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Disposable fibrous air filtration media represent one of the most convenient and effective approaches for personal health protection. Nevertheless, restricted by the technical bottlenecks of spinning technologies in fabricating ultrafine nanofibers and designing topological filtration networks, current filters cannot realize reliable ultra-protection against ultrafine particulate matter (PM). Moreover, non-degradable waste from excessive filter use imposes severe environmental burdens. Herein, we report a universal multi-level splitting electrospinning strategy for fabricating a variety of biodegradable trans-scale fiber membranes (TSFM). The hierarchical interweaving and stacking of ultrafine nanofibers, nanofibers, and submicron fibers endow the lightweight TSFM with tortuous interception networks and abundant mass and energy transport channels. Consequently, they can achieve a stable ultra-efficient PM0.3 removal, low air resistance, great breathability, and reduce polymer consumption by 99% relative to commercial N95 respirators. This work may boost the iterative upgrading of advanced spinning technologies and the development of high-performance, sustainable filtration and separation materials.

Clients insured by Ghana's National Health Insurance Scheme (NHIS) who seek healthcare at credentialed facilities incur substantial out-of-pocket (OOP) payments for services covered by the scheme. While co-payments are part of OOP payments, the extent of these co-payments has received limited empirical attention. This study sought to determine co-payment levels and identify the social and demographic factors associated with co-payment for outpatient services, inpatient care, and drugs among insured clients of the scheme. We used the 2022 Ghana Demographic and Health Survey data. This was a cross-sectional design, which employed a stratified two-stage random sampling technique. We analysed data involving 8,467 respondents with information on utilisation and payment for health services. Data were analysed using Stata version 16. Descriptive and inferential statistics were performed with statistical significance at p&#x2009;<&#x2009;0.05. Among insured clients who made any out-of-pocket payment, 58.4% reported it as a co-payment for drugs, 52.5% for inpatient care, and 48.4% for outpatient consultation. Respondents aged 25-34 years (AOR: 0.43; CI: 0.18-0.99; p&#x2009;<&#x2009;0.05) had significantly reduced odds of co-payment for inpatient care, while urban residents had increased odds of co-payment for drugs (AOR: 1.42; CI: 1.03-1.95; p&#x2009;<&#x2009;0.05) compared to their rural counterparts. Furthermore, being from the Eastern (p&#x2009;<&#x2009;0.05), Upper West (p&#x2009;<&#x2009;0.05) and Northern (p&#x2009;<&#x2009;0.05) regions was associated with reduced odds of co-payment for outpatient consultation and drugs. However, compared to no formal education, having primary education statistically significantly increases the odds of co-payment for outpatient consultation (AOR: 2.66; CI: 1.13-6.27; p&#x2009;<&#x2009;0.05) and drugs (AOR: 1.82; CI: 1.11-2.99; p&#x2009;<&#x2009;0.05) while being rich significantly reduces the odds of co-payment for outpatient consultation (AOR: 0.40; CI: 0.19-0.84; p&#x2009;<&#x2009;0.05). Insured clients presenting at credentialed health facilities make co-payments for outpatient services, inpatient care, and drugs covered by the scheme. The study highlights the multifaceted determinants of co-payments. The extent of co-payments may impede Ghana's progress toward achieving Universal Health Coverage (UHC). There is a need to eliminate co-payments for outpatient services, inpatient care, and drugs for insured clients to realize the UHC goal.

The precision diagnosis and effective treatment of neurological diseases have long been hampered by the blood-brain barrier (BBB). Nanomaterials capable of crossing the BBB, endowed with unique advantages such as targeted delivery and transbarrier penetration, provide a crucial solution for overcoming this bottleneck, thereby significantly enhancing the precision and effectiveness of diagnosis and treatment. This review is based on the systematic collection and analysis of recent literature. On this basis, this review summarizes the core characteristics and relative advantages of several major penetration mechanisms: receptor-mediated penetration relies on specific binding to receptors, featuring high targeting specificity and low toxicity; adsorption-mediated penetration depends on surface interactions, with broad universality and simple preparation; and carriermediated penetration achieves transport via carriers, exhibiting high drug-loading capacity but moderate targeting specificity. Correspondingly, different types of nanomaterials have distinct focuses on their applicable scenarios: metallic nanomaterials are suitable for imaging diagnosis, tumor hyperthermia, etc.; polymeric nanomaterials are applicable for drug delivery, gene therapy, etc.; lipid-based nanomaterials are appropriate for small-molecule drug delivery, brain-targeted drug administration, etc. Nanomaterials capable of crossing the BBB share common limitations. For example, these include the long-term biological safety of nanomaterials, challenges in improving targeting efficiency, and hurdles in large-scale preparation. To address the aforementioned limitations, we propose specific and forward-looking future research directions. These include the development of intelligent responsive nanocarriers and the establishment of a standardized toxicity assessment system, which are expected to provide constructive insights for advancing the clinical translation of BBB-crossing nanomaterials in neurological disease diagnosis and treatment.

China has a large population, and the prevalence of dyslipidemia varies across regions. The prevalence of dyslipidemia is closely associated with the increasing burden of cardiovascular disease. Currently, there is a lack of high-quality data on early-onset dyslipidemia in Northwest China. This study aims to comprehensively assess the prevalence and risk factors of early-onset dyslipidemia among adults in this region, providing epidemiological evidence for disease prevention and health promotion. This is a cross-sectional study based on the universal health check-up program conducted in northwestern China from January to December 2019. Adults (aged 18 to 65 years old) living in both rural and urban areas were included. Participants received a questionnaire survey, physical examination, and laboratory tests, including liver and kidney function, complete blood count, fasting blood glucose, and lipid profile. This study included a total of 3,559,141 participants (43.2% male and 56.8% female). The prevalence of early-onset dyslipidemia was 25.7%, with hypercholesterolemia accounting for 3.6%, hypertriglyceridemia for 10.6%, elevated low-density lipoprotein cholesterol for 2.7%, and reduced high-density lipoprotein cholesterol for 14.5%. Abnormalities in a single lipid parameter were observed in 20.5% of participants, while abnormalities in two, three, and four lipid parameters were observed in 4.6%, 0.6%, and 0.1% of participants, respectively. Male sex, age, diabetes, hypertension, smoking, alcohol consumption, and overweight/obesity were all significant risk factors for early-onset dyslipidemia. The age-standardized prevalence of early-onset dyslipidemia and its subtypes in Northwest China remains lower than the national level. Existing evidence consistently indicates that males, advancing age, diabetes, hypertension, smoking, alcohol consumption, and overweight/obesity are independent risk factors for early-onset dyslipidemia. Therefore, systematic screening should be initiated for this population (<&#x2009;40 years old), with stratified management involving enhanced lifestyle interventions combined with evidence-based lipid-lowering medications.

Fluorescent nucleobase analogs (FBAs) are valuable tools for studying nucleic acid structure and dynamics. However, their utility is often limited by substantial fluorescence quenching upon incorporation into oligonucleotides and variable brightness influenced by neighboring bases. In this study, we present a novel turn-on nucleoside, 3b, a thiazolyl-dU analog (hereinafter referred as TzdU), engineered to overcome these limitations and enable reliable DNA fluorescence imaging. Compared to its nearly nonfluorescent free form, TzdU shows approximately a 10-fold increase in brightness in single-stranded DNA (ssDNA) and up to a 50-fold enhancement in double-stranded DNA (dsDNA). Importantly, it maintains relatively stable brightness regardless of surrounding bases by evading common quenching pathways, including solvent-induced collisional quenching and excited-state proton transfer (ESPT). The triphosphate derivative of TzdU is efficiently utilized by various DNA polymerases, including Deep Vent and KOD XL, facilitating real-time, intensity-based monitoring of critical enzymatic processes such as PCR and primer extension without external labels. Furthermore, TzdU can illuminate DNA in a gradient manner, enabling the visualization and encryption of information. As the first FBA to achieve universal turn-on characteristics, sequence insensitivity, and compatibility with enzymatic reactions, TzdU serves as a novel tool for investigating nucleic acid dynamics and advancing fluorescence-based methodologies.

Ponds are biodiversity hotspots that harbor diverse macro-organisms and microbial communities, despite being isolated, highly variable environments with island-like features. These factors may give rise to unique biogeographic patterns and drivers of microbial community diversity. Here, we evaluated environmental and regional drivers of pond fungal and bacterial biodiversity to determine whether these communities follow commonly observed biogeographical trends. We collected water and muck from 40 ponds across 8 states in the Eastern USA and sequenced sections of the 16S rRNA and ITS1 genes to survey the bacterial and fungal communities and test (1) whether these communities follow latitudinal diversity gradients and distance decay relationships, and (2) if variation in community composition or richness was related to specific environmental or land-use factors. We found that pond microbial communities exhibit distinct distribution patterns and relationships with environmental drivers depending on the microhabitat and microbial taxa. For example, muck fungal communities followed latitudinal diversity gradients, but bacterial communities did not. Abiotic conditions explained more variation than surrounding land use or the distance between sites, with temperature universally linked to microbial biodiversity. However, all sample types displayed weak distance-decay relationships, likely because of low spatial autocorrelation in environmental conditions and the lack of connectivity across ponds.

HER2-positive breast cancer is highly aggressive and has a poor prognosis in clinical treatment primarily due to the overexpression of HER2 protein. Trastuzumab can significantly improve the therapeutic outcome for HER2-positive breast cancer, but 70% of patients develop drug resistance. Trastuzumab-drug conjugates have emerged as a promising modality in the treatment of HER2-positive breast cancer, while their therapeutic efficacy remains limited. Herein, we report a multi-payload trastuzumab conjugate, QC-AA@Tra, prepared by attaching an AIPH-bearing NIR-II fluorophore (Q3) to trastuzumab via nucleophilic substitution. After intravenous administration, QC-AA@Tra selectively accumulates at tumor sites. Under 808&#x202f;nm laser irradiation, it produces a strong photothermal-dynamic effect through thermal release of nitrogen gas and free radicals from AIPH. Combined with trastuzumab's targeting, this leads to marked suppression of HER2-positive BT474 xenograft tumors in mice. Our design may offer a powerful and universal modality for precise diagnosis and treatment of HER2-positive malignant tumors.

Intimate partner violence (IPV) during pregnancy causes serious harm to both the mother and the child. The magnitude of the problem is likely underestimated due to the sensitive nature of the topic and lack of consensus on screening practices, including frequency, tools, and whether screening should be systematic or risk-based. This scoping review aimed to map existing screening tools and healthcare-based screening programmes for detecting IPV in European countries within antenatal and postpartum care. Joanna Briggs Institute methodology was used and reported following PRISMA-ScR guidelines. Seven databases (Embase, PsycINFO, SocINDEX, PubMed, Web of Science, Scopus, and CINAHL) were searched up to June 2025 to identify screening tools used in European countries. A quality assessment was conducted. To identify current screening programmes within antenatal and postpartum healthcare systems, representatives from 46 European countries were consulted. Twenty-four studies were included, and methodological quality ranged from low to serious risk of bias. Thirteen screening tools for physical, emotional, and sexual IPV were identified. No tools for stalking or digital violence were found. Most studies were cross-sectional. Data were received from 22 of 46 European countries (48%) regarding screening programmes in antenatal or post-partum care: 17 countries have screening programmes, while five reported none. The Abuse Assessment Screen (AAS) and the Woman Abuse Screening Tool (WAST) were the tools most commonly used in both the literature and screening programmes. Most countries with screening program recommendations, recommended a universal screening approach. Screening tools and practices for detecting IPV during antenatal and post-partum care vary substantially across Europe, highlighting a lack of evidence and consensus on screening tools for IPV within antenatal and postpartum care.

To meet the pressing need for convenient power in wearable electronics, this work presents self-charging power textiles based on an integrated harvesting-management-storage strategy. The system employs fiber-shaped triboelectric nanogenerators (F-TENGs) paired with an energy management module to harvest energy from motion. Meanwhile, a Zn2+-assisted in situ rapid cross-linking strategy using a sodium alginate/polyvinyl alcohol (SA/PVA) hydrogel electrolyte enables scalable production of fiber-shaped zinc-ion batteries (F-ZIBs). This hydrogel electrolyte establishes continuous Zn2+ conduction pathways, allowing the F-ZIB to retain 95.7% capacity after 100 cycles at 0.2 A g-1 and 86.5% after 1,000 cycles at 2 A g-1, with good environmental tolerance. The composite yarns for F-TENGs are fully compatible with large-scale manufacturing. By co-weaving F-ZIBs and F-TENGs, the power textile demonstrates synergistic, long-term operation capable of powering commercial devices such as smartphones, smart rings, and AI glasses. This study provides an accessible and universal energy solution for next-generation self-powered wearable systems.

During August-September 2024, a diphtheria outbreak involving 10 children was reported from Devkher village of Naraini Block, Banda district, Uttar Pradesh, India. Despite the availability of diphtheria-containing vaccines under India's Universal Immunization Program, immunization gaps continue to persist in underserved rural communities. To explore the social, geographic, and systemic factors contributing to immunization gaps during the diphtheria outbreak in Devkher village. A mixed-methods qualitative exploratory study was conducted between September and October 2024 in Devkher village. In-depth interviews were conducted among caregivers of affected children and frontline healthcare workers, including auxiliary nurse midwives (ANMs) and accredited social health activists (ASHAs). Descriptive outbreak-related data were obtained from local health records. Field observations and community-level contextual assessments were performed to understand geographic accessibility and healthcare outreach barriers. Thematic analysis was used for qualitative data interpretation. Major themes identified included migration-related disruption of vaccination schedules, poor awareness regarding immunization and booster doses, misinformation, inadequate documentation of vaccination status, and mistrust toward the healthcare system. Peripheral habitation, distance from healthcare facilities, and limited outreach services were identified as important contextual barriers contributing to delayed immunization and healthcare utilization. Immunization gaps observed during the outbreak were influenced by interconnected social, geographic, and systemic factors. Strengthening outreach among migratory populations, improving immunization tracking systems, and enhancing community trust and healthcare accessibility are essential to prevent future outbreaks.

The research aims to reveal the supports and accommodations that support undergraduate nursing students who identify as neurodivergent in their studies. Undergraduate nursing students who identify as neurodivergent face unique challenges in academic and clinical environments. These include difficulties with communication, executive functioning and sensory processing that are often not accommodated in traditional nursing education. Despite increasing awareness, nursing programs remain largely designed without student neurodiversity in mind, creating barriers to success. A descriptive qualitative study. Semi-structured interviews were conducted in low-stimulation environments with eighteen undergraduate nursing students who self-identified or had formal diagnoses of neurodiverse conditions. The interviews were held face-to-face and transcribed electronically. Data analysis occurred using Braun and Clarke's (2022) reflexive thematic analysis. Eighteen nursing students who self-identified as neurodiverse were included in the study. A total of three themes were identified: 1) 'Student challenges in study,' 2) 'Placement challenges,' and 3) 'Strategies for success'. Undergraduate nursing students who identify as neurodivergent contribute valuable strengths to the profession, including empathy, creativity and innovative problem-solving. Yet, systemic barriers within educational and clinical environments often impede their progress. To support their success, nursing education must embrace inclusive teaching practices, recognise and legitimise accommodations and offer flexible assessment formats. Adopting a social justice lens toward neurodiversity can promote equity and drive innovation across nursing education.

Early identification of discharge destination is an important aspect of hospital care for frail older adults. This retrospective cohort study examined whether physical, cognitive and social functioning assessments at admission are associated with discharge destination. Data from 114 community-dwelling patients aged &#x2265;65 years, acutely admitted to a geriatric ward, were analyzed. Frailty was defined at admission by impaired Katz-Activities of Daily Living (ADL) or increased fall risk. Initial screening included Katz-ADL, fall risk and the Malnutrition Universal Screening Tool (MUST). Additional assessments comprised handgrip strength, Timed-Up-and-Go (TUG), Six-item Cognitive Impairment Test (6-CIT) and living situation. Multivariable logistic regression, adjusted for age and sex, showed that worse Katz-ADL scores (OR 1.45, 95% CI 1.18-1.78), lower handgrip strength (OR 2.28, 95% CI 1.02-5.10) and slower TUG performance (OR 11.19, 95% CI 3.40-36.89) were significantly associated with non-home discharge. Cognitive status and living situation were not. These findings indicate that these functional assessments are associated with discharge destination in frail older adults.

Retention of qualified health professionals is critical for achieving universal health coverage (UHC) in Lao People's Democratic Republic (Lao PDR). Despite policy commitments, the public health sector continues to experience high turnover, especially among non-permanent staff. This study examined key factors influencing health professionals' intention to remain in government service. A cross-sectional survey was conducted from June to August 2023 among 1,873 public-sector health professionals in five provinces representing high and low-turnover areas. A structured questionnaire developed with the Department of Health Personnel (DHP) and administered via KoboToolbox collected data on demographics, employment status, income, motivation, and job satisfaction. Descriptive, bivariate, and multivariate logistic-regression analyses identified predictors of attrition intention. Overall, 37.4% of respondents reported having considered leaving the public sector. Contractual (AOR = 2.24, 95% CI: 1.573.21) and volunteer (AOR = 2.90, 95% CI: 1.904.44) staff were significantly more likely to intend departure than civil servants. Late salary or bonus payments (AOR = 2.25, 95% CI: 1.543.31) strongly increased attrition intent. Conversely, perceiving salary incentives and career-development opportunities as effective was protective (AOR = 0.35, 95% CI: 0.210.58, for moderately effective). Health professionals outside Vientiane Capital showed 3540% lower odds of intending to leave. Retention in Lao PDR is driven by employment security, financial predictability, and professional-development opportunities. Regularizing contractual and volunteer positions, ensuring timely remuneration, and expanding career pathways are critical to implementing the national Human Resources for Health (HRH) Development Strategy 20212030 and achieving UHC by 2025.

Oncogenic viral and bacterial infections constitute a significant portion of the global cancer burden, accounting for up to 15% of cases, particularly in low- and middle-income countries. Prophylactic vaccination thus appears to be the most effective tool for preventing these preventable cancers, especially those linked to human papillomavirus (HPV) and hepatitis B virus (HBV). This narrative review synthesizes recent data concerning the impact, advances, limitations, and prospects of available and developing cancer vaccines. Research shows that HPV vaccination significantly reduces the incidence of vaccine-specific infections, precancerous lesions (CIN2+), and, in the longer term, invasive cancers, with an enhanced effect when vaccination coverage is high and administration is early. Similarly, the universal introduction of the HBV vaccine has led to a remarkable decrease in chronic infections and hepatocellular carcinoma, as evidenced by the successes observed in Taiwan and The Gambia. Despite these advances, challenges remain, including limited access, costs, logistics, sociocultural acceptability, and insufficient vaccination coverage, particularly for the birth dose of HBV and in resource-limited countries. Furthermore, several prophylactic vaccines against oncogenic agents such as EBV, H. pylori, HCV, HTLV-1, and KSHV are under development, supported by the rise of innovative platforms, notably mRNA.

Hepatitis B and D display a distinctive epidemiological pattern in the Western Amazon, disproportionately affecting Indigenous peoples and riverine populations across Brazil, Peru, Colombia, Venezuela, and Ecuador. Despite more than three decades of universal hepatitis B vaccination, moderate endemicity and a high burden of chronic carriers persist in the region. In the state of Amazonas, Brazil, the Funda&#xe7;&#xe3;o de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) has played a pivotal historical and contemporary role in the recognition, diagnosis, clinical management, surveillance, and research of HBV and HDV infections, serving as a major reference center for the region. The local health-care network is aligned with national policies but faces substantial challenges related to the vast geographic territory, strong centralization of specialized services in Manaus, and limited availability of trained professionals in endemic and remote areas. Logistical, socioeconomic, and cultural barriers continue to restrict timely access to diagnosis and treatment, while universal vaccination, widespread rapid testing, and ongoing decentralization efforts represent key facilitating factors. Looking ahead, the proposed research agenda emphasizes integrated surveillance, genomic and clinical-epidemiological studies, evaluation of the care cascade, and strengthening of primary health care as essential strategies to reduce regional inequalities and accelerate progress toward the elimination of viral hepatitis by 2030.

Topological entanglements are central to understanding and predicting the properties of polymer melts. Yet, they make equilibrium sampling computationally challenging, as decorrelation times grow rapidly with chain length. Here, we introduce a Monte Carlo scheme that bypasses typical computational bottlenecks by working in a self-assembly ensemble rather than at fixed composition. Strictly local moves efficiently propagate backbone reconnections across scales while conserving the number of linear chains, achieving near-linear scaling of decorrelation time with system size, &#x3c4;eq&#xa0;~&#xa0;V 1.0. With this method, formulated for a fully-packed lattice, we equilibrate periodic systems totalling up to &#xa0;&#x2243;&#xa0;1.1&#xa0;&#xd7;&#xa0;109 monomers, accessing a universal melt regime insensitive to lattice details. We analyze intra- and inter-chain entanglements for chains of up to N &#x2243;&#xa0;5 &#xd7;&#xa0;105 monomers, revealing that they manifest as localized knots and links rather than as global tangles. Finally, we show that the magnitude of the Gauss linking integral between neighbouring chains grows only as N1/4.

This study aimed to examine the independent and joint associations of maternal gestational weight gain (GWG) patterns and offspring BMI growth trajectories with lipid and glycemic profiles at age 6. This analysis included 39,169 mother-child pairs from the Tianjin Women and Children Health Cohort. Maternal GWG was categorized into four trajectories: Adequate throughout (reference), Excessive early-only, Excessive late-only, and Excessive throughout. Offspring body mass index (BMI) trajectories from birth to age 6 were identified using group-based trajectory modeling, yielding four groups: Persistent Low, Normal (reference), Early Rapid, and Late Rapid. Multivariable linear regression assessed associations with triglycerides (TG), total cholesterol (CHO), and fasting glucose (GLU) at age 6. Interaction was tested via two-way ANOVA. Children with Late Rapid BMI growth (18.7%; accelerated gain after age 3) were almost universally overweight or obese by age 6 (99.7%). This trajectory was the strongest independent predictor of adverse metabolic outcomes. Compared to the Normal trajectory, the Late Rapid group had significantly higher TG (&#x3b2; = 0.193&#xa0;mmol/L, 95% CI: 0.179-0.206) and GLU (&#x3b2; = 0.047&#xa0;mmol/L, 95% CI: 0.030-0.064). The Persistent Low trajectory (12.3%) was associated with lower TG and GLU. Maternal GWG trajectories showed no independent association with offspring TG or GLU after adjustment for child's current BMI; only Excessive early-only GWG retained a weak association with higher CHO (&#x3b2; = 0.038, 95% CI: 0.011-0.064). A significant interaction was observed for TG (P = 0.012). Late preschool BMI acceleration is the most influential factor for adverse cardiometabolic risk at school entry identified in this cohort, affecting one in five children with effect sizes five times larger than any maternal GWG pattern. Maternal GWG exerts minimal direct effects beyond shaping childhood growth. The preschool years represent a critical window for early BMI trajectory monitoring and targeted intervention.

Enteral nutrition (EN) constitutes a critical therapeutic intervention in the management of patients with sepsis; however, the optimal timing for its initiation remains uncertain. This study sought to evaluate the impact of early versus delayed EN on mortality rates and clinical outcomes among adult patients with sepsis in intensive care units (ICU). Retrospective cohort study using propensity score matching (PSM) methodology. A tertiary hospital ICU in Hebei Province, China, from 2015 to 2024. This retrospective analysis involved adult ICU patients with sepsis (meeting Sepsis 3.0 criteria) from January 2015 to December 2024 who began EN within 7&#x2009;days of admission. Patients were classified into early (within 2&#x2009;days) or delayed (2-7&#x2009;days) EN groups based on when nutrition was initiated. Primary outcomes were 28-day and 60-day mortality, with secondary outcomes including hospital/ICU stay length, mechanical ventilation duration and nutrition-related complications. A study of 2205 patients compared early EN (EEN) in 1500 patients (68.0%) with delayed EN in 705 patients (32.0%). After PSM, the EEN group showed a higher mortality risk at 28 days (HR 1.44, 95% CI 1.08 to 1.92)&#x2009;and 60 days (HR 1.45, 95%&#x2009;CI 1.11 to 1.89), confirmed by multivariable Cox regression and inverse probability weighting. EEN patients also had more gastric retention (OR 1.77, 95%&#x2009;CI 1.14 to 2.79). The increased mortality risk was notably pronounced in younger male patients with a body mass index of less than 24&#x2009;kg/m&#xb2;, abdominal infections, those with severe sepsis and patients necessitating vasopressor support at a norepinephrine equivalent of &#x2265;0.1&#x2009;&#xb5;g/kg/min. Sensitivity analyses supported these findings. Our retrospective analysis of 2205 propensity score-matched patients with sepsis found that EEN is linked to higher short-term mortality, especially in younger males, those with severe illness, abdominal infections or needing moderate to high vasopressor support. This suggests that personalised nutritional timing might be better than universal early feeding. However, these findings are preliminary and need confirmation through randomised controlled trials.

Robotic surgery has progressively expanded within hepato-pancreato-biliary (HPB) practice, aiming to overcome the technical limitations of conventional laparoscopy in complex resections and reconstructions. Over the past 2 decades, its role has evolved from feasibility reports to comparative analyses, consensus statements, and randomized controlled trials. However, evidence remains heterogeneous across liver, pancreas, and biliary domains, and the clinical impact of robotic surgery appears to be procedure-specific rather than universal. This study aimed to provide an evidence-based narrative review of the evolution of robotic HPB surgery, with emphasis on perioperative outcomes, oncologic safety, technical indications, and current limitations. A narrative literature review was conducted using PubMed, Embase, and Scopus databases, including studies published between January 2000 and February 2026. Search terms included combinations of "robotic surgery", "hepatectomy", "liver resection", "pancreatic surgery", "pancreatoduodenectomy", "distal pancreatectomy", "biliary surgery", "cholangiocarcinoma", and "hepaticojejunostomy". Original studies, systematic reviews, meta-analyses, randomized trials, and consensus guidelines were included. Data were synthesized qualitatively, incorporating quantitative outcomes when available, including operative time, estimated blood loss, conversion rates, complications, oncologic outcomes, and learning-curve metrics. Robotic liver surgery has demonstrated comparable perioperative and oncologic outcomes to laparoscopic and open approaches, with lower conversion rates, reduced blood loss, and shorter operative time in selected high-difficulty resections. Robotic pancreatic surgery has expanded with increasing standardization. Robotic distal pancreatectomy shows consistent advantages compared to laparoscopic distal pancreatectomy with comparable overall morbidity and shorter postoperative hospital stay. Robotic pancreatoduodenectomy has reached randomized evaluation with comparable overall morbidity and shorter postoperative recovery when performed in high-volume centers by experienced surgeons. Robotic biliary surgery remains less standardized and is concentrated in specialized centers; however, recent comparative studies suggest feasibility in bile duct reconstruction and potential advantages in lymphadenectomy. Across all domains, outcomes are strongly influenced by institutional expertise, structured training, and case selection. Robotic HPB surgery has emerged as a key advancement in minimally invasive surgery, with its greatest value in complexity-dependent, technically demanding procedures. Although current evidence supports its safety and oncologic adequacy in selected patients, outcomes remain highly contingent on case selection, surgical expertise, and structured implementation. Future progress will depend on defining optimal indications rather than feasibility, supported by standardized reporting, cost-effectiveness analyses, and robust long-term oncologic data.