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Native Veterans experience disproportionately high rates of PTSD and suicide compared to other Veteran populations and face significant barriers to accessing mental healthcare, particularly in rural areas where many reside. This study aimed to support the delivery of Personalized Implementation of Video Telehealth for Rural Native Veterans (PIVOT-RNV) and examine the longitudinal impact on mental health engagement. PIVOT-RNV involves Implementation Facilitation strategies at the partnering VAMCs focused on technology adoption, cultural considerations, and outreach strategies for RNV communities. For this project, we engaged eight partner VAMCs in fiscal years 2023-2024. Using VA health records data, we conducted linear growth curve models to examine the effects of PIVOT-RNV on overall mental health care encounters and telemental health care specifically and whether this changed over time. Across all sites, telemental health encounters for rural Native Veterans significantly increased over time. Importantly, PIVOT-RNV sites experienced a significantly greater increase in telemental health encounters for RNVs over time compared to control sites. Sites with PIVOT-RNV also demonstrated a marginally significant greater increase in overall mental health encounters over time. These findings indicate PIVOT-RNV shows promise for improving RNV's access to VA healthcare by increasing both access to and engagement in video-based mental health. There is a need to further test and implement PIVOT-RNV across other health systems and to examine additional clinical and access outcomes.

The study investigated the effectiveness of dysgeusia-specific acupuncture combined with self-acupressure compared to supportive acupuncture and self-acupressure for chemotherapy-induced dysgeusia in cancer patients with cancer-related fatigue (CRF) and dysgeusia. This multicenter, randomized, controlled, two-armed parallel-group, single-blind trial included cancer patients with CRF and dysgeusia during chemotherapy. All participants received CRF treatment consisting of eight acupuncture sessions over 8 weeks and had access to an eLearning course for self-acupressure. Patients in the intervention group received additional dysgeusia-specific acupuncture treatment and an eLearning with instructions to acupressure points, whereas the control group received an intervention focused solely on addressing CRF. The main outcome was perceived dysgeusia over 8 weeks, measured weekly after each acupuncture session on a numeric rating scale from 1 to 10. Other outcomes included taste and smell tests, and assessments of perceived dysgeusia, fatigue, distress, and quality of life. Due to a small sample size, results can be only judged exploratory. The study was approved by the Cantonal Ethics Committee (CEC) (Kanton Zürich Kantonale Ethikkommission) (approval no. KEK-ZH-Nr. 2020-01900). Since we included only twenty-one patients (11 intervention, 10 control, 90% female) instead of the target sample size of 130, no confirmatory effectiveness analyses were conducted. All participants showed a substantial decrease in dysgeusia over time, regardless of treatment type (estimated mean reduction per session - 0.30; 95% CI - 0.43 to - 0.18), reflecting a 0.30-point reduction per session. Quality of life and cancer-related fatigue improved over time. The exploratory analyses did not show substantial differences between groups in any outcomes. No serious adverse events occurred. Exploratory findings showed no substantial differences between the study groups in perceived dysgeusia, but both study groups improved over time. DRKS00023348 at 03.11.2020, SNCTP000004128.

Electrical stimulation is a central tool in the evaluation and management of arrhythmias in the electrophysiological laboratory. Targeted atrial and ventricular pacing maneuvers allow induction, mechanistic characterization, and termination of arrhythmias. This provides important insights into the involved conduction pathways, anatomical location, and the underlying arrhythmogenic substrate, thereby forming the basis for a tailored ablation strategy. A structured approach even prior to the first stimulation maneuver establishes the foundation for successful diagnosis and therapy (ensuring stable catheter positions, optimal signal quality, and reliable capture). Understanding fundamental principles such as incremental, programmed, burst and overdrive stimulation is essential for accurate interpretation of electrophysiological responses. The consolidation of knowledge over the past three decades has helped ensure that, today, a few key maneuvers are usually sufficient to enable a rapid and reliable diagnosis. These play a key role in differentiating regular narrow-complex tachycardias, distinguishing wide-complex tachycardias, and identifying reentrant vs. nonreentrant mechanisms. They are also indispensable for assessing procedural endpoints after ablation, including confirmation of noninducibility of the clinical tachycardia or successful pulmonary vein isolation. The present review further outlines practical solutions to common challenges such as inconsistent pacing responses, far-field signals, and nonreproducible arrhythmia induction. Overall, systematic application of pacing maneuvers enables precise mechanistic classification of tachycardias and significantly contributes to safe, efficient, and individualized electrophysiological therapy. Die elektrische Stimulation ist ein zentrales Werkzeug in der Diagnostik und Behandlung von Herzrhythmusstörungen im elektrophysiologischen Labor. Durch gezielte atriale und ventrikuläre Stimulationsmanöver können Arrhythmien induziert, mechanistisch charakterisiert und terminiert werden. Dies ermöglicht Rückschlüsse auf beteiligte Leitungsstrukturen, die anatomische Lokalisation sowie das zugrunde liegende Substrat und bildet damit die Grundlage für eine zielgerichtete Ablationsstrategie. Ein strukturiertes Vorgehen bereits vor dem ersten Stimulationsmanöver schafft das Fundament für die erfolgreiche Diagnostik und Therapie (Sicherstellung stabiler Katheterpositionen, optimale Signalqualität, zuverlässiges Capture). Die Kenntnis grundlegender Prinzipien wie inkrementeller, programmierter, Burst- und Overdrive-Stimulation ist entscheidend, um elektrophysiologische Antworten korrekt zu interpretieren. Die Wissensverdichtung der vergangenen 3 Jahrzehnte hat dazu beigetragen, dass heute in der Regel einige zentrale Manöver eine rasche und sichere Diagnostik ermöglichen. Diese spielen eine zentrale Rolle für die Differenzierung regelmäßiger Schmalkomplextachykardien, Abgrenzung von Breitkomplextachykardien sowie Unterscheidung zwischen Reentry- und Nicht-Reentry-basierten Mechanismen. Darüber hinaus sind sie essenziell zur Überprüfung prozeduraler Endpunkte nach Ablation, etwa zur Bestätigung der Nichtinduzierbarkeit der klinischen Tachykardie oder einer erfolgreichen Pulmonalvenenisolation. In der vorliegenden Übersicht werden darüber hinaus Lösungsvorschläge für typische Herausforderungen wie inkonsistente Stimulusantworten und Far-Field-Signale oder nichtreproduzierbare Induktionen erläutert. Insgesamt ermöglicht ein systematischer Einsatz von Stimulationsmanövern eine präzise mechanistische Einordnung von Tachykardien und trägt wesentlich zu einer sicheren, effizienten und individualisierten elektrophysiologischen Therapie bei.

Just over 125 years has passed since the 'filterable' agents of tobacco mosaic disease and foot-and-mouth disease were first described as infectious, replicating entities smaller than bacteria. Today, viruses are formally classified into more than 16,000 species ranked into genera, families and higher taxa. The development of an official virus taxonomy has been overseen by an International Committee, first constituted in 1966 and renamed as the International Committee on Taxonomy of Viruses (ICTV) in 1975. Despite the engagement of the ICTV in virus taxonomy over the last 60 years, many aspects of virus classification and nomenclature may seem odd or sometimes incomprehensible to virologists more familiar with the taxonomy of cellular organisms. Who runs the ICTV? What are virus species demarcation criteria? Why have all virus species names become binomial? How can a sequence in a metagenomic dataset be assigned to a virus species? This article attempts to answer several such questions and outlines how a large, inclusive and global community of virologists has developed new and responsive policies for virus taxonomy in a decade when the pace of virus discovery has dramatically accelerated.

Neural circuits are remarkably robust to perturbations that threaten their function. Activity-dependent homeostatic plasticity (ADHP) is a stabilizing mechanism that supports robustness by tuning neuronal ion conductances to combat chronic over- or under-activity. Its restorative capacity has been demonstrated in the pyloric circuit of the crustacean stomatogastric ganglion, whose neurons must burst in a specific order to coordinate digestive muscles. After disruption by physical and pharmacological manipulations, this circuit reliably recovers not only the activity levels of constituent neurons, but also the proper burst order. But how could ADHP, operating only on local information about each neuron's average activity, maintain higher-order circuit properties? We explored this question in a computational model of the pyloric pattern generator. We first optimized a set of pyloric-like networks, then optimized ADHP mechanisms for each network to restore its pyloric character after parametric perturbations. This was possible for some networks and impossible for others, so we aimed to explain this disparity. We found that successful homeostatic regulators target average neural activity levels which happen to occur only among pyloric circuits and not among non-pyloric ones, within the set of reachable circuit configurations. Therefore, in subsets of parameter space where such dissociation is possible, activity carries indirect information about burst order, which ADHP can exploit to maintain pyloricness. Other subsets, whose pyloric averages are inseparable from non-pyloric ones, cannot be perfectly regulated. This separability property may explain differences in recovery capacity across perturbations and across individuals.

To assess trends in volume and utilization of neuroimaging (CT and MR) across Europe over the last decade, within the context of evolving clinical practice on behalf of the European Society of Neuroradiology's Choosing Wisely committee. A systematic search of PubMed was performed (following PRISMA 2020 guidelines) to identify studies reporting European neuroimaging volumes. As no eligible studies were identified, descriptive analysis of Eurostat and OECD data was performed for 29 European countries from 2015 to 2022, covering CT and MR examination volumes and scanner availability per 100,000 population across four geographic regions (Northern, Southern, Eastern, and Western Europe). Total CT/MR volumes served as neuroimaging surrogates. 316 publications were identified (with none meeting predefined inclusion criteria). Eurostat data from 29 countries revealed substantial growth in imaging from 2015 to 2022. Per capita CT exam rates increased 40.8% (10,872 to 15,312 per 100,000 population), and MR scan rates increased 43.5% (5746 to 8244 per 100,000 population). Scanner availability also increased (CT scanners from 2.3 to 2.68, MR scanners from 1.43 to 2.11 per 100,000 population). Regional variations were evident: Western Europe showed the highest utilization rates, Eastern Europe demonstrated the largest relative growth despite lower absolute numbers. All regions experienced consistent growth except during the 2020 COVID-19 disruptions. Neuroimaging utilization has substantially increased across Europe from 2015 to 2022, with disproportionate growth in scan volumes relative to scanner availability. These findings highlight regional disparities in utilization and underscore the need for coordinated evidence-based appropriateness initiatives to support sustainable neuroimaging practice. Question Have CT and MR neuroimaging utilization rates changed across Europe over the last decade compared to scanner availability? Findings CT and MR scan rates increased 40.8% and 43.5%, respectively, from 2015 to 2022, reflecting increased per-scanner utilization across the continent. Clinical relevance Neuroimaging examination volumes increased substantially across Europe from 2015 to 2022. This highlights the value of evidence-based imaging appropriateness initiatives to ensure sustainable healthcare resource utilization.

Rapid urbanization in semi-arid regions subjects metropolitan rivers to a distinctive form of hydrologic-physical impairment-herein designated as Type 4 degradation-characterized by connectivity fragmentation, baseflow depletion, and physical habitat homogenization, in which groundwater over-extraction elevates zero-flow days and concrete channelization eliminates substrate heterogeneity. Conventional assessment protocols, developed predominantly for humid-region perennial streams, inadequately capture the multidimensional connectivity dynamics critical to water-limited systems. To address this diagnostic gap, this study developed a hybrid Random Forest-Deep Neural Network (RF-DNN) framework that integrates objective feature selection with nonlinear modeling capacity and couples SHAP-based interpretability for mechanistic inference. A comprehensive indicator system encompassing 26 metrics across hydrology, hydrochemistry, physical habitat, biological organization, and socioeconomic pressure was constructed and evaluated using 96 observations collected from 24 monitoring sites across Xi'an's Ba, Chan, Feng, and Hei Rivers over 2 years. Under leave-one-river-out (LORO) cross-validation, the framework achieved a relative deviation of 7.6&#x2009;&#xb1;&#x2009;1.3%, Cohen's &#x3ba; of 0.76&#x2009;&#xb1;&#x2009;0.05, and ecological validity &#x3c1; of 0.79&#x2009;&#xb1;&#x2009;0.07, outperforming AHP-Fuzzy (15.2&#x2009;&#xb1;&#x2009;2.8%) and AHP-TOPSIS (17.1&#x2009;&#xb1;&#x2009;3.3%) methods as well as stand-alone XGBoost, SVM, Full-RF, and Full-DNN models (all paired-test p&#x2009;<&#x2009;0.05). SHAP analysis identified urbanization rate (mean |SHAP|=&#x2009;0.068), ammonia nitrogen (0.032), population density (0.028), and flow velocity (0.022) as dominant predictors of health variation, and revealed critical ecological transition zones-bootstrap-validated at 45% impervious cover (95% CI 38-52%) and 0.8&#xa0;mg/L NH&#x2083;-N (95% CI 0.65-0.94&#xa0;mg/L), with synergistic toxicity amplification of approximately 42% under co-occurring oxygen depletion (DO&#x2009;<&#x2009;4.0&#xa0;mg/L). Spatial assessment revealed a systematic longitudinal gradient (Hei&#x2009;>&#x2009;Feng&#x2009;>&#x2009;Chan&#x2009;>&#x2009;Ba), with the downstream urban reaches of Ba River exhibiting a mean dry-season RHI of only 0.2482, while wet-season improvements produced grade-level transitions at 10 of 24 sites (41.67%). The framework advances mechanistic diagnosis for semi-arid urban watersheds and supports evidence-based prioritization of flow reallocation, coupled NH&#x2083;-N/DO management, and riparian habitat reconstruction for restoration planning.

Birth trauma is a common experience, with 50% of birthing individuals perceiving their birth as traumatic. Using interpretive phenomenological analysis with an intersectional feminist trauma lens, this study aimed to understand how people experience healing from birth trauma. Eleven participants, who self-identified as having experienced and healed from a psychologically traumatic birth, were recruited. Data were collected through in-person interviews, follow-up phone interviews, and optional focus groups. The study identified five key themes related to the experience of healing from birth trauma: (1) seeking and strengthening support, (2) creating community and sharing stories, (3) empowerment as reframing the narrative and returning to self, (4) giving birth again, and (5) healing over time. The participants sought support from partners, friends, family, and healthcare providers, with some seeking professional therapy and medication. Creating communities and sharing stories, both in-person and online, helped reduce isolation and validate their experiences. For most participants, giving birth again was a major component of healing, providing opportunities for self-advocacy, regaining control, and experiencing patient-centered care. Empowerment is a key healing experience involving reframing narratives and self-acceptance. Healing was experienced as a nonlinear process over time, with moments of realization and reflection. Findings suggest that while psychological intervention is sometimes accessed, sharing stories, creating a community, and strengthening support systems over time are key components in moving forward from birth trauma. Interventions should integrate peer-led support and focus on reducing isolation and promoting community for those with birth trauma.

To evaluate the dissemination and real-world implementation of recommendations from the 5th Edition of the Japanese Esophageal Cancer Practice Guidelines and to inform development of the upcoming 6th Edition, the Guideline Committee of the Japanese Esophageal Society conducted a nationwide Quality Indicator (QI) survey in Japan. A nationwide, cross-sectional, web-based questionnaire survey was distributed to 381 certified institutions participating in the 2023 National Registry of Esophageal Cancer in Japan. Conducted in November 2024, the survey covered six domains-epidemiology, surgery, endoscopy, chemotherapy, radiation therapy, and pathology-reflecting key recommendations of the 5th Edition. Responses were summarized descriptively at the institutional level. Valid responses were obtained from 190 institutions (49.9%). Smoking cessation guidance was implemented in more than 90% of institutions, and over 90% also provided guidance on alcohol abstinence or moderation, although complete alcohol abstinence was less uniformly recommended. Minimally invasive, including robot-assisted, esophagectomy was adopted by over 90% of institutions. The proportion of institutions performing prophylactic cervical lymph node dissection varied by tumor location and stage, reflecting contemporary staging concepts. The DCF regimen was the predominant neoadjuvant therapy for stage II/III disease (94.7%), and immune checkpoint inhibitor-based chemotherapy was widely used for unresectable or recurrent disease. Advanced endoscopic diagnostic modalities, including magnifying and image-enhanced endoscopy, were widely adopted. This nationwide QI survey demonstrates broad adherence to guideline-based multidisciplinary management of esophageal cancer in Japan and provides an evidence base for refining recommendations in the 6th Edition of the Japanese Esophageal Cancer Practice Guidelines.

Predicting clinically significant drug-drug interactions (DDIs) continues to be an unresolved challenge in contemporary pharmacovigilance, primarily due to the inadequacy of current computational frameworks in addressing the nonlinear, multi-scale characteristics of simultaneous drug metabolism. This paper presents the Quantum Graph-Differential (QGD) model an exact mathematical framework that combines quantum-inspired graph theory with a set of interconnected fractional differential equations to describe and forecast pairwise drug-drug interactions (DDIs). The principal component of our construction is the quantum interaction graph [Formula: see text], wherein the vertex set represents distinct drug molecules as quantum states within a finite-dimensional Hilbert space, and the complex-valued edge weights are obtained from the overlap of shared metabolic pathways and transporter affinity profiles.A Schr&#xf6;dinger-type equation on [Formula: see text] governs drug-drug coupling, and the graph Hamiltonian [Formula: see text] is constructed from a novel fractional quantum graph Laplacian [Formula: see text], [Formula: see text]. A hybrid quantum-classical dynamical model is created by coupling the time evolution of the interaction wavefunction [Formula: see text] to a compartmental pharmacokinetic/pharmacodynamic (PK/PD) ordinary differential equation system. Using Banach fixed-point and semigroup theory, we prove existence, uniqueness, and long-time asymptotic stability of solutions. Using the QGD framework on a selected dataset of 7,428 clinically confirmed DDI pairs from DrugBank v5.1, TWOSIDES, and FAERS, our model outperforms five established baselines by 1.5-13.9 percentage points in AUC, with an average precision of 0.948 and an AUC of 0.962. Quantum edge weighting alone explains a 3.7% relative F1 gain over unweighted graph methods, according to ablation experiments. These results show that quantifiable, interpretable improvements in DDI prediction can be obtained by incorporating quantum mechanical concepts into graph-differential frameworks.

Hydrogenation is widely used in the synthesis of industrial chemicals, yet its reliance on pressurized H2 poses safety risks and contributes to carbon emissions. Transfer hydrogenation offers an attractive alternative, but it remains constrained by the high cost of typical hydrogen donors. Polyethylene (PE), a major contributor to persistent plastic wastes, is a hydrogen-rich polymer capable of releasing hydrogen during catalytic deconstruction. Here, we propose the use of PE as an inexpensive hydrogen donor for the selective transfer hydrogenation of C&#x2500;O bonds. We evaluate the transfer hydrogenation of representative substrates, including methanol and lignin model compounds such as anisole and phenoxy ethylbenzene, and show that C&#x2500;OH, Caryl&#x2500;O&#x2500;CH3, and &#x3b2;-O-4 linkages undergo efficient and selective cleavage to afford the desired products over acidic zeolites under mild conditions (ambient pressure, <200&#xb0;C). Control experiments show that the acid sites of the zeolite activate PE to generate hydrogen species while simultaneously polarizing the C&#x2500;O bonds of the substrates, thereby enabling C&#x2500;O bond transfer hydrogenolysis. These findings uncover a previously unrecognized hydrogen-transfer pathway between PE and C&#x2500;O bonds, and provide a basis for developing integrated upcycling strategies for plastic waste and biomass.

Alzheimer's disease and related dementias (ADRD) are progressive neurodegenerative conditions where early detection is critical for timely intervention and care planning. However, current diagnostic methods are often inaccessible, costly, and delayed, especially for underserved populations. There is a growing need for scalable, noninvasive tools that can support timely diagnosis. Spontaneous speech contains rich acoustic and linguistic markers that can serve as noninvasive behavioral markers for cognitive decline. Foundation models, pretrained on large-scale audio or text data, generate high-dimensional embeddings that encode rich contextual and acoustic information. This study benchmarks open-source foundation language and speech models to evaluate their effectiveness in detecting ADRD from spontaneous speech as a potential solution for early, noninvasive, and scalable ADRD detection. In this study, we used the Pioneering Research for Early Prediction of Alzheimer's and Related Dementias EUREKA (PREPARE) Challenge dataset, which consists of audio recordings from over 1600 participants with 3 distinct categories of cognitive decline: healthy control (HC), mild cognitive impairment (MCI), and Alzheimer's disease (AD). We further excluded samples that are non-English, nonspontaneous speech, or of poor quality. Our final samples included 703 (59.13%) HC, 81 (6.81%) MCI, and 405 (34.06%) AD cases. We systematically benchmarked 18 open-source foundation speech and language models to classify cognitive status into 3 categories (HC, MCI, or AD). Post hoc interpretability analysis was performed for the best-performing model using Shapley additive explanations linking high-dimensional embeddings with explainable acoustic and linguistic markers. Whisper-medium model achieved the highest performance among speech models at 0.731 accuracy and 0.802 area under the curve, while Bidirectional Encoder Representations from Transformers with pause annotation achieved the top accuracy of 0.662 and 0.744 area under the curve among language models. Overall, ADRD detection based on state-of-the-art automatic speech recognition model-generated audio-embeddings outperformed other models, and the inclusion of nonsemantic information, such as pause patterns, consistently improved the classification performance of text-embedding-based models. Our work presents a comprehensive comparative evaluation of state-of-the-art speech and language models for AD and MCI detection on a large, clinically relevant dataset. Embeddings derived from acoustic models, which capture both semantic and acoustic information, show promising performance and highlight the potential for developing a more scalable, noninvasive, and cost-effective early detection tool for ADRD.

Healthcare artificial intelligence (AI) has moved beyond answering medical questions. In early 2026, OpenAI, Anthropic, and Google launched agentic systems that retrieve evidence, use tools, and execute multi-step workflows. These systems can integrate information across multiple clinical knowledge domains within a single workflow, but the evidence base for evaluating their reliability in clinical practice has not kept pace with deployment. This perspective argues that healthcare is adopting a technology evolving faster than anyone can evaluate, and that a brief window exists to shape integration before the architecture becomes entrenched. These systems share common architectural principles, yet only 19 prospective trials exist among over 4,600 clinical large language model studies, none evaluating agentic pipelines. The architecture is locking in, professional roles are being redefined, and builders hold a structural information advantage. Transparency, adaptive governance, and broader participation are needed before these choices become irreversible, and to ensure that the boundary between human clinical judgment and automated capability is drawn in a way that strengthens both. Every stakeholder in healthcare must engage with this shift now.

Employed informal caregivers in Iran navigate caregiving responsibilities within a context of absent formal support infrastructure, rigid cultural expectations, and economic constraints. This study explored their lived experiences, focusing on work-care balance, stress management, and interactions with support structures.&#xa0;A qualitative descriptive study was conducted using semi-structured in-depth interviews with five employed female informal caregivers of older persons (aged 65 and above) in urban Iran. Interviews were conducted in Persian via Zoom between January and March 2025, lasting 60 to 120&#xa0;min. Data were analyzed using Reflexive Thematic Analysis, informed by Role Theory and Lazarus and Folkman's Stress and Coping Theory.&#xa0;Six themes emerged: (1) onset and context of caregiving, (2) work-care role balance, (3) stress and coping strategies, (4) social and workplace support, (5) personal and cultural experiences, and (6) advice and future perspectives. Findings reveal a distinctive "triple burden" where structural barriers (absent caregiver leave policies, inadequate insurance coverage, limited respite services), cultural expectations (filial piety norms, gendered care obligations), and economic pressures (inability to reduce work hours, high caregiving costs) converge to create unsustainable caregiving conditions. Participants sacrificed sleep, personal relationships, and career advancement while experiencing chronic exhaustion, workplace discrimination, and social isolation. Coping strategies proved insufficient without formal support structures.&#xa0;Unlike developed countries with established support systems, Iranian caregivers operate within institutional silence where caregiving remains an exclusively private burden. Urgent policy reforms are needed: caregiver leave policies, subsidized respite services, insurance coverage for home care, workplace accommodations, and culturally sensitive counseling programs.

As remote-access thyroidectomy (RAT) becomes more widely used, evidence on patient- reported outcomes, particularly health-related quality of life (HRQoL), remains scarce and inconsistent. This meta-analysis compared postoperative HRQoL between thyroid cancer (TC) patients undergoing RAT and open thyroidectomy (OT) and assessed changes over time. A comprehensive search of five major databases was conducted from inception to August 2025. Studies reporting HRQoL after RAT or OT were included. Outcomes were grouped by postoperative timepoints. Outcomes were stratified across distinct postoperative timepoints to calculate pooled standardized mean difference (SMD) or mean difference (MD). Heterogeneity was explored through rigorous subgroup analyses encompassing surgical modalities, countries, and assessment instruments. Forty-one studies met the inclusion criteria, and 29 records were included in the quantitative synthesis. RAT demonstrated early advantages in comprehensive quality of life at 1&#xa0;month and 3&#xa0;months, and these advantages dissipated long term. Pain trajectories exhibited a biphasic pattern: RAT was associated with lower pain scores on postoperative day 1 but paradoxically higher scores during the 1-2&#xa0;week period, with subsequent convergence. Cosmetic satisfaction and swallowing function consistently favored RAT from 1-2&#xa0;weeks through 6&#xa0;months, while voice outcomes showed no discernible differences. RAT appears to confer selected short- to medium-term patient-reported advantages over OT, particularly in cosmetic satisfaction and swallowing function. But these benefits are heterogeneous and not consistently maintained across all domains or timepoints. Future studies should standardize cross-culturally validated PRO instruments and adopt harmonized follow-up intervals and reporting guidelines to clarify the patient-centered value of RAT.