High-fidelity large-field-of-view (LFOV) 3D sensing, essential for autonomous platforms, is hindered by the coupling of anisotropic off-axis aberrations and the ill-posed nature of monocular depth estimation. To address this fundamental physical bottleneck, we propose the bio-inspired monocentric imaging (BMI) framework, a holistic co-design integrating a monocentric optical topology with a physics-aware reconstruction network. By pairing a concentric spherical lens with a hemispherical sensor, our system structurally eliminates coma, astigmatism, and field curvature. Instead of relying on external modulators or hardware redundancy, we exploit the intrinsic aberration as a deterministic, radially symmetric carrier for depth encoding. Theoretical analysis via the Cramér-Rao lower bound confirms that this topology maintains superior depth sensitivity across the entire FOV. To decode these optical cues, our framework utilizes a dual-head network to jointly recover high-fidelity all-in-focus images and dense metric depth maps from single-shot captures. The efficacy of this co-design is evaluated through physically-based simulations of field-dependent PSFs across the full optical FOV. On NYU Depth V2, our system achieves a superior balance of image fidelity (31.15dB PSNR) and depth precision (0.161m RMSE). It further maintains consistent reconstruction under spatially varying PSFs sampled across a 120∘ optical FOV, mitigating the peripheral degradation observed in conventional wide-field designs.

Cerebral malaria (CM) remains a leading contributor to paediatric mortality and long-term neurocognitive sequelae in sub-Saharan Africa, driven by a complex interplay between Plasmodium falciparum sequestration and host endothelial dysfunction. Clinical recovery is typically defined by parasite clearance and neurological improvement; however, the temporal relationship between vascular restoration and symptomatic resolution remains inadequately characterized. This study aimed to delineate the recovery kinetics of angiopoietin imbalance and soluble thrombomodulin (sTM) in CM and determine whether these pathways resolve in a coordinated or sequential manner. In this prospective longitudinal cohort study, we assessed 30 Ghanaian children with CM, 30 with uncomplicated malaria (UM) and 34 age-matched healthy controls. Serial measurements of angiopoietin-1 (ANG1), angiopoietin-2 (ANG2) and sTM were performed with CM at admission, coma recovery, and on days 7 and 14 thereafter, and UM at presentation and on days 7 and 14. Among CM cases, abnormal ANG2:ANG1 ratios increased from 10% at admission to 53% at coma recovery, then declined to ≤12% by day 14 thereafter. Abnormal sTM levels decreased more gradually, from 71% to 15% over the same period, suggesting a temporal dissociation between functional endothelial stabilization and structural endothelial repair. UM displayed milder, transient sTM elevations, which resolved more rapidly. These findings reveal a lag between clinical stabilization and biomarker normalization, suggesting a post-treatment window of microvascular vulnerability. Concurrent monitoring of ANG and sTM may provide complementary mechanistic insights into malaria pathophysiology and inform risk stratification, longitudinal monitoring, and the development of endothelial-targeted adjunctive therapies for paediatric malaria.

Orbital angular momentum (OAM) mode recognition of vortex beams is essential for free-space optical communication; however, it becomes considerably more challenging under slant-path propagation where atmospheric turbulence and optical aberrations jointly distort the beam structure. Here, we propose an improved multi-task residual network, termed DCA-ResNet18, for the simultaneous recognition of the topological charge, spherical aberration coefficient, and coma aberration coefficient of vortex beams under slant-path atmospheric turbulence. The model incorporates dual 3×3 input convolutions, task-adaptive branches, and a convolutional block attention module (CBAM) to enhance the extraction of ring, dark-core, and asymmetric distortion features. Three datasets corresponding to single-coma-aberration, single-spherical-aberration, and dual-aberration condition are generated using a slant-path multi-phase-screen propagation model. The proposed model achieves near-perfect accuracy under single-aberration conditions over different zenith angles (0°, 60°, 80°) and propagation distances (2000, 3000, and 4000 m). Under combined-aberration conditions, the recognition accuracy of all tasks remains above 98% even at a zenith angle of 80° and a propagation distance of 3000 m, demonstrating strong robustness under severe distortion conditions. Compared with ResNet18, ResNet34, Xception, and EfficientNet-B0, DCA-ResNet18 consistently achieves superior performance in dual-aberration recognition. These results demonstrate the effectiveness and robustness of the proposed framework for simultaneous multi-parameter recognition of vortex beams under slant-path atmospheric turbulence with optical aberrations.

Background Extubation is an important step in the recovery of critically ill patients, but some patients deteriorate after removal of the endotracheal tube and require reintubation. Extubation failure can prolong intensive care and is associated with poor outcomes. This study examined the factors associated with reintubation and the clinical outcomes of patients who failed planned extubation. Methods We prospectively followed adult patients undergoing planned extubation in the adult ICU of a tertiary care hospital between June 2025 and June 2026. Patients were observed for 72 hours after extubation, and those requiring reintubation during this period were considered to have experienced extubation failure. Demographic, clinical, physiological, and laboratory characteristics were compared between patients who remained successfully extubated and those who required reintubation. Factors associated with reintubation and in-hospital mortality were examined using multivariable logistic regression. Results A total of 180 patients were included, of whom 27 (15.0%) required reintubation within 72 hours. The patients who required reintubation were older and had higher Acute Physiology and Chronic Health Evaluation II (APACHE II) and Rapid Shallow Breathing Index (RSBI) scores, while their Glasgow Coma Scale (GCS) scores and serum albumin levels were lower. Positive fluid balance, emergency admission, congestive heart failure, chronic lung disease, and acute kidney injury requiring renal replacement therapy were also more frequent in this group. Reintubation was associated with a longer duration of mechanical ventilation, longer ICU and hospital stays, and higher rates of ventilator-associated pneumonia and tracheostomy. ICU and in-hospital mortality were also considerably higher among patients who required reintubation. After adjustment for other factors, APACHE II score >20, GCS <12, RSBI >105, serum albumin <3.5 g/dL, positive fluid balance >1 L, and mechanical ventilation >7 days were associated with reintubation. Reintubation was strongly associated with in-hospital mortality (adjusted OR, 5.84; 95% CI, 2.31-14.78; P < 0.001). Conclusions In this cohort, patients who required reintubation after planned extubation had a substantially more difficult clinical course and a higher risk of death. Greater illness severity, poor respiratory reserve, low serum albumin, positive fluid balance, and prolonged mechanical ventilation were associated with extubation failure. Identifying these features before extubation and maintaining close observation after extubation may help clinicians recognize patients at higher risk of deterioration.

Normothermic regional perfusion (NRP) may mitigate ischemic injury in controlled donation after circulatory death (cDCD) liver transplantation. We updated the most recent meta-analysis (search closed June 2023) by incorporating subsequent evidence and comparing NRP with non-NRP cDCD and with donation after brain death (DBD). We performed a systematic review of five databases and random-effects meta-analyses; dichotomous outcomes were pooled as risk ratios, the Mantel-Haenszel estimator was preferred for rare events, pooled incidences used a logit-binomial model, risk of bias was assessed with ROBINS-I and certainty with GRADE. Twenty observational studies were included (1776 NRP-cDCD liver recipients). Versus non-NRP cDCD, NRP reduced ischemic cholangiopathy (risk ratio 0.16, 95% confidence interval 0.09-0.28; number needed to treat 9), graft loss (0.41, 0.32-0.54), recipient death (0.46, 0.34-0.62), hepatic artery thrombosis (0.51, 0.30-0.85), other biliary complications (0.49, 0.32-0.73) and primary non-function (0.51, 0.28-0.94); these reductions persisted after excluding grafts managed with ex situ machine perfusion. Versus DBD, no outcome differed significantly. Pooled ischemic cholangiopathy incidence was 1.8%, 12.7% and 1.2% with NRP, non-NRP and DBD. NRP markedly reduces ischemic cholangiopathy and improves other outcomes versus non-NRP cDCD, approaching DBD; the evidence remains observational, with moderate-to-serious risk of bias.

Myxoedema coma is a rare but life-threatening manifestation of hypothyroidism with high associated mortality. We present the case of a man in his sixties with known hypothyroidism and alcohol dependence who collapsed at home with profound hypothermia, refractory hypoglycaemia, hypoxia and reduced consciousness. Initial findings were easily attributable to excess alcohol; however, clinical features including periorbital oedema and bedside echocardiogram revealed moderate pericardial effusion, which prompted further investigation. Thyroid function tests confirmed severe hypothyroidism with elevated thyroid-stimulating hormone and suppressed free T3 and free T4 levels. Imaging revealed a substantial pericardial effusion and left basal pneumonia. The patient was treated with intravenous glucose, active warming, hydrocortisone and intravenous thyroxine along with antibiotics and supportive care. The patient achieved steady clinical and biochemical improvements following critical care admission. This case highlights the diagnostic challenge of recognising myxoedema coma and emphasises the importance of maintaining a high index of suspicion for endocrine emergencies.

Craniomaxillofacial trauma is a significant public health concern because of its association with severe injuries, long-term morbidity, and mortality. This study evaluated sex-based differences in trauma severity, length of hospital stay, and mortality among patients with craniomaxillofacial (CMF) trauma in Puerto Rico. This retrospective cohort study used electronic medical records from a trauma center in Puerto Rico from January 2018 to October 2022. Data collected included demographics, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), length of hospital stay, comorbidities, and survival outcomes. Statistical analyses included the χ2 test and t tests to evaluate sex-based differences. Multivariable logistic regression was used to assess the independent association between sex and in-hospital mortality. A total of 1161 patients were included in the study, comprising 960 males and 201 females. Males demonstrated higher in-hospital mortality than females (12.7% versus 6.5%; P=0.012) and presented with lower GCS and RTS scores. Motor-vehicle accidents were the most common mechanism of injury, with males more frequently involved in noncar incidents and females more commonly injured in car accidents. In the fully adjusted model including comorbidities, male sex was independently associated with in-hospital mortality (aOR: 3.73, P=0.014). Lower GCS was the strongest predictor of mortality. These findings suggest that the male sex is associated with increased mortality following CMF trauma after adjusting for injury severity and comorbid burden, highlighting the potential importance of incorporating sex into trauma risk stratification and prevention strategies.

Hydrogen sulfide (H2S) has garnered increasing attention in recent years, not only as a hazardous environmental pollutant but also as the third endogenous gas signaling molecule, alongside nitric oxide and carbon monoxide. At elevated concentrations, it poses serious threats to human health by irritating the respiratory tract and nervous system, with high-level exposure potentially leading to coma or even death. Conversely, at physiological levels, H2S participates in a variety of essential biological processes, including cardiovascular regulation, neuroprotection and cellular metabolism. Given this dual nature, reliable monitoring of H2S concentrations in both biological matrices and environmental samples is of considerable significance. Fluorescent probes have emerged as powerful analytical tools for this purpose, owing to their high sensitivity, excellent spatiotemporal resolution and non-invasive imaging capabilities. By exploiting the intrinsic chemical features of H2S, such as nucleophilicity, reducing potency and affinity for metal ions, a diverse array of fluorescent sensors has been developed over the past few years. This review aims to provide a systematic overview of recent progress in the design and application of these probes, with particular emphasis on their distinct response mechanisms and their utility in H2S sensing and bioimaging. Representative examples from each category are discussed, and the strengths and limitations of different strategies are compared. Through this summary, we hope to offer useful insights for the future development of more advanced H2S probes tailored to specific research or diagnostic needs.