Search Results (351)

Background/Objectives: Ovarian function suppression (OFS) is part of endocrine therapy treatment for high-risk premenopausal women with hormone receptor-positive (HR+) breast cancer (BC). Incomplete OFS may occur and compromise treatment efficacy. Methods: We conducted a retrospective single-center cohort study of premenopausal patients with HR + BC treated with OFS therapy at the Centre des maladies du sein (CMS) of the CHU de Québec (Québec, Canada). Ovarian function suppression failure was defined as either biochemical failure (estradiol (E2) levels within the premenopausal range according to local immunoassays used) or clinical failure (return of menstrual bleeding). Patients’ characteristics, treatment specifics and side effects, timing and type of OFS failure, recurrence, and mortality were analyzed. Results: Among 208 included patients, 17 (8.2%) experienced at least one episode of OFS failure during a median follow-up of 62.6 months. Most failures occurred early, with 76.2% occurring within the first year of treatment. No significant differences were observed between patients with and without OFS failure regarding age, body mass index (BMI), or prior chemotherapy exposure. Patients with OFS failure had a significantly younger age at first pregnancy and higher rates of active smoking. No BC recurrence or death occurred among patients with OFS failure. Treatment-related side effects were common, and 23.0% of OFS regimens were discontinued due to adverse effects. Conclusions: In this study, OFS failure occurred in fewer than 10% of premenopausal patients. Younger age at first pregnancy and active smoking may be associated with OFS failure, but further data are needed to validate these exploratory associations. These findings reinforce the need for larger prospective studies to better assess OFS failure and develop standardized monitoring strategies to optimize treatment efficacy. Full article

Background: This study aimed to evaluate the effectiveness and safety of first-line pembrolizumab monotherapy in patients with advanced non-small cell lung cancer (NSCLC) in real-world clinical practice in Vietnam. Methods: We performed a multicenter retrospective cohort study of patients with locally advanced or metastatic NSCLC who received first-line pembrolizumab monotherapy in Vietnam between January 2018 and August 2024. The primary endpoints were progression-free survival (PFS), overall survival (OS), and safety profile. Results: A total of 73 patients were included, with a median age of 69 years (range, 47–92). Most patients had good performance status (ECOG PS 0–1, 75.3%) and high PD-L1 expression (TPS ≥ 50%, 86.3%). The overall response rate was 60.3%, and the disease control rate was 79.5%. Median PFS was 11.3 months (95% CI, 6.9–15.8), and median OS was 25.4 months (95% CI, 20.8–30.0). Multivariate analysis identified never-smoking status (HR 3.14, 95% CI 1.16–8.50; p = 0.024), squamous histology (HR 4.09, 95% CI 1.18–14.17; p = 0.026), and low PD-L1 expression (TPS 1–49%) (HR 3.67, 95% CI 1.14–11.78; p = 0.029) as independent predictors of inferior overall survival. Immune-related adverse events, including pneumonitis, hepatitis, nephritis, fever, skin reactions, and myositis, were mostly mild and manageable, with grade 3 toxicity occurring in only 4.2% of patients. Better survival was observed in patients with high PD-L1 expression and non-squamous histology. However, the association with non-squamous histology should be interpreted with caution due to the very small number of squamous cases. Conclusions: First-line pembrolizumab monotherapy demonstrated favorable effectiveness and acceptable safety in patients with advanced NSCLC in real-world clinical practice in Vietnam. Clinical outcomes were particularly favorable in patients with high PD-L1 expression, non-squamous histology, and a history of smoking. Nevertheless, the survival benefit associated with non-squamous histology should be interpreted cautiously, given the limited number of patients with squamous histology. These findings support the use of pembrolizumab monotherapy in selected patient populations within resource-limited settings. Full article

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Beyond established risk factors such as smoking and exposure to pollutants increasing evidence emphasizes the role of oxidative stress (OS) in COPD pathophysiology. OS contributes to chronic inflammation, to the progression of the disease and affects both lung function and exacerbations, which opens a rationale for the use of antioxidant and redox-modulating substances in the treatment of the disease. Although numerous substances with antioxidant capacity have been evaluated in randomized clinical trials (RCTs), their clinical relevance remains uncertain. Therefore, a systematic review was conducted to evaluate the effects of these therapies in COPD. Also, a meta-analysis to evaluate the effects on exacerbations was performed. Nineteen RCTs meet the eligibility criteria and were included in the study. Quantitative analyses were performed using random-effects models. N-acetylcysteine-based interventions were associated with a significant reduction in exacerbation risk (risk ratio 0.80; 95% confidence interval 0.66–0.98), corresponding to a 20% relative reduction. No study reported serious adverse effects. These findings suggest that antioxidant-based strategies may have clinically meaningful benefits in COPD. However, larger, more robust RCTs are required to confirm these results and establish optimal therapeutic strategies. Full article

Background: Oral squamous cell carcinoma (OSCC) is an aggressive cancer closely associated with smoking and alcohol consumption, with a higher incidence in men. Despite changes in treatment strategies, poor survival persists in most patients, highlighting the need for novel and improved therapeutic options. Naphthoquinone analogs are being investigated because of their active redox structure and broad pharmacological profile; they demonstrate cytotoxic antitumor activity, making them potential candidates for new drug agents. Objective: This study investigated new benzyl-naphthoquinone compounds as potential anticancer agents for various genotypes of oral squamous cell carcinoma (OSCC) and other cancer cells. Methods: This study reports the synthesis and evaluation of a series of eight benzyl-naphthoquinone compounds against oral squamous cell carcinoma. Results: Four compounds 1–4 showed the best cytotoxic profiles, with a selectivity index ≥ 3 for all OSCC cell lines tested. Compound 1 was the most selective compound in all OSCC models, showing a higher selectivity index than both carboplatin and shikonin. Furthermore, compound 1 induced DNA fragmentation, cell-cycle arrest, and caspase-3/7 activation, changes consistent with apoptosis, and time-lapse imaging corroborated the apoptotic phenotype. Hemolysis assays showed minimal toxicity in human erythrocytes, and acute in vivo evaluation in mice revealed no evident adverse effects under the conditions tested, indicating low acute toxicity, although more detailed histopathological and biochemical studies will be required to fully establish the safety profile. Molecular modeling suggested that compound 1 may interact with topoisomerase II, RSK2, and PKM2, which could contribute to the activation of apoptotic pathways, although these interactions remain predictive and require biochemical validation. Finally, in silico analysis of physicochemical and ADMET parameters indicated properties compatible with oral absorption and systemic exposure, together with predicted low toxicity; however, these results are model-based and should be confirmed experimentally. Conclusions: Based on these findings, compound 1 emerges as a promising lead candidate for the development of a novel chemotherapeutic agent against OSCC, with potential therapeutic efficacy against other cancer types. Full article

Dental amalgam remains widely used in restorative dentistry due to its durability and cost-effectiveness, yet concerns persist regarding potential biological effects related to mercury release. This narrative review critically synthesizes current evidence on oral mucosal alterations and salivary biomarker changes reported in association with amalgam restorations. Experimental research supports biological plausibility for oxidative and inflammatory responses to mercury exposure; however, most human evidence derives from observational studies demonstrating heterogeneous associations rather than consistent causal relationships. Reported variations in salivary biomarkers, including interleukin-8 and ceruloplasmin, are generally modest and influenced by confounding factors such as periodontal status, smoking, and systemic inflammation. Histopathological findings adjacent to amalgam restorations include epithelial and inflammatory changes, though many are nonspecific and comparable to other chronic irritative conditions. Overall, current clinical and epidemiological data do not indicate uniform or clinically significant adverse effects in the general population attributable solely to dental amalgam. Regulatory phase-down initiatives primarily reflect environmental and precautionary policies. Available evidence supports a balanced and evidence-based interpretation of amalgam-related biological findings in contemporary dental practice. Full article

Background: Non-small cell lung cancer (NSCLC) constitutes about 80–85% of lung cancers, and ~60–70% of NSCLC patients are diagnosed at an advanced stage of the disease. Concurrent chemoradiotherapy (cCRT) followed by consolidation durvalumab has become the standard of care for unresectable stage III NSCLC, following the phase III PACIFIC trial, which demonstrated significantly improved progression-free survival (PFS) and overall survival (OS) with durvalumab. Methods: We conducted a single-center retrospective study with unresectable stage III NSCLC patients who received cCRT between January 2021 and December 2025 at the Białystok Oncology Center (Poland). Patients with an ECOG performance status of 0–1 and no disease progression (PD) after cCRT were treated with durvalumab consolidation up to 12 months or until PD or unacceptable toxicity. The clinical outcomes and treatment tolerance were analyzed. Results: Out of 94 cCRT-treated patients (pts), 78 received durvalumab consolidation therapy. The median age of the pts was 66.5 years; 64.1% pts were >65 years old. Squamous carcinoma was the predominant histology (56.4%). The median time from cCRT completion to durvalumab initiation was 45 days (range: 15–85). A majority (57.7%) of patients completed the full 12 months of durvalumab. With a median follow-up of 40 months, the median PFS was ~1224 days (40.2 months). At 3 years, PFS was 52.8%. There were no significant differences in PFS by age (<65 vs. ≥65 years), HR:0.65, clinical stage (IIIA vs. IIIB/IIIC) HR:1.01, histology (squamous vs. non-squamous carcinoma), HR:0.76; sex HR:0.6, ECOG 0 vs. 1 HR:0.82; or initiation of durvalumab ≤42 vs. >42 days after cCRT, HR:0.62 (p > 0.05 for all). The sole factor significantly affecting PFS was smoking status: ever-smokers had a longer PFS than never-smokers (median ~46 months vs. ~21 months, HR:2.11, p = 0.04). Durvalumab consolidation was generally well tolerated. Grade 3–4 adverse events (mainly pneumonitis and esophagitis) leading to permanent durvalumab discontinuation occurred in 7 patients (9%), almost all over 65 years old. Conclusions: Real-world data from our single-center study confirm that consolidation durvalumab therapy after cCRT provides substantial clinical benefit in unresectable stage III NSCLC, even in older patients. The PFS and safety outcomes in our cohort, which had a higher proportion of elderly and locally advanced cases, were comparable with those reported in clinical trials (PACIFIC) and observational studies (PACIFIC-R), underscoring the effectiveness and tolerability of this approach in routine practice. We acknowledge the limitations of the retrospective design and sample size, but our findings support the use of cCRT followed by durvalumab in eligible stage III NSCLC patients and highlight the need for further research on optimizing outcomes (e.g., the impact of smoking and other biomarkers). Full article

Background/Objectives: Although the adverse metabolic effects of PM2.5 and the health benefits of physical activity are well-established, evidence on whether physical activity modifies the association between PM2.5 exposure and metabolic syndrome or health-related quality of life (HRQoL) remains limited. Methods: This observational analytical cross-sectional study examined the modifying effect of physical activity on the associations between long-term PM2.5 exposure and metabolic syndrome and HRQoL in Chiang Mai, Thailand, and to explore these associations across physical activity levels using stratified analyses. A total of 347 participants (209 from higher PM2.5 areas and 138 from lower PM2.5 areas) were recruited in Chiang Mai between March and May 2024. Metabolic syndrome was assessed using blood tests and anthropometric measurement, while HRQoL was evaluated using the Thai version of the SF-36 questionnaire. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for metabolic syndrome. HRQoL differences were analyzed using generalized linear models with robust standard errors. Interaction between PM2.5 exposure and physical activity was assessed to examine potential effect modification. All models were adjusted for age, sex, BMI, smoking status, and educational level, with additional stratified analyses across physical activity levels. Results: Higher long-term PM2.5 exposure was associated with lower odds of metabolic syndrome (OR = 0.34, 95% CI: 0.14–0.83) but was not associated with HRQoL. Physical activity was not independently associated with either outcome, and no interaction between PM2.5 exposure and physical activity was observed. In stratified analyses, the inverse association between PM2.5 exposure and metabolic syndrome was observed only among individuals with high physical activity, while significantly lower HRQoL scores were observed among those with moderate and high physical activity levels. Conclusions: Higher long-term PM2.5 exposure was associated with lower odds of metabolic syndrome and lower HRQoL. Physical activity was not independently associated with these outcomes, and no interaction between PM2.5 exposure and physical activity was observed. Stratified analyses suggested variation in these associations across physical activity levels. Full article

Background/Objectives: The rise of artificial intelligence is injecting intelligence into the healthcare sector, including surgery. Vision-based intelligent systems that assist surgical procedures can significantly increase productivity, safety, and effectiveness during surgery. Surgical instruments are central components of any surgical intervention, yet detecting and locating them during live surgeries remains challenging due to adverse imaging conditions such as blood occlusion, smoke, blur, glare, low-contrast, instrument scale variation, and other artifacts. Methods: To address these challenges, we developed an advanced segmentation architecture termed the frozen-filters-based morphology-aware segmentation network (FFMS-Net). Accurate surgical instrument segmentation strongly depends on edge and morphology information; however, in conventional neural networks, this spatial information is progressively degraded during spatial processing. FFMS-Net introduces a frozen and learnable feature pipeline (FLFP) that simultaneously exploits frozen edge representations and learnable features. Within FLFP, Sobel and Laplacian filters are frozen to preserve edge and orientation information, which is subsequently fused with learnable initial spatial features. Moreover, a tri-atrous blending (TAB) block is employed at the end of the encoder to fuse multi-receptive-field-based contextual information, preserving instrument morphology and improving robustness under challenging conditions such as blur, blood occlusion, and smoke. Datasets focused on surgical instruments often suffer from severe class imbalance and poor instrument visibility. To mitigate these issues, FFMS-Net incorporates a progressively structure-preserving decoder (PSPD) that aggregates dilated and standard spatial information after each upsampling stage to maintain class structure. Multi-scale spatial features from different encoder levels are further fused using light skip paths (LSPs) to project channels with task-relevant patterns. Results/Conclusions: FFMS-Net is extensively evaluated on three challenging datasets: UW-Sinus-surgery-live, UW-Sinus-cadaveric, and CholecSeg8k. The proposed method demonstrates promising performance compared with state-of-the-art approaches while requiring only 1.5 million trainable parameters. In addition, an open-source large language model is integrated for non-clinical summarization of the surgical scene based on the predicted mask and deterministic descriptors derived from it. Full article

The electronic cigarette has divided the medical community. While promoted as a tool for smoking cessation, its use has opened a Pandora’s box. Evidence from studies on both cardiovascular and pulmonary health demonstrates that e-cigarettes are associated with multiple adverse effects. In this review, we specifically examine their consequences and associations with coronary artery disease, myocardial infarction, arrhythmias, arterial hypertension, and related conditions. Finally, we highlight approaches to counter the spread of these so-called harm-reduction alternatives, drawing on data from the European Respiratory Society, the European Society of Cardiology, and the Cochrane Collaboration. Full article

Background: Smoking adversely affects pulmonary function and systemic health; however, its impact on diaphragm muscle morphology and its relationship with functional capacity and psychosocial outcomes in individuals without clinically diagnosed respiratory disease remain unclear. This study aimed to evaluate diaphragm muscle thickness in smokers and to investigate its associations with pulmonary function, functional capacity, sleep quality, and depression. Methods: This cross-sectional observational study included 20 smokers and 20 age-matched never-smokers. Pulmonary function was assessed using spirometry. Functional capacity was evaluated with the 6-Minute Walk Test (6 MWT) and the 30 s sit-to-stand test (30 s STST). Sleep quality and depression were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Beck Depression Inventory (BDI). Inspiratory and expiratory diaphragm muscle thicknesses were measured by ultrasonography. Between-group comparisons and correlation analyses were performed. Results: Smokers exhibited significant impairments in all assessed parameters except expiratory diaphragm thickness compared with controls (p < 0.05). Large to very large effect sizes were observed for FEV₁, FEF_25–75%, functional capacity, and inspiratory diaphragm thickness. Inspiratory diaphragm thickness showed moderate to strong positive correlations with pulmonary function parameters and a very strong positive correlation with functional capacity, while strong negative correlations were observed with sleep quality and depression (p < 0.05). Smoking duration was strongly associated with poorer functional and psychosocial outcomes. Conclusions: Smoking is associated with early and multidimensional impairments in diaphragm muscle morphology, pulmonary function, functional capacity, and psychosocial status, even in individuals without overt respiratory disease. Reduced inspiratory diaphragm thickness may represent an early and clinically meaningful marker of smoking-related respiratory muscle dysfunction. Full article

This study evaluated the feasibility of incorporating a protein–oil emulsion based on beef tripe, meat trimmings, and vegetable oil into semi-smoked sausages produced from maral (red deer) meat, with maral fat used as the sole animal fat source. Four sausage variants were formulated and produced to evaluate the effects of different protein–oil emulsion inclusion levels (0, 10, 15, and 20%) on nutritional, textural, and sensory characteristics. Replacement of part of the maral fat with the protein–oil emulsion resulted in a reduction in total fat content (11.6–14.7%) while protein levels remained stable (20.6–21.4%). Fatty acid analysis demonstrated a significant decrease in saturated fatty acids (from 54.64% in the control to 35.45% in the highest emulsion variant) accompanied by a marked increase in polyunsaturated fatty acids (from 22.20% to 37.57%), primarily due to higher linoleic acid content. Texture profile analysis showed a progressive reduction in hardness, gumminess, and chewiness with increasing emulsion inclusion (p < 0.05), whereas springiness and cohesiveness were not significantly affected (p > 0.05), indicating the preservation of elastic and cohesive properties. Sensory evaluation confirmed that sausages containing moderate levels of the protein–oil emulsion maintained favorable appearance, flavor, and juiciness, with no adverse effects on overall acceptability. These results indicate that combining maral fat with a protein–oil emulsion is an effective strategy for producing nutritionally improved red deer meat sausages with balanced lipid composition and consumer-acceptable texture and sensory quality. Full article

Background: Concerns that human papillomavirus (HPV) vaccination may adversely affect ovarian reserve contribute to vaccine hesitancy, yet longitudinal data with paired anti-Müllerian hormone (AMH) measurements are limited. We evaluated whether HPV vaccination was associated with short-term changes in AMH compared with an unvaccinated control group. Methods: In this retrospective cohort, women aged 18–45 years who completed a three-dose 9-valent HPV vaccination (Gardasil 9®, Merck Sharp & Dohme LLC, West Point/Pennsylvania/USA) schedule and had AMH measured before dose 1 and after dose 3 were compared with unvaccinated controls who had two AMH measurements during routine gynecologic evaluation. AMH change was summarized as absolute change (ΔAMH), percent change, and log change. To compare rates of AMH change while accounting for heterogeneous follow-up and confounding, AMH was analyzed on the natural log scale using a linear mixed-effects model with a random intercept for participant and fixed effects for time (years), group, and a time × group interaction, adjusted for age, current smoking, gravidity, and parity. Annual percent change was derived from model coefficients. Prespecified sensitivity analyses repeated the primary model under follow-up restrictions and after restricting baseline AMH to 1.0–5.0 ng/mL. Results: The cohort included 158 vaccinated and 106 control women. Baseline AMH was similar between groups (median 1.88 vs. 1.94 ng/mL), while the follow-up interval was shorter in vaccinated women (6.7 vs. 8.9 months). Unadjusted AMH decline was smaller in vaccinated women (median ΔAMH −0.13 vs. −0.27 ng/mL; p = 0.015; median percent change −10.9% vs. −20.6%; p = 0.006). In the adjusted mixed-effects model, controls showed an estimated AMH decline of −27.6% per year (95% CI −35.5% to −18.7%; p < 0.001). The time × group interaction was positive (β = 0.170, 95% CI 0.027 to 0.312; p = 0.020), corresponding to a slope ratio of 1.185 (95% CI 1.02–1.366) and an implied annual change of −14.2% per year (95% CI −21.0% to −6.7%) in vaccinated women. Results were broadly consistent in follow-up-restricted sensitivity analyses; however, in the baseline AMH 1.0–5.0 ng/mL restricted cohort (vaccinated n = 82, control n = 67), the interaction was attenuated and not statistically significant (β = 0.082, p = 0.237). Conclusions: In this retrospective cohort with paired AMH measurements, HPV vaccination was not associated with evidence of clinically meaningful short-term impairment in ovarian reserve as assessed by AMH. Observed differences in AMH alterations were modest and should be interpreted cautiously, given residual confounding, measurement variability, and reduced precision in restricted-cohort analyses. Full article

Background: Smoking is a major public health concern worldwide and is associated with adverse effects on pulmonary function, postural control, and overall physical performance. Aquatic exercise has gained increasing attention as a safe and effective training modality due to its unique physical properties. However, evidence regarding the effects of aquatic exercise on pulmonary function and dynamic balance in young adult smokers remains limited. Objective: This study aimed to investigate the effects of an 8-week aquatic exercise training program on pulmonary function parameters and dynamic balance performance in young adult smokers. Methods: Twenty-two physically inactive male smokers were randomly assigned to an experimental group (n = 11) or a control group (n = 11). The experimental group participated in an aquatic exercise program three times per week for eight weeks, while the control group maintained their usual daily activities. Pulmonary function parameters, including FEV₁, FVC, FEV₁/FVC, PEF, PIF, MVV, VC, TV, and IVC, were assessed using spirometers. Dynamic balance performance was evaluated using a portable dynamic balance platform under single-leg (right and left) and double-leg conditions. Data were analyzed using a two-way repeated-measures ANOVA. Results: Statistically significant time × group interaction effects were observed for vital capacity (VC) (p = 0.033, η²_p = 0.378) and tidal volume (TV) (p < 0.001, η²_p = 0.734), suggesting potentially greater changes in the experimental group compared to the control group. Peak expiratory flow (PEF) demonstrated significant main effects of time (p = 0.047) and group (p = 0.031). Dynamic balance performance showed statistically significant time × group interaction effects across right-leg, left-leg, and bilateral conditions (p < 0.01), with large effect sizes (η²_p = 0.762, 0.609, and 0.507, respectively). However, given the pilot nature and limited sample size of the study, these findings should be interpreted as preliminary. No significant changes were observed in FEV₁, FVC, or FEV₁/FVC ratio. Conclusions: This pilot randomized trial suggests that an 8-week aquatic exercise program is feasible and may produce preliminary improvements in selected pulmonary function parameters and dynamic balance in young adult smokers. Larger, adequately powered trials are required to confirm these findings. Full article

Background/Objectives: Surgery is the most effective treatment for early-stage lung cancer but imposes a greater physical burden than other therapies. We previously identified socioclinical factors associated with reduced perioperative health-related quality of life (HR-QOL) in patients undergoing anatomical pulmonary resection. This study aimed to evaluate the relationship between predictors of HR-QOL and long-term survival. Methods: In this prospective study, 87 patients undergoing anatomical pulmonary resection for non-small cell lung cancer at Shonan Kamakura General Hospital, Japan, were evaluated using the Short Form Health Survey 36. Multivariable analyses identified socioclinical factors associated with physical and mental QOL preoperatively and at 6 months postoperatively. Survival analyses were performed for factors showing differences in multivariable analysis and related trends in univariable analysis of HR-QOL. Results: Preoperatively, lower performance status (PS) and living alone were independently associated with poorer physical QOL (regression coefficient [95% CI]: −10.94 [−14.34–−7.54] and −9.86 [−13.89–−5.82], respectively; both p < 0.001) and mental QOL (−9.34 [−13.30–−5.37] and −10.33 [−15.30–−5.35]; both p < 0.001). At 6 months postoperatively, smoking cessation within 1 year, lower PS, and living alone predicted worse physical QOL, while smoking cessation and lower PS predicted worse mental QOL. Lower PS and higher comorbidity burden were also adverse prognostic factors for long-term survival (p < 0.001 and p = 0.015, respectively). Conclusions: Reduced physical activity and greater comorbidity are associated with poorer HR-QOL and survival after lung cancer surgery. These findings highlight the need for careful consideration of surgical indications in patients with these risk factors. Full article

Stairwells constitute critical escape routes for emergency evacuation during building disasters. The spread of fire smoke and the failure of lighting systems can significantly reduce visibility within stairwells, thereby adversely affecting evacuation speed. This issue is particularly pronounced in super high-rise buildings. In this study, a typical super high-rise building was selected as the experimental site. The variation laws of key parameters such as evacuation time, speed, and heart rate were investigated for groups with different gender proportions in stairwells under different visibility conditions. The experimental results show that: First, collaboration within multi-person groups can effectively mitigate the adverse impact of reduced visibility on evacuation speed. Second, different gender proportions within groups affect evacuation speed, with groups having a higher proportion of males demonstrating relatively faster evacuation speed. Third, under identical visibility conditions, the heart rates of multi-person groups during evacuation are generally lower than those of individual groups; in low-visibility environments, the heart rates of members within the same group are significantly higher than those under normal visibility conditions. Accordingly, this study proposes a mixed-gender group evacuation strategy under low-visibility conditions. The findings provide empirical data support for the formulation of emergency evacuation response strategies in super high-rise buildings. Full article