Amyotrophic Lateral Sclerosis (ALS) is a rapidly progressing neurodegenerative disease causing severe physical, bulbar, and respiratory disability, rendering traditional center-based care highly burdensome for patients and informal caregivers. To evaluate how digital health can bridge hospital-to-home management, this narrative review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) quality criteria. A comprehensive search was performed across the PubMed/Medline, Web of Science, and Scopus databases to analyze telerehabilitation modalities, remote functional telemonitoring, and caregiver-centered tools. The evidence supports the feasibility of several home-based approaches and the measurement validity of selected motor, respiratory, and bulbar digital markers; however, improved detection of progression does not itself establish therapeutic benefit. Although selected respiratory telemonitoring pathways have reported favorable healthcare-utilization outcomes, current evidence does not consistently demonstrate reductions in hospital admissions or caregiver burden across the technologies reviewed; benefits for functional status and quality of life also remain uncertain for many interventions. Key technologies include wearable inertial sensors, non-invasive ventilation telemetry, markerless computer vision, eye-tracking systems, and mobile applications; however, significant limitations have been reported, particularly in clinical, technological, and evidence-based domains. Therefore, a cross-disease bridging framework is needed to translate and adapt validated digital solutions from higher-prevalence neurological populations to ALS patients. However, specific clinical trials are required to provide ALS-specific data, integrating telemedicine solutions within hybrid care models and providing sustainable solutions to optimize multidisciplinary ALS management.
Accurate early prediction and multi-stage diagnostic classification compliant with AJCC TNM staging criteria are essential for effective treatment planning in pancreatic cancer. Although deep learning (DL) approaches show promising results, interpreting their predictions remains challenging. This study proposes Squeeze-and-Excitation Visual-Efficient Tabular Network (SE-VETNet), an interpretable multimodal DL framework designed for early prediction and multi-stage pancreatic cancer diagnostic classification using medical imaging and clinical data. The framework integrates Visual Geometry Group (VGG) and EfficientNet architectures enhanced with Squeeze-and-Excitation (SE) blocks for feature recalibration, alongside Tabular Network (TabNet) for clinical feature extraction. Attention mechanisms identify relevant tumor characteristics and clinical attributes. An optimized processing pipeline preserves image details and clinical data integrity while improving computational efficiency. To address class imbalance, balancing is applied exclusively to training data, while five-fold cross-validation supports robust evaluation and minimizes potential bias. Experiments demonstrate consistent performance across all folds, achieving a mean test accuracy of 99.21% with minimal variability across five diagnostic cohorts (Healthy and T1–T4). Furthermore, Explainable Artificial Intelligence (XAI) techniques, including Gradient-weighted Class Activation Mapping (Grad-CAM), quantitatively validated against expert ground-truth masks via Intersection over Union (IoU), and TabNet attention, provide insights into image-based and clinical feature contributions, respectively. By integrating multimodal learning, robust evaluation, and explainability, SE-VETNet offers a promising approach to early pancreatic cancer prediction, multi-stage staging, and transparent clinical decision-making. However, validation using independent and diverse clinical datasets remains necessary to establish generalizability and assess its suitability for practical deployment.
Background: The Arieș River basin in Romania is historically mining-impacted, and data on metal accumulation in its fish and the associated risk to consumers are scarce. Aims: This study investigated elemental accumulation in fish from the Arieș River and evaluated the potential health risks associated with fish consumption. Methods: A total of 40 fish representing five species were collected by angling between June and September 2025, after the legal fishing prohibition period. Eight tissues per fish (muscle, gills, liver, skin, bones, scales, eyes, and caudal fin) were analyzed by inductively coupled plasma–mass spectrometry (ICP-MS). Contamination and exposure were evaluated using the pollution index (PI), metal contamination index (MCI), estimated daily intake (EDI), target hazard quotient (THQ), and hazard index (HI) for non-carcinogenic risk, and carcinogenic risk and total carcinogenic risk (TCR) for carcinogenic risk. Species and tissue patterns were examined by multivariate analysis, including linear discriminant analysis (LDA). Results: Multivariate statistical analysis revealed distinct species- and tissue-related patterns in elemental composition. LDA differentiated species with an initial classification accuracy of 82.5% and a leave-one-out cross-validated accuracy of 72.5%, with Cr, Mn, Pb, Sr, and Ni having the highest contribution. Tissue discrimination was lower (approximately 60%), with Sr, Zn, and Cu as main discrimination variable. THQ values for individual elements and HI were below 1, indicating no appreciable non-carcinogenic risk under the assumed exposure conditions. The highest CR values were associated with Ni (nase muscle, 2.26 × 10−6) and As (nase skin, 6.28 × 10−7). TCR ranged from 3.16 × 10−7 to 3.37 × 10−6 and remained below 1 × 10−4, within the acceptable range. Conclusions: Elemental contamination in fish from the Arieș River was generally low, and species and tissue type influenced elemental composition and dietary relevance. Continued monitoring is advised, with seasonal sampling, inorganic arsenic speciation, and attention to species such as nase when assessing consumption risk.
Background: Cancer diagnoses among males of reproductive age are increasing, yet male fertility preservation remains underutilized. Systemic cancer therapies differentially affect spermatogenesis, testosterone production, and sexual function, with substantial drug-class-specific variability. Methods: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Cochrane Library, and Scopus using standardized terms related to male fertility, spermatogenesis, gonadotoxicity, sperm banking, and testicular toxicity, combined with chemotherapy, tyrosine kinase inhibitors (TKIs), immune checkpoint inhibitors (ICIs), and antibody–drug conjugates (ADCs). Guidelines of the American Society of Clinical Oncology (ASCO), the European Society for Medical Oncology (ESMO), the European Association of Urology (EAU), and the National Comprehensive Cancer Network (NCCN) were also reviewed. Records from database inception to July 2026 were searched, with emphasis on studies published since 2000, including prospective cohorts, semen analyses, seminal-fluid pharmacokinetic studies, and preclinical reproductive toxicology. The certainty of evidence for each drug class was graded with an approach adapted from the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results: Chemotherapy causes dose-dependent spermatogonial depletion, with alkylating agents associated with the greatest risk of severe and potentially permanent azoospermia. Platinum agents and taxanes demonstrate intermediate gonadotoxicity, with recovery potentially requiring 1–5 years. TKIs show variable reproductive toxicity; imatinib, dasatinib, and nilotinib have demonstrated preclinical testicular effects, while limited clinical data suggest predominantly transient abnormalities. The labels of several TKIs recommend male contraception during and after treatment. Evidence of direct ICI spermatotoxicity is of very low certainty (one prospective cohort of 26 men showed a non-significant decline in sperm output), but ICIs may indirectly impair the hypothalamic–pituitary–gonadal axis through immune-mediated endocrinopathies. ADCs lack human fertility data, although payload-dependent testicular toxicity has been observed in animals. Conclusions: Fertility preservation should be integrated into the care of reproductive-age men receiving systemic anticancer therapy, with sperm cryopreservation offered before potentially gonadotoxic treatment. For TKIs, ICIs, and ADCs, this offer rests on low- to very-low-certainty evidence and precaution, which should be stated explicitly during counseling. Drug-class-specific counseling regarding fertility risks, recovery, and paternal safety is essential. Prospective studies and paternal outcome registries for TKIs, ICIs, and ADCs are needed.
Gracilaria corticata, an abundant red seaweed rich in agar, is a valuable resource for sustainable hydrocolloid production. High-yield native crude agar with preserved structural and rheological properties was extracted using ultrasound pre-treatment followed by hot-water extraction (95 °C, 2 h) without alkali pre-treatment. Response surface methodology with central composite design predicted 32.87 min and 61.58% amplitude as optimum conditions, giving a predicted yield of 28.66% (w/w). Acoustic cavitation-induced cell wall disruption significantly enhanced agar yield (validated: 29.31 ± 0.70%) versus conventional hot-water extraction (14.01 ± 0.43%). Commercial agar (C-AP) had higher gel strength. Ultrasound-assisted (US-AP) and conventionally extracted agar (CE-AP) had higher sulfate and lower 3,6-anhydrogalactose contents (p < 0.05). C-AG showed higher gel strength. FTIR confirmed agar functional groups in all samples, indicating preserved functional groups. Syneresis remained below 2%. Microstructure showed a more porous network in CE-AG and US-AG than in C-AG. Rheology demonstrated thermo-reversible gel behaviour, with gelation onset at 38–46 °C. Extracted agars were cytocompatible with BJ fibroblasts after 48 h, supporting soft-gel applications without chemical modification. Low gel-strength seaweeds such as G. corticata can be utilized for high-yield agar extraction via ultrasonication.
