after correction. Negative predictive values were high (78–99%) but prevalence-dependent, with modest likelihood ratios. Adding TT and SHBD to clinical variables improved discrimination (AUC 0.69 → 0.78; DeLong p < 0.001). Conclusions: TT and SHBD show a limited but independent diagnostic signal that may complement, not replace, clinical screening; CTML showed no clinically meaningful discrimination in this cohort. Proposed cut-offs are exploratory and require standardized measurement, reproducibility testing, and external validation before clinical adoption. Full article