Medical sciences (Basel, Switzerland)最新文献

{"title":"Acute Events and Fatal Outcomes Following Exposure to Volcanic Gases (SO₂, CO₂, H₂S): A Systematic Review.","authors":"Cristina Genovese, Giovanni Paolo Piccolo, Alessandro Gattuso, Antonio Mistretta, Francesco Leonforte, Daniela Lo Giudice, Daniele Maisano, Raffaele Squeri, Caterina Elisabetta Rizzo","doi":"10.3390/medsci14050531","DOIUrl":"10.3390/medsci14050531","url":null,"abstract":"<p><strong>Background: </strong>Volcanic gas emissions represent an important but frequently underestimated non-eruptive natural hazard capable of causing severe acute intoxication and sudden death, even in the absence of volcanic eruptions. Although numerous reviews have investigated the chronic health effects of volcanic emissions, evidence regarding acute exposure events remains fragmented. This systematic review aimed to synthesize the available evidence on acute intoxication events and fatalities associated with exposure to sulfur dioxide (SO₂), carbon dioxide (CO₂), and hydrogen sulfide (H₂S) of volcanic origin.</p><p><strong>Materials and methods: </strong>A systematic literature search was conducted according to the PRISMA 2020 guidelines across six electronic databases (PubMed/MEDLINE, Scopus, Web of Science, Embase, Google Scholar, and WHO IRIS).</p><p><strong>Results: </strong>Six eligible studies describing fatal and non-fatal acute exposure events from five countries (Italy, France, the United States, Cameroon, and the Democratic Republic of Congo) were included. Carbon dioxide and hydrogen sulfide were the gases most frequently associated with fatal outcomes, predominantly occurring in confined spaces, geothermal areas, fumaroles, topographic depressions, or environments where adverse meteorological conditions promoted gas accumulation. The most common clinical manifestations included sudden loss of consciousness, pulmonary edema, respiratory failure, and asphyxial death. The largest documented event, the 1986 Lake Nyos disaster, resulted in more than 1700 fatalities following a massive limnic release of carbon dioxide.</p><p><strong>Conclusions: </strong>Across the included studies, recurring environmental determinants, exposure pathways, and toxicological mechanisms highlighted the critical role of environmental accumulation in shaping exposure risk. Despite the limited number of published cases, the available evidence demonstrates that acute volcanic gas exposure constitutes a significant yet underrecognized public health hazard. Strengthening environmental monitoring, risk communication, visitor safety measures, and interdisciplinary surveillance systems may substantially reduce preventable morbidity and mortality in volcanically active regions.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Supported Evidence Synthesis: A Case Study of Smart Infusion Pump Interoperability.","authors":"Carlos Sanchez-Piedra, Ivo Heyerdahl-Viau, Esther-Elena Garcia-Carpintero, Juan-Manuel Martinez-Nuñez, Francisco-Javier Prado-Galbarro","doi":"10.3390/medsci14050533","DOIUrl":"10.3390/medsci14050533","url":null,"abstract":"<p><strong>Background/objectives: </strong>Artificial intelligence tools have emerged as promising methodological support for systematic reviews and health technology assessment (HTA). Smart infusion pump interoperability represents a relevant case study due to its implications for medication safety, nursing workflow, and hospital quality improvement. The aim was to evaluate the performance of artificial intelligence as a methodological support tool across a systematic review, using the evidence synthesis on smart infusion pump-electronic health record interoperability as a case study.</p><p><strong>Methods: </strong>A systematic review following PRISMA 2020 guidelines was conducted. Searches were performed in MEDLINE, Embase, and Cochrane Library databases. AI-assisted tools (ChatGPT GPT-4 and Open Science Reviewer) were incorporated into data extraction, reporting appraisal based on STROBE criteria, and exploratory identification of methodological limitations under strict human supervision. Concordance between AI-assisted and manual extraction was evaluated descriptively.</p><p><strong>Results: </strong>Overall concordance between AI-assisted and manual data extraction was 82.5% (99/120) across assessed variables. Agreement was highest for structured variables, including study design (10/10; 100.0%), study identification variables (19/20; 95.0%), and participant characteristics (36/40; 90.0%). Agreement was lower for study content variables (18/30; 60.0%) and methodological appraisal (16/20; 80.0%). Among the 21 discrepancies, misclassification errors were most common (13/21; 61.9%), followed by omissions (3/21; 14.3%), incomplete data (3/21; 14.3%), and hallucinations (2/21; 9.5%). AI-assisted identification of methodological limitations showed substantial descriptive agreement with human assessments but demonstrated limited capacity for judgmental interpretations.</p><p><strong>Conclusions: </strong>Artificial intelligence demonstrated utility for structured review tasks such as data extraction and reporting appraisal, but showed limitations in tasks requiring interpretative and methodological judgement. Human oversight therefore remains essential throughout the review process. These findings derive from a single case study and should not be generalised beyond the evaluated context and AI tools.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Gut-Immune-Brain Axis in Aging: Integrating Immunosenescence, Inflammaging, and Neuroinflammation for Precision Medicine.","authors":"Dejana Bajić, Jelena Vučković, Nikolina Pupovac, Danijel Slavić, Mirjana Stojšić, Nikola Hodoba, Nemanja Todorović, Milica Plazačić, Nataša Milošević","doi":"10.3390/medsci14050536","DOIUrl":"10.3390/medsci14050536","url":null,"abstract":"<p><p><b>Background:</b> Population aging is accompanied by progressive immune remodeling, chronic low-grade inflammation, and increased susceptibility to neurodegenerative diseases. Although the microbiota-gut-brain axis is increasingly recognized as a regulator of neuroimmune homeostasis, mechanisms linking age-associated dysbiosis with immunosenescence, barrier dysfunction, and brain aging remain incompletely understood. This review integrates current evidence into the proposed Gut-Immune-Brain Resilience Axis (GIBRA), a systems-level model describing how microbial signaling shapes neuroimmune resilience during aging. <b>Methods:</b> A structured narrative review was conducted using PubMed and the Web of Science Core Collection from database inception up to July 2026. Evidence from systematic reviews, meta-analyses, consensus statements, mechanistic and translational studies, longitudinal cohorts, randomized clinical trials, and observational studies was synthesized. <b>Results:</b> Current evidence supports an important role for the disruption of microbial functional signaling in neuroimmune aging, while microbial taxonomy and functional profiles provide complementary levels of biological information. Reduced short-chain fatty acid production, dysregulated tryptophan metabolism, microbial translocation, endotoxin-mediated innate immune activation, and gut-conditioned adaptive immune responses promote immunosenescence, inflammaging, barrier dysfunction, and microglial priming. The proposed Double-Barrier Hypothesis links intestinal and blood-brain barrier dysfunction as complementary mechanisms underlying chronic neuroinflammation. GIBRA highlights functional microbiome endotypes, biomarkers, multi-omics, and artificial intelligence as emerging tools for precision medicine. <b>Conclusions:</b> GIBRA provides an integrated systems biology perspective connecting microbial signaling, immune resilience, barrier integrity, and brain resilience during aging. Prioritizing functional resilience over microbial taxonomy may improve biomarker discovery, patient stratification, and microbiome-targeted interventions for neurodegenerative disease prevention. Prospective longitudinal studies integrating multi-omics are needed to support clinical translation.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13608902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise, Sleep, and Cognitive Performance in Older Adults: A Structured Review of Mechanisms and Clinical Implications.","authors":"Elton Fernando Ferreira de Souza Vieira, Raphael Lopes Olegário, Cláudia Goulart, Otávio Toledo Nóbrega, Emmanuel Frimpong, Arsenio Paez, Thien Thanh Dang-Vu, Einstein Francisco Camargos","doi":"10.3390/medsci14050532","DOIUrl":"10.3390/medsci14050532","url":null,"abstract":"<p><p><b>Background</b>: Age-related cognitive decline is a major public health challenge, and modifiable lifestyle factors such as physical exercise and sleep have emerged as promising targets for preserving cognitive health. Our review aimed to synthesize evidence on the relationships between physical exercise, sleep, and cognitive performance in adults aged ≥60 years, with particular emphasis on the potential mediating or moderating role of sleep. <b>Methods</b>: Electronic searches were conducted in PubMed/MEDLINE, EMBASE, the Cochrane Library, Scopus, Web of Science, and Google Scholar to identify studies published between 2015 and 2025. Eligible studies evaluated structured exercise interventions or habitual physical activity and reported at least one sleep outcome alongside at least one cognitive outcome. <b>Results</b>: Twelve studies met the inclusion criteria, comprising randomized controlled trials, non-randomized intervention studies, and observational studies. Moderate-intensity aerobic exercise, multicomponent training, and mind-body interventions were the most frequently investigated exercise modalities. Across studies, exercise was generally associated with improved sleep quality and maintenance or enhancement of cognitive performance. Several studies identified sleep quality or sleep efficiency as potential mediators or moderators of exercise-related cognitive benefits; however, heterogeneity in study designs, interventions, sleep assessments, and cognitive outcomes precluded conclusions regarding causality. <b>Conclusions</b>: Current evidence suggests that sleep may represent an important behavioral pathway through which exercise contributes to cognitive health in older adults. Further well-designed randomized controlled trials incorporating objective sleep measures and mechanistic biomarkers are warranted to clarify these relationships.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609376/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-HLA Antibodies in Kidney Transplantation: Mediators of Allograft Injury or Markers of Dysregulated Humoral Immunity?","authors":"Ariadni Fouza, Maria Daoudaki","doi":"10.3390/medsci14050534","DOIUrl":"10.3390/medsci14050534","url":null,"abstract":"<p><p>Antibody-mediated rejection (AMR) remains a major cause of kidney allograft injury and loss. Although donor-specific antibodies against human leukocyte antigens (HLA-DSAs) are central to humoral alloimmunity, they do not explain all cases of microvascular inflammation or graft dysfunction. This review critically evaluates non-HLA antibodies as potential mediators of allograft injury and markers of dysregulated humoral immunity by integrating functional, experimental, clinicopathological, and clinical evidence. Receptor-targeting antibodies, especially those against the angiotensin II type 1 receptor (AT1R) and the endothelin-1 type A receptor (ETAR), have the strongest evidence for direct pathogenicity. Antibodies against major histocompatibility complex class I-related chain A (MICA) and glutathione S-transferase theta-1 (GSTT1) reflect non-HLA alloimmunity, whereas antibodies targeting perlecan-derived LG3, vimentin, and injury-associated antigens may arise through secondary autoimmunity and mark broader humoral activation. We propose that selected pathogenic non-HLA antibodies participate in a feed-forward cycle of graft injury, antigen exposure, epitope spreading, and humoral amplification, although this model requires longitudinal validation. Crucially, non-HLA antibody positivity alone should neither establish AMR nor guide antibody-specific treatment. Its interpretation should be target-specific and integrated with HLA-DSAs, histopathology, molecular findings, graft function, and evidence of immune activation.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13608934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blue-Light Filters in Eye Care: A State-of-the-Art Review.","authors":"Rowan Abass, Arwa Fathy, Ahmed Abass","doi":"10.3390/medsci14050530","DOIUrl":"10.3390/medsci14050530","url":null,"abstract":"<p><p>Blue-light filters now span spectacle, contact and intraocular lenses, but the term encompasses technologies with markedly different spectral characteristics and intended outcomes. This state-of-the-art narrative review synthesises peer-reviewed evidence on optical performance, digital eye strain, glare, photostress, sleep and circadian physiology, retinal phototoxicity, macular health, reported adverse effects and commercial translation. Near-clear spectacle filters preserve high-contrast acuity in most studies, but randomised and systematic reviews show no clinically meaningful average reduction in short-term digital eye strain. Some products reduce blue-colour contrast, particularly under low-contrast or low-light conditions, and adverse-event reporting is sparse. Studies of evening filters are heterogeneous: substantial amber attenuation can alter circadian light exposure, yet several trials have found no objective sleep benefit. Conventional visual outcomes with blue-filtering intraocular lenses are broadly comparable with ultraviolet-only lenses, although some individual studies report small mesopic colour or contrast disadvantages; long-term macular protection remains unresolved. Research on contact lenses is limited, typically short-term and often manufacturer-associated, and focuses on glare, photostress, scatter and perceived brightness rather than long-term health outcomes. Taken together, the evidence should be interpreted by filter spectrum and intended outcome, rather than treating blue-light filtering as a single intervention.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Lymphovascular Invasion: Site-Dependent Patterns of Lymphatic, Venous and Perineural Involvement in Laryngo-Hypopharyngeal Carcinoma.","authors":"Roxana-Andreea Popa, Cosmin-Gabriel Popa, Delia Hînganu, Marius Valeriu Hînganu, Cristinel Ionel Stan, Rares-Vasile Tracicaru, Otilia Boișteanu","doi":"10.3390/medsci14050527","DOIUrl":"10.3390/medsci14050527","url":null,"abstract":"<p><strong>Background: </strong>Building on our recent characterization of a layer-specific neurovascular microenvironment in the normal human vocal fold, we examined how that unit behaves in laryngo-hypopharyngeal carcinoma, where lymphatic and venous involvement are conventionally reported together.</p><p><strong>Methods: </strong>We retrospectively analyzed 48 laryngo-hypopharyngeal squamous cell carcinomas (2017-2025) with complete TNM vascular reporting, confirmed by CD31 and neuron-specific enolase (NSE) immunohistochemistry. Lymphatic (L) versus venous (V) assignment rested on morphological criteria, since CD31 cannot discriminate lymphatic from blood vessels and D2-40 was unavailable. L, V and perineural (Pn) status were related to pT stage and topography and combined into a composite score (NV = L + V + Pn), reassessed after adjustment for pT.</p><p><strong>Results: </strong>Concordant patterns predominated (L0V0 60.4%, L1V1 27.1%); 12.5% were dissociated. Vascular invasion correlated with pT (ρ = 0.393, <i>p</i> = 0.006) and, unadjusted, with Pn, but not after adjustment for pT. NV tracked pT more strongly than any single axis (KR-20 = 0.725; ρ = 0.534, <i>p</i> < 0.001). Glottic-only carcinoma showed the lowest involvement on all axes.</p><p><strong>Conclusions: </strong>Reporting L, V and Pn separately-parameters already in routine TNM notation-may capture tumor aggressiveness more completely than LVI as a single entity. This series cannot establish stage-independent co-variation in these axes, validate the L/V distinction molecularly, or, lacking follow-up, demonstrate prognostic value.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Profiles in Children and Adolescents with Visual Impairment: The Role of Syndromic Etiology and Vision Severity.","authors":"Mara L Cordeiro, Tiago S Bara, Vanessa Furlin, Daniel Almeida do Valle, Perola G Iankilevich, Carolina Prando","doi":"10.3390/medsci14050529","DOIUrl":"10.3390/medsci14050529","url":null,"abstract":"<p><p><b>Background:</b> Visual impairment is associated with mental health difficulties in children, yet emotional and behavioral profiles across different etiologies and levels of visual impairment remain poorly characterized. We investigated whether these outcomes were associated with syndromic etiology or visual impairment severity. <b>Methods:</b> In this cross-sectional study, parents of 69 children and adolescents aged 6-17 years with visual impairment completed the Child Behavior Checklist (CBCL/6-18). Participants were grouped by etiology (syndromic, <i>n</i> = 14; non-syndromic, <i>n</i> = 55) and by visual impairment severity (mild-to-moderate, <i>n</i> = 33; severe-to-profound, <i>n</i> = 36). Group differences were assessed using Mann-Whitney U tests with false discovery rate (FDR) correction, complemented by categorical analyses using scale-specific CBCL clinical thresholds. <b>Results:</b> No significant differences in emotional or behavioral symptoms were observed between the syndromic and non-syndromic groups, although the small syndromic subgroup limited statistical power. In contrast, children with mild-to-moderate visual impairment had significantly higher scores on the Anxious/Depressed and Somatic Complaints scales than those with severe-to-profound impairment, with both differences remaining significant after FDR correction. Categorical analyses also showed a higher prevalence of clinically significant Anxious/Depressed and Internalizing Problems in the mild-to-moderate group. <b>Conclusions:</b> Children with mild-to-moderate visual impairment exhibited higher Anxious/Depressed and Somatic Complaints scores than those with severe-to-profound impairment. These findings suggest that children with residual vision may represent an underrecognized subgroup at risk for emotional difficulties and support routine psychological screening across the spectrum of pediatric visual impairment.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metabolic and Inflammatory Risk Stratification in Resected Cholangiocarcinoma: A Retrospective Exploratory Analysis.","authors":"Piya Prajumwongs, Attapol Titapun, Vasin Thanasukarn, Apiwat Jareanrat, Natcha Khuntikeo, Nisana Namwat, Poramate Klanrit, Arporn Wangwiwatsin, Jarin Chindaprasirt, Prakasit Sa-Ngiamwibool, Nattha Muangritdech, Sittiruk Roytrakul, Watcharin Loilome","doi":"10.3390/medsci14050525","DOIUrl":"10.3390/medsci14050525","url":null,"abstract":"<p><p><b>Background:</b> Cholangiocarcinoma (CCA) frequently recurs after curative-intent resection. Metabolic alterations and systemic inflammation may contribute to aggressive disease, but their combined prognostic relevance remains unclear. <b>Methods:</b> We retrospectively reanalyzed 88 patients with resected CCA and documented recurrence, including 37 with early and 51 with late recurrence. A metabolite-based risk score was developed from recurrence-associated serum metabolites identified previously. Model development and internal validation used all 88 patients, whereas analyses involving preoperative neutrophil-to-lymphocyte ratio (NLR), clinicopathological variables, and survival outcomes included 85 patients with complete clinical data. Performance was assessed using repeated nested cross-validation, bootstrap validation, discrimination, calibration, and survival analyses. <b>Results:</b> The 10-metabolite risk score (MRS-10) showed moderate internally validated discrimination for distinguishing early from late recurrence, with a pooled patient-level out-of-fold AUC of 0.828 (95% CI, 0.725-0.911), with limited calibration. High MRS was associated with shorter disease-free survival (DFS) and overall survival (OS) (both <i>p</i> < 0.001) and remained independently associated with DFS events (HR, 7.92; 95% CI, 3.94-15.92) and mortality (HR, 4.05; 95% CI, 2.08-7.89). High MRS was also associated with elevated NLR (<i>p</i> < 0.001). The combined MRS-NLR framework improved prognostic discrimination and stratified patients into groups with stepwise differences in DFS and OS. Exploratory subgroup analyses showed broadly consistent adverse associations across selected clinicopathological strata. <b>Conclusions:</b> In this retrospective exploratory analysis, a metabolite-based risk score combined with preoperative NLR was associated with recurrence and survival outcomes in resected CCA. This metabolic-inflammatory framework may provide complementary prognostic information alongside conventional clinicopathological factors. However, the findings remain hypothesis-generating and require validation in larger independent cohorts before clinical application.</p>","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Communicating Artery Aneurysm Microsurgery: PComA-CORE, an Anatomy-Informed Explainable AI Framework for Complexity, Neurovascular Risk, Oculomotor Recovery and Functional Outcome.","authors":"Matei Șerban, Corneliu Toader, Alexandru Vlad Ciurea, Leon Dănăilă, Răzvan-Adrian Covache-Busuioc","doi":"10.3390/medsci14050528","DOIUrl":"10.3390/medsci14050528","url":null,"abstract":"&lt;p&gt;&lt;p&gt;The posterior communicating artery (PComA) aneurysm is a challenging microsurgical problem due to multiple factors. These include the technical complexity of the surgery itself, potential injury to blood vessels during surgery, recovery of cranial nerve function, and overall neurological outcome after the operation. These are all related to the area where the PComA aneurysm is located, but they have fundamentally different biological determinants. Prior methods of describing aneurysms do not adequately describe how the relationships of the internal carotid artery (ICA) and PComA/P1 configuration influence the proximity of the aneurysm to other important structures such as the perforating arteries, the anterior choroidal artery (AChA), cranial nerve III (CN III), and the surgical corridor. We created PComA-CORE, an artificial intelligence-based framework designed to evaluate whether the elements of experienced microsurgeons' thought processes can be measured individually while still maintaining temporally valid predictions, human interpretability, and explicit estimates of predictive uncertainty. &lt;b&gt;Methods:&lt;/b&gt; Using a highly detailed database of clinical, radiographic, anatomical, intraoperative, and longitudinal data from 687 adult patients who underwent microsurgical clipping of PComA aneurysms over the period 1997-2026, we applied PComA-CORE to predict separately: Microsurgical Complexity (C); Oculomotor Recovery (O); Neurovascular Preservation Risk (R); and Expected 90-Day Functional Outcome (E). The models used cases from 1997-2020 (&lt;i&gt;n&lt;/i&gt; = 564) for development and cases from 2021-2026 (&lt;i&gt;n&lt;/i&gt; = 123) for temporal evaluation. Several architectures, including penalized regression, machine-learning techniques, interpretable machine learning, and ensembles, were compared using nested cross-validation, discrimination metrics, calibration metrics, decision-curve analysis, explainability measures, uncertainty-aware prediction, inter-observer reproducibility, and model-to-score distillation. &lt;b&gt;Results:&lt;/b&gt; Four discrete predictive architectures were identified by PComA-CORE. PComA-C was found to be highly dependent upon anatomy because the specific geometric characteristics of individual vascular segments and the presence or incorporation of branches around the aneurysm strongly influenced temporal predictions. PComA-R was found to behave as a distributed susceptibility phenotype based on neurovascular attributes rather than a deterministic injury model and achieved a temporal AUC of 0.703. Among patients with preoperative CN III palsy, PComA-O identified that recovery primarily depended upon the time course of neurological dysfunction and structural deformation of the affected nerve. Temporal validation was not feasible given the small number of recent non-recovery events. Conversely, PComA-E showed that global functional outcome continued to depend predominantly upon clinical neurological severity, with a temporally evaluated penalize","PeriodicalId":74152,"journal":{"name":"Medical sciences (Basel, Switzerland)","volume":"14 5","pages":""},"PeriodicalIF":4.4,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13609308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149042460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}