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Patients with chronic thromboembolic pulmonary hypertension (CTEPH) were traditionally advised against exercise training, based on unsubstantiated concerns that exercise-induced increases in pulmonary blood flow might aggravate vascular remodeling and trigger right ventricular decompensation. This dogma has been overturned by robust clinical evidence demonstrating that supervised exercise and respiratory training are both safe and effective. Exercise interventions consistently improve functional capacity, pulmonary hemodynamics, and health-related quality of life. Reflecting this paradigm shift, the latest European Society of Cardiology/European Respiratory Society guidelines endorse structured rehabilitation as an integral adjunct to established pharmacologic and interventional therapies.

Chronic hepatitis delta (CHD) causes severe chronic viral hepatitis. This study examines the predictors and outcomes of CHD course in a large contemporary cohort. CHD patients with ≥3 years follow-up from the multicentre retrospective D-SOLVE and hepatitis D virus (HDV)-1000 database (6 European centres) were enrolled. Longitudinal changes in biochemical and laboratory markers were analysed. Time-to-event analysis was performed and predictors of liver-related events (LREs) were assessed with univariable and multivariable Cox regression analysis. Among a total of 1004 patients, 565 (56%) with ≥3 years follow-up were included. Patients had a mean (SD) age of 45 (12) years, with 55% men and 60% of European origin. At baseline, 77.8% were HDV RNA+, 39.8% had cirrhosis and 45% had previous interferon therapy. During a median (IQR) follow-up of 55 (46-62) months, 48 patients progressed to cirrhosis at 1, 3 and 5-year cumulative incidence of 1.8%, 5.6% and 13.6%, respectively. De-novo LREs occurred in 47 (9%) patients at 1, 3 and 5-year cumulative incidence of 0.8%, 2.4% and 10.8%, respectively. Cox regression analysis showed that anti-hepatitis C virus+ (adjusted hazard ratio (aHR)=1.72, 95% CI 1.22 to 5.88) and elevated gamma-glutamyl transferase (GGT) (aHR=2.77, 95% CI 1.22 to 6.27) at baseline were significantly associated with cirrhosis onset, while older age (aHR=1.03, 95% CI 1.00 to 1.07), elevated GGT (aHR=4.38, 95% CI 1.81 to 10.57), detectable HDV RNA (aHR=10.32, 95% CI 1.34 to 79.53) and cirrhosis diagnosis (aHR=2.23, 95% CI 1.03 to 4.84) correlated with LREs. The risk for LREs increased from HDV RNA ≥1000 IU/mL, while hepatitis B surface antigen (HBsAg) levels did not correlate with disease progression. In a large real-life cohort of CHD patients, older age, GGT elevation, cirrhosis and detectable HDV RNA were the main determinants of liver-related outcomes, with worse prognosis noted from HDV RNA ≥1000 IU/mL.

Despite the demonstrated clinical benefits of poly(ADP-ribose) polymerase inhibitors (PARPis), up to 25% of newly diagnosed patients are nonadherent. To maximize clinical outcomes, there is a need to identify best practices used at centers of excellence that treat patients with advanced epithelial ovarian cancer (aEOC) with PARPis. A qualitative initiative was undertaken in which healthcare professionals (HCPs) from select centers of excellence in the European Union and North America were invited to complete an online survey, be interviewed, and participate in a virtual workshop. The 15-item survey asked questions about the factors comprising PARPi models of care at their center, the typical patient journey, and current treatment challenges. The interview and workshop were intended to gain additional insights and to further define the key components of care models, as well as factors contributing to long-term therapeutic success. Twelve centers of excellence, six in the European Union and six in North America, participated. Five factors were identified as contributing to PARPi models of care at the participating centers of excellence: (1) supportive infrastructure to optimize patient care, (2) best communication practices for HCPs, (3) HCP education and support to optimize patient care, (4) PARPi maintenance treatment initiation to support long-term adherence, and (5) PARPi maintenance treatment adherence and continuation. The creation of a compassionate, supportive healthcare environment is essential to maximizing the likelihood of patients with aEOC initiating, adhering to, and continuing with first-line maintenance treatment with a PARPi.

Coccidiosis remains a major constraint in poultry production; therefore, this study evaluated the anticoccidial efficacy of a phytogenic blend of cinnamon bark and Rumex nervosus leaf in Eimeria tenella-challenged broilers. Birds were assigned to six treatments: low (PL-C), medium (PM-C), and high (PHC) phytogenic, a standard anticoccidial (STD-C), an infected untreated control (IUC), and an unchallenged untreated control (UUC). All groups except UUC were orally challenged on day 15 with 2 &#xd7; 104 sporulated Eimeria tenella oocysts per bird, and performance and anticoccidial responses were evaluated during 7 days post-inoculation (DPI). The phytogenic blend was selected for the complementary biological activities of cinnamon and Rumex nervosus and was characterized by abundant phenolic compounds, particularly gallic acid and cinnamaldehyde derivatives, associated with antiparasitic, antioxidant, antimicrobial, and gut-protective effects. Infection markedly impaired growth performance, feed efficiency, performance index, and European production efficiency factor in the IUC group. Dietary phytogenic supplementation alleviated these adverse effects (P < 0.05) by reducing oocyst output (24.2-31.0%), increasing oocyst inhibition rates (69.0-75.8%), and lowering lesion severity and bloody diarrhea scores compared with IUC. Among phytogenic treatments, PHC exhibited the strongest anticoccidial activity, with the lowest oocyst counts and improved cecal morphometric recovery, particularly reduced cecal wall thickness, whereas PL-C showed the greatest improvement in body weight gain and production performance among phytogenic groups. Anticoccidial index values indicated marked anticoccidial activity for phytogenic treatments (162.3-167.8) and excellent activity for STD-C (187.5), compared with inactive status in IUC (83.6). Phytogenic supplementation also improved cecal integrity through increased villus height, reduced crypt depth, and enhanced villus height-to-crypt depth ratio, indicating improved absorptive capacity and mucosal recovery. Overall, the cinnamon- Rumex nervosus blend effectively mitigated Eimeria tenella-induced damage and demonstrated strong potential as a natural alternative to conventional anticoccidials, although its efficacy remained slightly lower than the standard drug treatment.

Preoperative cardiovascular risk stratification is essential in noncardiac surgery, but conventional testing is frequently overused, increasing costs without improving outcomes. Artificial intelligence (AI)-enabled electrocardiography (ECG) may enhance perioperative risk assessment by identifying surgical candidates at very low-risk for adverse events. This study aimed to evaluate whether AI-ECG-based risk stratification could help decrease low-yield preoperative cardiovascular testing and reduce associated costs, without an observed increase in postoperative adverse outcomes, in candidates for noncardiac surgery. We retrospectively analyzed 41,218 patients (46,135 ECG-surgery pairs) undergoing noncardiac surgery at Seoul National University Bundang Hospital (2020-2021). An AI-ECG algorithm generated eight probability scores for cardiac conditions, classifying cases as low- or high-risk. Based on the performance and results of preoperative cardiovascular testing (transthoracic echocardiography, coronary computed tomography angiography, single-photon emission computed tomography, or coronary angiography), cases were classified as no advanced cardiovascular imaging, negative-test, or positive-test. The primary end point was a 30-day composite of all-cause mortality and unplanned percutaneous coronary intervention. AI-ECG classified 92.3% (42,599/46,135) of cases as low-risk, with a composite outcome rate of 0.2% (79/42,599) vs 2.9% (101/3536) in high-risk cases. Preoperative cardiovascular testing was performed in 11.8% (5458/46,135) of cases, with only 16.3% (892/5458) yielding positive findings. In AI-ECG low-risk cases, event rates were uniformly low (0.2%-0.4%) irrespective of whether advanced cardiovascular testing was performed, whereas in high-risk cases, rates were consistently high (2.6%-3.4%). The incidence of the composite outcome was consistently higher in AI-ECG-graded high-risk cases across all European Society of Cardiology surgical risk and Revised Cardiac Risk Index strata. In this retrospective cohort, a multitask AI-ECG identified surgical candidates at low-risk for postoperative complications, for whom advanced cardiovascular testing demonstrated low diagnostic yield. Integrating AI-ECG with conventional risk tools may offer an exploratory strategy to optimize resource use and minimize redundant testing. Prospective studies are needed to confirm the clinical and economic benefits of AI-ECG as a screening tool.

Dyeing wastewater is a significant source of industrial pollution, with emerging contaminants posing risks to aquatic ecosystems and human health, yet integrated assessments of multiple contaminant classes in dyeing wastewater at the enterprise scale remain scarce. This study investigated the occurrence, removal efficiency, and ecological risk of polyfluoroalkyl substances (PFAS), bisphenols (BPs), and phthalates (PAEs) in wastewater samplesfrom 18 dyeing enterprises in Guangdong Province, China. Detected concentrations ranged from 1.20-111 ng/L for PFAS, 10.5-1.98 &#xd7;103 ng/L for BPs, and 15-3.27 &#xd7; 104 ng/L for PAEs, revealing significant inter-enterprise variability. Removal efficiencies varied substantially across enterprises, with some compounds exhibiting negative removal rates, indicating possible transformation, desorption, or process-induced release during treatment. Ecological risk assessment identified bisphenol A (BPA) and diethylhexyl phthalate (DEHP) as priority contaminants. Given the persistence and bioaccumulation potential of PFAS, additional risk assessment focused on fish collected near discharge points. While PFAS concentrations in some samples exceeded European Union regulatory thresholds, overall levels suggest limited short-term health risk, although potential long-term exposure remains a concern. Given its high concentration of dyeing enterprises and substantial wastewater discharge intensity, Guangdong represents a critical case for understanding dyeing wastewater impacts in China. The findings and solutions derived from this region are therefore not only locally relevant but also provide a valuable reference for dyeing industries across China.

The recommendations of the European association of urology (EAU) suggests treating the bladder phenotype with Hunner's lesion (HL) associated with bladder pain syndrome (BPS) by transurethral resection (TUR) or coagulation of the lesions. We present the results of this approach in our practice. Retrospective monocentric study including consecutive patients presenting BPS with HL assessed during cystoscopy between 1998 and 2026. Patients were divided in two groups according to treatment strategy: group 1 with medical management (association of Cimetidine or bladder instillations of RIMSO or Pentosan polysulfate de sodium (CRP)) and group 2 with surgical management (immediate TUR, repeated if pain and HL recurrence). The primary objective was to compare success of each management strategy, defined by complete resolution of pain. Secondary objectives were to describe efficacy on pollakiuria symptoms and morbidity of surgical management. Thirty-two patients were included (group 1 n=9, group 2 n=23). Success of treatment was achieved in 11.1% (1/9) cases in group 1 and in 78,2% (18/23) cases in group 2 (p=0.001). In group 1, the only pain resolution was observed after RIMSO bladder instillation. In group 2, 61,1% (11/18) experienced a pain recurrence after being cured with a median delay of 13 [6-30.25] months. 12 patients required a 2nd TUR. Resolution of pollakiuria occurred in 0% in group 1 and 34,8% (8/23) in group 2 (p=0.07). Three patients required reintervention after TUR, 2 for bladder perforation (1 open and 1 laparoscopic bladder repair), 1 for gross haematuria requiring coagulation and 12.5% (4/32) patients ultimately underwent cystectomy. in case of BPS with a bladder phenotype and one or more Hunner's lesions, treatment by transurethral resection of the inflammatory lesion is more effective for pain and, to a lesser extent, for pollakiuria than our usual medical treatment (CRP) but does not prevent recurrence after varying periods of time.

Paediatric regional anaesthesia (RA) is a safe and effective modality for peri-operative pain management, associated with improved outcomes and reduced opioid use. However, utilisation remains variable, and defining appropriate benchmarks is challenging. We conducted a 28-day retrospective audit of RA practice in a tertiary paediatric centre. All anaesthesiologist-performed regional blocks were recorded. Surgical cases not typically amenable to RA were excluded. The primary outcome was the proportion of patients receiving RA, with secondary analysis excluding unsuitable procedures. A total of 491 patients underwent surgery, of whom 94 (19.1%) received RA, increasing to 20.8% following case exclusion. A total of 117 blocks were performed, comprising 86 peripheral (73.5%) and 31 central (26.5%) blocks. Peripheral techniques included 42 lower limb (35.9%), 30 truncal/craniofacial (25.6%), and 14 upper limb (12.0%) blocks. Central blocks included 15 caudal (12.8%), 10 epidural (8.5%), and 6 paravertebral (5.2%) blocks. RA utilisation in our institution is consistent with European data. These findings establish a local benchmark and support ongoing audit and quality improvement in paediatric anaesthesia practice.

Biosimilars are a critical strategy for improving access to high-cost biologics and ensuring the sustainability of healthcare systems worldwide. Over the past decade, China has transformed from a nascent market into one of the world's most active regions for biosimilar development. This review evaluates this transformation with a focus on regulatory evolution, approval dynamics, and global integration. We trace the development of China's biosimilar regulatory framework from the foundational 2015 Technical Guidelines to the current system of 19 technical and product-specific guidelines, highlighting the maturation of a stepwise, science-driven comparability paradigm aligned with international regulatory standards. Drawing on a systematic analysis of 83 biosimilars approved between 2019 and 2025, we analyze trends across molecular classes, therapeutic areas, and regulatory review pathways, illustrating how regulatory expectations and sponsor development strategies have evolved through representative case examples. Notably, the 2025 annual reports from both the US Food and Drug Administration and European Medicines Agency emphasize the increasing number of biosimilar approvals, therefore, we place China's approval experience in brief comparative context. Finally, we discuss China's expanding biosimilar development pipeline in the context of the forthcoming global biologics patent cliff and ongoing international initiatives to streamline biosimilar development, highlighting China's increasing integration into the global biopharmaceutical landscape.

Cutaneous melanoma poses a growing global health concern, with solar ultraviolet radiation (UVR) as its main risk factor. Outdoor workers may be at increased risk due to prolonged occupational solar UVR exposure, but evidence remains limited. To examine the risk of melanoma associated with occupational solar UVR exposure in a nationwide cohort of Danish workers. Using Danish national registers, we established a cohort of all individuals employed between 1977 and 2015 and linked occupational histories to first-time melanoma diagnoses in the Danish Cancer Registry. Cumulative occupational solar UVR exposure was estimated by matching occupational histories to a European job exposure matrix and expressed as cumulative standard erythema dose (SED)-years. Incidence rate ratios (IRRs) for cutaneous melanoma were calculated using discrete-time hazard models, and exposure-response relations were further examined with restricted cubic splines. We adjusted for age, sex, calendar year, smoking, dermatological or immunological disease, organ transplantation, parental history of melanoma and medications. Among 2.9 million workers followed for a median of 19 years, 11,344 workers developed cutaneous melanoma. The median cumulative occupational solar UVR exposure was 5.99 SED-years. Melanoma incidence increased with increasing cumulative exposure, reaching a peak IRR of 1.59 (1.43-1.76) at 14.80 SED-years in the spline analysis, and with an adjusted IRR of 1.57 (95% CI: 1.43-1.71) for workers in the highest vs. the lowest exposure quartile. Occupational solar UVR exposure was associated with an exposure-response relation increase in melanoma risk. These findings highlight the urgent need for workplace sun-protection policies.

Positive margins occur in 12% to 30% of breast-conserving surgeries and are associated with increased local recurrence risks. Accurate and efficient intraoperative margin assessment, therefore, remains an unmet clinical need. To evaluate the success rate of intraoperative specimen positron emission tomography (PET)-computed tomography (CT) imaging in addressing positive margins in patients with invasive ductal carcinoma. This was an interventional, multicenter, nonrandomized clinical trial that recruited patients from June 2022 to March 2025. Patients were followed up 2 weeks after surgery. Six European breast cancer centers participated and integrated specimen PET-CT imaging into their routine surgical flow. The analysis included eligible patients with early-stage breast cancer scheduled for breast-conserving surgery. Patients received an intravenous injection of low-dose 18F-fluorodeoxyglucose (FDG; 0.8 MBq/kg). After tumor excision, the specimen was imaged intraoperatively using a dedicated specimen PET-CT scanner. Surgeons interpreted PET-CT images intraoperatively, and additional tissue was excised when margins were deemed suspicious to achieve final negative margins. The primary outcome was the success rate of specimen PET-CT in addressing positive margins for the invasive component in patients undergoing breast-conserving surgery for invasive ductal carcinoma. Secondary outcomes included success rates in other breast cancer subtypes, final positive margin rates, reoperation rates, and diagnostic performance using histopathology as the reference standard. The analysis cohort consisted of 148 female patients with a median (IQR) age of 65 (53-73) years and a median (IQR) preoperative tumor size of 17 (12-22) mm. For the invasive component of invasive ductal carcinoma, success rates increased from 83.3% (70 of 84 patients) without intraoperative margin assessment (IMA) to 86.9% (73 of 84 patients) with routine margin assessment and to 95.2% (80 of 84 patients) with specimen PET-CT (P < .001 vs no IMA). Across all study groups, success rates improved from 76.4% (113 of 148 patients) without IMA to 81.8% (121 of 148 patients) with routine margin assessment techniques and to 91.9% (136 of 148 patients) with specimen PET-CT (P < .001 vs no IMA; P = .009 vs standard-of-care IMA). Study findings show that specimen PET-CT imaging was associated with an improvement in the assessment of positive margins for invasive component in patients undergoing conserving surgery for early breast cancer. The use of this integrated approach might lead to a substantial reduction of re-excision rates after breast-conserving surgery. ClinicalTrials.gov Identifier: NCT04999917.

Apical aneurysms in hypertrophic cardiomyopathy (HCM) have been linked to sudden cardiac death (SCD) and a nidus for thromboembolism. Uncertainty remains regarding the level of risk and significance of aneurysm size. The objective of the study was to determine the rate of SCD events and prevalence of apical thrombus or embolic events by size (maximum transverse dimension). Apical aneurysms were identified in 510 patients from 10 centers, followed a median of 4.1 years for SCD events (SCD, appropriate implantable cardioverter defibrillator therapy, and resuscitated SCD) or development of apical thrombus/thromboembolism. Relationship between size and SCD events was analyzed using multivariable Cox proportional hazard models. In 510 HCM patients: 19% had small aneurysms (<10 mm), 39% medium (10-19 mm), 39% large (20-39 mm), and 3% very large (&#x2265;40 mm). SCD event rate was 2.1%/year, with risk increasing with increasing aneurysm size: 0.2%/year in small, 2.3%/year in medium, 3.0%/year in large and 8.2%/year in very large (P < 0.001). On multivariable analysis, greater size was associated with SCD events, independent of other risk markers or European Society of Cardiology-SCD score. Either an embolic event (3.6% of patients) or apical thrombus (10% of patients) occurred in 13% of patients and was independently associated with greater aneurysm size, 3% in small to 25% in very large aneurysms (P < 0.001). In a large cohort of HCM patients with apical aneurysms, rates of SCD events were high, with continuous relationship between size and risk. Small aneurysms (<10 mm) were associated with low risk for SCD events (0.2%/year), whereas aneurysms &#x2265;10 mm with high risk (>2%/year). Although embolic events were uncommon, increasing aneurysm size was associated with the prevalence of apical thrombi.

There is conflicting evidence regarding the merits of patellar resurfacing during total knee replacement (TKR), as previous randomised controlled trials (RCTs) have been under-powered and with follow-up of ten years or less. A pragmatic, multicentre, open-label RCT was initiated in 1999 in the UK. Within a partial-factorial design, participants were randomly allocated to receive or not receive patellar resurfacing during primary TKR and were followed up for 20 years. Adult (aged &#x2265;18 years) patients due to have a primary TKR under the care of a collaborating surgeon were eligible. Participants were allocated (1:1) using an automated telephone service stratified by surgeon, with minimisation according to the patients' age (<60 years, 60-79 years, &#x2265;80 years), sex, and location of d isease. The primary outcome measure was the Oxford Knee Score (OKS), analysed using repeated measures mixed-effects linear regression analysis with marginal differences reported. Secondary measures included the 12-Item Short Form Health Survey (SF-12), the European Quality of Life 5-Dimensions 3-Levels (EQ-5D-3L), costs, cost-effectiveness, and subsequent knee surgery. This trial is registered with ISRCTN Registry, ISRCTN45837371. Between April 8, 1999, and Jan 13, 2003, 1715 participants (955 female and 760 male; mean age 70 years [SD 8], mean BMI 29&#xb7;7 kg/m2) were randomly assigned: 861 to patellar resurfacing and 854 to no resurfacing. At the 20-year follow-up, 132 participants in the patellar resurfacing group and 110 participants in the non-resurfacing group provided outcome data, although marginal differences included earlier data for participants who died or had missing 20-year data. The marginal difference in OKS over the whole 20-year follow-up was 0&#xb7;76 (95% CI -0&#xb7;08 to 1&#xb7;59; p=0&#xb7;076) in favour of patellar resurfacing. During the 20-year follow-up period, although not significant, differences in OKS, SF-12, and EQ-5D-3L, readmissions, minor or intermediate operations, patella-related operations, major operations, and complications all favoured patellar resurfacing. At 20 years, the resurfaced group accrued significantly more quality-adjusted life-years (QALYs) than the non-resurfaced group (7&#xb7;295 vs 6&#xb7;884; difference 0&#xb7;380, 95% CI 0&#xb7;061 to 0&#xb7;700; p=0&#xb7;020). However, QALY differences were smaller in a sensitivity analysis assuming no difference in mortality (7&#xb7;209 vs 6&#xb7;964; difference 0&#xb7;183, 95% CI -0&#xb7;034 to 0&#xb7;400; p=0&#xb7;10). The cost of readmissions was non-significantly lower in the resurfaced group and offset the higher cost of primary TKR; therefore, overall 20-year health-care costs per participant were similar (&#xa3;10&#x2008;825 vs &#xa3;10&#x2008;889; difference -&#xa3;6, 95% CI -&#xa3;721 to &#xa3;708; p=0&#xb7;99). There was no significant difference in primary outcome (OKS) or other clinical endpoints. However, as clinical differences tend to support patellar resurfacing, the resurfacing group had significantly higher QALYs. There was no difference in costs over the 20-year period, and patellar resurfacing had a 99% probability of being cost-effective at any threshold above &#xa3;10&#x2008;000 per QALY gained. The evidence is therefore weighted towards resurfacing being the approach of first choice. UK National Institute for Health and Care Research Health Technology Assessment Programme.

Parental distress impacts children's emotional adjustment, highlighting the need to identify protective factors. Promising candidates include positive control (i.e., autonomy support, indexed by parental encouragement, praise, and open-ended questions) and representational mind-mindedness (the propensity for parents to view children as independent agents). To counterbalance the focus on European and North American samples, we included 849 parent-child dyads from England, Hong Kong and Mainland China (Mchild age&#x2009;=&#x2009;5.17 years, SD&#x2009;=&#x2009;0.51). Parents rated their own distress and child internalizing problems; their interactions with their children were assessed for positive control, and their speech samples were coded for representational mind-mindedness. In a single-paper meta-analysis, parental distress was associated with elevated child internalizing problems and low positive control consistently across sites, but only associated with low mind-mindedness in England. Within-site analyses showed that intergenerational associations in distress-internalizing problems were attenuated by positive control in Mainland China and by mind-mindedness in England; multi-group modeling demonstrated that this latter effect was site-specific. These findings highlight the importance of widening the cultural scope of this research field.

Advanced head and neck squamous cell carcinoma (HNSCC) carries a poor prognosis, particularly in resource-limited settings with restricted access to targeted or immune therapies. We evaluated whether adding triple oral metronomic chemotherapy (OMCT; erlotinib, celecoxib, methotrexate) to paclitaxel-carboplatin (PC) improves overall survival (OS) in patients with platinum-sensitive, unresectable advanced HNSCC. This was a single-center, investigator-initiated, prospective, randomized, open-label, phase III superiority trial conducted at a tertiary cancer center in North India. A total of 238 adults with histologically confirmed, unresectable advanced HNSCC eligible for palliative platinum-based chemotherapy were randomly assigned 1:1 after stratification by tumor site and Eastern Cooperative Oncology Group (ECOG) performance status. Arm A received PC plus OMCT; Arm B received PC alone. The primary end point was OS. Secondary end points included progression-free survival (PFS), quality of life (QoL; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Functional Assessment of Cancer Therapy-Head & Neck), and safety. Among 238 patients (119 per arm), the median age was 47 years; 97.8% were male, and 78% had ECOG performance status (PS) 0-1. The median OS was 10 months (95% CI, 8.3 to 11.7) with PC + OMCT versus 5 months (95% CI, 3.9 to 6.1) with PC alone (hazard ratio [HR], 0.54 [95% CI, 0.41 to 0.72]; P < .001). The median PFS was 6 months versus 2 months, respectively (HR, 0.38 [95% CI, 0.28 to 0.50]; P < .001). QoL analyses demonstrated clinically meaningful preservation across multiple domains in the PC + OMCT arm. Grade &#x2265;3 toxicities did not increase with the addition of OMCT. In platinum-sensitive advanced HNSCC, the addition of triple OMCT to PC significantly improved OS and PFS with acceptable toxicity. PC + OMCT represents a feasible and cost-conscious first-line option in resource-constrained settings.