Cumulative interpersonal traumatisation increases the risk of psychosis and is linked to psychotic symptom severity and reduced recovery rates. Psychosis and treatment themselves can also be traumatising, with a first episode of psychosis posing challenges to one's identity. Despite a growing evidence base for the safety and effectiveness of trauma therapies for psychosis, implementation remains poor in early intervention for psychosis (EIP) services, partly due to resource constraints. Narrative exposure therapy (NET) is an effective intervention for post-traumatic stress disorder in ethnically diverse populations. Crucially it has potential to address barriers to implementation of trauma therapies in EIP as it has a brief duration with minimal training requirements. This feasibility study will evaluate the feasibility and acceptability of conducting a definite trial of NET in people with early psychosis. An individually randomised parallel groups feasibility randomised controlled trial with embedded qualitative evaluation will be conducted. 50 individuals with first episode psychosis and a history of multiple trauma under the care of an EIP service in two NHS trusts in England will be recruited. Participants will be randomised to receive either 15 sessions of NET in addition to treatment as usual or treatment as usual alone. Assessor blinded assessments will be conducted at baseline, 4 months (post-intervention) and 8 months (follow-up). Analyses will focus on feasibility outcomes (recruitment, retention and completion rates) and preliminary estimates of intervention effects to inform planning for a fully powered trial. Qualitative interviews will be carried out with participants allocated to NET and clinicians to investigate acceptability, barriers and facilitators, possible mechanisms of change, potential benefits or harms and recommendations. A sub-study in the NET group will investigate acceptability of completing Experience Sampling Data daily during therapy to monitor changes on candidate primary and secondary outcomes. This study received REC/HRA ethical approval from the London - City & East Research Ethics Committee (REC) (25/LO/0350). The results of the study will be reported and disseminated at international conferences and in open-access peer-reviewed scientific journals. ISRCTN39471182.
Deep Brain Stimulation (DBS) is an established treatment for advanced Parkinson's disease (PD), yet registry-based data from developing countries remain limited. This study reports the establishment and feasibility of the Iranian Deep Brain Stimulation Registry for Parkinson's Disease (IDBSR-PD). We conducted a single-center feasibility study at the Research Center for Neuromodulation and Pain, including all PD patients undergoing DBS implantation since 2014. Primary feasibility outcomes included patient enrollment coverage, follow-up adherence, data completeness, multidisciplinary implementation, and the sustainability of technical infrastructure. Secondary outcomes included descriptive patient characteristics. Only descriptive statistics were performed; no hypothesis testing or longitudinal outcome analyses were conducted. A total of 208 patients were enrolled (65.4% male; mean age 58.4 ± 10.2 years). Enrollment increased progressively over time, peaking in 2024 (n = 41). Patients were referred from multiple provinces across Iran. Data validation mechanisms and regular surveillance ensured acceptable data completeness. The IDBSR-PD demonstrates the feasibility and sustainability of a web-based DBS registry in a developing country. These findings confirm the viability of structured data collection and provide a foundation for future multicenter and longitudinal outcome research.
Rapid sequence intubation (RSI) in helicopter emergency medical services (HEMS) is conventionally performed at the scene before transport, potentially delaying time to definitive care. The feasibility of performing RSI during flight in civilian HEMS operations has not been established in the United Kingdom. We evaluate the feasibility, safety, and temporal efficiency of performing simulated in-flight RSI in an AW169 helicopter under operational flight conditions. A prospective proof-of-concept study using high-fidelity simulation was conducted across 2 phases (May 2023, January 2025) at the Air Ambulance Charity Kent Surrey Sussex. Eight simulations were completed by 4 distinct clinical teams comprising operationally experienced HEMS physicians and paramedics. Scenarios replicated a standardized traumatic brain injury scenario requiring RSI during the return transit phase. The primary outcome was time from RSI checklist initiation to confirmed intubation. Secondary outcomes included overall mission times, safety events, and crew-perceived feasibility assessed via post-scenario questionnaires. All simulations (8/8, 100%) achieved successful first-pass intubation. Median time from checklist initiation to confirmed intubation was 5 minutes (interquartile range [IQR]: 5-7). Median total mission time from base departure to RSI completion was 42 minutes (IQR 40-44). No safety events, procedural complications, or communication failures occurred. Crew questionnaires (93% response rate) confirmed unanimous perceived feasibility, with participants identifying adequate workspace, effective communication, and manageable equipment accessibility. High-fidelity simulation demonstrates that in-flight RSI is technically feasible in an AW169 helicopter, with consistent procedural times and no safety events. These findings may support further evaluation of in-flight RSI as a complementary strategy for time-critical patients where scene-based airway management may delay definitive care.
This study describes the development and feasibility testing of a digital health guide (DHG) to streamline genetic education, reduce barriers, and promote informed genetic testing (GT) decisions among cancer survivors. This study reports on the DHG's development, usability testing, acceptability, feasibility, and preliminary efficacy in improving genetic counseling (GC) and GT access for cancer survivors. Guided by the Ottawa Decision Support Framework, the DHG prototype was developed following community engagement with cancer patients and at-risk relatives from diverse sociodemographically backgrounds. It was refined through user (content-focused) and usability (functionality-focused) testing. Pilot trial participants provided data through semi-structured interviews and usability assessments. Qualitative data were analyzed using the Framework Method. The preliminary impact of the DHG on GC and GT uptake, and informed decision-making, was assessed in a feasibility and accessibility trial. The Chatbot Usability Questionnaire score for the DHG was 70.3 (IQR = 12.5), indicating good acceptability. The DHG also facilitated GT uptake (73.3%) compared to enhanced usual care (EUC; 7.7%). Pretest GC was requested by 1 of 13 patients in the EUC arm, while no request (0 of 15 patients) was made in the DHG arm. Users' feedback led to clearer language, improved navigation, and stronger messaging regarding data security. DHG participants had lower decisional conflict (33.37 ± 21.09) and decision regret (17.5 ± 16.50) than those in the EUC arm (53.25 ± 22.66 and 37.08 ± 17.38, respectively). The digital intervention is feasible, acceptable, and a promising strategy for expanding GT access and promoting informed decision-making. Further testing in a definitive randomized controlled trial is warranted. Clinical trial registration. This study was preregistered at the NIH clinical trial registry ( https://clinicaltrials.gov/study/NCT06184867 ).
Transcranial direct current stimulation (tDCS) has potential as a treatment for adult depression, but its effectiveness in adolescents remains unexplored. This study evaluated the feasibility, safety, and efficacy of tDCS in young in-patients with depression. In a randomized, double-blind, sham-controlled trial, 34 adolescent in-patients (mean age 15.48 years) received ten sessions of either tDCS or sham stimulation over two weeks, alongside standard treatment. Depression severity, quality of life, emotional and behavioral issues, and executive functions were assessed before, immediately after, and two weeks post-treatment. The results indicated that tDCS was feasible and well-tolerated, with 28 patients completing at least eight sessions. Side effects were reported in nearly half of the sessions (45% sham, 48% tDCS), primarily mild to moderate, and no sessions were interrupted due to discomfort. Both groups experienced significant improvements in depressive symptoms and high treatment satisfaction, but no significant differences were found between the tDCS and sham groups. In conclusion, while tDCS appears to be a safe treatment option for adolescents with depression, this study could not show it to be superior to sham treatment. Further research with greater statistical power is needed to control for covariates.
This research provides a techno-economic and environmental evaluation of a large-scale hybrid renewable energy system (HRES) to support sustainable coastal development in Egypt, considering Ras El-Hekma as a representative case study. Six hybrid system configurations, including both grid-connected and off-grid modes, are modeled and evaluated using HOMER Pro. A large-scale load profile is developed with a peak demand of 28.8 MW and an annual electricity consumption of approximately 100.46 GWh over a 20-year project lifetime. The simulation results indicate that the optimal configuration is a 15 MW grid-connected wind energy system, achieving a Cost of Energy (COE) of $0.03409/kWh and a Net Present Cost (NPC) of $37.46 million with an initial investment cost of $24.8 million. The proposed system also achieves a renewable energy fraction of 68.6% and reduces CO₂ emissions by 60.45% compared with the base case grid-only scenario. Sensitivity analysis reveals that wind speed, project lifetime, inflation rate, and discount rate are the most influential factors affecting system feasibility and economic viability. The results demonstrate the strong potential of large-scale HRESs for sustainable energy development across Egypt's coastal megaprojects.
Same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) is increasingly adopted as a standard of care. This systematic review and meta-analysis assess the safety and effectiveness of SDD compared with conventional inpatient (IP) management. A literature search was conducted in accordance with PRISMA guidelines using PubMed/MEDLINE, Embase, Web of Science, and Scopus databases up to February 2025, including only comparative studies reporting on SDD versus IP RARP. The primary endpoint was postoperative complication rates. Secondary endpoints included 30-day readmission rates, unplanned postoperative visits, and patient-reported satisfaction. Subgroup analysis focused on studies involving single-port (SP) robotic platforms. Nineteen studies were included, encompassing 11 211 SDD and 114 999 IP cases. Overall complication rates were lower in the SDD group (odds ratio [OR]: 0.65, 95% confidence intervals [CI]: 0.50-0.84, p < 0.001). The pooled OR favored the outpatient group for both minor and major complications (OR: 0.52, 95% CI: 0.28-0.98, p = 0.042). No significant differences were found in 30-d readmissions (OR: 0.89, 95% CI: 0.77-1.02, p = 0.082), unplanned visits (odds OR: 0.61, 95% CI: 0.35-1.07, p = 0.081), or continence recovery. In the SP subgroup, no differences were observed in major complications (OR: 0.71, 95% CI: 0.39-1.29; p = 0.7) or readmission rates (OR: 1.88, 95% CI: 0.56-6.39, p = 0.3). The main limitation was the retrospective design of most studies. The available evidence does not allow reliable causal comparisons between SDD and inpatient care after RARP; however, perioperative outcomes within SDD cohorts appear acceptable, supporting the feasibility of SDD in carefully selected patients.
In this prospective study, we evaluated the performance of thoracoabdominal photon-counting detector computed tomography (PCD-CT) for breast cancer assessment with MRI as reference standard and iodine uptake as a potential marker for breast cancer subtyping. 75 women (mean age: 55.8 ± 13.9 years [SD]) with 79 newly diagnosed breast cancers and indication for staging CT received a prone-positioned contrast-enhanced thoracoabdominal PCD-CT and a breast MRI. Cancer visibility (median 1/1/1, IQR 0/1/1) and image quality (median 1/1/1, IQR 0/0/0) were rated excellent in PCD-CT on a 4-point Likert scale (1 = excellent, 4 = poor). Cancer size in PCD-CT correlated significantly with MRI (p < 0.001). Diagnostic accuracy was good for T-stage (pooled accuracy 0.814), focality (0.772), axillary (0.822) and internal mammary lymph nodes (0.981), moderate for ductal carcinoma in situ (0.591). A significantly lower maximum iodine uptake was revealed in cancer with ductal carcinoma in situ (p = 0.027), a significantly lower mean iodine uptake in triple negative cancers (p = 0.003). Thoracoabdominal PCD-CT demonstrated excellent cancer visibility with convincing results for assessing cancer size, T-stage, and lymph node status. Iodine uptake shows promising associations with triple negative breast cancer.
To evaluate diagnostic equity, feasibility and acceptability of a remote photoplethysmography-based blood pressure screening application among adults with darker skin tones in Nigeria. Prospective observational multisite field evaluation. Three hospitals in Kebbi State, Nigeria. Adults with Fitzpatrick skin types V-VI. Feasibility, agreement, diagnostic accuracy, acceptability, and equity relevant factors including facial tribal markings and internet bandwidth, using automated cuff measurements as the reference standard and a 140 over 90 mm Hg hypertension threshold. Among 306 enrolled participants, 249 (81.4%) produced usable readings. Agreement was poor (systolic mean absolute error (MAE) 15.4 mm Hg, root mean square error (RMSE) 19.9; diastolic MAE 10.9 mm Hg, RMSE 13.6). Sensitivity for threshold-based systolic and diastolic blood pressure classification was very low (systolic 0.04; diastolic 0.10), with systolic sensitivity 0.00 in Fitzpatrick type VI. Specificity was high (systolic 0.99; diastolic 0.89). Lower internet bandwidth correlated with reading failure (r = -0.69 to -0.51). While 70% of patients and over 90% of staff rated the tool favourably, technical limitations created a clear perception-performance gap. In an exploratory interaction analysis, Fitzpatrick type VI was associated with higher odds of measurement failure (OR 5.08, 95% CI 2.41 to 10.72), but there was no clear evidence that facial tribal markings modified this association (interaction OR 0.66, 95% CI 0.16 to 2.73; p=0.564). Remote photoplethysmography (rPPG)-based blood pressure screening was feasible but showed inadequate performance in this darker-skinned field cohort, with critically low sensitivity. Without algorithmic recalibration for skin tone diversity and improved offline functionality, cloud-dependent rPPG systems deployed without spectrum-balanced validation may risk exacerbating diagnostic inequities in similar settings.
Subsequent to an intracerebral hemorrhage (ICH), a cascade of neuroinflammatory response drives the process of secondary brain injury. At present, no anti-inflammatory nor neuroprotective pharmacological interventions have been demonstrated to improve functional outcome after ICH. This Phase 2b study was designed to establish the safety and feasibility of CN-105, a neuroprotective and anti-inflammatory pentapeptide designed from the receptor binding region of apolipoprotein E, in patients with acute primary supratentorial ICH. The Singapore CN-105 in Participants with Acute Supratentorial ICH Trial (S-CATCH, NCT03711903) was a randomized, double-blind, placebo-controlled trial involving 60 patients (30 CN-105, 30 placebo) treated within 12 h of symptom onset. Safety was assessed through adverse events (AEs) and serious AEs (SAEs), while efficacy was evaluated using functional outcome measures, including the modified Rankin Scale (mRS) at 90 days. CN-105 was safe and well tolerated in patients with acute ICH, with no significant differences in incidence of SAEs between groups (30% SAEs in placebo vs. 26.7% in CN-105). Notably, fewer patients treated with CN-105 group experienced in-hospital neurological deterioration (0 vs. 10% in placebo). While treatment was not associated with a statistically significant improvement in 90-day mRS, higher proportion of patients treated with CN-105 achieved favorable mRS scores (≤ 3) compared with those in the placebo group (77.8 vs. 66.7%; p = 0.35). This Phase 2b trial confirmed the safety and feasibility of CN-105 administration in the acute setting of ICH. Although no statistically significant improvements in neurological outcomes were found, the observed trends warrant further investigation. Future Phase 3 trials should focus on refining patient selection and assessing the therapeutic efficacy of CN-105 in more targeted subgroups such as those with medium-sized subcortical ICH. Trial registration NCT03711903, https://clinicaltrials.gov/ https://clinicaltrials.gov/study/NCT03711903?term=NCT03711903&rank=1 . Registered 16 October 2018.
Behavioral parent training is a first-line psychosocial intervention for young children with Attention-Deficit/Hyperactivity Disorder. Traditional face-to-face delivery is limited by access to therapists, feasibility, and/or affordability, which may be addressed by online Behavioral parent training. This study (a) evaluated outcomes for face-to-face vs. asynchronous online Behavioral parent training relative to a wait-list control condition in a large sample of young children with Attention-Deficit/Hyperactivity Disorder and (b) extended outcome measurement beyond parent ratings to masked assessment of child behavior self-regulation and home observation of parent-child interactions. Participants were 196 young children with Attention-Deficit/Hyperactivity Disorder (65% male, Mage = 50.08 months; SD = 8.55) and primary caregivers randomly assigned to face-to-face Behavioral parent training (n = 66), online Behavioral parent training (n = 65), or WLC (n = 65). BPT comprised 10 sessions of behavior management and optimism training (cognitive-behavioral intervention to reduce pessimistic parenting attributions) that were equivalent across Behavioral parent training delivery modes. Intent-to-treat analyses found no significant differences in session attendance, outcomes, or treatment acceptability for face-to-face and online Behavioral parent training with both conditions yielding significant medium magnitude reductions (ds range from 0.41 to 0.74) in child Attention-Deficit/Hyperactivity Disorder and defiant/aggressive behavior and parent pessimism, along with increases in observed positive parenting behavior relative to wait-list control. No significant differences were found for child self-regulation skills or observed parent or child negative behaviors. Asynchronous online Behavioral parent training may be a viable option for families who have limited access to clinic-based treatment due to feasibility or affordability challenges.
Fatigue is a predictable operational hazard in air medical transport, impairing vigilance, reaction time, decision making, and communication-capabilities essential for both aviation and critical care. Despite widespread emphasis on team communication and risk management, fatigue is often managed informally at the individual level. We propose a practical fatigue-readiness framework for rotor- and fixed-wing air medical programs centered on 2 checkpoints: a routine readiness check at the start of shift and a premission "Safety Pause" for elevated-risk operations. The framework optionally incorporates objective alertness assessment (eg, brief psychomotor vigilance testing [PVT]) to complement subjective self-assessment and uses a green/amber/red ladder to guide mitigation and documentation in a nonpunitive manner. Drawing on air medical experience with PVT, established aviation fatigue countermeasures, and health care fatigue risk management literature, we discuss implementation considerations, governance needs, and limitations. A single, standard operating procedures-ready figure summarizes the workflow and provides a shared vocabulary for team-based readiness decisions. Implementation requires explicit nonpunitive governance, protected reporting, and careful attention to privacy to avoid unintended deterrence of fatigue disclosure. The intent is to shift fatigue management from "endurance" to "readiness" while preserving operational feasibility and psychological safety for crew members.
Hepatitis C virus self-testing (HCVST) has emerged as a potential strategy to expand testing among key populations. We assessed the feasibility of HCVST in cisgender men-who-have-sex-with-men (cis-MSM) and transgender women (TGW) on pre-exposure prophylaxis (PrEP). This cross-sectional study included cis-MSM or TGW attending a PrEP consultation in Rio de Janeiro (Brazil). Participants performed HCVST using blood-based and oral-fluid kits on the same day under observation. Difficulties, errors and assistance during HCVST were recorded. Re-reading and re-testing concordance [Kappa(k)] and values/preferences were assessed. A total of 250 participants (88% cis-MSM, age = 34 [IQR,28-41] years, 42% with high education level) were included. The main steps where participants requested assistance (95%CI) for blood-based HCVST were to add buffer [35.6%(29.9-41.8)] and to collect blood sample with the dropper [34.0%(28.4-40.1)]. The main error during oral fluid HCVST was incorrect collection of oral fluid [29.6% (95%CI,24.2-35.6)]. A total of 62.4% (95%CI,56.2-68.2) and 28.8% (95%CI,23.5-34.8) participants needed assistance in at least one step of blood-based and oral fluid HCVST, respectively. Lower education level was associated with higher odds of needing assistance for blood-based HCVST [aOR = 2.07 (95%CI,1.99-3.59),p = 0.009]. Re-reading and re-testing k-indexes were 0.92 and 0.89 for blood-based, and 1.00 and 0.75 for oral fluid HCVST, respectively. More than 95% of people felt safe; would repeat or would recommend HCVST. A total of 46.4% (95%CI,40.3-52.6) preferred oral fluid versus 36.4% (95%CI,30.6-42.6) who preferred blood-based. A relatively high proportion of participants needed assistance, especially for blood-based HCVST. Despite these challenges, high re-reading and re-testing agreements were observed and HCVST was well-accepted.
Coronary obstruction is a critical risk in valve-in-valve transcatheter aortic valve replacement (TAVR). The UNICORN (undermining iatrogenic coronary obstruction with radiofrequency needle) technique mitigates this risk via intraleaflet valve deployment. However, comprehensive bench testing data regarding this technique is lacking in the literature. The aims of this study were to evaluate leaflet behavior after intraleaflet balloon dilatation across different transcatheter heart valve (THV) platforms, simulate the crossing of a second THV across de novo fenestrations, and understand leaflet behavior during and after deployment. In vitro bench testing used 4 index THV platforms: SAPIEN 3, Evolut, Navitor, and ACURATE neo2. Following leaflet traversal, target leaflets underwent sequential balloon dilatation (8-14 mm). We assessed the maximum balloon size tolerated without laceration, the minimum size required for a second balloon-expandable THV (SAPIEN 3 Ultra RESILIA) to cross the fenestration, deployment feasibility, and postdeployment valve geometry. Most index THV leaflets tolerated balloon dilatation up to 12 to 14 mm without laceration. A minimum fenestration size of 12 to 14 mm facilitated most of the second THV crossing. Postdeployment models confirmed coronary clearance on the treated side. Successful intraleaflet THV deployment was achieved with the SAPIEN 3, Evolut, and ACURATE neo2. Conversely, intraleaflet deployment in the Navitor (and Portico) platform was unsuccessful; the leaflet remained intact following expansion, resulting in frame distortion and inner-valve tilting possibly due to stiff leaflet and compliant frame. This bench study defines optimal balloon sizing for UNICORN across common THV platforms and confirms coronary clearance. It was determined that one index valve resisted intraleaflet deployment. Further clinical validation is required before widespread adoption.
Ureolytic microbially-induced carbonate precipitation and ureolytic enzymatically-induced carbonate precipitation have been proposed in recent years as emerging environmentally friendly techniques for heavy metal fixation. However, they rely on the hydrolysis of urea for generating carbonate ions needed to immobilize heavy metal cations. In this study, for the first time, a novel alternative is proposed, and its feasibility for lead removal in aqueous solutions is examined. The method relies on direct CO2 biocementation. Where contaminated solutions are exposed to CO2, and CO2 hydration and formation of carbonate ions is biologically facilitated through (I) microbial strains capable of producing carbonic anhydrase enzyme (i.e., microbially-facilitated carbonation, MFC), and (II) an enzymatic solution containing bovine CA enzyme (i.e., enzymatically-facilitated carbonation, EFC). The results of atomic absorption spectrophotometry indicate up to 99% Pb removal achieved in both MFC and EFC, comparable to the control ureolytic test (98%). However, the former (proposed) techniques are ammonium-free and more environmentally benign. Furthermore, they provide a dual environmental benefit: a method for carbon capture through biomineralization and its utilization for heavy metal removal. The use of Tris buffer considerably enhanced the efficiency of enzymatically-facilitated carbonation for Pb removal (i.e., increasing it from 78% to 99%). The results of microfabric analysis of precipitates (i.e., SEM imaging, XRD, FTIR, and Raman spectroscopy) confirmed the formation of calcium and lead carbonates such as calcite, cerussite, and hydrocerussite, indicating potential removal mechanisms such as lead carbonate precipitation as well as Pb trapping inside calcium carbonate crystals.
Health interventions should be designed to be appropriate for scaling from the outset, but the extent to which factors that are important for scalability are reported on in pilot randomised trials is unclear. This review assesses the extent to which pilot randomised trials report on 15 domains of intervention scalability. Methodological review. Four journals were searched: BMJ Open, BMC Pilot and Feasibility Studies, BMC Trials and PLoS One for articles published between January 2023 and October 2024. We included pilot randomised trials of health interventions. Data relevant to 15 scalability domains, derived from the Intervention Scalability Assessment Tool and wider implementation science literature, were extracted. Data were double-extracted for 20% of the included studies. Two authors scored all studies from 0 to 3 (0=Not at all; 1=Small extent; 2=Moderate extent; 3=Large extent) on the extent to which each of the 15 scalability domains was reported. For each scalability domain, we calculated the mean score and the frequency of each categorical score across the included studies. Titles and abstracts screening (521 publications) resulted in 132 full-text publications for review. Of the 104 eligible studies, a random sample of 50 studies were selected for detailed review. Through snowballing, an additional 49 associated publications were identified (eg, protocols), resulting in 99 publications across 50 studies. Most studies reported the Problem (30/50, 60%; mean=2.4 ± 0.8) and the Intervention (37/50, 74%; mean=2.7 ± 0.4) to a large extent (ie, scored 3), with the Delivery Setting and Workforce domain most often receiving a score of 2 (28/50, 56%; mean=2.2 ± 0.7). For eight of the scalability domains, the majority of studies scored 0. The extent of scalability domain reporting in pilot trials of health interventions is limited. Explicit consideration of scalability in pilot trials could improve the design of fully powered randomised controlled trials and enhance the potential for effective interventions to be translated into practice. Future research should consider if and how to incorporate scalability considerations into pilot trials, and whether pilot trial and intervention reporting guidelines should be expanded to include scalability considerations.
Lymphodepletion (LD) is a critical prerequisite for successful chimeric antigen receptor T-cell (CAR-T) therapy. While fludarabine and cyclophosphamide (Flu/Cy) remain the standard LD regimen, bendamustine has emerged as a potential alternative due to its distinct immunomodulatory properties and more favorable toxicity profile. This systematic review evaluates the safety, efficacy, and feasibility of bendamustine-based LD in patients undergoing CAR-T therapy for hematologic malignancies. A comprehensive literature search was conducted through January 2026 across PubMed, Embase, Web of Science, and clinical trial registries. Studies were eligible if they reported clinical outcomes following bendamustine-based lymphodepletion prior to CD19-, CD30-, or BCMA-directed CAR-T therapy. Extracted endpoints included overall response rate (ORR), complete response rate (CRR), progression-free survival (PFS), overall survival (OS), and treatment-related toxicities. Eighteen studies comprising over 1400 patients were included. Across disease indications-including B- and T-cell non-Hodgkin lymphoma, Hodgkin lymphoma (HL), and multiple myeloma (MM)-ORRs ranged from 50% to 88%, with CRRs up to 74%. Compared with Flu/Cy, bendamustine-based LD demonstrated comparable efficacy while being associated with significantly lower rates of cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), and grade ≥3 cytopenias. Additionally, bendamustine facilitated outpatient CAR-T delivery, with reduced hospitalization and intensive care unit (ICU) utilization. However, prior exposure to bendamustine before leukapheresis was associated with inferior CAR-T outcomes. Bendamustine-based LD represents a safe and effective alternative to Flu/Cy, particularly in outpatient settings and in patients at higher risk of treatment-related toxicity. However, the current evidence is largely derived from retrospective and non-randomized studies. Prospective, comparative trials are warranted to validate these findings and to better define the optimal LD strategy across disease types and CAR-T platforms.
BATMAN (balloon-assisted translocation of the mitral anterior leaflet) is an increasingly adopted technique to modify the anterior mitral leaflet (AML) and prevent left ventricular outflow tract (LVOT) obstruction during transcatheter mitral valve replacement (TMVR). The aim of this study was to evaluate the feasibility, efficacy, and safety of the BATMAN technique during transseptal TMVR. This was an international, multicenter cohort study of all consecutive patients at high risk for LVOT obstruction undergoing transseptal BATMAN TMVR for valve-in-valve (ViV), valve-in-ring (ViR) and valve-in-mitral annular calcification (ViMAC) at 22 structural heart disease centers in North America and Europe. The primary efficacy endpoint was the rate of successful TMVR free from LVOT obstruction and procedural death. The primary safety endpoint was the in-hospital composite of death, stroke, or major cardiac structural complications. A total of 83 patients were included: 24 undergoing ViV, 39 ViR, and 19 ViMAC procedures. Technical success was achieved in all but 1 case (98.8%) that was converted to tip-to-base LAMPOON (laceration of the anterior mitral leaflet to prevent outflow obstruction). Pre-emptive mechanical cardiocirculatory support was used in 28.9% of cases. The primary efficacy endpoint was met in 95.1% of cases (100% in ViR, 95.8% in ViV, and 84.2% of ViMAC; P = 0.03). The primary safety endpoint occurred in 7.3% of patients and was higher in the ViMAC group (0% in ViR, 8.3% in ViV, and 21.1% in ViMAC; P = 0.02). There was 1 major cardiac structural complication directly attributed to BATMAN in a ViMAC patient. BATMAN was associated with high technical success and effectiveness in preventing LVOT obstruction and appeared to be safe in ViR and ViV procedures. Adverse events were higher in ViMAC.
Color difference detection remains a critical challenge in textile manufacturing, where traditional visual inspection and offline measurement methods suffer from subjectivity, low efficiency, and delayed feedback. This study emphasizes engineering integration for online industrial fabric inspection rather than proposing a single new color-difference algorithm. The proposed system integrates a custom-designed optical acquisition platform with a lightweight color analysis pipeline, including bilateral filtering for noise suppression, K-means clustering for representative color extraction, RGB-to-CIELab color space conversion, and perceptually weighted [Formula: see text] computation. The system was deployed on an actual textile production line and evaluated using ten fabric rolls with different colors and materials. Experimental results show roll-level agreement with manual inspection in the tested samples and indicate the feasibility of continuous monitoring of chromatic variations along the fabric length. The proposed system provides a practical engineering solution for automated textile color quality control and may support production-line decision making while reducing dependence on subjective visual inspection in industrial environments.
We report a case of fertility preservation through ex vivo oocyte aspiration in an adolescent who underwent bilateral oophorectomy due to asynchronous borderline ovarian tumors. A 17-year-old nulligravid patient was initially diagnosed with a left-sided serous borderline ovarian tumor and treated with left salpingo-oophorectomy. One year later, a lesion was identified in the contralateral ovary, with surgical indication for salpingo-oophorectomy. Ovarian stimulation was performed using recombinant FSH and hMG, with final oocyte maturation triggered by a GnRH agonist. Oocyte retrieval was conducted ex vivo, immediately after surgical removal of the ovary. A total of 13 oocytes were obtained, 10 of which were in metaphase II and successfully cryopreserved. This case highlights the feasibility and efficacy of ex vivo oocyte retrieval as a fertility preservation strategy in oncology patients requiring urgent bilateral oophorectomy.